L-carnitine is a chemical made in the body and found in some foods. It plays an important role in energy production by transporting fatty acids into mitochondria and is often used as a dietary supplement to help with fat loss, exercise performance, and recovery.
Table of Contents
Outcome Summary
This tier list summarizes the primary outcomes of l-carnitine supplementation and grades them from A (best) to E (worst), based on up-to-date scientific evidence.
- A: Best in class for that particular outcome. Recommended for practically everyone.
- B: Worth the money for most people and backed by scientific evidence to provide significant positive effects.
- C: Might be worth trying, but the effects are small to modest, or the research is limited in size and scope.
- D: Generally ineffective, although not harmful.
- E: Negative or even harmful effects.
You can find references in the detailed research review of each outcome below.
| Effect | Tier (A = best, E = worst) | Summary |
| Exercicse Performance | C | L-carnitine might allow you to do more reps or improve high-intensity exercise like sprinting slightly. |
| Muscle Growth | C | Some studies show a slight increase in muscle mass, primarily in older adults. |
| Muscle Damage | B | L-carnitine moderately reduces muscle damage and soreness after exercise. |
| Weight Loss | B | Supplementing with L-carnitine might help increase weight- and fat loss, primarily in overweight and obese adults, by a small amount. |
| Sperm Health | B | Carnitine has the potential to improve sperm quality and male fertility. |
| Cardiovascular Health | D | L-carnitine might offer some benefits for cardiovascular health, including reduced blood pressure. However, the evidence is mixed regarding overall benefits, with recent research finding no or even harmful effects. |
| Brain Health | B | L-carnitine may boost brain health by helping produce energy for brain cells and protecting them from damage, which could improve memory and mental clarity, primarily in older adults and those with cognitive decline. |
| Blood Glucose Control | B | L-carnitine supplements might improve blood sugar control, particularly for people with diabetes, high blood sugar, or those who are overweight. |
What Is L-Carnitine?
L-carnitine is a naturally occurring compound in the body. It is a vitamin-like substance derived from the amino acids lysine and methionine.
Carnitine’s primary role is in energy production. It helps transport long-chain fatty acids into the mitochondria of cells, where they are oxidized (burned) to produce energy. It is essential for energy metabolism, particularly in muscle cells.
In addition to energy production, carnitine is also involved in glucose metabolism and is an antioxidant that helps protect cells from metabolic stress.
Sources
Carnitine is primarily found in meat (red meat is the richest natural source of L-carnitine,) fish, and dairy products, but it can also be synthesized in the body, mainly in the liver and kidneys.
In people who eat animal-based foods, diet accounts for almost three-fourths of the carnitine stored in the body. In vegans, almost all the carnitine is produced by the body.
Carnitine levels are maintained within a normal range despite varying dietary intake due to an efficient kidney system that reabsorbs most of the carnitine filtered by the body. Any excess is excreted through the urine, but 90–99% of filtered carnitine is reabsorbed, keeping levels stable under most conditions.
References: 1
Different Forms of Carnitine
L-carnitine is the most common form of carnitine, often found in supplements. However, there are several other types of carnitine.
- Acetyl-L-Carnitine (ALCAR) is an acetyl ester (a type of chemical compound where an acetyl group (a small part made of two carbon atoms, oxygen, and hydrogen) is attached to another molecule to form a new substance) of L-carnitine. The brain more readily absorbs it, and it has potential neuroprotective and anti-depressive effects.
- Propionyl-L-Carnitine (PLC) is involved in energy production in muscle tissue and also the heart. It has been considered to treat circulatory issues like congestive heart failure and peripheral arterial disease. It is also a powerful antioxidant.
- L-Carnitine L-Tartrate (LCLT) is a more bioavailable form of L-carnitine due to the addition of tartrate, a salt derived from tartaric acid, which increases absorption and reduces the time it takes to reach the bloodstream. It is often used in sports supplements for its potential benefits, including reduced muscle damage.
- D-Carnitine is not biologically active and is considered potentially harmful when consumed in significant amounts. It can also interfere with the body’s absorption of L-carnitine, leading to deficiencies and causing issues in fatty acid metabolism.
