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L-carnitine has been the best researched of the carnitines with many favorable studies. Also, taking L-carnitine increases the blood level of not just carnitine, but also of acetyl-L-carnitine, so favorable studies for acetyl-carnitine should apply as well. While all areas need more research to be certain of benefits, multiple double-blind studies each show benefit for angina, hepatic encephalopathy, heart attacks, heart failure, kidney dialysis, and sperm motility looks extensive and favorable. Single double-blind studies have found benefit for ADHD, Chronic Fatigue Syndrome, COPD, fatigue in the elderly, intermittent claudication, sickle cell, and various fatigue conditions. Of course, what I wonder is whether carnitine could have any preventive effect, i.e., prevent heart attacks and death? Most importantly, will it help you life longer? Side-effects of L-carnitine have been transient nausea and vomiting, increased body odor, and gastritis. These are all mild and uncommon. Seizures have been reported in rare instances (Medical Letter 11/22/04;46:96). Animal Research suggests possible benefits in areas not yet studied in humans: aging, hepatitis and liver cancer, impulsive behavior, wound healing, protecting the liver and stomach from the effects of alcohol, and protecting the testes. ADHD, Aggression in Small DB: In an 16-week DB PC crossover study of 24 ADHD children, 54% improved during the 8 weeks on 100 mg/kg/day up to 4 g/day on home behavior vs. 13% of the same children during the 8 weeks on placebo (P < 0.02). In 54% on carnitine, school behavior also improved as assessed with the Conners teacher-rating score (P < 0.05). Before treatment, the CBCL total and sub-scores were significantly different from those of normal Dutch boys (P < 0.0001). Responders showed a significant improvement of the CBCL total scores compared to baseline (P < 0.0001). In the majority of boys no side effects were seen. At baseline and after carnitine treatment, responders showed higher levels of plasma-free carnitine (P < 0.03) and acetylcarnitine (P < 0.05). Compared to baseline, the carnitine treatment caused in the responsive patients a decrease of 20-65% (8-48 points) as assessed by the CBCL total problem rating scale. Netherlands. Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder. Van Oudheusden LJ, Scholte HR. Prostaglandins Leukot Essent Fatty Acids 2002 Jul;67(1):33-8 (Ed: The cost of carnitine in tablet form is roughly $40/month or in powder form $17/month if 1 kilo powder were purchased, an 8 months supply. DexterSportsScience.com A smaller 2 g/d dose might work as well since it does with most adult conditions. A depression study suggests that even 1 g/day might be helpful. Angina Helped in Large Study: In a 6-month study of 200 angina patients, L-carnitine 2 g/day significantly reduced the number of premature ventricular contractions (PVC) at rest, as well as an increased exercise tolerance and reduced ST-segment depression during maximal effort. Cardiac function improved with a reduction in the consumption of cardioactive drugs. Laboratory analysis showed an improvement in plasma lipid levels. The therapeutic effect of L-carnitine in patients with exercise-induced stable angina: a controlled study. Cacciatore L, Cerio R, et al., University of Naples, Italy. Drugs Exp Clin Res. 1991;17(4):225-35. Angina Helped by Carnitine: In a DB PC study of 44 men with chronic angina using L-carnitine (1 g twice daily), the mean exercise work load increased after L-carnitine (103 vs. 97 watts, p = 0.001), as did the watts to onset of angina (96 vs. 87, p = 0.000). ST segment depression was reduced by L-carnitine at the maximum work load (1.40 vs. 1.69 mm, p = 0.05). 22.7% of the patients became free of angina with L-carnitine and 9.1% with placebo. Resting and exercise blood pressure, heart-rate and double product were unaffected by L-carnitine. 1 patient decided to discontinue the trial because of gastric pyrosis while taking the active drug. Effects of L-carnitine on exercise tolerance in chronic stable angina: a multicenter, double-blind, randomized, placebo controlled crossover study. Cherchi A, Lai C, et al. Int J Clin Pharmacol Ther Toxicol. 