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April 1, 1998
The nutritional supplement L-Carnitine appears to be a promising treatment for chronic fatigue and immune dysfunction syndrome (CFIDS), according to an article published in the medical journal Neuropsychobiology (1997; 35:16-23).
Dr. Audrius V. Plioplys, of the Chronic Fatigue Syndrome Center and Department of Research at Mercy Hospital and Medical Center in Chicago, Illinois, authored the article. He conducted a crossover study examining the prescription anti-viral drug amantadine and L-Carnitine treatment of CFIDS and found that L-Carnitine yielded the best results of the two. "L-Carnitine was found to promote statistically significant clinical improvement in 12 of 18 chronic fatigue patients," Dr. Plioplys reports. "L-Carnitine is a very safe and very well-tolerated therapy which improves the clinical status of CFIDS patients," he says. "Along with helping to reduce physical fatigue, our study showed that L-Carnitine also helped aspects related to depression as well as mental fatigue."
According to Dr. Plioplys, it has been scientifically established that orally administered L-Carnitine is an effective therapy in treating the fatigue seen in a number of chronic neurologic diseases. "Perhaps the L-Carnitine helps provide the cells of CFIDS patients with a useful energy source," he ventures. "Further study is warranted."
While L-Carnitine markedly improved a constellation of CFIDS symptoms, amantadine was tolerated quite poorly by study participants. In fact, only 15 of the 30 individuals taking it were able to complete eight weeks of treatment; the other 15 had to stop taking the medicine due to side effects. In those participants who completed the treatment, there was no statistically significant difference in any of the clinical parameters that were followed. "We were surprised to see how badly people did on amantadine," says Dr. Plioplys. "Amantadine is one of the most effective medicines for treating the fatigue seen in multiple sclerosis patients, but it did not help CFIDS patients in our study."
CFIDS is a disorder of unknown cause for which no effective treatment exists. The incidence of CFIDS, as diagnosed using the Centers for Disease Control and Prevention (CDC) criteria, is greater than one half a million cases in the United States, and could be much higher. About 80 percent of reported cases are women. The multitude of CFIDS symptoms includes persistent, disabling fatigue which causes a substantial reduction in activity level. Other symptoms include recurrent infections, sleep disturbances, neurocognitive dysfunction or "brain fog," flu-like episodes, muscle pain and weakness, low-grade fever, sore throat, headache, swelling and tenderness of lymph nodes, and bowel disorders.
Patients in the trial ingested one gram of L-Carnitine in tablet form three times a day for eight weeks. As the greatest improvement in patients took place between the fourth and eighth weeks of L-Carnitine treatment, "...it follows that individuals should take one gram of this supplement, three times a day, for at least eight weeks to see if it helps their condition," says Dr. Plioplys. "Make sure that you always take L-Carnitine, and never any other form of carnitine, such as the D form, which can be toxic when taken in large amounts."
L-Carnitine is synthesized in the human body, mainly in the liver and kidneys, from essential amino acids, lysine and methionine. Carnitine's main function in the body is to transport long-chain fatty acids into the mitochondria, which serve as the metabolic furnaces of the cells. Given that fatty acids are the major sources for production of energy in the heart and skeletal muscles, it's easy to understand why L-Carnitine may literally stoke up the body's energy reserves. "Previous research investigations have reported decreased carnitine levels in CFIDS patients," says Dr. Plioplys. "Disturbance in mitochondrial function may contribute to or cause the fatigue seen in CFIDS patients."
According to Sheldon Hendler, M.D., PhD., writing in The Doctor's Vitamin and Mineral Encyclopedia, carnitine is a vital energy source for the muscles and increases the use of fat as an energy source. By helping burn fat, carnitine helps prevent fatty build-up in the heart, liver, skeletal muscles, and other areas. Carnitine can be made by the body only if the necessary amounts of iron, vitamin B1 (thiamine), vitamin B6 (pyridoxine), and the amino acids lysine and methionine are present.
Carnitine synthesis also depends on there being appropriate vitamin C levels in the body. Deficiencies in any of these nutrients can result in a carnitine deficiency. Carnitine can also be obtained from meat and other foods of animal origin. In addition, carnitine has been proven to lower health risks caused by inefficient fat metabolism associated with diabetes. L-carnitine has also been reported to lessen the risk of heart disorders, by inhibiting alcohol-induced fatty liver.
Because L-Carnitine yielded such positive results in his research trial, Dr. Plioplys is planning a placebo-controlled, double-blind trial that will further study L-Carnitine supplementation in CFIDS patients. "Our grant proposal is under review," he says. "We're hoping that the study will be carried out in the near future."
Source: Dr. Audrius V. Plioplys;Sheldon Hendler
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