Feb. 4, 2000

'Q10' combats effects of heart attack

By Mike Falcon
With Dr. Jonathan M. Sackier, medical adviser
A Doctor In Your House.com

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An inexpensive new version of an over-the-counter supplement called coenzyme Q10 is shaping up to be an ailing heart's best friend. But only a small fraction of people who could benefit know about it.

"There's no question that coenzyme Q10 can play a significant role in recovery for heart attack," adds Dr. Peter H. Loensjoen, a cardiologist in Tyler, Texas, who has authored numerous journal articles on the use of CoQ10. "In hundreds of studies, and in my own practice, I've seen results that we would have said were highly unlikely, if not impossible."

Longsjoen cites marked improvement in patients with ischemia (inadequate blood flow to the heart, which may cause chest pain), cardiomyopathy (a weakened heart muscle which can result in congestive heart failure), and hypertension (high blood pressure).

"It's unthinkable to practice cardiology without it," says cardiologist and medical educator Stephen T. Sinatra, the author of The Coenzyme Q10 Phenomenon. "But some still do…"

"Despite two decades of increasingly persuasive clinical studies, the effects of CoQ10 are still not as well known as those of some new prescription drugs," observes Robert Lefavi, professor of public health and sports medicine at Armstrong Atlantic State University in Savannah, Ga.

 

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"But that's not as surprising as it first sounds," says the expert. "Q10 is not patentable, so we don't see huge amounts of money invested in research, or on marketing. As a result, it's diffused unevenly throughout the market."

What is coenzyme Q10?

Coenzyme Q10 resists easy classification. Because it's an organic compound acting as an enzyme or coenzyme necessary in small amounts for normal body function, most researchers consider it a vitamin, or "vitamin-like."

Q10 is synthesized in all cells in the body and is found in meats and some protein-rich nuts, but the concentrations are weak. Fifteen pounds of peanut butter - or an equally improbable three-and-a-half pounds of sardines - provide just 100 mg of Q10. This is the amount the University of Washington School of Medicine Physicians' Update calls "a reasonable daily supplement." To get optimal amounts of Q10, the enzyme is taken orally.

Why we need Q10

Coenzyme Q10 is most often recognized as an essential component in the body's production of ATP, also known as "muscle fuel." Without ATP, our muscles cannot move. Without Q10, we can't manufacture ATP.

We have enough ATP inside us for only about 6-8 minutes of vigorous physical activity. Under usual conditions, ATP is constantly manufactured and replaced to keep the heart pumping normally. Even high levels of regular physical activity usually allow for Q10 and ATP replacement.

One exception to this is the extreme athlete who pushes through daily high-intensity training over a long period of time. Unless he supplements his diet with additional amounts of Q10, his levels may become chronically low, even though vigorous exercise separated by periodic recovery makes the body produce more Q10.

Grueling exercise is not the only thing that lowers Q10 levels. After age 20, Q10 declines gradually. After 50, it plummets. The elderly and some people with heart disease and other critical illnesses often have Q10 levels in the blood that are just a fraction of normal.

"This is especially important in the heart," says Langsjoen. "It's a large 'high energy' organ with the highest concentration of Q10 in the body." Its continual pumping demands a ready supply of Q10 and ATP. Chronic low levels of Q10 may allow the heart to become weak and vulnerable to disease.

Beyond the heart

In addition to its critical role in ATP and energy production, Q10's powerful anti-oxidative feature becomes markedly reduced as levels fall, decreasing the body's disease-fighting abilities. Free radicals - oxidized toxic byproducts of cellular activity and repair - damage other cells unless neutralized by anti-oxidants.

Q10's anti-oxidant properties also make it a likely candidate in helping prevent or treat other diseases where oxidative stress and free radicals play a role. Oxidative stress is suspected as a possible contributing factor to - or "trigger" for - a number of diseases, including breast and colorectal cancers. One recent study of breast cancer patients found Q10 levels well below normal throughout the entire sample.

Other applications for the enzyme include possible roles in treating neurological disorders, controlling insulin levels, treating periodontal disease, and enhancing athletic performance. These far-ranging benefits are supported by a number of studies.

"With the exception of significantly increased athletic performance, each of these shows not only promise," says Sinatra, "but have at least solid initial research which demands further long-term, large-scale studies."

Dosage and delivery

Effective supplementation is measured by the amount of the enzyme in the blood. "Adequate, normal levels in whole blood are about 1.0 micrograms per milliliter (1.0 mg/ml)," advises Langsjoen. "Between .3 and .5 micrograms indicates the patient is basically dying." An effective dosage within a therapeutic setting would achieve levels of 2.0-3.0 mg/ml, he says.

Getting the right amount of Q10 into your bloodstream and maintaining sufficient levels in the body is more complex than just taking Q10 capsules. Effective oral Q10 dosages vary widely.

To achieve a normal blood level, you might have to swallow anywhere between 50 mg and 400 mg a day. This is because absorption rates are highly individualized and may vary as much as 300%.

A major factor in the bioavailability of Q10 is the delivery system for the enzyme. Q10 molecules are so large that some researchers believe they stretch the definition of the word. Because of their size, these fat-soluble molecules need some assistance for optimal absorption.

In its usual commercially available form - an orange crystalline powder in a gelatin capsule - Q10 is best absorbed with a fat "carrier," advises Langsjoen. "A tablespoon of peanut butter works well."

Pre-emulsified, pre-organized products

The most effective capsules now contain both emulsified Q10 and a fatty oil to assist in absorption. While the emulsification process usually occurs naturally within the body, Q10 which is pre-emulsified in an oil base relieves the body of the process and can "elevate absorption levels by a factor of up to three times," according to Dr. Roy Brabham, a reconstructive surgeon in Baton Rouge, La.

Encapsulators have labored for years to develop delivery systems which do not require additional fats, but still bring reliable, predictable amounts of Q10 to the body. The latest and biggest advance in delivery is the pre-organization of emulsified Q10 into tiny spheres called micelles.

With usual delivery systems, Q10 micelles are created naturally in the bowel. But a significant amount of Q10 does not make it through the micelle formation stage and passes through the body unused. By pre-forming these tiny spheres - placing the fat-soluble portions outermost for optimal absorption - the micelles move through the bowel wall and into the bloodstream quickly.

Absorption of fat soluble Q10 can be up to nine times as great as in crystallized Q10, according to a study reported in the Asia Pacific Journal of Clinical Nutrition in 1998. The technology was developed in Australia, but was recently licensed for use in the USA by Changes International, a Twinlab company.

"It's a great method to ensure consistently reliable amounts of Q10 within the bloodstream," says Lefavi, who consults for Twinlab. "It doesn't require special eating times, or additional fats, and it makes it easy to take."

Now that technology effectively delivers CoQ10's healing power, the biggest remaining challenge is getting the word out. "Anything that helps us accomplish public health benefits by making it easier and more reliable for people is a big plus," says Lefavi. "Now, if we could just get every cardiologist to read about it by the time I retire, I'd feel a whole lot better."