Ketogenic Diet - Powerful Dietary Strategy for Certain Conditions

[Gaby]

Re: Ketogenic Diet - Path To Transformation?

Gut bacteria ferments undigested soluble fiber into short-chain fatty acids such as butyrate. This is very good for health, the butyrate that is, not the veggies... So on the keto diet, getting an extra amount of short chain fatty acids should help a person transition not only health-wise, but also gut transit-wise. This is where butter or ghee butter comes in handy. They are both very rich in butyrate. Perhaps those who are intolerant to even ghee butter and are having gut/stools problems, can try buying butyrate as a supplement. You can also make enemas with it.

 

[Gaby]

Re: Ketogenic Diet - Path To Transformation?

Overall, I am still feeling great..super clear mind and lots of energy. Way fewer aches and pains as well.

That is great! Heart palpitations and even shortness of breath can be due to lack of minerals that the bone broth provides. You can also have potassium and magnesium at hand just in case.

 

[Angchop]

Re: Ketogenic Diet - Path To Transformation?

That is great! Heart palpitations and even shortness of breath can be due to lack of minerals that the bone broth provides. You can also have potassium and magnesium at hand just in case.

Thanks Psyche! I was wondering, can having too much potassium cause palpitations? I haven't taken my potassium supplement for a couple of days, and my palpitations are gone. Plus the last time I was at the doctor, they did my blood work and said my potassium was a little high. I had taken a potassium pill the day before the blood work. Maybe I just don't need as much as I am taking. The bone broth definitely seems to help. I might just try taking it every few days and see what happens.

 

[Horseofadifferentcolor]

Re: Ketogenic Diet - Path To Transformation?

Overall, I am still feeling great..super clear mind and lots of energy. Way fewer aches and pains as well.

That is great! Heart palpitations and even shortness of breath can be due to lack of minerals that the bone broth provides. You can also have potassium and magnesium at hand just in case.

Hello Psyche, my husband used to have heart palpitations and was taking meds for it. I bought him some hibiscus tea and with change of diet this has gone away, but I would really like to read on this further. What do you recomend reading for this? His family has frowned upon no meds, so I would really like some good reading to show him, myself, and the family. Thankyou

 

[dugdeep]

Re: Ketogenic Diet - Path To Transformation?

There’s a reputable enzyme product that’s marketed for digestion and inflammation pain. We used to use it years back and we’re going to try it again, in light of all this enzyme talk. What triggered my memory overnight is that pancreatic enzymes are spoken about in the article I copied above, and that is in this Wobenzym N.

We used it when our diets were atrocious, so who’s to say what kind of isolated effect it had on us, but we did keep buying it when we had the spare cash. I recall that this product would reduce my overall body puffiness (as in my wedding ring could finally fit) – I recently had the same results with a parasite cleanse from this spring, except that it’s been long lasting, fwiw.

I think it's important to differentiate here between digestive enzymes and proteolytic enzymes taken away from food to deal with inflammation in the body. Wobenzyme is the latter. Proteolytic enzyme formulations are taken away from food and are used to digest scar tissue, allergen complexes and other body-wide inflammatory protein complexes. They're done on an empty stomach in order to make sure they aren't wasted on digesting your food. For one thing, they're quite expensive to be used as a digestive enzyme. Although they will digest food, they're really not formulated for digestion. They are quite helpful taken between meals, however, as I've seen a number of people helped with inflammatory conditions. I take proteolytic enzymes every once in awhile as a kind of 'cleanup'.

I can understand if someone would be concerned that this could knock them out of ketosis since there are plant & fruit products listed, plus those could cause an inflammation response in some too. I have no way to state an opinion on that one way or the other. There is no carb break down on the label, and I’m not pretending to know if isolated enzymes “count.”

Enzymes are proteins, and they're so tiny that I doubt they would add anything to your total protein consumption for the day (plus they should be entering your system whole, not broken down and used for energy). They shouldn't affect ketosis in any way. They also shouldn't cause inflammation - they're used to prevent it :)

 

[dugdeep]

Re: Ketogenic Diet - Path To Transformation?

Gut bacteria ferments undigested soluble fiber into short-chain fatty acids such as butyrate. This is very good for health, the butyrate that is, not the veggies... So on the keto diet, getting an extra amount of short chain fatty acids should help a person transition not only health-wise, but also gut transit-wise. This is where butter or ghee butter comes in handy. They are both very rich in butyrate. Perhaps those who are intolerant to even ghee butter and are having gut/stools problems, can try buying butyrate as a supplement. You can also make enemas with it.

