Acetyl L-Carnitine

(...Treatments 7)

Along with Alpha Lipoic Acid, you will often see the name Acetyl L-Carnitine, when you go looking for non-chemical treatments in the supplement and health shops. It's another supplement that seems to have several useful purposes, especially for HIV patients.

What is it?
Acetyl L-carnitine HCL is an amino acid naturally manufactured in the body through the conversion of L-carnitine and used by cells to produce fuel for energy. It is also involved in a variety of processes that regulate muscle movement and heart and brain function.

Acetyl L-carnitine deficiency has also been shown to be present in a significant percentage of HIV-infected individuals diagnosed with peripheral neuropathy. In small studies, supplementation with this nutrient alone has been successful in reversing the peripheral neuropathy seen in both diabetes mellitus and HIV disease which may have led to yet further research into the need for it to be supplemented - from then on, it's a short step to commercial production but like everything else, we have to be sure it's worth the effort, doesn't do any harm and improves our own personal situation.
Other studies have found that regular supplementation with carnitine can help to reduce abnormal levels of triglycerides, a fatty substance in the blood (see earlier post about Triglycerides).

After you're convinced about those things, you need to consider the fact that it's another very pricey supplement and considering the high doses needed, it can be beyond many people's budgets (a dose of 1500mg twice daily was used in one of the primary studies and is often quoted as the effective dose, though there is some anecdotal evidence for effectiveness at a lower dose).

Acetyl L-carnitine HCL is known by a variety of other names, including acetyl L-carnitine hydrochloride, acetyl L-carnitine and simply acetyl carnitine. It is synthesized in the liver and kidneys and stored in the heart, brain, muscle tissue and sperm. Most people produce sufficient amounts of this amino acid.

There have been several scientific researches into the efficacy of Acetyl L-Carnitine:

In 2004, scientists at the Blond McIndoe Centre at the Royal Free and University College Medical School in London published the results of ALCAR administration to 21 HIV-positive neuropathy patients. They found that twice-daily administration of 1500 mg ALCAR for 6 to 12 months reduced neuropathy symptoms and increased nerve regeneration. No changes in CD4 cell count or HIV viral load were observed. Their positive results were published in the journal AIDS, and prompted further research.

A 2005 report issued by researchers at the Royal Free Hospital, London, sought to establish whether this symptomatic improvement was long-term. Through follow-up assessment of 16 participants with different adherences to ALCAR treatment, they determined that the improvement was in fact long-term. They also found that patients did not need to discontinue their use of NRTIs to experience this improvement, and outlined their findings in the journal HIV Clinical Trials.

Research from the University of Milan and the Department of Infectious Diseases of Milan released the results of a four-week study with ALCAR treatment in the Journal of the Peripheral Nervous System (abstract) in 2006. Through administration of 2000 mg of ALCAR per day to 20 HIV/Neuropathy patients, they corroborated previous findings that the supplement reduced pain symptoms. However, they noted no nerve regeneration.

A 2007 publication in HIV Medicine by researchers from both the London and Milan groups examined the effects of injected and oral doses of ALCAR to assess the overall safety of ALCAR in either application. The intramuscular injections were administered twice daily in 500 mg doses, and the oral supplements 1000 mg once daily. Both resulted in decreased pain versus the placebo group, and both were reported to be safe. Because the study only took place over an eight-week time period, no inferences on nerve regrowth were drawn.

The most recent report, released in 2009 in HIV Medicine (abstract) by the Hawaii AIDS Clinical Research Program, found that patients treated with 3000 mg ALCAR daily experienced significant improvement in their pain symptoms over 24 weeks. It was again noted that this improvement did not coincide with any nerve regeneration.

Investigation of ALCAR’s ability to reduce pain and induce nerve regrowth in people suffering from neuropathy continues. Additionally, a phase 2 clinical trial is currently underway to see if ALCAR can prevent nerve damage in people taking antiretroviral drugs.

As with almost all supplement investigations and research, you will also find articles which counter the claims of others and the results of tests on Acetyl L-Carnitine are not universally accepted as being positive but the worst anybody seems to be able to say is that the results are inconclusive and not that Acetyl L-Carnitine is in any way harmful.

As with any supplement, you should therefore discuss Acetyl L-Carnitine with your doctor before adding it to your drug list - it does seem to be widely recognised as an option, by HIV specialists and neurologists these days.

A combination of Acetyl L-Carnitine and Alpha Lipoic Acid in one pill/capsule is also widely available via various manufacturers and that may well help with the cost problems but again, you should always carefully check how much of both supplements is actually contained in the supplement. It's sometimes a bit of a minefield but especially when you're trying to cut costs, it's wise to make sure you're getting the best value for money.