1985 Oct;23(10):569-72. Angina Helped by Carnitine: In a DB PC study of 12 stable angina patients of L-carnitine (900 mg. daily), the exercise time was 11.4 minutes in the placebo period. This increased to 12.2 min (p < 0.05) after 4 weeks and 12.8 min (p < 0.01) after 12 weeks of treatment with carnitine. The time required for 1 mm ST depression to occur was 6.4 min in the placebo period, 7.6 after 4 weeks and 8.8 min after 12 weeks of treatment (p < 0.05). Effects of L-carnitine on exercise tolerance in patients with stable angina pectoris. Kamikawa T, Suzuki Y, et al. Jpn Heart J. 1984 Jul;25(4):587-97. Athletes: L-Carnitine Helped Fatigue and Body After Light Exercise: In a 30 day DB PC study of 84 elderly with rapid muscle fatigue after light exercise, those given 2 g/d of carnitine had considerably less fatigue. Total fat mass decreased (-3.1 vs. -0.5 kg); total muscle mass increased (+2.1 vs. +0.2 kg); total cholesterol decreased (-1.2 vs. +0.1 mmol/L); bad LDL-Cholesterol decreased (-1.1 vs -0.2 mmol/L); good HDL-Cholesterol increased (+0.2 vs. +0.01 mmol/L); triglycerides decreased (-0.3 vs 0.0 mmol/L),; apoA1 decreased (-0.2 vs 0.0 g/L); and apoB decreased (-0.3 vs -0.1 g/L). Wessely and Powell scores decreased significantly by 40% (physical fatigue) and 45% (mental fatigue) in subjects taking levocarnitine, compared with decreases of 11% physical and 8% mental fatigue with placebo (p < 0.001). No adverse events were reported. Univ. Catania. Levocarnitine administration in elderly subjects with rapid muscle fatigue : effect on body composition, lipid profile and fatigue. Pistone G, Marino A, Leotta C, Dell'Arte S, Finocchiaro G, Malaguarnera M. Drugs Aging. 2003;20(10):761-7; Athletes: L-Carnitine No Benefit Marathon: L-carnitine DB study did not affect the metabolism or improve the physical performance of the endurance-trained athletes during the run and did not alter their recovery. Eur J Appl Physiol Occup Physiol 1996;73(5):434-9 Athletes: L-Carnitine: May Benefit Athletes: Several studies, but not all, have found it allows athletes to exercise longer. At 2 grams per day, trained runners increased their peak speed by 5.7% and carnitine also helped non-trained runners. Carnitine prevents muscle damage during vigorous exercise. It causes vasodilatation leading to improved energetic metabolism. It also decreases lipid peroxide formation. R Crayhon, J Am Coll Nutr 17:649, ’98. However, these conclusions are denied by EP Brass in J Am Coll Nutr 17:207 ‘98 Athletes: Brief Carnitine Failed to Benefit 20 K Run: In a DB PC study of trained athletes, 2 grams of L-carnitine two hours before and after a 20 km run failed to improve physical performance or exercise recovery. Columbani P, Wenk C, Kunz I, et al. Effect of L-carnitine supplementation on physical performance and energy metabolism of endurance-trained athletes: a double blind crossover field study. Eur J Appl Physiol 1996;73:434-9. Autism: Carnitine Low; Ammonia High = Mitochondrial Dysfunction: In a retrospective study of 100 autistic children, free and total carnitine (p < 0.001), and pyruvate (p = 0.006) were reduced while ammonia and alanine levels were considerably elevated (p < 0.001). is suggestive of mild mitochondrial dysfunction. Relative carnitine deficiency in autism. Filipek PA, Juranek J, et al. University of California, Irvine, CA, J Autism Dev Disord. 2004 Dec;34(6):615-23 Cocaine Dependence: Neither Olanzapine nor Valproate nor L-Carnitine with CoQ10 Helped: In an 8-week DB PC study of 68 cocaine addicts using either olanzapine (10 mg/day), or valproate (1500 mg/day), or coenzyme Q10 (200 mg/day) and L-carnitine (500 mg/day) combination or placebo with all receiving individual cognitive behavioral counseling, none of the study medications were superior to placebo. A placebo-controlled screening trial of olanzapine, valproate, and coenzyme Q10/L-carnitine for the treatment of cocaine dependence. Reid MS, Casadonte P, et al. New York University. Addiction. 