Carnitine Confusion

This is another one of my articles inspired yet again, by my travels through Thailand. I see products all over filled with one type of supplement or another and carnitine is common. You may have heard of this compound before. Do you take supplemental carnitine? What is it good for and do we need more than what is provided in a healthy diet?
Carnitine comes from an amino acid and is in almost all of the body’s cells. It was initially found in meat and you may have seen it written as L-Carnitine, propionyl-L-Carnitine, and acetyl-L-Carnitine. If you have ever seen it touted for its ability to burn calories or provide energy, that is true. It helps bring certain fats into the mitochondria (the powerhouses of the cell) so they can be burned, or in more scientific terms, oxidized to make energy. It also removes toxic compounds that are generated in the mitochondria by transporting them out. So, carnitine does help burn fat and prevent build up of toxic substances, but that doesn’t mean extra carnitine will lead to extra fat loss.
As far as recommended intakes are concerned, most people do not need supplemental carnitine because our bodies can make and store what we need. Most of it is concentrated in skeletal and cardiac muscles that can and do use fat from food as fuel. There are a few exceptions for needing supplemental carnitine, however they are very specific and related to genetic and medical issues. The liver and kidneys synthesize carnitine from the amino acids lysine and methionine and animal products are the best, naturally occurring sources of carnitine. It is found in meat, fish, poultry, and dairy products (primarily in whey), and then of course, there are products with added carnitine.

Carnitine Supplementation
Carnitine is naturally found in fish and meat.

So what’s the scoop, or the goop?! The Food And Nutrition Board (FNB) has not set recommendations on intake amounts as they concluded it is not an essential nutrient after reviewing various studies. A good place to look is at the metabolism of supplements in question and see what happens when we have too much. Our bodies are able to regulate and maintain proper blood concentrations of many substances and compounds in the body, that whole homeostasis thing, and so our kidneys do that for us with carnitine. Even those who may not consume much carnitine, like vegetarians and vegans, are able to maintain proper blood levels. Furthermore, and according to the National Institute of Health, most (54-86%) of the carnitine that we do eat is easily absorbed in the small intestine and enters into the bloodstream. Guess what happens when we eat too much? The kidneys will excrete it in our urine, it helps maintain that stable blood concentration. So while we may want more of a good thing, something that helps us burn fat, extra amounts do not really help if its weight loss we are looking for.
With that, however, there may be some instances where additional carnitine, more specifically, acetyl-L-carnitine, is warranted. This form of L-carnitine is better absorbed in the small intestine and gets into brain tissue better (it can cross the blood brain barrier more easily). Regarding athletics, there has been inconsistent evidence showing that carnitine enhances performance, helps the body use more oxygen, improves metabolism during exercise, nor has it been shown to increase intra muscular levels of it. When it comes to aging, and some other instances, added carnitine maybe beneficial. It may play a positive role in improving mental function and lessen deterioration in adults with some cognitive impairments and Alzheimer’s disease. Supplemental carnitine may help manage cardiovascular and peripheral artery disease, fatigue caused by chemotherapy for cancer treatment, type 2 diabetes; and in HIV and AIDS, it may slow progression and reduce neuropathy associated with the disease. But, these benefits are very specific and if you are affected by any of them, speak to your doctor for more case specific treatment regarding supplemental carnitine, Furthermore, many studies yield mixed results, so more research is always needed.
In short, we excrete carnitine beyond what the body needs, so supplements to improve athletic performance or to speed weight loss are largely ineffective. In the case of products with added carnitine, you can eat or drink them if you like, but like all things, do so in moderation. I’m not going to lie, sometimes I like the cool, fruit flavored jelly pouches in Thailand that have various supplements in them, but I only eat them occasionally and do so mostly because they are tasty and refreshing in the heat! Overall, eat a healthy diet with lean protein and skip the supplemental carnitine.

Nutrition Education in Developing Nations

Sampon Boat, Bangladesh
Sometimes when you travel, you have a lot of time to think about things.

This is kind of a random “other” post blog, but these things are always on my mind and I felt like putting them down onto internet paper. I just got back from a week in Bangladesh and have even more things on my to do list now yet the more I travel, the more tired I’m becoming. Maybe a good break early next year will be good and I can start putting some ideas into motion!

