Carnitine Week? Maybe.

For the epileptic and bipolar vegans out there dutifully taking their VPA (valproic acid or its derivatives, like my Depakote ER):

via a fresh question of mine on Stackexchange:

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.

If you have any answers to the above questions, feel free to follow the link to answer on stackexchange, or add to the comments any info you may indepently have. I am happy to receive new data or get mine debunked.

Tool for brain, diff coffee

Another day a different coffee.

The cubano again, but with soy milk instead of dairy; heavier cap, denser feel. good taste, possibly a heartier embrace but I will need to drink a few more to really get a good feel on that.

brioso cubano with soy

Anyway, the purpose of this is to announce a small'ish project. I am looking to anyone who has landed here searching information on valproate toxicity, epilepsy and L-Carniine deficiency, Depakote ER poisoning, or Hyperammonia toxicity, and hyperammonemia. Basically, I want to compile a pretty exhaustive resource for people who are suffering from body betrayal due to carnitine deficiency related to depakote dependency.

Systemic carnitine deficiency: Carnitine is required for transport of long-chain fatty acids into mitochondria. Its deficiency causes nonketotic hypoglycemia, increase in liver transaminases, and modest elevation of ammonium level. Patients may have muscle weakness, cardiomyopathy, hepatomegaly, and/or growth retardation.

So anyway, systemic carnitine deficiency resulting from Depakote dependence and a low carnitine diet can cause hyperamonemia as one of the "fatty acid oxidation defects"; or in this case, the systemic carnitine deficiency is not a bug, it's a FEATURE! For most of us, carnitine is not on the list of things to consider when checking a multi-vitamin label; our body produces it by it's own processes, but Depakote binds up the process and you end up evacuating most of it without using it.

Anyway, I am looking for further research materials also involving the remainder of the urea cycle (i.e. ways to improve kidney, liver function to aid processing of ammonia after mitochondrial a passage), as well as mitochondrial information. If you have any of these, or a story to tell, post freely below. I am casting the net wide, looking for ways to aid pre-cell ammonia build-up (i.e. digestive enzymes in tandem with carnitine supplements), ways of improving mitochondrial transport (ditto), ways of improving passage of ammonia through urea cycle.

Looking forward to elbows-deep!

epilepsy and vegans redux

hey! you two people who came here looking for "carnitine depakote vegetarian" & "valproic acid vegan sources"! i hope you found what you were looking for :) . if you by any chance were in the same situation as me let me know id love to hear from you.

[maybe im kinda fishing for comments on the blog today but what the hell.]

bipolar/epileptic vegans and protein; (di)valproic acid and ammonia?

this is a summary of prevailing wisdom on proteins in a vegan diet, with an exception to include an amino acid "L-Carnitine" because i am on depakote, specifically divalproex 2500mg (/500mg ER tabs) daily.

most say that for a regular, 3000 cal, omniverous diet you need about .36g protein per pound of body weight. in application, 54g protein for a 150lb person. the same person on a vegetarian diet needs about .45g/1lb; which amounts to 68g for a 150lb person.

now when my girlfriend and friends went vegan however-many-months back, i skimmed the reading materials and did decently well until about the four week mark. getting used to the constraints was one thing, and i may have been winding down in my will anyway. however, i ran into a physical wall. i became fatigued, and physically ill at the drop of a hat and it had been going on for awhile into the diet and wasnt going away. but i knew i wasnt having problems getting enough, or a sufficiently varied array, of protein.

Carnitine: molecule of the month!what i came to find out was that the illness was to to having a specific amino acid deficiency, L-Carnitine, which was a direct result of combining a vegan diet with depakote. so to all the vegans who are epileptic/bipolar and on mood stabilizers like valproic acid, be mindful if you are perpetually vomiting and tired as your blood may be clogging with ammonia waste from cells (the result of the deficiency). 

(aside from being basically unheard of,) the thing with L-Carnitine is that it really isnt listed as the essential amino acids because the minor amount included in your diet and produced by your body is basically enough for the majority of people. (TMYK: the definition of "non-essential" amino acids is one produced by your body, so i guess i used the word 'essential' ambiguously, but double-effectively).

now, as is the FDAs wont, there are no specific caps on the amount of soy protein (or any other food with a well-endowed subsidy and agro-fiefdom behind it, but i digress) that you should allow into the recommended diet of "varied sources of protein." however, the following clip is recited ad nauseum at the soy beans PAC: “25 grams of soy protein a day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”

so, lets stay strict for the sake of creating flexibility and take that to mean you need 43g of other proteins (68g@150/lb - 25g soy protein), and you need to get some L-Carnitine in there too, but obviously not from fat and bone. So, for those of you who want to get the most bang for your soy buck with the Carnies, go for Tempeh. In just half a cup (100g) you get 19.5 mg L-Carnitine, and 15g protein. Fortunately we can also derive some from avocados and peanuts and bread. Now, if you decide to go the supplement route, they get expensive. Heres one on the cheap without any additives (+/- ?) at £6.95 ($10ish?) / 100g. heres a list of not on the cheap with additives (the particular additive i searched for was CoQ, which supposedly aids in absorption and activation) at google shopping.

as for me myself, if i get serious about trying veganinity again, i think i am going to get most of my soy protein from tempeh because a) its the bomb and b) it gets my my carnies AND c) its got some of the b12ies that get stripped from my diet by my meds. im going to eat more avocados because theyre rad. i already eat lots of peanut butter. maybe were going to start drinking almond milk? anyway. i have no position on whether you should take a supplement, much less whether you should go for in the raw or with CoQ. i am skeptical of them and only take b-complex and drink tons of oj (when im being good). i saw that vitamin C and B6 are pretty intertwined in the carnie process so you should probably be on a +C and +B-complex regimen, too (hell if youre an omniverous bipolar/epileptic you should be on it anyway because you are more than 80% likely to suffer from depression and both help with that!).

and a final, unqualitative note for people with these anti-seizure / mood stabilizer meds; "[In the treatment of valproate toxicity] L-carnitine supplementation ...is thought to provide benefit, particularly in patients with concomitant hyperammonemia, encephalopathy, and/or hepatotoxicity." this is not a highly substantiated claim, and is one open to further blah blah. additionally, you should know by now that anything you do chemically can have a profound impact on your level. so yeah normal people have to "check with their docs before taking supps" yada, but you really need to. you know your brain doctor matters more than your gen/pdoc. so make sure she/he knows what youre doing. also, while youre there, get a blood test to find out where your ammonia level is next time you get your blood drawn. a very good summary can be found on supplementation here.

for more links:

http://www.chm.bris.ac.uk/motm/carnitine/Carnitine.htm

http://www.vegan-supplement-checklist.com/2008/10/l-carnitine.html

http://www.umm.edu/altmed/articles/carnitine-l-000291.htm (#)

(round up:) http://www.savvyvegetarian.com/articles/protein-veg-diet.php

http://emedicine.medscape.com/article/819315-treatment (#)

(#) = same source?