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The 2-year limit exists because clinical trials hadnt extensively studied outcomes beyond this duration when NICE made its recommendation, and because of cost-effectiveness modelling

The boost in fatty acid oxidation allows for more L-carnitine to be taken up into our cells, allowing for increased muscle metabolism and growth

Off-label means the medication has not been FDA-approved to treat the condition, but a healthcare provider uses their professional judgment and believes the medication may be useful, so they can prescribe it in this case

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