CARNITINE FOR ENERGY
CARNITINE - WHAT IS IT?
Many people, (and many doctors) have never heard of carnitine. Yet we are all familiar with it, although we may not know it. It is part of the food we know as meat; is particularly found in red meat and gives us sustaining energy.
The word carnitine is a derivative of the Latin root "carnis" - as in carnivore or meat-eater.
Carnitine is an essential part of releasing energy from protein foods. Carnitine is not an energy source itself. It is a catalyst. It allows protein food particles to pass into the muscle cell by linking up, carrying it through and returning it to its original form on the other side. Without this process we are down on a lot of energy, more likely to feel tired, have no get-up-and-go.
Carnitine is an amino acid ie part of the
structure of protein. The best sources of protein are animal foods like
meat. Meat has many things we need including iron, B vitamins, a special
meat vitamin C, Vitamin A, minerals, many amino acids, including carnitine and
taurine, protein building blocks for cell repair and growth, and fatty acids as
a source of fuel for muscle action. In fact it contains many of the
things needed to maintain and sustain, our normal body function.
CARNITINE HISTORY
1905 - Carnitine was isolated from meat.
1927 - The chemical structure was identified.
1952 - Urwin Fritz discovered that carnitine was involved in the oxidation of long chain fatty acids. It was Fritz who found that it was important as a growth factor for meal worms.
1973 - The role of carnitine in human disease was recognised in 1973 when Engel and Angelini first described a young woman who had limb weakness and lipid storage myopathy (fat globules abnormally present in muscle tissue).
1985 - Carnitine was added to soy baby formulae to prevent "floppy baby syndrome" as it was realised that carnitine is present in breast and cow's milk but not other milk substitutes.
Over the last 20 years a lot more research has
been done on carnitine insufficiency syndromes, although recognition of the
role of carnitine in health is still relatively new and your doctor may never
have heard of it.
Fritz's work in 1952 showed that for meal worms,
carnitine is a vitamin as for them it is essential for life. They need to
get it all from their diet. They cannot make carnitine. Without it
they grow fat and die. In humans, provided we have the necessary
ingredients from other foods we can produce some of our daily needs within the
body. Body synthesis supplies 25% of our body's needs, primarily in the
liver and kidneys. (So people with liver or kidney problems will have
problems getting enough carnitine.) The remaining 75% that our body
needs, we must get from our diet, primarily in our red meats. The amounts
in chicken and milk are negligible compared to that available in red
meat. The chart below shows the carnitine value of some common foods.
FOOD SOURCES of CARNITINE
|
FOOD |
mg/100g of food |
|
avocado |
?? 100.0?? 1.25 |
|
mutton |
210.0 |
|
lamb |
78.0 |
|
beef |
64.0 |
|
pork |
30.0 |
|
chicken |
7.5 |
|
lamb's fry |
2.6 |
|
milk (cow) |
2.0 |
|
fish |
1.3 |
|
cheese |
0.5 |
|
bread (wholemeal) |
0.2 |
|
eggs |
0.01 |
For people having to take supplemental carnitine to get enough to resolve problems like fatigue and muscle pain, doses are in combinations of 250mg capsules or the equivalent in powder form.
We have worked out that to get the equivalent of
a 250mg capsule you would need to eat
1/3
kilo of lamb (120g mutton)
nearly 1/2
kilo of beef
nearly a whole kilo of pork
3 1/3
kilos of chicken
12 1/2
litres of milk
or......(suspected but not
confirmed) a medium sized (250g) whole avocado
What if I need 4 - 10 capsules a day? Can we really get this amount from our diet?
The essential ingredients to produce our own carnitine are the amino acids;- lysine, (also from meat proteins) methionine (from plant as well animal proteins) and Vitamins C, B3 and B6.
CARNITINE INSUFFICIENCY INDICATORS
We suspect the following physical characteristics
may be indicators of insufficient carnitine availability.
