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Low-impact aerobic exercise and acetyl-L-carnitine health effects in review

Some doctors say it's the fat from the red meat, not the red meat that's bad for you. Others add it's also the smoking, grilling at high heat, or processing of red meat into deli cold cuts that's not so healthy. So if you don't eat red meat, how do you get carnitine into your body so the carnitine can move the omega fatty acids into your cells and repair them? You have studies linking carnitine to help with low impact aerobic exercise. And studies that explain how low-impact aerobic exercise reduces fatigue in auto-immune conditions say multi-study reviews. Researchers say that “Cooling techniques and nutritional supplements such as acetyl-L-carnitine and fish oil showed a number of benefits, but need to be looked at in more detail,” according to the November 29, 2006 news release, "Low impact aerobic exercise reduces fatigue in auto-immune conditions says multi-study review."

How many health-related uses are there for carnitine in its various forms?
Photo by Joe Raedle/Getty Images

The study referred to in the news release, is "Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis or systemic lupus erythematosus: a systematic review." Authors are Neill J, Belan I and Ried K. Journal of Advanced Nursing. Volume 56.6, pages 617-635. So how does carnitine fit into the big picture of health and fitness? You could check out the abstract of another noteworthy study, "Acetyl-L-carnitine ameliorates mitochondrial dysfunction following contusion spinal cord injury," J Neurochem. 2010.

And a September 28, 2011news release about another study explains that carnitine is likely to improve outcomes and recovery for individuals who sustain a spinal cord injury (SCI), according to research conducted by University of Kentucky neuroscientists. For example, Sasha Rabchevsky, associate professor of physiology, Patrick Sullivan, associate professor of anatomy and neurobiology, and Samir Patel, senior research scientist -- all of the UK Spinal Cord and Brain Injury Research Center (SCoBIRC) -- have discovered that in experimental models, severe spinal cord injury can be treated effectively by administering the supplement acetyl-L-carnitine or ALC, a derivative of essential amino acids that can generate metabolic energy, soon after injury, according to the September 28, 2011 news release, "Commonly used supplement may improve recovery from spinal cord injuries." The study referred to is "Acetyl-L-Carnitine Ameliorates Mitochondrial Dysfunction Following Contusion Spinal Cord Injury." J Neurochem, 2010. Authors are Patel, S.P., et al.

So how many health-related uses are there for carnitine in its various forms?

Low impact aerobic exercise, such as walking and cycling, can effectively reduce fatigue in adults with chronic auto-immune conditions, according to a research review in the latest issue of the UK-based Journal of Advanced Nursing. A team led by nurse researcher Dr Jane Neill from Flinders University in Adelaide, examined 162 research studies published between 1987 and 2006, analysing 36 in detail.

They discovered that there was evidence that people with conditions like multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus could benefit from exercise that gradually increased in intensity, duration and frequency. “Fatigue is a major symptom in all three conditions and can cause a range of physical, psychological and social problems” says Dr Neill.

“Our review showed that aerobic exercise can significantly reduce fatigue and that some behavioural, nutritional and physiological interventions are also very effective.” Studies reviewed by the team tested 38 interventions on more than 1,700 patients. 24 resulted in statistically reduced fatigue or increased vitality levels.

The effective aerobic exercise programs lasted an average of 12 weeks, with participants exercising for 30 to 60 minutes, three times a week.

Group interventions involved supervised exercise classes, including warm up, low impact aerobic activity and strengthening or stretching exercises before cool down. Home-based programs made use of exercise bicycles, walking, cycling, jogging or swimming.

“There is good evidence that people experiencing fatigue from chronic auto-immune conditions can benefit from a range of non-medicinal interventions” concludes Dr Neill, according to the news release, "Low impact aerobic exercise reduces fatigue in auto-immune conditions says multi-study review." “Other effective strategies, apart from aerobic exercise, include health education and cognitive behavioral therapy.

