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The Koeth findings established a biologically plausible mechanism and a population association, but the human cardiovascular evidence on supplemental L-carnitine is mixed some carnitine trials report neutral or even favorable cardiovascular markers, particularly in cardiac and metabolic patient populations

However, the implementation of holistic solutions that consider synergies and trade-offs to target the United Nations' SDGs (181) and simultaneously address health and climate change challenges is restricted by the lack of action by decision-makers at both the national and global levels (189, 193196)

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This suggests a potential cross-feeding or collaborative mechanism for efficient B 6 metabolism (Fig

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