Overview

Why is L-Carnitine important?
It helps provide energy for the body at a cellular level:

L-carnitine is naturally found in food and synthesized in the body, where the heart and skeletal muscles rely on its ability to bring fatty acids into the cells, where it is used as fuel.†

Why use Vitaline^® L-Carnitine ?
It provides pure, clinically-studied L-Carnitine for your heart health:†

Nearly 70% of the energy needed for your heart is derived from fatty acid breakdown. Vitaline^® L-Carnitine transports fatty acids into the mitochondria of the cells, where it is burned for cellular energy where you need it most.†

Directions

One caplet one to three times daily, or as directed by a healthcare practitioner prior to use.

Interactions and Depletions

Technical Data

DESCRIPTION
Vitaline® L-Carnitine is a dietary supplement containing pure L-carnitine, a vitamin-like nutrient derived from amino acids found naturally in the body.^1-3

HOW DOES IT WORK?
The primary function of carnitine is to carry long-chain fatty acids across the inner mitochondrial membrane and shuttle acetyl groups out of the mitochondria.† This is a complex process involving several steps.^1-5

Simply stated, carnitine carries long-chain fatty acids into the mitochondria by esterification of the long-chain fatty acids into acylcarnitines, which are then transported into the mitochondrial matrix.† Once inside the mitochondria, the fatty acid splits away from the carnitine where it undergoes beta-oxidation for cellular energy production. Carnitine then facilitates the removal of short-chain and medium-chain fatty acids that accumulate from fatty acid beta-oxidation.†^1-5

Fatty acids are utilized in energy production in all tissues except the brain. In the cortex of the kidney and heart muscle, fatty acid oxidation is the major fuel.² For this reason, L-carnitine's role in these tissues is well researched and documented.†

Fatty Acid Oxidation
The only site of degradation and oxidation of fatty acids is the mitochondria. Therefore, use of fatty acids for energy production is dependent on their transport into the mitochondria by carnitine.† The process of fatty acid degradation requires the progressive release of two-carbon segments (beta-carbons) from each fatty acid molecule. This process, beta-oxidation, results in tremendous amounts of adenosine triphosphate (ATP), the high energy compound required for almost all metabolic reactions. Fatty acid molecule to ATP molecule ratios can be as high as 1:146.^1,6 This means one fatty acid molecule can yield 146 molecules of ATP.

Vitaline® L-Carnitine and Support of Renal (Kidney) Health
The kidneys regulate water and electrolyte balance through maintenance of a stable environment. Unwanted substances are filtered by the kidneys from the plasma and excreted in the urine. The kidneys then return needed substances back to the blood. Some substances do not require filtration from the plasma. Albumin, the most abundant plasma protein, has a high molecular weight, eliminating the need for filtration.^7,8

The kidneys have physiologic activities in addition to water and electrolyte balance. Well-functioning kidneys form between 89% and 95% of the body's erythropoietin, a circulating hormone that regulates red blood cell production.^7,8 L-carnitine supports healthy microcirculation and tissue oxygen delivery in the kidney, as well as healthy serum albumin concentration.†^9-12

Vitaline® L-Carnitine and Support of Immune Health
Immunity is the resistance to disease that is provided by the immune system. Cell-mediated immunity depends on T-cell responses to cellular antigens. Non-specific immune mechanisms include cytokines, which are produced mainly by T-cells. Cytokines function as intercellular signals that regulate immune responses. All types and subsets of T-cells are required for healthy immune function.^13,14 L-carnitine supports immune health, including support of cytokine response and lymphocyte response.†^15-19

Vitaline® L-Carnitine and Support of Cardiovascular Health
Cardiac muscle cells contain many mitochondria, reflecting their continuous energy needs. ATP production, therefore, occurs in higher quantities in cardiac cells than in other cells. This ATP in turn conveys energy for cellular function.²⁰ Generally, cardiac muscles do not require carbohydrates for normal cellular metabolism as do other tissues. Under resting conditions, cardiac muscle uses fatty acids for 70% of its energy requirements.²¹ L-carnitine supplementation supports healthy cardiac enzyme levels, heart contractility and subsequent circulation and exercise tolerance, because of the special role L-carnitine plays in transporting fatty acids into the cell for energy production.†^22-32

