Other Supplements

A number of studies have examined various supplements to aid in weight loss.
There are a couple of candidates with relevance to both renal disease and
weight loss.

One of these substances is acetyl L carnitine. This protein is made of two
amino acids, lysine, and methionine. It is available primarily from meat
protein, but is also synthesized in the body. However, some conditions and
medications may interfere with its metabolism and may even cause secondary
deficiency.

Carnitine is needed for metabolism of fat by the mitochondria. Insufficiency
can mean a decreased ability to burn dietary and stored fat. For any
patient, symptoms of potential insufficiency include the following: 1)
excessive fat storage, 2) low muscle tone, 3) increased appetite (unable to
make adequate ATP from food consumed), 4) poor exercise endurance, 5)
increased fatigue, 6) excessive sleeping, 7) muscle pain with exertion, [image:
8)] elevated triglycerides, 9) low or unpredictable blood sugar levels
(resulting from inability to effectively use stored fat for energy), and 10)
cardiomyopathy. Hemodialysis patients with insufficient L-carnitine may have
difficulty maintaining adequate red blood cell production.
Provision of acetyl L carnitine has been shown to help with a variety of
symptoms, including diabetic neuropathy, insulin resistance in metabolic
syndrome, improved lipid parameters, improved exercise endurance, improved
blood sugar levels, and improvement in memory.

L-carnitine has been studied in the hemodialysis population. There is tissue
depletion related to hemodialysis duration and extent of disease. In several
studies, provision of L-carnitine in hemodialysis patients decreased need
for erythropoetin to maintain hemoglobin levels. It has also been shown to
have a protein sparing effect in hemodialysis patients.

In a study of children on hemodialysis, provision of l-carnitine reduced
triglycerides, free fatty acids, total cholesterol, and increased HDL-C.
Hemodialysis patients generally require IV administration of L-carnitine;
however, a few studies have used oral L-carnitine. In addition to decreased
need for erythropoietin, quality-of life-indicators have also improved with
L-carnitine administration.

The majority of L-carnintine is found in muscle and brain tissue; thus,
serum levels of L-carnitine do not reflect muscle stores. A trial of oral
L-carnitine in doses of 50mg/kg/day[67] or a typical dosage in adults of
3,000mg per day may be worth trying to see if energy levels improve in
patients trying to lose weight. Patients may be better able to manage
appetite if they are able to effectively burn stored fat. More research
regarding acetyl-L-carnitine supplementation, specifically in post-weight loss surgery patients, would be helpful.

A second supplement showing benefit in postoperative weight loss was found
as an unexpected consequence of its use. In a study initially designed
to see the impact on intestinal bacterial overgrowth and vitamin B12 levels,
researchers found an additional impact on weight loss. Compared to control
subjects, the probiotics provided in this study not only improved bacterial
overgrowth and B12 levels compared to pre-operative levels, but also
improved initial weight loss in postoperative patients during the initial
three months after surgery.

Two small studies examined the effect probiotics have on reduction of
uremic toxins in patients with stages 3 and 4 CKD. The authors found a
reduction in blood urea nitrogen (BUN), but not creatinine. Longer duration
studies with larger numbers of CKD patients are needed to determine
effectiveness and safety of probiotics in the long term. The safety of use
of probiotics in renal post-weight loss surgical patients remains a subject
for further studies.