Coronary Artery Disease (CAD) and Angina and Carnitine

L-carnitine (carnitine) might be a good addition to standard therapy for angina.

Carnitine is a vitamin-like substance used by the body 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, including angina.

Carnitine plays a role in the cellular production of energy. Although carnitine does not address the cause of angina, it appears to help the heart produce energy more efficiently, thereby enabling it to get by with less oxygen.

Read more details about Carnitine.

In one controlled but not double-blind study, 200 individuals with angina (the exercise-induced variety) received either a daily dose of L-carnitine or were left untreated.¹ All the study participants continued to take their usual medication for angina. Those taking carnitine showed improvement in several measures of heart function, including a significantly greater ability to exercise without chest pain. They were also able to reduce the dosage of some of their heart medications (under medical supervision) as their symptoms decreased.

A smaller trial that did use a double-blind, placebo-controlled format evaluated 52 people with angina.² The results showed that daily use of L-carnitine significantly improved symptoms as compared to placebo.

Other studies (both single- and double-blind) used a special form of L-carnitine called L-propionyl-carnitine, and researchers found evidence of benefit.^3-6

Typical adult dosages of carnitine range from 500 mg to 1,000 mg three times daily.

Carnitine is taken in three forms: L-carnitine (for heart and other conditions), propionyl-L-carnitine (for heart conditions), and acetyl-L-carnitine (for Alzheimer's disease). The dosage is the same for all three forms.

Note: Angina is a serious disease that absolutely requires conventional medical evaluation and supervision. No one should self-treat for angina. However, alternative treatments such as carnitine may provide a useful adjunct to standard medical care when monitored by an appropriate healthcare professional. Consult with your physician regarding carnitine dosage and specific safety issues.

• MD
• Clinical nutritionist or registered dietitian
• Naturopath

Safety Issues

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. ¹ 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.

1. Benvenga S, Lakshmanan M, Trimarchi F. Carnitine is a naturally occurring inhibitor of thyroid hormone nuclear uptake. Thyroid. 10(12):1043-50.

1. Cacciatore L, Cerio R, Ciarimboli M, et al. The therapeutic effect of L-carnitine in patients with exercise-induced stable angina: a controlled study. Drugs Exp Clin Res. 1991;17:225-235.
2. Cherchi A, Lai C, Angelino F, et al. Effects of L-carnitine on exercise tolerance in chronic stable angina: a multicenter, double-blind, randomized, placebo controlled crossover study. Int J Clin Pharmacol Ther Toxicol. 1985;23:569-572.
3. Bartels GL, Remme WJ, Pillay M, et al. Effects of L-propionylcarnitine on ischemia-induced myocardial dysfunction in men with angina pectoris. Am J Cardiol. 1994;74:125-130.
4. Bartels GL, Remme WJ, den Hartog FR, et al. Additional anti-ischemic effects of long-term L-propionylcarnitine in anginal patients treated with conventional antianginal therapy. Cardiovasc Drugs Ther. 1995;9:749-753.
5. Lagioia R, Scrutinio D, Mangini SG, et al. Propionyl-L-carnitine: a new compound in the metabolic approach to the treatment of effort angina. Int J Cardiol. 1992;34:167-172.
6. Bartels GL, Remme WJ, Holwerda KJ, et al. Anti-ischaemic efficacy of L-propionylcarnitine—a promising novel metabolic approach to ischaemia? Eur Heart J. 1996;17:414-420.