at worst, fakes could actively harm people who take them
Citicoline in acute ischemic stroke: A randomized controlled trial
The increase of L-carnitine in plasma via oral administration, even up to and exceeding 2 mg, is limited, since L-carnitine has a very poor absorption and bioavailability, a very high renal clearance, and active uptake into tissues
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This allows for sustained GH release with less frequent dosing