Frontiers Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD): the interplay of gut microbiome, insulin resistance, and diabetes L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active Role of L carnitine in exercise training: Anti inflammatory, antioxidant, and metabolic interactions ScienceDirect Carnitine Deficiency: What You Need to Know The Medical Biochemistry Page The Importance of the Fatty Acid Transporter L Carnitine in Non Alcoholic Fatty Liver Disease (NAFLD)