2005 Mar;100 Suppl 1:43-57. COPD: Carnitine Improved Exercise Tolerancew and Respiratory Muscle Strength: In a 6-week DB PC study of 16 COPD patients, L-carnitine (2 g/day, orally) improved inspiratory muscle strength and walking test tolerance more (40 vs 14 cmH2O, and 87 vs 34 m; P < 0.05). Blood lactate concentration was lower as well (1.6 vs 2.3 mM, P < 0.05). L-carnitine as an ergogenic aid for patients with chronic obstructive pulmonary disease submitted to whole-body and respiratory muscle training programs. Borghi-Silva A, et al. Universidade Federal de Sao Carlos. Braz J Med Biol Res 2006 Apr;39(4):465-74. Chronic Fatigue Syndrome: Carnitine Clearly Better Than Amantidine: Carnitine is essential for mitochondrial energy production. Disturbance in mitochondrial function may contribute to or cause the fatigue seen in Chronic Fatigue Syndrome (CFS) patients. In a randomized crossover study of 30 CFS patients, each received 2 months of L-carnitine and amantadine with 2 weeks washout in between. Amantadine was poorly tolerated with only 15 were able to complete the treatment. In those completing, there was no significant difference in any clinical parameter. However, with L-carnitine significant clinical improvement in 12 of the 18 studied parameters. The greatest improvement took place between 4 and 8 weeks. Only 1 patient was unable to complete due to diarrhea. Amantadine and L-carnitine treatment of Chronic Fatigue Syndrome. Plioplys AV, Plioplys S. Mercy Hospital Chicago. Neuropsychobiology. 1997;35(1):16-23 Diabetes: Possible Mild Benefit: In a DB PC study of 22 male and 13 female type II diabetics, 1 g of L-carnitine three times a day for a period of 12 weeks decreased fasting blood glucose from 143 to 130 mg/dl (P=0.03), but increased triglycerides from 196 to 233 mg/dl (P=0.05). There was no significant change in LDL-C, HDL-C, HbA1C, LP(a) or total cholesterol. Effect of L-carnitine on plasma glycemic and lipidemic profile in patients with type II diabetes mellitus. Rahbar AR, Shakerhosseini R, et al. Shahid Beheshtee University of Tehran, Iran. European Journal of Clinical Nutrition, 2 March 2005. Dropped Head Syndrome Due to Carnitine Deficiency Due to Valproic Acid: Dropped head syndrome is characterized by a gradual forward sagging of the head due to the isolated weakness of the neck extensor muscles. The syndrome has a relatively benign clinical course. Nine adults with intractable epilepsy, each presenting with apparent dropped head, with symptoms from 3 to 15 years, with a slowly progressing weakness in most of the patients. The weakness in all of the subjects was strictly limited to the cervical paraspinal muscles. Laboratory studies produced normal results from all subjects. EMG and muscle biopsy were normal or revealed subtle nonspecific myopathic changes without inflammation in the cervical paraspinal muscles. Polymyographic investigation revealed that none of the patients had convincing dystonic spasms of the anterior neck muscles. No atrophy or fatty changes of the neck extensor muscles were observed on CT or MRI. In most of the patients (7/9), altered l-carnitine concentrations were observed (four patients displayed a marked decrease in plasma carnitine concentrations, and three other patients showed abnormalities in urinary excretion of carnitine). This suggests that a secondary carnitine deficiency, induced by antiepileptic drugs (principally valproic acid), represents a plausible pathogenetic mechanism for the development of dropped head in some epileptic patients. Dropped head syndrome in severe intractable epilepsies with mental retardation. Brazdil M, Fojtikova D, et al. St. Anne's University Hospital, Brno, Czech Republic. Seizure. 2005 Jun;14(4):282-7. Encephalopathy due to Carnitine Deficiency in Gluten Enteropathy: A 48-year-old male had two episodes of fever, headache, confusion and seizures following an upper respiratory tract infection. Electroencephalography (EEG) revealed diffuse slowing. Plasma free carnitine and serum lipid levels were low; fecal fat content and serum antigliadin antibodies were elevated. Duodenal biopsy was compatible with gluten enteropathy. Symptoms improved after the patient was started on a gluten-free diet and carnitine replacement therapy. Karakoc E, et al. Ankara, Turkey. Clin Neuro Neurosurg 2005 Nov 30. Exercise: Carnitine Increases Power Output: In a DB PC crossover study of 10 trained young men, 2 g of L-carnitine 1 hour before exercise significantly increased both maximal oxygen uptake, and power output. At similar exercise intensities in the L-carnitine trial oxygen uptake, carbon dioxide production, pulmonary ventilation and plasma lactate were reduced. Influence of L-carnitine administration on maximal physical exercise. Vecchiet L, Di Lisa F, et al. Universita di Chieti, Italy. Eur J Appl Physiol Occup Physiol. 