Carnitine is a substance used by the body uses to turn fat into energy. It is not normally considered an essential nutrient because the body can manufacture all it needs. However, supplemental carnitine could in theory improve the ability of certain tissues to produce energy. This has led to the use of carnitine for various muscle diseases as well as heart conditions.
There is no dietary requirement for carnitine. However, a few individuals have a genetic defect that hinders the body’s ability to make carnitine. In addition, diseases of the liver, kidneys, or brain may inhibit carnitine production. Certain medications, especially the antiseizure drugs valproic acid (Depakene) and phenytoin (Dilantin), may reduce carnitine levels; however, whether taking extra carnitine would be helpful has not been determined.1-11 Heart muscle tissue, because of its high energy requirements, is particularly vulnerable to carnitine deficiency.
The principal dietary sources of carnitine are meat and dairy products, but to obtain therapeutic dosages a supplement is necessary.
Typical adult dosages for the diseases described here range from 500 mg to 1,000 mg three times daily. For children, one study used 50 mg/kg twice daily, up to a maximum of 4 g daily.73
Carnitine is taken in three forms: L-carnitine (for heart and other conditions), propionyl-L-carnitine (for heart conditions), and acetyl-L-carnitine (for Alzheimer’s disease). The dosage is the same for all three forms.
Carnitine is primarily used for heart-related conditions. Some evidence suggests that it can be used along with conventional treatment for angina to improve symptoms and reduce medication needs.12-17 When combined with conventional therapy, it may or may not help prevent medical complications or sudden cardiac death in the months following a heart attack.18,19,34,36, 88
Lesser evidence suggests that it may be helpful for a condition called intermittent claudication (pain in the legs after walking due to narrowing of the arteries),20-30 as well as congestive heart failure.12,31-33 In addition, a few studies suggest that carnitine may be useful for cardiomyopathy.27,35
Carnitine may also be helpful for improving exercise tolerance in people with chronic pulmonary obstruction disease (COPD), more commonly known as emphysema.37,38,39
Warning: You should not attempt to self-treat any of these serious medical conditions, nor should you use carnitine as a substitute for standard drugs.
Growing, if not entirely consistent, evidence suggests that L-carnitine or acetyl-L-carnitine, or their combination, may be helpful for improving sperm function and thereby provide benefits in male infertility.58-66,71, 80,86, 90-92,103
Carnitine has also shown promise for improving male sexual function81,82,93 and improving mental and physical fatigue in seniors.81,87,108
Two studies found evidence that carnitine is helpful for Peyronie’s disease, a condition affecting the penis.54,74
Some studies have found evidence that one particular form of carnitine, acetyl-L-carnitine, might be helpful in Alzheimer’s disease,40-46 but the two most recent and largest studies found no benefit.47,48 One review evaluated published and unpublished double-blind, placebo-controlled trials, and concluded that acetyl-L-carnitine may only be helpful for very mild Alzheimer’s disease.70
In preliminary trials, acetyl-L-carnitine has shown some promise for treatment of depression or dysthymia (a milder condition related to depression).49,50, 94
Some evidence suggests that carnitine may be useful for improving blood sugar control in people with type 2 (adult-onset) diabetes.52,85 Better evidence suggests benefit with acetyl-L-carnitine for a major complication of diabetes, diabetic peripheral neuropathy (injury to nerves of the extremities caused by diabetes).83 Acetyl-L-carnitine might help prevent diabetic cardiac autonomic neuropathy (injury to the nerves of the heart caused by diabetes).53 However, one study found that carnitine supplements had an adverse effect on triglyceride levels in people with diabetes.85
Much weaker evidence suggests possible benefits for neuropathy caused by the chemotherapy drugs cisplatin and paclitaxel.95 Weak evidence hints that carnitine might help reduce liver and heart toxicity caused by the chemotherapy drug adriamycin.104
Some evidence suggests that carnitine may be able to improve cholesterol profile.18,84
One small study demonstrated a beneficial effect of L-carnitine on anemia and high cholesterol in patients on hemodialysis for chronic renal failure.109
A genetic condition called fragile X syndrome can cause behavioral disturbances such as hyperactivity, along with intellectual disability, autism, and alterations in appearance. A preliminary study of 17 boys found that acetyl-L-carnitine might help to reduce hyperactive behavior associated with this condition.51 Evidence for the effectiveness of L-carnitine in attention deficit and hyperactivity disorder (ADHD) has been mixed.73,111
Celiac disease is an autoimmune disease affecting the digestive tract. Fatigue is a common symptom of the disease. One small double-blind trial found evidence that use of L-carnitine at a dose of 2 g daily might help alleviate this symptom.107 Weak evidence hints that carnitine may help people with degeneration of the cerebellum (the structure of the brain responsible for voluntary muscular movement).55 One very small study suggests carnitine may be helpful for reducing symptoms of chronic fatigue syndrome.56 Another study suggests that carnitine may be of value for treating hyperthyroidism57 and for severe liver disease.96 A substantial study marred by poor design (specifically, far too many primary endpoints) found equivocal evidence that L-carnitine, taken at dose of 500 mg three times daily, might be more effective than placebo for the treatment of fibromyalgia.106
Other weak evidence suggests that carnitine may be helpful for decreasing the muscle toxicity of AZT (a drug used to treat HIV infection).67,68 Other weak evidence hints that the acetyl-L-carnitine might reduce nerve-related side effects caused by HIV drugs in general.105
One study failed to find carnitine effective for promoting weight loss,88although another found that carnitine might lead to improvements in body composition (fat-muscle ratio).87
Carnitine is widely touted as a physical sports performance enhancer, but there is no real evidence that it is effective and some research indicates that it is not.69,97,110
Little to no evidence supports other claimed benefits such as treating irregular heartbeat, Down’s syndrome, muscular dystrophy, and alcoholic fatty liver disease. However, in a randomized trial involving 25 patients with liver cirrhosis and early brain dysfunction (hepatic encephalopathy) associated with severe forms of this condition, carnitine appeared to significantly improve the function of both the liver and the brain after 3 months of treatment.112
What Is the Scientific Evidence for Carnitine?
