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The side effects that do exist are narrow and well-characterized: gastrointestinal upset at higher oral doses, a distinctive fishy body odor from a carnitine metabolite, and one genuinely debated caveat an indirect cardiovascular signal involving the gut-derived metabolite TMAO

Since renal medullary cells, whose role is to concentrate urine, are constantly exposed to extremely high levels of sodium chloride and urea, the accumulation of betaine in renal medullary cells helps balance the hypertonicity in interstitial fluid (Kempson et al., 2014)