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These synthetic forms are not biologically active in the same way as the natural L-isomer and can actually competitively inhibit the absorption and utilization of naturally occurring L-carnitine, potentially inducing a state of carnitine deficiency and worsening fatigue symptoms

10.1016/j.jconrel.2023.11.054 257 ZhouQ.LinW.WangC.SunF.JuS.ChenQ.et al (2022)

To be absorbed, a drug given orally must survive encounters with low pH and numerous gastrointestinal (GI) secretions, including potentially degrading enzymes

10.1016/j.phrs.2022.106306 109 LiL.MengY.LiZ.DaiW.XuX.BiX.et al (2019a)

Cooking the pancakes: Pour a small amount of batter into the pan for each pancake