Vitamin B11 (L-carnitine, levocarnitine, vitamin BT)

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— All about proper nutrition — B vitamins
B vitamins are compounds whose sources are plant or animal foods. Their role in the body is to regulate biological processes. Vitamin deficiency occurs with dietary restrictions, stress, acute or chronic diseases of the gastrointestinal tract and poses a health hazard.

The role of L-carnitine

To determine the effect of vitamin B11 on the health of older people, a double-blind, placebo-controlled study was conducted in Italy in 2007. During the experiment, each participant was supposed to consume 2 grams of the beneficial compound daily for six months, which was 6.5 times the daily requirement for an ordinary person. After the specified period, the subjects improved their muscle mass (increase by 3.8 kilograms) and fat mass (decrease by 1.8 kilograms). In addition, the patients' cognitive function increased, signs of fatigue (mental, physical) decreased, and total cholesterol levels decreased.

Let's look at why vitamin B11 is needed.

1. For transport of long-chain fatty acids into the mitochondrial matrix. Triglyceride oxidation and ATP synthesis play an important role in energy production. The key participant in these reactions is L-carnitine. The compound supplies long-chain fatty acids to mitochondria through their inner membrane, where β-oxidation of the substance to acetyl-CoA occurs.
2. To control and modulate the intracellular pool of CoASH. Vitamin B11 maintains a stable level of coenzyme A in the body, which is needed to activate carboxyl-containing metabolites. As a consequence, L-carnitine participates in intermediate metabolism, regulating the acetyl-CoA/CoASH ratio in the cell. By maintaining free CoASH at the required level, levocarnitine ensures beta-oxidation, detoxification of xenobiotics and organic acids, and the catabolism of certain amino acids. The compound removes short-chain fatty acids from the mitochondria, freeing intramitochondrial coenzyme A, which is needed for energy metabolism.
3. To perform anabolic functions. Systematic use of the drug relieves the athlete of excess fat deposits, accelerates muscle gain and protein metabolism. The anabolic effect of vitamin B11 is caused by increased secretion and enzymatic activity of gastric juice, as well as the intestinal mucosa, which increases the digestibility of food (namely protein) and increases performance when performing strength exercises. In addition, the compound controls the level of accumulated lactic acid in the muscles, reducing the risk of getting soreness after intense exercise, which is especially important for athletes.
4. To enhance physical and mental activity.
5. For detoxification of organic acids. Thanks to this property, levocarnitine eliminates biogenic waste that accumulates in mitochondria as a result of the oxidation of xenobiotics and triglycerides. Vitamin B11 is effectively used to relieve alcohol or drug intoxication.
6. To increase stress resistance. L-carnitine increases the body's resistance to psycho-emotional stress. Research has found that a vitamin-like compound increases a person's ability to adapt to stress. This means that the substance protects nerve tissue from the harmful effects of glutamate, amphetamine, and ammonia.
7. To improve eye function. Levocarnitine inhibits the transformation of retinal vessels of the dystrophic type, prevents a decrease in visual acuity and reduces the likelihood of cataracts by 40%.
8. To protect the heart muscle and blood vessels. Studies have confirmed that after consuming “carnitine-containing” drugs, patients’ myocardial condition improves. This is achieved by improving metabolism in the heart muscle and lowering cholesterol levels in the blood, which prevents the formation of plaques on the walls of blood vessels, narrowing of blood vessels and, as a consequence, the development of heart attack, hypertension, coronary artery disease, atherosclerosis and stroke.
9. To protect the body from apoptosis (cell death) caused by inhibition of ceramide synthesis and caspase activity.
10. To support the immune system. L-carnitine improves well-being, eliminates chronic fatigue syndrome, increases performance and endurance.
11. To slow down the process of leaching calcium from bones. The systematic intake of levocarnitine is especially important for women during menopause and the elderly, since these categories of people are most susceptible to bone loss.

In addition to the above positive properties, vitamin B11 reduces subcutaneous fat.

B vitamins in clinical practice

THOSE.
Morozova , Doctor of Medical Sciences, Professor,
O.S.
Durnetsova , Candidate of Medical Sciences,
First Moscow State Medical University named after.
THEM. Sechenov The article discusses the role of B vitamins in the treatment of neurological diseases. The results of research and experience in using the combined drug Neuromultivit are covered.

Vitamins play an important role in the normal functioning of the body, as well as in the pathogenesis of certain diseases, many of which are indispensable participants in various metabolic processes. They are necessary for normal cellular metabolism and tissue trophism, normal performance and maintenance of vital functions of the body. A variety of reasons lead to vitamin deficiency, such as diseases of the gastrointestinal tract leading to malabsorption, malnutrition, alcoholism, metabolic disorders, etc. Currently, more than 30 vitamins and vitamin-like substances are known. Most of them are coenzymes of various enzymes and are involved in the regulation of carbohydrate, protein, fat and mineral metabolism, in maintaining cellular structure, and the body’s resistance to adverse environmental factors [1].

Vitamins are divided into fat-soluble (vitamins A, D, E and K) and water-soluble (B vitamins and vitamin C). The absence of any of them leads to insufficient formation of certain vital enzymes in the body and, as a consequence, to a specific metabolic disorder. Thus, it is well known that retinol (vitamin A) plays an important role in the processes of growth, reproduction, and visual function; vitamin K is necessary for the synthesis of coagulation factors II, VII, IX and X in the liver and has antihemorrhagic properties; vitamin D regulates the mineralization of bone tissue, increases the permeability of the intestinal epithelium to calcium and phosphates, B vitamins are neurotropic and are used for diseases of the nervous system, etc. [2].

Clinical symptoms and manifestations of hypovitaminosis are diverse and can affect various organs and systems ( Table 1

). Since most vitamins are not synthesized in the body, and it is impossible to compensate for their deficiency using only food, vitamin medications are of great importance. They are widely used for prevention and as part of complex therapy for diseases of various human organs and systems [1]. Currently, vitamin complexes are increasingly used to correct functional states and increase human reserve capabilities in various clinical situations [3].