1990;61(5-6):486-90 Exercise: No Benefit Endurance: In a 4- week each DB PC crossover study of 15 trained males, 3 g L-Carnitine had no effect on substrate utilization or endurance performance. Effects of four weeks L-carnitine L-tartrate ingestion on substrate utilization during prolonged exercise. Broad EM, et al. University of Stirling, Scotland, UK. Int J Sports Nutr Exer Metab 2005 Dec;15(6):665-79. Fatigue from Hepatitis C Treatment: Carnitine Helped: Hepatitis C virus (HCV) leads to chronic hepatitis in 80% of cases. Treatment is based on interferon (IFN)-alpha, effective in less than 50%; many responders relapse after interferon withdrawal. IFN-induced fatigue is common. In a 50-patient DB PC study, all received leucocytic IFN-alpha 3 million IU three times a week; half received carnitine 2 g/day. Fatigue was less for carnitine at both 1 and 3 months (p<.01) and also much less severe (p<.0005). L-carnitine decreases severity and type of fatigue induced by interferon-alpha in the treatment of patients with hepatitis C. Neri S, Pistone G, Saraceno B, Pennisi G, Luca S, Malaguarnera M., University of Catania, Catania, Italy. Neuropsychobiology. 2003;47(2):94-7 Fatigue and Depression: Carnitine Used for Cancer Patients: A one week open trial, as a preliminary to a DB PC study now underway found 83% of cancer patients with fatigue had low carnitine levels. The 13 taking the supplement reported less fatigue, depression, and sleep disruption. l-Carnitine Supplementation for the Treatment of Fatigue and Depressed Mood in Cancer Patients with Carnitine Deficiency: A Preliminary Analysis. Cruciani RA, Dvorkin E, et al. Beth Israel Medical Center, New York, NY. Ann N Y Acad Sci. 2004 Nov;1033:168-76. Ed: Fortunately, the authors made no claims of effectiveness or "response rates" and are doing a DB trial. However, I have noted some individuals with depression appear to have fatigue as their biggest symptoms. I have had apparent success with a couple patients with carnitine. Research on this issue would be a good idea. Friedreich’s Ataxia: L-Carnitine May Help: Impaired oxidative phosphorylation is a crucial factor in causing Friedreich's ataxia (FA). L-carnitine and creatine enhance cellular energy transduction. In a PC triple-phase crossover trial of L-carnitine (3 g/d) and creatine (6.75 g/d) in 16 patients with genetically confirmed FA, after 4 months on L-carnitine phosphocreatine recovery was improved compared to baseline (p < 0.03) but comparison to placebo and creatine effects did not quite reach significance (p = 0.06). Ataxia rating scale and echocardiographic parameters remained unchanged. Creatine had no effect. L-carnitine is a promising substance for the treatment of FA patients, and larger trials are warranted. L-carnitine and creatine in Friedreich's ataxia. A randomized, placebo-controlled crossover trial. Schols L, Zange J, et al. University of Tubingen, Germany. J Neural Transm. 2004 Oct 12 Genetic Diseases: Carnitine Used From Many Genetic Diseases in Infants: Carnitine deficiency is a secondary complication of many inborn errors of metabolism. Pharmacological treatment with carnitine not only corrects the deficiency, it facilitates removal of accumulating toxic acyl intermediates and the generation of mitochondrial free coenzyme A (CoA). The FDA approved carnitine for the treatment of inborn errors of metabolism in 1992. Complications of carnitine treatment are few, with gastrointestinal disturbances and odor being the most frequent. No laboratory or clinical safety issues were identified. Carnitine treatment of inborn errors of metabolism is a safe and integral part of the treatment regime for these disorders. Treatment of carnitine deficiency. Winter SC. UCSF. J Inherit Metab Dis. 2003;26(2-3):171-80. Heart Attacks: L-Carnitine Helped in 2 Studies: In a 28-day DB PC 101-patient study after myocardial infarction, those given l-carnitine 2 g/day had decreased angina (17% vs. 36%), arrhythmias (14% vs. 28%), and L-ventricular enlargement (23% vs. 36%). Deaths due to heart disease or heart attacks were 15% with l-carnitine vs. 26% placebo. Singh, India, Postgrad Med J ’96;72:45; In a 12-month DB PC study of 472 heart attack victims, L-carnitine slowed ventricular dilation but had no significant difference in heart failure or death. S Iliceto et al. Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-Carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) Trial. J Am Coll Cardiol. 1995;26:380. Heart Attacks: L-Carnitine Helps After Acute MI: Early and long-term administration of L-carnitine attenuates progressive left ventricular dilatation after acute anterior MI. Results show significant, consistent reductions in end-diastolic volume and end-systolic volume in patients who received L-carnitine compared with placebo. DB multi-center Italian study. Am Heart J 2000 Feb;139(2 Pt 3):S124-30 Heart Failure: L-Carnitine Helped: In a 3-year Greek DB study of 80 adults with 3 years of L-carnitine administration for heart failure caused by dilated cardiomyopathy with moderate to severe heart failure (New York Heart Association classification III to IV), there was a lower death rate with one carnitine death vs. six with placebo. Am Heart J 2000 Feb;139(2 Pt 3):S120-3 Heart: Hemosiderosis Heart Function Helped: Heart disease from chronic anemia and hemosiderosis is the major cause of illness and death in thalassemic patients. Chronic anemia and the tissue hypoxia it induces impair free fatty acid oxidation and ATP production in myocardial cells. In an open study of L-carnitine 30 mg/kg/day on cardiac function in 30 thalassemia major patients, multigated equilibrium radionuclide angiography showed a significant improvement of diastolic heart function (p < 0.02). Systolic heart function showed a significant increase in the left ventricular ejection fraction from 58 to 64 (p = 0.0001). Improvement of cardiac function in thalassemia major treated with L-carnitine. El-Beshlawy A, Ragab L, et al. New Cairo University Children Hospital, Egypt. Acta Haematol. 2004;111(3):143-8 Heart: Scorpion Sting Myocardial Toxicity Treated with Carnitine: In an uncontrolled report of treating 24 vicitms with 2 g/day, authors thought carnitine helpful. None died. Natl Med J India. 2004 Nov-Dec;17(6):307-9. Heart: L-Carnitine Added to Statin Lowered Lp(a) Levels: Lipoprotein(a) [Lp(a)] is generally related to coronary artery disease and cerebrovascular disease. In an open, randomised, parallel-group study of 52 patients with type 2 diabetes with a triglyceride serum levels <400 mg/dL, and Lp(a) levels >20 mg/dL, simvastatin (20 mg/d) alone was inferior to simvastatin plus l-carnitine (2 g/day) for 60 days. There were no differences in the reduction of LDL cholesterol, non-HDL cholesterol, and apoB serum levels. Lp(a) serum levels increased from baseline to 60 days in the simvastatin group alone versus a significant decrease in the combination group. Efficacy and tolerability of combined treatment with l-carnitine and simvastatin in lowering lipoprotein(a) serum levels in patients with type 2 diabetes mellitus. Solfrizzi V, et al. University of Bari, Italy. Atherosclerosis 2005 Dec 26. HIV: Very Popular: No controlled studies have been done, but a Nov. '05 report is that these supplements are very popular among victims with some uncontrolled evidence of benefit. Hyperlidipemia: No Benefit on the Lipid Profiles of Hyperlipidemic Children: Acta Pediatrica 2005 Jun;94(6):711-6. Hypertension: Carnitine Reportedly of Benefit: In a DB PC study of patients with essential hypertension and diabetes mellitus type II, L-carnitine at 2 g twice daily for 45 weeks resulted in extrasystoles, some disorders of A-V conduction and some electrocardiographic signs of ischemia being stopped or diminished and symptoms, chiefly asthenia, significantly improved. No side effects were observed. The benefits of L-carnitine therapy in essential arterial hypertension with diabetes mellitus type II. Digiesi V, Palchetti R, Cantini F., Universita di Firenze. Minerva Med. 1989 Mar;80(3):227-31. The information available to me of this study is sketchy. Intermittent Claudication: L-Carnitine Helps: In a DB PC crossover study of 20 patients receiving 2 g/d found distance walked increased from 170 feet to 300 feet. Brevetti, Circ 4/88 Kidney: L-Carnitine No Help to Chronic Dialysis Patients: Clin Nephrol 2000 Dec;54(6):470-7; Other studies have