© Whole Foods Magazine

February 2004


Coenzyme Q-10 and Heart Disease

An interview with cardiologist Stephen Sinatra, MD

Part 2: The "Magic" of CoQ-10

By Richard A. Passwater, Ph.D.

Last month we chatted with cardiologist Dr. Stephen Sinatra about the real risk factors in cardiovascular disease and how Dr. Sinatra became involved with coenzyme Q-10 in his cardiology practice. We also discussed the actions of coenzyme Q-10 that especially benefit heart and vascular health, and how Dr. Sinatra uses coenzyme Q-10 in his cardiology practice. This month we look into why coenzyme Q-10, the nutrient Dr. Sinatra calls "the fertilizer for the heart," is becoming used as an adjunct treatment by more and more cardiologists and the studies behind this acceptance. We also discuss congestive heart failure (CHF) and mitral valve prolapse and talk about a couple of dramatic cases.

Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., is a board-certified cardiologist and a certified bioenergetic psychotherapist. He has more than 25 years of experience in helping patients prevent and reverse heart disease. He also is certified in anti-aging medicine. He is a fellow of the American College of Cardiology and former chief of cardiology at Manchester Memorial Hospital where he was director of medical education for 18 years. Dr. Sinatra is also assistant clinical professor of medicine at the University of Connecticut School of Medicine.

At his New England Heart & Longevity Center in Manchester, CT, Dr. Sinatra integrates conventional medical treatments for heart disease with complementary nutritional, anti-aging and psychological therapies that help heal the heart. He is uniquely qualified to give advice on nutritional supplements and the heart. Dr. Sinatra is one of the few medical doctors who formulates his own vitamins. He knows how to pick quality ingredients and is expert in dosage, absorption and the effects of combining supplements with cardiac medications.

Dr. Sinatra has authored and/or co-authored several books on heart disease and is the editor of the monthly newsletter on heart health, The Sinatra Health Report. His most recent book, co-authored with his wife, Jan Sinatra A.P.R.N., is Lower Your Blood Pressure in Eight Weeks (Ballantine Books, 2003). Additional information can be found on his website at www.drsinatra.com.

Passwater: Last month, we left off talking about the 43 studies with coenzyme Q-10 and heart diseases and the fact that 39 of the studies showed definite benefit whereas only four of the studies did not. You mentioned that in the studies failing to show benefit, either the amounts or type of coenzyme Q-10 used were not sufficient to raise the blood levels of coenzyme Q-10 above the 2.5 mcg per milliliter of blood needed to produce a therapeutic effect, the minimum amount required for significant benefit in class 3 and 4 heart patients. As a result, most cardiologists are looking only at the few inappropriate negative results rather than the body of evidence that shows coenzyme Q-10 to produce significant heart benefits.

I would think that your books are being taken to some cardiologists by their patients. Are these cardiologists listening? Are they learning anything about coenzyme Q-10 and heart disease?

Sinatra: Itís happening slowly. First of all, coenzyme Q-10 is in the textbooks of cardiology. Itís in Dr. Eugene Braunwaldís book in Europe [Heart Disease: A Textbook of Cardiovascular Medicine Braunwald, E., Zipes, D. P. and Libby, P. Saunders 2001]. Itís sort of a Bible of cardiology in Europe and itís becoming one here too. There is also a book called Cardiovascular Pharmacotherapeutics (McGraw-Hill, 2003). The editors are Drs. William Frishman, Edmund Sonnenblick and Domenic Sica. They are leading cardiologists, and they asked me to do the chapter on alternative cardiology for them. It was interesting. Dr. Frishman knows I am so passionate on coenzyme Q-10, yet he says, "we have somebody else doing the chapter on coenzyme Q-10, so donít mention it." I did mention it though. It is interesting that major textbooks on cardiology right now are coming out with sections on coenzyme Q-10.

Passwater: Itís really about time though.

Sinatra: It will take about another 10 years for cardiologists to really be using coenzyme Q-10 on a regular basis.

Passwater: They picked up on vitamin E somewhat in the last 10 years or so after resisting that for 50 years.

