Determining and Surveying the Role of Carnitine and Folic Acid to Decrease Fatigue in β-Thalassemia Minor Subjects

Abstract

Beta-thalassemia minor (BTM) patients usually experience fatigue, bone pain complaint, and muscle weakness. Carnitine is an essential protein for transportation of long-chain fatty acids to the matrix for beta-oxidation. BTM patients have abnormally low plasma carnitine concentrations, which results in deficient ATP production. Carnitine and folic acid together may have a role in preventing bone pain complaint and fatigue in these patients. The aim of this study is to determine the effect of carnitine and folic acid supplementation in subjects with BTM. Seventy three BTM (mean age 11.06 ± 5.46 years) and 23 healthy controls (mean age 8.48 ± 3.78 years) were enrolled in the study. Fasting blood was drawn to determine baseline free and total carnitine levels, red blood cell folate concentration, and hemoglobin level. BTM were divided into three groups and received different types of supplementation for 3 months: Group 1, 50 mg/kg/day carnitine; Group 2, 50 mg/kg/day carnitine plus 1 mg/day folic acid; and Group 3, 1 mg/day folic acid. Controls did not receive supplementation. Laboratory parameters were again evaluated after 3 months' supplementation. A detailed quality of life questionnaire was designed to investigate muscle symptoms before and after supplementation. Free and total plasma carnitine concentration and hemoglobin levels in BTM subjects increased significantly after carnitine supplementation (P < .0001). Bone pain complaint and muscle weakness decreased with carnitine. Red blood cell folate level increased after folic acid supplementation. Carnitine and folic acid supplementation resulted in a decrease in bone pain complaint and muscle weakness in cases with β-thalassemia minor.

Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence

“…Folate (vitamin B9) supplementation has been successfully tested in patients with beta-thalassemia, an inherited disorder in which red blood cells and hemoglobin levels are affected, leading to fatigue and muscular weakness. In spite of some methodological drawbacks, it has been found that, in 73 thalassemic children aged approximately 10 years, folic acid supplementation (1 mg/day for 3 months) led to a reduction of reported fatigue perception [122].…”

Chronic Fatigue Syndrome in Patients with Deteriorated Iron Metabolism

“…While et al show that the leading symptom of sickle cell anemia is chronic fatigue and complaints of pain [ 112 ]. In the context of fatigue therapy, Tabei et al demonstrated that patients with beta-thalassemia minor anemia have low levels of free and total plasma carnitine and reported the efficacy of carnitine and folic acid supplementation in reducing fatigue and muscle weakness in these patients [ 113 ]. They studied 73 children with beta-thalassemia minor, evaluating their laboratory parameters and the level of plasma-free carnitine, total carnitine, red blood cell folate, and hemoglobin.…”

Hemoglobinopathies in Iran: An Updated Review

“…The β-thal minor patients usually experience bone pain complaint, muscle weakness, myalgia and fatigue 57 . Abnormal low plasma carnitine concentrations which lead to deficient ATP production, fatigue and bone pain complaint has been reported in these patients and carnitine and folic acid supplementation lead to a decrease in muscle weakness and bone pain complaint 58 . β-thalassemia intermedia .Genetic heterogeneity of β-TI is associated with wide clinical spectrum manifestation from mild to severe hemolytic anemia.…”