“Cooling techniques and nutritional supplements such as acetyl-L-carnitine and fish oil showed a number of benefits, but need to be looked at in more detail.” The authors suggest electro-magnetic field devices also warrant further investigation, due to promising results. But they add that low-cost, low technology interventions that promote self-management of fatigue are probably more appropriate and feasible than those requiring specialised equipment or professional expertise.

They emphasize that any exercise programmes must be suitable for each individual and take account of issues that affect how people manage their conditions, like reduced mobility, pain, nausea and stress. “Healthcare professionals should ask people about their fatigue and assess each person’s symptoms” adds Dr Neill, according to the news release “People with fatigue should be encouraged to design their own exercise routines based on awareness of their individual fatigue patterns and daily priorities, while group activities must take account of the changing nature of fatigue over time.”

Previous research suggests that 70 per cent of people with multiple sclerosis suffer daily fatigue, 57 per cent of people with rheumatoid arthritis experience fatigue and 81 per cent of those with system lupus erythematosus find fatigue moderately to severely disabling. “Any measures that can reduce people’s fatigue and improve their quality of life are to be welcomed. Our review shows that some interventions have great potential, particularly in the short term, but that more research is needed to measure their long-term effectiveness” says Dr Neill, accoding to the news release, "Low impact aerobic exercise reduces fatigue in auto-immune conditions says multi-study review." You may wish to check out the study or its abstract, "Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review. Authors are Neill J, Belan I and Ried K. Journal of Advanced Nursing. Volume 56.6, pages 617-635. 2006.

How important is acetyl-l-carnitine to the brain and the rest of the body?

Acetyl-L-carnitine produces acetyl-choline, an important neurotransmitter of memory and mood in the brain. And carnitine is essential for moving healthful fats into the cell membranes. What acetyl-L-Carnitine does is help move fatty acids into your membranes. If you check out some of the older studies on acetyl-L-carnitine, the research reveals that 4 g a day of carnitine decreased the death rate over 6-fold in folks who had already had a heart attack. Now the question arises whether most heart attack and heart failure patients have low carnitine levels? Does acetyl-L-carnitine in the right dosage for a particular individual's needs help that person's brain and heart?

A noteworthy study to check out is, "L-carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centenarians: a randomized and controlled clinical trial," American Journal of Clinical Nutrition, 2007. Authors are Malaguarnera M, et al. Or see, "Caloric restriction and L-carnitine administration improves insulin sensitivity in patients with impaired glucose metabolism," JPEN J Parenter Enteral Nutrition,, 2010. Another noteworthy study to peruse is "Carnitine insufficiency caused by aging and over-nutrition compromises mitochondrial performance and metabolic control," J Biolog Chem, 2009. Authors are Noland RC, et al. There's also another noteworthy study, Propionyl-L-carnitine Corrects Metabolic and Cardiovascular Alterations in Diet-Induced Obese Mice and Improves Liver Respiratory Chain Activity. (2012)," PloS one. Authors are Mingorance C, et al.

You also may wish to see the abstract of a 2013 the Mayo Clinic carnitine study with 3,600 patients that revealed carnitine supplementation was associated with a 27% reduction in death from all causes, a 65% reduction in ventricular arrhythmias, and a 40% reduction in angina in folks who’ve already had a heart attack.

Should vegans take carnitine supplements?

After all, carnitine is found in red meat. But is the health issues with red meat in the meat or in the fat from the red meat? A major contributer to health problems is pollution from plastics containing phtalates, and small pollution particles in the air from heavy traffic and some types of factory production as well as smoke.

When scientists research acetyl-L-carnitine, they find that acetyl-L-carnitine makes acetyl-choline, an important neurotransmitter of memory and mood in the brain. The next step that's researched by many scientists is how carnitine moves the more healthful fats into the cell membranes, for example a balance of the omega fats 3,6,7, and 9. If you take fatty acid supplements such as cod liver oil, your body needs to move them into your cells so the dense nutrition will repair damaged and aged cells.

Carnitine supplements reverse glucose intolerance in animals: Will the same effects take place in humans?