* Stooped/rounded shoulders
* Inability to hold self erect
* Slumped posture
* Postural back muscle ache
* "hitting the wall" feeling
* "flag out" after lunch - catnaps
* Restoration of energy after rest or short
sleep
* "heavy feeling" in muscles
* Effort to lift arms and/or legs
Two types of carnitine problems are now known. Primary ie of genetic origin where no other systemic illness is present to account for reduced carnitine plasma and/or tissue levels, and secondary, which includes genetic metabolic errors, acquired medical conditions or iatrogenic disease (resulting from medical treatment eg valproate given for epilepsy).
We are seeing a third group now emerging. Self-inflicted carnitine deficiency. People who are deliberately not eating red meat because either they have an aversion to eating animals and feel this is cruel, or people who for health reasons, like high cholesterol or fear of meat contributing to cancer and heart disease, think they are doing the right thing.
We can add another category here too, people who have lost their taste for meat because their zinc levels are too low. When zinc is low you lose your sense of taste and smell. Also zinc is needed for hydrochloric acid production in the stomach so your ability to digest meat will diminish. People who are stressed or are on the Pill or HRT, are often low on zinc because adrenaline and sex hormone production uses more zinc (amongst other things).
Research we have undertaken in conjunction with SOMA Health WA, (a consumer health organisation looking at orthomolecular medicine), shows that depending on your blood group, you are programmed for the foods available in the environment in which your blood group developed.
So if you are an O or an A2 blood group you are programmed to eat a lot of meat whereas an A1 can almost be vegetarian. This also has a bearing on how much and how often red meat is part of our diet. If you are O or A2 blood group and eating little meat per week, this will be a contributing factor to fatigue and tiredness. It is not just low iron levels or low B12 levels.
Certain disease groups are also showing signs of insufficient carnitine. eg Post polio, chronic fatigue, muscular dystrophy, heart disease, renal dialysis and AIDS patients. In pregnancy the growing baby uses half of mum's carnitine.
A new development discovered in WA as part of the research in post polio, is that children and grandchildren of polio survivors are developing low carnitine levels too. Can this happen to others who have reduced their red meat intake before and during pregnancy, and thus affect their children and successive generations too?
We have not been aware of the effects of low carnitine levels long enough to know all the subsequent dangers yet.
The following symptoms, a number of which may collectively be present, are now recognised as indicative of reduced carnitine capacity. These symptoms will vary from individual to individual.
SYMPTOMS EXHIBITED by CARNITINE DEFICIENCY
(common complaints by polio survivors = P)
Fatigue
P
Poor muscle tone
P
Muscle pain
P
Exercise intolerance
P
Increased serum creatinine
kinase
P
(indicates muscle break down)
Apnea (temporary cessation of
breathing) P
Gastro-oesophageal reflux (indigestion)
P
Acidosis (characterised by sweet smelling urine)
P
Hypoglycaemia (low blood sugar)
Fasting intolerance
Heart irregularities
Non specific abdominal pain
Recurrent vomiting
Pyloric stenosis (projectile vomiting)
Kidney abnormalities
IN INFANTS
'Floppy baby' Syndrome
Failure to thrive
Pyloric stenosis
Developmental delay
Cardiomyopathy (disease of heart muscle)
Unexplained sudden death
GETTING ENERGY FROM FOOD
Most people do not need to take supplemental
carnitine. Unless we have one of the secondary causes listed on the back
page (eg post polio, chronic fatigue, muscular dystrophy, heart failure,
diabetes, coeliac disease, liver disease) we should be able to get enough
carnitine from our diet and make the remaining 25% in the liver. If the
kidneys are working well, most carnitine will be reabsorbed and reused.
97% percent of body carnitine is found and stored in skeletal muscle. So in people with diseases of muscle, storage capacity can be affected. This may be why in post polio, a top up is needed first thing in the morning. The heart, liver and brain share equal amounts of the remaining 3%, with low levels in the kidneys and lowest amounts circulating in the blood.
Dietry carnitine has better absorption from the gut than supplemental carnitine, so we should attempt to get as much from our diet as possible.
