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Disruption of carnitine homeostasis is also associated with pulmonary vascular endothelial dysfunction, and carnitine supplementation can alleviate this endothelial dysfunction by restoring nitric oxide signaling and reducing reactive oxygen species production [311]
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Additionally, for individuals who cannot tolerate full therapeutic doses of metformin due to side effects, adding inositol might allow for lower metformin doses while maintaining some metabolic benefits, though this approach requires medical supervision
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