Can l-carnitine reduce post-COVID-19 fatigue?, Vaziri-Harami and Delkash, 2021

[Dolphin]

Free full text:
https://www.sciencedirect.com/science/article/pii/S2049080121010955

Review
Can l-carnitine reduce post-COVID-19 fatigue?
RoyaVaziri-harami a ParisaDelkash b
https://doi.org/10.1016/j.amsu.2021.103145Get rights and content

Highlights


•
The coronavirus disease is a viral infection that could induce different respiratory.

•
A significant number of patients infected with the new coronavirus suffer from chronic fatigue.

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Clinical trials have shown the effectiveness of L-carnitine in relieving fatigue.



Abstract
A significant number of patients infected with the new coronavirus suffer from chronic fatigue syndrome after COVID-19, and their symptoms may persist for months after the infection. Nevertheless, no particular treatment for post-disease fatigue has been found. At the same time, many clinical trials have shown the effectiveness of l-carnitine in relieving fatigue caused by the treatment of diseases such as cancer, MS, and many other diseases. Therefore, it can be considered as a potential option to eliminate the effects of fatigue caused by COVID-19, and its consumption is recommended in future clinical trials to evaluate its effectiveness and safety.

CFS
Chronic fatigue syndrome
PVN
paraventricular nucleus
ACE2
angiotensin-converting enzyme 2
RAS
renin-angiotensin system
IL
interleukin

Keywords
COVID-19
Fatigue
l-carnitine
Coronavirus

 

[Dolphin]

Possibly an unpopular post with some here who seem to dislike the idea that a supplement might help.
Personally I think supplements shouldn't be all grouped together: they should be treated like drugs and looked at individually.

After reading this trial of 3000 mg of l-carnitine per day in CFS https://pubmed.ncbi.nlm.nih.gov/9018019/, I tried it and found benefit (but certainly no cure). The effect was evident when I stopped taking it.

A lot of people with ME/CFS have only tried acetyl l-carnitine, which is different.
Or they have only tried a low dosage of it. If you went by the labelling on supplement packets, you would probably try 1000 mg a day max and probably a lot less.

 

[Hoopoe]

It works for me too. Since taking it fairly regularly I'm able to function better. It improves my low stamina levels and poor fasting intolerance. Stopping carnitine suddenly can cause worse fatigue, hunger and hypoglycemia. However I'm not able to tolerate more than a relatively small dose because anything larger is too mentally stimulating and will begin to negatively affect sleep or increase the risk of PEM by making me do too much.

I take acetyl-l-carnitine. Would l-carnitine be less mentally stimulating, thereby allowing me to increase the dose?

 

[Andy]

The paper says

Fatigue is often a sign of a serious disease such as cancer or autoimmune diseases. Chronic fatigue syndrome (CFS) is defined as a particular case in which most patients report other signs such as pain and cognitive impairment [6].

 

[Arnie Pye]

Personally I think supplements shouldn't be all grouped together: they should be treated like drugs and looked at individually.

I have similar feelings on the subject of supplements although, with a few rare exceptions, I tend to stick to vitamins and minerals. I've decided against trying L-Carnitine though, because of this comment :

Underactive thyroid (hypothyroidism): Taking L-carnitine might make symptoms of hypothyroidism worse.

Source : https://www.webmd.com/vitamins/ai/ingredientmono-1026/l-carnitine

 

[Dolphin]

I take acetyl-l-carnitine. Would l-carnitine be less mentally stimulating, thereby allowing me to increase the dose?

Potentially. I’ve read before that Acetyl L-Carnitine affects the brain more.

This study “Exploratory open label, randomized study of acetyl- and propionylcarnitine in chronic fatigue syndrome” https://pubmed.ncbi.nlm.nih.gov/15039515/ found ALC helped more mental fatigue while the other type which I believe is more like l-carnitine helped physical fatigue.

I take both but I also take a sedating tricyclic which I started before taking either. It was years before I took the ALC: it was the l-carnitine where I noticed the more noticeable effect on my general functioning.

 

[Dolphin]

Personally I think supplements shouldn't be all grouped together: they should be treated like drugs and looked at individually.

Of course, the problem with this is that unless there is a patent, it generally doesn’t make financial sense for a company to invest in an expensive clinical trial of an individual supplement.

 

[Hutan]

We have a thread discussing l-carnitine here. Also clicking on the l-carnitine tag (at the top left of this thread) will list other threads tagged with l-carnitine.

This paper from two Iranian authors is speculative; it does not report any new experimental results. So, they are basically just saying, l-carnitine helps with fatigue in other illnesses so it's worth doing some trials for post-covid-19 fatigue.

Conclusion
Since the beneficial effects of this medication in relieving fatigue caused by diseases such as cancer, MS, etc. have been demonstrated, it can also be considered as a potential option for relieving the fatigue caused by COVID-19. Therefore, in order for evaluating the effect and safety of l-carnitine, its administration is recommended in future randomized clinical trials.

l-Carnitine (3-hydroxy-4-N-trimethyl-aminobutyrate) is a micronutrient

I thought it was interesting that the l-carnitine molecule includes butyrate. I think there have been some indications of abnormally low levels of butyrate producing organisms in the microbiome of people with ME/CFS.

Decreased serum acetyl-l-carnitine, polymorphism of serotonin genes, and autoantibodies against muscarinic cholinergic receptors were seen in cases experiencing CFS. The use of l-carnitine, a precursor of acetyl-l-carnitine, improves the clinical condition of CFS patients [31]
[31] T. Okada, et al.
Mechanisms underlying fatigue: a voxel-based morphometric study of chronic fatigue syndrome, 2004

I'm not sure about all of the claims they are suggesting this 2004 paper made, but it would be interesting to look at the paper. I can't remember if low levels of serum acetyl-l-carnitine has been found in other studies.

In addition, l-carnitine may reduce the oxidative stress of skeletal muscles caused by intermittent hypoxia, thereby improving the strength, regeneration, and recovery of fatigue of muscles
L. Shen, et al.
L-carnitine's role in KAATSU training- induced neuromuscular fatigue, 2020

Another paper that sounded interesting.

Comparably, cognitive-behavioral treatments are not enough to help with this condition. Also, hypothalamic-pituitary-adrenal insufficiency in patients with CFS has been described as a result of activation of the immune and inflammatory pathways
S.R. Bornstein, et al.
Chronic post-COVID-19 syndrome and chronic fatigue syndrome: is there a role for extracorporeal apheresis?, 2021

Good to see these Iranian researchers accepting that CBT doesn't help with Post-Covid-19 fatigue.

 

[Arnie Pye]

Of course, the problem with this is that unless there is a patent, it generally doesn’t make financial sense for a company to invest in an expensive clinical trial of an individual supplement.

There is a supplement I take called NAC i.e. N-Acetyl-Cysteine. I read somewhere that it has been available without prescription since the 1960s. It helps a lot of people with severe lung problems. As an ex-heavy smoker I've been using it for about 9 years and it helps to keep my lungs functional most of the time. A lot of people have discovered it in the USA since Covid started. It used to be available online on sites like Amazon US. The FDA has had it removed from Amazon US in the last few months. Apparently pharma companies want to sell it as a drug. It hasn't been removed from sites in the UK, and can still be found online even in the USA. But it is slowly getting harder to find in the USA.