Butyrate enemas? That's interesting since I know butyrate taken in throught the diet, as butter or ghee, should't be reaching the large intestine since it's absorbed in the small intestine. Since I'm one of those having transit issues, this idea intrigues me. I'm wondering though, would one just use ghee mixed with water to accomplish this? Also, my understanding is that enemas don't generally reach much past the sigmoid colon, maybe getting into the descending colon. This isn't where the bacteria hang out (which is why coffee enemas don't kill off your good bacteria). Would we need to do something to get the butyrate deeper into the colon in order to make it effective?

 

[Gaby]

Re: Ketogenic Diet - Path To Transformation?

Thanks Psyche! I was wondering, can having too much potassium cause palpitations? I haven't taken my potassium supplement for a couple of days, and my palpitations are gone. Plus the last time I was at the doctor, they did my blood work and said my potassium was a little high. I had taken a potassium pill the day before the blood work. Maybe I just don't need as much as I am taking. The bone broth definitely seems to help. I might just try taking it every few days and see what happens.

Yes, having too much potassium can cause problems. It can be dangerous to overstep on this one. I've read about potassium and very low carb diets, and the general consensus seem to be that by following label instructions of your supplemental potassium, you are already on the safe side.

But getting lab test results of around 5 is already too high. Around 4mEq/l of potassium is more like it. 3 or 3.5 is already a little bit too low, even though it can be considered within range. I often saw people going into heart arrhytmias with these levels and then going into normal rhythm as their potassium went up to 4 or 4.2.

It was good that you had a chance to get your blood work done, so you can have a better idea of where you stand on this one.

This is another way to guide when you don't need supplements anymore: the moment they give you the very symptoms that they were supposed to deal, you know you can stop them.

I would stick to the broth and leave the supplements in stock for when the right time comes. Under normal circumstances, a good and fatty bone broth would do it.

 

[Gaby]

Re: Ketogenic Diet - Path To Transformation?

Hello Psyche, my husband used to have heart palpitations and was taking meds for it. I bought him some hibiscus tea and with change of diet this has gone away, but I would really like to read on this further. What do you recomend reading for this? His family has frowned upon no meds, so I would really like some good reading to show him, myself, and the family. Thankyou

Hmm, I'm trying to think of a single source, but the importance of the diet and heart health is emphasized on Life Without Bread, The Art and Living of Low Carb by Phinney, The Doctor's Heart Cure by Al Sears and The Magnesium Miracle by Carolyn Dean for example. It is in some parts of the book. Nothing that is overemphasized, but there are some good articles. For example, the role of heart drugs in aggravating, perpetuating and causing heart palpitations to begin with:

Oral Magnesium for Cardiac Arrhythmias: Current Clinical Perspective
http://www.mgwater.com/arr.shtml

The mgwater.com website is highly recommended by about everybody that writes about magnesium. It is a huge database of the importance of magnesium in our health, and how it is currently ignored by mainstream medicine despite the glaringly obvious facts.

Omega 3s are very important in stabilizing the electrical activity in the heart, and since most people eat transfats and vegetable oils, then it is no surprise to see a surge in heart arrhytmias, especially as one gets old. Then people are put into dangerous drugs that mean to stop the arrhytmias, but actually end up deteriorating them even faster, if not killing them out right when all was needed was to increase the intake of animal fats and Omega-3s... You know how it goes. The amount of mainstream articles on this subject is also significant. But the cognitive dissonance is such, that despite the facts and the amount of them, there is no sign of mass enlightenment. Anyway, here is one reuters article that might help:

Omega-3 fatty acids tied to lower heart arrhythmia risk
http://www.reuters.com/article/2012/02/02/us-fish-heart-idUSTRE81108620120202

Coupled with a paleo diet, a useful cocktail for heart palpitations is vitamin C, Coenzyme Q10, magnesium, potassium and L-carnitine. That should deal with it. Coffee must be avoided too. A carb metabolism leaves us prone to heart rhythm imbalances. Think of sugar shock. For this, Primal Body, Primal Mind will come in handy to read.