Table 1. Clinical manifestations and symptoms of hypovitaminosis

In this review, we will dwell in more detail on the pharmacological aspects and clinical possibilities of using B vitamins.

B vitamins

B vitamins occupy an important place in clinical practice.
They are used in a variety of fields of medicine in various categories of patients, but they are most widely used in the treatment of diseases of the peripheral and central nervous system. B vitamins are considered neurotropic, because they are necessary for the normal functioning of the central and peripheral nervous system. B vitamins have a metabolic effect on axonal transport and myelination processes in peripheral nerve fibers. Among all the B vitamins, these properties are most characteristic of three of them - thiamine (B1), pyridoxine (B6) and cyanocobalamin (B12). The effect of B vitamins, primarily thiamine, on the central nervous system is mediated through the metabolism of gamma-aminobutyric acid (GABA) and serotonin, which also provides an analgesic effect that manifests itself when used in high doses. The main physiological effects are summarized in Table 2

[4—6].

Table 2. Physiological effects of B vitamins

It should be emphasized that vitamin B1 (thiamine) is necessary for the oxidative decarboxylation of keto acids (pyruvic and lactic), the synthesis of acetylcholine, it is involved in carbohydrate metabolism and related energy, fat, protein, water-salt metabolism, has a regulatory effect on trophism and activity of the nervous system. With insufficient intake of thiamine, pyruvic and lactic acids accumulate in tissues, the synthesis of acetylcholine is disrupted, as a result of which the functions of a number of systems, primarily the nervous, cardiovascular and digestive ones, deteriorate. Thiamine optimizes cognitive activity and brain function. It has a positive effect on energy levels, growth, normal appetite, learning ability and is essential for muscle tone in the digestive tract, stomach and heart. Thiamine acts as an antioxidant, protecting the body from the destructive effects of aging, alcohol and tobacco.

Vitamin B6 (pyridoxine) is involved in the synthesis of a number of neurotransmitters. In phosphorylated form, it provides the processes of decarboxylation, transamination, deamination of amino acids, participates in the synthesis of protein, enzymes, hemoglobin, prostaglandins, the metabolism of serotonin, catecholamines, glutamic acid, GABA, histamine, improves the use of unsaturated fatty acids, reduces cholesterol and lipids in the blood, improves myocardial contractility, promotes the conversion of folic acid into its active form, stimulates hematopoiesis.

The most important property of vitamin B12 (cyanocobalamin) is its participation in hematopoiesis and erythropoiesis (prevention of neuroanemic syndrome) and activation of the blood coagulation system. In addition, like two other B vitamins, it is involved in the synthesis/regeneration of the myelin sheath and has an analgesic effect in neurogenic pain syndrome (reduces the synthesis of glutamate in the central nervous system).

Each of these vitamins can be used as monotherapy, but a combination of B vitamins (B1, B6, B12) has a more pronounced effect, since B vitamins can complement each other’s effects in the biochemical processes of nervous tissue [7, 8].

A wide area of ​​application of drugs containing B vitamins is various pain syndromes. There is extensive experience in using them in cases of both nocioceptive and mixed pain of medium and low intensity, in the treatment of neuropathic pain, as a preventive treatment after relieving exacerbation of chronic pain, and in polyneuropathies of various origins. High doses of B vitamins have a positive effect on nerve regeneration, which justifies their use in the relief of acute pain syndrome and for the prevention of exacerbations of chronic pain [7, 9].

The optimal route of administration of B vitamins is oral. The use of parenteral forms may be complicated by the development of infiltrates and inflammatory reactions at the site of drug administration.

One of the drugs for oral administration containing a combination of the 3 B vitamins listed above in high doses is Neuromultivit (Lannacher, Austria), which is widely used in the practice of neurologists and endocrinologists. It contains 3 B vitamins in therapeutic doses (100 mg of thiamine hydrochloride, 200 mg of pyridoxine hydrochloride and 200 mcg of cyanocobalamin (vitamin B12). The absence of unwanted interactions between the components determines the generally good bioavailability of the drug. The components of the drug Neuromultivit are water-soluble vitamins, which eliminates the possibility of their cumulation in the body. Thiamine and pyridoxine are absorbed in the upper intestine, the degree of absorption depends on their dose. The absorption of cyanocobalamin is largely determined by the presence of an internal factor in the stomach and upper intestine, and further delivery of cyanocobalamin to the tissues is carried out by the transport protein transcobalamin II . Thiamine, pyridoxine and cyanocobalamin are metabolized in the liver. Thiamine and pyridoxine are excreted by the kidneys (about 8-10% unchanged). In case of overdose, the excretion of thiamine and pyridoxine through the intestines significantly increases. Cyanocobalamin is excreted mainly in bile, the degree of excretion by the kidneys is variable - from 6 to 30% [1, 3].

The use of B vitamins in neurological practice

As already noted, B vitamins are neurotropic substances.
Due to their active participation in biochemical processes that ensure the normal functioning of the structures of the nervous system, they are used in diabetic polyneuropathy and in the treatment of pain syndromes. Combined preparations of B vitamins are also used for complex therapy of pain syndromes [10]. In the practice of a doctor in almost any specialty, patients with dorsalgia or, in other words, with pain syndrome (PS) in the back area, are quite often encountered, the proportion of which is growing. The incidence of BS is quite high. Epidemiological studies have shown that on average 60-70% of the population have experienced acute back pain at least once in their lives, and in a third, the nature of the pain changes and becomes chronic. Often, pain syndrome occurs at a young age and subsequently accompanies the patient throughout his life. Moreover, among pain neurological syndromes of nociceptive origin caused by damage to the muscular system, myofascial pain has taken one of the first places in recent years [11].

The quality of life of these patients largely depends on timely, correctly selected and adequate pharmacotherapy. Inadequate treatment often leads to chronic pain syndrome. It is no secret that a large number of patients self-medicate, trying to reduce the severity of pain by taking painkillers and nonsteroidal anti-inflammatory drugs (NSAIDs).

