Acetyl L Carnitine for Depression and ADHD

Carnitine is more often associated with its benefits for heart health and while it is not an essential amino acid it can be considered a conditionally essential amino acid in those with heart conditions which might require additional supply (3)  But newer research is showing that L carnitine (in the acetyl form) can also have a positive impact on those with symptoms of depression and ADHD.

It may also be useful for those with PTSD and cognitive loss. This is because carnitine is needed for the hippocampus to work correctly. The hippocampus is the part responsible for memory and this part of the brain can shrink in those with PTSD.

What Is Carnitine

Carnitine occurs naturally and is made in the brain, kidneys and the liver. It has similarities to choline and resembles some of the B vitamins. In order to process carnitine, iron, vitamin C, B6 and niacin are needed. A deficiency in either vitamin C or iron can cause low carnitine levels. (6)

It is needed to release energy from fat and it transports fatty acids into the mitochondria which is the power house of your cells (5)

Because it is synthesized by the body from lysine and methionine it is not an essential amino acid. Only the L form of carnitine is biologically active. (6)

According to Dr. Gaby in Nutritional Medicine, Acetyl L Carnitine is different than carnitine in that this form more closely resembles acetyl choline and functions as a cholinergic neurotransmitter. But this form can also be used for heart health and will still transport fatty acids into the mitochondria. (6) So if you want to address say depression and CVD, you can just take the ALC form for both. (choline by the way is also a brain supportive nutrient that if you are deficient in can lead to mood disorders-egg yolks contain a high amount but beef liver contains the highest amount. Other foods with choline(but in lower amounts) include salmon, chicken breast, almonds, thus vegans and vegetarians  may be deficient in choline.)

Carnitine and Depression

A Stanford School of medicine scientist has found that those with depression have low blood levels of acetyl l carnitine (ALC). (1) . The findings were published in July 2018 in the Proceedings of the National Academy of Sciences but is based on studies in animals.

In theses studies oral and intravenous acetyl L carnitine reversed symptoms of depression within several days (1).

After the animal studies they then looked at men and women ages 20-70 who had been diagnosed with depression. 2 were judged to have moderate depression and 43 with severe depression.

They then compared blood samples with non-depressed people and the depressed people were found with acetyl l carnitine blood levels substantially lower. These finding were found in both the male and females and across all the age groups.

The study also showed that those with the worst symptoms of depression also had the lowest levels of acetyl l carnitine. ALC levels were also found to be lower in those whose depression started at earlier onset in childhood and who also reported abuse, neglect, poverty and exposure to violence. (1)

As opposed to medications for depression, ALC may be of benefit due to its novel mechanism of action because of its diverse functions related with neuroplasticity. ALC’s neuroplasticity effect, membrane modulation, and neurotransmitter regulation may play an important role in treatment of depression. (2)

Carnitine and ADHD

L carnitine, used in a double-blind study for 8 weeks resulted in improvements in 54% of a group of boys diagnosed with ADHD. This was compared to a 13% improvement in the placebo group. They gave the boys 100 mg of L carnitine per 2.2 pounds of body weight with none of the boys receiving more than 4 grams total per day. No adverse effects were seen. However, long term use of L carnitine has not been studies in children so always discuss usage with your health professional first. (5)

Carnitine Food Sources

There is no RDA for carnitine since it is not considered essential. (3)

Carnitine absorption in a typical Western diet is estimated at 54-87% with the rest of it degraded in the intestinal tract. (6) Absorption from L carnitine supplements can be even lower, at 20% and the rest excreted via your urine.

If you are a meat eater you probably consume around 50-300 mg or carnitine per day. If you eat a lacto-ovo-vegetarian diet you consume on average 10-40 mg. of carnitine daily. If you are a vegan, you consume only 1-3 mg of carnitine daily. (6) Thus, if you are a vegetarian or a vegan and are also experiencing ADHD symptoms, fatigue, depression, weakness, and/or impaired cognitive dysfunction, you may want to consider a carnitine deficiency. (6)

Carnitine is found only in animal foods such as breast milk, meat, poultry and dairy products. Children synthesize at age 2 ½ only about 30% the rate of adults. Full carnitine synthesis does not occur until 15 years old. (3)

The highest natural amounts of carnitine are found in red meats. Best sources of carnitine include (in 3.5 ounces) beef steak, 592 grams, ground beef, 582 grams, pork, 172 grams, fish 35 grams, chicken 24 grams.

Who Should Try Carnitine?

IF you are a vegan and suffer from depression and/or ADHD, you may be low in carnitine since the main source is red meat. Pregnant women and those who are breast feeding may also be deficient.

