by Lynn Hinderliter CN, LDN

carnitineOf the  nutrients that support the health of the heart, in first place I position Coenzyme Q10 , and  second on the list I would place L-Carnitine.  I have been recommending it for many years now, but we live in exciting times nutritionally, and new research is continually being published that underscores its vital part in the cardiovascular system, and for other health conditions. In fact, it is a little hard to limit an article on l-Carnitine JUST to the heart, because this substance has been positively linked to improvements in health problems as apparently far removed as obesity and Parkinsonism.

Vegetarians are likely to be deficient in L-Carnitine, since the best source is red meat.

First, however, what it is. The prefix “L” would lead one to suppose that it is an amino acid – but strictly speaking, although its structure is similar to amino acids , it is more closely related to the B vitamins, and it plays no role in protein structures. I would urge parents to be very careful when raising their children as vegetarians from birth, because of the effect a deficiency of Carnitine could have on the growth pattern and development of the child. (Arch Fr Pediatr. 1984 Dec;41(10):715-9.) When one considers the problems attached to congenital defects in Carnitine metabolism, such as heart damage, its importance in the developing body is clear.  http://www.rehabinfo.net/resources/diseases/list/disease.asp?id=37

It is considered a nonessential nutrient in the sense that the body can manufacture it from other nutrients present in the body (Lysine, Methionine, B6 among others, with Vitamin C being a limiting factor), but it is highly essential in its actions.  In the diet it is found mostly in muscle meats ( as the name would suggest, coming from the Latin root for meat), and while it is rare for an actual clinical deficiency to exist, sub-optimal levels can lead to many problems associated with diabetes, obesity, cardiovascular disease and possibly Alzheimer and muscular dystrophy.

The reason L-Carnitine can be involved in such a wide range of problems, and the reason for its extreme importance in the maintenance of heart health, is its influence on the destiny of the massive amounts of carbohydrates in the average American diet.

As science advances, new forms of L-Carnitine are becoming available.  We now have Carnitine bounds to Arginine, with perhaps a greater affinity for brain energy, and an exciting new compound called Ester Carnitine, which is Propionyl L Carnitine bound to Glycine.  Excess carbohydrates are stored as fat, and Carnitine facilitates the burning of fat for energy by making it possible for the long chain fatty acids it transports to enter the cell . After all, if the fatty acids cannot reach the mitochondria where they are transformed to cellular energy, it stands to reason they are going to be deposited in places where the body will suffer from their presence, as happens in fatty liver disease, fatty build-up in the heart, and your plain old everyday variety obesity, where fatty build-up occurs in the muscles..

A 2001 study in Cardiovascular research by study by Lango et al said ” It has also been shown that propionyl-L-carnitine, which penetrates faster than carnitine into myocytes,  is effective in inhibiting production of free radicals. Beneficial effects of carnitine supplementation have been demonstrated under a variety of clinical conditions such as acute cardiac ischemia, during extracorporeal circulation, in carnitine-dependent cardiomyopathy as well as in patients with chronic circulatory failure and in cardiogenic shock.

The two commonly available forms of L-Carnitine are Carnitine fumarate, and Carnitine tartrate. The former is made by Sigma-Tau, and the latter by Lonza.  They are both of high quality, if there can be said to be a difference in the carriers, it is that  the tartrate is perhaps more on the side  of an antioxidant, while the fumarate (which converts to malate in the Krebs cycle) leans more towards energy.

My hero Dr. Whitaker compares the heart deficient in Carnitine to a car without a fuel pump!

L-Carnitine and Thyroid function

However, as you can plainly see, the heart is not the only organ that can benefit from more efficient burning of fats for energy: Carnitine has its uses in the following conditions: angina, myocardial infarction, recovery from heart surgery, hypertension and high cholesterol levels, also high triglycerides, Alzheimer’s, liver disease (including alcohol induced liver problems) diabetes, diabetic neuropathy male infertility, diabetic neuropathy, Parkinson’s and many other more obscure afflictions.

Dr. Stephen deFelice has done some very interesting research into the effect of L-Carnitine on hyperthyroidism, which you will find here, http://www.fimdefelice.org/archives/arc.comment11_02.html.  The bottom line,

Three female patients with classic hyperthyroidism were selected. All had the common manifestations of tremors, weight loss, nervousness, insomnia, heat intolerance, excessive sweating and emotional instability.

I treated them with carnitine, and within a ten-day period all three were virtually without signs and symptoms.

In fact, Carnitine deficiencies may play a role in both hypo and hyper thyroidism – http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15803480

In his book, The Carnitine Miracle, Robert Crayhon MS, CN says

A Jan 1998  article by Dr. Richard Podell M.D. touches on the excellent research which enables him to say that he is now able to recommend L-Carnitine as standard treatment for intermittent claudication, an extremely painful condition that causes great pain in the legs during exercise.  He based this on studies in Italy using a Carnitine derivative where double-blind, placebo controlled research with 245 patients showed not only that Carnitine helped the condition, but that the more severe the problem, the greater the degree of relief.  The initial dose was 500mg twice a day, and the highest dose used ( incremental increases) where no improvement occurred at lower doses was 1500mg twice a day. ” Nearly one-third of all deaths related to heart disease occur because of arrhythmias.  Carnitine is a valuable nutrient for the control of arrhythmias …” and he goes on to recommend also taurine, magnesium and fish liver oils.  This combination, he states, has eliminated every case of arrhythmia he has seen in his practice.

