Supplements 101: Carnitine—Boost Energy and Ease Pain

Acetyl-L-carnitine (ALCAR) is a powerful nutrient with a long history in science and medicine. Known for its role as a "biological shuttle bus," ALCAR transports fats into mitochondria, our cells' power plants, where they are converted into energy (ATP). But ALCAR doesn’t stop there. It has been widely studied for its benefits in brain health, nerve pain, and energy production. Could this versatile supplement hold the key to symptom relief for ME/CFS and fibromyalgia? Let’s dive in.

Carnitine: The Key Players

When supplementing with carnitine, there are a few forms to know:

• L-Carnitine: The basic form, commonly found in food and supplements.

• Acetyl-L-Carnitine (ALCAR): This form is better absorbed and can cross the blood-brain barrier, enhancing its effects on cognition and brain health.

• Propionyl-L-Carnitine (PLCAR): Known for improving muscle energy and oxygen efficiency but may lower blood pressure due to its vasodilating effects.

For most people with chronic conditions, ALCAR stands out for its superior bioavailability and versatility, especially when addressing brain fog, fatigue, and nerve pain.

Brain Health Benefits of ALCAR

ALCAR supports brain health by:

• Boosting Neurotransmitters: It enhances acetylcholine, vital for learning, memory, and reducing brain inflammation.

• Increasing Glutathione: A key antioxidant, especially important for neuroprotection.

• Supporting Nerve Myelination: It promotes nerve health and repair by incorporating its acetyl group into nerve cells.

In a 2003 study on multiple sclerosis patients, ALCAR supplementation for six months significantly increased glutathione levels in cerebrospinal fluid and reduced oxidative stress markers.

Carnitine in Food: Are You Getting Enough?

Animal products like red meat, fish, and dairy are the richest sources of L-carnitine. For example, a 4 oz serving of beef provides up to 160 mg. However, vegan and vegetarian diets are low in carnitine, often providing only 10–12 mg daily. While the body can synthesize carnitine from amino acids like methionine and lysine, production declines with age, making supplementation more critical for older adults.

Medications That Deplete Carnitine

Certain drugs can lower ALCAR levels, including anticonvulsants like valproic acid, phenobarbital, and phenytoin. If you’re taking these medications, supplementing with ALCAR could help offset deficiencies.

The TMAO Debate: Should You Be Concerned?

Recent headlines linked carnitine intake to heart disease risk due to a metabolite called trimethylamine oxide (TMAO). However, the evidence is far from conclusive:

• Foods like carrots, cauliflower, peanuts, and even seafood produce more TMAO than red meat.

• Seafood, despite being a high TMAO producer, is consistently linked to heart health.

Some studies even suggest that carnitine is cardioprotective, reducing oxidative stress in heart tissue and improving conditions like angina and heart failure.

ALCAR for ME/CFS and Fibromyalgia

Research on ALCAR in ME/CFS and fibromyalgia is promising:

• Energy Production: ALCAR improves mitochondrial function and enhances the activity of pyruvate dehydrogenase (PDH), a key enzyme impaired in ME/CFS.

• Nerve Protection: ALCAR relieves nerve pain and improves nerve function in conditions like chemotherapy-induced neuropathy and HIV-related nerve damage.

Key Studies:

1. A 2002 study found that ME/CFS patients with lower blood levels of ALCAR experienced more severe fatigue.

2. A 2007 study of fibromyalgia patients showed reduced pain and improved quality of life after supplementing with 1g/day of ALCAR.

3. A meta-analysis of clinical trials demonstrated that 1.5–3g/day of ALCAR improved cognitive function and memory in older adults.

ALCAR for Pain Relief

ALCAR’s neuroprotective effects are particularly beneficial for fibromyalgia patients, who often experience small fiber neuropathy (SFN). Symptoms of SFN include heightened pain sensitivity, abnormal sweating, and restless legs. Since ALCAR has shown benefits for nerve pain in other conditions, it could be a game-changer for fibromyalgia-related pain as well.

How to Supplement with ALCAR

Dosage:

• For general benefits: Start with 2g/day.

• For fibromyalgia or severe fatigue: Up to 4g/day, in divided doses, may be more effective.

• Pro Tip: ALCAR works best on an empty stomach for optimal absorption.

Safety:

Side effects are rare but may include mild nausea, headache, or diarrhea. If you experience low blood pressure, avoid propionyl-L-carnitine.

The Bottom Line

ALCAR is a versatile supplement with a strong track record in supporting mitochondrial function, reducing pain, and enhancing cognitive health. It holds particular promise for ME/CFS and fibromyalgia patients, especially those struggling with fatigue, brain fog, and nerve pain. When choosing a supplement, prioritize acetyl-L-carnitine for its superior absorption and brain health benefits.

References

Rebouche, C. J. (2004). Kinetics, Pharmacokinetics, and Regulation of l-Carnitine and Acetyl-l-carnitine Metabolism. Annals of the New York Academy of Sciences, 1033(1), 30–41.

Ferreira GC & McKenna MC (2017) L-Carnitine and Acetyl-L-carnitine Roles and Neuroprotection in Developing Brain. Neurochem Res; 42(6):1661-1675. Neurochem Res. 28(9):1321-8.

Calabrese V. et al (2003) Disruption of thiol homeostasis and nitrosative stress in the cerebrospinal fluid of patients with active multiple sclerosis: evidence for a protective role of acetylcarnitine.

Kuratsune H. et al (2002) Brain regions involved in fatigue sensation: reduced acetylcarnitine uptake into the brain. Neuroimage; 17(3):1256-65.  

Vermeulen RC & Scholte HR. (2004) Exploratory open label, randomized study of acetyl- and propionylcarnitine in chronic fatigue syndrome. Psychosom Med. 66(2):276-82.

Montgomery SA, Thal LJ, Amrein R. (2003) Meta-analysis of double blind randomized controlled clinical trials of acetyl-L-carnitine versus placebo in the treatment of mild cognitive impairment and mild Alzheimer’s disease. Int Clin Psychopharmacol. 18:61-71.

Rossini, M. et al. (2007) Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol. 25(2):182-8.

Leombruni P et al. (2015) A randomised controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgic patients: preliminary data. Clin Exp Rheumatol. 33(1 Suppl 88):S82-5.

Malaguarnera M, Gargante MP, Cristaldi E, Colonna V, Messano M, Koverech A et al. (2008). Acetyl L-carnitine (ALC) treatment in elderly patients with fatigue. Arch Gerontol Geriatr 46: 181–190.