Now, however, I’m recommending L-carnitine to more and more of my patients because recent studies show that when older people take this safe, inexpensive nutritional supplement, it boosts physical and mental energy and endurance, reduces fatigue and muscle loss, and enhances cognitive function.

Two Key Benefits of L-Carnitine: Energy and Healthy Aging

Carnitine is an amino acid that is synthesized in the liver and kidneys—and concentrated in the body’s most metabolically active organs: the brain, heart, and muscles. Its primary job is to transport fatty acids into themitochondria, where they’re burned for energy.

Young, healthy people produce all the carnitine they need. However, levels may be depleted by kidney and liver disease, genetic defects, valproic acid (an epilepsy drug), cancer—and advancing age. Declines in mitochondrial function are a significant underlying cause of the energy drain associated with aging, and carnitine plays an essential role in increasing energy production. Therefore, it’s not surprising that deficiencies in this amino acid are associated with fatigue, loss of muscle mass and increase in body fat, mental and physical slowdown, and frailty.

This leads to an obvious question. Could replenishing carnitine stores with nutritional supplements delay or reverse some of the adverse effects of aging?

L-Carnitine Puts Pep in Your Step

Clinical trials of supplemental L-carnitine have yielded consistently positive results in terms of self-reported physical and mental fatigue, ability to exercise, and improvements in body composition—particularly when the study subjects are older and/or have documented carnitine deficiencies. Here’s an example.

Italian researchers enrolled centenarians, who fatigued easily and had impaired strength and mobility, and gave them either 2 g of L-carnitine or placebo capsules daily. After six months, no significant changes were noted in the placebo group. Those who took L-carnitine, however, gained an average of 8.4 pounds of muscle mass and lost four pounds of fat. Mental and physical endurance improved, and they gained an average of four points on the 0–30 scale of the Mini-Mental State Examination, a common test of memory function.

Now you can see why I’m so enthusiastic about the health benefits of L-carnitine. If 100-year-olds can have such remarkable turnarounds, just imagine what it could do if you started taking L-carnitine in your 60s or 70s, when carnitine concentrations begin to plummet?

L-Carnitine Offers Extraordinary Cardiovascular Support

At Whitaker Wellness, we put all our patients with cardiovascular disease on L-carnitine. Its efficacy was confirmed by a meta-analysis published recently in the Mayo Clinic Proceedings. Researchers analyzed 13 placebo-controlled studies involving 3,629 patients with a history of heart attack. Compared with placebo, L-carnitine reduced angina by 40 percent, dangerous ventricular arrhythmias by 65 percent, and death by 27 percent.

Before we go on, I want to address a safety issue in regard to heart disease. A few days before this meta-analysis was released, the media had a feeding frenzy over a small, insignificant study that suggested dietary carnitine and L-carnitine supplements promote cardiovascular disease. The stupidity of this nonsensical conclusion is evident to anyone who bothers to check the science. But most media outlets do little more than regurgitate press releases or march lockstep with the likes of the New York Times, which did a real hatchet job, and the sound bite about “the dangers of carnitine” went viral. (For more information, refer to this blog post.)

Meanwhile, the stunning, absolutely newsworthy Mayo Clinic Proceedings meta-analysis was all but ignored. Nobody retracted the warning against L-carnitine—you’ll still find it on the Internet from what I used to think of as reputable sources such as Dr. Oz. Do not believe it. The science indisputably proves that L-carnitine is exceptionally safe and does not cause heart disease. On the contrary, it’s one of the best supplements for treating cardiovascular conditions.

Even More Health Benefits of L-Carnitine

L-carnitine is often positioned as a weight loss aid. Although it definitely improves body composition in older people, many of the studies in younger people aren’t so positive, probably because they already have optimal carnitine stores. It can, however, enhance exercise endurance and capacity in all age groups by increasing muscle carnitine levels and improving energy metabolism. L-carnitine is by no means a magic bullet, but if you’re willing to exercise regularly—especially if you follow the mini-fast with exercise protocol—it may help.

Other health benefits of L-carnitine, especially acetyl-L-carnitine, include improved memory in older people and slowing of Alzheimer’s progression. The acetyl group in this type of L-carnitine can be used to form acetylcholine, an important neurotransmitter that markedly declines as dementia advances. Both forms, however, increase mitochondrial energy production and power up energy-starved brain cells.

