Caveat emptor a healthy practice in your health

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Pinch the skin on the back of your hand and watch it snap back into place, or observe it sit there like the tent the Army made my home for a period of time.

One explanation for the aging process is that the skin and other organs have a layer of elastic tissue. Lost elasticity, especially in our arteries, has been considered as a major factor in the process of getting old.

Some of us would argue that the most important marker of age is losing emotional elasticity. We have less tolerance of noise, either too loud or too soft, or light that’s very bright or dim, or ideas that stray from the hard-set wisdom we’ve accumulated over a lifetime.

I wrote the paragraph above as I prepared to launch a series of reports on why we get old and approximately where we can detect a wiggle in our divining rod and find the fountain of youth. With apologies, I can’t finish until next month.

A reader fed me a tough question that warrants a timely response. He takes a form of carnitine that makes him feel more energetic. He is a very active man, but he expressed concern about the way the supplement, acetyl-L-carnitine is metabolized in his gut. By implication, do all carnitine supplements increase a person’s risk of dying of a heart attack?

In answering the question, I have to remind my readers that 50 years of practicing medicine allows me to offer opinions that are based on my own experience, an interest in your health and a desire to encourage critical thinking. Here’s what I think about acetyl-L-carnitine (let’s call it ALC) and I’ll revisit carnitine issues that may have been confusing.

Acetyl is a chemical that is linked to carnitine and changes some of its features. Think of acetic acid, a small molecule with one carbon that is the main component in vinegar.

It isn’t clear to me that the intestine metabolizes ALC in a significantly different way than carnitine. On the other hand, it can enter some cells directly that carnitine cannot. That includes brain cells. Claims have been made that ACL may be a way to protect our brains by functioning as an antioxidant.

Studies in old rats, for example, indicate that both L-carnitine and ALC increase their level of physical activity but only ALC lowered the products of oxidation. The University of California, Berkeley, authors suggest that ALC may be a better dietary supplement than L-carnitine.

Sadly, they don’t prove that the net effect of either is beneficial.

Remember from my earlier paper that the serious adverse effects of L-carnitine were mitigated in vegetarians, as reported by a Cleveland Clinic group in April. Their studies were backed by logical chemistry, and they fit well with the observations of Seventh-day Adventist vegetarians. It also provides an explanation of the large number of coronary events in patients with normal cholesterol levels.

The matter isn’t settled, but the data warrants our concern and attention to personal decisions whether to modify our lifestyles and diets. We have to think that we may have been emphasizing the wrong things for decades. We can predict that opponents will dig for evidence of any weakness in the studies.

My answer, for now, is that repeating important studies is a prime rule for science. We make decisions on the best available data and understand that we may have to adjust as new information becomes available.

Studies that are hardest to repeat are those that involve subjective feelings. Drugs for emotional disorders, such as bipolar illness, have relied more on placebo effects than most patients or physicians are willing to believe. Drug companies have controlled release of important data, as reported in The New England Journal of Medicine.

I can’t determine whether the patient who wrote to me is experiencing benefit that is caused by ALC. When there is no proof of efficacy, based on replicable, double-blind randomized studies, we often make decisions based on the reputation of the claimant.

Bruce Ames has been a major proponent of various supplements, including ALC. He is a brilliant researcher. I’ll be looking at his work when I begin with the subject of aging.

Like other brilliant men, he can seem extreme. Some researchers do great work in one area and get off the rails when they go in other directions.

Ames has been quoted to say that “pesticides lower cancer rates” and “pollution is largely a red herring as a cause of cancer.” I consider those as defensible, but probably wrong.

The promoters of L-carnitine tend to be linked to profit-making entities. Caveat emptor is nowhere as important as when you want to stay healthy and protect the ones you love.

Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at amazon.com and other online book retailers. He can be reached at mulkerin@charter.net.

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