Vitaline® L-Carnitine and Support of Healthy Glucose Levels
The human body uses glucose and fatty acids to meet its energy needs. Control of the body's fuel supply is a complex process that relies on several metabolic processes for regulation. Free fatty acids stimulate beta cells to stimulate increased insulin secretion. They also inhibit glucose uptake, phosphorylation, and glycogen storage. Free fatty acids mediate and stimulate insulin delivery and glucose production.^33,34 L-carnitine transports fatty acids into the mitochondrial matrix for oxidation and supports healthy glucose levels.†^35-37

Safe, Physiologic Active Form
While L-carnitine occurs naturally and provides beneficial biologic properties, D-carnitine is biologically inactive. D-carnitine interferes with the absorption and utilization of L-carnitine. When D-carnitine is synthesized in a mixture of D and L carnitine, the negative effects of D-carnitine persist, causing depletion of carnitine.³⁸ Therefore, only L-carnitine is used in Vitaline® L-Carnitine .

RECOMMENDATIONS
One caplet one to three times daily, or as directed by a healthcare practitioner prior to use.

PRECAUTIONS
Various mild gastrointestinal complaints have been reported during the long-term administration of L-carnitine. Taking Vitaline® L-Carnitine with meals may relieve these symptoms.

HOW IS IT SUPPLIED?

• 06596;60 Caplets

Due to the hygroscopic nature of L-carnitine, each bottle contains two desiccants.

STORAGE RECOMMENDATIONS
Store at controlled room temperature, 59° to 86°F (15° to 30°C).