Sinatra: The data on coenzyme Q-10 are stronger than for vitamin E. Much stronger! A lot of cardiologists take vitamin E. Unfortunately, a lot of cardiologists take statins too, and statin cardiomyopathy is one of the new diseases that we are finding in cardiology. I suspect that once coenzyme Q-10 gets raised at meetings like those of the American College of Cardiology or put into more textbooks of cardiology, they will eventually learn about it. We are mentioning coenzyme Q-10 in journals of cardiology all the time because I review journals and I write articles. I did an editorial on cholesterol and mentioned coenzyme Q-10 in it. I suspect that once these peer review journals start discussing coenzyme Q-10, cardiologists will become more and more relaxed about using it in their practices.

Passwater: The bulk of the studies with coenzyme Q-10 published in the scientific literature involve congestive heart failure (CHF). You would think that the relationship between the lack of energy production in the heart and coenzyme Q-10 deficiency would be more obvious to cardiologists.

Sinatra: Yes, CHF is a condition in which the heart is so weak it cannot effectively pump blood. Patients with this condition usually experience fatigue and shortness of breath with minimal exertion. Fluid buildup in the lower legs and congestion in the lungs may occur. This is because the pumping ability of the heart depends upon the functional capacity of heart cells to expand and to contract. In CHF, there are insufficient myocardial contractive forces in the heart. In other words, the heart is not strong enough to pump blood out of the heart, which is why it becomes congested. The heart struggling with CHF is literally an exhausted starved heart with insufficient energy for the heart to pump.

What is needed is to "fertilize the heart." This is what coenzyme Q-10 does. If you look at muscle cells with an electron microscope, you see about 200 mitochondria per cell in your biceps. Most healthy people can use their biceps to lift a quart or even a gallon of milk over their head. However, a lot of people over the age of 70 canít do that. ATP is required to get action out of those biceps. Now, in a heart cell there are 5,000 mitochondria per cell. Heart cells are made up of mostly mitochondria. So if you have a fertilizer like coenzyme Q-10 to fortify the mitochondria it makes sense to take an energy-starved heart with all those mitochondria and fortify it with fertilizer.

This is the magic of coenzyme Q-10. Itís really in its ability to fortify mitochondria and the inner mitochondrial membranes and make the cardiac cell pulsate more or get more mileage out of the cell, especially an ischemic cell.

I think the best indication of coenzyme Q-10 is in the setting of cardiac ischemia. Whether it is coming off a bypass pump, putting in a bypass graft, doing an angioplasty, doing a stent, or treating an acute myocardial infarction, or even giving a clot-buster drug such as streptokinase or TPA, or any clot busters, because the magic of coenzyme Q-10 is in that setting where the heart is starving for oxygen. That is where it does its work. I am sure Drs. Fred Crane and Gian Littarru and the late Emile Bliznakov would all agree on that except that they donít use it on a day-to-day basis as I do with my cardiac patients. I see enormous effects. It is really awesome.

Passwater: For the benefit of cardiologists who may be reading this because some of our readers may have taken this article to them, where can they find quick references to this in the scientific literature?

Sinatra: There certainly are many. For example, one study published in 1990 in the American Journal of Cardiology reported that coenzyme Q-10 produced improvement in heart function and an enhanced quality of life (Langsjoen, P. H., et al., Amer. J. Cardiol. 1990; 65:512-523).

Another study presented at the 1991 meeting of the American Heart Association dealt with a double-blind, placebo-controlled crossover clinical trial showing that coenzyme Q-10, when added to conventional therapy, produced significant enhancement of exercise capacity and quality of life (Hoffman-Bang, C., et al., Amer. J. Cardiol. 1992 Suppl. 19:216A).

Another double-blind study involving 641 patients using about a milligram of coenzyme Q-10 for every pound of bodyweight (actually 2 mg/kg) reduced the number of patients having pulmonary edema in half and reduced hospitalization by 20% (Morisco, C., et al., The Clinical Investigator 1993; 71:S134-S136).

Perhaps, the best study is the multi-center study by Dr. E. Baggio and colleagues (Baggio, E., et al., Molecular Aspects of Medicine 1994; 15:S287-S294). This study involved 2,664 patients with CHF. Coenzyme Q-10 was given in the range of 50-150 mg/day, with the majority of patients receiving 100 mg/day.

After three months of coenzyme Q-10 treatment, the following symptoms were decreased; edema by 79%, liver enlargement by 49%, venous congestion by 72%, shortness of breath by 53%, and heart palpitations by 75%. More than half of the patients had significant improvements in at least three of these symptoms.

