I am on a regimen of 2500mg daily of Depakote ER, a Valproic Acid (VPA) derivative, and on a vegan diet. Previously I attempted to put the two together with the resulting fatigue and nausea (likely resulting from hyperammonemia) associated with secondary carnitine deficiency.
As far as I have been able to put together (please correct me if I am wrong);
- VPA binds to and otherwise renders ineffective large stores of carnitine in the body and reduces the body's ability to synthesize it
- L-Carnitine is responsible for evacuation of NH3 from cells, and a deficiency leads to ammonia poisoning
- Vegans consume significantly less L-Carnitine in their diet, and, when coupled with VPA treatment, can facilitate hyperammonemia.`
Currently I am already consulting with my neurologist with respect to maintaining the efficacy of my medication, however I would like to find out more about improving my absorption and body stores of carnitine and staving off secondary carnitine deficiency due to the shift to a vegan diet.
As such I have a few questions related to carnitine supplementation to ensure a healthy mitochondrial transfer process:
- What approximate intake (mg/150 lb adult) is necessary to prevent hyperammonemia in a non-valproate treated adult (if any, considering it can be synthesized by the body as necessary)?
- What intake (mg/150 lb adult) is necessary for someone being treated with VPA? (i.e. what is the ratio of milligrams L-Carnitine displaced per milligram of VPA in a 150 lb adult)
Since supplements are absorbed at a rate of about 14-18%, and ingested L-Carnitine is much higher, how can absorption be improved? According to one study:
[B]ioavailability of L-carnitine in individuals adapted to low-carnitine diets (i.e., vegetarians) is higher than those adapted to high-carnitine diets (i.e., regular red meat eaters; 66%-86% versus 54%-72%) [LPI]
- What complementary foods or supplements boost bioavailability of, specificially, L-Carnitine in the body?
- Does Alpha Lipoic Acid (as found in spinach) boost bioavailbility of L-Carnitine as it does Acetyl L-Carnitine?
L-Carnitine vs. Acetyl L-Carnitine
More than one resource promotes the combination of Alpha Lipoic Acid with the chemically similar Acetyl L-Carnitine in its efficacy related to mitochondrial health; the sum of the two is reportedly greater than the parts.
- Is this a dead end or distraction with respect to treating secondary carnitine deficiency related to VPA treatment?
- Is substituting Acetyl L-Carnitine effective for L-Carnitine supplementation since the two can be converted back and forth? ALC is typically more expensive than LC, so it would be especially helpful to know if it would be more effective.
Per the concern regarding answering this question related to its specificty and scope:
I would like to encourage that information is put forward. The criteria for usefulness (up-voting) would be any researched answer to any one or more of the above questions. Usefulness need not be comprehensive, just informative regarding the admittedly specialized questions below.