It is very useful and helpful for people trying to lose weight, but only if their diet is deficient in Carnitine.  To quote from a release by the Lonza Group ( who manufacture L-Carnitine):” Studies in obese people have shown that only low calorie diets together with exercise will guarantee long term weight loss.  Both of these measure induce a deficiency in L-Carnitine. Sub-optimal levels of L-Carnitine may also cause fatigue and strongly impair beta-oxidation.  Clinical studies demonstrate the effectiveness of supplementary L-Carnitine for weight management, the improvement of exercise performance and maintenance of a healthy heart.”

As a less scientific side-note, when people are on a low carbohydrate diet, we have found that supplementary L-Carnitine lessens the irritability and nervousness that such an extreme change in body chemistry often brings.

The average amount of Carnitine found in the daily diet is app. 50 mgs: therapeutic levels range from 500 to 2000 mgs. Deficiencies may be due to a genetic error in Carnitine synthesis, or to low levels of lysine, high levels of homocysteine, or vegetarianism . There do not appear to be any side effects from its use even at high dosages, but it is wise to increase Vitamin C supplementation, since some studies show that high amounts of Carnitine cause loss of Vitamin C from the body.

Athletes have known about Carnitine’s ability to burn fat for energy for some time, but heart disease sufferers are just beginning to realize the benefits that come from using a substance that provides the heart with its main fuel: the heart gets two thirds of its energy from burning fat! Less pain and more endurance can be associated with supplementing with L-Carnitine, specifically the propionyl carnitine, which is the more active form in muscle tissue, with no downside.  It works synergistically with Coenzyme Q 10.

L-Carnitine may be upsetting to the stomach, so make sure to take it with a meal.  Dr. Podell also urges caution if a person has any kidney or liver problems, or is pregnant or lactating.

Lactic acid build-up can really be a villain, not just for athletic performance but for energy production generally: particularly unfortunate are its repercussions on brain function. Fortunately there is a nutrient so effective at addressing it that it has also been developed as a  “drug”. That nutrient is Acetyl-L-Carnitine (ALC),  the form of Carnitine which appears to have more specificity for neurons, which can be produced in the liver from 2 amino acids (Lysine and Cysteine) but is often not available in sufficient quantities because its synthesis requires several vitamins which our diets are often inadequate to provide: B6, Folic acid, Pantothenic acid, Biotin and C.

The Acetyl form of Carnitine is more expensive than plain vanilla L-Carnitine, but also more effective for energy related problems because it is better assimilated, and also has been shown to pass the blood/brain barrier more efficiently.  (This, of course, accounts for the studies that have found an influence on Alzheimer’s, where lactic acid build-up in  the brain is being studied as a causative factor – more here at http://www.nutritionreporter.com/carnitine.html).

ALC has been shown to boost the activity of an enzyme, carnitine acetyltransferase,  which increases the burning of fatty acids for fuel in the mitochondria.  It is therefore helpful at two levels,  as a remover of waste, and  as a provider of fuel – both positively affecting energy levels. Whether this is the case throughout the body, or mainly in the brain, has not yet been determined.

Since I have had a few queries related to PEYRONIE’ DISEASE, which at the time I had little advise for, other than vitamin E and anti-inflammatory enzymes, I am appending this information here.  Studies have been completed in Italy comparing Acetyl-L-Carnitine and the only medication which has had any effect on PEYRONIE’ DISEASE to date – Tamoxifen. Since Tamoxifen has real dangers attached to its use, I am glad to report that there was absolutely no doubt about the results:  at the end of the study, participants were asked about pain during erection.  About 50% of the drug group reported lessened pain, while  over 90% of the Carnitine users were improved.  The drug had no effect on PEYRONIE’ DISEASE, curvature of the penis, while the Acetyl-L-Carnitine users experienced a 47% improvement.  Plaque ( the cause of the curvature)  was also significantly reduced.  This is excellent!   Remember, too, that ACL has other benefits for the brain, the mood and vision.  The study was published in BJU Int., 2001; 88:63-67, and the recommended dosage is half a gram four times a day for a total of 2 grams, with meals and at bedtime.

Find the recommended supplements here

Here is the study abstract – http://www.findarticles.com/p/articles/mi_m0FDN/is_5_6/ai_80490890

For further help with PEYRONIE’ DISEASE, go here – http:/hop.clickbank.net/?vtmnldy/apolinar

Research Articles for L-Carnitine – http://www.carnipure.com/carnipure/en/promotional_material/newsletter.html

L-Propionyl carnitine has been shown to improve the heart’s mechanical recovery – http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1321584&dopt=Abstract

Acetyl-l-Carnitine and energy in the Elderly – http://www.vitasearch.com/get-clp-summary/36743

L-Carnitine and Hyperthyroidism – http://www.fimdefelice.org/archives/arc.comment11_02.html

Related articles you may find interesting:

A program for help with Peyronie’s Disease – http://hop.clickbank.net/?vtmnldy/apolinar