Dr. Teitelbaum, a well-known fatigue and pain expert, has researched ME/CFS & fibromyalgia patients’ nutritional and therapeutic needs for more than 20 years. This information is excerpted with kind permission* from his educational web site at Vitality101.com.
We have noted for several decades that the nutrient Acetyl L-Carnitine is low in chronic fatigue syndrome (ME/CFS) & Fibromyalgia, and this deficiency contributes to both the weight gain (see “How Fibromyalgia, CFS, and Stress Can Make You Gain Weight”) and fatigue.... The studies cited here show that it supports healthy mood, comfort and energy in Fibromyalgia as well… – Dr. Teitelbaum
Acetyl L-Carnitine, CFS, and Fibromyalgia
Low levels of the carnitine compound acylcarnitine in the blood or muscles of people with CFS/FMS have been found by different research centers.(1,2) [The most recent report being from the University of South Australia, Adelaide(3).]
Carnitine plays many roles in the body:
• It has the critical function of preventing the mitochondria from being shut down when the system backs up. (It does this by keeping a substance called acetyl coenzyme A from building up and shutting down the TCA cycle and the electron transport system, the cell's effective energy burning systems.)
• Also, without sufficient carnitine, the body cannot burn fat (and, in fact, makes excess fat), resulting in large weight gains.
L-Carnitine is a naturally occurring form of carnitine that is only found in animal flesh (think "Carni-vore"), and any brand [of the supplement form] is fine as long as it is pure Acetyl L-Carnitine.
Although you may not see a marked effect, it helps lay the foundation for your getting better and may help you lose any weight you gained.
A study has now also found that it supports healthy mood and comfort in fibromyalgia. [See abstracts, below.]
• Take Acetyl L-Carnitine 500 mg twice a day for at least 4 months. Higher doses are actually LESS effective.
• Taking plain Carnitine (as opposed to Acetyl L-Carnitine) is not effective, as it does not get into your cells’ mitochondria (energy furnaces) properly.
L-Carnitine Trials Re Support of Healthy FM Mood and Comfort; Energy
> Double-blind, multicenter trial comparing Acetyl L-Carnitine with placebo in the treatment of fibromyalgia patients
– Source: Clinical and Experimental Rheumatology, Mar 1, 2007
By Rossini M, et al.
Objective: Fibromyalgia (FMS) is a chronic syndrome characterized by widespread pain, troubled sleep, disturbed mood, and fatigue.
Several analgesic strategies have been evaluated but the results are moderate and inconsistent. Antidepressant agents are now considered the treatment of choice in most patients.
It has been recently suggested that FMS may be associated with metabolic alterations including a deficit of carnitine. In this multicenter randomized clinical trial we evaluated the efficacy of Acetyl L-Carnitine (LAC) in patients with overt FMS.
Methods: 102 patients meeting the American College of Rheumatology criteria for FMS were randomized into the study. The treatment consisted of 2 capsules a day of 500 mg LAC or placebo plus one intramuscular (i.m.) injection of either 500 mg LAC or placebo for 2 weeks. During the following 8 weeks the patients took 3 capsules daily containing either 500 mg LAC or placebo.
The patients were seen during treatment after 2 (visit 3), 6 (visit 4) and 10 weeks (visit 5). The patients were also visited 4 weeks after treatment discontinuation (follow-up visit).
Outcome measures included the number of positive tender points; the sum of pain threshold (kg/cm2 or "total myalgic score"); the Short Form 36 (SF36) [measures health-related quality of life]; a 100 mm visual analog scale (VAS) for self-perceived stiffness, fatigue, tiredness on awakening, sleep, work status, depression, and muscular-skeletal pain; and the Hamilton depression scale.
• The "total myalgic score" and the number of positive tender points declined significantly and equally in both groups until the 6th week of treatment. At the 10th week, both parameters remained unchanged in the placebo group but they continued to improve in the LAC group with a statistically significant between-group difference.
• Most VAS scores significantly improved in both groups.
• A statistically significant between-group difference was observed for depression and musculo-skeletal pain. Significantly larger improvements in SF36 questionnaire [health related quality of life] were observed in LAC than in placebo group for most parameters.
• Treatment was well-tolerated.