Energy from the food we eat, comes from the complexity of the structure of the food. The more complex the food, the more time is taken in the breakdown process, so the longer the energy will last. Look at this table below.
|
Food |
sugar |
fruit |
veg |
grains/bread |
eggs/cheese/milk |
fish |
chicken |
pork |
red meat |
|
Example |
lolly |
1 piece |
1 cup |
2 slices |
2 eggs/slices/cups |
1 piece |
quarter |
chop |
2 sml chops |
|
Structure |
glucose |
simple sugar |
carbohydrate |
complex carb |
simple protein |
light protein |
white meat |
white meat |
complex meat |
|
Energy Time |
10 mins |
½ hour |
¾ - 1 hour |
1 - 1 ½ hour |
1 hour |
1 ½ - 2 hours |
2 - 2 ½ hours |
2 ½ - 3 hours |
3 - 4 hours |
|
Daily Serve |
little |
2 pieces |
5 pieces |
2 -3 slices |
1 serve of 1 |
1 serve & or |
1 serve & or |
1 serve & or |
1 - 2 serves |
If I eat a lolly I get instant energy in the form
of glucose. But it doesn't take much breaking down so is all gone very
quickly, in about 10 mins. A piece of steak however will fill me up, give
me energy and I won't be hungry for 3 - 4 hours. Our bodies need different
things from different foods. We need a mix of protein, carbohydrate, fats
and essential fatty acids, every day, to get our daily requirements for our
bodies to function well.
The Internet Web page of Dr Peter D'Adamo, author of "Eat Right for Your Type" has the proportions of carbohydrate, protein and fat required in the diet, depending on your blood group. Traditionally we are told the food pyramid allows for about 10% fat, 30% protein and 60% carbohydrate. To the right is the scale according to D'Adamo, with A2 added by us, because D'Adamo's work had not included A2, although he acknowledges he will start to include A2 in his research now. This is important because this probably reflects roughly, the proportions of type 1 & 2 muscles in the body, depending on your blood group, which correlates with the amount of red meat available in indigenous diets of our ancestors. Type 1 muscles need carnitine, so to get it we need to eat more red meat in our diet.
CARNITINE and DIGESTION
The breakdown of meat starts in the mouth with
chewing of our food and saliva. In the stomach, hydrochloric acid
provides a major dismantling of protein structure. The next step is the
small intestine where bile from the liver via the gall bladder has further
action in digestion of meat. Pancreatic enzymes are also released here,
with action on all classes of foods. When food hits the stomach, the
message goes out to mobilise insulin too. Insulin prepares the cells to
receive glucose. The messenger doesn't know how much is coming so whether
we are having a snack or a roast dinner, the body prepares for a big
meal. Carnitine is absorbed before fatty foods so supplements need to be
taken on an empty stomach.
TAURINE
Taurine is another amino acid found in meat.
Taurine is used to turn cholesterol into bile. Bile is needed to digest
meat (ie carnitine, fatty acids etc in meat). Without carnitine and
taurine, fats cannot be metabolised properly, so accumulate in liver and muscle
tissue. Taking extra taurine helps to clear fatty build up from the liver
and assists bile production so better absorption. With the liver working
better, there is room to make and store more carnitine. (As well as other
functions of the liver improving, like Vitamin A storage and conversion, B6,
magnesium etc.) We have found that taking 500mg of taurine over a 12
month period reduces the amount of supplemental carnitine needed. Taurine
improves eyesight as well. For hepatitis or gall bladder problems take
1000mg taurine and carnitine to avoid surgery.
GLUTAMINE
Glutamine is another amino acid but this one is
found mainly in grains with gluten. Glutamine is the main
neurotransmitter for the brain. So people who have problems thinking
clearly or are under stress will be down on glutamine. Glutamine changes
readily between glutamic acid, glutathionine and GABA. They are all
different forms of glutamine that have a specific function in some part of the
body. We have found that when carnitine is low then glutamine often is
too. Glutamine has a function in the muscle too. It mops up toxic
lactic acid caused by inappropriate energy production due to lack of carnitine
leading to greater dependence on carbohydrate fuels. If carbohydrate fuel
and carnitine is running low, the body can convert glutamine into glucose to
fuel the muscles. If this is occurring the glutamine cannot be recycled
again for brain function so runs low as a neurotransmitter and transformer of
toxic ammonia in the brain. The result is brain fog.
