The L-Carnitine ‘controversy'

I watched the Culture, Media & Sport committee in Parliament with interest yesterday 

There was a lot of confusion around the issue and I wanted to help explain it. 

L-Carnitine is a food suppliment used by athletes. It is present in meat, which would be it’s usual dietary source. Some people believe that it can help fat oxidation in exercise, though the evidence is actually quite poor. Nevertheless fat becomes an important energy source during a 2 hour marathon. It’s not really important in 800m-10,000m races. So Mo Farah had an injection of L-Carnitine before he did his marathon. He didn’t want to take it orally because it has to be taken with lots of sugar to help it get absorbed, and he didn’t want to have to eat loads of sugar whilst trying to lose weight. Understandable. So it was given as an injection instead. 

So let’s be clear. L-Carnitine is not a drug. It’s food. It is not prohibited in sport and there is no limit on the amount that an athlete can consume. 

The recommended dose of L-Carnitine is anything up to 65mg/Kg. . British Athletics actually used a slightly lower figure (50mg/Kg). Mo’s weight 54Kg. 0.05g x 54kg = 2.7grams of Carnitine. 

It comes in vials of 1 gram in 5mls, therefore to give 2.7grams it comes diluted in 13.5mls of water. So it was given as a quick injection with a small syringe, not a slow infusion via a drip.

So let’s just recap. L-Carnitine is not prohibited, and there is no maximum dose. The dose actually given was below recommended levels anyway. 

So why all the confusion??!!

The MP’s and Journalists seem to have confused the dose of drug, with the volume of liquid it was dissolved in. 

WADA does indeed place limits on the amount of liquid that can be infused - maximum 50mls (half a cup of water, or a tenth of a pint) in 6 hours. But this is a completely different issue. In actually fact the volume of fluid was about a quarter of that - 13.5mls. 

(So why does the other rule exist? Here’s a history lesson. EPO, the blood boosting drug is a big problem in sport. It increases red cells in the blood and makes the blood thicker - like treacle. Sports people who abuse it have blood that is so thick, it can cause clots or heart attacks. To prevent this they can have infusions of 1-2 litres of saline via a drip. This thins the blood overnight, but then it gets urinated out in the morning. So large infusions can be used to facilitate cheating with EPO. Hence the reason WADA has limited the volume that can be infused to 50mls in 6 hours. It has no nothing to do with the drug dissolved in it!!)

See also - 

So I’m really not sure what the fuss is all about. Sir Mo had a simple injection of a perfectly legal dietary supplement.  

Focus on Low Back Pain

 The Western world has seen a seismic shift in working patterns since the WWII such that the population is now far more sedentary throughout the day – commuting by car, sitting at work, consuming an energy rich (sugar & fat) diet, with evenings on the sofa watching TV. We are well aware of the consequences – obesity, metabolic syndrome and the like. However this physical inactivity also leads to poor muscular conditioning and poor posture, a consequence of which is increased load on the lumbar spine manifesting in many people with back pain.

Back Pain, along with Stress, accounts for a staggering amount of days lost from work in the adult population, but regular physical exercise can counter both. Simple interventions, such as standing workstations, have been shown to improve metabolic markers, and will also improve the tone of the postural muscles. Have you considered leading by example, and installing standing workstations in your own General Practice?

Low back pain can begin as a purely muscular phenomenon. Poorly conditioned muscles cannot hold posture for prolonged periods, which in turn leads to local fatigue. Imagine if you were asked to hold a weight out in front of you, and not put it down. It wouldn’t be long before your arm started to ache! Now imagine if you were asked to do this over and over again. Eventually the muscles form localized areas of cramp, so called myofascial ‘trigger points’. These can be temporarily eased with massage and manipulation, but if the underlying poor conditioning of the lumbar spine is not addressed, back pain can become chronic. Increased loading of the lumbar spine then leads to accelerated degeneration and worsening of pain.

Unfortunately compliance with therapeutic exercise for the back can often be very poor. Reasons include lack of time, motivation, belief in efficacy, or pain inhibition. Where pain prevents a patient from engaging in rehabilitation, a carefully delivered steroid injection can be very useful.

With advancing age, or trauma, degenerative changes will be seen in the Lumbar Spine on the MRI’s of most people. As such imaging can often cause confusion, rather than clarity. Disc Degeneration, MODIC change, Annular tears, Facet joint arthrosis, and disc prolapses are closely linked to back pain and sciatica, but these changes are seen in people without back pain too. Thus in an individual the root causes of mechanical back pain can be a diagnostic challenge.

Dr Creaney uses a combination of clinical assessment, imaging and image-guided (fluoroscopic) injections to investigate and treat patients with, so called, ‘mechanical back pain’ and ‘sciatica’. Please refer patients who would benefit from this approach in combination with a physiotherapy programme.