If you follow me on FB, you may know I applied for a fellowship with Duke University through the Academy for Nutrition and Dietetics. The Academy is the regulating body for registered dietitians in the US and the goal of the fellowship is to address chronic malnutrition in Central America through conducting a “mapping of the existing interventions and an assessment of the steps needed to address chronic malnutrition in Central America.” When this fellowship was announced, I was so excited. Having wanted to work in world nutrition for the past 10 years now, I thought this would be a perfect opportunity. I updated my resume and wrote a cover letter for the position. I did my best to convey my passion to work in this area, but I got no response between the application deadline and the start of the interview process. I emailed to follow up and I was told the interview period was extended. They received more applications than expected so I guess it was going to take longer to make a decision. I never heard back. I was a little crushed, I won’t lie, but the fact that the opportunity came up turned out to be a good thing. It reignited a passion that I’d let die down. I began looking for other opportunities, I followed some NGOs on Instagram, and I even applied for an international independent contractor position through the United Nations Operations website. The position is based in Yangon, Myanmar (woo hoo, one of my favorite countries), but it’s more related to nutrition policy and less field work. The application deadline was extended. It seems like an obscure position so I think they didn’t get enough applicants, but I also did not hear back from them, unfortunately. Anything to get my foot in the door with a big aid organization would be like getting a golden ticket!

Swedagon Pagoda, Yangon, Myanmar
The golden Shwedagon pagoda in Yangon, Myanmar

Back to my travels for a bit. When I began, I thought I would find some way to work or volunteer with an organization that has some focus on nutrition. Aside from my month long stay in Kathmandu, that has not happened. Since then, however, my friend Asta has been developing her NGO, World Friendship Nepal. They work with mothers and children to educate them on healthy, post partum practices. Uterine prolapse is a common occurrence in Nepal and the NGO is teaching women what they can do to protect themselves. Because the primary focus is on women and children, Asta wants to incorporate nutrition education as well because as we all know, child nutrition is so important! She will be using the documents we put together when I was in Nepal last year.

Nutrition Education in Nepal
Nutrition Education in Nepal

There are tons of aid organizations and NGOs out there, but it’s a matter of finding one that wants to align with a dietitian and place an emphasis on nutrition education. I’ve yet to find that perfect position or opportunity, so I swear I’m somehow going to create it for myself! Something must be done. Large aid organizations help in developing countries, they donate food, deliver supplements, and help with farming practices, but I know more can be done. I want to do research on how these organizations operate. What do they do, what do they donate, and why? What systems can be improved upon? How many people are out in the field? How many are in offices? I’ve read so many plans and policies to improve nutrition outcomes over time, but let’s stop wasting time writing up these documents. We need people out there, getting into these remote villages and connecting with people. Uniceff has a big vitamin a supplementation program, but why supplement? So many of the nations that are vitamin a deficient have foods rich in vitamin a. There are so many issues involved with supplementation programs, so why not teach people improved farming practices, introduce new, nutrient dense crops? I’m not saying these things are not being done, they are, but MORE can be done, right? The WFP does food drops and staple donations. But sometimes, these staples just fill, they don’t properly nourish. We need to start from the ground, literally, by planting better, and more nutrient dense crops. Yikes! I’m getting ahead of myself because in order to do that, you need to change culture and that’s not an easy feat. Rice here in Asia rules, yet it is so nutrient void. I wish people could really understand that and make a shift.

Plate of Rice
A plate of white rice, the centerpiece to any Bangladeshi meal.

I wish I knew more. I wish I could learn some languages in remote villages, I wish I could live and work alongside locals and see how they eat and live. I wish I could befriend them and teach them about nutrition for their own benefit. Basic nutrition practices can have such positive lifelong benefits.
Even though I love fitness and working with athletes and bodybuilders, the most dramatic changes take place at the basic level. Eating the right foods can easily prevent so many avoidable diseases.
I don’t know where the future will bring me. I’ve begun contemplating starting a PhD. Maybe I can create a long term project in some remote village, working in conjunction with a small, legit NGO. If anything, I’ve come up with some recipe ideas in my head for therapeutic supplements that are far more nutrient dense than existing products currently on the market. But, with superior quality comes higher costs. I can definitely see myself experimenting in my kitchen (next time I have my own, that is).

Purple Sweet Potatoes
Purple Sweet Potatoes in Laos.

I don’t know how all NGOs work, I don’t know if I can partner with one, but whatever the case, some day I will do/make/create something to somehow alleviate some of the malnutrition in this world. Vitamin A deficiency seems to me to be a key target and sweet potatoes are calling my name. I’m going to start a sweet potato revolution, I just have to figure out how to do it. So much more learning to do!