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This rare condition can lead to: low plasma carnitine progressive cardiomyopathy, or heart muscle disease skeletal myopathy hypoglycemia hypoammonemia weak muscles in the hips, shoulders upper arms, legs, neck, and jaw muscles Untreated it is fatal
This is why the STEP trial protocol includes two intermediate doses (1.7 mg) before reaching 2.4 mg, and why many people find their sweet spot below maximum
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