REFERENCES

1. Guyton AC, Hall JE. Use of triglycerides for energy: formation of adenosine triphosphate. In: Textbook of Medical Physiology 9th ed. Philadelphia, Pa: WB Saunders; 1996: 867-868.
2. Rebouche CJ. Carnitine. In: Modern Nutrition in Health and Disease. 9th ed. Shils, ME, Olson JA, Shilke M, et al. Eds. Philadelphia, Pa: Williams and Wilkins; 1999: 505-512.
3. Jones PJH, Kubow S. Lipids, sterols, and their metabolites. In: Modern Nutrition in Health and Disease. 9th ed. Shils, ME, Olson JA, Shilke M, et al. Eds. Philadelphia, Pa: Williams and Wilkins; 1999: 67-94.
4. Goa KL, Brogden RN. L-carnitine. A preliminary review of its pharmacokinetics, and its therapeutic use in ischemic cardiac disease and primary and secondary carnitine deficiencies in relationship to its role in fatty acid metabolism. Drugs. 1987;34:1-24.
5. Rebouche CJ. Carnitine function and requirements during the life cycle. FASEB J. 1992;6:3379-3386.
6. Porth CM, Carroll EW. Aerobic metabolism. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 15-16.
7. Guyton AC, Hall JE. Urine formation by the kidneys: I. Glomerular filtration, renal blood flow, and their control. In: Textbook of Medical Physiology. 9th ed. Philadelphia, Pa: WB Saunders; 1996: 321-322.
8. Porth CM. Erythropoietin. In: Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 579.
9. Sloan RS, Kastan B, Rice SI, et al. Quality of life during and between hemodialysis treatments: role of L-carnitine supplementation. Am J Kidney Dis. 1998;32:265-272.
10. Kletzmeyer J, Mayer G, Legenstein E, et al. Anemia and carnitine supplementation in hemodialyzed patients. Kidney Int Suppl. 1999;69:S93-106.
11. De los Reyes B, Navarro JA, Perez-Garcia R, et al. Effects of L-carnitine on erythrocyte acyl-CoA, free CoA, and glycerophospholipid acyltransferase in uremia. Am J Clin Nutr. 1998;67:386-390.
12. Nikolaos S, George A, Telemachos T, Maria S, Yannis M, Konstantinos M. Effect of L-carnitine supplementation on red blood cells deformity in hemodialysis patients. Ren Fail. 2000;22:73-80.
13. Sommers C. Immunity and inflammation. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa; Lippincott; 1998: 189-212.
14. Guyton AC, Hall JE. Resistance of the body to infection: II. Immunity and allergy. In: Textbook of Medical Physiology. 9th ed. Philadelphia, Pa: WB Saunders; 1996: 445-455.
15. Semino-Mora MC, Leon-Monzon ME, Dalkas MC. Effect of L-carnitine on the zidovudine-induced destruction of human myotubes. Part I: L-carnitine prevents the myotoxicity of AZT in vitro. Lab Invest. 1994;71:102-122.
16. Moretti S, Alesse E, Di Marizo L, et al. Effect of L-carnitine on human immunodeficiency virus-1 infection-associated apoptosis: a pilot study. Blood. 1998;91:3817-3824.
17. Famularo G, Moretti S, Marcellini S, et al. Acetyl-carnitine deficiency in AIDS patients with neurotoxicity on treatment with antiretroviral nucleoside analogues. AIDS. 1997;11:185-190.
18. De Simone C, Famularo G, Tzantzoglou S, Trinchieri V, Moretti S, Sorice F. Carnitine depletion in peripheral blood mononuclear cells from patients with AIDS: effect of oral L-carnitine. AIDS. 1994:8:655-660.
19. DeSimone C, Tzantzoglou S, Famularo G, et al. High dose L-carnitine improves immunologic and metabolic parameters in AIDS patients. Immunopharmacol Immunotoxicol. 1993;15:1-12.
20. Porth CM. Functional anatomy of the heart. In: Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998:307.
21. Guyton AC, Hall JE. Special features of cardiac metabolism. In: Textbook of Medical Physiology 9th ed. Philadelphia, Pa: WB Saunders; 1996: 259.
22. Bertelli A, Ronca F, Ronca G, Palmieri L, Zucchi R. L-carnitine and coenzyme Q10 protective action against ischaemia and reperfusion of working heart rat. Drugs Exp Clin Res. 1992;18:431-436.
23. Pepine CJ. New thoughts of pathophysiology and therapy of ischemic heart disease. Cardiologia. 1991;36:373-377.
24. Davini P, Bigalli A, Lamanna F, Boem A. Controlled study on L-carnitine therapeutic efficiency in post-infarction. Drugs Exp Clin Res. 1992;18:355-365.
25. Loster H, Miehe K, Punzel M, Stiller O, Pankau H, Schauer J. Prolonged oral L-carnitine substitution increases bicycle ergometer performance in patients with severe, ischemically induced cardiac insufficiency. Cardiovasc Drugs Ther. 1999;13:537-546.
26. Rizos I. Three-year survival of patients with kidney failure caused by dilated cardiomyopathy and L-carnitine administration. Am Heart J. 2000;139:S120-123.
27. Singh RB, Niaz MA, Agarwal P, Beegum R, Rastogi SS, Sachan DS. A randomised, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction. Postgrad Med J. 1996;72:45-50.
28. Cherchi A, Lai C, Angelino F, et al. Effects of L-carnitine on exercise tolerance in chronic stable angina: a multicenter, double-blind, randomized, placebo controlled crossover study. Int J Clin Pharmacol Ther Toxicol. 1985;23:569-572.
29. Brevetti G, Chiarello M, Ferulano G, et al. Increases in walking distance in patients with peripheral vascular disease treated with L-carnitine: a double-blind, cross-over study. Circulation. 1988;77:767-773.
30. Garzya G, Amico RM. Comparative study on the activity of racemic and laevorotory carnitine in stable angina pectoris. Int J Tiss Reac. 1980;2:175-180.
31. Watanabe S, Ajisaka R, Masuoka T, et al. Effects of L- and DL-carnitine on patients with impaired exercise intolerance. Jpn Heart J. 1995;36:319-331.
32. Plioplys AV, Plioplys S. Amantadine and L-carnitine treatment of Chronic Fatigue Syndrome. Neuropsychology. 1997;35:16-23.
33. Guven S, Kuenzi J. Type 2 diabetes mellitus. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 812.
34. Guyton AC, Hall JE. Insulin, glucagon, and diabetes mellitus. In: Textbook of Medical Physiology 9th ed. Philadelphia, Pa: WB Saunders; 1996: 971-983.
35. Giancaterini A, De Gaetano A, Mingrone G, et al. Acetyl-L-carnitine infusion increases glucose disposal in type 2 diabetic patients. Metabolism. 2000;49:704-708.
36. Mingrone G. Greco AV, Capristo E, et al. L-carnitine improves glucose disposal in type 2 diabetic patients. J Am Coll Nutr. 1999;18:77-82.
37. Tamamogullari N, Silig Y, Icagasioglu S, Atalay A. Carnitine deficiency in diabetes mellitus complications. J Diabetes Complications. 1999;13:251-253.
38. Bahl JJ, Bressler R. The pharmacology of carnitine. Annu Rev Pharmacol Toxicol. 1987;27:257-277.