As for an overview on the subject, Dr. Harvey Singh has written about 200 articles on coenzyme Q-10, mostly on cardiovascular disease. A good starting point is "Coenzyme Q in cardiovascular disease," published in the Journal of the Association of Physicians in India in 1998. (J Assoc Physicians India 1998 46; 3: 299-306)

Passwater: Dr. "Harvey" Singh? Is that Dr. R. B. Singh of the Heart Research Laboratory in Moradab, India?

Sinatra: Iím not sure, but every time weíre at a major conference on coenzyme Q-10, Dr. Singh and I talk about coenzyme Q-10, especially when we eat Indian food together. Recently, he has shown data demonstrating that if you give coenzyme Q-10 in the middle of a heart attack the survival rate is improved over placebo. That was reported in the international literature and I show that slide at a lot of lectures and even to cardiologists. Giving coenzyme Q-10 and also L-carnitine in the middle of a heart attack saves lives. The data on L-carnitine are equally impressive in survival when administered during a myocardial infarction.

Passwater: Do you administer them as oral supplements or give them by IV during heart attacks?

Sinatra: I give them in the oral form. One thing about coenzyme Q-10 is that if you give a very bioavailable formóand the problem with coenzyme Q-10 is that it is such a large molecule it is hard to be absorbedóbut if you give a bioavailable form in high doses it will be absorbed into the bloodstream quickly. One of the things I learned about coenzyme Q-10 in my practice is that if I have people who are very sick, I will give them a lower dosage every hour while awake as they absorb smaller doses quicker to build up a therapeutic level. The same goes for L-carnitine. If you take two grams of L-carnitine at one sitting, you absorb only 16%. With both L-carnitine and coenzyme Q-10, Iíll give them lower doses hourly and they will build up their blood levels quicker.

Passwater: Prior to cardiology textbooks mentioning coenzyme Q-10, did patients bring in copies of your book to their cardiologists? Your books are widely read by patients; did they also get into the hands of the patients, and were they then passed along to other cardiologists?

Sinatra: Actually patients still take my books to cardiologists. First of all, whenever a cardiologist calls me at the office and asks me about coenzyme Q-10, I always take the call. Usually it is a cardiologist who has been subjected to pressure from one or more of his patients. Itís usually a sick patient in an Intensive Care Unit (ICU) or Critical Care Unit (CCU), and the cardiologist will call me and ask me my experience. A lot of these cardiologists are genuinely interested in using coenzyme Q-10. Iíll send them my books and Iíll send them peer-reviewed articles. I have written on coenzyme Q-10. Most of these practitioners are very receptive.

Then there is the flip side. You have cardiologists out there falsely claiming that nothing has been written on coenzyme Q-10 and cardiovascular disease. To me, that just shows how ignorant some of these doctors are, because if they would just plug in "ubiquinone" in Medline or any search engine on the web, they would get thousands of articles. That is what I tell the most resistant cardiologist to do. Iíll ask them, "Why donít you just go on the Web and plug in the name and see what happens? Then you decide." I donít try to convince cardiologists anymore. I just say go to the Web and see what respectable journals are saying about coenzyme Q-10. Then you make your own decision.

Passwater: Itís easier to use the chemical name "ubiquinone" in search engines, rather than the more popular name coenzyme Q-10 or CoQ-10. Search engines can handle single words better than groups of words. Unfortunately, many cardiologists may not even know the chemical name "ubiquinone."

You mentioned that the patient might be in the ICU when the cardiologist calls you. Is there a way of administering coenzyme Q-10 other than orally. Can it be put it into an IV, for example?

Sinatra: It can. We donít use IV coenzyme Q-10. I have no experience with IV coenzyme Q-10. They have used it in South America and they have used it in Europe. If you take a highly bioavailable form of liquid coenzyme Q-10 such as the Q Gel brand, which is highly soluble in both water and fats, you can just put a nasal gastric tube (NG tube) down these patients and administer it to them in the ICU that way, especially if the coenzyme Q-10 is in liquid form, and thatís what we have done.

In fact we had one lady who was on a CNN newscast because she was a descendent of Thomas Alva Edison. Itís an interesting story about a woman in her late 70s who actually purchased a new carpet, which was apparently still out-gassing formaldehyde. It caused her to contract a respiratory infection, and, to make a long story short, she developed pneumonia. When she was in the hospital, they found out she had an undiagnosed congenital heart defect. She had hypertropic cardiomyopathy (too much muscle tissue in the heart wall, which obliterates the chamber of the left ventricle). She crashed. She went down the tubesóshe developed shock, she was bleeding and then she started to go into renal failure and then they had to transfuse her and she had profound gastrointestinal bleeding. It was a disaster. She went into acute respiratory failure and was placed on a ventilator.

