Exercise modifies glutamate and other metabolic biomarkers in cerebrospinal fluid from Gulf War Illness and [ME/CFS], Baranuik et al, 2021

Andy · Jan 14, 2021

Myalgic encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) and Gulf War Illness (GWI) share many symptoms of fatigue, pain, and cognitive dysfunction that are not relieved by rest. Patterns of serum metabolites in ME/CFS and GWI are different from control groups and suggest potential dysfunction of energy and lipid metabolism.

The metabolomics of cerebrospinal fluid was contrasted between ME/CFS, GWI and sedentary controls in 2 sets of subjects who had lumbar punctures after either (a) rest or (b) submaximal exercise stress tests. Postexercise GWI and control subjects were subdivided according to acquired transient postexertional postural tachycardia. Banked cerebrospinal fluid specimens were assayed using Biocrates AbsoluteIDQ® p180 kits for quantitative targeted metabolomics studies of amino acids, amines, acylcarnitines, sphingolipids, lysophospholipids, alkyl and ether phosphocholines.

Glutamate was significantly higher in the subgroup of postexercise GWI subjects who did not develop postural tachycardia after exercise compared to nonexercise and other postexercise groups. The only difference between nonexercise groups was higher lysoPC a C28:0 in GWI than ME/CFS suggesting this biochemical or phospholipase activities may have potential as a biomarker to distinguish between the 2 diseases. Exercise effects were suggested by elevation of short chain acylcarnitine C5-OH (C3-DC-M) in postexercise controls compared to nonexercise ME/CFS.

Limitations include small subgroup sample sizes and absence of postexercise ME/CFS specimens. Mechanisms of glutamate neuroexcitotoxicity may contribute to neuropathology and “neuroinflammation” in the GWI subset who did not develop postural tachycardia after exercise. Dysfunctional lipid metabolism may distinguish the predominantly female ME/CFS group from predominantly male GWI subjects.
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Open access, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244116

Hoopoe · Jan 14, 2021

These data suggest the hypothesis that reduced carnitine palmitoyltransferase-I (CPT-I) activity and mitochondrial fatty acid transport may contribute to the pathogenesis of ME/CFS and GWI,
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Carnitine is the only thing that seems to increase my ability to function somewhat.

Creekside · Jan 14, 2021

At one point in my ME (maybe year 12?) I developed worse symptoms after eating fatty meals. That was treated by taking carnitine with the meal. After a year or two of supplementing carnitine, the problem went away.

mat · Jan 14, 2021

Maybe I should try L-Carnitine again. Have you noticed any difference during PEM? @strategist @Creekside

Dolphin · Jan 15, 2021

Just to point out that there has been a trial of L-carnitine for CFS.

https://pubmed.ncbi.nlm.nih.gov/9018019/

doi: 10.1159/000119325.
Amantadine and L-carnitine treatment of Chronic Fatigue Syndrome
A V Plioplys 1, S Plioplys
Affiliations

PMID: 9018019

DOI: 10.1159/000119325

Abstract

Carnitine is essential for mitochondrial energy production. Disturbance in mitochondrial function may contribute to or cause the fatigue seen in Chronic Fatigue Syndrome (CFS) patients. Previous investigations have reported decreased carnitine levels in CFS. Orally administered L-carnitine is an effective medicine in treating the fatigue seen in a number of chronic neurologic diseases. Amantadine is one of the most effective medicines for treating the fatigue seen in multiple sclerosis patients. Isolated reports suggest that it may also be effective in treating CFS patients. Formal investigations of the use of L-carnitine and amantadine for treating CFS have not been previously reported. We treated 30 CFS patients in a crossover design comparing L-carnitine and amantadine. Each medicine was given for 2 months, with a 2-week washout period between medicines. L-Carnitine or amantadine was alternately assigned as fist medicine. Amantadine was poorly tolerated by the CFS patients. Only 15 were able to complete 8 weeks of treatment, the others had to stop taking the medicine due to side effects. In those individuals who completed 8 weeks of treatment, there was no statistically significant difference in any of the clinical parameters that were followed. However, with L-carnitine we found statistically significant clinical improvement in 12 of the 18 studied parameters after 8 weeks of treatment. None of the clinical parameters showed any deterioration. The greatest improvement took place between 4 and 8 weeks of L-carnitine treatment. Only 1 patient was unable to complete 8 weeks of treatment due to diarrhea. L-Carnitine is a safe and very well tolerated medicine which improves the clinical status of CFS patients. In this study we also analyzed clinical and laboratory correlates of CFS symptomatology and improvement parameters.
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Though the abstract doesn't mention it, it used a dosage of 3000 mg/day.
This is a larger dose than is usually recommended on product packaging.

Creekside · Jan 15, 2021

mat said: ↑

Have you noticed any difference during PEM?
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I didn't notice any difference during PEM. For me it was just 'fatty meal without carnitine = worse symptoms. With carnitine = no extra symptom severity'. I didn't need 3000 mg either; I think I took half a level tsp or so.

Dolphin · Jan 15, 2021

Note that acetyl l-carnitine and l-carnitine are not necessarily the same. I have read before that acetyl l-carnitine acts more on the brain. This study would seem to bear this out. I read somewhere that propionylcarnitine is more similar to l-carnitine than acetyl l-carnitine.

Clinical Trial Psychosom Med Mar-Apr 2004;66(2):276-82. doi: 10.1097/01.psy.0000116249.60477.e9.

Exploratory open label, randomized study of acetyl- and propionylcarnitine in chronic fatigue syndrome

Ruud C W Vermeulen 1, Hans R Scholte

PMID: 15039515 DOI: 10.1097/01.psy.0000116249.60477.e9

Abstract

Objectives: We compared the effects of acetylcarnitine, propionylcarnitine and both compounds on the symptoms of chronic fatigue syndrome (CFS).

Methods: In an open, randomized fashion we compared 2 g/d acetyl-L-carnitine, 2 g/d propionyl-L-carnitine, and its combination in 3 groups of 30 CFS patients during 24 weeks. Effects were rated by clinical global impression of change. Secondary endpoints were the Multidimensional Fatigue Inventory, McGill Pain Questionnaire, and the Stroop attention concentration test. Scores were assessed 8 weeks before treatment; at randomization; after 8, 16, and 24 weeks of treatment; and 2 weeks later.

Results: Clinical global impression of change after treatment showed considerable improvement in 59% of the patients in the acetylcarnitine group and 63% in the propionylcarnitine group, but less in the acetylcarnitine plus propionylcarnitine group (37%). Acetylcarnitine significantly improved mental fatigue (p =.015) and propionylcarnitine improved general fatigue (p =.004). Attention concentration improved in all groups, whereas pain complaints did not decrease in any group. Two weeks after treatment*, worsening of fatigue was experienced by 52%, 50%, and 37% in the acetylcarnitine, propionylcarnitine, and combined group, respectively. In the acetylcarnitine group, but not in the other groups, the changes in plasma carnitine levels correlated with clinical improvement.

Conclusions: Acetylcarnitine and propionylcarnitine showed beneficial effect on fatigue and attention concentration. Less improvement was found by the combined treatment. Acetylcarnitine had main effect on mental fatigue and propionylcarnitine on general fatigue.
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*In case this is not clear, this means 2 weeks after stopping treatment

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Exercise modifies glutamate and other metabolic biomarkers in cerebrospinal fluid from Gulf War Illness and [ME/CFS], Baranuik et al, 2021

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Exercise modifies glutamate and other metabolic biomarkers in cerebrospinal fluid from Gulf War Illness and [ME/CFS], Baranuik et al, 2021

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