Accurate Education – Acetyl-L-Carnitine

Acetyl-L-Carnitine

 

See also:

 

CAM Alternatives for Pain:

   NRF2 Activators

   Alpha-Lipoic Acid

   Curcumin (Meriva)

   Green Tea

   Palmitoylethanolamide (PEA)

   PolyResveratrol

   Quercetin

   Synaptamine

 

 

Terms:

Neuropathic Pain (“Nerve Pain”)

“Neuropathic” or nerve pain is pain initiated or caused by a primary lesion or dysfunction in a nerve or in the nervous system or pain arising as a direct consequence of a lesion or disease affecting the nervous system. Nerve pain is usually perceived as burning, electric, shock-like, tingling or sharp and may start at one location and shoot, or “radiate” to another location (like sciatica).

 

Neuropathic pain can be “peripheral,”  (outside the central nervous system),”  like carpal tunnel pain or “central,” originating in the spinal cord or brain.  Neuropathic pain is often a disease process, not simply the symptom of one.

 

For more information:  Assessment and management of Neuropathic Pain

3d rendered close up of human cells and free radicales

Acetyl-L-Carnitine (ALC)

Acetyl-L-carnitine (ALC) is synthesized from L-carnitine that is manufactured in the brain, liver, and kidney from carnitine, found in the diet. Red meat (particularly lamb) and dairy products are the main food sources of carnitine. It can also be found in fish, poultry, tempeh, wheat, asparagus, avocados, and peanut butter.

 

ALC supports fat metabolism and energy production in the mitochondria, the energy factory of the cell. Usually, your body can make all the carnitine it needs. Some people, however, may not have enough carnitine because their bodies cannot make enough or can’t transport it into tissues so it can be used. Some other conditions, such as heart or peripheral vascular disease, can also cause low levels of carnitine in the body, as can some medications.

 

Research over the last decade has shown that ALC may also have effective pharmacological benefits, particularly with neuropathic pain and possibly brain function by enhancing production of the neurotransmitter acetylcholine.

 

Potential Benefits from Supplementing with Acetyl-L-carnitine (ALC):

 

Neuropathic Pain (see also Neuropathic Pain)

 

Diabetic Peripheral Neuropathy (DPN)

Symptoms of DPN may involve the sensory and motor systems. Numbness, tingling, pain, vibratory hypoesthesia to the low extremities, and muscle weakness are some of the clinical symptoms of DPN.

 

The potential effectiveness of LAC for diabetic neuropathy has been evaluated in multiple, large research trials. In one study, after 1 year of treatment with LAC, improvements were observed in both pain and nerve function as identified by nerve conduction studies. Another study with L-acetylcarnitine (500 and 1000 mg/day, 3x/day.) showed improvement in paresthesia and hyperesthesia that was associated with significant increased regenerating nerve fibers.

 

Patients who showed the greatest response to L-acetylcarnitine were those with type 2 diabetes of short duration. L-Acetylcarnitine was well tolerated and there was no difference in the incidence of adverse effects.

 

ALC and Brain (Cognitive) Function

Several studies have demonstrated ALC’s effectiveness in supporting cognitive function in the elderly, especially when supplementation is started early when symptoms start.  In addition, co-administration of ALC with other mitochondrial nutrients, such as alpha-lipoic acid and coenzyme Q10, appears more effective in improving cognitive dysfunction and reducing oxidative mitochondrial dysfunction.

 

ALC and Depression

A review of current evidence for acetyl-L-carnitine in the treatment of depression concluded that “ALC may be a potentially effective and tolerable treatment option with novel action mechanisms for patients with depression, in particular older population and patients with comorbid medical conditions who are vulnerable to adverse events from antidepressants.”  However, more clinical trial data will be needed to conclude whether ALC as a monotherapy or secondary  agent may be effective and clinically beneficial for depression.

 

 

 

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Acetyl-L-Carnitine (ALC) Forms:

Carnitine is available as a supplement in a variety of forms:

 

  1. L-carnitine: the most widely available and least expensive
  2. Acetyl-L-carnitine: better absorbed and crosses the blood-brain barrier better than L-carnitine.
  3. Propionyl-L-carnitine: Often used in studies for heart disease and peripheral vascular disease

 

Avoid D-carnitine supplements. They interfere with the natural form of L-carnitine and may produce unwanted side effects.

  

Dosing of Acetyl-L-carnitine (ALC)

While there are no established guidelines for dosing with ALC, research findings suggest that LAC may be safely administered at doses up to 3000 mg/day and that benefits may be more likely at relatively higher doses in this range. Frequent recommended dosages of Acetyl-L- Carnitine range from 500-1500 mgs daily. It is given two to three divided oral doses.

 

 

Side effects ALC

Side effects for using LAC as a supplement are generally mild. High doses (5 or more grams per day) may cause diarrhea. Other rare side effects include increased appetite, body odor, and rash.

 

Synergistic Benefits of Combining with other Supplements

There is theoretical and research evidence that the combining of ALA with other supplements may provide a synergistic benefit, where the benefits of a combination would be greater than the individual supplements on their own.

