Coenzyme Q-10 and Heart Health

An interview with Dr. Stephen Sinatra: Part 4

Controlling Blood Pressure with Nutraceuticals

By Richard A. Passwater, Ph.D.

In the February issue, we chatted with cardiologist 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. In the March issue, we looked 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 we discussed the studies behind this acceptance. We also covered congestive heart failure (CHF) and mitral valve prolapse, and we talked about a couple of dramatic cases.

In the April issue, Dr. Sinatra discussed the "The Twin Pillars of Heart Health," and we learned that his clinical experience now suggests that even better heart health can be obtained with a third nutrient to form what Dr. Sinatra sees now as the "triad" that may become the new frontier for metabolic cardiology. In this issue, Dr. Sinatra chats with us about using nutrients to help lower high blood pressure.

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

Passwater: Dr. Sinatra, you and your wife Jan have recently written a book, Lower Your Blood Pressure in Eight Weeks (Ballantine Books, NY, 2003). In this book you discuss ways to reduce the use of drugs through the use of nutrients and lifestyle changes. What specific techniques do you teach to your readers?

Sinatra: One of the reasons I wrote the book is that the fourth leading cause of death in the United States is properly prescribed drugs in a hospital environment. It really behooves the public to look at drugs very cautiously. When someone takes a drug, some things happen knowingly, but other things may happen unknowingly. For example, if you take calcium channel blockers and drink grapefruit juice you can raise the amount of calcium blockers in your blood. This is because of the way P450 liver enzymes interact with the grapefruit juice. The end result may be that the liver is so seriously affected that you wonít be able to properly metabolize the drug. A lot of people donít understand something as simple as this.

I tell my patients that if they are taking any pharmaceutical drugs, they must use grapefruit juice with caution. Why do I bring this up? The reason is that there are so many situations where people have had catastrophic arrhythmia, shock, sudden death, stroke, liver failure with drugs. The classic one is Tylenol and liver damage. Phenylpropylamine was taken off the market because of strokes and hemorrhages. It was a favorite cough syrup that was given to adults and kids. So if you can treat high blood pressure without the use of drugs, that would be the optimum way of doing it.

It wasnít just my own insight. My patients would frequently come to me and ask if they really had to take those drugs. In my practice, I have to treat many cardiovascular disorders ranging from heart failure to arrhythmias to high blood pressure. Sure, I may have to use a combination of drugs and nutraceuticals. But, with the guidance given in the book, the dosage of drugs needed can be lowered and often eliminated completely. The book recommends a non-inflammatory diet, the right nutraceuticals, and it also looks at some mind-body interactions. A large portion of the book deals with nutraceuticals and how they lower high blood pressure.

Certainly the hallmark nutraceutical is coenzyme Q-10. I cite the clinical studies that researchers have done with coenzyme Q-10 and blood pressure. The most exciting thing about the book is that when I was in medical school and we learned about high blood pressure, we were told as students that 80% to 90% of high blood pressure was idiopathic or essential hypertension. All that meant was that there was no known cause for the high blood pressure. They would say it was due to stress, or to the environment, or to salt intake, but itís not due to a constriction of the aorta, kidney disease, or hyperactive adrenal gland or thyroid gland. Only about 10% of high blood pressure cases are related to those causes.

In my practice, I have been able to lower the dosages of many patientsí blood pressure drugs with coenzyme Q-10. The scientific literature backs this up as well. In one placebo-controlled, double-blind study, patients given a total of 200 mg of coenzyme Q-10 daily in divided doses had reduced blood pressure, both diastolic and systolic. The patients given the placebo did not. In another study, published in 1994, coenzyme Q-10 enabled more than 50% of patients with high blood pressure to discard at least one, and some patients as many as three, of their blood pressure drugs.

A 2001 randomized, double-blind, placebo-controlled clinical study in isolated systolic hypertensive patients involving 46 men and 37 women showed that 60 mg of coenzyme Q-10 taken twice daily was effective. Coenzyme Q-10 reduced their elevated systolic blood pressure by a mean of 18 mm Hg (+- 7 mm Hg), whereas those receiving the placebo were not significantly changed.

What we have learned now, only within the last three to four years, is that in this country insulin resistance causes a deadly quartet of high blood pressure, weight gain around the abdomen, low HDL and high triglycerides. Here is what usually happens when people go into the doctorís office with this deadly quartet: The doctor gives them drugs to lower the blood pressure, gives them drugs to lower the triglycerides, may give them drugs to lose weight, or drugs to raise HDL, or drugs to affect the blood sugar. But, all they need to do is exercise and lose weight and take some nutraceuticals such as fish oil, alpha-lipoic acid and coenzyme Q-10, to mention a few.

