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Factsheet L-CARNITINE and L-ACETYLCARNITINE FactSHEET L-CARNITINE AND L-ACETYLCARNITINE What is carnitine? 2.helping to decrease levels of lactic acid in the blood L-carnitine is an amino acid found in red meat 3.reducing higher-than-normal levels of and acetyl-L-carnitine is another form of this cholesterol and/or triglycerides nutrient. Carnitine can be made in small quantities by the brain, liver and kidneys. 4.helping to maintain muscle growth Among other things, this amino acid plays a role in helping to release energy from fat by 1. To manage peripheral neuropathy (nerve moving fats to power plants within cells where damage causing tingling, numbness or fats can be burnt as fuel. These cellular power burning in the hands, feet and legs) plants are called mitochondria and are Levels of carnitine in the blood are sometimes responsible for making the energy a cell needs lower in PHAs with peripheral neuropathy, to survive and function. particularly under the following conditions: Carnitine appears to have antioxidant • damage from viral infections such as HIV properties and may also play a role in and CMV (cytomegalovirus) maintaining blood sugar levels. According to at least one study, people with HIV/AIDS • the use of “d” drugs such as d4T, ddI and (PHAs) can have normal levels of carnitine in ddC their serum (the fluid part of the blood) while • the use of some anti-cancer drugs and still having very low levels in the cells, where antibiotics carnitine is needed. • alcohol abuse In PHAs whose health has improved because • diabetes of highly active antiretroviral therapy (HAART), carnitine levels may not return to normal. What the medications in the above list have When taken orally as a supplement, only a in common is that they can damage the relatively small amount—between 5% and energy-producing parts of nerve cells—the 18%—of carnitine is absorbed. mitochondria. Injured mitochondria cannot supply sufficient energy and nerves begin to malfunction and can die. Nerves in the feet, Why do PHAs use this legs and hands, particularly in the skin supplement? covering those body parts, appear to be especially susceptible to PN. Some researchers Carnitine has many potential uses, including have noticed that PHAs with PN can develop the following: abnormal sweating, suggesting that nerves in 1.helping to heal damaged nerves—peripheral sweat glands can also be affected. neuropathy (PN) One formulation of carnitine, acetyl-L-carnitine CATIE FactSHEET Carnitine, page 1 of 6 (ALCAR), may play a role in the management of Overall, this study goes a long way toward PN. This compound helps mitochondria function helping researchers explore the role of and also appears to enhance the effect of a carnitine, particularly ALCAR, as part of the chemical that helps nerves grow—nerve growth management of PN. factor. Two randomized, placebo-controlled studies Researchers in England conducted an extensive using ALCAR 500 mg/day or 1,000 mg/day study of ALCAR in PHAs with peripheral have also found it to be beneficial in the neuropathy. Their findings revealed that most management of PN in HIV negative people PHAs showed some degree of recovery from with diabetes. nerve damage after taking ALCAR 1.5 grams twice daily for up to 2¾ years. 2. To help reduce lactic acid levels in the blood Seventy-six percent of participants had significantly reduced pain. Because this was not One of the complications that can occur in a controlled clinical trial comparing ALCAR to a users of a class of anti-HIV drugs called placebo or another substance, researchers nucleoside analogues, is the development of cannot be certain that the reduction in pain higher-than-normal levels of lactic acid. If was indeed caused by ALCAR. To clarify this levels become very high, the following signs/ issue, placebo-controlled studies of ALCAR are symptoms may occur as part of a condition taking place in the European Union and in called lactic acidosis: Vancouver, British Columbia. • unexpected tiredness In the British study, analyses of skin samples • abdominal pain taken during the clinical trial found that after six months of ALCAR use, nerve fibres were • swollen, fatty liver undergoing re-growth. The longer participants • shortness of breath took the supplement, the greater the re-growth. • nausea and/or vomiting Nerve fibres are slow-growing so it clearly takes many months, perhaps even years, for the The following blood tests help identify lactic damage from PN to heal. acidosis: There were no significant changes to CD4+ and • lactate levels of 5 mmol/L or greater CD8+ cells or viral load measures during the • bicarbonate levels of 20 mmol/L or lower study. Anecdotal reports suggest that L-carnitine may The research team speculates that ALCAR may play a role in helping PHAs to recover from have helped nerves for the following reasons: lactic acidosis. In a pilot study of six PHAs who were extremely ill and who had