Does Acetyl-L-Cartinite (ALCAR) raise TMAO?

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I was planning to supplement L-carnitine, specially because I've been dealing with some muscle loss. I realized it is pretty bad for the heart though, as it increases TMAO levels considerably.

Research shows that gut bacteria can turn L-carnitine into TMAO. However, I found no data indicating if ALCAR would also cause that. Does anyone have any more details?

Alternatively, does anybody use L-carnitine in any safer way, bypassing gut? Most formulations in the market are oral. Haven't seen many sublingual. I would also be interested in that.

Edit:
Forgot to mention one thing. Apparently raw garlic can inhibit the TMAO production. I could also consider combining oral L-carnitine with garlic. Not sure about the amount though.

https://www.sciencedirect.com/science/article/abs/pii/S1756464615001735
 
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Methyl90

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I was planning to supplement L-carnitine, specially because I've been dealing with some muscle loss. I realized it is pretty bad for the heart though, as it increases TMAO levels considerably.

Research shows that gut bacteria can turn L-carnitine into TMAO. However, I found no data indicating if ALCAR would also cause that. Does anyone have any more details?

Alternatively, does anybody use L-carnitine in any safer way, bypassing gut? Most formulations in the market are oral. Haven't seen many sublingual. I would also be interested in that.

Edit:
Forgot to mention one thing. Apparently raw garlic can inhibit the TMAO production. I could also consider combining oral L-carnitine with garlic. Not sure about the amount though.

https://www.sciencedirect.com/science/article/abs/pii/S1756464615001735
Have you tried constant small sublingual doses between the lip and gum? I take 4 doses of 60mg before training and if I am tired even after then about 500mg.
 
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Have you tried constant small sublingual doses between the lip and gum? I take 4 doses of 60mg before training and if I am tired even after then about 500mg.
Have not tried it. Do you have any brand you would recommend?
The most widely available alternative seems to be the injectable type, which is used by bodybuilders. I was considering that one.
 

Learner1

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I was planning to supplement L-carnitine, specially because I've been dealing with some muscle loss.
What are your amino acids and protein levels like? How much exercise do you do?
I realized it is pretty bad for the heart though, as it increases TMAO levels considerably.

Alternatively, does anybody use L-carnitine in any safer way, bypassing gut?
I have gotten carnitine IV, and, as you found, there's an injectable version. However, just because something is injected, it doesn't mean it won't affect the microbiome.

The TMAO studies are poor quality and pushed by vegan groups.

Carnitine is rather important to proper cell and mitochondrial function. It has two jobs:

  • to transport long-chain fatty acids into the mitochondrion.
  • to regulate the intramitochondrial ratio of acylocoenzyme A to free coenzyme A. This function is important because it allows to remove excessive (and potentially toxic) short- and medium-chain fatty acids from the mitochondrion, and because it maintains sufficient free coenzyme A within the mitochondrion to support energy metabolism.
The most widely available alternative seems to be the injectable type, which is used by bodybuilders. I was considering that one.
That sounds like an awful lot of bother and expense. I am always a little suspicious of bodybuilding supplements, although I have taken a few. It's a whole racket and the quality standards are not as high as the nutritional supplement companies who aren't focused on body builders.

You might also consider acetyl L-Carnitine which benefits the brain.
 

drmullin30

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@marcjf this article https://well.org/nutrition/tmao-high-risks/ says it's important to make sure you have a healthy gut and eat lots of vegetables including brussels sprouts. I take about 1000 -1500 mg a day of ALCAR but I also eat a lot of vegetables including brussels sprouts and I eat a lot of garlic and I exercise frequently. I also take phosphatidylcholine and eat eggs and red meat so this is very interesting to me.

ALCAR has proven very important for my energy levels and mental health.

This article https://labs.selfdecode.com/blog/tmao/ says that fish is particularly TMAO inducing. I don't eat a lot of fish. It also says this:

- "
3) L-Carnitine Supplements
Oral L-carnitine supplements increased TMAO levels in 31 patients on hemodialysis [49].

L-carnitine supplements can also increase TMAO levels in people with organic acidemias (these are rare inherited inborn errors of metabolism), irrespective of meat consumption. However, these studies are small and need much more follow up work before any conclusions are drawn from it [50]."

The TMAO studies are poor quality and pushed by vegan groups.
I agree, my quick perusal of the studies brought up the usual suspects of pharmaceutical backed vegetarian an vegan lobby groups. If you have problems when you eat meat maybe you should get TMAO levels checked. I eat a low oxalate, ketogenic paleo diet (no dairy, no grains, no sugars, no chemicals) with lots of meat and lots of fruit and vegetables and I am in the best shape of my life physically (body fat percentage is down to under 10%, resting heart rate is 50, blood pressure is 110/65 and I am able to put on muscle mass) and mentally I have eliminated my anxiety and depression so I don't think TMAO is an issue for me but I will think about getting this tested in the future.

I do worry about CKD which high protein diets and TMAO is implicated in and I'm waiting to get some results back on my kidneys.
 

Methyl90

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I give you personal advice if you want to optimize the Carnitine flow in your system ... lower Vitamin A. Horse meats are low in Vitamin A ... and rich in carnosine at the same time (I don't mean creatine and not even carnitine). Keep milk and eggs on board anyway ...
 

Methyl90

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Have not tried it. Do you have any brand you would recommend?
L'alternativa più ampiamente disponibile sembra essere il tipo iniettabile, utilizzato dai bodybuilder. Stavo considerando quello.


It doesn't make much difference maybe make sure you have an analysis sheet ... the last one I got came from poland and it's really effective. I've never been comfortable with the fumarate version ... no effect on me.
 
