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Their recent research further indicated that both omnivores and vegans or vegetarians could rapidly convert carnitine to GBB, while the subsequent gut microbial-dependent conversion of GBB to TMA was diet induced, especially through omnivorous dietary patterns and chronic L-carnitine exposure (Koeth et al., 2019)

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The disease is also believed to have affected other ethnic groups, but was misdiagnosed due to the doctors' ignorance (236, 237)