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By this point, your body should be adapted to using ketones for fuel, and the appetite suppression from ketosis should partially compensate for the loss of pharmaceutical appetite control

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This is not an interaction with Acetyl-l-carnitine it is a separate effect of the medicine, and it is a reason some people are advised to supplement rather than to avoid one: Read the full Metformin, Rosiglitazone nutrient depletion report Acetyl-l-carnitine is itself a nutrient we track see which medications may deplete ACETYL-L-CARNITINE

However, a campaign that asks patients to check a register before they make a purchase still places the burden of vigilance on a subset of the public who may be particularly vulnerable, likely price-sensitive and looking for a rapid solution