End Fatigue

Lose weight and treat your CFS & Fibromyalgia. We have noted for several decades that the nutrient Acetyl-L-Carnitine is low in CFS & Fibromyalgia and this deficiency contributes to both the weight gain (see How Fibromyalgia, CFS, and Stress can Make You Gain Weight!) and fatigue. This new study shows that it also helps pain and depression in Fibromyalgia as well. A second study shows it even helps cancer related fatigue. The dose to take is 500 mg 2 x day. Higher doses are LESS effective.

Acetyl-L-Carnitine for CFS, Cancer Related Fatigue and Fibromyalgia

Low levels of the carnitine compound acylcarnitine in the blood or muscles of people with CFS/FMS have been found by two different research centers.^(1,2) Carnitine plays many roles in the body. It has the critical function of preventing the mitochondria from being shut down when the system backs up. Also, without sufficient carnitine, the body cannot burn fat (and, in fact, makes excess fat), resulting in large weight gains. L-Carnitine is a naturally occurring form of carnitine that is only found in animal flesh (think "Carni-vore"), and any brand is fine as long as it is pure acetyl-L-carnitine. Although you may not see a marked effect, it helps lay the foundation for your getting better and may help you lose any weight you gained. A new study has now also found that it helps pain and depression in fibromyalgia (3) and even helps cancer related fatigue(4). Take Acetyl-L-Carnitine 500 mg twice a day for at least 4 months. Higher doses are actually less effective. Taking plain Carnitine (as opposed to Acetyl-L-Carnitine) is not effective as it does not get into your cells mitochondria (energy furnaces) properly.

1-A.V. Plioplys and S. Plioplys, "Amantadine and L-Carnitine Treatment of Chronic Fatigue Syndrome," Neuropsychobiology 35 (1) (1997): 16-23.

2-. H. Kuratsune, K. Yamaguti, M. Takahashi, et al., "Acylcarnitine Deficiency in Chronic Fatigue Syndrome," Clinical Infectious Disease 18 (3 Supplement 1) (January 1994): S62-S67.

Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients.

M Rossini, O Di Munno, G Valentini, G Bianchi, G Biasi, E Cacace, D Malesci, G La Montagna, O Viapiana, and S Adami
Clin Exp Rheumatol, March 1, 2007; 25(2): 182-8.

Authors and affiliation: Rossini M, Di Munno O, Valentini G, Bianchi G, Biasi G, Cacace E, Malesci D, La Montagna G, Viapiana O, Adami S. Rheumatology Unit, University of Verona, Italy.

PMID: 17543140

Objective: Fibromyalgia (FMS) is a chronic syndrome characterized by widespread pain, troubled sleep, disturbed mood, and fatigue.

Several analgesic strategies have been evaluated but the results are moderate and inconsistent. Antidepressant agents are now considered the treatment of choice in most patients.

It has been recently suggested that FMS may be associated with metabolic alterations including a deficit of carnitine.

In this multicenter randomized clinical trial we evaluated the efficacy of acetyl L-carnitine (LAC) in patients with overt FMS.

Methods: 102 patients meeting the American College of Rheumatology criteria for FMS were randomized into the study. The treatment consisted of 2 capsules/day of 500 mg LAC or placebo plus one intramuscular (i.m.) injection of either 500 mg LAC or placebo for 2 weeks. During the following 8 weeks the patients took 3 capsules daily containing either 500 mg LAC or placebo. The patients were seen during treatment after 2 (visit 3), 6 (visit 4) and 10 weeks (visit 5). The patients were also visited 4 weeks after treatment discontinuation (follow-up visit).

Outcome measures included the number of positive tender points, the sum of pain threshold (kg/cm² or "total myalgic score"), the Short Form 36 (SF36), a 100 mm visual analog scale (VAS) for self-perceived stiffness, fatigue, tiredness on awakening, sleep, work status, depression, and muscular-skeletal pain, and the Hamilton depression scale.

Results: The "total myalgic score" and the number of positive tender points declined significantly and equally in both groups until the 6th week of treatment. At the 10th week both parameters remained unchanged in the placebo group but they continued to improve in the LAC group with a statistically significant between-group difference.

Most VAS scores significantly improved in both groups.

A statistically significant between-group difference was observed for depression and musculo-skeletal pain. Significantly larger improvements in SF36 questionnaire were observed in LAC than in placebo group for most parameters. Treatment was well-tolerated.

Conclusion: Although this experience deserves further studies, these results indicate that LAC may be of benefit in patients with FMS, providing improvement in pain as well as the general and mental health of these patients.

Safety, Tolerability and Symptom Outcomes Associated with l-Carnitine Supplementation in Patients with Cancer, Fatigue, and Carnitine Deficiency: A Phase I/II Study

Cruciani RA, Dvorkin E, et al, J Pain Symptom Manage, 2006; 32(6): 551-559. (Address: Department of Pain Medicine and Palliative Care (R.A.C., E.D., P.H., J.L., R.K.P.) and Cancer Center (S.M., B.C.), Beth Israel Medical Center, New York; Departments of Neurology and Anesthesiology (R.A.C., R.K.P.) and Pediatrics (N.E.-C.), Albert Einstein College of Medicine, Bronx; and Children's Hospital at Montefiore (N.E.-C.), Bronx, New York, USA).

In a phase I/II open-label trial designed to assess the safety and tolerability of oral supplementation with L-carnitine, doses up to 3,000 mg/d were found to be safe, well tolerated, and reduce fatigue in patients with advanced cancer, in a dose-dependent manner. Study subjects were patients with advanced cancer, moderate to severe fatigue, carnitine deficiency (defined as levels of free carnitine <35 for males and <25 for females or acyl/free carnitine ratio of >0.4) and a score of at least 50 on the Karnofsky Performance Status. Fatigue, depressed mood, quality of sleep and KPS were assessed at baseline and after one week. 27 patients participated in the study, 21 completed the study, and 17 were responders. Subjects were divided into groups and each group was given a successively higher dose of L-carnitine for one week, starting at 250 mg/d and increasing in increments of 500 mg, up to 2750 mg/d, plus a final dose of 3000 mg/d. None of the subjects reported significa nt side effects or toxicities. In the 27 patients who participated in the study, levels of total carnitine and free carnitine were found to increase, fatigue was found to significantly decrease, depression was found to decrease and sleep was found to improve. Among the 17 responders, L-carnitine was found to be associated with total carnitine, free carnitine, and fatigue in a dose-dependent manner. These results suggest that L-carnitine may be safe and well-tolerated in doses up to 3,000 mg/d. Furthermore, supplementation with L-carnitine may help to reduce fatigue in patients with advanced cancer. The authors conclude, "This study provides the basis for the design of future placebo-controlled studies of l-carnitine supplementation for cancer-related fatigue.