Physiological Roles of L-Carnitine
L-carnitine plays several important physiological roles in the human body, primarily associated with energy metabolism, fat oxidation, and cellular function.
As a supplement, it is used for fat loss, enhanced athletic performance, recovery, heart health, and cognitive support
In addition, it is the primary treatment for L-carnitine deficiency, a medical condition leading to tiredness, muscle weakness, and sometimes heart or liver problems.
Here is a breakdown of its physiologial roles.
Fatty Acid Transport and Oxidation
L-carnitine is critical for transporting long-chain fatty acids into the mitochondria for beta-oxidation, a process that breaks down fatty acids for energy production.1
Energy Production
Through beta-oxidation, as mentioned above, L-carnitine helps making ATP (adenosine triphosphate), which is the primary energy carrier in cells, through the Krebs (Citric acid) cycle.6
During exercise, L-carnitine can help the body use fat as fuel, potentially sparing glycogen stores for prolonged endurance training.7
Reduction of Lactic Acid Build-Up
L-carnitine can help delay the onset of muscle fatigue by reducing the accumulation of lactic acid during intense physical activity.8
During high-intensity exercise, the body produces acetyl-CoA, a molecule that links the breakdown of carbohydrates, fats, and proteins to the production of energy through the citric acid cycle and increases lactate. Carnitine reacts with that acetyl-CoA and can supress the accumulation of lactic acid.
Cellular Detoxification
L-carnitine helps detoxify cells by binding to harmful byproducts of metabolism, such as acyl residues.6 These residues can build up and become toxic to the cell, especially during the breakdown of fatty acids. By attaching to these residues, L-carnitine transports them out of the cell, making sure that toxic compounds are removed and the cell remains healthy. This process also frees up vital molecules like Coenzyme A (CoA), which the cell needs for energy production and other important functions.
In addition, L-carnitine can help remove excess ammonia from cells, particularly in muscles, during prolonged or intense physical activity. Ammonia buildup is associated with muscle fatigue and impaired performance.
Antioxidant Properties
L-carnitine has antioxidant properties that help reduce oxidative damage in cells by scavenging free radicals and boosting the antioxidant defense system in the body, particularly during periods of intense exercise or metabolic stress.9 It reduces the production of reactive oxygen species (ROS) and improves mitochondrial function, leading to decreased oxidative damage in cells.
L-carnitine’s antioxidant effects are particularly beneficial in protecting cells from damage in tissues like the heart, brain, and muscles, where energy demand is high, making it a potential supplement for mitigating oxidative stress in conditions like cardiovascular diseases, neurodegenerative diseases, and exercise-induced muscle damage.
In addition, L-carnitine’s role in maintaining mitochondrial function and reducing oxidative stress has led to its use in anti-aging interventions.10 Mitochondrial dysfunction is a hallmark of aging, and L-carnitine may help preserve cellular energy production and delay age-related decline.
Does L-Carnitine Increase Exercise Performance?
Carnitine might improve exercise performance, particularly when used for high-intensity activities or when combined with carbohydrates.
However, the evidence is inconsistent, and the benefits are generally small and not guaranteed for all types of exercise.
Carnitine might improve high-intensity exercise like sprinting or strength training by making energy production more effective, reducing lactic acid build-up in the muscles, and helping deliver oxygen more efficiently.
Research Findings
- A few small studies show that taking carnitine supplements (2–4 g/day for several weeks) can improve how much oxygen your body can use (VO2 max) and how hard you can work during exercise. However, other studies found no significant improvements in sprinting speed or power during high-intensity interval training (HIIT).
- In one study, 2 grams of carnitine daily for nine weeks slightly improved strength training performance in trained men. They were able to do more repetitions in the leg press. Another study showed increased training volume in the bench press with carnitine compared to a placebo.
- The effect of carnitine on moderate-intensity exercise (like running or cycling at 50–79% of your maximum effort) is unclear. In theory, carnitine can help the body use more fat as fuel and save glycogen for later in the workout, potentially boosting endurance and reducing fatigue. Long-term supplementation (3–4 g/day for 9–24 weeks), especially when combined with carbohydrates, has shown some benefits in reducing perceived effort and conserving glycogen, but the results are inconsistent across different studies.