high levels • Carnitine has antioxidant properties, possibly of lactic acid in their blood from drug-related protecting nerve cells from the toxicity of side effects, researchers gave them intravenous nucleoside analogues. L-carnitine at doses between 50 mg and 100 • By improving the transport of fats and sugar, mg/kg of body weight per day. Despite this carnitine may have helped cells become more treatment, only three of the participants energetic and active, perhaps stimulating survived and recovered from lactic acidosis. their recovery. Other researchers have intervened at earlier • Carnitine could have helped nerve regrowth stages of lactic acidosis with oral supplements and repair by enhancing the effects of nerve of B vitamins and L-carnitine with successful growth factor. results. • PHAs with PN have been found to have decreased levels of ALCAR in their blood and the supplement could have reversed this. CATIE FactSHEET Carnitine, page 2 of 6 3. To reduce high levels of cholesterol and/or L-carnitine twice daily for three months. triglycerides in the blood However, this supplement did not prevent fat loss, though cholesterol but not triglyceride Having higher-than-normal levels of lipids— levels fell significantly. Researchers at the cholesterol and triglycerides— in the blood University of Modena in Italy are planning a increases the risk of cardiovascular disease. clinical trial of acetyl-l-carnitine at a dose of 3 In a small, controlled trial of HIV positive grams daily to assess any impact on the HIV people, carnitine caused triglyceride levels to lipodystrophy syndrome. They have decided drop significantly after two weeks at a dose of to do this because they have previously six grams daily. However, this study was done conducted lab experiments with cells, nukes in 1993, when AZT was the only antiretroviral and ALCAR. In doing those experiments, they drug being used. found that this supplement was able to partially In 2001, results of a pilot study in Montreal prevent some of the damage caused by d4T were released. L-carnitine at a dose of 3 grams and AZT (Giovanni Guaraldi MD, personal daily was used by 16 PHAs who were also communication). taking HAART. Triglyceride levels decreased For further information about lipodystrophy and significantly within the first month and by the ways to manage HIV drug-related side effects, end of the study had deceased by about 35%. please see CATIE’s Practical Guide to By the end of the study, 70% of participants Managing Drug Side Effects at http:// had their triglyceride levels return to the normal www.catie.ca/sideeffects_e.nsf. range. In the same year, a German study found that Availability L-carnitine at a dose of 1 gram twice daily for three months lowered cholesterol but not Carnitine is made by the Sigma-Tau company, triglyceride levels in 12 PHAs. in Italy, in two formulations: • L-carnitine 4. To avoid muscle wasting and fatigue • acetyl-L-carnitine Some HIV positive people use carnitine L-carnitine is sold under the brand name supplements to treat muscle wasting and Carnitor and is available by prescription in fatigue due to anti-HIV drugs. A 1994 study North America. Acetyl-L-carnitine (ALCAR) is of 21 men with AZT-related myopathy (muscle sold under the brand name Nicetile in Italy wasting) showed that the men’s muscle tissue and some countries of the European Union. had been damaged and that lipids (fats) had Sigma-Tau does not appear to market ALCAR built up in the tissue. The study also showed in North America. In Canada and the United that the most badly damaged muscle had the States, some health food stores also sell lowest levels of carnitine. A test-tube study different brands and formulations of carnitine. done the same year suggested that carnitine All formulations of carnitine are expensive. supplements might improve AZT-related ALCAR is more often used in studies of myopathy, although no trials in HIV positive neuropathy and may be most useful for this people have been done to assess this condition. Both formulations of carnitine have compound’s impact on muscle wasting and been used in trials related to HIV, although fatigue. some HIV nutritional experts have suggested the acetyl form may be more useful. 5. To delay or minimize fat wasting The dose usually recommended for PHAs L-carnitine has been tested in Germany as a varies between 500 mg and 3,000 mg (3 potential treatment to stop the loss of fat that grams) a day. This can be divided into several can occur with the HIV lipodystrophy doses and taken with food. syndrome. Twelve PHAs were given 1 gram of CATIE FactSHEET Carnitine, page 3 of 6 Side effects Drug interactions 1. Gastrointestinal Always tell your doctor and other members of your health care team about all the Nausea, vomiting and diarrhea may occur, medications—prescription and non- especially in people who take more than 4 prescription—herbs and supplements that you grams per day.
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