So you can see that other areas of the body depend on carnitine working properly so that they can too. Choline and Vit B12 help to stop excretion of carnitine in urine. Low levels of Vit C increase urinary excretion of carnitine. So does antibiotics especially ampicillins and poor kidney function. We have found that without reasonable available carnitine, B6 and magnesium can't function well. Many other vitamins, minerals and amino acids are interlinked to adequate carnitine too so a cascade effect of ill health results from poor carnitine levels. Insulin function in the body can be effected, leading eventually to late onset diabetes as well.
HOW DOES CARNITINE WORK
Carnitine is essentially a transporter. It
picks up at one end and delivers to the other side. If we use the story
below - carnitine arrives on the meat bus with a lot of other visitors all
coming to a number of parties in lots of places. (ie all the other things
we get from meat that help our bodies to work, as mentioned before, like iron,
B6, B12, taurine etc.) One of the breakdowns of meat through digestion is
fatty acids. Acyl means fat. So we'll call our hero "fatty
acyl".
|
|
"Fatty acyl" walks for a way, then finds a horse called "CoA" and hitches a ride to get to his destination. On the way they find a deep, swift flowing river that must be crossed to get to the party. There is a tree on either side (the carnitine enzymes) and strung between them is a rope called carnitine. (the carnitine rope may have come on the bus too and someone else has thrown it across, tying it to the 2 trees.) "Fatty acyl" can hang onto the rope and pull himself across. CoA, the horse, has to swim across. On the other side, "fatty acyl" climbs back on his horse to go to the party, leaving the carnitine rope in place, ready for the return trip after the party.
|
Now here's the same story in
medical terms.
Carnitine transports long chain fatty acids from the
metabolism of protein foods, across the mitochondrial membrane in the muscle
cell with the aid of carnitine enzymes to enable further oxidation via the
Krebs cycle, to produce energy in the form of ATP. Short chain fatty acid
by-products of this process, can recombine with carnitine to exit the cell for
excretion via urine.
So, this diagram is not really so difficult is it?
If this process does not occur, fatty acids accumulate in muscle and liver tissue, unable to be used and getting in the way. Finally, the small amounts of carnitine that are there, have to partner the fatty acids to try and get them out of the way and out of the body. So carnitine is used on the mop-up process instead of transportation to create energy. The end result is fatigue and muscle pain, lack of endurance and muscle weakness.
BLOOD LEVELS of CARNITINE
Serum carnitine levels can be done at some
children's hospitals. This is the case in WA and in other Australian
states. Your doctor can order free and total carnitine levels to be done.
These are covered by Medicare if he feels you have
possible symptoms of low carnitine.
INTERPRETING YOUR RESULTS
Normal levels are generally taken to be
|
Free carnitine 30
- 60 umol/L |
The research being done at the Polio Clinic in
WA, shows that polio survivors often have free serum carnitine levels in the
lower half of the normal range or even below normal range. For resolution
of symptoms of fatigue and muscle pain, levels need to be in the high levels of
normal. So for POLIO the free carnitine levels:
|
for female polios
need to be above 45 umol/L |
ACYL/TOTAL PERCENTAGE
The other factor is working out the usage of
available carnitine in the body. If you subtract the free from the total
reading, it gives the acylcarnitine level. Multiply the acyl reading by
100 then divide by the total reading. This will give the acyl/free
percentage. Normal usage will give a percentage of 10% - 25%. If
the percent is low, then you are not using available carnitine well for some
reason. If the percent is high, then a lot of mopping up of unused fatty
acids is occurring. A percentage above 40% is certainly cause for
alarm. We have found that increasing available carnitine by
supplementation usually resolves these abnormalities.
RESULTS
Your results may look like this:
|
Date
10/8/99
18/9/99 (Normal) Free
carn
29
55 (30-60)
|
The first reading taken before starting carnitine shows a free level well below 45 needed for polio female and 41% is too high. The second reading, taken after being on carnitine for a month, shows that the free level is in the high levels of normal, the percentage is midrange at 17% and hey! - you are feeling a lot better.
Here is a graph showing some changes in readings
See how the first set of readings are low and the
second set for each person are above the 45 dotted line needed to alleviate
fatigue in female post polios.
