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Oral L-Carnitine has notoriously low bioavailability some studies estimate as little as 5-18% absorption, especially at higher doses, because much of it is metabolized by gut bacteria before it ever reaches the bloodstream
Starting at a lower dose and gradually titrating upwards, as recommended in the Summary of Product Characteristics (SmPC), helps minimise these effects
Zhang Q, Ramracheya R, Lahmann C et al (2013) Role of KATP channels in glucose-regulated glucagon secretion and impaired counterregulation in type 2 diabetes
[13] Coskun T, et al
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