Low-dose supplements shouldn’t adversely affect health
Q: I am a healthy 46-yearold woman who exercises daily for health, strength and stress relief. I also want to stay relatively lean. In order to maintain muscle mass and control fat, I’ve been advised consistently (by a Ph.D. nutritionist and a couple of “nutrition coach” trainers) to take 1 gram of protein per pound of body weight daily. They have also advised leucine and L-carnitine supplements. I usually have 1 scoop of whey protein (about 25 g) and ½ to 1 scoop of plant protein daily. I take about 1 g of leucine per day. My L-carnitine supplement is 500 mg.
My question is whether any, or all, of these supplements are safe for long-term use and whether there are any concerns or possible side effects I should be concerned about. I have read plenty that recommend them, but the goals are usually short term.
Other than having extra protein, my diet is slanted toward whole foods and lots of vegetables and away from sugar. I work out seven days a week, including four to five “hard” days of cardio and weightlifting and two to three “light” days of easy cardio. I also stretch and get at least seven hours of sleep daily.
I want to have health, mobility and strength as long as possible and want to make sure I’m not inadvertently hurting the long goal by using supplements now.
A: Understanding advice on nutrition and supplements for exercise is difficult because the evidence is often poor quality and conflicting, probably due to the fact that what is effective for one person may be ineffective for another.
Carnitine is found naturally in muscle and is important in moving fat into the mitochondria, where it can be used as energy. Carnitine supplementation has been shown to improve exercise tolerance and increase use of body fat stores for energy. It also can improve blood and oxygen flow to the muscle if taken with large amounts of carbohydrate (the study authors used 4 ounces of simple sugar in water — more than it sounds like you take in, and perhaps more than optimal for good health). Carnitine is safe at the dose you are taking: At doses six times that high, it may cause nausea, vomiting and diarrhea.
Leucine, like valine and isoleucine, is a branched-chain
amino acid. They are “essential,” meaning they cannot be synthesized in the body but are found in red meat and dairy products. They are also found in legumes, nuts, grains and seeds, but a person on a strict vegan diet needs to be careful to mix these appropriately to get all the essential amino acids they need.
Some claim that branchedchain amino acids reduce fatigue, improve endurance, provide fuel for working muscle and reduce muscle protein breakdown and soreness from exercise, but there is no highquality evidence that they are effective. A chicken breast contains the equivalent of seven average branched-chain amino acid supplement tablets. Leucine in the dose you are taking should have no adverse effects.
The standard guideline recommends that individuals consume 150 g of protein-rich foods
daily for a 2,000 calorie diet. You may be exercising more than 2,000 calories, but I think you are certainly getting all the protein you need. Excess animal protein may worsen kidney function, but plant protein does not seem to cause that issue.
In my opinion, your diet and exercise, which are remarkable, are much more likely to achieve your goals than your supplements, but I do not think the supplements are harming you.
Q: I am 64. I started taking statins to lower my cholesterol about two years ago. My cholesterol level sometimes went over 200, and after seesawing results, my doctor advised that I was unable to maintain a low cholesterol by diet alone and prescribed a statin. I took 10 mg of atorvastatin. I noticed I started having very detailed and vivid nightmares.
(I would rather be awake than be in these nightmares.) The doctor changed me to 5 mg of rosuvastatin. The doctor says my results are very good (cholesterol is 140). I am still having nightmares, but not as frequent as before. I also am having memory issues (e.g., could not remember the names of close colleagues from only two years ago). I recently saw an article that suggested there may be a link between dementia and use of statins.
Can you provide comments on nightmares and/or dementia links to statins?
A: Large-scale studies in people at high risk for, or with, heart disease suggest that statins reduce the incidence of dementia by about 15 percent to 30 percent. This may be due to their reduction of strokes, which can cause dementia, but may also worsen function in
people with Alzheimer’s disease. Or it may be due to statins’ ability to reduce amyloid protein in the brain. These effects are postulated and not confirmed by trials specifically designed to look at dementia.
On the other hand, there are certainly people who can develop forgetfulness on statin drugs. This side effect seems to be much more common in people taking simvastatin (Zocor) and atorvastatin (Lipitor) than pravastatin (Pravachol) or rosuvastatin (Crestor). Unlike dementia, the side effect of worsened memory halts when the medicine is stopped.
I found a few case reports of nightmares associated with simvastatin and atorvastatin, but a literature review found no correlation between nightmares and statins. The problem with studies like these is that they are not likely to find rare side effects. It is certainly possible the simvastatin caused the nightmares (and I’m not sure if the rosuvastatin is, too), but it seems to be a very unusual side effect.
Q: I have someone close to me who was having chest pains and back pains for about a month. This person went to the ER, where they did an EKG and a chest Xray, and they also took blood tests. Everything came back looking good. The person was told they have acid reflux (which is understandable because my friend hasn’t been eating right), but about 40 minutes later, my friend got a call saying something else showed up and that their white blood cells are low (2.1). Any reason for concern?
A:
The normal range for a white blood cell count is from about 3.5 to about 11. (That’s actually 3,500 to 11,000 white blood cells per microliter.) When we see white blood cell counts that low, we generally repeat them to be sure there wasn’t an error, and if persistent, your friend should visit a regular doctor or hematologist (blood expert). There are many possibilities: Medications and infections are common causes. A familial condition called “Duffy-null” produces low white cell counts but doesn’t cause problems such as recurrent infections. Unfortunately, low white cell counts can sometimes indicate a severe bone marrow problem, so your friend does need to get an evaluation if the repeat test still shows a very low count.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.