.
Percentages have also come up or down to a more normal level
CARNITINE OVERDOSE
Carnitine is self limiting. If you take more
than your body needs, it will simply come out the other end in a hurry, ie
diarrhoea. So it is easy to tell if you have taken too much. Some
people may get some tummy discomfit with this. It simply means you have
overdone the dose and your body is rectifying the situation. If you are
very allergic or super sensitive to other medications or supple-ments, go
cautiously with increasing your dose.
INDIVIDUAL DOSE NEEDS
To work out how much supplemental carnitine you may
need, we advise that you start with 250mg and increase by 250mg every 3 days
until you get diarrhoea then reduce by the last 250mg to get your right
dose. Often, below that dose you will still be tired. We have found
it best to take your whole dose, first thing in the morning as soon as you get
up. Do not take it at night. It is likely to keep you awake.
If you are running out of energy later in the day and still have to go out at
night, take another 250mg then. If you are going to have a more energetic
day than normal, eg shopping, gym, golf, physio, mowing the lawn, digging the
garden etc, do take another 250mg just before you undertake this extra
activity. (if you take extra too early you will get diarrhoea.)
Make it work for what you need or want to do.
CARNITINE AVAILABILITY
Carnitine can be obtained in capsule or powder
form. There is some available in health food shops but we have
found that most commercial carnitine is crystalline instead of the proper
powder and this doesn't work as well. It may be okay for healthy sports
people who take large quantities, but we have found that for post polio, chronic
fatigue etc we need the really good stuff. We have established a source
of good quality powder through a professor at Monash Uni who can assure us of
the quality.
People in Australia can order through the WA Clinic and supplies can be sent straight to you from our suppliers. They do not have the time for taking individual orders or counselling so would prefer orders to be directed through the WA Polio Clinic so that you can get advice and we can monitor results. Contact Tessa at Post Polio WA (08) 9383 9050 to have it mailed out. See Carnitine Prices
CARNITINE and DISEASE
Secondary carnitine deficiency can be associated
with a number of diseases. The work of the WA Polio Clinic is showing low
levels in many polio survivors and their descendants. Other research on
autism is showing that at least 50% of autistic children have a carnitine
problem. Carnitine is part of the picture in chronic fatigue.
Muscular dystrophy is showing poor carnitine levels. Malabsorption
syndromes can lead to low carnitine as can pregnancy. People with liver,
kidney and thyroid disease, cystic fibrosis and diabetes can be low in
carnitine. Epileptic drugs and antibiotics can lower carnitine levels.
CARDIAC
As much as 80% of heart muscle is fuelled by fatty
acids and carnitine. Heart disease can result from poor carnitine
levels. Carnitine lowers cholesterol by allowing utilisation of fats,
lowers blood pressure, reduces irregular heart beats, angina and strengthens
heart muscle
DIABETES
Diabetic levels are known to stabilise with
carnitine supplementation. If we look at the way fuel is provided to the
muscle we can see that insulin is the major catalyst in Type 2 muscles and
carnitine in Type 1 muscle. If the carnitine cycle is functioning poorly,
this puts more strain on the insulin-carbohydrate cycle to fuel Type 1 muscles
as well as Type 2. But the amount of energy required is a lot greater
(129 ATP for Type 1 compared to 36 ATP via glucose in the Krebbs for Type
2). So that the insulin cycle has to work at more than 4 times the rate
it was designed to and there is a greater craving for carbohydrate foods to
keep up the energy supply. Eventually this breaks down too and we call it
diabetes. Fixing the carnitine cycle may have prevented this happening.
POST POLIO
In post polio there is a documented increase in
Type 1 muscles, changed from Type 2 in the recovery process after polio due to
nerve sprouting. This increases the amount of carnitine needed to run
these extra Type 1 muscles. These muscles are larger and less efficient
so carnitine storage can be depleted too. We have been researching
carnitine in post polio in WA since 1994. Many of our members have
resolved fatigue and pain issues with a daily carnitine supplement. Some
have returned to work, having previously taken a Disability pension because of
fatigue and pain. Most say this has given them a new lease on life.