Exploring fat loss supplements and drugs: L-carnitine, yohimbine, & more | Peter Attia & Derek MPMD

Summary

The transcript discusses the use of L-carnitine for fat loss and muscle growth, noting its presence in red meat and its role in energy production. It also addresses concerns about TMAO conversion when ingesting high doses and the potential benefits of injecting L-carnitine for better bioavailability. The conversation further explores the effectiveness of caffeine for appetite suppression and fat oxidation, comparing it to other stimulants like yohimbine, which can increase adrenaline signaling but may not be as reliable for daily use.

Takeaways

• 🥩 Carnitine is found in red meat and may be deficient in some diets, playing a role in incorporating free fatty acids into the mitochondria for energy production.
• 💉 L-Carnitine injections are used by some to bypass low oral bioavailability and potential TMAO conversion issues associated with oral intake.
• 🚱 Concerns about homebrewing L-carnitine injections include the risk of contamination and the lack of proper sterilization methods.
• 🏥 Compounded versions of L-carnitine are available from pharmacies, which may offer more safety in terms of manufacturing processes.
• ⚠️ The risks of using non-FDA approved or improperly manufactured injectables can be severe, including contamination and health complications.
• ☕ Caffeine is a reliable stimulant for increasing energy expenditure and suppressing appetite, with a well-established safety profile.
• 💊 Yohimbine is an alpha-2 adrenergic antagonist that can increase adrenaline signaling and potentially enhance exercise performance and libido.
• 🔄 The effects of L-carnitine on muscle growth and testosterone expression are anecdotal and not well-supported by clinical trials.
• 🌱 Vegans or those with low meat intake may benefit more from L-carnitine supplementation due to potential deficiency.
• 🏋️‍♂️ Caffeine is recommended for most people, especially in a calorie deficit, for its ability to increase gym performance and metabolic output.
• 🤔 The use of yohimbine is more situational and may not be as universally applicable as caffeine, depending on individual needs and responses.

Q & A

What is L-carnitine and why is it used by some people for fat loss?

L-carnitine is an amino acid present in red meat that helps incorporate free fatty acids into the mitochondria for energy production. It is also implicated in indirect processes like androgen receptor content in muscles. People use it to potentially increase the expression of what can be achieved with testosterone input, aiming to get more out of less androgen.

Is it necessary to take super physiologic doses of L-carnitine if you have a sufficient diet?

If you're getting enough L-carnitine through your diet, taking super physiologic doses, such as injecting 500 milligrams, may not be necessary. It's not analogous to creatine, and you might not saturate muscle stores, but it's not something you'd want to inject in large volumes.

Why do some people prefer injecting L-carnitine instead of taking it orally?

The oral format of L-carnitine has low bioavailability, around 10 to 15%, requiring a much higher dose to achieve the same effect as an injection. Additionally, there's a potential risk of TMAO conversion when ingesting large amounts of carnitine and choline, which can be avoided by injecting.

What are the concerns with homebrewing L-carnitine injections?

Homebrewing L-carnitine injections can be risky due to the challenges of properly sterilizing the water and ensuring the product is safe for injection. Without proper knowledge and equipment, this process can lead to health risks.

How can one ensure the safety of L-carnitine injections if not homebrewing?

One can opt for compounded versions of L-carnitine made in a pharmacy that adheres to good manufacturing practices. It's important to vet the pharmacy to ensure the product is safe and effective.

What is the role of caffeine in appetite suppression and fat oxidation?

Caffeine is known to increase energy expenditure and has appetite-suppressing qualities. It is considered reliable and safe for use, with the FDA suggesting an upper tolerability limit of 400 mg per day.

How does caffeine affect energy levels during a calorie deficit?

Caffeine can help attenuate an energy deficit by increasing metabolic output and providing a boost in the gym. It's a reliable way to support energy levels, especially when nutrient deprivation makes it difficult to fuel everyday activity.

What is yohimbine and how does it differ from caffeine in terms of effects?

Yohimbine is an alpha 2 adrenergic antagonist that raises adrenaline signaling significantly. Unlike caffeine, which is an adenosine receptor antagonist, yohimbine induces a more racy and aggressive energy feeling, but it's not as euphoric.

