L - Carnitine
[Technically carnitine refers to a mix of the D and L forms of carnitine, but I shall use the term carnitine interchangeably with L-carnitine, which is the 'active' form of carnitine in this respect.]
Carnitine is the carrier molecule that takes fuel in the form of acetate groups from the cell across mitochondrial membranes where it is needed to fuel energy production by Kreb's citric acid cycle and oxidative phosphorylation (Please see Fibromyalgia - possible causes and implications for treatment for more detail on oxidative phosphorylation and associated processes.) Acetate groups in the cell bind to carnitine to form acetyl L-carnitine, which can then pass through the mitchondrial membrane. The acetate group is then given up and L-carnitine passes back through the mitochondrial membrane into the cell in order to pick up another molecule of acetate. Using the car analogy, carnitine is like the nozzle on the fuel pump that delivers fuel into the tank of your car where it is needed.
Carnitine can be made in both the liver and the kidney from cysteine and methionine (both amino acids in animal protein) and requires iron and vitamin C for its synthesis. In muscle meats L-carnitine makes up 0.1% of dry matter. There is very little carnitine in plant derived foods, which may partly explain why vegetarianism seems to be a risk factor for chronic fatigue.
A typical sort of dose to treat problems associated with poor mitochondrial function is 2 grams a day. Studies have shown it is highly effective in ischaemic heart disease. It has also been trialled in the treatment of chronic fatigue syndrome and a precis of results of that trial are as follows:
- "Carnitine is essential for mitochondrial energy production. Disturbance in mitochondrial function may contribute to cause of the fatigue seen in Chronic Fatigue Syndrome (CFS) patients. Previous investigations have reported decreased carnitine levels in CFS. Orally administered L-carnitine is an effective medicine in treating the fatigue seen in a number of chronic neurological diseases. Amantadine is one of the most effective medicines for treating the fatigue seen in multiple sclerosis patients. Isolated reports suggest that it may also be effective in treating CFS patients. Formal investigations of the use of L-carnitine and amantadine for treating CFS have not been previously reported.
- We treated 30 CFS patients in a crossover design comparing L-carnitine and amantadine. Each medicine was given for two months, with a 2-week washout period between medicines. L-Carnitine or amantadine was alternately assigned as first medicine. Amantadine was poorly tolerated by the CFS patients. Only 15 were able to complete 8 weeks of treatment, the others had to stop taking the medicine due to side effects. In those individuals who completed 8 weeks of treatment, there was no statistically significant difference in any of the clinical parameters that were followed. However, with L-carnitine we found statistically significant clinical improvement in 12 of the 18 studied parameters after 8 weeks of treatment. None of the clinical parameters showed any deterioration. The greatest improvement took place between 4 and 8 weeks of L-carnitine treatment. Only 1 patient was unable to complete 8 weeks of treatment due to diarrhoea. L-Carnitine is a safe and very well tolerated medicine which improves the clinical status of CFS patients. In this study, we also analysed clinical and laboratory correlates of CFS symptomatology and improvement parameters".
Acumen laboratories now routinely check Acetyl-L-carnitine levels for me, as part of the Mitochondrial Function tets, and they are almost always low in CFSs.
Testing Acetyl L carnitine this is now a routine part of the Mitochondrial Function Profile
- "Amantadine and L-carnitine treatment of Chronic Fatigue Syndrome". Plioplys AV, Plioplys S., Chronic Fatigue Syndrome Center, Department of Research, Mercy Hospital, Chicago, Ill 60616, USA, Neuropsychobiology. 1997;35(1):16-23
For those who are interested, the full article can be downloaded or viewed here Amantadine and L-carnitine treatment of Chronic Fatigue Syndrome.pdf
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