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Similarly, antibiotics containing pivalic acid bind to carnitine and force the body to excrete it, effectively robbing the body of its free carnitine pool [12] [13]

Han T, Xu Y, Liu H, Sun L, Cheng X, Shen Y, Wei J

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While skeletal muscle detoxifies ammonia, hyperammonemia decreases serum BCAA and increases myostatin levels, both of which result in inhibition of mammalian target of rapamycin signaling and decreased protein synthesis [41, 42]