Your Nutrients

Age-related cognitive decline (ARCD) Alzheimer’s disease (early-stage) Glaucoma (normal tension glaucoma) Intermittent claudication Altitude sickness (prevention) Depression (for elderly people) Erectile dysfunction (of vascular origin) Macular degeneration Schizophrenia (in combination with haloperidol) Vertigo Vitiligo Asthma Atherosclerosis Deafness, acute cochlear Memory enhancement (in healthy adults) Ménière’s disease Migraine headaches Multiple sclerosis (injections) Premenstrual syndrome Raynaud’s disease Retinopathy Tinnitus Type 1 diabetes Type 2 diabetes

Excessive bleeding has been reported in a few individuals taking ginkgo, although a cause/effect relationship was not proven. In addition, two elderly individuals with well-controlled epilepsy developed recurrent seizures within two weeks after starting ginkgo. Mild headaches lasting for a day or two and mild upset stomach have been reported in a small number of people using ginkgo. Ginkgo leaves are known to contain a group of potentially toxic constituents known as alkylphenols. To reduce the potential for adverse effects, the German Commission E Monograph requires that ginkgo products for human consumption contain less than 5 parts per million of alkylphenols. One small clinical trial found that ginkgo supplementation for three months increased secretion of insulin by the pancreas, but did not affect blood glucose levels, in healthy young adults. These results suggest that the participants may have developed an insensitivity to insulin, a potential concern because insulin insensitivity may be a precursor to type 2 diabetes. However, this trial does not prove that ginkgo causes insulin insensitivity, nor does it prove that long-term ginkgo supplementation increases the risk for any disease. In addition, the results of this trial are not consistent with other research on ginkgo. Larger and more rigorously designed clinical trials of ginkgo supplementation have found no significant adverse effects after as many as 12 months of supplementation. People should seek an accurate medical diagnosis prior to self-prescribing ginkgo. This is especially important for the elderly, whose circulatory conditions can involve serious disease, and for people scheduled for surgery, as ginkgo may affect bleeding time. Certain medicines may interact with Ginkgo biloba. Refer to drug interactions for a list of those medicines.

Most clinical trials have used between 120 and 240 mg of ginkgo (standardized to contain 6% terpene lactones and 24% flavone glycosides) per day, generally divided into two or three portions. The higher amount (240 mg per day) has been used in some people with mild-to-moderate Alzheimer’s disease, age-related cognitive decline, intermittent claudication, and resistant depression. Ginkgo may need to be taken for eight to twelve weeks before desired actions such as cognitive improvement are noticed. Although nonstandardized Ginkgo biloba leaf and tinctures are available, there is no well-established amount or use for these forms.

Alpha lipoic acid (ALA) is a vitamin-like antioxidant, sometimes referred to as the “universal antioxidant” because it is soluble in both fat and water. ALA is manufactured in the body and is found in some foods, particularly liver and yeast.

The body makes small amounts of alpha lipoic acid. There is only limited knowledge about the food sources of this nutrient. However, foods that contain mitochondria (a specialized component of cells), such as red meats, are believed to provide the most alpha lipoic acid. Supplements are also available.

Although alpha lipoic acid was thought to be a vitamin when it was first discovered, subsequent research determined that it is created in the human body and thus is not an essential nutrient. For this reason, deficiencies of alpha lipoic acid are not known to occur in humans.

Type 1 diabetes Type 2 diabetes Glaucoma Hepatitis

Side effects with alpha lipoic acid are rare but can include skin rash and the potential of hypoglycemia in diabetic patients. People who may be deficient in vitamin B1 (such as alcoholics) should take vitamin B1 along with alpha lipoic acid supplements. Chronic administration of alpha lipoic acid in animals has interfered with the actions of the vitamin, biotin. Whether this has significance for humans remains unknown. At the time of writing, there were no well-known drug interactions with alpha lipoic acid.

The amount of alpha lipoic acid used in research to improve diabetic neuropathies is 800 mg per day and 150 mg per day for glaucoma. However, much lower amounts, such as 20–50 mg per day, are recommended by some doctors for general antioxidant protection, although there is no clear evidence that such general use has any benefit.

Acetyl-L-carnitine is similar in form to the amino acid L-carnitine and also has some similar functions, such as being involved in the metabolism of food into energy. The acetyl group that is part of acetyl-L-carnitine contributes to the production of the neurotransmitter acetylcholine, which is required for mental function.

Acetyl-L-carnitine is a molecule that occurs naturally in the brain, liver, and kidney. It is also available as a dietary supplement.