You can search individually about CoQ10 and L-carnitine and their importance in heart health, as it goes well beyond heart palpitations. L-carnitine is involved in getting fats within the mitochondria and is supplied with a fatty meat meal. But it takes awhile to change the metabolism after a life time eating carbs.

I did a search and came across this article as well which seem to cover a lot of the above:

Understanding Arrhythmias
_http://www.heartmdinstitute.com/health-concerns/cardiovascular-system/heart-health/atrial-fibrillation-other-arrhythmias

Just ignore the part of cigarette smoking ;)

 

[Alcarohtare]

Re: Ketogenic Diet - Path To Transformation?

imbalanced potassium levels is mine issue too. It was too low, but after intense supplementation, the level arised, even too much, as i had palpations of another kind adn some other disturbances.. I've taken supplements of potassium citrate with potassium aspartate, 6 pills at the beginning( 1x 99mg), then reduced to 4, now 2 pills every other day. Maybe i should put them aside for a while and see what happens.
Thanks, Psyche.

 

[Gaby]

Re: Ketogenic Diet - Path To Transformation?

Butyrate enemas? That's interesting since I know butyrate taken in throught the diet, as butter or ghee, should't be reaching the large intestine since it's absorbed in the small intestine. Since I'm one of those having transit issues, this idea intrigues me. I'm wondering though, would one just use ghee mixed with water to accomplish this? Also, my understanding is that enemas don't generally reach much past the sigmoid colon, maybe getting into the descending colon. This isn't where the bacteria hang out (which is why coffee enemas don't kill off your good bacteria). Would we need to do something to get the butyrate deeper into the colon in order to make it effective?

It might have an "explosive" effect, but yeah, butyrate is one almighty thing. It is researched for ulcerative colitis and Crohn's disease, but the applications and implications goes well beyond that. Here is some info I just came across:

_http://wholehealthsource.blogspot.com.es/2009/12/butyric-acid-ancient-controller-of.html

Butyrate Suppresses Inflammation in the Gut and Other Tissues

In most animals, the highest concentration of butyrate is found in the gut. That's because it's produced by intestinal bacteria from carbohydrate that the host cannot digest, such as cellulose and pectin. Indigestible carbohydrate is the main form of dietary fiber.

It turns out, butyrate has been around in the mammalian gut for so long that the lining of our large intestine has evolved to use it as its primary source of energy. It does more than just feed the bowel, however. It also has potent anti-inflammatory and anti-cancer effects. So much so, that investigators are using oral butyrate supplements and butyrate enemas to treat inflammatory bowel diseases such as Crohn's and ulcerative colitis. Investigators are also suggesting that inflammatory bowel disorders may be caused or exacerbated by a deficiency of butyrate in the first place.

Butyrate, and other short-chain fatty acids produced by gut bacteria**, has a remarkable effect on intestinal permeability. In tissue culture and live rats, short-chain fatty acids cause a large and rapid decrease in intestinal permeability. Butyrate, or dietary fiber, prevents the loss of intestinal premeability in rat models of ulcerative colitis. This shows that short-chain fatty acids, including butyrate, play an important role in the maintenance of gut barrier integrity. Impaired gut barrier integrity is associated with many diseases, including fatty liver, heart failure and autoimmune diseases (thanks to Pedro Bastos for this information-- I'll be covering the topic in more detail later).

Butyrate's role doesn't end in the gut. It's absorbed into the circulation, and may exert effects on the rest of the body as well. In human blood immune cells, butyrate is potently anti-inflammatory***.

Butyrate Increases Resistance to Metabolic and Physical Stress

Certain types of fiber reduce atherosclerosis in animal models, and this effect may be due to butyrate production produced when the fiber is fermented. Fiber intake was associated with lower blood markers of inflammation in the Women's Health Initiative study, and has been repeatedly associated with lower heart attack risk and reduced progression of atherosclerosis in humans. Butyrate also sharply reduces the harmful effects of type 1 diabetes in rats, as does dietary fiber to a lesser extent.

Butyrate increases the function and survival of mice with certain neurodegenerative diseases. Polyglutamine diseases, which are the most common class of genetic neurodegenerative diseases, are delayed in mice treated with butyrate (1, 2, 3). Many of you have probably heard of Huntington's disease, which is the most common of the class. I did my thesis on a polyglutamine disease called SCA7, and this is the first suggestion I've seen that diet may be able to modify its course.