Another possible cause of pain is various polyneuropathies. Among all types of neuropathies, diabetic polyneuropathy firmly ranks first, significantly ahead of other types of neuropathies (alcoholic, mixed origin, inflammatory, toxic, etc.), and the proportion of such patients is very large in general clinical practice [12].

The tactics of managing patients with pain syndrome involves the use of non-drug and drug treatment methods, the main goal of which is to relieve the pain syndrome or, at a minimum, reduce its severity. The therapy is also aimed at treating the underlying pathological process that led to the formation of the pain syndrome and improving the patient’s quality of life.

During the period of exacerbation, it is necessary to adhere to a gentle regime of physical activity and limit stress. Physiotherapy, manual therapy, acupuncture, and physical activity aimed at strengthening the muscle corset and stretching certain muscles or muscle groups are used. Non-drug recommendations also include recommendations for changing the patient’s habits, developing the “right” skills, teaching muscle relaxation techniques, correcting posture, teaching weight lifting techniques, and performing certain types of physical activity.

For pharmacotherapy of acute and chronic pain syndrome, it is possible to use various classes of drugs, which include B vitamins, both in monotherapy and in combination with each other ( Table 3

): - NSAIDs, - B vitamins, - muscle relaxants, - chondroprotectors, - antidepressants, - anticonvulsants, - selective serotonin reuptake inhibitors (SSRIs), - blockade with local anesthetics (in severe cases), - narcotic analgesics [11].

Table 3. Differentiated approach to pain therapy

The pathogenetic basis for choosing a drug for the treatment of pain is based on knowledge, on the one hand, of the main pathophysiological mechanisms of its formation, and on the other, the mechanisms of action of the drug.

Since back pain is often mixed in nature with the participation of nociceptive and neuropathic components, it is advisable to prescribe both NSAIDs, which have a greater effect on the nociceptive component, and B vitamins, which affect the neuropathic component.

It is known that for various pain syndromes, B vitamins are often used to relieve it, which can have their own analgesic effect, and also enhance the analgesic effect of NSAIDs. Numerous studies have proven that under the influence of B vitamins, patients with acute back pain experience clinical improvement.

The analgesic effect of B vitamins has been known in medicine for a long time. As many years of clinical experience show, intramuscular administration of a combination of thiamine, pyridoxine and cyanocobalamin helps relieve pain, normalizes reflex reactions, and reduces sensitivity disorders. The mechanism of this action lies primarily in the inhibition of nociceptive responses. The antinociceptive effect of the combined vitamin complex may be due to inhibition of synthesis and/or blocking the action of inflammatory mediators. Clinically and in experimental models, it has been shown that co-administration with B vitamins enhances the analgesic effect of non-steroidal anti-inflammatory drugs, the anti-allodynic effect of gabapentin, dexamethasone and valproate in neuropathies [10].

Considering these properties of B vitamins, the main indications for the use of Neuromultivit are various diseases and lesions of the nervous system with pain syndromes:

- polyneuropathy; - neuritis; neuralgia; trigeminal neuralgia; - radicular syndrome caused by degenerative changes in the spine; sciatica; lumbago; - plexite; intercostal neuralgia; - paresis of the facial nerve.

Experience in using the combination drug Neuromultivit

The clinical effectiveness and good safety profile of the drug Neuromultivit for various diseases have a large evidence base, including meta-analyses [5, 13-16].
In recent years, there has been a fairly large number of works reflecting the experience of using the complex drug Neuromultivit in different categories of patients. These are mainly patients with neuropathies of various origins (diabetic, alcoholic) and pain syndromes in the back (dorsalgia). In patients with diabetes and endocrine neuropathy, positive dynamics with the use of Neuromultivit is expressed in the form of improved vibration and tactile sensitivity, reduced pain and increased quality of life in patients with DPN [14-16].

The results of a large number of studies of the drug Neuromultivit indicate a good safety profile and good tolerability of the drug by most patients. A Cochrane systematic review, including the results of 30 studies involving 741 patients with alcoholic and endocrine neuropathy, convincingly demonstrated that B vitamins were well tolerated in clinical studies [17–19].

In isolated cases, side effects may appear, most often associated with an overdose of the drug components, manifested by nausea, palpitations, and sometimes skin reactions develop in the form of itching and urticaria. Overdose is only possible if extremely high doses are taken for a very long time.

There are restrictions on the use of the drug during pregnancy and lactation.

Since Neuromultivit contains therapeutic doses of vitamins, it is not recommended to combine it with other B vitamins. Clinical symptoms of an overdose of vitamins contained in the Neuromultivit drug are possible only if the recommended doses are significantly exceeded, mainly due to vitamin B6 (if its dose is more than 2 g per day ). In this case, there is a risk of developing neuropathy with ataxia and sensory disturbances, seizures with EEG changes, in some cases hypochromic anemia and seborrheic dermatitis. Treatment is symptomatic.

Issues of contraindications to the prescription of certain drugs are important in the practice of any doctor. This fully applies to vitamin preparations. The practicing physician must have detailed information about who can and cannot be prescribed vitamin preparations. Very often this question concerns patients with tumor processes of both benign and malignant nature. Research results demonstrate weak anticarcinogenic activity or the absence of any effect on tumor growth of vitamins in physiological doses [20-24]. A number of studies have demonstrated the safety of taking vitamins, including B vitamins, in cancer patients [25-27]. Also, B vitamins can be part of complex maintenance therapy during or after chemotherapy [28].

Thus, the complex drug Neuromultivit can be recommended for use as part of complex therapy for pain syndromes of various origins, for manifestations of polyneuropathy of various origins (including alcoholic and diabetic polyneuropathy) and even in some cases as part of maintenance therapy for cancer patients. It is also widely used in neurological practice in the complex treatment of patients suffering from neuritis, neuralgia, sciatica, lumbago, as well as radicular syndrome, which is caused by degenerative changes in the spine, plexitis, intercostal neuralgia, facial paresis and trigeminal neuralgia.

