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Debilitating Physical Fatigue: By restoring the carnitine shuttle and facilitating the transport of long-chain fatty acids into the mitochondria, L-carnitine directly supports the production of ATP, helping to alleviate the profound, leaden exhaustion associated with Long COVID and ME/CFS

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High-dose use While trials have tested up to 1200mg/day (even as high as 2400mg/day) and illustrated safety, some report higher rates of gastrointestinal side effects, dizziness, and skin reactions at these levels.14 28 38 Additionally, these higher doses are often short-term (35 weeks) and used under clinical supervision

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29,30 however, when structured clinical examinations and vibration perception thresholds are used, the prevalence increases to 28%

These findings should be viewed as hypothesis-generating , providing a systems-level context for the observed metabolite changes rather than evidence of causal normalization