They tried to talk the daughter into pulling the plug on her and just let her go since she was 79 years old anyway. This woman had never been in a hospital in her entire life. Her son happened to be a Ph.D. expert on coenzyme Q-10. He sent the doctors at the hospital a stack of references on coenzyme Q-10 about two feet high, and then he asked me to call the hospital to see if the doctors would give his mother coenzyme Q-10.

I spoke with some of the doctors. I called them and said, "Look, I will give you some coenzyme Q-10." I told them it was very simple to administer and if they wanted, I would give them a conference and a medical education seminar on it. They refused. They were very hostile to me. They erroneously claimed it causes liver failure. I will never forget it. I asked them where they had read that!

They didnít want to use it. Then it got very nasty because the other doctors wanted to pull the plug the second time. Her son called me again to ask me if I would take her as a transfer. I said, "You canít expect good results bagging somebody for 40 minutes in an ambulance. You probably will end up transferring a corpse."

Passwater: "Bagging" is the process of forcing air into someoneís lungs by means of a leather bag having a one-way valve, and then letting the lungs relax to expel the air, when someone is unable to breathe for him- or herself. Itís certainly not an ideal situation to have to depend on over a long time. Iíve "bagged" people for more than 40 minutes myself, and the results are better with younger and healthier patients. I have had to do it with respiratory arrest patients and also with cardiac arrest patients while doing cardiopulmonary resuscitation (CPR). The nearest hospital was 30-35 minutes away. I remember bagging a woman in her early 30s who tried to commit suicide with drugs and alcohol. Her heart was still beating weakly, but she was in respiratory arrest when I arrived in the ambulance. Not only did I bag her all the way to the hospital, but I had to continue bagging her while they drew blood for analysis and figured out what to do. Eventually, she was put on a respirator and she recovered, but I was a tired puppy with burning forearms. At least with CPR, you get to switch back and forth between bagging and compressions.

So what happened with your patient?

Sinatra: Despite my negative reaction about a transfer, I decided to take her when her son said to me, "At least she would have a fighting chance." When she arrived, she already had an NG tube in. I gave her a gram of IV magnesium four times a day, which I am sure helped. I gave her multivitamins, actually ones I developed myself. I crushed up six a day and put them through an NG tube. I gave her 450 mg of coenzyme Q-10 daily. That was a big dose of coenzyme Q-10 back in 1997 when this incident occurred.

Passwater: That was a big and expensive dose in those days.

Sinatra: Nobody else was using doses like that then. I was giving her 150 mgs every eight hours in her NG tube. She was in a dense coma when she came in, but after the third day, she started blinking her eyes. After 10 days, we removed her from the ventilator, and after 17 days she walked out of the hospital on her own power. Remember, eight doctors had certified her to have the plug pulled on her twice. The other hospital even got a court order to block the transfer, so it got very messy.

Would you believe that not one doctor from that team of eight doctors called me to say "good job or congratulations?" I didnít hear from one of those guys. They just wanted to bury her and get on with it. She has a library of 3,000 books and I saw her in the office three weeks ago and she is doing great. She is now in her mid-80s.

Passwater: Well, at least thereís a good ending. Another dramatic example with a good ending is one that I saw in 1997 on the ABC World News involving the miraculous recovery of a 24-year-old woman in Texas. Reporter John McKenzie was interviewing Gina Ferguson as she was jumping on a trampoline. Hereís the transcript of the news story. Ms. Ferguson explained, "I couldnít walk to the bathroom without feeling I had walked a mile. I would have shortness of breath to the point of gasping. The cardiologist they sent me to told me my life expectancy was very shortó10 days."

McKenzie added, "Doctors already had put her on a variety of powerful medications. Finally, running out of ideas, they suggested she try something very differentóa little known nutritional supplement called coenzyme Q-10. Within one month of taking coenzyme Q-10, her heart was measurably improved."

Ms. Ferguson adds, "The end result is that Iím still here. I can still be a mother to my child and I can still be a wife. Coenzyme Q-10, for me, itís my lifeline."