How does yohimbine affect exercise performance and libido?

Yohimbine can enhance exercise performance by increasing adrenaline, providing a boost in energy. Interestingly, it can also enhance erections and libido, which is unusual for a stimulant.

When is it appropriate to consider using yohimbine as part of a fat loss strategy?

Yohimbine might be considered when standard low-hanging fruit options have been exhausted, and there's a need to boost energy in a way that isn't overwhelming or causing an energetic state of deprivation.

What are the potential risks of using injectable L-carnitine from non-pharmaceutical sources?

The risks include contamination and the possibility of using a product that has not been properly manufactured or tested for safety. It's crucial to ensure the source is reputable and follows good manufacturing practices.

Outlines

00:00

💉 Carnitine and Fat Loss Pharmacopia

The first paragraph delves into the topic of L-carnitine, a substance often used in the context of fat loss and muscle enhancement. It is naturally present in red meat and may be deficient in certain diets. L-carnitine is known to aid in the transportation of fatty acids to the mitochondria for energy production and has been implicated in increasing androgen receptor content in muscle tissue, although this is considered fringe literature. The paragraph discusses the use of L-carnitine injections for those who may not get enough through diet, the potential benefits of this supplementation in terms of enhancing the effects of testosterone, and the risks associated with self-injection and sourcing the compound from questionable sources like online vendors or compounding pharmacies. It also touches on the importance of proper manufacturing processes to avoid contamination and health risks.

05:01

☕️ Caffeine and Yohimbine for Fat Oxidation and Energy

The second paragraph explores the use of caffeine and yohimbine as aids in fat loss and energy expenditure. Caffeine is highlighted as a reliable stimulant that can increase energy levels, metabolic output, and performance in the gym, while also suppressing appetite. It is considered safe with a recommended upper tolerability limit set by the FDA. Yohimbine, an alpha-2 adrenergic antagonist, is discussed as a substance that can raise adrenaline signaling, potentially liberating free fatty acids for use during exercise. While its energy expending component may not be significant, the adrenaline-inducing effects can enhance workout performance and are markedly different from caffeine's adenosine receptor antagonism. Yohimbine's effects on libido and erectile function are also mentioned, making it an interesting compound for some individuals looking to boost both exercise performance and sexual health.

10:03

🤔 The Considerations of Yohimbine Use

The third paragraph continues the discussion on yohimbine, focusing on its specific use cases and potential side effects. It is suggested that yohimbine is not a first-line option for boosting energy during a calorie deficit but rather a tool for those who have exhausted more conventional methods. The paragraph notes that yohimbine may be attractive for individuals seeking an increase in both exercise performance and sexual performance. However, it also cautions against its use due to the potential for anxiety and irritability, and suggests that it should be reserved for specific situations where an acute energy boost is needed without overwhelming the individual's energy or sleep state.

Keywords

💡Carnitine

Carnitine is an amino acid that is naturally present in red meat and is essential for transporting fatty acids into the mitochondria for energy production. In the context of the video, it is discussed as a supplement that may help with fat loss and muscle growth, particularly when injected rather than taken orally due to its low bioavailability in oral form. The script mentions that some individuals believe it can increase the effectiveness of testosterone.

💡Mitochondria

Mitochondria are organelles found in the cells of most eukaryotic organisms. They are often referred to as the 'powerhouses' of the cell because they generate most of the cell's supply of adenosine triphosphate (ATP), which is used as a source of chemical energy. In the video, the role of L-carnitine in helping incorporate free fatty acids into the mitochondria for energy production is highlighted.

💡Anabolic Stimulation

Anabolic stimulation refers to the process that promotes anabolism, the set of metabolic pathways that construct molecules needed by cells. In the script, it is mentioned in the context of how L-carnitine may increase the expression of androgen receptors in the presence of sufficient anabolic stimulation, potentially enhancing muscle growth.

💡AR Content

AR content refers to Androgen Receptor content, which is related to the sensitivity and response of the body to androgens like testosterone. The video discusses the fringe literature suggesting that L-carnitine might increase AR content in muscle, though this is not a widely accepted or proven effect.