found some benefits. Kidney: L-Carnitine Improved Vitality in Dialysis: In a 6-month DB PC of 101 dialysis patients, 1 g L-carnitine before and after every hemodialysis treatment had an early positive effect on general health (P < 0.02) and physical function (P < 0.03), but the perceived effect was not sustained throughout the 6 months of the study. In the 3-month group, L-carnitine supplementation improved vitality (P < 0.02) and general health (P < 0.01). Quality of life during and between hemodialysis treatments: role of L-carnitine supplementation. Sloan RS, Kastan B, et al., University of Louisville. Am J Kidney Dis. 1998 Aug;32(2):265-72. l-carnitine stimulates erythropoiesis in mouse bone marrow cells, partially accounting for its mitigating effect on renal anaemia. Nephrol Dial Transplant. 2005 May;20(5):981-4 Kidney: L-Carnitine Helped in Dialysis: In a DB PC study of 103 hemodialysis patients, those given intravenous injections of L-carnitine 20 mg/kg three times a week at the end of each hemodialysis treatment for 6 months had a statistically significant decrease in serum C-reactive protein and increase in serum albumin and transferrin, blood hemoglobin, and body mass index. Placebo-treated had decreases in serum albumin, serum transferrin, and body mass index. L-carnitine therapy may suppress inflammation, particularly among those patients with C-reactive protein > or =3 mg/dL, and may improve protein-energy nutritional status. L-carnitine infusions may suppress serum C-reactive protein and improve nutritional status in maintenance hemodialysis patients. Savica V, Santoro D, et al. University of Messina, Italy. J Ren Nutr. 2005 Apr;15(2):225-30. Kidney: Carnitine Reduces Hospitalization for Dialysis Patients: The Fresenius Medical Care North America dialysis database was used for this retrospective analysis. Adults carnitine for at least 3 months, and had at least 3 months of pre-carnitine follow-up were included in the study. Carnitine therapy at a mean dose of 1.5 g/d for an average of 9.7 months was associated with a significant reduction in hospital utilization. Patients with hospitalizations for angina, myocardial infarction, arrhythmia, congestive heart failure, cerebral vascular disease or peripheral vascular disease prior to receiving carnitine, and those with anemia and hypoalbuminemia derived the greatest benefit from carnitine therapy. In a multivariate analysis, compared to 3 months prior to the initiation of carnitine, the adjusted relative risk for hospitalization was 11, 11, and 15% lower at 3, 6, and 9 months, respectively. Among patients with cardiovascular disease, the reduction in risk was even more significant (24, 31, and 34% lower). Carnitine Therapy Is Associated with Decreased Hospital Utilization among Hemodialysis Patients. Kazmi WH, Obrador GT, et al. Tufts-New England Medical Center, Boston. Am J Nephrol. 2005 Mar 22;25(2):106-115 Kidney: Dialysis Patients Helped in DB: In a 24-week DB PC study of 50 hemodialysis patients, 2 g/day IV carnitine improved Medical Outcomes Short Form-36 scores and erythropoietin doses were reduced. Carnitine Treatment Improved Quality-of-Life Measure in a Sample of Midwestern Hemodialysis Patients. Steiber AL, et al. Case Western Reserve University, Cleveland, Ohio. J Parental Enteral Nutr 2006 Jan-Feb;30(1):10-5. Liver: Cirrhotic Encephalopathy Helped by Carnitine: Hepatic encephalopathy (HE) is one of the major complications of cirrhosis. In a 60-day DB PC study of 120 patients, L-carnitine (2 g twice a day) significantly reduced ammonia levels and had a protective effect against ammonia-precipitated encephalopathy in cirrhotic patients. Improvement occurred with first month and was marked by the end. L-Carnitine in the treatment of mild or moderate hepatic encephalopathy. Malaguarnera M, Pistone G, et al. Catania, Italia. Dig Dis. 2003;21(3):271-5. Liver: Hepatic Encephalopathy Helped: In a 90 Day DB PC study of 150 patients with hepatic encephalopathy (10 patients with alcoholism, 41 patients with hepatitis virus B infection, 78 patients with hepatitis C virus infection, 21 patients with cryptogenetic cirrhosis), L-carnitine (2 g twice a day) caused a great decrease in NH4 fasting serum levels (P<0.05). Differences were also found between symbol digit modalities test