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Letter to the Editor

Journal of Intercultural Ethnopharmacology

www.jicep.com
DOI: xx.xxxx/xxx.xxxxxxxxxxxxxx

On the use of carnosine and

antioxidants: Aletter from Russia
Sir,
Carnosine, an endogenously synthesized dipeptide found in
muscular and other tissues, was reported to possess antioxidant
properties. Favorable actions of carnosine were explained
by its effects against reactive oxygen species (ROS), against
peroxynitrite damage and different types of viral injury [1-6].
Moreover, one of the mechanisms of detoxification from
aldehydes, accumulating in inflammation, ischemia, and
other pathological conditions was reported to be conjugation
with carnosine [7-10]. Among other potential applications,
carnosine-containing eye drops have been recommended
for the treatment, dissolution and prevention of cataracts,
in particular, senile cataracts [5,11]. From the viewpoint of
biochemistry, it is difficult to envisage how carnosine can
contribute to the dissolution of cataracts, regarded to be the
end stage of metabolic and structural transformations including
conformational changes and aggregation of proteins [12].
To decide whether a local or general supplementation of
a substance is indicated, the question should be answered
whether there is a local or general deficiency. Such deficiency
is prima facie improbable for substances that are supplied with
food and can be synthesized in different cells and tissues of
the body. Tissue carnosine concentrations are influenced by
the diet being lower in vegetarians [1,4,13]. If the presence of
carnosine in body fluids is important for the preservation of the
lens transparency [5,11] or some physiological functions [4,14],
the incidence of cataracts or other pathological conditions
among vegetarians/vegans would be higher than in the general
population. On the contrary, vegetarians have been reported
to have a lower risk of cataract than meat eaters: There was a
strong relation between the cataract risk and a diet group, with
a progressive decrease in risk of cataracts in high meat eaters
to low meat eaters, fish eaters, vegetarians, and vegans [15].
Admittedly, the topic is not without controversy [16], probably
confounded by geographical (exposure to sunlight) and other
factors. Furthermore, it has been suggested that carnosine
is an anti-aging substance with a beneficial effect on the
cardiovascular system [3,17,18]. There is, however, evidence
that vegetarians have lower rates of coronary heart disease,
hypertension, etc. Overall, their cancer rates appear to be
moderately lower than in other people living in the same
communities, and life expectancy appears to be greater [19].
A very low meat intake was reported to be associated with
greater longevity [20]. However, benefits from the vegetarian
versus carnivorous diet [9] are beyond the scope of this letter.
Carnosine has been used in sports nutrition to increase
performance and was reported to have benefits in obesity
J Intercult Ethnopharmacol ??? ??? ???

and diabetes mellitus [2,21]. The latter is understandable as

peptides are non-carbohydrate nutrients favorable for diabetics.
Nutritive value of carnosine can explain for higher performance
in sports. Dietary supplementation of carnosine has been
shown to suppress stress in animals, to improve cognition and
well-being in humans [22], which can be also explained by the
nutritive value. Modulation of glycolysis and inhibition of the
glycolysis-induced protein dysfunction have been attributed
to carnosine [3]; however, modulation or inhibition of
dysfunction is a regulatory function that cannot be ascribed
to a simple substance as it presupposes a feedback mechanism.
The following logical fallacy can be encountered in some papers
on substances participating in metabolism such as carnosine.
First, the important biochemical role of the substance is
stressed, which is natural for a metabolite. After that, benefits
from supplementation are discussed, even though it remains
unproven, whether a deficiency of the substance occurs, and
if it does, whether it can be compensated by a diet or some
natural products. Purified preparations might be both expensive
and unnecessary. Diet modification, e.g., consumption of more
meat as a source of carnosine may suffice if supplementation
is indeed indicated.
As for antioxidants affecting ROS, their increased levels may
produce unpredictable outcomes since ROS can have both
harmful and beneficial effects [23]. The same is true particularly
for carnosine [24]. Generation of ROS is usually considered to be
a side effect of aerobic metabolism [23], which is a ubiquitous
process in living organisms. The redox status is maintained
in dynamic equilibrium of oxidative and reductive processes
under the impact of numerous factors [25-27]. Some experts
suggest that boosting of antioxidant status has no benefits [25].
Certain reviews on antioxidants discuss vitamins and other
substances with complex action mechanisms [28,29]. In general,
antioxidants are regarded to be far from any scientifically
founded clinical application [23]. It has largely remained unclear
whether, when, and how much antioxidants should be taken
in [23,30,31], the more so as antioxidants at higher doses may
act as pro-oxidants [25].
Some generalizations regarding the oxidants/antioxidants
balance, attempting to present it as universal biological concept,
seem to be oversimplifications. The problem consists of several
partly interrelated topics: Antioxidants and cancer [23], wine,
ethanol and cardiovascular risk [28,32], radiation protection [33],
lens transparency and cataract [5,11], flavonoids, healthy aging,
menopause, atherosclerosis prevention [34], antioxidants,
carnosine and diseases of the nervous system [22,35-37], etc.
Indications to the use of particular substances are questionable.
1