💡Supraphysiological Doses

Supraphysiological doses refer to doses of a substance that exceed the normal physiological levels found in the body. The script mentions that injecting L-carnitine in doses much higher than what is typically found in the diet may not be necessary or beneficial, as it may not saturate muscle stores significantly.

💡Compounding Pharmacies

Compounding pharmacies are specialized pharmacies that create customized medications for individuals with specific needs. In the video, there is a discussion about the potential risks of obtaining L-carnitine injections from compounding pharmacies or online sources due to concerns about sterility and quality control.

💡Caffeine

Caffeine is a natural stimulant that is commonly used to reduce the feeling of fatigue and to increase alertness. In the video, caffeine is discussed as a reliable substance for increasing energy expenditure, suppressing appetite, and enhancing performance in the gym, making it a popular choice for those looking to support their fat loss efforts.

💡Fat Oxidation

Fat oxidation is the process by which the body breaks down stored fat into energy. The script touches on the potential effects of caffeine on fat oxidation, suggesting that while it may not be a potent fat burner, it can still contribute to increased metabolic output and support fat loss.

💡Yohimbine

Yohimbine is an alkaloid derived from the bark of the yohimbe tree. It is used as a stimulant and is discussed in the video as an alpha-2 adrenergic antagonist that can increase adrenaline signaling, potentially aiding in fat loss by liberating free fatty acids. It is also noted for its unique effects on energy and libido.

💡TMAO Conversion

TMAO, or trimethylamine N-oxide, is a compound that has been linked to cardiovascular disease when present at high levels in the body. The script mentions a potential concern with high oral doses of carnitine and choline leading to TMAO conversion in the gut, which can be mitigated by injecting carnitine or using allicin to prevent conversion.

💡Allicin

Allicin is a compound found in garlic that has various health benefits. In the video, allicin is discussed as a substance that may help attenuate TMAO conversion in the gut when taken with carnitine, although this use is considered fringe and not well-established.

Highlights

L-carnitine is found in red meat and can be beneficial for incorporating free fatty acids into mitochondria for energy production.

L-carnitine may indirectly increase androgen receptor content in muscle, suggesting potential for enhanced testosterone effects.

People often use L-carnitine injections to get more benefits from their diet and anabolic stimulation.

The necessity of L-carnitine supplementation depends on dietary intake and potential deficiency.

High doses of L-carnitine injections may not be necessary if sufficient levels are obtained through diet.

Injectable L-carnitine is often preferred over oral forms due to significantly higher bioavailability.

There are concerns about TMAO conversion when ingesting high doses of carnitine and choline.

Allicin from garlic is suggested to potentially attenuate TMAO conversion in the gut.

Clinical trials on L-carnitine show mixed results, with anecdotal evidence being more prevalent.

Caffeine is a reliable stimulant for increasing energy expenditure, appetite suppression, and gym performance.

Yohimbine is an alpha-2 adrenergic antagonist that can increase adrenaline signaling and energy.

Yohimbine is used for its stimulatory effects on training and potential enhancement of erections.

Ephedrine is a beta-2 receptor agonist that may provide a different type of stimulant effect compared to yohimbine.

Yohimbine's effects are short-lived, making it suitable for pre-workout use in calorie deficit situations.

The use of yohimbine is more case-specific and not as universally recommended as caffeine.

The safety and effectiveness of compounding pharmacies can vary, with some leading to serious health issues.

Homebrewing injectable substances can be dangerous without proper sterilization and knowledge of the process.