Conclusion: Although this experience deserves further studies, these results indicate that LAC may be of benefit in patients with FMS, providing:
• Improvement in pain,
• As well as the general and mental health of these patients.
Source: Clinical and Experimental Rheumatology, Mar 1, 2007; 25(2): 182-8. PMID: 17543140, by Rossini M, Di Munno O, Valentini G, Bianchi G, Biasi G, Cacace E, Malesci D, La Montagna G, Viapiana O, Adami S. Rheumatology Unit, University of Verona, Italy.
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> Safety, tolerability and symptom outcomes associated with L-Carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: A Phase I/II study
- Source: Journal of Pain and Symptom Management, Dec 2006
By RA Cruciani, et al.
In a phase I/II open-label trial designed to assess the safety and tolerability of oral supplementation with L-Carnitine, doses up to 3,000 mg a day were found to be safe, well tolerated, and reduce fatigue in patients with advanced cancer, in a dose-dependent manner.
Study subjects were patients with advanced cancer, moderate to severe fatigue, carnitine deficiency (defined as levels of free carnitine <35 for males and <25 for females or acyl/free carnitine ratio of >0.4) and a score of at least 50 on the Karnofsky Performance Status.
Fatigue, depressed mood, quality of sleep and KPS were assessed at baseline and after one week. 27 patients participated in the study, 21 completed the study, and 17 were responders. Subjects were divided into groups and each group was given a successively higher dose of L-Carnitine for one week, starting at 250 mg a day and increasing in increments of 500 mg, up to 2,750 mg a day, plus a final dose of 3,000 mg a day.
None of the subjects reported significant side effects or toxicities.
In the 27 patients who participated in the study:
• Levels of total carnitine and free carnitine were found to increase,
• Fatigue was found to significantly decrease,
• Depression was found to decrease,
• And sleep was found to improve.
Among the 17 responders, L-Carnitine was found to be associated with total carnitine, free carnitine, and fatigue in a dose-dependent manner.
These results suggest that L-Carnitine may be safe and well-tolerated in doses up to 3,000 mg/d. Furthermore, supplementation with L-Carnitine may help to reduce fatigue in patients with advanced cancer.
The authors conclude, "This study provides the basis for the design of future placebo-controlled studies of L-Carnitine supplementation for cancer-related fatigue."
Source: Journal of Pain and Symptom Management, Dec 2006; 32(6): 551-559.. PMID:17157757, by Cruciani RA, Dvorkin E, Homel P, Malamud S, Culliney B, Lapin J, Portenoy RK, Esteban-Cruciani N. Department of Pain Medicine and Palliative Care and Cancer Center, Beth Israel Medical Center, New York; Departments of Neurology and Anesthesiology and Pediatrics, Albert Einstein College of Medicine, Bronx; Children's Hospital at Montefiore, Bronx, New York, USA. [Email: email@example.com]
1. A.V. Plioplys and S. Plioplys, full text "Amantadine and L-Carnitine Treatment of Chronic Fatigue Syndrome," Neuropsychobiology 35(1) (1997): 16-23. [See also summary: “Study Finds CFIDS Symptoms Improve with L-Carnitine Supplementation.”]
2. H. Kuratsune, K. Yamaguti, M. Takahashi, et al., abstract "Acylcarnitine Deficiency in Chronic Fatigue Syndrome," Clinical Infectious Disease 18 (3 Supplement 1) (January 1994): S62-S67.
3. S. E. Reuter and A. M. Evans, abstract “Long-chain acylcarnitine deficiency in patients with chronic fatigue syndrome. Potential involvement of altered carnitine palmitoyltransferase-I activity,” Journal of Internal Medicine, July 2011.
* Copyright © 2011 by The Annapolis Chronic Fatigue and Fibromyalgia Research Center for Effective CFS/FMS Therapies. All rights reserved.
Other Resources: Research also demonstrates L-Carnitine's role in support of healthy cognitive function for ME/CFS patients - see "L-Carnitine: Breaking Through the Mental Fog."]
Disclaimer: These statements have not been evaluated by the FDA. This information and the supplements discussed are not intended to diagnose, prevent, treat or cure any illness, condition or disease. They are general, represent the opinions and research of Dr. Teitalbaum unless otherwise noted, and are not meant to replace the attention of a personal physician. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.