and block design (P<0.05). There is an important protective effect of L-carnitine against ammonia-precipitated encephalopathy in cirrhotic patients. Effects of L-carnitine in patients with hepatic encephalopathy. Malaguarnera M, et al. Catania, Italy. . World J Gastroenterol 2005 Dec 7;11(45):7197-202. Liver Damage of Depakote May Have Been Helped: Valproate hepatotoxicity is rare but often fatal, and long-term valproate therapy may induce a carnitine deficiency and cause non-specific symptoms of hepatotoxicity and hyperammonemia. A case of valproate-induced acute liver injury doing well after L-carnitine therapy is reported. A case of valproate-associated hepatotoxicity treated with L-carnitine. Romero-Falcon A, de la Santa-Belda E, et al. Sevilla, Spain. 2004 Liver: Carnitine Used for Valproic Acid Overdoses: Three years of poison center charts from more than 300,000 patients were reviewed; 674 patients ingested valproic acid. l -Carnitine was routinely recommended if the ammonia level was elevated. Fifty-five doses of carnitine were administered to 19 patients who had isolated VPA ingestions and 196 doses of carnitine were administered to patients with mixed overdoses that included VPA, all with an elevated ammonia level. No patient had a documented allergic reaction or side effects. l-carnitine was safely administered in the setting of valproate toxicity. Lovecchio F, Shriki J, Samaddar R. Am J Emerg Med. 2005 May;23(3):321-2. Muscle: Fatigue and Pain Helped by L-Carnitine: Two adults with muscular fatigability and soreness during prolonged physical exercise had serum creatine kinase increased. Muscle biopsy revealed a lipid storage myopathy affecting predominantly the type I fibers. Skeletal muscle carnitine content was reduced to 15% and 21% of the normal mean values, while serum carnitine levels were either normal or decreased. Four months of oral therapy with L-carnitine (3 g per day) resolved the clinical symptoms completely with a marked reduction of lipid storage, along with increased muscle carnitine levels. There were mild defects of the carnitine transporter in one patient and of carnitine biosynthesis in the other. Primary carnitine deficiency: adult onset lipid storage myopathy with a mild clinical course. Vielhaber S, Feistner H, et al. University Magdeburg, Germany. J Clin Neurosci. 2004 Nov;11(8):919-24. Muscle: Pain Helped by L-Carnitine: A single-blind study 0f 6 untrained adults given 3 g/day of placebo for 3 weeks and, after a week's interval, 3 g/day of L-carnitine for 3 weeks found L-carnitine significantly reduced pain, tenderness and CK release after the effort with respect to placebo. Giamberardino MA, Dragani L, Valente R, et al. University of Chieti, Italy. Effects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effort. Int J Sports Med 1996;17:320-4. Newborn Hypoxia: Carnitine Deficiency Common: Total and free carnitine levels were measured in 20 normal term neonates and 20 term neonates who were diagnosed as hypoxia-ischemia. Results: Both total carnitine levels (43.7 vs. 27.8 microg/dl, p<0.0001) and free carnitine levels (28.0 vs. 13.2 microg/dl, p<0.0001) were lower in 20 hypoxic-ischemic term newborns vs. 20 normal infants. Acyl/total carnitine ratio was higher in the asphyxic group (0.33 vs. 0.56, p<0.0001). Neonates with hypoxia-ischemia suffer carnitine deficiency. Carnitine Levels in Neonatal Hypoxia. Cam H, Yildirim B, et al. Istanbul University, Turkey. J Trop Pediatr. 2005 Jan 26 Obesity: L-Carnitine Didn't Help; Nausea-Diarrhea Side-Effects at 4 g/d: In an 8 week DB PC study of 36 moderately overweight premenopausal women, L-carnitine 4 g/d did not help weight loss or reduce fat mass when combined with an exercise program. Five of the L-C group experienced nausea or diarrhea and did not complete the study. L-Carnitine supplementation combined with aerobic training does not promote weight loss in moderately obese women. Villani RG, Gannon J, et al. Royal Melbourne Institute of Technology, Australia. Int J Sport Nutr Exerc Metab. 