L-Carnitine (Pt. 2)
L-Carnitine and the heart
As we have seen, the main job of L-carnitine is to transport fatty acids to the inner mitochondrial membrane where they are burned as fuel. A healthy heart obtains 60% of its fuel from fat, therefore, maximizing the burning of this fat is crucial for heart function.
The more advanced the heart disease is the harder it is to get oxygen, and the more blood congestion backing up into the lungs and tissues occurs. When this is the case, a thorough nutritional program can make a great difference. L-Carnitine, with the help of the ‘Heart and Body Extract’ and other nutrients that we will look at in following blogs, can be life altering.
Atherosclerosis sufferers with various degrees of congestive heart failure are the most compromised in their symptoms, all of which are related to a heart that is starved of oxygen, struggling to pump hard enough to keep the blood moving forward. Dr. Sinatra recalls how much improvement he saw when he combined L-carnitine with nutrients like CoQ10, D-Ribose and hawthorn for the most symptomatic of his patients. Hawthorn is one of the ingredients found in the ‘Heart and Body Extract’, making it a great addition to your heart protocol for its circulation enhancing properties. All of these nutrients can be used to treat any of the following heart conditions quite effectively.
L-Carnitine and angina
Angina is caused by insufficient supply of oxygen to the heart tissue due to blockages or spasms of the coronary arteries. Symptoms of angina are pressure, burning discomfort on the chest or pain from shoulder to shoulder or up into the neck, radiating into the back and left arm. Shortness of breath is also a sign because the body is trying to get more oxygen to compensate for the shortage. This symptom may be the only warning for someone with diabetes because their nerve endings have lost sensitivity. Other less typical signs of angina are throat tightness, soreness or pain in the jaw, a tooth, the back or the forearms.
Regardless of the cause, the source is always a lack of oxygen in the heart muscle, due to coronary arteries that have become blocked either from a build-up of inflammatory cholesterol plaque that progresses with age. As these blockages increase in size, they crowd the artery opening and limit the flow of oxygen to the heart muscle. This lack of oxygen leads to the symptoms, because lack of oxygen leads to energy depletion, which kills the cell, resulting in numbness and pain.
While the traditional treatment for angina works by reducing the workload of the heart and oxygen demand and can widen the arterial walls, these drugs can’t improve the oxygen demand ratio and do little to affect the energy imbalance. L-carnitine, on the contrary, can alleviate the symptoms of angina most effectively.
Many double-blinded placebo controlled research studies in the cardiovascular literature show the efficacy of L-carnitine and its cousin propionyl-L-carnitine (PLC) in treating angina and other cardiovascular disorders. PLC is taken into the myocardial cells more readily than other forms of carnitine. While acetyl-L-carnitine is taken up more widely by the brain.
As we have seen, L-carnitine enhances fatty acid metabolism and prevents the accumulation of toxic fatty acid metabolites inside the heart. In angina it improves overall oxygen use by the heart cells, allowing the heart to do more things with less oxygen.
L-carnitine was found to be helpful in angina and myocardial ischemia. Ischemia is defined as the lack of oxygenated blood flow to a tissue. When this happens it triggers other effects that compound the problem:
- Toxic levels of fatty acids and their metabolites start accumulating, which paralyze mitochondria.
- ATP levels crash.
- ATP breakdown products form and leave the cell, depleting the energy pool.
Studies have shown the effectiveness of L-Carnitine for all these conditions.
L-carnitine and myocardial infarction
Myocardial infarction is another term used to refer to a heart attack; infarction refers to tissue death. Dr. Sinatra explains that a heart attack can start when a clot coming from an artery plaque rupture site gets stuck in a coronary artery. Sometimes a clot can form somewhere else and it becomes stuck where it can not get through, creating a blocked artery. Another cause is a spasm that lasts so long that the blood congeals in an open area of circulation. In any case, it always results in an emergency, because without blood supply the heart muscle will die.
A lot of research has been done on the role of L-carnitine in heart attacks. In one study researchers tried to determine whether L-carnitine would protect the heart and micro-circulation against heart attack damage when given immediately during the acute phase of a heart attack. The results indicated that L-carnitine slows down the progression of a heart disease and limits its size.
Another study tried to determine whether propionyl-L-carnitine could improve exercise tolerance and physical function following a heart attack. They observed that 100 mg a day increased the level of total L-carnitine in both the blood serum and the heart muscle by 15-23%. Exercise capacity also increased by 3%, while in the group that didn’t receive L-carnitine it decreased by 16%.
