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Triggers include gallstones (40%), alcohol (30%), and medications (2-5%)

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A second research literature concerns the microbial metabolism of dietary carnitine rather than carnitine itself: Koeth and colleagues (Nat Med, 2013) reported that gut microbiota convert carnitine to trimethylamine, which is oxidised hepatically to trimethylamine-N-oxide, and examined the association of that metabolite with atherosclerosis in animal models