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What are your amino acids and protein levels like? How much exercise do you do?
I am pretty functional, I would say. I go for daily walks, but noticed that there is poor circulation going on. Sometimes I will have leg pain after coming back from a walk. I lost a bit of weight since getting sick as well, and I assume that to be muscle mass. I try to keep up with the calories, but it does not seem to be enough.

I do not have a full picture of my aminoacids. I have been working with a health professional that ordered a stool test where I had short chain fatty acids measured, that was mostly ok, acetate a bit lower than expected.
He also noticed that my Secretory IgA is pretty low. I am supposed to start taking L-glutamine. This one could actually explain a lot some of the weight loss. Glutamine is fuel for both muscle and immune system.

The idea to supplement carnitine is more of my own observation regarding circulation issues. It is not unheard of people actually taking propionyl-L-carnitine (another metabolyte), for example, to improve it. Actually that one may even be more interesting to me than ALCAR in my case.


@marcjf this article https://well.org/nutrition/tmao-high-risks/ says it's important to make sure you have a healthy gut and eat lots of vegetables including brussels sprouts. I take about 1000 -1500 mg a day of ALCAR but I also eat a lot of vegetables including brussels sprouts and I eat a lot of garlic and I exercise frequently. I also take phosphatidylcholine and eat eggs and red meat so this is very interesting to me.
I think we are just starting to understand the role of TMAO in inflammation. Most of the papers are recent.
I've seen some people even wondering if TMAO is the new cholesterol. Specialists spent decades demonizing cholesterol because "it was found in the crime scene". And today we know it has very little to do with the risk of atherosclerosis. So far with TMAO, there does seem to be something more than just correlation, like: https://pubmed.ncbi.nlm.nih.gov/27833015/

I think eventually we will learn how much of it is just caused by dysbiosis, like you mentioned. See the profile of bacteria that produce it, like are they gram-negative?

By the way, I am not cutting any meat or eggs out of my diet. I was mainly worried because with supplements, you are adding a very high intake. The last thing I want is inflammation right now.
Thank you very much for the link. We can always improve our diet.
 

Methyl90

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@marcjf focus on mobility and stretching ... you must be aligned before embarking on any path of strengthening / strengthening muscle mass. Having healthy bones, tendons and ligaments before muscles is a vital step. Many bodybuilders using steroids certainly manage to achieve extraordinary results in a very short time but their tendons and ligaments are unable to support the loads that steroids provide ... and they end up getting seriously injured. Try to always have an overview and not only of details ... using glutamine alone could create problems in the methylation cycle ... but it is just an example ... how even using ALCAR alone could create necks of bottle around and not knowing how to intervene.
 

Methyl90

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What are your amino acids and protein levels like?


My amino acids as far as I'm concerned have always been in the reference range ... those in the blood. Since I partially relieved the methylation block thanks to Fred I have slightly had signs that the muscles were also waking up from a deep coma ... without using alcar yet. Now I use it sporadically.

How much exercise do you do?
I have gotten carnitine IV, and, as you found, there's an injectable version. However, just because something is injected, it doesn't mean it won't affect the microbiome.

The TMAO studies are poor quality and pushed by vegan groups.

Carnitine is rather important to proper cell and mitochondrial function. It has two jobs:

  • to transport long-chain fatty acids into the mitochondrion.
  • to regulate the intramitochondrial ratio of acylocoenzyme A to free coenzyme A. This function is important because it allows to remove excessive (and potentially toxic) short- and medium-chain fatty acids from the mitochondrion, and because it maintains sufficient free coenzyme A within the mitochondrion to support energy metabolism.
I always thought that short and medium fats were the preferred ones for mitochondria as opposed to long chain ones. Can you clarify? ☺️


That sounds like an awful lot of bother and expense. I am always a little suspicious of bodybuilding supplements, although I have taken a few. It's a whole racket and the quality standards are not as high as the nutritional supplement companies who aren't focused on body builders.

You might also consider acetyl L-Carnitine which benefits the brain.


Does it have a negative impact on the thyroid or doesn't it?
 

Learner1

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@marcjf I find it useful to do both plasma AND urine amino acids and have found some very interesting things that gave my doctors and me excellent insights along the way.

Repeated findings in ME/CFS patients are that we have issues with deficiencies of various lipids that make up cell and mitochondrial membranes, as well as having mitochondrial dysfunction. I have personally benefited by replenishing lipids using healthy sources.

It is a mistake to take research based on the "normal" population eating a SAD (standard American diet), people prone to diabetes and cardiovascular disease. There are also biases in the research on TMAO, the studies, which are small, have been used as propaganda to push veganism.

Cardiovascular disease is also linked to high carbohydrate consumption, particularly linked to high unhealthy fats. A family member recently earned as PhD from Tufts Friedman School of Nutrition and recounted a story that cardiologist, Dariush Mozzafarian, head of the school and member of the American Heart Association board told - when the AHA board was presented with the facts that a high carb diet promotes heart disease, and that saturated fats are helpful to health, the board was dithering about what that meant as all of their investments in programs and literature villanizes fat and promoted high carb diets that have made Americans fat and diabetic, he said he just looked at them and said, "Why don't you just tell people the truth?'

In the end, we can't rely on population wide research or research on certain population subsets that don't match us. We should look to the ME/CFS metabolomics research and then our own lab results before making decisions on supplements or foods that affect our health. Many patients with ME/CFS have environmental dresses on their bodies which can cause huge need for nutrient intake. I've found that supporting this increased nutrient need has led to improved function.