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The question is what happens when all of them land together, and thats a question the FDA hasnt fully answered yet

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The colonic barrier is composed of multiple barriers: (1) the gut microbiota (a biological barrier), (2) a mucus layer (a physical barrier), (3) an epithelial layer (a physical and chemical barrier), and (4) the immune system (an immunological barrier) ( Figure 2 ) (8)

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L-Carnitine supplementation an lead to improvements in several complications seen in uremic patients, including cardiac complications, impaired exercise and functional capacities, muscle symptoms, increased symptomatic intradialytic hypotension, and erythropoietin-resistant anemia through normalizing the reduced carnitine palmitoyl transferase activity in red cells [43]