DESCRIPTION The present invention relates to a nutritional composition or medical food for subjects in a debilitated state as a result of stress.

In the developed countries, stress syndrome afflicts a substantial number of people. The causes of the stress are multiple and attributable mainly to living conditions in large and overcrowded urban areas and to the problems these give rise to such as trafic, noise and pollution. Another important cause consists in problems associated with working activity or economic worries.

This syndrome afflicts all social classes, but mainly affects people involved in the production cycle, who often, as a result, are subject to greater competitive stress stirnuli both in the work environment and in the conduct of their social relations.

Generally speaking, stress syndrome is not a debilitating "disease"to the extent that it makes people bed-ridden, but it is certainly a frequent cause of people taking days off work. Since it afflicts a substantial number of individuals, it causes a considerable burden of economic damage to the entire community during the working year. Stress syndrome, which in the past was improperly called"nervous breakdown", is characterised, in the absence of active disease, by concomitant states of malaise, such as a lack of strength, debilitation, states of mental and physical fatigue, lack of concentration and attention, and lack of sexual vigour and libido.

There are no specific drugs for the treatment of stress.

Temporary detachment from the causes of the stress, for instance by spending a holiday in a pleasant locality and in a relaxing

environment, would certainly have a positive effect, facilitating recovery of mental and physical well-being with an improvement in physical performance and an increase in sexual vigour and libido.

This, however, is not always possible for various reasons such as, for example, work commitments, family demands and economic difficulties.

A number of patients suffering from stress are treated with benzodiazepines or with drugs which are active in mood disorders.

Benzodiazepines are used to alleviate symptoms such as anxiety or irritability, but present the drawback of causing addiction as well as further depressing libido and sexual vigour, thus triggering a mechanism in male subjects of reproductive age which itself proves to be a cause of additional malaise.

A number of substances which are useful for the treatment of impotence of psychogenic or other origin are already well known. Equally well known are substances endowed with stimulant activity. For example, L-carnitine, when used for the treatment of patients undergoing regular dialysis treatment, also induces recovery of normal sexual function in such patients (De Felice SL, Lyons P, Gaffar MC, Sheridan MJ, Dial- ? 5ansplan 1996, voI/iss/pg.

25/6 368-373).

Popular medicine (and belief) in oriental and South American countries (China, Brazil) have, since time immemorial, accredited the extracts of the roots, bark and leaves of various"exotic"plants with multiple therapeutic and stimulant effects. Ginseng has been used in Chinese medicine for more than 2000 years for the treatment of sexual impotence and for other diseases. Also well known is the activity of yohimbine in improving sexual function; see, for example,"Clinical Studies in Impotence" : K Reid et al., Lancet 2, 421-423 (1987). Guarana is used by Brazilian indigenous

populations for the preparation of a stimulating beverage (Pharmacognosy, Edward P Claus, Varro E Tyler, Lynn R Brady, 6th edition pp. 292-293). Damiana has also long been known to be endowed, according to popular belief, with stimulant activity (J Psychoactive Drugs 16 (3): 267-268,1984).

The purpose of the present invention is now to provide a therapeutic medical food suitable for alleviating and treating states of malaise caused by stress and for promoting sexual vigour. The therapeutic medical food of the invention comprises the following compounds in combination: 1) L-carnitine or an alkanoyl L-carnitine in which the linear or branched-chain alkanoyl has 2-8, and preferably 2-6, carbon atoms, or one of their pharnacologically acceptable salts; 2) ginseng (natural extract of Panax ginseng); 3) yohimbine (natural extract of Corynanthe yohimbe); 4) guarana (natural extract of Paullinia cupana); 5) damiana (natural extract of TY/mera disa,ar. aphrodisiaco); 6) lecithin of soya, and 7) malic acid.

The alkanoyl L-carnitine should preferably be chosen from among the group comprising acetyl, propionyl, butyryl, valeryl and isovaleryl L-camitine or one of its pharmacologically acceptable salts.

What is meant by pharmacologically acceptable salt of L- carnitine or of an alkanoyl L-camitine is any salt of these with an acid which does not give rise to unwanted toxic or side effets. Such acids are well known to pharmacologists and experts in pharmacy.

Non-limiting examples of pharmacologically acceptable salts of L-carnitine or of the alkanoyl L-carnitines are chloride, bromide, orotate, acid aspartate, acid citrate, acid phosphate, fumarate and

acid fumarate, lactate, maleate and acid maleate, acid oxalate, acid sulphate, glucose phosphate, tartrate and acid tartrate.

The components of the combination according to the invention, once combine, exhibit an unexpected potent synergistic effect which brings about an improvement in physical performance and in the mental and physical condition of patients suffering from stress syndrome. Very important and surprising is the synergistic effect shown by the combination of ginseng, yohimbine and L-carnitine in restoring sexual vigour and libido.

The effect of the combination is, in fact, distinctly superior to the sum of the effects of the individual components.

Of particular interest is the interaction between malic acid and L-carnitine. The complementary effect exerted by these two compounds on energy production via two different metabolic pathways-malic acid via the Krebs cycle, and L-carnitine via B- oxidation-stimulates the body to produce a large amount of energy, which is useful in enabling the individual to emerge from the state of fatigue, debilitation or asthenia caused by stress.

The interaction between guarana and damiana also results in an intense stimulatory effect, enabling most subjects presenting a state of torpor or lack of interest to emerge from these conditions.

L-carnitine and lecithin of soya favour the metabolisation of fatty acids, exerting a hypolipaemic effect on the body, which, though having no direct repercussions in terms of improving stress syndrome, is aimed at enhancing the individual's general state of health.

The weight-to-weight ratio of L-carnitine or of an alkanoyl L- carnitine to ginseng, yohimbine, guarana and damiana may vary over a broad range, This ratio should preferably range from

1: 0. 1: 0.0025: 0.1: 0.1 to 1: 10: 0.25: 100: 100. One preferred ratio is 1: 1: 1.

By way of non-limiting examples a number of sachet formulations according to the invention are given containing the following components in combination: Composition 1 L-carnitine HC1 200 mg Ginseng 200 mg Lecithin of soya 400 mg Aspartame 20 mg Sucrose 1500 mg Tangerine flavouring 100 mg Yohimbine 5 mg Malic acid 50 mg Granular mannitol q. s. to 3000 mg Composition 2 L-carnitine HCI 200 mg Ginseng 200 mg Lecithin of soya 200 mg Aspartame 20 mg Sucrose 1000 mg Tangerine flavouring 100 mg Yohimbine 5 mg Guarana 200 mg Damiana 200 mg Malic acid 50 mg Granular mannitol q. s. to 3000 mg

Composition 3 L-carnitine HC1 200 mg Ginseng 200 mg Lecithin of soya 200 mg Aspartame 20 mg Sucrose 1000 mg Tangerine flavouring 100 mg Yohimbine 5 mg Guarana 500 mg Damiana 500 mg Malic acid 50 mg Granular mannitol q. s. to 3000 mg The composition according to the invention may additionally contain vitamins, metals, coenzymes, inorganic or organic antioxidants or their precursors.