Hi
I read an article about red meat last weekend - I hope it's Ok to quote a small para here. It mainly talks about industrialised farming and how that's damaged both meat, faming and the climate. But this part was interesting because I take acetyl-l-carnitine to help with MS and now I wonder if it's more damaging than beneficial:
"The status of red meat as an “unhealthy food” has become a dietary dogma in some quarters but research is beginning to reveal a more complex picture. Studies have shown that patients diagnosed with heart disease have a significantly greater risk of dying over the next five years if they have high levels of an organic compound called trimethylamine N-oxide (TMAO) in their blood. Red meat has been identified as a potential contributor. Red meat doesn’t provide TMAO directly, but it contains L-carnitine and choline, two compounds metabolised by microbes in our gut microbiome and then transformed into TMAO in the liver."
J
L-carnitine - possible downside
Re: L-carnitine - possible downside
Hi,
I'd argue that you shouldn't worry in this way about carnitine. It is absolutely essential for making energy. When we eat foods that contain long chain fatty acids they need to be converted into ATP- the energy currency of our cells. This happens in two steps in the cell 1) the krebs cycle and 2) the electron transport chain. The products of these steps ultimately drives a molecular machine called ATP synthase that makes ATP. This molecule must be always available (supply must always equal demand - instantly). If this doesn't happen we fail. As an extreme example, when we die rigor mortis sets in because we don't have any ATP being formed to enable muscles to relax.
Carnitine is a super special molecule. It can readily attach itself to fatty acids and transport them across the walls of the mitochondria. Long chain fatty acids cannot enter the krebs cycle by themselves as they are unable to cross the mitochondrial walls. When the fatty acids are transported by carnitine into the mitochondria they can be converted through a process called beta oxidation into the feedstock that drives the electron transport chain. If you can't adequately support beta oxidation then you would become very sick as ATP production would be impacted.
Carnitine is made of lysine and methionine. You would need a vegetarian diet rich in those compounds to synthesise it yourself. The shortcut is to eat meat.
There are other products of beta oxidation called NADH and FADH2. The first three letters of each make up abbreviations of derivatives of B group vitamins. The H stands for hydrogen ions released in beta oxidation. You absolutely need NAD and FAD via your diet but without the H - you will be stuffed!
If you didn't support adequate beta oxidation then you would need to rely on glycolysis (which happens without oxygen). Beta oxidation uses oxygen. Fatty acids and oxygen supply the most energy. Glycolysis starts a process which through several steps makes 36 or so molecules per cycle whereas a single 16 chain fatty acid produces 129 molecules.
You really do need carnitine.
I've used a lot of terms that don't get discussed often on these pages. Youtube is full of lectures about each one. It is now basic science.
I'd keep your eye on the doughnut, not on the hole.
Hope that helps.
Regards,
I'd argue that you shouldn't worry in this way about carnitine. It is absolutely essential for making energy. When we eat foods that contain long chain fatty acids they need to be converted into ATP- the energy currency of our cells. This happens in two steps in the cell 1) the krebs cycle and 2) the electron transport chain. The products of these steps ultimately drives a molecular machine called ATP synthase that makes ATP. This molecule must be always available (supply must always equal demand - instantly). If this doesn't happen we fail. As an extreme example, when we die rigor mortis sets in because we don't have any ATP being formed to enable muscles to relax.
Carnitine is a super special molecule. It can readily attach itself to fatty acids and transport them across the walls of the mitochondria. Long chain fatty acids cannot enter the krebs cycle by themselves as they are unable to cross the mitochondrial walls. When the fatty acids are transported by carnitine into the mitochondria they can be converted through a process called beta oxidation into the feedstock that drives the electron transport chain. If you can't adequately support beta oxidation then you would become very sick as ATP production would be impacted.
Carnitine is made of lysine and methionine. You would need a vegetarian diet rich in those compounds to synthesise it yourself. The shortcut is to eat meat.
There are other products of beta oxidation called NADH and FADH2. The first three letters of each make up abbreviations of derivatives of B group vitamins. The H stands for hydrogen ions released in beta oxidation. You absolutely need NAD and FAD via your diet but without the H - you will be stuffed!
If you didn't support adequate beta oxidation then you would need to rely on glycolysis (which happens without oxygen). Beta oxidation uses oxygen. Fatty acids and oxygen supply the most energy. Glycolysis starts a process which through several steps makes 36 or so molecules per cycle whereas a single 16 chain fatty acid produces 129 molecules.
You really do need carnitine.
