Is PropeL Good for Your Heart?

Dear Dr. Dean,

I'm a week away from my 70th birthday and I’ve been taking the recommended dosage of PropeL religiously for about six and a half months. I started taking it for ED issues and at this point in time I would have to say the situation hasn’t improved. I also take 1100 mg of Ashwaghanda daily and L-citrulline lozenges to naturally promote NO production. For one thing, before I decide to either continue or stop taking PropeL, my first question would be: Are there benefits to taking the L-carnitines that go beyond ED—for instance, heart health, etc.? If I continue to take it for heart heath reasons should the dosage remain the same? The next question: Are there any known side effects associated with extended use of PropeL?

Any direction you could offer would be greatly appreciated. I’m getting ready to reorder PropeL and I wanted to have this information to help me make a decision.

DON, Hoffman Estates, IL

Dear Don,

The ingredients in PropeL—acetyl-L-carnitine (ALC), propionyl-L-carnitine (PLC), and alpha-lipoic acid (ALA)—are natural substances that boost our energy by acting as sources of the amino acid carnitine. Carnitine facilitates the transport of fatty acid molecules across mitochondrial membranes.1 Without these fuel molecules, our mitochondria (the cells’ chemical “powerhouses”) would cease functioning—and so would we. Carnitine levels tend to decline with age, so maintaining a healthy supply is a good idea.

You are right about the importance of carnitine for heart health. A recent meta-analysis reviewed 13 trials with a total of 3629 participants who had already experienced a heart attack. The review indicated that L-carnitine is helpful for heart disease.2 The study found that carnitine was associated with significant reduction in death from all causes and a highly significant reduction in ventricular arrhythmias and anginal attacks (chest pain due to ischemia of the heart muscle) following a heart attack, compared with placebo or control. In other words, carnitine is extremely helpful to the heart, so much so that it actually heals it!

Clinical trials have shown that carnitine supplements increase exercise capacity in people with heart disease-related chest pain (angina),3 and people with intermittent claudication (pain with exertion in the legs due to atherosclerosis of the lower extremities) were able to walk farther without pain after treatment with carnitine for six months.4 Moreover, in those with congestive heart failure, carnitine increased exercise capacity, improved heart function, and increased survival times.5 Finally, another trial showed that those who took carnitine after suffering a heart attack had a 90 percent decrease in mortality over the next 12 months, compared with those who did not receive carnitine.6

ALC also improves memory and other cognitive functions in people with mild cognitive impairment and early Alzheimer’s disease, exerts a neuroprotective effect, thereby inhibiting the peripheral neuropathy that often accompanies diabetes, and helps to prevent age-related glycation, which degrades the proteins in our eyes’ lenses.

To answer your specific question regarding dosage, the same dosages of ALC recommended for ED are generally used for their cardiovascular and cognitive-enhancing effects.7 There is no down-side to long-term use.

Other supplements that may help with your ED include Korean Red Ginseng,8,9 Ginkgo biloba (240 mg/day),10 and the amino acid citrulline (1.5 gm/day).11 Citrulline increases intra-vascular nitric oxide formation, via the urea cycle. This is the same effect of the ED drugs Viagra and Cialis. Another source of nitric oxide is beetroots. Learn to love beets.

Finally, you might consider testosterone replacement therapy. Although one popular form of testosterone replacement is by use of topical creams, I believe this approach is less effective than intramuscular injections. All hormones act on receptors. Constant elevated hormone levels result in reduced hormone receptors and loss of hormone receptor sensitivity, making the hormone less effective. In normal young men, testosterone levels are high at night, and lower during the day, thus giving the testosterone receptors a daily “break.” With the topical creams, the hormone is absorbed into the subcutaneous fat, thereby resulting in a “flat line” constant hormone level. There is no way to pharmacologically replace testosterone in a manner that mimics the normal diurnal rise and fall of testosterone each day.

I believe intramuscular injections are the most physiological means to restore normal testosterone levels. By using intramuscular injections of testosterone, we are able to obtain youthful levels of testosterone for a week or so, which then drop into the sub-normal range in the second or third week. Thus, we are replacing a daily rhythm with a weekly or bi-weekly rhythm (just as female hormones cycle on a monthly basis).

I generally recommend injections of testosterone cypionate, 200 mg every three weeks—adjusted up or down, or more or less often, depending on blood tests and the patient’s clinical response. Of course, you will need your physician to prescribe this regimen for you.

Ward Dean, MD

References

  1. Marcovina SM, Sirtori C, Peracino A, Gheorghiade M, Borum P, Remuzzi G, Ardehali H. Translating the basic knowledge of mitochondrial functions to metabolic therapy: role of L-carnitine. Transl Res. 2013 Feb;161(2):73-84.
  2. Dinicolantonio JJ, Lavie CJ, Fares H, Menezes AR, O’Keefe JH. L-Carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Mayo Clin Proc. 2013 Apr 15. doi:pii: S0025-6196(13)00127-4. 10.1016/j.mayocp.2013.02.007.
  3. Cherchi A, Lai C, Angelino F, Trucco G, Caponnetto S, Mereto PE, Rosolen G, Manzoli U, Schiavoni G, Reale A, 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 Oct;23(10):569-72.
  4. Hiatt WR, Regensteiner JG, Creager MA, Hirsch AT, Cooke JP, Olin JW, Gorbunov GN, Isner J, Lukjanov YV, Tsitsiashvili MS, Zabelskaya TF, Amato A. Propionyl-L-carnitine improves exercise performance and functional status in patients with claudication. Am J Med. 2001 Jun 1;110(8):616-22.
  5. Anand I, Chandrashekhan Y, De Giuli F, Pasini E, Mazzoletti A, Confortini R, Ferrari R. Acute and chronic effects of propionyl-L-carnitine on the hemodynamics, exercise capacity, and hormones in patients with congestive heart failure. Cardiovasc Drugs Ther. 1998 Jul;12(3):291-9.
  6. Davini P, Bigalli A, Lamanna F, Boem A. Controlled study on L-carnitine therapeutic efficacy in post-infarction. Drugs Exp Clin Res. 1992;18(8):355-65.
  7. Cavallini G, Caracciolo S, Vitali G, Modenini F, Biagiotti G. Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology. 2004;63:641-6.
  8. Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002 Nov;168(5):2070-3.
  9. Jang DJ1, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. Oct 2008; 66(4): 444-50.
  10. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Educ Ther. 1991;17: 53-61.
  11. Cormio L, De Siati M, Lorusso F, Selvaggio O, Mirabella L, Sanguedolce F, Carrieri G. Oral citrulline supplementation improves erection hardness in men with mild erectile dysfunction. Urology. 2011 Jan;77(1):119-22.

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