Dr. Sahelian on Acetyl-l-Carnitine and a-Lipoic Acid

   (1) Carnitine and ALC (acetyl-l-carnitine)
         A. How They Work
             Found in meat and dairy products. Most non-vegetarians get 100 mg. to 300 mg. per day. ALC is the coenzyme form, and can cross the BBB (blood-brain barrier) with ease, whereas carnitine cannot. Consumption of ALC in rats (Maccari, 1990) showed a reduction in lipofuscin levels as they aged. Carnitine also stabilizes cell membranes, protects synapses, and helps prevent oxidative damage.
         B. Clinical Uses
             ALC showed variable levels of minor improvement in Alzheimer’s patients, but significant remediation for age-related cognitive decline.
         C. Availability and Dosage
             ALC is expensive, and available in doses from 100 mg. to 500 mg.
         D. An Expert’s Opinion
             He likes it. Increases alertness.
          E. The Author’s Experience Same thing.
          F. Cautions and Side Effects
              Very well tolerated.
          G. Recommendations
              Recommends 100 to 250 mg. per day for vegetarians.

    He also says,
    "ALC (acetyl-l-carnitine) play several important roles in the human body, particularly in energy metabolism. These nutrients shuttle acetyl groups and fatty acids in mitochondria for energy production. Without carnitine, fatty acids cannot easily enter into the mitochondria. The acetyl group of ALC is used to form acetyl-CoA, the most important intermediary in the generation of energy from amino acids, fats, and carbohydrates. Therefore, ALC serves as an energy reservoir of acetyl groups and help improve energy production. Those who take carnitine pills notice an increase in energy levels. The acetyl group of ALC  is also used to make the important brain chemical acetylcholine. Some studies suggest that perhaps ALC can even act as a neurotransmitter itself.
    "In addition to producing energy, these two nutrients remove toxic accumulations of fatty acids from mitochondria, keeping these organelles healthy and functioning at their best (Carta, 1993). Energy production in the mitochondria is not a perfect process, and toxic metabolites can accumulate. Accumulation of these toxic metabolites and the resulting oxidative damage is likely to contribute to aging of cells. (Shigenaga, 1994). A waste substance called lipofuscin accumulates in cells as we age, and perhaps adequate ALC intake can help minimize this accumulation. A study in rats providing them with ALC from their youth, showed this nutrient to decrease lipofuscin in their brains as they got older (Maccari, 1990); therefore, it is theoretically possible that supplementation with ALC can slow the aging process.
    "As if the above benefits weren't enough, studies show that ALC stabilizes cell membranes, protects synapses, and protects neurons from damage against oxidation."

   (3) Lipoic Acid (LA)
        Lipoic Acid is a coenzyme (also known as alpha-lipoic acid or thiotic acid). Helps raise glutathione levels. Cognitive studies so far have been performed only with animals.
        A.Role in Neural Disorders and Memory
           Improved memory slightly in older mice but not in young mice.
        B.Availability and Dosage
           Available in 50 and 100 mg. capsules, but you only need 5 to 20 mg.
        C.The Author’s Experience 
           There’s actually a noticeable effect from taking LA. Gives a relaxed sense of well-being and slightly enhanced visual acuity. Doses of 40 mg. or more caused insomnia.
        D.Cautions and Side Effects
           High doses can cause stomach upset, over-stimulation, and insomnia. Can lower blood sugar levels.
        E.Recommendations
           Doesn’t recommend taking more than 20 mg. a day.

Dr. Sahelian writes,
    "Lipoic acid (LA) is a natural coenzyme important in the regulation of carbohydrate metabolism. Lipoic acid is also becoming recognized as having some unique and powerful antioxidant abilities. I would have included LA in the chapter on antioxidants but chose to place it in this chapter since, unlike other antioxidants such as vitamins E and C, LA is more clearly involved in energy production and provides noticeable cognitive effects. Over the past few years this nutrient has been tested in the treatment and prevention of a broad range of diseases, including diabetes and diabetic neuropathy.
    "LA is often mentioned in the medical literature as alpha-lipoic acid or "thiotic acid". Although LA is found in small amounts in foods (such as meats and spinach), full evaluation of LA in food contents have not been done as well as they have for other nutrients.
    "LA has some particularly useful antioxidant properties. It can help preserve the function of vitamins C and E, and increase the levels of glutathione, a very important antioxidant normally found in our cells (Busse, 1992). Glutathione (perioxidase) is an important natural antioxidant in the brain particularly for patients with Parkinson's Disease. Dr. Lester Packer and colleagues from the University of California at Berkeley have done extensive studies with LA (Parker, 1997). They say,

"The membrane antioxidant alpha-lipoate is absorbed from the diet and crosses the blood-brain barrier. Alpha-lipoate offers antioxidant protection to both intracellular and extracellular environments. This potent antioxidant can regulate other antioxidants like vitamin C and vitamin E, and raises intracellular glutathione levels. Thus, it would seem an ideal substance in the treatment of oxidative brain and neural disorders involving free-radical processes."

    "Dr. Parker informs me that research on lipoic acid and the brain has thus far been done only with animals and no studies are available regarding the cognitive role lipoic acid plays in humans.

"Role in Neural Disorders and Memory
    "Nerves constantly use a lot of energy and thus are vulnerable to oxidative stress. In order to produce energy, nerve cells have a large number of mitochondria. Energy production produces free radicals, which can damage the DNA within cells. It's possible that an inadequate antioxidant defense system can lead to degenerative disorders of the nervous system.
    "Studies with LA and cognition are limited. When aging mice were given LA for fifteen days, they performed slightly better in memory tests than their younger counterparts given LA. and the number of NMDA receptors in brain cells improved (NMDA, which stand for N-methyl-D-aspartate, is a type of receptor involved with memory). Treatment with LA did not improve memory in young rats. LA has been used in the treatment of diabetic retinopathy with moderate success.