In short, L-carnitine could help you perform better in high-effort activities, like “all out” tests, Wingate sprints, or strength training by increasing work capacity, peak power, and the number of repetitions.
However, the potential performance enhancements are slight, and carnitine does not seem like a reliable performance booster, regardless of exercise type or training intensity.
Does L-Carnitine Build Muscle?
While generally not marketed as a muscle-building supplement, a few studies have shown increases in muscle mass after carnitine supplementation in certain populations.
- Six months of carnitine supplementation in 66 people 100 years old or older resulted in increases in muscle, improved physical effort tolerance, and cognitive function.15
- In another study, 84 older men and women gained, on average, 2.1 kilograms of muscle after 30 days of taking carnitine, compared to 0.2 kilograms in a control group.16
- However, in one study involving healthy aged women (65–70 years), 24 weeks of L-carnitine supplementation did not lead to changes in muscle mass or strength.17
- In addition, a recent study investigated the effects of nine weeks of L-carnitine supplementation in men who lifted weights four days per week. The results showed significant improvements in strength, particularly in bench press and leg press performance. However, they did not gain muscle mass compared to the placebo group.18
In short, L-carnitine may have a small but positive impact on muscle mass, particularly in older populations, but there is little evidence that it boosts muscle gain in young, healthy, strength-training adults.
Does L-Carnitine Reduce Muscle Damage and Soreness After Exercise?
Research shows that L-carnitine supplementation might reduce muscle damage, lower inflammation, and enhance recovery by reducing oxidative stress. Studies also suggest potential improvements in fatigue and muscle soreness.19
More studies are needed to understand the mechanisms behind these effects and confirm long-term benefits, but evidence supports L-carnitine’s benefits in reducing exercise-induced muscle damage, and it could be a helpful supplement for improving recovery after strenuous exercise.
Does L-Carnitine Improve Weight Loss and Reduce Body Fat?
According to two recent meta-analyses, L-carnitine supplementation can lead to weight loss and a reduction in body fat, particularly in overweight and obese individuals.
- One meta-analysis of 37 randomized controlled clinical trials with a total of 2,292 participants found that L-carnitine significantly decreased body weight by an average of 1.21 kg, fat mass by 2.08 kg, and BMI by 0.24 kg/m². However, it didn’t significanly reduce waist size or body fat percentage.20
- Another meta-analysis, this one looking at 43 randomized controlled trials, also found that L-carnitine significantly decreased body weight (-1.129 kg), BMI (-0.359 kg/m²), and fat mass (-1.158 kg.). Again, the participant’s body fat percentage or waist size did not change significantly. The review also noted that L-carnitine was only effective in overweight or obese people, and the effects were greater when combined with diet modifications and exercise.21
In short, L-carnitine can be useful for modest weight loss and fat reduction, especially for overweight and obese individuals, but it doesn’t significantly change fat percentage or waist size.
Does L-Carnitine Improve Sperm Health?
L-carnitine may be beneficial for sperm health through several mechanisms, according to scientific evidence.22
- Energy Production: L-carnitine is part of the transportation of fatty acids into the mitochondria, the part of the cell responsible for energy production. An L-carnitine supplement might increase the energy available to sperm cells, improving their movement and vitality.
- Reducing Oxidative Stress: One of the reasons men experience fertility issues is because of oxidative stress, which occurs when molecules called reactive oxygen species (ROS) build up in the body. ROS damages sperm structure making them less effective at fertilizing an egg. Because L-carnitine is a powerful antioxidant, it might neutralize these harmful molecules and protect the sperm from damage.
- Improving Sperm Development: L-carnitine supports so-called Sertoli cells, which are critical for the development of sperm cells. By promoting the health of these cells, it supports better sperm development and maturation.
- Reducing Lipid Peroxidation: Sperm membranes are full of fatty acids, which are vulnerable to damage by ROS. L-carnitine might be able to prevent at least some of this damage by holding the structure and integrity of the sperm together, leading to better sperm motility (movement) and shape (morphology).