The magic of coenzyme Q-10 is here. Coenzyme Q-10 works in the pancreas. We donít know why, but we do know that people with insulin resistance or people with diabetes have low blood levels of coenzyme Q-10. Is that due to the organ? It is like the chicken-and-egg phenomenon. What is it due to? We donít know. But I know that Dr. Fred Crane, the discoverer of coenzyme Q-10, whom you interviewed near the beginning of this series, was taking coenzyme Q-10 to treat his diabetes and that higher doses of coenzyme Q-10 were lowering his blood sugar. We know, too, that in people with a family history of diabetes three of the best things they can take to prevent onset of the disease are vitamin E, coenzyme Q-10 and alpha-lipoic acid.

If you really look at the nutritional principles underlying this phenomenon, it makes sense. Coenzyme Q-10 is instrumental in regenerating oxidized vitamin E back to its reduced form. We know that people with low levels of vitamin E, like the Finnish people or the Scandinavians, are more prone to diabetes, and taking coenzyme Q-10 for these people is critical.

The way coenzyme Q-10 works in insulin resistanceóand this is so new it is mind-bogglingóis that it supports the pancreas and reduces adrenaline-like mediators in the urine. We know that people taking coenzyme Q-10 have lower levels of adrenal mediators, which raise blood pressure. There is a link between the pancreas, insulin resistance, and high blood pressure. Coenzyme Q-10 is a key to breaking this link and helps to keep blood pressure normal. We havenít elucidated the mechanism completely.

Passwater: This indeed is new and interesting information.

Sinatra: Iím concerned that so many people today are depleted of coenzyme Q-10, not only because they are older and coenzyme Q-10 production in the body falls off with age, but because they are on medications such as the cholesterol drugs called "statins." Others are on beta-blockers, antidepressants, hypoglycemics and other medications that lower coenzyme Q-10 levels. Weíre talking about 100 million people right there. I think one of the reasons that cancer is on the rise is that if you lower the bodyís level of coenzyme Q-10 in a toxic petrochemical environment, you are setting the stage for DNA mutations. Dr. Karl Folkers talked about that years ago.

Passwater: These are essentially the same words I heard from Dr. Bill Judy two weeks ago when I visited him at the Southeastern Institute of Biomedical Research (SIBR). We have discussed this some in a previous column, but we will be discussing Drs. Judyís and Folkersí research with coenzyme Q-10 and cancer in more detail in a future article. Just before Dr. Folkers died in 1997, at the age of 91, he believed that he had elucidated the mechanism by which coenzyme Q-10 protected against cancer as Drs. Folkers and Judy had found in their studies.

Sinatra: The last paper that I saw from Dr. Folkers was about coenzyme Q-10 and the pairing of DNA bases. I had a conversation with him about two weeks before he died. He was disgusted with American cardiologists because they dropped the ball with coenzyme Q-10 and heart disease. He told me that he was shifting all of his research over to cancer where he had also seen promising results.

During that conversation, I mentioned to Dr. Folkers, "You know, itís really interesting that most people get cancer at an age when their bodies begin to fall off in production of coenzyme Q-10. He said, "Exactly! Itís a big piece of the puzzle."

Passwater: Well, we understand more about it now.

Sinatra: Weíre raising a lot of these issues in our book. I keep coming back to insulin resistance. The way I am treating blood pressure today is by giving these nutraceuticals, and there are about a dozen of them. We have often spoken of L-carnitine and omega-3 fish oils. I usually recommend 1,000 to 2,000 mg of L-carnitine daily for blood pressure lowering. At three grams a day, omega-3 oils aid vasodilation and reduce vasoconstriction while, at the same time, having a positive impact on heart rate variability.

I give OPC (oligomeric proanthocyanidins), L-arginine and vitamin C to support proper nitric oxide release. I often give quercetin and hawthorn. There are so many different mechanisms affected by nutraceuticals that you can almost target a plan for your patient, and the blood pressure will go down.

Passwater: We have chatted about the mineral magnesium several times before and its role in cardiovascular health. You call magnesium the cardiologistís mineral. Its effect on lowering high blood pressure has been well studied.

Sinatra: Yes, magnesium has a profound influence on coronary tone and reactivity. I have successfully treated episodes of angina and cardiac arrhythmia with magnesium for years. Several studies have shown magnesium to be effective in the first few hours after a heart attack. It can stabilize cell membranes and prevent life-threatening arrhythmias such as ventricular tachycardia.

Magnesium acts much like a calcium channel blocker by preventing blood vessel spasms. It also is vital for the functioning of many enzymes and is involved in energy production. Research has shown that low levels of magnesium are associated with high blood pressure, and, moreover, insulin resistance and Type II diabetes.

We have documented that inadequate magnesium levels cause blood vessel spasm and constriction. Any narrowing of the blood vessels makes the heart work harder and results in higher blood pressure. In my treatment of high blood pressure in patients with normal kidney function, I find that 800 mg of magnesium daily is helpful to most.

Passwater: Well, we have discussed how nutrients help protect us from several different forms of heart disease and high blood pressure. Letís stop here for now. When we get together next time, we can finish up with a look at an important new form of a newly available advanced nutrient to prevent heart disease, as well as some new non-invasive tools that have been developed to help find those at risk for heart disease. WF