Carnitine might be a good addition to standard therapy for angina. In one controlled study, 200 individuals with angina (the exercise-induced variety) took either 2 g daily of L-carnitine or were left untreated. All the study participants continued to take their usual medication for angina. Those taking carnitine showed improvement in several measures of heart function, including a significantly greater ability to exercise without chest pain.12 They were also able to reduce the dosages of some of their heart medications (under medical supervision) as their symptoms decreased.
Unfortunately, the results of this study can’t be fully trusted because researchers didn’t use a double-blind protocol. Another trial did use a double-blind, placebo-controlled, design tested L-carnitine in 52 people with angina and found evidence of benefit.16
In addition, several small studies (some of them double-blind) tested propionyl-L-carnitine for the treatment of angina, and also found evidence of benefit.13-17
People with advanced hardening of the arteries, or atherosclerosis, often have difficulty walking due to lack of blood flow to the legs, a condition called intermittent claudication. Pain may develop after walking less than half a block. Although carnitine does not increase blood flow, it appears to improve the muscle’s ability to function under difficult circumstances.26 A 12-month, double-blind, placebo-controlled trial of 485 patients with intermittent claudication evaluated the potential benefits of propionyl-L-carnitine.29 Participants with relatively severe disease showed a 44% improvement in walking distance as compared to placebo. However, no improvement was seen in those with mild disease. Another double-blind study followed 245 people and also found benefit.20
Similar results have been seen in most but not all other studies of L-carnitine or propionyl-L-carnitine.21-28,30 Propionyl-L-carnitine may be more effective for intermittent claudication than plain carnitine.
Congestive Heart Failure
Several small studies have found that carnitine, often in the form of propionyl-L-carnitine, can improve symptoms of congestive heart failure.12,31-33 In one trial, benefits were maintained for 60 days after treatment with carnitine was stopped.79
After a Heart Attack
L-carnitine has shown inconsistent promise for use after a heart attack.
A double-blind, placebo-controlled study that followed 101 people for 1 month after a heart attack found that use of L-carnitine, in addition to standard care, reduced the size of the infarct (dead heart tissue).34
In the months following a severe heart attack, the left ventricle of the heart often enlarges, and the pumping action of the heart becomes less efficient. Some evidence suggests that L-carnitine can help prevent heart enlargement, but that it does not improve heart function. In a 12-month, double-blind, placebo-controlled study of 472 individuals who had just undergone a heart attack, use of carnitine at a dose of 6 g/day significantly decreased the rate of heart enlargement.19 However, heart function was not significantly altered.
A 3-month, double-blind, placebo-controlled study of 60 individuals who had just undergone a heart attack also failed to find improvements in heart function.36 (Heart enlargement was not studied.)
Results consistent with those of the studies above were seen in a 6-month double blind, placebo-controlled study of 2,330 people who had just had a heart attack.98 Carnitine failed to produce significant reductions in mortality or heart failure (serious decline in heart function) over the 6-month period. However, the study did find reductions in early death. (Unfortunately, for statistical reasons, the meaningfulness of this last finding is questionable. Reduction in early death was a secondary endpoint rather than a primary one.)
Note: Carnitine is used along with conventional treatment, not as a substitute for it.
High levels of blood sugar can damage the nerves leading to the extremities, causing pain and numbness. This condition is called diabetic peripheral neuropathy. Nerve damage may also develop in the heart, a condition called cardiac autonomic neuropathy. Acetyl-L-carnitine has shown considerable promise for diabetic peripheral neuropathy and some promise for cardiac autonomic neuropathy.
Two 52-week double-blind, placebo-controlled studies, involving a total of 1,257 people with diabetic peripheral neuropathy, evaluated the potential benefits of ALC taken at 500 mg or 1000 mg daily.83 The results showed that use of ALC, especially at the higher dose, improved sensory perception and decreased pain levels. In addition, the supplement appeared to promote nerve fiber regeneration.