Studies and Presentations using Vitaline L-Carnitine
Sakurabayashi T, Takaesu Y, Haginoshita S, et al. Improvement of myocardial fatty acid metabolism through L-carnitine administration to chronic hemodialysis patients. Am J Nephrol. 1999;19:480-484.

Sakurauchi Y, Matsumoto Y, Shinzato T, et al. Effects of L-carnitine supplementation on muscular symptoms in hemodialyzed patients. Am J Kid Dis. 1998;32:258-264.

Nakai Y, Ohnaka K, Endo T, Maed Y. Poster Session P-440. Presented at: The 42nd Annual Congress of Japanese Society for Dialysis Therapy. July 1997.

Sakurabayashi T, Takaesu Y, Hagino S, et al. Effect of L-carnitine on inhibition of advancing anemia and on lowering serum phosphor level in chronically hemodialyzed patients. Presented at: The 42nd Annual Congress of Japanese Society for Dialysis Therapy. July 1997.

Sobue Y, Ido H, Tanaka S, Ohta K. L-carnitine status in dialysis patients. Presented at: The 42nd Annual Congress of Japanese Society for Dialysis Therapy. July 1997.

Nakata M, Sezaki R, Ekisaikai N. Carnitine deficiency syndromes (1): dialysis associated muscle symptoms. Presented at: The 42nd Annual Congress of Japanese Society for Dialysis Therapy. July 1997.

Miwa T, Segawa T, Matsumoto Y, Shinzato T, Maeda K, Satog M. Carnitine deficiency syndromes (2): dialysis associated cardiomyopathy. Presented at: The 43rd Annual Congress of Japanese Society for Dialysis Therapy, Yokohama, Japan, 1998.

Itoh E, Matsumoto Y, Tomimatsu I, et al. Carnitine deficiency syndromes (3): erythropoietin-resistant anemia. Presented at: The 43rd Annual Congress of Japanese Society for Dialysis Therapy, Yokohama, Japan, 1998.

Tomimatsu K, Matsumoto Y, Itoh E, et al. Carnitine deficiency syndromes (4): ): erythropoietin-resistant anemia. Presented at: The 43rd Annual Congress of Japanese Society for Dialysis Therapy, Yokohama, Japan, 1998.

Takeda F, Kiriono H, Morio A, et al. One case report in which oral L-carnitine supplementation showed efficacy in renal anemia in maintenance hemodialysis patients in EPO dose. Presented at: The 43rd Annual Congress of Japanese Society for Dialysis Therapy, Yokohama, Japan, 1998.

Danielson BG, Lundquist T. Bioequivalence study with L-carnitine tablets in healthy volunteers. Department of Medicine, University Hospital, Uppsala, Sweden.

There have been over 20 additional studies utilizing Vitaline® L-Carnitine published in Japan. At this time, English translations of titles and abstracts are not available.

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