Neuromultivit can be prescribed as part of complex therapy in combination with NSAIDs, muscle relaxants, and various non-drug therapies, enhancing their analgesic effect. The drug can also be used as maintenance therapy after discontinuation of NSAIDs to reduce the risk of relapse and chronic pain.

Literature

1. Clinical pharmacology: national guidelines. Ed. Yu.B. Belousova, V.K. Lepakhina, V.I. Petrova. M.: GEOTAR-Media, 2008. (Series “National Guides”, chapter 37). 2. Fauci AS, Braunwald E, Isselbacher KJ. Harrison's principles of internal medicine14th edition, 1998. Chapter 79: Vitamin deficiency and excess. P. 480-7. 3. Shikh E.V. Clinical and pharmacological aspects of the use of vitamin preparations in the clinic of internal diseases. Ministry of Health of the Russian Federation. Gazette of the Scientific Center for Expertise and State Control of Medicines. 2001, 1 (5): 46-52. 4. Leninger A.L. Fundamentals of biochemistry. Per. from English T. 1, 2, 3. M.: Mir, 1985. 5. Kozelkin A.A., Kuznetsov A.A., Medvedkova S.A. Application of neuromultivit in neurological practice. Therapia, 2008, 11(31): 1-5. 6. Akhmedzhanova L.T., Solokha O.A., Strokov I.A. B vitamins in the treatment of neurological diseases. RMJ, 2009, 17(11): 776-83. 7. Strokov I.A. The use of high doses of B vitamins in neurology. I.A. Strokov, L.T. Akhmedzhanova, O.A. Solokha. Difficult Patient, 2009, 10: 17-22. 8. Becker KW, Kienecker EW, Dick P. A contribution to the scientific assessment of degenerative and regenerative processes of peripheral nerves following axonotmesis under the systemic administration of vitamins B1, B6 and B12 – light and electron microscopy findings of the saphenous nerve in the rabbit. Neurochirurgia (Stuttg.), 1990, 33(4): 113-121. 9. Lutsky I.S., Lyutikova L.V., Lutsky E.I. B vitamins in neurological practice. Int. Neurol J., 2008, 2: 89-93. 10. Danilov A.B. The use of B vitamins for back pain: new analgesics? RMJ, 2008, 16: 35-9. 11. Vyalov S.S. Patients with lumbar neuralgia: features of treatment for lumbar syndrome. Polyclinic Physician's Handbook, 2013, 12: 16-22. 12. Doskina E.V. Diabetic polyneuropathy and B12 deficiency conditions: basics of pathogenesis, ways of treatment and prevention. E.V. Rumyantseva. Farmateka, 2011, 20: 1-6. 13. Zhirov I.V. Experience with the use of the drug Neuromultivit for alcoholic polyneuropathy. I.V. Zhirov, M.A. Fedina, A.B. Pokrovsky. New Drugs, 2002, 12: 10-18. 14. Gurevich K.G. Neuromultivitis: application in modern practice. Pharmatheka, 2004, 9-10: 48-51. 15. Tokmakova A.Yu. Possibilities of using Neuromultivit in complex therapy of polyneuropathy in patients with diabetes mellitus. A.Yu. Tokmakova, M.B. Antsiferov. Diabetes Mellitus, 2001, 11(2): 33-35. 16. Bregovsky V.B. Application of Neuromultivit in patients with chronic diabetic sensorimotor polyneuropathy of the lower extremities. V.B. Bregovsky, E.V. Belogurova, V.A. Kuzmina. New Drugs, 2002, 6: 7-10. 17. Ang CD, Alviar MJ, Dans AL et al. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev., 2008, 16(3). 18. Peters TJ, Kotowicz J, Nyka W et al. Treatment of alcoholic polyneuropathy with vitamin complex: a randomized controlled trial. Alcohol & Alcoholism, 2006, 41(4): 636-642. 19. Golovacheva V.A. Treatment of diabetic and alcoholic polyneuropathy: possibilities and prospects of pharmacotherapy. V.A. Golovacheva, I.A. Strokov. RMJ, 2014, 16: 1193-1197. 20. Den Heijer M. Are B. Vitamins a risk factor for VTE? Perhaps. J Thromb Haemost., 2006, Feb., 4(2): 309-11. 21. Krishnan AV, Moreno J, Nonn L et al. Novel pathways that contribute to the anti–proliferative and chemopreventive activities of calcitriol in prostate cancer. J Steroid Biochem Mol Biol., 2007, Jan. 15. 22. Lajous M, Lazcano-Ponce E, Hernandez-Avila M et al Folate, vitamin B(6), and vitamin B(12) intake and the risk of breast cancer among Mexican women. Cancer Epidemiol Biomarkers Prev., 2006, Mar.15(3): 443-448. 23. Lajous M, Romieu I, Sabia S et al. Folate, vitamin B12 and postmenopausal breast cancer in a prospective study of French women. Cancer Causes Control, 2006, Nov., 17(9): 1209-1213. 24. Xu WH, Dai Q, Xiang YB, Zhao GM et al. Nutritional factors in relation to endometrial cancer: A report from a population–based case–control study in Shanghai, China. Int J Cancer, 2007, Jan. 17. 25. Nascimento MM, Suliman ME, Murayama Y et al. Effect of high-dose thiamine and pyridoxine on advanced glycation end products and other oxidative stress markers in hemodialysis patients: a randomized placebo-controlled study. J Ren Nutr., 2006, Apr., 16(2): 119-124. 26. Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev., 2004, Oct., 18(4): CD004183. Evid Based Nurs., 2005, Apr., 8(2): 48. 27. Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol., 2006, Nov., 5(11): 949-960. 28. Gromova O.A. Clinical pharmacology of vitamin B12. Evidence-based research. Pediatric Practice, 2006, 3: 20-24.

Daily norm

The body’s physiological need for levocarnitine depends on the person’s type of activity, age, gender, weight, and the presence of diseases.

