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This increase is needed for L-Carnitine to enter the muscle cells

Systemic FXR agonists such as OCA may cause dyslipidemia and pruritus, while selective intestinal FXR activators like Fexaramine can avoid direct hepatic activation, circumvent related toxicity risks, and significantly improve obesity and insulin resistance in animal models ( TGR5 is mainly expressed in enteroendocrine L cells of the distal ileum and colon and can be activated by bile acid agonists, including natural bile acid analogs (such as DCA) and synthetic small-molecule agonists (such as INT-777)

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For people on these medications, the process is much more accelerated. Losing muscle can lead to frailty, falls, and fractures, so doctors advise GLP-1 users to exercise, including strength training, and to eat enough protein