Taking 1 to 3 grams of L-carnitine daily for 3 to 6 months may improve sperm health, including how well they move, their shape, concentration, and their number. In addition, a few studies show that men who take L-carnitine may see improved chances of pregnancy with their partner.
While the optimal dosage is currently unknown, existing data supports its use as a supplement for improving sperm quality and possibly enhancing fertility outcomes in men.
L-Carnitine and Cardiovascular Health
L-carnitine plays a role in lipid metabolism and cardiovascular health. It facilitates fatty acid transport into the mitochondria for energy production, potentially protecting the heart through reduced inflammation and oxidative stress. Some research suggests that L-carnitine supplementation can support heart health and reduce cardiovascular disease (CVD) risks and complications.
High blood pressure is a significant risk factor for several diseases, including cardiovascular disease. Two grams or more of L-carnitine daily reduces diastolic blood pressure but not systolic blood pressure in adults.23
Some studies suggest that L-carnitine may help reduce damage from ischemic events (like heart attacks) by enhancing blood flow and reducing oxidative stress. It has been researched as a treatment to improve outcomes in people with coronary artery disease and heart failure.
Research Findings
- A 2013 meta-analysis found that in patients suffering from an acute myocardial infarction, L-carnitine has been linked to astounding benefits: a 27% decrease in overall mortality, a 65% reduction in ventricular arrhythmias (VAs), and a 40% improvement in anginal symptoms, compared to those receiving a placebo or standard treatment.24
- Indeed, those results might have been too astounding, with other researchers pointing out significant flaws in the included studies.25
- That being said, later reviews conclude that L-carnitine does act protectively against conditions prevalent in CVD, including ventricular dysfunction, ischemia-reperfusion injury, cardiac arrhythmia, and myocardial injury.26
- To add further confusion to the debate, a recent Mendelian randomization study (a study that uses people’s natural genetic differences to help figure out if something actually causes a health problem rather than just being associated with it) found no benefits of carnitine in cardiovascular disease or any of its risk factors. In fact, they found some evidence that it might do more harm than good.27
In short, while L-carnitine supplementation may offer cardiovascular benefits, the evidence is mixed, and more research is needed. It has been considered for individuals with specific cardiovascular conditions or those at higher risk of heart disease, but recent research has cast some doubt over any potential benefits.
Does L-Carnitine Improve Brain Health?
L-carnitine, particularly its acetylated form called acetyl-L-carnitine (ALCAR), has shown potential benefits for brain health and function. These benefits are primarily related to its role in energy production and its antioxidant properties.
Cognitive Decline
Several studies suggest L-carnitine and ALCAR may help slow cognitive decline in conditions like Alzheimer’s disease and mild cognitive impairment.28
Research also indicates that ALCAR can improve mental performance in older adults, including improvements in memory, learning, and focus. ALCAR is thought to work by enhancing brain energy production and neurotransmitter activity, as well as protecting neurons from damage.
While some studies show ALCAR may improve memory and behavior, other more extensive studies do not find it very effective. One issue is that different studies use varying methods, making results hard to compare.
Despite some promising evidence, more research is needed to understand ALCAR’s effects fully and to confirm whether it can be used systematically in treating dementia and age-related cognitive decline.
Antidepressant Effects
There is some evidence that ALCAR may have antidepressant properties. Several studies have shown that people with depression often have lower levels of certain carnitines, such as ALCAR, in their blood compared to healthy individuals.29
Supplementation of ALCAR has shown promise in improving depressive symptoms and may even serve as a potential treatment for depression. However, further research is needed to understand the exact role of carnitines in mental health and whether they can be used as biomarkers for diagnosing depression or as part of the treatment.
Cognitive Function in Healthy Adults
Studies have also examined whether L-carnitine can improve cognitive function, including memory, reasoning, and attention, in healthy people without cognitive impairments.30 However, those studies are of low quality, and there is no evidence of such beneficial effects.
In short, L-carnitine (especially acetyl-L-carnitine) offers potential benefits for brain health through neuroprotection, improved mitochondrial function, and support for cognitive performance and mood. These effects are most prominent in older people or those at risk of cognitive decline.
