Can metabolic activators NAC, nicotinamide riboside, and L-carnitine speed recovery time in mild, moderate COVID-19?


Researchers enrolled 309 adult COVID-19 outpatients in Turkey to receive either the mixture of the metabolic activators or a placebo twice daily for 14 days.

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COVID-19 patients often experience mitochondrial dysfunction and metabolic abnormalities, including deficiency of nicotinamide adenine dinucleotide (NAD+) and deficient glutathione metabolism. In a new study, researchers from King’s College London and KTH-Royal Institute of Technology studied whether a combination of metabolic activators (CMA)—specifically, N-acetyl-L-cysteine (NAC), nicotinamide riboside (NR), and L-carnitine—could support metabolic function and shorten recovery time in patients with mild to moderate cases of COVID-19.

In a phase-3, double-blind, randomized, placebo-controlled study, researchers enrolled 309 adult COVID-19 outpatients in Turkey to receive either the mixture of the metabolic activators (containing 3.73 g L-carnitine tartrate, 2.55 g NAC, 1 g NR, and 12.35 g serine) or a placebo twice daily for 14 days.

The CMA supplement shortened recovery time from 9.2 days to 5.7 days. The subjects receiving the CMA intervention also showed higher plasma levels of proteins and metabolites linked with inflammation and antioxidant metabolism. The researchers noted, “Mortality in COVID-19 patients has been strongly associated with the presence of the cytokine storm induced by the virus. Increased cytokine levels are also linked with increased viral load and the severe form of the disease.”

“The results show that treating patients infected with COVID-19 with CMAs lead to a more rapid, symptom-free recovery, suggesting a role for such a therapeutic regime in the treatment of infections leading to respiratory problems,” the researchers wrote. Such an intervention is especially of interest for subjects with mitochondrial dysfunction and metabolic abnormalities.

The CMAs in this study, NAC, NR, and L-carnitine, have been demonstrated to be beneficial for treating lung diseases and viral infections diseases, the researchers added. The NR ingredient was provided by ChromaDex Inc. (Irvine, CA).


  1. Altay O. “Combined metabolic activators accelerates recovery in mild-to-moderate COVID-19.” Advanced Science. Published online June 28, 2021.
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