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Lipodystrophy and WastingLipodystrophy and Wasting
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Feeling Weak & Supplements
May 19, 2000

Sir: I have a question which I think is of interest to a lot of HIV-positive people. Are L-carnitine and DHEA really worth the high costs which could be spent elsewhere on proven remedies (including a gym membership, for example)?

Many positive guys I know swear by these supplements. What seems frustrating is that most of their doctors know little about these things and aren't even interested (I guess that's why you guys are here). Thanks. Eric

Response from Dr. Hellerstein

You're right; I'm very interested, but definitely do not swear by these supplements. The evidence and the basic ideas behind them still leave a lot to be desired.

DHEA. This agent has a lot of promise but little that is known. If you give it to an obese rodent (there are mouse and rat models of obesity), the animals lose weight. Indeed, the major interest of pharmaceutical companies in DHEA and its analogues is for weight loss and insulin-sensitizing effects, certainly not for weight gain and muscle accrual.

Some people believe that it provides energy and strength. This may be true, but it is hard to be sure (lots of things make people feel better, and as often as not, it is the power of persuasion--the placebo effect-not a real biological action). Also, the idea that this is an oral testosterone is quite wrong. It has very, very weak androgenic (testosterone-like) actions. There are a lot better ways to get testosterone in your body than DHEA! So I don't want to say that it couldn't help you in any way, but that it hasn't yet been proven to do much that would help someone like you.

Carnitine has even less proof. The idea here is to help the fats in your cells enter into the mitochondria (the place where fuels are burned). Carnitine helps transport fats in. The problem is that carnitine levels per se in the cell probably do not control how well fats can get in --that is, there's already more than enough carnitine there. Adding supplements therefore would not provide any benefit. At least that's what looks to be the case -- we could definitely stand some proper studies of this question.

The take-home message is that you have no idea if these agents work or not. If you take them, it's almost entirely on faith. In contrast, working out at a gym is proven to work.

Take your choice!

Marc Hellerstein, M.D., Ph.D.

Newly diagnosed and gaining weight

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