For newborns and infants up to one year, the daily requirement of vitamin B11 is 10-15 milligrams, for children from 1 to 3 years old - 30-50, for children from 4 to 6 years old - 60-90, for school-age children and adolescents from 7 to 18 years – 100-250, for adults – 300.

The liver and kidneys of healthy children, men and women produce L-carnitine from the amino acids lysine and methionine, fully covering the body's need for this nutrient. However, this occurs only under the condition of proper nutrition and sufficient intake of vitamins, C, and methionine.

The daily requirement for levocarnitine increases in people who lead an active lifestyle, experience heavy physical activity (during training), mental stress, or have diseases of the digestive system.

At the same time, the opinions of nutritionists regarding taking large doses (2000-4000 milligrams) of vitamin B11 are not clear. Some believe that systematically exceeding the daily dose of 300 micrograms can cause adverse reactions (allergies), addiction of the body, and as a result, reduce the production of its own levocarnitine. As a result, this will serve as a reason for the development of addiction. Other nutritionists believe that increasing the norm has a beneficial effect on the human body: it improves the functioning of the heart, blood vessels, energy metabolism, and “dries out” muscle mass.

Hypovitaminosis and hypervitaminosis L-carnitine

The following types of carnitine deficiency are distinguished:

• primary, occurs as a result of genetic disorders, the first signs of deviation appear in the fifth year of life: the child experiences musculoskeletal weakness, cardiomyopathy and hypoglycemia develop;
• secondary, appears against the background of decreased absorption of nutrients, including foods rich in carnitine.

Characteristic symptoms of vitamin B11 deficiency in the body:

• cardiac dysfunction (atrial fibrillation, cardiomyopathy, angina pectoris, tachycardia);
• increased fatigue, weakness;
• muscle tremors;
• atherosclerosis;
• muscle pain during intense physical activity;
• gaining excess weight;
• asthenia;
• irritability;
• insomnia;
• lowering blood pressure.

Reasons for the development of L-carnitine deficiency:

• lack of B vitamins, iron, methionine in the body;
• raw food diet, vegetarian diet;
• gastrointestinal diseases;
• hemodialysis;
• taking antibiotics or drugs that slow down blood clotting (hirudin, sodium citrate, heparin).

Carnitine deficiency in the body reduces the concentration of fatty acids in mitochondria, as a result, energy production decreases, which leads to the development of degenerative processes in the myocardium.

An overdose of vitamin B11 is an uncharacteristic phenomenon. The medical literature describes only a few cases of hypervitaminosis of a beneficial compound.

Excess levocarnitine causes the following side effects:

• diarrhea;
• increased ammonia levels without hepatotoxicity;
• depression;
• increased blood pressure;
• increased heart rate;
• pain in the epigastric region;
• convulsions;
• fever.

A single dose of L-carnitine (over 10,000 micrograms) can lead to nausea, vomiting, indigestion, increased excitability of the nervous system, and a sharp increase in appetite.

Harm and side effects of carnitine

We can say with complete confidence that carnitine is not harmful and completely safe. This statement can be confirmed by several theses:

1. Levocarnitine is a natural compound that is produced by cells and performs a number of vital functions.
2. Levocarnitine is used in newborns (including premature babies), and a positive effect on the growth and development of the child is observed.
3. When taking carnitine 100 times more than the recommended daily dosage, no toxic effects were observed.

At the same time, we should not forget the famous catchphrase of the ancient Greek physician Hippocrates: “Everything is good in moderation. Avoid extremes if you want to maintain balance." It is the extreme, namely excessive consumption of carnitine, that can cause side effects (although they are extremely rare).

1. Insomnia due to increased energy release. Therefore, it is not recommended to take carnitine in the afternoon and especially in the evening.
2. Individual intolerance to increased doses of carnitine may be accompanied by abdominal pain, digestive disorders, headaches and stool disorders.
3. In patients on hemodialysis, taking carnitine can trigger the development of myasthenia gravis (muscle weakness).
4. In studies conducted in 2013, it was shown that L-carnitine is metabolized by intestinal microflora to trimethylamine-N-oxide, which can provoke the development of heart and vascular diseases, in particular atherosclerosis (the study was carried out on mice).

Indications and contraindications

Vitamin B11 is used for:

• relieving alcohol intoxication;
• improving memory in people over 60 years of age due to age-related changes in brain cells;
• reducing depression;
• improvement of sexual activity;
• elimination of B11-hypovitaminosis;
• stimulating growth in children.

In addition, L-carnitine is indicated for premature babies, with loss of muscle mass, asphyxia, anorexia nervosa, and in the postoperative period to accelerate tissue recovery.

Contraindications to the use of the drug:

• cirrhosis of the liver;
• diabetes;
• peripheral vascular diseases;
• individual intolerance to the active substance;
• pregnancy;
• breastfeeding period;
• trimethylaminuria;
• hypertonic disease;
• kidney dysfunction.

The possibility of using vitamin B11 for the treatment of mitochondrial myopathy caused by the antiviral drug Zidovudine is currently under study.

Signs of levocarnitine deficiency

In the initial stages, it is almost impossible to determine a lack of B11. It disguises itself as other diseases and gives as symptoms:

• 
  general weakness;

• easy but rapid weight gain;
• fatigue;
• decreased performance;
• minor muscle pain in normal circumstances;
• prolonged muscle pain after training.

However, with a medically established deficiency of levocarnitine, although rare, the following symptoms and diseases may appear:

• muscular dystrophy;
• myopathy (muscular dystrophy that progresses rapidly);
• hepatic encephalopathy;
• cardiomyopathy (weakening of the heart muscle);
• angina pectoris;
• risk of heart attack;
• deterioration of blood composition;
• slow recovery after surgery;
• obesity of different types;
• slow growth in childhood and adolescence;
• skin diseases (dermatitis, eczema, psoriasis and others);
• excess production of thyroid hormones;
• decreased sperm production and sperm activity.