Transcripts

okay so let's talk about some of the the

the fat loss pharmacopia uh the fat loss

pharmacopia so um I have friends that

swear up and down by carnitine El

carnitine I think they inject it is that

so tell me about that so the L carnitine

is um present in red meat and depending

on your diet you may or may not be

deficient in it and it is something that

can help uh um incorporate free fatty

acids into the mitochondria and help you

produce energy and and it also is

implicated in certain indirect processes

like AR content in the muscle which is

some of the more Fringe literature but

it seems to in the presence of

sufficient anabolic stimulation actually

increase the expression of what you can

get out of your testosterone input so

this is the main reason why people I

know use it and presumably why a lot of

people use it that you know too is it's

often advertised as get more out of less

Androgen essentially but does

this work if you are getting sufficient

carnitine in your diet do you need super

super physiologic

doses well in general if you're

injecting 500 milligrams for example

like you will be Supra so it's not

something similar to creatine you can

make the argument that endogenously or

through your diet you may be get enough

to satisfy um like maybe you're not

going to saturate muscle stores but I

mean it is is it's not analogous to

creatine but it seems to be at least in

supplemental form and this is something

you inject subq daily depending on the

volume because it is depending where you

get it could be 200 milligrams a

milliliter 500 a milliliter and you can

only put so much oil subq or water sorry

it's waterbased subq before you have

lumps so even though it's more easily

absorbed it's still not something you

want to be injecting milliliters of like

typically subq shots you want so are we

back in the same problem of like where

are people getting this stuff typically

compounding pharmacies or online or

they're making it themselves cuz it is

just an amino acid that you could just

buy anyways so Homebrew sometimes but

the reason they're injecting it

typically is because home brew how are

they sterilizing the water

and I'm not I'm not a chemist who's

going to explain really how you would do

it but it's the same process by which

you would make your underground steroids

presumably so it's like in other words

this is a bad idea yeah yeah maybe this

is an awful idea unless you know what

you're doing cuz some of them are like

pretty I don't know intelligent but I

still wouldn't risk it even if I had the

instruction manual personally yeah so in

general though there is pharmaceutical

not grade but like compounded versions

that are made in an environment that's

been at least fact checked depending on

the rigor of the pharmacy in question of

course because you've done many uh deep

dives into compounding yeah which I

recommend people check out yeah we did

it I think we did an AMA where we

covered the the the ins and outs of

compounding and even with compounding

pharmacies there have been enormous

breaches of um of good manufacturing

processes and that results in

contaminations of legitimate FDA

approved molecules like cortical

steroids that have led to literally

thousands of deaths so you know it's one

thing when people are compounding things

without good manufacturing process that

you'll take orally because the gut is a

lot more forgiving yeah um but the

moment you start talking about things

that are injectable and now you are

injecting something in yourself that's

dirty you know that could be a huge

compromise so yeah anyway I I I uh I I

hope there are ways for people to vet

that stuff yeah um how effective is

caffeine both in terms of its effect on

appetite and potentially its effect on

fat oxidation by the way I did I want to

touch on quarantine quickly the reason

people inject it is typically because

the oral format is only about 10 to 15%

bioavailable so you have to take

literally 10 x the dose to achieve the

same yield outcome and then in addition

to that when you ingest things like

carnitin and choline there is a

potentially unfounded but still

potentially

concerning scenario where there is tmao

conversion so when you ingest a lot of

carnitine like four plus grams to get

your yield that is enough to actually

have some sort of effect that has shown

to have some hopeful AR content up

regulation which is still like a fringe

thing you're seeking that may not be

ultimately

founded you are using an amount that is

going to have some level of conversion

that you could avoid by injecting yeah

so you are averting the need to use as

high of a dose and in addition to that

you are potentially avoiding some level

of risk from gut related circum saying

some people use Allison with it to kind

of like circumvent and try and prevent

TMO conversion what's Allison it's from

garlic and it seems to attenuate TMO

conversion in the gut but it's also like

a fringe application with like a hopeful

outcome that I guess you can measure in

serum your tmao before and after Allison

versus not and see if there's a

difference but are there any clinical

trials that demonstrate any efficacy of

injectable or oral El carnitine with

carnitine the results are mixed some of

it looks promising and then some of it

doesn't so

this is one of those things where you

largely go by anecdotes and with it

being a natural amino acid a lot of