The news story identifies Texas cardiologist, Dr. Peter Langsjoen, who is among hundreds of researchers who have studied this vitamin-like substance and found the results encouraging, as putting Ms. Ferguson on coenzyme Q-10. The cameras then cut to Dr. Langsjoen who says, "Its effects are so clear. They are not subtle. They are dramatic."

You know Dr. Peter Langsjoen well, and perhaps you knew his father, cardiologist Dr. Per Langsjoen. Do you remember this particular news story? Have you seen similar dramatic cases in your practice?

Sinatra: Yes, I know Peter well, but I didnít know his father personally. However, I dedicated one my books on coenzyme Q-10 to the father, Dr. Per Langsjoen because I respected the pioneering efforts he made and, sadly, because this research led to him being ostracized by his peers.

I have seen many cases like the Gina Ferguson story and I have documented cases on record where patients were taken off the heart transplant list after taking therapeutic doses of coenzyme Q-10. I use coenzyme Q-10 in wide variety of cardiovascular diseases including arrhythmia, high blood pressure, angina, congestive heart failure and even mitral valve prolapse.

Passwater: I have several friends who have had mitral valve prolapse. I am aware of the studies showing that coenzyme Q-10 is beneficial in these cases, so I have recommended coenzyme Q-10 to them and they have done well. What has your experience been with mitral valve prolapse (MVP) and coenzyme Q-10?

Sinatra: Outstanding! The mitral valve sits between the left atrium and the left ventricle. Its major function is to open freely and far enough to allow blood to enter the left ventricle and shut tightly enough so that blood does not backwash into the left atrium, causing an eventual backup of fluid into the lungs. MVP is a deformity in the mitral valve, usually a thickening of one or two of its leaflets that is frequently associated with a prolapse (flopping back) of the cusp(s) into the left atrium.

Mitral valve prolapse, like hypertrophic cardiomyopathy, can cause diastolic dysfunction of the heart. What this means is that it takes more energy to fill the heart with blood than to empty the heart. A defect in the natural filling of the heart may take one to three decades to manifest itself in symptoms such as shortness of breath.

Diastolic dysfunction is more common in women than in men, especially in women with high blood pressure and/or mitral valve prolapse. To my knowledge, there are no drugs that treat diastolic dysfunction. Coenzyme Q-10 is the only antidote because of its importance in energy production. In my book Heart Sense for Women [Lifeline 2000], I discuss this relationship in detail, but for now, if you are a women with mitral valve prolapse and are experiencing shortness of breath and fatigue, coenzyme Q-10 and magnesium can improve your symptoms remarkably.

Years ago, when I was a fellow in cardiology in a cardiac clinic that had over 300 symptomatic patients with mitral valve prolapse, I found that beta-blockers gave these patients some relief. But now I give them coenzyme Q-10 and magnesium, and I find that they have a much better quality of life. In the future, a new sub-specialty in cardiology, i.e., metabolic-biochemical cardiology, will surface. Coenzyme Q-10 , L-carnitine, omega-3 fish oils such as DHA, and ribose will be some of the new therapeutic modalities in this emerging field.

Cardiovascular disease treatment will start with increasing the energy delivered to the cell, and this will open a whole new world of heart disease research.

Passwater: Weíll chat about the actions and health benefits of these other nutrients later, especially magnesium, which you call the cardiologistsí mineral because of its many benefits to heart and vascular health. Are there literature references on coenzyme Q-10 and diastolic dysfunction that you would recommend to cite to other cardiologists?

Sinatra: At the most recent International Conference on Coenzyme Q-10 in London in November 2002, several papers on diastolic dysfunction were presented. One of these papers focused on the fact the statin drugs used to lower cholesterol can even cause diastolic dysfunction. These papers will be coming out in Spring 2004 edition of the journal Biofactors. Your interview with the late Dr. Emile Bliznakov discussed the problem, noting that statins may reduce coenzyme Q-10 levels and urging that anyone taking statins should also take a coenzyme Q-10 chaser.

Passwater: Yes, that article, "Donít take cholesterol-lowering drugs unless you also take coenzyme Q-10," was published in the February 2003 issue of Whole Foods and can also be found on my website at http://www.drpasswater.com/nutrition_library/bliznakov_md.htm.

Well, this is a lot of important information. Letís pause here to digest it and continue next time with "The Twin Pillars of Heart Health." WF

© 2004 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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