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Barton, the discussant, took a cautionary view, saying that there are some things to consider before going out and telling patients to consider acetyl-carnitine for their peripheral neuropathy. It was unclear from the results reported whether the two treatment groups were well balanced and what criteria were used to define improvement for the secondary outcomes, she noted

Several studies show elevated plasma long-chain acyl-carnitine but not free L-carnitine and medium-chain acyl-carnitine to be associated with fibrosis, inflammation and cirrhosis in patients

Oral supplementation of L-carnitine to the patients receiving hemodialysis improved not only their muscle discomfort but also their gastrointestinal disorders and microbiota, although its effect on the prognosis of hemodialysis patients should be further investigated