The Healthy Nook - UAF Student Health & Counseling

The University of Alaska Fairbanks Student Health and Counseling Center provides medical and counseling services to the UAF campus students. Our articles are written by staff members and are to help keep students informed about good physical, mental and emotional health.

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What does L-Carnitine have to do with Fatigue & Nerves

                                                         CARNITINE, FATIGUE, AND NERVE FUNCTION

A substance needed for cellular energy production is L- carnitine. This quasi amino acid is normally found in the body, and is easily interconverted from one form to another. Some is obtained from eating red meat and dairy products, and the body can also synthesize it from other dietary amino acids. A few people with specific medical conditions have actual deficiencies which are alleviated by supplementation; for this reason it is sometimes called vitamin B(t). It has been tried as treatment for many other situations. It is sometimes touted as beneficial for body building; unfortunately, there is no evidence that it helps athletes or otherwise healthy people perform better when exercising, nor with weight loss. There is some evidence that some (not all) people with fatigue due to hepatitis, celiac disease, chronic fatigue syndrome, advanced age, multiple sclerosis or cancer can obtain modest relief when taking a supplement. One cause of male infertility may also be improved, as could some persons with certain types of heart disease, and those taking the seizure medication valproic acid. One small study (ie, statistically not very significant) indicated slight benefit in diabetic weight loss when combined with orlistat, an over the counter medication that blocks fat absorption.

 Larger studies need to be done to provide more solid evidence of benefit from L-carnitine supplementation.  Supplementation has been reported for fatigue in vegans, persons with ADHD, anorexia or Lyme disease; no studies have been performed in persons with these issues except with ADHD due to the fragile X syndrome, in which case it may be helpful.

Consumption can cause nausea, vomiting, abdominal cramps, heartburn, gastritis, diarrhea, and a fishy body odor. L-carnitine should not be consumed as a supplement by persons with thyroid disorders or a history of seizures without consulting their medical provider.

Another form of L-carnitine, acetyl-l-carnitine, is used for several nerve-related conditions. There is some evidence of improved cognition in those with mild age-related (over 65) or chronic alcoholic-related cognitive impairment, and in depression in the elderly. Doses tested ranged from 1500 to 4000 mg daily, divided into 2-3 doses.  Pain from diabetic neuropathy may be decreased with the higher doses of this form of carnitine.

Although these two forms of carnitine can be interconverted by the body, because research has been done on one substance or the other, that product should be used. The cost of these products can vary wildly; comparison shopping is recommended. In addition, and as is true with all supplements, the FDA does not regulate these products for purity or to ensure they contain what they claim.


Natural Medicines Comprehensive Database, accessed 9/24/2012

Up-to-Date, accessed 10/9/2012

Tagged: L-carnitineFatigueNervesJune ThomassonUAF CHCChcUAF


Vitamin C by June Thomasson, PA-C

Vitamin C

This vitamin is probably the vitamin most consumed, for the most indications, for the longest time in the US. Starting with Linus Pauling’s ground-breaking research, the American vitamin industry has taken off; it has been said that Americans have the most expensive urine in the world! Unfortunately, there still is incomplete research on the actual benefits of supplementation with vitamin C other than curing scurvy. The vitamin is vital to a number of physiological functions; the nonspecific symptom of fatigue could be the first symptom of deficiency. One study suggested 30% of the population is deficient due to poor eating habits; consumption in the diet is still the best source. The recommended daily allowance for men is 90 mg daily, non-pregnant and non-nursing women is 75 mg daily; users of tobacco should consume an additional 35 mg vitamin C daily. About 90 mg  is contained in 1/2 cup raw sweet red pepper, 1 large kiwi fruit, 1 cup orange juice (recently opened, see below), 1 cup strawberries, or 1 ½ c cooked broccoli, green peas or kale.


Vitamin C is very frequently used to prevent or treat the common cold. Since Dr. Pauling’s small study in Swiss school children on a ski holiday, amazingly little further research has been done.  A Cochrane review of studies in 2000, (the most recent of those included in my sources) concluded that high doses (1-3 grams daily) might decrease the duration of cold symptoms by one to one and a half days in some patients, although doses over 2 grams are more likely to cause stomach upset and diarrhea. That review found that vitamin C taken to prevent colds doesn’t help.

Other possibly effective uses include to decrease sunburn (orally or topically with vitamin E), to slow progression of atherosclerosis  (though this may be true only in specific populations), decrease risk of gout, and to decrease risk of developing mouth cancer (but no other cancer). Taken with iron pills, vitamin C does increase the amount of iron absorbed from supplements. 


