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Carnitine is a quaternary ammonium compound which is derived from an amino acid, and is found nearly all cells of the body. It plays an important role in metabolism of most mammals, plants, and some bacteria.

Some facts about Carnitine:

  • Long-chain fatty acids are transported by Carnitine into mitochondria to be oxidized for energy production in support of energy metabolism. So, it plays a critical role in energy production.
  • It is also an important factor in removing products of metabolism from cells as the toxic compounds generated out of this cellular organelle is transported by it to prevent their accumulation
  • Carnitine is present in tissues like skeletal and cardiac muscle that metabolize fatty acids as an energy source.
  • Supplementation of Carnitine is not required in general as even a strict vegetarians synthesize enough L-carnitine in vivo.
  • Pure carnitine is a white powder at room temperature and a water-soluble zwitterion with low toxicity.
  • Dietary supplementation is required for individuals with genetic or medical disorders such as preterm infants as they cannot make enough carnitine.
  • Triglycerides are made by the liver from excess glucose when it is supplied with glucose that cannot be oxidized or stored as glycogen which increases the concentration of malonyl-CoA. Malonyl-CoA is the first intermediate in fatty acid synthesis, which inhibitate carnitine acyltransferase 1, to prevent fatty acid entering into the mitochondrial matrix for β oxidation. Fatty acid is prevented to breakdown by this inhibition while synthesis occurs.
  • Shuttle activation of Carnitine occurs due to a need for fatty acid oxidation which is required for energy production. ATP concentration decreases and AMP concentration increases leading to the activation of AMP-activated protein kinase (AMPK) during vigorous muscle contraction or during fasting. The concentration of malonyl-CoA will be lowered by AMPK phosphorylates acetyl-CoA carboxylase by inhibiting acetyl-CoA carboxylase. The import of fatty acid to the mitochondria is allowed, ultimately replenishing the supply of ATP as lower levels of malonyl-CoA disinhibits carnitine acyltransferase 1.
  • Carnitine deficiency is rare in healthy people without metabolic disorders as adequate levels of carnitine normally produced through fatty acid metabolism.
  • Carnitine-fortified infant formulas can be used as a replacement for breast milk for premature infants, if necessary. Carnitine deficiency can happen in premature infants as they have low stores of carnitine.
  • There are two types of carnitine deficiency.
  • The genetic disorder of the cellular carnitine transporter system is known as Primary carnitine deficiency which typically appears at the age of five. Cardiomyopathy, skeletal-muscle weakness, and hypoglycemia are some of the symptoms of Primary carnitine deficiency.
  • Certain disorders, such as chronic kidney failure, or conditions in which carnitine absorption is reduced or its excretion is increased, such as use of antibiotics, malnutrition, and poor absorption following digestion can be some of the reaseons for developing Secondary carnitine deficiencies.
  • Oxygen consumption or metabolic functions will not be increased by Carnitine supplements when exercising. They are aslo not proven to increase the amount of carnitine in muscle.
  • It may be helpful in treating male infertility as the carnitine content of seminal fluid is directly related to sperm count and motility.
  • The cardiac function in people with heart failure can be improved with  L-carnitine supplementation. However, its overall efficacy in lowering the risk or treating cardiovascular diseases have to be determined yet.
  • L-carnitine supplementation can be used for improving symptoms of type 2 diabetes, such as improving glucose tolerance or lowering fasting levels of blood glucose.
  • The urinary elimination of carnitine increases, endogenous synthesis decreases, and poor nutrition as a result of disease-induced anorexia can result in carnitine deficiency in the case of renal impairment.
  • The overall homeostasis in the body, including carnitine levels are contributed by the kidney.
  • Carnitine will have no effect on most parameters of the body in end stage kidney disease, although it may lower C-reactive protein, a biomarker for systemic inflammation.
  • Anemia, muscle weakness, fatigue, altered levels of blood fats, and heart disorders can be a result of lower Carnitine blood levels and muscle stores.
  • High doses of l-carnitine may aid in anemia management which is often injected.
  • Animal products such as meat, fish, poultry, and milk are some of the carnitine rich food. The carnitine content will be higher if the meat is more red.
  • Carnitine is found in two forms, known as D and L, that are isomers of each other. Out of these two form, only L-carnitine is active in the body and is found in food.
  • Dietary carnitine is mostly absorbed in the small intestine of the body and enters the bloodstream.
  • The excess of carnitine is excreted in the urine as through the kidneys to maintain stable blood concentrations instead of being metabolized.
  • Vegetarians get considerably less amount of carnitine as they avoid animal-derived foods.

Health benefits of Carnitine:

  • A high dose supplementation of acetyl-L-carnitine and alpha-lipoic acid can help reduce the aging process.
  • Supplements of acetyl-L-carnitine may help improve mental function and reduce deterioration in older adults with mild cognitive impairment and Alzheimer's disease.
  • Fatigue resulting from chemotherapy, radiation treatment, and poor nutritional status in Cancer patients can be reduced with supplements of acetyl-L-carnitine. Mood and quality of sleep can also be improved.
  • Insulin sensitivity in diabetics can be improved by decreasing fat levels in muscle when supplementation with L-carnitine is provided intravenously. It may also help lower glucose levels in the blood by more promptly increasing its oxidation in cells.
  • Significant relief of nerve pain and improved vibration perception can be provided in those with diabetic neuropathy.
  • The lipodystrophy syndrom caused by human immunodeficiency virus (HIV) may represent mitochondrial toxicity caused by the HIV infection and the antiretroviral drugs used to treat it, and can induce a carnitine deficiency that limits mitochondrial fat metabolism. The death of lymphocytes can be slow down which in turn may slow HIV progression by providing supplementation with carnitine both intravenously and orally. It can also reduce neuropathy, and favorably affect blood lipid levels.

Side Effects of Carnitine:

  • Nausea, vomiting, abdominal cramps, diarrhea, and a fishy body odor are some of the possible side effects of carnitine supplements.
  • Muscle weakness in uremic patients and seizures in those with seizure disorders are some of the rarer side effects.
  • The risk of cardiovascular disease increases due to the substance TMAO generated when intestinal bacteria metabolize carnitine.

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