Yet another interesting finding in the first paper I discussed: mice treated with butyrate were more cold-resistant than the comparison group. When they were both placed in a cold room, body temperature dropped quite a bit in the comparison group, while it remained relatively stable in the butyrate group, despite the fact that the butyrate group was leaner****. This was due to increased heat production in the butyrate group.

Due to the potent effect butyrate has on a number of bodily processes, I believe it may be a fundamental controller of metabolism, stress resistance and the immune system in mammals, similar to omega-6:3 balance.

[...]

Butyrate also occurs in significant amounts in food. What foods contain butyrate? Hmm, I wonder where the name BUTYR-ate came from? Butter perhaps? Butter is 3-4 percent butyrate, the richest known source. But everyone knows butter is bad for you, right?

After thinking about it, I've decided that butyrate must have been a principal component of Dr. Weston Price's legendary butter oil. Price used this oil in conjunction with high-vitamin cod liver oil to heal tooth decay and a number of other ailments in his patients. The method he used to produce it would have concentrated fats with a low melting temperature, including butyrate, in addition to vitamin K2*****. Thus, the combination of high-vitamin cod liver oil and butter oil would have provided a potent cocktail of fat-soluble vitamins (A, D3, K2), omega-3 fatty acids and butyrate. It's no wonder it was so effective in his patients.

Butyrate was used as a concept to rationalize the intake of veggies among paleo bloggers such as the one above, when it is OBVIOUS that if butter is the richest source, then no veggies are needed! Isn't it? The research of Weston Price alone is very telling on the subject of butter.

But there can be troubleshooting when transitioning and perhaps some supplemental butyrate might come in handy?

From this article we get an idea of how much butyrate is needed:

_http://www.lef.org/magazine/mag98/may98_colitis.html

Butyrate enemas can be ordered from the following pharmacies: Lloyd Center Pharmacy 800-358-8974 Lloyd's butyrate enema kit includes two reusable enema bottles and 200 ml of concentrated butyrate, which makes 2,800 ml of reconstituted butyrate (a two-week supply). The patient supplies distilled water. The kit includes directions. Key Pharmacy 800-878-1322 Key's butyrate enema kit includes 28 disposable, single-use enema bottles with tops, 12 oz. of concentrated butyrate which when reconstituted is a two-week supply, a funnel, and a measuring cup. The patient supplies distilled water. The kit includes directions. A prescription from your doctor is needed when ordering butyrate enemas.

An article about butyrate's healing effects on the colon:

_http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383116/

Butyrate enema therapy stimulates mucosal repair in experimental colitis in the rat.
J D Butzner, R Parmar, C J Bell, and V Dalal
Author information ► Copyright and License information ►
This article has been cited by other articles in PMC.
Abstract

BACKGROUND--The short chain fatty acid (SCFA) butyrate provides energy for colonocytes, stimulates colonic fluid and electrolyte absorption and is recognised as an effective treatment for multiple types of colitis. AIM--To examine the impact of butyrate enema therapy on the clinical course, severity of inflammation, and SCFA stimulated Na+ absorption in a chronic experimental colitis. METHODS--Distal colitis was induced in rats with a trinitrobenzenesulphonic acid (TNBS) enema. Five days after induction, rats were divided into groups to receive: no treatment, saline enemas, or 100 mM Na-butyrate enemas daily. On day 24, colonic damage score and tissue myeloperoxidase (MPO) activity were evaluated. Colon was mounted in Ussing chambers and Na+ transport and electrical activities were measured during a basal period and after stimulation with 25 mM butyrate. RESULTS--In the untreated and the saline enema treated TNBS groups, diarrhoea and extensive colonic damage were seen, associated with increased tissue MPO activities and absent butyrate stimulated Na+ absorption. In contrast, in the butyrate enema treated TNBS group, diarrhoea ceased, colonic damage score improved, and tissue MPO activity as well as butyrate stimulated Na+ absorption recovered to control values. CONCLUSION--Butyrate enema therapy stimulated colonic repair, as evidenced by clinical recovery, decreased inflammation, and restoration of SCFA stimulated electrolyte absorption.