L-carnitine is a necessary substance for the normal functioning of the body, but extreme manifestations of its deficiency occur quite rarely. Mostly children under 10 years of age, as well as older people, suffer from its deficiency.

L-carnitine for weight loss

In modern life, the amount of calories consumed, as a rule, prevails over energy expenditure. As a result, people begin to develop obesity and health problems appear.

To restore the metabolic process, nutritionists recommend leading a healthy lifestyle: going to the gym, moving more, eating right. During physical activity, metabolic reactions in the body accelerate 2-5 times. Thus, burning excess fat occurs much faster. To speed up the process of getting rid of excess pounds, you can take additional vitamin B11 as a supplement.

Levocarnitine helps the body in the process of burning fat, increasing its efforts. Fitness instructors claim that the supplement is harmless and, in combination with proper nutrition and regular exercise, improves well-being and gives a great figure.

Remember, only an integrated approach will help you achieve your desired goal.

Release form of L-carnitine

1. Liquid vitamin B11. This drug is popular among professional athletes and people who want to stay in shape. There is no need to prepare the product before taking it - just open the bottle and drink the contents. Concentrated syrups that have an acceptable taste are also available for sale. The difference between these drugs is not great. Before use, the concentrate should be mixed with water, observing the proportions established by the manufacturer. There is liquid L-carnitine in ampoules. People often get confused when they call the form of release of a substance injectable. It is actually a drug that is taken orally as a drink. Liquid levocarnitine, compared to tablets, is absorbed faster and provides greater flexibility with dosage. However, it has a high cost, a short shelf life (an open bottle is stored for no more than a day), a lot of chemical additives in its composition (flavors, dyes), is difficult to transport, and requires “special” storage conditions - refrigeration.
2. B11 in capsules. This drug is taken as tablets: the dietary supplement should be washed down with 150 milliliters of still water or juice. The capsule consists of two gelatin parts. The advantages of this form of L-carnitine release are rapid breakdown in the stomach, good absorption by the body, long shelf life without loss of beneficial properties (up to 3 years). If necessary, the capsule can be opened and the powder contents can be poured into a protein shake. Due to this property, it can be used by people who have difficulty swallowing tablets. Today, one-piece gelatin capsules are also available, which are completely sealed, but have a significant limitation of space, which means that the contents are not compressed to a significant extent. The main disadvantages of this drug: high cost, impressive size.
3. Levocarnitine tablets. This form of additive production is the most economical, since it requires the least production costs. Tablets allow you to form a portion of the vitamin (pure material) directly in space, without additional coating or placing it in a gelatin capsule. Let's consider the harm and benefits of this form of vitamin compound. The main advantages of vitamin B11 produced in tablets are ease of use and low price (20% lower than the cost of liquid L-carnitine). The disadvantages of the useful compound include: irritation of the mucous membrane of the gastrointestinal tract, lack of flexibility in dosing, slow absorption of the substance (the rate of absorption of levocarnine taken in liquid form or in capsules is much higher). Recently, American experts have come to the conclusion that tablet vitamins “live” only 7 days after opening the package. After this period, they lose their biological value. Such tablets do not harm human health, but do not provide any benefit. The effectiveness of their use is equivalent to taking candy. In addition, people who have difficulty swallowing “packaged” drugs and have diseases of the digestive tract should avoid purchasing the supplement in tablets.
4. L-carnitine powder. Advantages of this form: ease of use, affordable cost, high dosage flexibility, rapid absorption. Disadvantages: negative effect on the walls of the stomach, inconvenience of use associated with the need to accurately calculate the weight of raw materials and prepare a solution. Before taking levocarnitine, dilute the powder in 500 milliliters of water and drink at one time.

Thus, there is no ideal format for releasing vitamin B11. Each of them has its pros and cons.

The active ingredient in all drugs is the same; they differ only in the time of absorption. Any means is suitable for burning fat, the main thing is to eat right and lead an active lifestyle.

The most popular analogues of levocarnitine: “Carnitene”, “Cartan”, “Elkar”, “L-Carnitine300”, “Carnifit”.

Appetite and weight under control

Let's talk about cinnamon rolls again. According to research, the essential oils in the spice help regulate blood sugar levels and prevent sudden spikes. So, in theory, baking with cinnamon is almost not a crime against your figure, but a healthy compromise.

But seriously, spices can actually be good for keeping fit. During the cold season, we traditionally eat more “comfortable”, well-satisfying foods. But meat, thick soups, nuts, starchy vegetables and all kinds of pies are relatively difficult foods to digest. Spices can make it easier to digest. Rosemary, chili, turmeric, and paprika are traditionally used for marinating meat and preparing multi-ingredient dishes precisely because they soften proteins and help digest foods of different natures. And quality digestion is already half the battle in the fight for harmony.

No matter how useful seasonings are, the principle of moderation in use is not fraught with problems with the digestive, nervous and cardiovascular systems.

How to take levocarnitine

After L-carnitine enters the body, the compound penetrates into muscle cells within 3 hours, where it begins to fight fat deposits. Vitamin B11 works directly during intense exercise, as well as for a long time after training.

Divide the daily dose of the dietary supplement into 2-3 doses of 200 – 250 milligrams. The maximum amount of vitamin B11 (500 - 600 milligrams) on training days should enter the body at least 1 - 1.5 hours before going to the gym. The remaining dose should be divided into morning and afternoon doses. During rest periods (non-training days), levocarnitine should be taken in the morning and lunchtime, 30 to 60 minutes before the start of the meal. Only if this regimen is followed does the substance promote weight loss, otherwise the effect of the supplement is weakened by the food intake.

Let's consider when it is better to drink vitamin B11, depending on the form of release.

