Chronic Fatigue Syndrome (CFS) and Carnitine
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.
Effect of Carnitine on Chronic Fatigue Syndrome (CFS)
Early studies reported decreased carnitine levels in people with chornic fatigue syndrome.18 So naturally, supplementing it is thought to possibly help in the treatment of the condition.
Research Evidence on Carnitine
An unblinded crossover trial (8 weeks with each treatment, and a 2-week "washout" period in between) enrolled 30 individuals with CFS to evaluate the potential benefits of carnitine supplements.19 The results suggest potential benefit with this supplement.
However, this study was severely flawed. One problem was that, rather than using a placebo group for comparison purposes, researchers chose to investigate the antiviral drug amantadine. This drug has no proven efficacy in CFS, and it caused so many side effects that more than half of the participants dropped out during the period they were taking amantadine. This high dropout rate makes statistical interpretation of the results unreliable. In addition, the lack of blinding in the study also impairs the trustworthiness of the results.
How to Use Carnitine
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
Side Effects and Warnings
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. ^ 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.
- Hug C, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr. 1991;119:799-802.
- Chung S, Choi J, Hyun T, et al. Alterations in the carnitine metabolism in epileptic children treated with valproic acid. J Korean Med Sci. 1997;12:553-558.
- Melegh B, Trombitas K. Valproate treatment induces lipid globule accumulation with ultrastructural abnormalities of mitochondria in skeletal muscle. Neuropediatrics. 1997;28:257-261.
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr. 1995;84:93-95.
- Coulter DL. Carnitine deficiency in epilepsy: risk factors and treatment. J Child Neurol. 1995;10(suppl 2):S32-S39.
- Melegh B, Pap M, Morava E, et al. Carnitine-dependent changes of metabolic fuel consumption during long-term treatment with valproic acid. J Pediatr. 1994;125:317-321.
- De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: current perspectives. Epilepsia. 1998;13:1216-1225.
- Matsuda I, Ohtani Y. Carnitine status in Reye and Reye-like syndromes. Pediatr Neurol. 1986;2:90-94.
- Camina MF, Rozas I, Gomez M, et al. Short-term effects of administration of anticonvulsant drugs on free carnitine and acylcarnitine in mouse serum and tissues. Br J Pharmacol. 1991;103:1179-1183.
- Rodriguez-Segade S, de la Pena CA, Tutor JC, et al. Carnitine deficiency associated with anticonvulsant therapy. Clin Chim Acta. 1989;181:175-181.
- Ater SB. A developmental center population treated with VPA and L-carnitine. In: Update 1993: inborn errors of metabolism in the patient with epilepsy. Sigma-Tau Pharmaceuticals; 1993.
- Plioplys AV, Plioplys S. Amantadine and L-carnitine treatment of chronic fatigue syndrome. Neuropsychobiology. 1997;35:16-23.