Supplementing obese rats with the nutrient carnitine helps the animals to clear the extra sugar in their blood, something they had trouble doing on their own, researchers at Duke University Medical Center report. A team led by Deborah Muoio (Moo-ee-oo), Ph.D., of the Duke Sarah W. Stedman Nutrition and Metabolism Center, also performed tests on human muscle cells that showed supplementing with carnitine might help older people with prediabetes, diabetes, and other disorders that make glucose (sugar) metabolism difficult.

Carnitine is made in the liver and recycled by the kidney, but in some cases when this is insufficient, dietary carnitine from red meat and other animal foods can compensate for the shortfall. After just eight weeks of supplementation with carnitine, the obese rats restored their cells' fuel- burning capacity (which was shut down by a lack of natural carnitine) and improved their glucose tolerance, a health outcome that indicates a lower risk of diabetes.

These results offer hope for a new therapeutic option for people with glucose intolerance, older people, people with kidney disease, and those with type 2 diabetes (what used to be called adult-onset diabetes)

Muoio said, according to the August 12, 2009 news release, "Carnitine supplements reverse glucose intolerance in animals," that soon her team of researchers will begin a small clinical trial of carnitine supplementation in people who fit the profile of those who might benefit from additional carnitine – older people (60 to 80 years) with glucose intolerance. The study is published in the August 21, 2009 issue of the Journal of Biological Chemistry.

The Duke researchers began studying carnitine more closely when abnormalities in the nutrient emerged from blood chemistry profiles of obese and old animals. These chemical profiles report on hundreds of byproducts of cell metabolism called metabolites and give scientists an opportunity to identify markers of disease states.

Carnitine is a natural compound known for helping fatty acids enter the mitochondria, the powerhouses of cells, where fatty acids are 'burned' to give cells energy for their various tasks. Carnitine also helps move excess fuel from cells into the circulating blood, which then redistributes this energy source to needier organs or to the kidneys for removal. These processes occur through the formation of acylcarnitine molecules, energy molecules that can cross membrane barriers that encase all cells.

Imbalance linked to fuel-burning problems which means impairments in the cells' combustion of fat and sugar/glucose

Researchers at Duke had observed that skeletal muscle of obese rats produced high amounts of the acylcarnitines, which requires free carnitine. As these molecules started to accumulate, the availability of free, unprocessed carnitine decreased. This imbalance was linked to fuel-burning problems, that is, impairments in the cells' combustion of both fat and glucose fuel.

"We suspected that persistent increases in acylcarnitines in the rats were causing problems, and we could also see that the availability of free carnitine was decreasing with weight gain and aging," said Muoio, according to the news release. "It appeared that carnitine could no longer do its job when chronic metabolic disruptions were stressing the system. That's when we designed an experiment to add extra carnitine to the rats' diet." Muoio at the time of the news release is mentioned also as a professor in the departments of medicine, pharmacology and cancer biology.

Other study authors included Robert C. Noland, Sarah E. Seiler, Helen Lum, Olga Ilkayeva, Robert Stevens, and Timothy R. Koves of the Sarah W. Stedman Nutrition and Metabolism Center. Koves is also with the Duke Department of Medicine. Robert M. Lust is with the Department of Physiology at East Carolina University in Greenville, N.C., and Fausto G. Hegardt is with the CIBER division Fisiopatología de la Obesidad y la Nutrición of the Instituto de Salud Carlos III in Spain. Supporters of the work were grants from the National Institutes of Health, and the American Diabetes Association, and a John A. Hartford Duke Center for Excellence Award.

News of other studies on carnitine's health effects

News of one study proposes a hypothesis that L-carnitine exhibits neuroprotective effects. Check out, "How does L-carnitine maintain the normal structure of sciatic nerve in crush injury?" News of L-carnitine exhibits neuroprotective effects is explained in the July 17, 2104 press release, "How does L-carnitine maintain the normal structure of sciatic nerve in crush injury?"