Does L-Carnitine Improve Blood Sugar Control?
L-carnitine might affect carbohydrate metabolism, blood sugar levels, and other markers related to diabetes in adults in several ways, including:
- Regulating how certain enzymes control energy production in cells.
- Affecting the production of enzymes that break down or create sugar.
- Influencing how genes involved in insulin signaling work.
- Activating pathways related to IGF-1, a growth factor that helps with insulin function.
A recent meta-analysis gathered all available studies to examine if L-carnitine supplements could help improve factors like fasting blood sugar, long-term blood sugar, insulin levels, and insulin resistance.31
Research Findings
It reviewed 41 studies involving almost 3,000 people. In these studies, people took L-carnitine supplements for at least seven days. The researchers compared these people to others who didn’t take the supplement to see if L-carnitine affected their blood sugar levels.
- L-carnitine helped reduce fasting blood sugar by a small amount, especially for people who already had higher blood sugar levels, those who were overweight, or people with diabetes.
- L-carnitine also reduced HbA1c, a marker that shows average blood sugar over a few months. This effect was more noticeable when people took the supplement for at least 12 weeks or at higher doses.
- It improved insulin resistance (a condition where the body doesn’t use insulin properly) in people who took it for longer periods or in higher doses, especially those who were overweight.
An even more recent meta-analysis confirmed these findings and added that L-carnitine might have a potential role as adjunctive therapy (an additional treatment used alongside the main one to help improve results or manage symptoms more effectively) in diabetes. It may help address the reduced insulin sensitivity and insulin resistance of diabetes types 1 and 2, respectively.32
In short, L-carnitine supplements might be helpful for improving blood sugar control, particularly for people with diabetes, high blood sugar, or those who are overweight. They seem to work better when taken for a longer time (≥50 weeks) and in higher doses ( ≥2 g/day).
Safety of L-Carnitine
L-carnitine supplementation is generally considered safe for most people when taken in recommended dosages.
However, it may cause side effects in some individuals or under certain conditions.
Common Side Effects
- Nausea, upset stomach, or diarrhea: Some users may experience gastrointestinal discomfort, from nausea to diarrhea.33
- Fishy body odor: High doses of L-carnitine can sometimes cause a noticeable fishy smell in sweat, breath, and urine (≥3 g/day).33
Less Common or Potential Side Effects
- Some studies have raised concerns that gut bacteria could convert high levels of carnitine from food or supplements into a compound called trimethylamine-N-oxide (TMAO), linked to an increased risk of atherosclerosis and cardiovascular disease.27 This is still an area of active research and debate.
- L-carnitine could interact with certain medications, including anticoagulants like warfarin and acenocoumarol.34
Safe Dosage
In general, doses of up to 2,000 mg per day of carnitine are considered safe.35 Higher doses might also be safe and have been used in studies without adverse effects. However, there is not sufficient data to support the long-term safety of very high doses.
L-Carnitine Dosage
The recommended dosage of L-carnitine supplementation varies depending on the form of L-carnitine being used and the intended purpose. These are the dosages used in the studies mentioned above.
For general health benefits and wellness:
500-2,000 mg per day (L-carnitine (Base Form)).
For exercise performance:
- 1,000 mg to 4,000 mg (1 to 4 g) per day (L-carnitine or L-carnitine L-tartrate (LCLT)).
For specific medical conditions (under medical supervision through a healthcare provdider):
- Cognitive enhancement, memory, and mental clarity: 600 mg to 2,500 mg per day ((Acetyl-L-carnitine (ALCAR)).
- Circulatory and heart health: 1,000 mg to 2,000 mg per day (Propionyl-L-carnitine)
- Sperm health: 1,000 mg to 2,000 mg per day (L-carnitine).
- Blood glucose control: 2,000 mg per day (L-carnitine).
Timing:
Taking L-carnitine with a meal that includes carbohydrates or protein increases its absorption, as insulin helps transport L-carnitine into cells.36
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References
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- J Clin Med. 2023 Sep; 12(18): 5796. L-Carnitine and Male Fertility: Is Supplementation Beneficial?
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