people that use it it depends on their

Baseline circumstance too the deficient

will obviously get more exactly like you

could sort of see a see a scenario where

somebody's like a vegan and there a huge

benefit obviously then you might see

well maybe the risk is worth the payoff

but if you're an omnivore who happens to

eat red meat I don't know maybe maybe

it's less so I'm sure of you you saw the

data you would not be convinced that

it's worth trying so I'll just put that

out there for people who watch your

stuff I don't think that they would

blindly want to inject this so this is a

the reason people find it very

attractive is because it works through a

different Vector people anecdotally have

seen muscle growth outcomes on the same

dose of anabolics or lesser so and a

grow leaner when they use it so it's not

like there's literature to show when

you're on testosterone plus carnitine

you get better results than just test

but

that's what people claim and seems to be

at least somewhat reproduced anecdotally

but you know that's uh speculative I

would not hang my hat on that and be

like I recommend for sure you take this

so just putting that out there um I

don't think it's a potent fat burner by

any means which is like the subsection

we're kind of talking about as far as

caffeine super reliable one of the best

things you could do you know where the

data lies for upper tolerability and

safety I think the FDA even has like a

threshold amount that they say you're

good to take it's like 400 which which

is pretty significant um and yeah you

can get some level of increased energy

expenditure from that but largely the

benefit from the stimulant category I

would say comes from the increase energy

you have even as you go deeper into a

deficit as well so as you enter into

nutrient deprivation territory it

becomes a lot harder to even move

subconsciously let alone actually fuel

your everyday activity so I'm not to say

you should become a caffeine addict to

support your deficit that's not

necessarily sustainable but it's if you

were going to use something to help

attenuate an energy deficit or you know

one day where you need a bump like

caffeine is certainly a reliable way to

do it that increases metabolic output

but also reliably increases performance

in the gym and has appetite suppressing

qualities and has safety data

simultaneously so I would you know

pretty blindly recommend caffeine for

most people short of like special

circumstances you mentioned yiman

earlier yeah let's say more about that

so that is a alpha 2 adrenergic

antagonist and when it comes to some of

these like

adrenergic type receptors it gets kind

of confusing because some of them will

have like even though it's an antagonist

of the Alpha 2 receptors it will

have stimulatory effects but

contradictory to what you'd expect from

a stimulant that's not vasoconstrictive

the same way you might get from a

amphetamine or like essentially any

other stimulant that works well so this

stuff raises adrenaline signaling very

significantly and there was thought that

it could liberate free fatty acids via

the adrenic signaling that you could

then you know like take advantage of

during exercise now is the energy

expending component of it worth hanging

your hat on I would say no but the

adrenaline inducing component opponent

is substantial enough that some

people really really enjoy the use of it

in their training and get a uptick and

energy that is markedly different than

through a adenosine receptor antagonism

which is CA caffeine yeah so like it

feels much more racy and aggressive than

caffeine and it's almost like a sub how

does it compare to like ephedrin

ephedrin I believe is a beta 2 receptor

Agonist off the top of my head I could

be wrong on that but it is less euphoric

I would say and more like adrenaline

spiking so you feel more like it's

almost borderline anxious to a degree

where you have ay how long does it last

um yohimbine halflife can't recall off

the top of my head but it's relatively

short the type of thing that people take

for the workout when they're in calorie

deficit typically you would take it

before cardio or before training is the

typical application but interestingly

enough it's also used as an

afrc and can enhance erections which is

weird because you wouldn't expect that

from s say and also like that doesn't

seem like the right mix of things to be

super anxious and you know irritable

sure yeah but it has the that's one of

the things where it's like is this a

drug for you cuz if you happen to get an

uptick in performance in exercise

performance and then also you get some

sort of uptick in libido and or enhanced

bedroom performance later in the day

could be attractive it is not something

that is uh I would typically reserve it

for a deficit whereby you have tried all

standard low hanging fruit options and

you're kind of okay now I need to

actually boost my energy in some way

that is not like I'm at my wits end for

I can't lower card do more cardio or

reduce my intake of calories anymore

without it being overwhelming or I'm

just in like a very deprived energetic

state or I got low sleep and I need to

acutely modulate it so I don't use it I

wouldn't use as much as caffeine

caffeine I would like very easily

recommend daily use in a diet I think

this is something that's more use case

specific and not as

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reliable oh