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These include the following: Bone maintenance

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D-carnitine without bioactivities in people, however, has adverse biological effects via suppressing the carnitine acetyltransferase (23), with supplementation of D-carnitine inducing oxidative stress, liver inflammation, and apoptosis in animal studies (24), causing secondary carnitine deficiency, and therefore, almost no human studies of D-carnitine have been conducted (21)

Ngoei KRW, Langendorf CG, Ling NXY, Hoque A, Varghese S, Camerino MA, et al

These gastrointestinal effects can lead to dehydration and acute kidney injury in some patients