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Letter to the Editor

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Several large randomized clinical trials found that antioxidant

supplementation does not reduce the risk of cardiovascular,
mental disease and cancer, or the evidence was found to be not
relevant to clinicians or consumers [23,30,35]. For example,
numerous reports on inverse relationship between regular
intake of low to moderate amounts of alcoholic beverages and
cardiovascular risk have inspired some people to drink more
alcohol in spite of possible psychosocial and other complications.
While the association between alcohol consumption and
decreased cardiovascular risks is regarded to be proven, it
remains uncertain whether this implies causation. Although
a number of points do suggest that the association between
moderate alcohol consumption and decreased cardiovascular
risk may indeed represent a cause-effect relationship, it is
unclear to what extent it is related to antioxidants in wine and to
ethanol per se [32]. The question can be clarified by large-scale
experiments with different diets and supplements. However,
human studies and animal experiments may be planned only
in the presence of integrity, adequate equipment and ability to
objectively evaluate scientific data.
The topic of antioxidants, in particular, is complicated by
conflicts of interests. Some antioxidants seem to be propagated
as inexpensive substitutes for evidence-based medications,
i.e., in support for placebo marketing. There are many examples
of marketed substances without scientifically demonstrated
effectiveness [38-41]. Publications of questionable reliability
are sometimes indirectly used in Russia for advertising of
drugs and food supplements, for their official registration and
obtaining permissions for practical use. As a result, substances
with unproven effects can be offered to the elderly and other
patients misinformed not only by advertising but also by
some publications supposed to be scientific. The carnosine
eye drops sold in Russia are relatively expensive; they are
prescribed to aged patients. Theoretically, at least for patients
with low income, carnosine preparations could be replaced
by a meat-rich diet and/or by isotonic defatted meat broth or
extract applied locally to eyes. It can be reasonably assumed
that useful properties, e.g., chicken broth [6,42] are related not
specifically to carnosine but to the whole mixture of peptides
and other substances. A similar suggestion was made, e.g., in
regard to glycosaminoglycan-containing chondroprotective
agents versus natural glycosaminoglycans for osteoarthritis [41].
To support the placebo effect, the patients may be advised
that the natural products can be sources of carnosine
similarly to pharmaceuticals, although an effect is guaranteed
neither from the drugs nor from meat products. However,
considering uncertainties about antioxidant effects discussed
above, we would rather abstain from such recommendations.
Even more precarious, because of complication risks [43],
are recommendations of peribulbar injections of carcinine
(the analog of carnosine) as an antioxidant for prophylactic
purposes [44]. Until recently, peribulbar injections of amino acid
taurine were used in the former Soviet Union for the treatment
of eye conditions associated with atherosclerosis and aging [45]
or inflammatory conditions [46], against payment in elderly
patients, while hematomas were observed as complications.
Analogously to carnosine, taurine is widely distributed in tissues,
synthesized within the body and supplied with animal-derived
2

food products [47]. In conclusion, practical recommendations

should be based on research of high quality shielded from
conflicts of interest. Only such research should be included
into reviews and meta-analyses.

Sergei V. Jargin
Department of Public Health, Peoples Friendship University of
Russia, Moscow, Russia
Address for correspondence:
Sergei V. Jargin, Department of Public Health, Peoples Friendship
University of Russia, Clementovski Per 6-82, Moscow, Russia.
E-mail: [email protected]
Received: March 17, 2016
Accepted: April 09, 2016
Published: ???

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SAGEYA. This is an open access article licensed under the terms

of the Creative Commons Attribution Non-Commercial License (http://
creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted,
noncommercial use, distribution and reproduction in any medium, provided
the work is properly cited.
Source of Support: Nil, Conict of Interest: None declared.

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