Others who may be deficient in carnitine include those on a keto diet (those on high fat diets), after surgery, burn victims, those on dialysis, liver dysfunction, the elderly, and those with malabsorption issues. (5)

While a severe deficiency is rare it is now thought that some suffer from milder deficiency. It is possible that some have greater carnitine needs that is not being met by diet and endogenous synthesis. (5)

Those Who May Benefit from Carnitine Supplementation (4)

  • Alcohol abuse
  • Angina pectoris
  • Atherosclerosis
  • Cardiac arrhythmias
  • Elevated triglycerides
  • General fatigue
  • Hypothyroidism
  • Immune suppression
  • Ischemic heart disease
  • Low HDL cholesterol
  • Male infertility
  • Muscle weakness
  • Overweight
  • Poor endurance
  • In pregnancy
  • Depression (2)
  • ADHD (5)

Keep in mind that those with weight and heart health issues may benefit from L Carnitine while those with mental health issues and fatigue may be better off with the acetyl L carnitine form.

 

How to Take and Which Form to Take (L Carnitine or Acetyl L Carnitine)

 

L carnitine and acetyl L carnitine are both used to improve mitochondrial function. It has been argued that the ALC form is more readily absorbed however studies comparing the efficacy of the two are limited. However, ALC was more effective at reducing oxidative damage (7). This is important because oxidative damage is associated with systemic inflammation and this inflammation can be a root cause of depression.

There are other differences between L carnitine and ALC form. The L form is often use for weight loss, heart health and for athletes. The ALC form is used for enhancing your cognitive status such as with learning, memory, focus (8) The ACL form can help to remove toxins from the brain and also to remove damaged fats from the brain. The ALC form also crosses the blood brain barrier thus is a better choice for mental health issues. (9)

As stated, because of its effect on fatty acids and energy production especially in the heart muscles it has been known as a nutrient that is useful for cardiovascular disease. (It has been shown to reduce triglycerides and increases HDL). L carnitine has also been useful in weight loss, and it may enhance muscle building and stamina. (4)

Carnitine comes from lysine and methionine (2 essential amino acids). Essential amino acids are those in which you need to get from your diet as your body cannot make these. In many of the studies, the dose was 3 grams.

Start out with one gram and you may need up to 4 grams but gradually work up to this dose. It is best if taken in divided doses. The results could take 4 to 8 weeks for you to notice if carnitine is of benefit for you. Take it on an empty stomach so you may want to start off with one gram in the morning at least 30 minutes before you eat and then when you add a dose if needed, add another one gram later in day on empty stomach (30 minutes prior to meal, 2 hours or more after a meal or snack). If two grams is not helping, increase the morning dose so that you are at 3 grams and then if need be, increase the afternoon dose. (5,6)

If you are at the 4- gram dose for 4 weeks and do not see an improvement, you may want to still continue for another 4 weeks. But if no improvement in mood at 4 grams in 8 weeks, carnitine may not be what you need. (I have not seen any studies that were with doses higher than 4 grams)

You can also divide this into 4 doses, but I find that most people are not as compliant when it comes to taking supplements more than twice per day.

Safety Concerns and Medication Interactions

Carnitine is very safe and has very few side effects even at high doses. However, caution should be used if you have kidney problems or diabetes. (4)

Certain meds may deplete carnitine, and this includes Valproic acid, Pivampicillin, emetine, sulfadiazine, Adriamycin, Lovastatin, and pyrimethamine. Beta blockers may also deplete carnitine stores. (3,6)

Bottom Line

ALC can be worth it to try and see if it helps you, BUT you still need to take a hard look at your diet and possible root causes.  If your diet is filled with processed foods and low in plant foods just adding a supplement may not help.  Typically addressing depression and ADHD needs more than just one supplement.  Your processed diet may be disrupting your blood sugar and your microbiome and may be nutrient deficient.  Always best to take a look at your diet first!

 

Sources

  1. https://med.stanford.edu/news/all-news/2018/07/study-links-depression-to-low-blood-levels-of-acetyl-l-carnitine.html
  2. https://www.sciencedirect.com/science/article/abs/pii/S0022395614000454
  3. Mars, R. (1999) Medical Nutrition, second edition. Oregon: Omni Press
  4. Haas, E. (2006) Staying Healthy with Nutrition. The Complete Guide to Nutritional Medicine. CA: Celestial Arts.
  5. Gaby, A. (2006) The Natural Pharmacy. Revised and Updated, 3rd NY: Three Rivers Press.
  6. Gaby, A. (2011) Nutritional Medicine. NH: Fritz Perlberg Publishing.
  7. https://www.ncbi.nlm.nih.gov/pubmed/15591009/
  8. https://www.ncbi.nlm.nih.gov/pubmed/15039515
  9. https://www.ncbi.nlm.nih.gov/pubmed/3221536