Patients with cancer will likely benefit from L-carnitine as well. Most people who undergo chemotherapy and/or radiation report significant fatigue. In addition, advanced disease is associated with cachexia, or muscle wasting and weight loss, and low carnitine levels may well contribute to this. L-carnitine is not a cancer therapy, but it has been reported to improve fatigue and quality of life—and that’s reason enough to use it.

More benefits of L-carnitine include relief from chronic fatigue syndrome, diabetic neuropathy, peripheral vascular disease and intermittent claudication, insulin resistance and type 2 diabetes, kidney disease and dialysis, and male infertility and erectile dysfunction.

For all these reasons and more, I’ve added L-carnitine to my daily supplement regimen and suggest you consider doing the same.

Start Reaping the Benefits of L-Carnitine

You can get carnitine from dietary sources including poultry, fish, dairy, and red meat, but for therapeutic purposes I recommend supplements. If memory is your main concern, you may want to go with acetyl-L-carnitine; otherwise, I’d stick with less expensive L-carnitine. The suggested dose is 2–4 g per day, taken in divided doses (1–2 g twice a day) between meals.

There are a few things to consider and there isn’t one right answer for everyone. There are also different ways to maintain a ketogenic program which will depend on the individual. Going into the process blind can lead to frustration, but with the following guidelines and things to look out for, you will have a better idea of the right way to transition from carbs to fats and the benefits that come along with it.

How Do You Get into Ketosis?

Ketosis is all about eliminating your body’s dependence on carbs as an energy source. That means reducing your net carb intake typically to below 50g per day. Ketosis can be encouraged by both fasting and aerobic exercise below the lactate threshold. [1] This is because by restricting carbohydrate intake and depleting stored glucose (glycogen) through exercise, your body will seek to breakdown fats as an alternative energy source.

How you initiate ketosis will depend on things like your activity level, schedule, and lifestyle considerations. Consider your experience with nutrition and diet before looking into various methods. Some sample approaches include the following: [2]

Moderate Approach: This is a good choice for most people who want to try a keto diet. Skip one meal per day while reducing your net carb intake below 30g per day. Skipping a single meal, typically either breakfast or dinner will encourage your body to enter ketosis. One consequence of ketosis is reduced appetite, so although you might feel like this is a big step, you can compensate with larger portions for your other two meals until your body adjusts.

Soft approach: For some, jumping in right away can be tricky. If this is case for you then you can start by cutting your main carb culprits. These include your breads, pastas, and desserts while adding in smaller quantities of healthy fat food sources. Work on reducing your net carb intake below 80g per day and continue to work down to below 30g of net carbs per day.

Hardcore approach: Others find that if they are going to do something, they need to go all in. If this sounds like you, then one thing you can try is to fast for a day or two followed by restricting net carb intake to below 20 grams per day. You can use MCT or coconut oil to help. This is not recommended for the beginner or for those who have not had experience with various fasting methods.

What are net carbs?

Net Carbs(g) = Total Carbs(g) – Total Fiber(g)

Since your body does not digest fiber and fiber does not raise your blood sugar (thus doesn’t trigger insulin response), it does not contribute to your carb count when factoring into a ketogenic diet. So when taking into consideration your carb intake, make sure to subtract your fiber from total carbs in your meal.

Three Types of Ketogenic Diet
Ketosis is all about reducing your carbs until your body is running off fats for fuel. This is a great way to burn fat while providing mental clarity and energy throughout your day. But there are a few situations that might require modifying your approach to ketosis. Here are different ways to apply a ketogenic diet depending on your activity level:

1. Standard Ketogenic Diet (SKD)

This is the most common and simplest application of a ketogenic diet. Once you have achieved ketosis, you simply keep your net carb intake below the required amount (around 30-50g) to sustain it. Unless you are engaged in strenuous exercise, or are an athlete, this is likely the diet for you. The good part is that it’s also the easiest to follow.

2. Targeted Ketogenic Diet (TKD) [3]

An intermediate application of the ketogenic diet, this variant applies to individuals who undergo regular high intensity training. High fat diets are able to support low intensity exercise but can make it difficult to achieve the results you may be looking for during high intensity workouts. This is because your body relies on stored sugars (glycogen) for these intense bursts of energy.