In a third study researchers measured energy levels in the heart following a heart attack, the three different forms of L-carnitine were used in three different groups to check if there was a difference. All three forms markedly improved recovery of energy in the tissue, increasing energy levels for an hour. Acetyl-L-carnitine was even stronger in its early response, but did not keep the energy level as high as L-carnitine. Propionyl-L-carnitine didn’t provide very early recovery as compared with the other two forms but by the end the recovery was greater.
All this information helps us conclude that all three forms of L-carnitine protect the heart against the intracellular damage associated with the buildup of lactic acid that normally happens during heart attacks. Heart patients that were given any of the forms of L-carnitine were able to withstand four induced heart attacks in succession.
In yet another study, researchers observed that L-carnitine was able to reduce infarct size, limiting tissue damage. There was also a reduction of ischemic arrhythmias and heart enlargement as well as the number of deaths.
Another study from the ‘Journal of the American College of Cardiology’ confirmed that supplementing with L-carnitine after an acute heart attack had a beneficial effect on the preservation of the left ventricle, where most heart attacks happen, by preventing an increase in heart size. Increased left ventricle during the first year of a heart attack is a very good predictor of future adverse cardiac events according to Dr. Sinatra.
L-Carnitine and congestive heart failure
In congestive heart failure the heart cannot contract with enough force to pump blood around the body. This is the reason for the congestion through the body: ankles, lungs and heart. One of the ways to help the heart is to supplement the diet with nutrients that strengthen heart contractions and help the heart fully relax so it can fill up again. L-carnitine is one of them.
One of the major problems with congestive heart failure is the scar tissue present after repeated heart attacks, which limits muscle function. Another side effect is a heart muscle that is stretched out, dilated and enlarged due to long standing high blood pressure. In any case, the research shows that in patients with end stage congestive heart failure and donor hearts, concentrations of L-carnitine in heart muscle was significantly lower and it correlated with ejection fraction. Ejection fraction measures the amount of blood volume pumped from the heart with each heartbeat. In congestive heart failure ejection fraction is reduced sometimes to 10-15%. Research showed that this condition made patients lose L-carnitine from the heart itself, creating a deficiency. This is evidence that a diseased heart has difficulty holding on to its L-carnitine. Conclusions of these studies showed that supplementation with L-carnitine was able to reverse this deadly trend. Advantages included improvement in arterial blood pressure, cholesterol levels, rhythm disorders and signs of congestive heart failure, but above all a reduction in mortality. Dr. Sinatra, working with his patients, has observed less shortness of breath, less fatigue, less ankle swelling, more energy, better sleep and increased appetite.
L-carnitine and peripheral vascular disease
Also known as intermittent claudication, peripheral vascular disease is a condition that mimics angina but the pain occurs in the calf instead of the heart. It is characterized by poor circulation in the legs with obstructed blood flow in a large artery, such as the femoral, due to loss of energy in the muscle tissue of the leg. It may happen after a bypass operation and the pain is due to reduced oxygen delivery to the legs, which encourages increased production of free radicals. Both angina and peripheral vascular disease share the fact that the pain can occur with normal everyday activities like walking. L-carnitine works for this condition as well as for angina, because it can help maximize cellular energy production if blood flow is compromised.
Research showed that propionyl-L-carnitine supplementation could increase exercise tolerance and reduce the pain associated with physical activity. Walking time increased by 54%, in walking time, distance and speed, muscle strength increased, pain was reduced and resulted in higher quality of life.
Two of the most frequent types of arrhythmia are ‘premature ventricular contractions’ (PVCs) and ‘premature arterial contractions’ (PACs). Both of these start with an early beat followed by a pause, often described as a palpitation. This pause is actually allowing more blood to enter the heart so that the next contraction feels more pronounced, creating a sensation like the heart is palpitating. These two conditions usually happen due to the accumulation of fatty acid metabolites that weaken the contraction of the heart and make the sufferer more vulnerable to irregular heartbeats, eventually injuring heart tissue, and interrupting electrical transmission of impulses. Supplementing with L-carnitine can help the heart keep the beat energetically. Research has shown that L-carnitine assists the body in free fatty acid metabolism and high grade ventricular arrhythmia. Dr. Sinatra also recommends to add magnesium, potassium, calcium and hawthorn berry, fish oil, CoQ10 and D-ribose as adjunct therapy.
Concluding, research has shown repeatedly the remarkable properties of L-carnitine in treating various heart disorders. Taken together with other nutrients like the ones present in the ‘Heart and Body Extract’ can add to its benefits and make a complete health protocol.
Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 101-143. Print.