The Brain and Mitochondria Boosting Benefits of Acetyl L Carnitine (ALCAR) by Alex Leaf, M.S. The Energy Blueprint Carnitine metabolism in hypertensive heart failure Hypertension Research L carnitine is primarily synthesized in the liver from the amino acids lysine and methionine through a series of four enzymatic reactions, with the liver and kidneys converting the precursor butyrobetaine into active Mitochondrial diseases Nature Reviews Disease Primers