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Metabolic demands for L-Carnitine Can be divided into 3 categories Primary Secondary Functional shortage age dependent condition dependent Muscle (lamb) - 2.03 Muscle (beef) - 0.61 Muscle (pig) - 0.27 Heart (cattle) - 0.23 Muscle (poultry)- 0.09 Milk (cow) - 0.026 Liver (lamb) - 0.022 Salmon - 0.0006 Rice - 0.018 Eggs and peas - 0.008 Potatoes - 0.0003 Carrots/spinach - 0.000 Carnitine content of foods (mg/g) adopted Heinz Loster 2003/Rigault 2007 Infants (3 kg) Skeletal muscle 1.98 Liver 0.55 Heart 0.77 Plasma males 0.026 females 0.023 Adults (70 kg) Skeletal muscle 3.96 Liver 2.90 Heart 4.80 Brain 0.30 Total Carnitine, humans (umol/ml) L-Carnitine in Pet Food Varies by type of ingredients foods of animal origin blended with other ingredients processing such boiling, soaked, washing freezing and/or drying Not understood is bioavailability of natural forms of L-Carnitine It matters: bound vs free L-Carnitine -Oxidation + + L-Carnitine L-Carnitine Krebs-Cycle Respiration CoA CoA CoA CoA CoA CoA Fatty acid + + + L-Carnitine L-Carnitine Energy (ATP) L-Carnitine physiology and its role in energy production Cell Mitochondria Cytosol Glucose Pyruvate Acetyl CoA OAA TCA Citrate -kg L-Carnitine supplementation can influence total metabolism Pyruvate Carboxylase Glycogen -oxidation Fat + L-Carnitine Protein Amino Acids BCAADH (leucine, iso,) Roles of L-Carnitine in the body Convert fat into energy

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Inject tirzepatide once weekly and Ipamorelin daily at bedtime, using separate injection sites, with ongoing physician monitoring to improve both dosages

Photo at top: From left to right: Thomas Flaig, MD