I've used a lot of terms that don't get discussed often on these pages. Youtube is full of lectures about each one. It is now basic science.
I'd keep your eye on the doughnut, not on the hole.
Hope that helps.
Regards,
Re: L-carnitine - possible downside
Thanks Scott1
Perhaps that could be why I am shattered today - I gave the acetyl-l-carnitine a miss this morning (and yesterday).
Also I am worried about some current symptoms and blood test results - thanks for your helpful reply.
Best
J
Perhaps that could be why I am shattered today - I gave the acetyl-l-carnitine a miss this morning (and yesterday).
Also I am worried about some current symptoms and blood test results - thanks for your helpful reply.
Best
J
Re: L-carnitine - possible downside
i read a tiny bit about l-carnitine and ended up in my latest rabbit hole again 
made it almost halfway down this page:
https://ods.od.nih.gov/factsheets/Carni ... fessional/
"...A decline in mitochondrial function is thought to contribute to the aging process. Carnitine may be involved because its concentration in tissues declines with age and thereby reduces the integrity of the mitochondrial membrane [12]."
then went sideways to:
Role of Sex Hormones on Brain Mitochondrial Function, with Special Reference to Aging and Neurodegenerative Diseases (2017)
https://www.frontiersin.org/articles/10 ... 00406/full
"... Several indications show that brain mitochondrial functions decline with age and that sex steroid loss is involved in the observed dysregulation of mitochondrial functions. Furthermore, sex differences in brain mitochondrial functions may explain, at least partially, the influence of sex steroids on neurodegenerative diseases such as AD and PD. These data describing the complex relationships between age, sex steroids and mitochondrial function should be taken into account when designing therapies for successful aging of both men and women. Investigating the mechanisms and optimizing the strategies of steroid supplementation, will help in better developing sex-specific cerebroprotective approaches."
made it almost halfway down this page:
https://ods.od.nih.gov/factsheets/Carni ... fessional/
"...A decline in mitochondrial function is thought to contribute to the aging process. Carnitine may be involved because its concentration in tissues declines with age and thereby reduces the integrity of the mitochondrial membrane [12]."
then went sideways to:
Role of Sex Hormones on Brain Mitochondrial Function, with Special Reference to Aging and Neurodegenerative Diseases (2017)
https://www.frontiersin.org/articles/10 ... 00406/full
"... Several indications show that brain mitochondrial functions decline with age and that sex steroid loss is involved in the observed dysregulation of mitochondrial functions. Furthermore, sex differences in brain mitochondrial functions may explain, at least partially, the influence of sex steroids on neurodegenerative diseases such as AD and PD. These data describing the complex relationships between age, sex steroids and mitochondrial function should be taken into account when designing therapies for successful aging of both men and women. Investigating the mechanisms and optimizing the strategies of steroid supplementation, will help in better developing sex-specific cerebroprotective approaches."
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Re: L-carnitine - possible downside
The bottom line is if don't want to be fatigued, you need to be able to convert the components of ATP (ADP+ phosphate) rapidly into ATP whenever there is a demand for it.
The most efficient way to get the components is by burning fatty acids in the krebs cycle. That's a great way to get the components referred to in the second article. That happens in the mitochondria. To get the fatty acid in there in the first place it needs to be transported. It can't get there by itself. Carnitine can move easily through the mitochondrial walls so the fatty acid attaches to it and hitches a ride. The process is called the carnitine shuffle. No need to mega dose but you do need carnitine.
Regards,
The most efficient way to get the components is by burning fatty acids in the krebs cycle. That's a great way to get the components referred to in the second article. That happens in the mitochondria. To get the fatty acid in there in the first place it needs to be transported. It can't get there by itself. Carnitine can move easily through the mitochondrial walls so the fatty acid attaches to it and hitches a ride. The process is called the carnitine shuffle. No need to mega dose but you do need carnitine.
Regards,
Re: L-carnitine - possible downside
Thanks JL and Scott1
I was concerned due to some heart problems I seem to be experiencing, and didn't want to be making things worse. I feel better on the carnitine today.
But the heart issues (if that's what they are) are worrying and even more so reading about PwMS being more likely to have heart disease. And my GP brushing aside readings that are going in the wrong direction. I have called back to ask them, but I am sure they will feel I am over-thinking something I know little about.
I am also reading The Cardiovascular Cure and must confess I have not been doing enough cardio of late. It is hard when I feel so exhausted.....but I have to make a start on that, even with being anaemic.