Studies don’t support use of vitamin C for acute bronchitis, Alzheimer’s disease, diabetes prevention, stroke, or “overall mortality”, ie death from any cause. More and larger studies are needed to clear up conflicting evidence regarding efficacy in hay fever, asthma, infertility, mental stress, cardiovascular disease, and cataracts.  Of interest are the results of a study in 2002 testing the amount of vitamin C in various ages and sources of orange juice. The study concluded that frozen orange juice consumed within one week of reconstitution is the strongest and most reliable [orange juice] source of the vitamin; all the juices lost about 2% of usable vitamin C daily once opened.  Ready-to-drink orange juice should be purchased 3 to 4 weeks before the expiration date and consumed within one week of opening.


Side effects usually don’t occur until daily doses of supplements exceed 2000 mg (2 grams). This is the dose recommended by the makers of EmergenC, which contains 1 gram in each packet. In some people, this amount can cause abdominal bloating and diarrhea, and increase the risk of kidney stones. Higher doses can trigger nausea and vomiting, heartburn, fatigue, headache and affect sleep. 



Natural Medicines Comprehensive Database, accessed 4/10/2012

UpToDate, accessed 4/10/2012

JAmDietAssoc, 2002 Apr; 102(4): 525-9.

Tagged: Vitamin CJune ThomassonUAF Health and Counseling


Ginkgo by June Thomasson, PA-C


Gingko is a Chinese herb which has been used for many applications. As is so common, only a few indications stand up to scientific testing, or have been sufficiently tested. In our college population, improving cognitive function is likely to generate the most interest. There are a number of aspects of cognitive function which can be evaluated; the studies and abstracts in my sources report using different names for these functions, and total number of subjects tested is low. However, in healthy, young to middle-aged people, overall memory improvements are likely in the range of 7%. Speed of working memory seems to be the function exhibiting the most improvement.
Several studies of healthy elderly report no protection to or improvement of memory, though in those with mild to moderate age-related memory or cognitive impairment there may be modest improvement. Studies of patients with dementias, including Alzheimer’s also indicate improvement, though these studies are of questionable quality.
Those with Raynaud’s syndrome and vertigo may experience fewer or less severe attacks, and women afflicted with breast tenderness and mood aspects of premenstrual syndrome may experience relief when taking ginkgo.
Other conditions likely improving with administration of ginkgo include the eye conditions diabetic retinopathy and glaucoma, and peripheral vascular disease.
Ginkgo may not be effective in reducing altitude sickness, SAD (seasonal affective disorder), sexual dysfunction, or tinnitus (ringing in the ear). A large trial showed that 240 mg daily in the elderly over 6 years does not significantly reduce the risk of hospitalization or death due to cardiovascular disease.
Initial studies with insufficient reliable evidence to rate effectiveness have been done on people with anxiety, ADHD, fibromyalgia, schizophrenia, recovery from stroke, and vitiligo (a skin condition).
The various chemical compounds in ginkgo can have significant adverse effects. Raw seeds, crude extracts, and even leaves, can cause strong allergic reactions, seizures and even death, or cause cancer; these sources are not recommended. Extracts of ginkgo leaves affect the ability of the liver to process various herbs and medications. Persons with seizure disorder and those taking medications that can increase the risk of seizure should not take ginkgo. Insulin and diabetic medications, and substances affecting blood clotting are likely to be affected, as are many other medications and herbs; it is best not to combine any substance (including ibuprofen, acetaminophen, and other over-the-counter medications) which is pharmacologically active without checking with your practitioner. Anyone with allergy to poison ivy, poison oak, poison sumac, mango rind, and cashew shell oil is more likely to have an allergic reaction to ginkgo.
Dosages vary, and likely vary depending on the extract. Because ginkgo irritates the gut, start at a maximum of 120 milligrams (mg) of standardized extract daily, divided into two or three doses, except for improvement of cognitive function when a single dose can be used. If no benefit occurs, and once the gut is normal, total daily dose can be tapered up to a total daily dose of 600 mg. Ginkgo leaf extract is often combined with American ginseng; this combination was used in studies of ADHD but should not be used for PMS. Ginkgo with co-enzyme Q10 was studied as treatment for fibromyalgia.
In a local grocery store natural health section, six products are available containing gingko. Three are combinations with multiple herbs, including gotu kola, an herb containing caffeine. One is one of the most frequently evaluated standardized extracts, and two are standardized extracts plus a modest amount of the dried whole leaf. There is some evidence of increased benefit from the whole leaf; presumably the amount added to these preparations is insufficient to cause side effects in most people.
Natural Medicines comprehensive Database, accessed 2/21/2012
UpToDate, accessed 1/31/2012

