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Secondary carnitine deficiency can be caused by increased losses, pharmacological therapy, a number of inherited metabolic disorders [38], poor diet or malabsorption of carnitine, from increased renal tubular loss of free carnitine (Fanconi syndrome), haemodialysis, peritoneal dialysis, or the increased excretion of acylcarnitines[39] with certain drugs

The levocarnitine addition does not fundamentally change this decision calculus

Weight loss expectations should be based primarily on the tirzepatide component

Raw data for statistical analyses and supplemental data are available at Zenodo (DOI: 10.5281/zenodo.14916225) Ethics statement The animal study was approved by Lower Saxony State Office for Consumer Protection and Food Safety (LAVES, Oldenburg, Germany)

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