Possible Mitochondrial Enhancer for Fibromyalgia

Could A Mitochondrial Enhancer Replace Cymbalta in Fibromyalgia? – Health Rising

How a Mitochondrial Booster Became an Antidepressant

Acetyl L-carnitine (ALCAR) is best known as an energy supplement and mitochondrial booster the but folks in this  fibromyalgia clinical trial were looking for more than increased energy; they were looking for relief from pain and depression as well. They pinned ALCAR not as an energy booster per se, but as a central nervous system protectant – and they had good reason to do so.

Clin Exp Rheumatol. 2015 Mar-Apr;33(1 Suppl 88):82-5. Epub 2015 Mar 18. A randomised controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgia patients: preliminary data.

Acetyl L-carnitine

Acetyl- L-carnitine’s (ALCAR) transport of the important metabolic factor Acetyl CoA into the mitochondria increases energy production. Similar in structure to acetylcholine, it also stimulates acetylcholine production and enhances cellular membrane health.

It’s where it does all this that is key. By enhancing energy stores and maintaining membrane fluidity in neurons it may reduce neuronal death. By reducing glutamate levels and oxidative stress in the brain it appears to reduce central nervous system excitotoxicity.  Either way it appears to have neuroprotective factors.  It’s been and is being studied in a variety of nervous system disorders.

a 2014 review suggested that acetyl-L-carnitine may be able to  alleviate depression

Acetyl-L-carnitine may also improve peripheral nerve functioning – a possibly important factor given the high incidence of small fiber neuropathy in FM (approx. 40%).

Six months of ALC supplementation (1,500 mgs/2 x’s daily) significantly increased sensory nerve density and reduced neuropathic pain in HIV patients with retroviral drug-induced nerve damage.

A recent meta-analysis suggests acetyl-L-carnitine has moderate pain-reducing effects in peripheral neuropathy. [see my next post on this study]


This Italian study randomized 65 female FM patients to either duloxetine (Cymbalta), an FDA-approved treatment for fibromyalgia, or 500 mgs. of acetyl-L-carnitine (three times a day) for three months. Fibromyalgia impact, pain and mood symptoms were assessed at several points during the trial

Both treatments produced significant improvements in depression, overall well-being, and physical functioning. Duloxetine improved pain. In contrast to earlier findings in FM and other disorders, ALCAR did not. Anxiety was not significantly improved in either group.

Serious side-effects appeared to be significantly reduced in the ALCAR group compared to the Cymbalta group. (Side-effects prompted almost twenty-five percent of FM patients to drop out of one study.)

They don’t mention Cymbalta’s horrible discontinuation syndrome (the medical term for withdrawal, except when referring to opioids). ALCAR can be stopped and started without serious side-effects, and that is a huge benefit.

Reduced Synergy = Reduced Results?

No studies suggest acetyl L-carnitine has other than moderate effects in disease. Moderate effects in many chronic diseases, however, can present a significant step forward.

Studies may also be under-estimating acetyl L-carnitine’s potential effects by using it in isolation..  Jon Kaiser of the aptly named Synergy trial asserts acetyl L-carnitine is much more effective when taken with alpha lipoic acid (ALA) and n-acetylcysteine (NAC)

It should be noted, though, that Cymbalta is not particularly effective. The number of FM patients needed to treat in order for one to have a fifty percent improvement in pain is seven (@ 120 mgs/day).

Kaiser, for instance, asserts ALCAR is much more effective when used with alpha lipoic acid and NAC.

Numerous studies suggest ALCAR’s ability to increase energy reserves in neurons and maintain cell membrane health and reduce oxidative stress  could have positive effects on both central nervous system and peripheral nervous system functioning.

Other thoughts?

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