In the link above, you can see several interesting articles on the right hand menu. Antioxidant properties, anti-inflammatory and so forth. In some of these articles, they might give away a few tips on how to do the enema. I would just pour a couple of capsules into a saline solution and use an enema kit. Depending on how it goes, I would use more. The studies show that its distal properties (on the rectum) are very good. Perhaps if it is only distal, it will still have a systemic beneficial effect since short chain fatty acids are readily absorbed.

Another thing that comes to mind is glutamine enemas.

_http://www.ncbi.nlm.nih.gov/pubmed/10496564

Dis Colon Rectum. 1999 Sep;42(9):1209-15.
L-glutamine enemas attenuate mucosal injury in experimental colitis.
Kaya E, Gür ES, Ozgüç H, Bayer A, Tokyay R.
Source

Department of Surgery, Uludag University School of Medicine, Bursa, Turkey.
Abstract
PURPOSE:

The aim of this study was to investigate the role of glutamine, short chain fatty acid, prednisolone, and mesalazine (5-aminosalicylic acid) enemas on mucosal damage and inflammation in experimental colitis.
METHODS:

Colitis was induced in rats with trinitrobenzene sulfonic acid in ethanol. Saline (n = 14), prednisolone (n = 13), 5-aminosalicylic acid (n = 14), 1-glutamine (n = 14), and short chain fatty acid (n = 13) enemas were applied twice daily to the rats for seven days after the induction of colitis. The sham group (n = 9) received only saline enemas. Rats were killed at the seventh day and their colonic macroscopic inflammatory scores were determined. Colonic mucosal gamma glutamyl transpeptidase activity and colonic mucosal malondialdehyde levels were measured. The same measurements but no enemas were done in the control group (n = 7).
RESULTS:

There were significant differences in macroscopic inflammatory scores between sham and colitis groups (P < 0.001). The macroscopic inflammatory scores of the colitis group were higher than the short chain fatty acid and glutamine groups (P < 0.05). Whereas the mucosal gamma glutamyl transpeptidase activity was diminished in prednisolone, 5-aminosalicylic acid, and short chain fatty acid groups when compared with the control group; in the colitis, sham, and glutamine groups the activity of this enzyme did not change. The mucosal malondialdehyde levels were significantly lower in the prednisolone and glutamine groups than in the colitis group.
CONCLUSION:

Only one of four agents tested, namely, 1-glutamine enemas, could decrease the severity of colitis both morphologically and biochemically. Moreover, L-glutamine prevented the colitis-induced oxidant injury in the colonic mucosa. On the other hand, prednisolone and short chain fatty acids seemed to improve only the physiologic changes of colitis.

This is another thing that can be done, pour some L-glutamine powder along the butyrate for an enema kit. Perhaps it might help, at least as a temporary measure.

 

[emilien512]

Re: Ketogenic Diet - Path To Transformation?

Folks, i didnt have the strenght to read the 102 pages of this topic yet, but i want to ask a simple question :

What about a diet composed only of fruits (mostly apples, bananas, etc...) ?
and how would you compare it to KD diet ?

 

[Horseofadifferentcolor]

Re: Ketogenic Diet - Path To Transformation?

Hello Psyche, my husband used to have heart palpitations and was taking meds for it. I bought him some hibiscus tea and with change of diet this has gone away, but I would really like to read on this further. What do you recomend reading for this? His family has frowned upon no meds, so I would really like some good reading to show him, myself, and the family. Thankyou

Hmm, I'm trying to think of a single source, but the importance of the diet and heart health is emphasized on Life Without Bread, The Art and Living of Low Carb by Phinney, The Doctor's Heart Cure by Al Sears and The Magnesium Miracle by Carolyn Dean for example. It is in some parts of the book. Nothing that is overemphasized, but there are some good articles. For example, the role of heart drugs in aggravating, perpetuating and causing heart palpitations to begin with:

Oral Magnesium for Cardiac Arrhythmias: Current Clinical Perspective
http://www.mgwater.com/arr.shtml

The mgwater.com website is highly recommended by about everybody that writes about magnesium. It is a huge database of the importance of magnesium in our health, and how it is currently ignored by mainstream medicine despite the glaringly obvious facts.