2000 Jun;10(2):199-207. Premature Birth: L-Carnitine No Value: In a DB PC study of 86 premature infants, there was no impact on growth or hypoglycemia. Shortland, Cardiff, Arch Dis Child Fetal Neonatal Ed ’98;78:185 Sickle Cell Disease Appears to be Helped: L-carnitine was given to randomly selected 37 Sickle Cell Disease (SCD) children for 6 months. Weight, height, serum ferritin levels, units of blood transfused and the number of veno-occlusive crises all showed significant improvement. Cardiac diastolic function and pulmonary hypertention showed some improvement after L-carnitine administration. Diastolic dysfunction and pulmonary hypertension in sickle cell anemia: is there a role for L-carnitine treatment? El-Beshlawy A, et al. Cairo University, Egypt. Acta Haematol 2006;115(1-2):91-6. Double-blind research is needed. Sperm: Carnitine Helped: In an academic reproductive care center, 170 patients including 48 smokers and 122 non-smokers participated in a before-after study of 1 g of L: -carnitine orally 3 x daily for 3 months. L-Carnitine improved the percentage of motile sperms, grade A sperms, and normal-shaped sperms. It improved the motile and grade A sperms in non-smokers. Only the change in the median percentile of normal forms was within the significant range in smokers. The effects of L-carnitine on sperm parameters in smoker and non-smoker patients with idiopathic sperm abnormalities. Khademi A, et al. Tehran University, Iran. Eur Neuropharm 2005 Nov 25; Similar in Chinese study of 90 men. Zhonghua Nan Ke Xue 2005 Oct;11(10):761-4. Sperm: Carnitine Helped Motility: In a 6-month study of 170 infertile men with below normal sperm motility (<50% motility), those of L-carnitine 1 g/d plus 500 mg/d acetyl-L-carnitine twice daily had a significant increase in total motility, live sperm count, membrane integrity and linearity of spermatic movement after 3 and 6 months and in capacity for cervical mucus penetration after 6 months of treatment, compared with baseline. Correlation between seminal carnitine and functional spermatozoal characteristics in men with semen dysfunction of various origins. DeRosa M, et al. University of Naples. Drugs R D. 2005;6(1):1-9 Sperm and Pregnancy: Carnitines Plus Cinnoxicam Improved Sperm and Pregnancy Rates: In a 6 month DB PC study of men with idiopathic and varicocele-associated oligoasthenospermia, L-carnitine (2 g/d) + acetyl-L-carnitine (1 g/d) improved pregnancy rates from 2% to 22% with those receiving the carnitines plus a 30-mg cinnoxicam suppository every 4 days had a 38% pregnancy rate. Sperm patterns improved in all except for those with the worst (grade V) varicoceles. All sperm patterns fell to baseline after therapy suspension. Cinnoxicam and L-carnitine/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia. Cavallini G, Ferraretti AP, et al. Bologna, Italy. J Androl. 2004 Sep-Oct;25(5):761-70 Sperm Motility Helped by Carnitine in Half of Men: In a study of 30 asthenozoospermic men given placebo for 3 months, L-cartinine 2 g/day for 3 months and against placebo for 3 months, only the half with normal phospholipid hydroperoxide glutathione peroxidase (PHGPx) levels showed an improvement of mean sperm motility. Oral carnitine supplementation increases sperm motility in asthenozoospermic men with normal sperm phospholipid hydroperoxide glutathione peroxidase levels. Garolla A, Maiorino M, et al. University of Padova, Italy. Fertil Steril. 2005 Feb;83(2):355-61 Sperm Motility Helped by Carnitines: In a 6-month DB PC study of 60 infertile men ages 20-40, l-carnitine (2 g/d) and l-acetyl-carnitine (1 g/d) increased all sperm parameters, especially sperm motility in groups with lower baseline levels. A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia. Lenzi A, Sgro P, et al. Rome, Italy. Fertil Steril. 2004 Jun;81(6):1578-84 Sperm: L-Carnitine Helped: Thirty-two patients ages 25-39 with asthenospermia with epididymal knob were given oral L-carnitine 2 g/d for 3 months. Only 4 remained unimproved in sperm parameters, while the other 28 were significantly improved in sperm concentration, forward sperm motility, total sperm motility, straight line velocity, curvilinear velocity and average path velocity. Four of the patients wives were pregnant and one patient fathered a child. Oral L-carnitine therapy is efficacious for asthenospermia with epididymal knob. Initial observation on L-carnitine for asthenospermia with epididymal knob. Shang X, Huang Y, et al. Nanjing, China.
Thomas E. Radecki, M.D., J.D.
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