Tagged: June ThomassonUAF CHCNatural Health





Upper respiratory infections (“colds”) and sinus infections are a common affliction in the dry climate of Fairbanks. Often resolving without use of antibiotics, or even any medications, some of the discomfort can be alleviated by moisturizing the mucosa. Nasal saline, or salt water, in a squeeze bottle, is the easiest to use, and can help with clearing thickened discharge from a common cold. In persons with a history of sinus infection, this treatment begun at the onset of cold symptoms can decrease the risk of progression to a full sinus infection, and relieves pressure and congestion.  Others find increased relief from a larger quantity of water as applied with a Neti pot or syringe. This physically removes some of the discharge, and relieves congestion and pressure. It also improves the function of the cilia, small hairs lining the sinuses. The cilia aid the clearance of discharge from the sinuses.

 Neti pots were recently in the news after two people in Louisiana got amoebic brain infections from using tap water for irrigation. Updated instructions suggest boiling water prior to use in irrigation to avoid this. However, our drinking water in Fairbanks is too cold for survival of the organism at fault in Louisiana, so use of Fairbanks or UAF tap water should be fine.  (However, if one is immune compromised, using boiled or distilled water would be safer.)To prevent reinfection of oneself, however, wash your pot, bottle, or syringe in hot soapy water after each use, sterilize or replace every two to three weeks, and don’t share your equipment with anyone else.

Directions and recipes are available on the web ( eg from the American Academy of allergy, Asthma and Immunology), or at the Student Health Center for those who have paid the health center fee.


UptoDate, referenced 1/31/12

Alaska Department of Environmental Conservation, verbal communication, 1/31/12

Tagged: nasal congestionJune ThomassonUAF chc


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Blueberries, Wine and Antioxidants by June Thomasson, PA-C

Blueberries, Wine, and Antioxidants

In the last few years, blueberries have been touted as containing anthocyanidins, substances that reverse or postpone aging. However, despite the presence of these and other antioxidants in blueberries, the one study (published in 2002) evaluating absorption of these chemicals into humans demonstrated poor absorption. Also, the studies showing anti-aging and anti tumor benefits were done on cell cultures and rats, not humans, with doses much more concentrated than possible from whole fruit. Similarly, preliminary evidence suggests blueberries can prevent bacterial adhesion to the bladder and bacterial colonization (as do cranberries); however, this evidence is insufficient to allow recommendation for this use, either. So enjoy eating our delicious blueberries as a part of a balanced diet, but don’t expect miracles!

Similarly, red wine has been marketed as a source of resveratrol, another antioxidant. Red wine is the best dietary source of resveratrol, in greatly varying amounts; this antioxidant is found in smaller amounts in blueberries. Significant research has been done in cell culture and animal models with “free” (unconjugated) resveratrol, showing reduced aging and incidence of cancer. However, humans can’t absorb enough of this compound from wine to be significant. At this time, there is no evidence that resveratrol supplements actually have any health benefit in humans; doses would likely need to be a thousand times that found naturally.

Consumption of small amounts of alcohol of any sort does decrease the risk of coronary heart disease, atherosclerosis (hardening of the arteries), and heart attack when compared with nondrinkers. This benefit is seen in women at one drink a day, and men at 2 drinks a day; more is NOT helpful. 3 (women) or 4 (men)drinks a day or more can cause heart, liver, memory, depression and anxiety problems, as well as a greater risk of problem drinking and violence. (One drink is 12 oz of beer, 5 oz wine, or 1.5 oz 80-proof distilled spirits.) The same (one or two drinks a day) or lighter consumption of alcohol may reduce the overall risk of mortality from any cause. However, any alcohol intake increases the risk for breast cancer; the effect is uncertain on other cancers until over 4 drinks, which is a risk factor for most cancers. The actual benefits of alcohol are difficult to measure, as there are many confounding variables.

Thus, if you have no health consideration, and are so inclined, one drink a day for women, two for men, three to four days a week may be beneficial to your health. (Saving them up to drink at one time, even occasionally, is called binge drinking, and is not healthy.) Supplements of these antioxidants have no proven efficacy.


Natural Medicines Database, accessed 23 August, 2011

UpToDate, accessed 23 August, 2011

Tagged: blueberriesantioxidantsJune Thomasson