ALSUntangled 53: Carnitine supplements

Figures & data

Table 1 Table of evidence for L-carnitine (LC).

	Grade	Explanation
Mechanism	A	LC improved blood biomarkers of antioxidants and oxidative stress in several human trials.
Pre-Clinical	C	A single flawed study in a peer-reviewed journal showed benefits of LC administration to the mutant SOD1 mouse model of ALS.
Cases	F	Neither of the 2 PALS we found taking LC reported any benefit.
Trials	F	A single very flawed pilot trial of LC in PALS found no benefit.
Risks	B	Mild-moderate gastrointestinal distress and/or rarely a fishy body odor may be experienced in <5% of patients.

Table 2 Table of evidence for acetyl-L-carnitine (ALCAR).

	Grade	Explanation
Mechanism	A	ALCAR increased blood ATP levels suggestive of increased mitochondrial energy production in a single human study.
Pre-Clinical	D	Two research groups showed benefits of oral ALCAR in two different mouse models of ALS. Neither of these studies have been published in a peer-reviewed journal.
Cases	C	One PALS with a validated diagnosis experienced substantial and sustained functional improvement (“ALS reversal”) on a multi-compound regimen that included ALCAR.
Trials	D	A single randomized double-blinded placebo-controlled clinical trial reported benefits in PALS; however, violations of protocol in subject selection, as well as, post-hoc sub-analysis of the results requires that the results be interpreted with caution.
Risks	B	Mild-moderate gastrointestinal distress and/or rarely a fishy body odor may be experienced in <5% of patients.

Table 3 Table of evidence for propionyl-L-carnitine (PLC).

	Grade	Explanation
Mechanism	A	PLC improved blood biomarkers of antioxidants and oxidative stress in several studies and increased blood ATP levels suggestive of increased mitochondrial energy prodution in a single study.
Pre-Clinical	U	We found no studies testing PLC in pre-clinical models of ALS.
Cases	U	We found no cases of PALS taking PLC.
Trials	U	We found no trials testing PLC that enrolled PALS.
Risks	B	Mild-moderate gastrointestinal distress and/or rarely a fishy body odor may be experienced in <5% of patients.