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Berger MM, Reintam-Blaser A, Calder PC, Casaer M, Hiesmayr MJ, Mayer K, et al

showed that TMAO production was dependent on the gut microbiota and that mice treated with antibiotics failed to provide the required gut microbiota for TMAO production ( ApoE / mice without changing circulating cholesterol levels (75)

Several interrelated mechanisms likely underlie this dysregulation, including the hyperglycemic microenvironment, insulin resistance, chronic oxidative stress, and progressive renal structural damage, which collectively impair carnitine homeostasis through multidimensional and cascading pathophysiological mechanisms

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These last results suggest that caffeine might affect carnitines pool differentially depending on the presence of alcohol