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Why Am I Tired in Ketosis? The Potential Role of L-Carnitine

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Why Am I Tired on a Ketogenic Diet?

I understand the feeling. Even after more than two months in ketosis, I experienced flatness and near exhaustion. I was hearing about boundless energy, mental clarity, and healing—but the “magic” of ketosis still seemed to elude me.

I was seeing positive changes: less joint pain and no more bloating. But my energy remained low.

That changed for me after I came across Dr Boz’s teaching, L-Carnitine: The Supplement Most Doctors Won’t Recommend (start at the 2:49 mark). Aceytle-L-carnitine made a noticeable difference to my energy.

I recently watched an interview with Nicole Laurent sharing that many adults on a ketogenic diet are deficient in carnitine which inspired this deep dive into the subject.  

The Role of Carnitine

Carnitine plays a critical role in your bodies energy production by helping the body use fat for energy. It is a co-factor that transports long-chain fatty acids into the mitochondria—the energy-producing parts of our cells—where they can be broken down and used as fuel.

Your body makes carnitine, and it is also found in certain foods and supplements. However due to the nature of ketogenic diet many keto people are deficient in this essential nutrient. 

Symptoms of Carnitine Deficiency

This is not a comprehensive list, but some symptoms associated with carnitine deficiency may include:

  • Hypoketonemia: Low levels of ketones in the blood.
  • Fatigue: Feeling tired and lacking energy.
  • Muscle weakness: Low muscle tone and muscle cramps.
  • Poor appetite.
  • Stomach upset: Nausea and diarrhoea.
  • Elevated triglycerides.
  • Brain issues: Confusion, brain dysfunction, lack of clarity, seizures and irritability.
  • Heart: Irregular heart rhythm.
  • Malaise: A general feeling of unwellness without a specific cause.

Benefits of Carnitine

This is not a comprehensive list, but some potential benefits of carnitine may include:

  • Supports the liver: May support healthy liver function and fat metabolism as well as assist in the production of ketones
  • Helps prevent fat build-up: May help reduce the accumulation of fat in the heart, liver and muscles.
  • Transports fats: Acts as a shuttle to move long-chain fatty acids into the mitochondria (the powerhouse of the cell), where they can be burned for energy.
  • Support Sports endurance: May help spare muscle glycogen and delay physical fatigue. It has been found to help preserve muscle glycogen, promote fat oxidation and decrease the accumulation of lactate.
  • Aids recovery: May help reduce markers of muscle damage and muscle soreness following exercise.
  • Powers the heart: Carnitine is stored within heart muscle, where it assists with steady energy production.
  • Clears waste: Helps transport certain toxic waste compounds out of cells.
  • Supports brain function: Can cross the blood-brain barrier and may support energy metabolism and cognitive health.
  • Supports blood glucose control: May help reduce fasting blood glucose and, over the long term, may contribute to lower HbA1c levels.
  • Supports reproduction: In men, carnitine may support sperm maturation, motility and spermatogenesis. In women, some studies have reported improved ovulation rates, thicker endometrium, improved menstrual cycles and higher pregnancy rates.

Where Is Carnitine Found?

Carnitine is present in many foods, especially those of animal origin, and is also available as a dietary supplement.

It is also synthesised endogenously in the liver, kidneys and brain. Carnitine is synthesised from the amino acids lysine and methionine.

Key Forms of Carnitine Supplements

  • Acetyl-L-Carnitine (ALCAR): Has superior cellular uptake and is often favoured for cognitive and neurological support because it readily enters the brain.
  • L-Carnitine L-Tartrate (LCLT): Is absorbed very rapidly in the digestive tract, making it a popular choice in sports nutrition for muscle recovery and exercise performance, even though its overall absolute tissue bioavailability is similar to standard L-carnitine.
  • Standard L-Carnitine: Oral supplements generally have relatively low passive absorption, with bioavailability ranging between 14% and 18%.

Safety

  • Carnitine does not have an established tolerable upper intake level. However, doses of approximately 3 g per day from carnitine supplements can cause side effects including nausea, vomiting, abdominal cramps, diarrhoea and a fishy body odour.
  • Carnitine may also cause muscle weakness in people with uraemia and may increase the risk of seizures in people with seizure disorders.
  • Carnitine can interact with certain medications, so consult your doctor or pharmacist before commencing supplementation.

For Further Research

Have you used L-Carnitine in your keto journey? If so what was your experience?

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Important safety information: Nutritional ketosis, which may occur with carbohydrate restriction or fasting, is not the same as diabetic ketoacidosis (DKA). DKA is a serious medical emergency that requires urgent care. If you have diabetes; kidney or liver disease; are pregnant or breastfeeding; or take medication that affects blood glucose, speak with a qualified healthcare professional before making dietary changes. ALL articles are intended for general information only and do not replace personalised medical advice.