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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.

Mechanism

As far as I have been able to put together (please correct me if I am wrong);

  1. VPA binds to and otherwise renders ineffective large stores of carnitine in the body and reduces the body's ability to synthesize it
  2. L-Carnitine is responsible for evacuation of NH3 from cells, and a deficiency leads to ammonia poisoning
  3. 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.

Intake, Dosing

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)

Bioavailability

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.

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I think you're going to have a hard time getting an answer since you are asking extremely specific questions that requires very specialized knowledge. Your best bet is to follow your doctor's advice or find one that is specialized in your condition. –  mike Nov 9 '11 at 1:18
    
@mike although I think you are correct, and ultimately that no authoritatively complete and comprehensive answer would be worth the time to others, I am hoping to gather and refine information. Debunking of what I have put together, and introduction of new data is deeply appreciated. Following the doctor's advice is helpful insofar as he can advise on the efficacy of the Depakote, however a doctor is unlikely to advise on supplement regimens. –  mfg Nov 9 '11 at 14:42
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closed as off topic by Matt Chan Apr 2 '12 at 2:07

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2 Answers

Yes I am vegan and take Valporic Acid. My carnitine levels are half of normal levels and I am very sick with new heart problems and fatigue. So talk to your doctor and get your levels tested. See too if any deficiency is a genetic metabolic disorder and not diet or drug related

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My advice: Work empirically. Since you only suspect that your fatigue and nausea are related to hyperammonemia, order blood tests for both ammonia and carnitine levels. If they are abnormal, start taking regular L-Carnitine supplements, standard dosage. Retest every 2 weeks to check for improvement. If you're better, be happy. If not, try increasing the dosage or mixing in Acetyl L-Carnitine, or whatever else makes sense.

My point is that this is a highly specific field of interest, and not that much is known about it. There are many aspects that are extremely hard to figure out just by searching the net and reading all kinds of studies. Sometimes it's way more efficient to experiment, especially since there's no substantial risk.

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