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doi: 10.1038/nrneurol.2011.137 57 NaruseK

Additional regional factors such as high baseline HBV endemicity (5-18%), dietary aflatoxin exposure, and lower NAFLD prevalence further limit direct extrapolation (105)

Certain groups should exercise particular caution: Individuals with hypothyroidism , as L-carnitine may interfere with thyroid hormone action at the tissue level Those with seizure disorders , as the levocarnitine SmPC notes a possible association with increased seizure frequency, particularly in those with a prior history People with kidney disease , for whom unsupervised supplementation is not advised Pregnant or breastfeeding women , for whom safety data remains limited When to seek help: Call 999 immediately if you experience severe chest pain, sudden shortness of breath, or symptoms that could indicate a heart attack or stroke Contact NHS 111 for urgent concerns that are not immediately life-threatening Contact your GP promptly if you experience palpitations, significant gastrointestinal symptoms, new or worsening seizures, or any unexpected changes in health after starting supplementation If you suspect you have experienced a side effect from a supplement or medicine, you can report it to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk