The chronic use of any of these medications has the potential to cause complications related to vitamin B12 deficiency, which includes impaired DNA synthesis, impaired cell division, hematopoiesis, hyperhomocysteinemia, and metabolism of odd-chain fatty acids that is necessary in preventing demyelination of nerves
The combination is always chosen based on the patients specific symptom profile, not a generic protocol
With meals: Some experts recommend taking L-carnitine with a meal, particularly those containing carbohydrates and protein, as this can increase insulin levels and help transport L-carnitine into muscle cells
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The daytime administration should be early in the morning on an empty stomach to prevent the suppressive effects of food intake and insulin release on GH secretion