When it comes to autism, you may wish to check out the May 7, 2012 news release, "Defective carnitine metabolism may play role in autism." The deletion of part of a gene that plays a role in the synthesis of carnitine – an amino acid derivative that helps the body use fat for energy – may play a role in milder forms of autism, said a group of researchers led by those at Baylor College of Medicine and Texas Children's Hospital.

You also may wish to check out news of another study mentioned in a May 8, 2013 news release, "Carnitine supplement may improve survival rates of children with heart defects." A common nutritional supplement may be part of the magic in improving the survival rates of babies born with heart defects, researchers report. Carnitine, a compound that helps transport fat inside the cell powerhouse where it can be used for energy production, is currently used for purposes ranging from weight loss to chest pain.

New research shows it appears to normalize the blood vessel dysfunction that can accompany congenital heart defects and linger even after corrective surgery, said Dr. Stephen M. Black, cell and molecular physiologist at the Vascular Biology Center at the Medical College of Georgia at Georgia Regents University, according to that news release.

according to the March 24, 2009 news release, "Long-term L-carnitine supplementation prevents development of liver cancer." A study published on March 21, 2009 in the World Journal of Gastroenterology addresses the question. A research group in King Saud University, Kingdom of Saudi Arabia investigated, for the first time, the role of carnitine, a naturally occurring compound that is synthesized mainly in the liver, during the development of hepatocarcinogenesis.

Authors of the study reported that carnitine deficiency is a risk factor and should be viewed as a mechanism in hepatic carcinogenesis, and that long-term L-carnitine supplementation prevents the development of liver cancer. Therefore, carnitine supplementation alone or in combination with other natural chemopreventive compounds could be used to prevent, slow or reverse the occurrence of liver cancer.

Studies on carnitine continue. And if you look back a few years in the various news releases about carnitine, there's even a news release mentioning a Professor of Medicine at Harvard Medical School, writing, according to that press release, that carnitine isn't all that effective, at least for dialysis patients. See the March 15, 2005 news release, "Government wasting your taxpayer money on ineffective drug cure." But is carnitine a drug?

Surely carnitine iss supposed to be a nutrient found in red meat, not a drug manufactured by humans. Then again, any supplement used as a capsule or pill becomes used as a drug, is labeled as uncontrolled to an extent, and well, isn't food used as medicine? But medicine can't be used as food. That makes supplements in a shady area....Are supplements foods or drugs? If you check out the news release from 2005, you can read there that the government (at the time of the news release) is funding a supplement medication, Levo-carnitine (L-carnitine), used for dialysis patients, even though there is no adequate scientific proof that the drug is effective, according to an article published in Seminars in Dialysis.

There's a later work of research published in 2013 in that journal, L-Carnitine Supplementation in Dialysis: Treatment in Quest of Disease. The abstract of the 2013 study notes that L-Carnitine (LC) administration has been recommended for specific indications in dialysis patients, including epoetin-resistant anemia, intradialytic hypotension, cardiomyopathy, fatigue, muscle weakness, and exercise performance; it may ameliorate insulin resistance, inflammation, and protein wasting.

Is the issue about government paying for a supplement--carnitine instead of a big pharma drug?

Use of LC for anemia and intradialytic hypotension has been approved for reimbursement by the Centers for Medicare and Medicaid Services. Yet, the data to support these recommendations are inadequate and have not been bolstered over several decades. LC administration continues to appeal to nephrologists because its use in dialysis patients has an attractive rationale, it addresses problems that persist despite dialysis, it is safe, and the existing literature does not refute its use, says the abstract of that research. Nevertheless, definitive trials to justify LC administration have not been conducted and are increasingly unlikely to be funded. In an era of shrinking resources and bundling of dialysis services, the use of LC in dialysis patients will, appropriately, diminish.

If you were on dialysis would you rather take a supplement or a drug? And does your body need carnitine to absorb the fatty acids in your diet that need to get into the various cells to repair them? Or is it about who's paying, the patient or the government when it comes to a nutritional supplement found in food compared to a manufactured drug where the big money resides? Is it all relative? And the bottom line, what works better-- supplement, food, drug, or something else?

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