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2.1 Trimethylamine-N-oxide and betaine in humans In humans, TMAO is mostly biosynthesized from the unabsorbed dietary constituents containing trimethylamine moiety such as choline (concentrated in egg yolk and liver) and L-carnitine (predominantly in red meat) through the activity of inhabitant bacteria of the human large intestine (Li et al., 2018a) (Figure 2)

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Levocarnitine promotes mitochondrial lipid oxidation in liver cells, reducing the accumulation of fat within hepatocytes

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It is unknown whether RYBELSUS causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined [see Warnings and Precautions (5.1), Nonclinical Toxicology (13.1)]