1. Beginner athletes are recommended to take tablets and capsules 2-3 times a day, 250–500 milligrams before physical activity, and professionals – 500–1500 milligrams at a time. The maximum duration of use of a weight loss supplement is 2 – 6 months.
2. The syrup should be taken 3 times a day, 5 milliliters, half an hour before physical activity (dosage for beginners). For experienced athletes, the single dose rate increases to 15 milliliters. The maximum duration of daily intake of liquid levocarnitine is 1.5 months. After this course, you need to take a 3-week break, then, if necessary, repeat the regimen.
3. If you purchase B11 in bulk form, before use, 2000 milligrams of powder must be dissolved in 500 milliliters of clean still water. If the amount of liquid is reduced, the drink will turn out cloying and unpleasant in taste. Drink the prepared solution on an empty stomach and immediately an hour before training. The course of taking the drug is 2–4 months. The maximum duration is half a year. Up to 6 courses can be completed in a year, with a minimum break between them of 2 weeks. Today, levocarnitine powder is available for sale in the flavors “Wild berries” and “Green Apple”.

If you missed taking L-carnitine before training, it is recommended to drink the vitamin in liquid form, which is quickly absorbed in the body and promotes a quick release of energy.

How does B11 work?

When taken orally, the vitamin is usually well absorbed. The maximum concentration of the beneficial compound in the body is observed three hours after administration, while the therapeutic concentration remains for 9 hours. In the case of intramuscular administration, the substance reaches the plasma after 3.5 - 4 hours, and when administered intravenously, the drug disappears from the blood after 3 hours. Taken L-carnitine quickly penetrates into the middle layer of the heart (myocardium) and liver, and more slowly into muscle tissue. The compound is excreted by the kidneys as acyl esters.

Interesting Facts

• 
  B11 was discovered in 1905 and synthesized in the laboratory in 1960. However, despite all its value for humans, it gained real popularity only a few decades ago. Mainly thanks to weight loss dieters and bodybuilders.

• Without exception, all athletes receive L-carnitine as a dietary supplement.
• Already now, B11 is used as a therapeutic (solo or as part of a complex), prophylactic agent to combat several hundred diseases.

Food sources

Considering the fact that vitamin B11 stimulates muscle growth, oxidizes and removes fats from the body, promoting weight loss, foods rich in the beneficial compound are always present in the menu of athletes and people who want to lose weight.
The largest amount of the nutrient is found in offal and meat. The second place in terms of the content of the “fat burning factor” belongs to lactic acid and dairy products. The smallest amount of levocarnitine is concentrated in plant foods. For this reason, adherents of a strict vegetarian diet often suffer from B11 hypovitaminosis. List of foods rich in L-carnitine

Thus, levocarnitine is widely used in the food industry.

A pattern has been noted: the redder the meat, the more vitamin B11 it contains. When food is frozen, the loss of the beneficial compound reaches 70%; after thawing, the remaining nutrient passes into melt water.

Enriching your diet with vitamin B11

It is quite difficult to consume enough levocarnitine from food, but you should try to build your diet in such a way as to achieve this.

At the same time, we must not forget that for its synthesis the body also requires other substances: B vitamins, ascorbic acid, lysine and other amino acids and enzymes.

The following foods are richest in vitamin B11:

That is, the main suppliers of L-carnitine are meat products and herring . It is worth noting that vitamin B11 gradually breaks down during heat treatment, so the most beneficial would be a lamb or beef steak that is quickly fried, rare.

Interaction of L-carnitine with various compounds

1. 
   Vitamin B11 enhances the effect of anticoagulants.

2. Antibiotics remove carnitine from the body, which leads to depletion of the nutrient.
3. Phenobarbital and valproic acid reduce the concentration of the vitamin in the blood.
4. When taking levocarnitine and thyroid hormones simultaneously, B11 suppresses their effect.
5. Glucocorticosteroids help accumulate vitamin compounds in body tissues (with the exception of the liver).
6. Lipoic acid and anabolic drugs enhance the therapeutic effect of L-carnitine.
7. Vitamin B11 reduces the toxic effects of zidovudine and doxorubicin on muscle tissue and cardiac muscle cells.
8. Levocarnitine alleviates the side effects of isotretinoin.
9. Sports nutrition goes well with vitamin B11. The simultaneous intake of carnitine and coenzyme Q10 is considered effective.

Contrary to popular belief that in no case should you combine taking a medication and ethyl drinks, this rule does not affect L-carnitine. Of course, the medicine puts additional stress on the liver, since the organ needs not only to break down the compound into simple particles, but also to remove its breakdown products. Alcohol entering the body disrupts this process and interferes with metabolic reactions. However, in the case of vitamin B11, things are much easier.

The nutrient does not react with ethanol, which means it is not prohibited to take the dietary supplement and strong drinks at the same time. It is important to follow safety measures - control the level of alcohol consumed.

Physicochemical properties of vitamin B11

In its pure form it is a hygroscopic white crystalline powder.
When the temperature reaches +195 °C, the powder begins to melt. Has excellent solubility in water and alcohol. Thanks to this, carnitine is sold in a more stable powder form, and is taken in an easily digestible dissolved form. When talking about this compound, L-carnitine is most often mentioned. It is this form that is biologically active. The D-form of carnitine is not used for medicinal purposes, since it does not have a positive effect on the body and, moreover, is toxic. The D-form blocks receptors for L-carnitine and nullifies the physiological effect of this compound.

Despite its structural similarity to choline, no role in nerve impulse transmission has been found for carnitine.

FAQ

How to enhance the effects of levocarnitine?

It's no secret that if you do not follow the recommended conditions for taking biologically active supplements or medications (by the manufacturer and your doctor), therapy will not bring the desired result.

In order for the beneficial properties of L-carnitine to be fully revealed, it is necessary to exercise physical activity while consuming the compound. The best option is aerobic exercise. Only when body temperature rises slightly and tissues are saturated with oxygen can the vitamin capture fat molecules. Fitness trainers recommend calculating your heart rate for cardio training and sticking to this indicator. To increase your heart rate, do brisk walking, aerobics, and running. The minimum training duration is half an hour. This time is enough to launch the natural processes of fat burning, as a result, levocarnitine will take effect.