TKD gets around this by incorporating a small intake of carbs around a workout. Because you will be looking for quick energy, it is best to consume these carbs relatively soon before your workout (recommendations range from an hour to 15 minutes prior). These carbs should also have a high glycemic index because you are looking for fast absorption.

The idea here is not to binge on carbs, but instead to provide your body with enough glycogen to draw on when achieving those high intensity workouts. By doing so, your body will deplete those stores and can return to its ketogenic state after your workout where you will retain the benefits of ketosis.

3. Cyclical Ketogenic Diet (CKD) [1]

This approach to ketosis should only be undertaken with prior experience with ketosis and high intensity activity demands. Like TKD, CKD adds carbs to your keto routine. However, instead of a small intake of carbs before your workout, you spend 5-6 days with a standard ketogenic diet followed by 1-2 days of a carb-intensive diet.

The idea here is that while ketosis depletes your glycogen stores your body will actually overcompensate when presented with carbs for energy and store more than it normally would. This provides plenty of energy to accomplish high intensity routines (particularly in the beginning of the week) while still maintaining the fat burning benefits of ketosis throughout the week. Unlike TKD where the idea is to absorb carbs quickly, for CKD it is better to choose carbs with a low glycemic index as your carb loading is more prolonged and will provide more glycogen when re-entering ketosis for the week.

These methods can almost be viewed as beginner, intermediate, and advanced applications of a ketogenic diet. If this is your first look into ketosis, the standard approach is definitely where you should start. If you already do your fair share of high intensity exercise, you might want to experiment with the targeted approach to see how it contributes to your routine. Only once you’ve tried both, and have significant high intensity activity demands as part of your routine, is it recommended to try the cyclical approach. All three methods have their place and can accommodate performance pitfalls you might encounter while applying your ketogenic diet.

Avoiding Common Mistakes. How to . . .

(i) Beat Keto Fog
Keto fog, sometimes referred to as keto-flu, happens when your body first adjusts to a ketogenic state. Especially if you have a very carb-intensive diet, your body might take time to adapt to ketosis. This is a temporary feeling and can be managed by helping your body receive the boost it needs during the transition.

One way to do this is with beta-hydroxybutyrate (BHB) salts. [4] BHB is one of the primary ketone bodies the body uses for energy while in ketosis. Providing your body with exogenous BHB salts will offer an easier energy source while your system adjusts to breaking down dietary fats and burning your stored fat for that energy.

Ketogenic diets can have a diuretic effect related to carbohydrate depletion so it is important to stay well hydrated to stave off any dehydration symptoms that may contribute to keto fog. One common remedy for symptoms includes consuming a good quality bone broth that offers nutrients, hydration, and sodium to replenish your system.

Note: Once you’ve felt like your body has adjusted, consider removing the BHB salts from your diet. Reliance on exogenous ketones will impair your body’s ability to break down its own fat stores which can get in the way of potential weight loss goals.

(ii) Maintain Adequate Micronutrients

Since ketogenic diets can be diuretic in nature they can also lead to a loss of electrolytes. Combined with a restriction in food variety, supplementing your transition–and even your keto diet in general–with a multivitamin along with electrolytes like calcium, potassium, and magnesium can ensure your body is receiving the micronutrients it needs to run smoothly. Careful planning with your keto diet can provide many of these nutrients over time but supplementing might provide a smoother transition. Make sure all supplement sources are sugar free so that they do not contribute to your carb intake.

Your success with ketosis will come down to finding the right way to transition from carbs to fats while accommodating your activity level with the best diet. Many reported downsides come from neglecting ways that can ease the process and provide the nutrients needed to sustain the transition and activity levels thereafter. By utilizing the right supplements and strategies around your workouts, you can forego the pitfalls of poorly executed ketogenic diets while reaping the benefits of fat loss, sustained energy, and mental clarity that a ketogenic diet can offer.

Sources
[1] http://www.thinkmuscle.com/articles/mcdonald/training-on-ketogenic-diet.htm
[2] https://paleomagazine.com/how-to-start-ketogenic-diet
[3] https://www.ruled.me/targeted-ketogenic-diet-indepth-look/
[4] https://www.perfectketo.com/exogenous-ketones-supplement-ketones/