 

Alpha Lipoic Acid (ALA), another antioxidant, has been studied in combination with ALC and this combination appears effective in treating neuropathic pain. (see ALA). Co-administration of ALC with other mitochondrial nutrients, such as alpha-lipoic acid and coenzyme Q10, appears more effective in improving cognitive dysfunction and reducing oxidative mitochondrial dysfunction.

 

Possible Drug Interactions with ALC

Thyroid hormone Carnitine may stop thyroid hormone from getting into cells, and theoretically may make thyroid hormone replacement less effective. If you take thyroid replacement hormone, talk to your health care provider before taking carnitine.

 

Valproic acid (Depakote) – The anti-seizure medication valproic acid may lower blood levels of carnitine. Taking L-carnitine supplements may prevent any deficiency and may also reduce the side effects of valproic acid. However, taking carnitine may increase the risk of seizures in people with a history of seizures.

 

ALC in Pregnancy

ALC hasn’t been studied in pregnant or breastfeeding women, so safety is not established.

 

Neurobiology of ALC

Study have shown that alterations of fatty acids and lipid metabolism occur in depression. It is hypothesized that depression is due to an alteration in membrane molecular dynamics which results in altered function of membrane proteins, such as receptors. The antidepressant activity of ALC is thought maybe to be due to their effect on membrane phospholipid metabolism.

 

ALC and Fatigue

Abnormal mitochondria have been observed in muscle of patients with fibromylagia and in some elderly patients with fatigue, suggesting underlying abnormalities in muscle mitochondrial energy production.  ALC acts as a donor of acetyl groups and facilitates the transfer of fatty acids from the intracellular fluid to mitochondria during oxidation of fatty acids and is helpful for cellular energy supply. It stimulates protein and membrane phospholipid synthesis, and prevents excessive neuronal cell death. Also, it enhances acetylcholine production helps in increasing physical activity.

 

 ALC can be administered orally or intravenously, and is absorbed in the small intestine via simple diffusion. It is transported into intracellular tissues through active transporters, and plasma concentrations of ALC and L-carnitine reach an equilibrium via carnitine acetyl-transferase activity. ALC can also readily cross the blood brain barrier.

 

ALC and Depression

Although ALC’s exact mechanism of action in treatment of depression is still not known, studies have proposed diverse mechanism of actions of ALC in treatment of depression. Among many, most well studied potential mechanism include neuroplasticity effect, membrane modulation, and neurotransmitter regulation. Epigenetics, the modification of gene expression (turning genes on or off), which is one of important parts of neuroplasticity, is also known to play an important role in the pathophysiology of major depression. Recent work in animals suggests ALC may work in depression through altering gene expression in the brain, resulting in a more rapid treatment response than conventional antidepressants.

 

 

References:

ALCOverviews

  1. Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: a… – PubMed – NCBI
  2. Current Status of use of Acetyl-L-Carnitine in Neuropsychiatry – 2012
  3. A RANDOMISED CONTROLLED TRIAL COMPARING DULOXETINE AND ACETYL L-CARNITINE IN FIBROMYALGIC PATIENTS – PRELIMINARY DATA. – 2016

 

ALC – Diabetic Peripheral Neuropathy (DPN)

  1. Acetyl-L-Carnitine in the Treatment of Peripheral Neuropathic Pain – A Systematic Review and Meta-Analysis of Randomized Controlled Trials
  2. Thioctic acid and acetyl-L-carnitine in the treatment of sciatic pain caused by a herniated disc: a randomized, double-blind, comparative study. – PubMed – NCBI
  3. L-Acetylcarnitine – A Proposed Therapeutic Agent for Painful Peripheral Neuropathies – 2006
  4. Acetyl-l-carnitine in the treatment of painful antiretroviral toxic neuropathy in human immunodeficiency virus patients: an open label study. – PubMed – NCBI
  5. L-acetylcarnitine as a new therapeutic approach for peripheral neuropathies with pain. – PubMed – NCBI
  6. Acetyl-L-Carnitine in the Treatment of Peripheral Neuropathic Pain – A Systematic Review and Meta-Analysis of Randomized Controlled Trials – 2015

 

ALC – Cognitive Dysfunciton

  1. The effects and mechanisms of mitochondrial nutrient alpha-lipoic acid on improving age-associated mitochondrial and cognitive dysfunction – 2008
  2. Current Status of use of Acetyl-L-Carnitine in Neuropsychiatry – 2012
  3. 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 – 2002

 

ALC – Depression

  1. Current Status of use of Acetyl-L-Carnitine in Neuropsychiatry – 2012
  2. A Placebo-Controlled Trial of Acetyl-L-Carnitine and α-Lipoic Acid in the Treatment of Bipolar Depression – 2013
  3. A review of current evidence for acetyl-L-carnitine in the treatment of depression – 2014
  4. L-acetylcarnitine causes rapid antidepressant effects through the epigenetic induction of mGlu2 receptors – 2012

 

ALC – Migraine Headache

  1. Acetyl-l-carnitine versus placebo for migraine prophylaxis: A randomized, triple-blind, crossover study. – PubMed – NCBI

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

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Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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