Acetyl-L-carnitine levels may decrease with advancing age. However, because it is not an essential nutrient, true deficiencies do not occur.

Age-related cognitive decline Alzheimer’s disease Cerebellar ataxia, degenerative Depression (for elderly people) Down’s syndrome Erectile dysfunction (in combination with L-carnitine) Macular degeneration (in combination with fish oil and coenzyme Q10) Type 1 diabetes Type 2 diabetes Amenorrhea Male infertility Peripheral neuropathy

Side effects from taking acetyl-L-carnitine are uncommon, although skin rash, increased appetite, nausea, vomiting, agitation, and body odor have been reported in people taking acetyl-L-carnitine. Certain medicines may interact with acetyl-L-carnitine. Refer to drug interactions for a list of those medicines.

Most research involving acetyl-L-carnitine has used 500 mg three times per day, though some research has used double this amount.

Acetyl-L-carnitine is similar in form to the amino acid L-carnitine and also has some similar functions, such as being involved in the metabolism of food into energy. The acetyl group that is part of acetyl-L-carnitine contributes to the production of the neurotransmitter acetylcholine, which is required for mental function.

Acetyl-L-carnitine is a molecule that occurs naturally in the brain, liver, and kidney. It is also available as a dietary supplement.

Acetyl-L-carnitine levels may decrease with advancing age. However, because it is not an essential nutrient, true deficiencies do not occur.

Age-related cognitive decline Alzheimer’s disease Cerebellar ataxia, degenerative Depression (for elderly people) Down’s syndrome Erectile dysfunction (in combination with L-carnitine) Macular degeneration (in combination with fish oil and coenzyme Q10) Type 1 diabetes Type 2 diabetes Amenorrhea Male infertility Peripheral neuropathy

Side effects from taking acetyl-L-carnitine are uncommon, although skin rash, increased appetite, nausea, vomiting, agitation, and body odor have been reported in people taking acetyl-L-carnitine. Certain medicines may interact with acetyl-L-carnitine. Refer to drug interactions for a list of those medicines.

Most research involving acetyl-L-carnitine has used 500 mg three times per day, though some research has used double this amount.

L-carnitine is made in the body from the amino acids lysine and methionine, and is needed to release energy from fat. It transports fatty acids into mitochondria, the powerhouses of cells. In infancy, and in situations of high energy needs, such as pregnancy and breast-feeding, the need for L-carnitine can exceed production by the body. Therefore, L-carnitine is considered a “conditionally essential” nutrient.

Dairy and red meat contain the greatest amounts of carnitine. Therefore, people who have a limited intake of meat and dairy products tend to have lower L-carnitine intakes.

Carnitine deficiencies are rare, even in strict vegetarians, because the body produces carnitine relatively easily. Rare genetic diseases can cause a carnitine deficiency. Also, deficiencies are occasionally associated with other diseases, such as diabetes and cirrhosis. Among people with diabetes, carnitine deficiency is more likely to be found in persons experiencing complications of diabetes (such as retinopathy, hyperlipidemia, or neuropathy), suggesting that carnitine deficiency may play a role in the development of these complications. A carnitine deficiency can also result from oxygen deprivation which can occur in some heart conditions. In Italy, L-carnitine is prescribed for heart failure, heart arrhythmias, angina, and lack of oxygen to the heart.

Angina Congestive heart failure (propionyl-L-carnitine) Heart attack Intermittent claudication (propionyl-L-carnitine) Anemia (for thalassemia) Attention deficit–hyperactivity disorder Chronic fatigue syndrome Chronic obstructive pulmonary disease (COPD) Erectile dysfunction (in combination with acetyl-L-carnitine) High triglycerides Infertility (male) Intermittent claudication (L-carnitine) Sprains and strains (for preventing exercise-related muscle injury) Type 1 diabetes Type 2 diabetes Athletic performance (for ultra-endurance only) Beta thalassemia major Cardiomyopathy (only for children with inherited cardiomyopathy) Chemotherapy-induced fatigue High cholesterol Liver cirrhosis Mitral valve prolapse Raynaud’s disease Weight loss

L-carnitine has not been consistently linked with any toxicity. The body needs lysine, methionine, vitamin C, iron, niacin, and vitamin B6 to produce carnitine. Certain medicines may interact with L-carnitine. Refer to drug interactions for a list of those medicines.

Most people do not need carnitine supplements. For therapeutic use, typical amounts are 1–3 grams per day. It remains unclear whether the propionyl-L-carnitine form of carnitine used in congestive heart failure research has greater benefits than the L-carnitine form, since limited research in both animals and humans with the more common L-carnitine has also shown very promising effects.