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This physiological shift often results in pronounced metabolic dysregulation, including increased adiposity, insulin resistance, and impaired glucose tolerance [146]

It also destabilizes the structure and decreases ATP production in cytochrome V (ATP synthase) (190, 191) and removes the regulatory inhibitory effect of high ATP levels on cytochrome IV (189), which is the natural negative feedback that decreases further ATP production and slows electron flow without its leakage

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The liver is a key organ for endogenous carnitine synthesis and metabolism, and carnitine homeostasis in the liver has a major effect on carnitine levels in other tissues throughout the body [213, 214]