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Carnitine acyltransferases are a family of enzymes responsible for production of acylcarnitines, and among them, they have specificities that cover fatty acids differing in chain-length, branching and other structural features, over the entire range of acyl chain lengths, depending on the cellular location and metabolic purpose, and they enable reversible shuttling of acyl groups between free CoA and carnitine

[21] In the niacinamide form used here, there's no flushing effect at typical beverage doses, and you get full participation in cellular energy production

J Chronic Fatigue Syndrome (2002) 10:3741

Therefore, additional studies focusing on long-term supplementation and its longitudinal effect on the TMAO metabolism and cardiovascular system are needed