J
I was concerned due to some heart problems I seem to be experiencing, and didn't want to be making things worse. I feel better on the carnitine today.
But the heart issues (if that's what they are) are worrying and even more so reading about PwMS being more likely to have heart disease. And my GP brushing aside readings that are going in the wrong direction. I have called back to ask them, but I am sure they will feel I am over-thinking something I know little about.
I am also reading The Cardiovascular Cure and must confess I have not been doing enough cardio of late. It is hard when I feel so exhausted.....but I have to make a start on that, even with being anaemic.
J
Re: L-carnitine - possible downside
Hi,
Whilst the carnitine will help improve the manufacture of energy, it's not the only thing. Beyond the krebs cycle step is the electron transport chain which has four complexes within it. The next step (ATPase) benefits from everything that has gone before it and is where most ATP is made. To help the electron transport chain work properly you need plenty of CoQ10. Terry Wahls focuses on organ meat to get it but you can take a man-made supplement called levocarnitine which is sold as CoQ10 (since 1985). That may also help.
The real question, as you say you are anaemic, is whether you have an adequate iron store. Iron is the core of heme which makes up haemoglobin. If you don't have an adequate iron supply then the oxygen has nothing to bind to so it can be carried through your blood vessels. Without enough oxygen, beta oxidation doesn't take place. You need to burn the fatty acid inside the mitochondria in the presence of oxygen. Iron isn't an issue for me so I'm less familiar when dealing with it.
The bottom line is you probably need to boost beta oxidation by using carnitine while getting more oxygen delivered to the mitochondria. The anaemia might be the key issue. Driving yourself to do cardio will deplete your ATP if your supply doesn't match the demand.
Regards,
Whilst the carnitine will help improve the manufacture of energy, it's not the only thing. Beyond the krebs cycle step is the electron transport chain which has four complexes within it. The next step (ATPase) benefits from everything that has gone before it and is where most ATP is made. To help the electron transport chain work properly you need plenty of CoQ10. Terry Wahls focuses on organ meat to get it but you can take a man-made supplement called levocarnitine which is sold as CoQ10 (since 1985). That may also help.
The real question, as you say you are anaemic, is whether you have an adequate iron store. Iron is the core of heme which makes up haemoglobin. If you don't have an adequate iron supply then the oxygen has nothing to bind to so it can be carried through your blood vessels. Without enough oxygen, beta oxidation doesn't take place. You need to burn the fatty acid inside the mitochondria in the presence of oxygen. Iron isn't an issue for me so I'm less familiar when dealing with it.
The bottom line is you probably need to boost beta oxidation by using carnitine while getting more oxygen delivered to the mitochondria. The anaemia might be the key issue. Driving yourself to do cardio will deplete your ATP if your supply doesn't match the demand.
Regards,
Re: L-carnitine - possible downside
Thanks Scott1
I take COQ10 too
My serum iron levels went from 9.6 uom/L last May to 12.6 in October and now it's at 17. I'm still taking ferrous fumerate and eating beef every couple of weeks.
It's the MCV at 78.4 - due to being thalasseamic meaning my RBC can't carry as much oxygen. But on the surface this looks like the IDA has resolved. But I am not feeling right. Interestingly they also measured something called Plasma B natruiuret peptide levels.
Last July this was 66ng/L which when I looked up meant my heart was straining and now it's 98. But they only become concerned when it's over 100 and even then it's not deemed important until it's way higher which kind of means post heart attack. I don't know if I am just overreacting. Here's a med report on that test.
https://medlineplus.gov/ency/article/00 ... P%20levels.
The other issue I have is my triglycerides have shot up - just nosing the top end of the normal range.
I don't know if anyone else has had similar issues - just posting this and hoping it might help others
J
I take COQ10 too
My serum iron levels went from 9.6 uom/L last May to 12.6 in October and now it's at 17. I'm still taking ferrous fumerate and eating beef every couple of weeks.
It's the MCV at 78.4 - due to being thalasseamic meaning my RBC can't carry as much oxygen. But on the surface this looks like the IDA has resolved. But I am not feeling right. Interestingly they also measured something called Plasma B natruiuret peptide levels.
Last July this was 66ng/L which when I looked up meant my heart was straining and now it's 98. But they only become concerned when it's over 100 and even then it's not deemed important until it's way higher which kind of means post heart attack. I don't know if I am just overreacting. Here's a med report on that test.
https://medlineplus.gov/ency/article/00 ... P%20levels.
The other issue I have is my triglycerides have shot up - just nosing the top end of the normal range.