Omega 3s are very important in stabilizing the electrical activity in the heart, and since most people eat transfats and vegetable oils, then it is no surprise to see a surge in heart arrhytmias, especially as one gets old. Then people are put into dangerous drugs that mean to stop the arrhytmias, but actually end up deteriorating them even faster, if not killing them out right when all was needed was to increase the intake of animal fats and Omega-3s... You know how it goes. The amount of mainstream articles on this subject is also significant. But the cognitive dissonance is such, that despite the facts and the amount of them, there is no sign of mass enlightenment. Anyway, here is one reuters article that might help:

Omega-3 fatty acids tied to lower heart arrhythmia risk
http://www.reuters.com/article/2012/02/02/us-fish-heart-idUSTRE81108620120202

Coupled with a paleo diet, a useful cocktail for heart palpitations is vitamin C, Coenzyme Q10, magnesium, potassium and L-carnitine. That should deal with it. Coffee must be avoided too. A carb metabolism leaves us prone to heart rhythm imbalances. Think of sugar shock. For this, Primal Body, Primal Mind will come in handy to read.

You can search individually about CoQ10 and L-carnitine and their importance in heart health, as it goes well beyond heart palpitations. L-carnitine is involved in getting fats within the mitochondria and is supplied with a fatty meat meal. But it takes awhile to change the metabolism after a life time eating carbs.

I did a search and came across this article as well which seem to cover a lot of the above:

Understanding Arrhythmias
_http://www.heartmdinstitute.com/health-concerns/cardiovascular-system/heart-health/atrial-fibrillation-other-arrhythmias

Just ignore the part of cigarette smoking ;)

Thankyou Psyche! I have the book Primal Body Primal Mind and I suggest it to anyone that will listen. The only supplement we have not tried yet is the CoQ10 and L- carnitine. If L-carnitine helps fat get to our mitochondria then its a must on my shopping list! Or do we need to be taking these after being on the KD. Even though I read all I can get my hands on, I am still a little unsure how much supplamentation we really need. Thanks again for taking time :)

 

[Laura]

Re: Ketogenic Diet - Path To Transformation?

Folks, i didnt have the strenght to read the 102 pages of this topic yet, but i want to ask a simple question :

What about a diet composed only of fruits (mostly apples, bananas, etc...) ?
and how would you compare it to KD diet ?

If you don't have the strength to read the thread, then you need to more than anything else.

As for your fruit diet, it's pure poison. Fruit is for birds and bats and insects. You are what you eat. But it's your body, your life; do as you choose.

 

[Chu]

Re: Ketogenic Diet - Path To Transformation?

Folks, i didnt have the strenght to read the 102 pages of this topic yet, but i want to ask a simple question :

What about a diet composed only of fruits (mostly apples, bananas, etc...) ?
and how would you compare it to KD diet ?

If you want to be sick, old and in pain, it's the perfect diet. Feed your body only sugar (the fact that it comes from fruit doesn't make it less of a carbohydrate), not ESSENTIAL fats, and you are set out for a nice life of constant suffering and a deteriorating brain. The KD diet couldn't be further from that. But it's up to you to do the reading...

 

[Gaby]

Re: Ketogenic Diet - Path To Transformation?

Thankyou Psyche! I have the book Primal Body Primal Mind and I suggest it to anyone that will listen. The only supplement we have not tried yet is the CoQ10 and L- carnitine. If L-carnitine helps fat get to our mitochondria then its a must on my shopping list! Or do we need to be taking these after being on the KD. Even though I read all I can get my hands on, I am still a little unsure how much supplamentation we really need. Thanks again for taking time :)

If you are doing fairly well on the ketogenic diet, you can even skip them. I would take them if I had heart palpitations only or something that might indicate an inability to get the fat burning system cranked up. For instance, muscle cramps often get relieved with L-carnitine when starting a ketogenic diet. That is because the fat energy can't reach the mitochondria. After a bottle's worth of carnitine, or a month or so, it might no longer be needed. Or you can just take it when you have cramps.

CoQ10 is especially helpful for those with heart problems: heart failure, heart palpitations, etc. It is also helpful for Parkinson's disease. Both nutrients are supplied with a diet rich in fat and fatty meat.

If you are doing well with bone broth, I would not worry though. I think it is more of the kind of supplementation that a person starting the diet should need. For instance, a person with heart palpitations who is starting the diet (in this case paleo diet) to deal with this problem.

If you think they are worth it and are the only ones that haven't tried so far, I would start with L-carnitine first. It is very difficult to find a good quality CoQ10 supplement. Its absorption from the gut is problematic, so highly available versions are often pricey. Perhaps the L-carnitine will be enough.