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This apparent discrepancy is actually consistent with a massive body of literature from psychology and neuroscience that human feelings (including symptoms) are not flawless reflections of peripheral sensory input but instead feelings are a loose interpretation or prediction merely tailored by peripheral sensory input (Kleckner and Quigley, 2015

However, caution is warranted, as this study was conducted in mice and relied on oral administration of L-carnitine, which limits extrapolation

On the other hand, canker sores (or aphthous ulcers) are noncontagious lesions that occur inside the oral cavity and are believed to be caused by various factors, including stress, inflammation, gut dysbiosis, nutritional deficiencies, and immune system dysregulation (figure 2)

But people with certain conditions, like kidney dysfunction, may need to get carnitine from food or supplements