I don't know if anyone else has had similar issues - just posting this and hoping it might help others
J
Re: L-carnitine - possible downside
Hi,
What a lot of issues. Although we are outside my normal area of focus, I think you described things pretty well. That BNP number probably tells the story. From what I can read, its not so much suggesting a possible heart attack caused by blocked arteries as heart failure cause by the inhibition of the process that allows the heart muscle to properly contract and relax . This would not be MS related but MS doesn't help.
In 2014, when I had a big MS attack, something like that happened to me. The top two chambers of my heart stopped contracting and just quivered instead. The result was the blood just trickled through my heart and pooled. The risk is that the pooling blood starts to clot. If the heart decides to beat properly then you distribute the blood clots. I took myself to hospital to get help for the bad MS attack but ended up in cardiology for two weeks and they didn't start giving me intravenous steroids for my MS for 10 days.
A cardiologist called Stephen Sinatra wrote a book called "The Sinatra solution: metabolic cardiology" which deals with how to treat congestive heart failure. He uses high dose CoQ10, aceytl-l-carntine and magnesium to correct this condition. I use a variation on this to treat my MS. Both my cardiologist and my neurologist don't know what to make of me because I have defied their expectations (in a positive way). Fatigue just doesn't exist for me at all and prior to following this idea it was a major problem.
For me, I take 750mg of CoQ10 at night (its a lot), 2x 1000mg daily of aceytl-l-carnitine and 2 x 500mg daily of mixed magnesium brew called Ethical nutrients mega magnesium (https://www.ethicalnutrients.com.au/pro ... -tablets-1 )
The other two supplements are made by Bioceuticals (https://www.bioceuticals.com.au/ ). The reason I take these brands is I am comfortable that the Australian National Association of Testing Authorities has given them the stamp that says they manufacture using good laboratory practice. Every country has a similar testing body and alternative medical practitioners are aware of them. I would only use what are called practitioner brands. That might require a bit of hunting to find them. In a store, they are usually behind the counter rather than in an aisle . Better standards should correlate with a more reliable product. When I last went to the UK, I was shocked how many products were full of fillers and 'stuff' rather than what the front label said. You'd need to make sure what you use is the real deal. They cost more but you get what you paid for.
Your heart needs to be able relax to fill with blood and then contract to push the blood. If you exercise using a 'fit cardio' type of regime but your heart doesn't properly relax between each beat then you push a suboptimal amount of oxygenated blood each beat. The result is not enough oxygen is transported and you fail to burn enough fatty acids ( using oxygen in beta oxidation) to keep up with the demand for ATP. The result is you are exhausted.
If your cardiologist has put you on a blood thinner and you decide to try what I have suggested above, you must tell your cardiologist that you are taking large doses of CoQ10. That supplement will change the coagulating properties of blood thinners like Warfarin. He might need to alter the blood thinner dose.
Both your cardiac muscles and your skeletal muscles move due to a process called excitation contraction coupling. The receptor that opens to make skeletal muscles contract is called the ryanodine receptor. The heart has similar receptors with the same name but they are cousins (closely related but different). All of them conduct calcium and it is calcium that ultimately makes contraction happen. Luckily, magnesium is equally conducted by the ryanodine receptor so if you take it then it will block some of the calcium and offset contraction. If you took the same amount of magnesium as I do it will impact on both heart and cardiac muscle. That should help your heart muscle to relax so it fills more readily with blood.
I don't know how to deal with your thalasseamic problem. Some sites suggest more B group vitamins so lots of dark green leafy vegetables may help (but I don't know).
Perhaps look at Sinatra's book for ideas.
Hope that helps.
Regards,
What a lot of issues. Although we are outside my normal area of focus, I think you described things pretty well. That BNP number probably tells the story. From what I can read, its not so much suggesting a possible heart attack caused by blocked arteries as heart failure cause by the inhibition of the process that allows the heart muscle to properly contract and relax . This would not be MS related but MS doesn't help.
In 2014, when I had a big MS attack, something like that happened to me. The top two chambers of my heart stopped contracting and just quivered instead. The result was the blood just trickled through my heart and pooled. The risk is that the pooling blood starts to clot. If the heart decides to beat properly then you distribute the blood clots. I took myself to hospital to get help for the bad MS attack but ended up in cardiology for two weeks and they didn't start giving me intravenous steroids for my MS for 10 days.