In addition to physical activity, for the drug to work, you need to eat right. Focus on foods rich in iron, vitamin C, and protein, which stimulate the production of your own vitamin B11. Low-calorie diets should be abandoned, otherwise the body will not have the strength and “building material” to gain muscle mass and start the process of losing weight.

A balanced diet, regular physical activity, drinking 2 liters of clean water per day is the best way to activate and enhance the effect of L-carnitine to combat extra pounds on the way to a slim and toned body.

What is the difference between vitamin B11 and fat burners?

Levocarnitine is absolutely safe. Many manufacturers add various stimulants to fat burners, which negatively affect the state of the digestive tract and the functioning of the nervous system (caffeine). In addition, there are clandestine supplements that are not certified in the country because they contain prohibited components. As a rule, such substances of the “non-stop” category stimulate the central nervous system, completely depleting it.

Vitamin B11, unlike prohibited components, does not affect the nervous system; the compound works exclusively with the utilization of triglycerides and fatty acids.

How to combine exercise and taking levocarnitine?

First of all, the result of losing weight depends on the correctness of the diet and the choice of physical activity. To get rid of extra pounds, it is recommended to perform cardio exercises 4 times a week, lasting no more than 45 minutes. Remember, too frequent and exhausting workouts will not bring the desired result, since in order to lose weight the body must have time to rest. The muscle recovery period is 48 hours.

If you follow an exercise-rest regime, eat right, but there is no visible effect, it is recommended to introduce L-carnitine into your daily diet. You need to drink the supplement 1 – 1.5 hours before training. Despite the fact that the nutrient is safe for human health, consuming the compound for a long time is not recommended. The duration of taking levocarnitine without interruption depends on the form of the drug. As a rule, it does not exceed 1.5 months, then the course must be interrupted for 2-3 weeks, after which it can be repeated.

Is it possible to take a “fat burning” vitamin at night?

Yes. At night, growth hormone is produced, which regulates fat metabolism. Due to this, fats are involved in the energy exchange reaction during sleep. It is recommended to eat salads and protein foods at night to maintain growth hormone at the proper level. Taking L-carnitine before bed promotes the complete processing of waste fatty acids. In fact, while a person is resting at night, the body burns triglycerides and loses weight.

Is it possible to drink fitness drinks during a workout? Which to choose?

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If the main task of losing weight is to utilize fat, it is better to avoid taking sweet, concentrated sports drink. To get rid of excess weight, the body must quickly burn carbohydrates accumulated in the liver in the form of glycogen, in order to use internal reserves to “melt” fat. When taking fitness drinks, it turns out that after the energy has run out, the body again receives a dose of carbohydrates, which the body “takes to work” first. As a result, the turn to consume (burn) fat never comes.

If the main goal is to build muscle, bars with levocarnitine, fortified and energy drinks will help the athlete replenish energy, increase performance, relieve fatigue, give strength, and dry out subcutaneous fat.

What is the best fitness drink?

When choosing a “sports drink,” we recommend paying attention to the manufacturer and the composition of the supplement. Products must be certified. During intense workouts, give preference to fitness drinks that contain: taurine, ginkgo biloba, ginseng, guarana, casein.

Which brand is better for L-carnitine?

Let's look at the TOP 11 vitamin compounds from branded manufacturers:

• Alcar 750 from SAN;
• Acetyl L-carnitine from Dymatize;
• L-Carnitine L-Tartrate from Al Sports Nutrition;
• L-Carnitine L-tartrate from Allmax;
• L-Carnitine xtreme from Dymatize;
• L-Carnitine from Source Naturals;
• Acetyl-L-Carnitine from Now Foods;
• L-Carnitine from Optimum;
• L-Carnitine Liquid from Now Foods;
• L-Carnitine Concentrate from Multipower;
• Power System L-Carnitine from Power System.

Use of vitamin B11 in medicine

After the discovery of L-carnitine, the beneficial compound was first used in medical practice, and only a few years later the nutrient became popular among athletes. Initially, vitamin B11 was used as a biological supplement to the diet of people undergoing rehabilitation after a heart attack. Today, to increase the effectiveness of the nutrient, it is combined with coenzyme Q10. In addition to stabilizing the condition of “cores,” levocarnitine is used in gastroenterology. The compound normalizes the acidity of gastric juice and has a beneficial effect on liver function.

Instructions for use of the drug

1. To improve immunity and lose weight, it is recommended to take vitamin B11 from 1500 to 3000 milligrams per day.
2. For the treatment of kidney diseases, liver diseases, and heart pathologies, the daily requirement for levokartina is 1000 milligrams.
3. For the rehabilitation of professional athletes after injuries, the daily requirement of L-carnitine is 2000 – 3000 milligrams.

In addition to consuming a synthetic form of the vitamin, patients are advised to enrich their daily diet with foods rich in the beneficial compound (see section Food sources).

Indications

There are special dosages prescribed for the treatment of certain diseases and special conditions:

• for excess weight (as determined by nutritionists), obesity - 1500–3000 mg;
• to increase immunity after operations, including those that caused iatrogenic diseases, for severe illnesses during the recovery period - 1500–4000 mg;
• for HIV infection, severe heart, liver, kidney diseases, for severe infectious diseases - 1000–1500 mg;
• as a short preventive course without special indications (4–8 weeks) - 1000 mg;
• as a short prophylactic course for severe illnesses (from 8 weeks as prescribed) - 1500 mg;
• for intense training - 1500–3000 mg;
• at the start of non-intensive training - 1000–1500 mg;
• for severe physical or mental stress - 500–1500 mg.

In current medical practice, vitamin B11 is prescribed whenever possible for any illness. An overdose of the drug is possible only if the dose is exceeded multiple times.

However, you need to strive for maximum consumption of levocarnitine in food, not forgetting that its synthesis requires vitamins C, , , , B12 , as well as a number of trace elements and enzymes .

The best diet for those who want to replenish B11 reserves is cottage cheese and red meat with vegetables.

Video: "The essence of using L-carnitine in sports "