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For instance, an 8-week double-blind controlled trial showed that when the subjects used a cream containing 2% L-carnitine daily and combined it with aerobic exercise three times a week, the average local fat thickness decreased by 12%-18%, and the proportion of fatty acid oxidation increased by approximately 15%-20%

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Studies show carnitine deficiencythough rare in healthy adultscorrelates with reduced exercise-induced fat loss and slower metabolic adaptation

Specifically, this connection was hypothesized to occur through the gut dysbiosis-ocular surface-lacrimal gland axis which consists of five proposed immune-related mechanisms describing how ratio changes of gut commensal can lead to DES [114, 115]