A cardiologist called Stephen Sinatra wrote a book called "The Sinatra solution: metabolic cardiology" which deals with how to treat congestive heart failure. He uses high dose CoQ10, aceytl-l-carntine and magnesium to correct this condition. I use a variation on this to treat my MS. Both my cardiologist and my neurologist don't know what to make of me because I have defied their expectations (in a positive way). Fatigue just doesn't exist for me at all and prior to following this idea it was a major problem.
For me, I take 750mg of CoQ10 at night (its a lot), 2x 1000mg daily of aceytl-l-carnitine and 2 x 500mg daily of mixed magnesium brew called Ethical nutrients mega magnesium (https://www.ethicalnutrients.com.au/pro ... -tablets-1 )
The other two supplements are made by Bioceuticals (https://www.bioceuticals.com.au/ ). The reason I take these brands is I am comfortable that the Australian National Association of Testing Authorities has given them the stamp that says they manufacture using good laboratory practice. Every country has a similar testing body and alternative medical practitioners are aware of them. I would only use what are called practitioner brands. That might require a bit of hunting to find them. In a store, they are usually behind the counter rather than in an aisle . Better standards should correlate with a more reliable product. When I last went to the UK, I was shocked how many products were full of fillers and 'stuff' rather than what the front label said. You'd need to make sure what you use is the real deal. They cost more but you get what you paid for.
Your heart needs to be able relax to fill with blood and then contract to push the blood. If you exercise using a 'fit cardio' type of regime but your heart doesn't properly relax between each beat then you push a suboptimal amount of oxygenated blood each beat. The result is not enough oxygen is transported and you fail to burn enough fatty acids ( using oxygen in beta oxidation) to keep up with the demand for ATP. The result is you are exhausted.
If your cardiologist has put you on a blood thinner and you decide to try what I have suggested above, you must tell your cardiologist that you are taking large doses of CoQ10. That supplement will change the coagulating properties of blood thinners like Warfarin. He might need to alter the blood thinner dose.
Both your cardiac muscles and your skeletal muscles move due to a process called excitation contraction coupling. The receptor that opens to make skeletal muscles contract is called the ryanodine receptor. The heart has similar receptors with the same name but they are cousins (closely related but different). All of them conduct calcium and it is calcium that ultimately makes contraction happen. Luckily, magnesium is equally conducted by the ryanodine receptor so if you take it then it will block some of the calcium and offset contraction. If you took the same amount of magnesium as I do it will impact on both heart and cardiac muscle. That should help your heart muscle to relax so it fills more readily with blood.
I don't know how to deal with your thalasseamic problem. Some sites suggest more B group vitamins so lots of dark green leafy vegetables may help (but I don't know).
Perhaps look at Sinatra's book for ideas.
Hope that helps.
Regards,
Re: L-carnitine - possible downside
Thanks so much for all this Scott1 and for looking into something outside your normal focus (as you said).
I am only taking 200mg COQ10 - it is a brand used by practitioners. And 360mg of mag glycinate - will have to check the brand. I am approx 50kg so thought that was adequate. I was taking 1000mg of acetyl-l-carnitine and now I am on half that dose. I changed from a better more expensive brand (Life Extension) to a cheaper one (Swanson) some time before covid, when I upped my dose to 1000mg. Even if I were to buy a good brand, at the moment I'd be nervous about increasing my daily dose.
Pre-covid I was fine - swimming and cycling at the gym and not feeling my heart was struggling but now I do feel that and like I can't get enough air.
I am shocked at how much you are taking - in a good way and if that has helped your fatigue then that's excellent.
I need to push my GP so I can see a cardiologist and maybe ad heamatologist. I have had low MCV for years - it's only now that it is having this impact on me. So there are other factors at play too.
Thanks for the info on Sinatra. I had a look at some online articles on his website. This about aneamia is very interesting https://heartmdinstitute.com/health-and ... the-heart/
Thanks again
I need to reorder some quality acetyl-l-carnitine, and maybe also mag glycinate!
J
I am only taking 200mg COQ10 - it is a brand used by practitioners. And 360mg of mag glycinate - will have to check the brand. I am approx 50kg so thought that was adequate. I was taking 1000mg of acetyl-l-carnitine and now I am on half that dose. I changed from a better more expensive brand (Life Extension) to a cheaper one (Swanson) some time before covid, when I upped my dose to 1000mg. Even if I were to buy a good brand, at the moment I'd be nervous about increasing my daily dose.
Pre-covid I was fine - swimming and cycling at the gym and not feeling my heart was struggling but now I do feel that and like I can't get enough air.
I am shocked at how much you are taking - in a good way and if that has helped your fatigue then that's excellent.