A small study found some potential benefits for cardiac autonomic neuropathy.53
Male Sexual Function
Carnitine has shown promise for improving male sexual function. One double-blind, placebo-controlled study of 120 subjects compared a combination of propionyl-L-carnitine (2 g per day) and acetyl-L-carnitine (2 g per day) against testosterone for the treatment of male aging symptoms (sexual dysfunction, depression, and fatigue).81 The results indicated that both testosterone and carnitine improved erectile function, mood, and fatigue, as compared to placebo. However, no improvements were seen in the placebo group. This is an unusual occurrence in studies of erectile dysfunction, so it casts some doubt on the study results.
A double-blind study of 40 men evaluated propionyl-L-carnitine (2 g per day) in diabetic men with erectile dysfunction who had not responded well to Viagra.82 The results indicated that carnitine significantly enhanced the effectiveness of Viagra.
In another double-blind study, a combination of the propionyl and acetyl forms of carnitine enhanced the effectiveness of Viagra in men who suffered from erectile dysfunction caused by prostate surgery.99
Growing evidence suggests that L-carnitine or acetyl-L-carnitine or their combination may be helpful for improving sperm quality and function, thereby benefiting male infertility.58-66,71,80,100-101,103
For example, in one double-blind, placebo-controlled study of 60 men, use of combined L-carnitine (2 g per day) and acetyl-L-carnitine (also at 2 g per day) significantly improved sperm quality.80
Chronic Obstructive Pulmonary Disease (COPD)
Evidence from three double-blind, placebo-controlled studies enrolling a total of 49 people suggests that L-carnitine can improve exercise tolerance in COPD, presumably by improving muscular efficiency in the lungs and other muscles.37-39
Numerous double- or single-blind studies involving a total of more than 1,400 people have evaluated the potential benefits of acetyl-L-carnitine in the treatment of Alzheimer’s disease and other forms of dementia.40-48,76-78 However, while early studies found evidence of modest benefit, two large and well-designed studies failed to find acetyl-L-carnitine effective at all.
The first of these was a double-blind, placebo-controlled trial that enrolled 431 participants for 1 year.47 Overall, acetyl-L-carnitine proved no better than placebo. However, because a close look at the data indicated that the supplement might help people who develop Alzheimer’s disease at an unusually young age, researchers performed a follow-up trial. This 1-year, double-blind, placebo-controlled trial evaluated acetyl-L-carnitine in 229 patients with early onset Alzheimer’s.8 Unfortunately, no benefits were seen here either.
One review of the literature concluded that acetyl-L-carnitine may be helpful for mild cases of Alzheimer’s disease, but not more severe cases.72
A double-blind study of 60 seniors with dysthymia (a mild form of depression) found that treatment with 3 g of carnitine daily over a 2-month period significantly improved symptoms as compared to placebo.49 Positive results were seen in two other studies as well, one of depression and one of dysthymia.50, 102
Enlargement of the thyroid (goiter) can be due to many causes, including cancer and iodine deficiency. In some cases, thyroid enlargement occurs without any known cause, so-called benign goiter.
Treatment of benign goiter generally consists of taking thyroid hormone pills. This causes the thyroid gland to become less active, and the goiter shrinks. However, there may be undesirable effects as well. Symptoms of hyperthyroidism (too much thyroid hormone) can develop, including heart palpitations, nervousness, weight loss, and bone breakdown.
A double-blind, placebo-controlled trial found evidence that use of L-carnitine could alleviate many of these symptoms. This 6-month study evaluated the effects of L-carnitine in 50 women who were taking thyroid hormone for benign goiter.57 The results showed that a dose of 2 g or 4 g of carnitine daily protected participants’ bones and reduced other symptoms of hyperthyroidism.
Carnitine is thought to affect thyroid hormone by blocking its action in cells.75 This suggests a potential concern—carnitine might be harmful for people who have low or borderline thyroid levels to begin with. This possibility has not been well explored as yet.
Peyronie’s disease is an inflammatory condition of the penis that develops in stages. In the first stage, penile pain occurs with erection; next, the penis becomes curved; finally, erectile dysfunction may occur. Many medications have been tried for Peyronie’s disease, with some success. One such drug is tamoxifen, which is better known as a treatment to prevent breast cancer recurrence. A 3-month, double-blind study compared the effectiveness of acetyl-L-carnitine to the drug tamoxifen in 48 men with Peyronie’s disease.74 Acetyl-L-carnitine (at a dose of 1 g daily) reduced penile curvature while tamoxifen did not; in addition, the supplement reduced pain and slowed disease progression to a greater extent than tamoxifen.
L-carnitine in its three forms appears to be quite safe. However, individuals with low or borderline-low thyroid levels should avoid carnitine because it might impair the action of thyroid hormone.75
Individuals on dialysis should not receive this (or any other supplement) without a physician’s supervision.
The maximum safe dosages for young children, pregnant or nursing women, or those with severe liver or kidney disease have not been established.
Interactions You Should Know About
If you are taking:
- Antiseizure medications, particularly valproic acid (Depakote, Depakene) but also phenytoin (Dilantin): You may need extra carnitine.
- Thyroid medication: Do not take carnitine except under a physician’s supervision.
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