I need to push my GP so I can see a cardiologist and maybe ad heamatologist. I have had low MCV for years - it's only now that it is having this impact on me. So there are other factors at play too.
Thanks for the info on Sinatra. I had a look at some online articles on his website. This about aneamia is very interesting https://heartmdinstitute.com/health-and ... the-heart/
Thanks again
I need to reorder some quality acetyl-l-carnitine, and maybe also mag glycinate!
J
Re: L-carnitine - possible downside
I take several supplements from the Doctor’s Best brand and have been fine with them so far. They offer an acetyl-L-carnitine that I’m going to try. I took acetyl-L-carnitine many years ago and had some beneficial effects, but stopped for reasons I can’t remember now.Jaded wrote: ↑Sat Mar 05, 2022 8:42 am I was taking 1000mg of acetyl-l-carnitine and now I am on half that dose. I changed from a better more expensive brand (Life Extension) to a cheaper one (Swanson) some time before covid, when I upped my dose to 1000mg. Even if I were to buy a good brand, at the moment I'd be nervous about increasing my daily dose.
https://www.iherb.com/pr/doctor-s-best-acetyl-l-carnitine-with-biosint-carnitines-500-mg-120-veggie-caps/
Re: L-carnitine - possible downside
Thanks for the recommendation NHE
Good luck - I do hope they help you feel better
J
Good luck - I do hope they help you feel better
J
Re: L-carnitine - possible downside
What about acetyl-l-carnitine arginate that promotes remyelination too according to some trials?
Re: L-carnitine - possible downside
Hi Dim,
I don't know. I was only looking at the role that carnitine plays in making sure you can burn fatty acids to make energy.
Remyelination would be an entirely separate process.
Regards
I don't know. I was only looking at the role that carnitine plays in making sure you can burn fatty acids to make energy.
Remyelination would be an entirely separate process.
Regards
Re: L-carnitine - possible downside
Comparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trial
J Neurol Sci. 2004 Mar 15;218(1-2):103-8.
Treatment with acetyl L-carnitine (ALCAR) has been shown to improve fatigue in patients with chronic fatigue syndrome, but there have been no trials on the effect of ALCAR for treating fatigue in multiple sclerosis (MS). To compare the efficacy of ALCAR with that of amantadine, one of the drugs most widely used to treat MS-related fatigue, 36 MS patients presenting fatigue were enrolled in a randomised, double-blind, crossover study. Patients were treated for 3 months with either amantadine (100 mg twice daily) or ALCAR (1 g twice daily). After a 3-month washout period, they crossed over to the alternative treatment for 3 months. Patients were rated at baseline and every 3 months according to the Fatigue Severity Scale (FSS), the primary endpoint of the study. Secondary outcome variables were: Fatigue Impact Scale (FIS), Beck Depression Inventory (BDI) and Social Experience Checklist (SEC). Six patients withdrew from the study because of adverse reactions (five on amantadine and one on ALCAR). Statistical analysis showed significant effects of ALCAR compared with amantadine for the Fatigue Severity Scale (p = 0.039). There were no significant effects for any of the secondary outcome variables. The results of this study show that ALCAR is better tolerated and more effective than amantadine for the treatment of MS-related fatigue.
J Neurol Sci. 2004 Mar 15;218(1-2):103-8.
Treatment with acetyl L-carnitine (ALCAR) has been shown to improve fatigue in patients with chronic fatigue syndrome, but there have been no trials on the effect of ALCAR for treating fatigue in multiple sclerosis (MS). To compare the efficacy of ALCAR with that of amantadine, one of the drugs most widely used to treat MS-related fatigue, 36 MS patients presenting fatigue were enrolled in a randomised, double-blind, crossover study. Patients were treated for 3 months with either amantadine (100 mg twice daily) or ALCAR (1 g twice daily). After a 3-month washout period, they crossed over to the alternative treatment for 3 months. Patients were rated at baseline and every 3 months according to the Fatigue Severity Scale (FSS), the primary endpoint of the study. Secondary outcome variables were: Fatigue Impact Scale (FIS), Beck Depression Inventory (BDI) and Social Experience Checklist (SEC). Six patients withdrew from the study because of adverse reactions (five on amantadine and one on ALCAR). Statistical analysis showed significant effects of ALCAR compared with amantadine for the Fatigue Severity Scale (p = 0.039). There were no significant effects for any of the secondary outcome variables. The results of this study show that ALCAR is better tolerated and more effective than amantadine for the treatment of MS-related fatigue.