New research on the supplement CoQ10, recently published in American and European medical journals, shows that it increases survival rates and decreases hospitalizations for people being treated for heart failure. CoQ10 (also called Coenzyme Q10, among other names) is a powerful antioxidant and acts as an essential factor in the heart’s energy production. In the past, clinical studies have provided evidence of its value as an adjunct treatment for angina, congestive heart failure, arrhythmia, and hypertension (high blood pressure). In addition, researchers have found that statin drugs deplete CoQ10, and so it has been suggested that people taking these cholesterol-lowering drugs should also use CoQ10 to support healthy heart function.
CoQ10 (also called Coenzyme Q10 and ubiquinone, among other names) is a powerful antioxidant and acts as an essential factor in the heart’s energy production. A naturally occurring and powerful antioxidant nutrient, it retards free radical formation in biological systems, and resembles vitamin E and vitamin K in chemical structure. Biochemically, it functions much like vitamin E in that it participates in antioxidant and free radical reactions.
NOW AVAILABLE FROM NYBC’S ONLINE CO-OP: Jarrow Formulas’ Q-Absorb, available in two strengths, utilizes a “completely natural proliposome lipid soluble delivery system clinically shown in humans to increase Co-Q10 levels up to 400% – three to four times better absorbed than chewable Co-Q10 tablets.” Price: $21- $29.
Douglas Labs’ Cardio Edge* employs plant sterols (phytosterols) from soy, Sytrinol (a proprietary extract of polymethoxylated flavones and tocotrienols from citrus and palm fruits), and pomegranate extract. Their Ultra Coenzyme Q10 ($121.60) has 60 chewable tablets with 200 mg CoQ10 combined with 500 mg lecithin.
* Note: Prices on Douglas Labs’ products are considerably lower for NYBC members!
The study lasted for two years and compared heart failure patients taking 100mg CoQ10 three times per day with patients who were not taking the supplement. By the end of the two-year period, the CoQ10 group showed a significantly lower rate of hospitalization for heart failure, significantly better functional capacity, and a significantly lower rate of death from cardiovascular disease.
NYBC has stocked CoQ10 since our founding, and has recently expanded its offerings. We’re happy that we’ve been able to provide this important supplement at discounted prices to our members over the years, and we’re happier still to see this new research strengthening the case for a supplement that already had a considerable amount of evidence demonstrating its benefit for heart health.
Here are some additional NYBC suggestions for cardiovascular health. All are based on our reading of the always-evolving research on nutrition and nutritional supplements:
Eating fatty fish (such as wild salmon) once or twice a week is an excellent approach to maintaining cardiovascular health; however, regular supplementation with fish oil can also provide the omega-3 fatty acids (called DHA and EPA) that have been closely linked to cardiovascular benefit. Note that supplements, when properly purified, avoid the problem of mercury contamination, a concern for those who eat sea food regularly.
Niacin, a B vitamin, is still one of the best agents for supporting cardiovascular health. In a long-term study, it was associated with lower risk of cardiovascular disease and death related to cardiovascular disease. (Don’t be misled by some recent reports about Niacin’s lack of effect, which only appeared in a study using a particular form of the supplement together with a statin drug.) The main drawback of Niacin is that it may cause flushing and itching, which make it difficult or impossible for some to take. Starting with a low dose of about 100 mg and working up to about 1,000 mg per day may minimize this reaction.
Other helpful agents include carnitine (which may lower triglycerides), pantethine (a B vitamin) and phytosterols, such as those in Douglas Labs’ CardioEdge.
At the end of 2013, there was much buzz about new studies showing that curing insomnia in people with depression might double the chance of a complete recovery from depression. The studies, financed by the National Institute of Mental Health, were welcomed as the most significant advance in treating depression since the introduction of the “selective serotonin re-uptake inhibitor” (SSRI), Prozac, twenty-five years ago. In effect, the new research findings turn conventional wisdom on its head, since they suggest that insomnia can be a main cause of depression, rather than just a symptom or a side effect, as previously assumed. If you can successfully treat a depressed person’s insomnia, according to the new view, you eliminate one of the main factors causing the depressed state.
New research findings turn conventional wisdom on its head suggesting that insomnia can be a main cause of depression rather than just a symptom or a side effect as previously assumed
As we followed reports on this breakthrough research on insomnia and depression, we were especially encouraged to read comments like the one from Washington DC psychiatrist James Gordon, who has advocated an integrative approach to treating depression. Here’s his letter to The New York Times:
I welcome a new report’s finding that cognitive behavioral therapy is improving the outcome for depressed people with significant insomnia (“Sleep Therapy Seen as an Aid for Depression,” front page, Nov. 19).
It reminds us that changes in attitude and perspective, and a therapeutic relationship, can right biological imbalances — like disordered sleep — and significantly enhance the lives of troubled people. The study also puts the therapeutic role of antidepressant medication in perspective: the depressed participants who received behavioral therapy did equally well whether or not they were taking the drugs.
I hope that these results will encourage the National Institute of Mental Health, researchers, clinicians and all of us to expand our horizons.
There are a number of other nonpharmacological therapies, including meditation, physical exercise, dietary change and nutritional supplementation, acupuncture and group support, that show promise for improving clinical depression and enhancing brain function.
At NYBC we have long believed that non-prescription therapies, such as supplements, are valuable alternatives for treating mood disorders and sleep disorders When the Centers for Disease Control surveyed use of antidepressant drugs in 2008, it found that one in 10 Americans was taking an antidepressant, and many had taken these drugs for years. Over a period of ten years, antidepressant use in the U.S. had shot up by 400%! So the question arises: how much of this spectacular increase represented real gains in treatment, and how much was over-prescribing? As Dr. Gordon mentions in his letter above, in some cases behavioral therapy for depression has worked just as well whether people were taking antidepressants or not—hardly a strong argument for the value of the prescription drugs.
A well-publicized 2008 report in the New England Journal of Medicine found that pharmaceutical companies had consistently reported only the most favorable trial outcomes for their popular antidepressants
A well-publicized 2008 report in the New England Journal of Medicine found that pharmaceutical companies had consistently reported only the most favorable trial outcomes for their popular antidepressants, passing over evidence that suggested a more limited effectiveness. Furthermore, as with many drugs, especially those used over a long period, antidepressants have side effects. Higher bone fracture risk and multiple cardiovascular risks have been identified; sexual side effects are common with antidepressants in both men and women; and withdrawal symptoms for those tapering off antidepressants include a long list of problems, such as panic attacks, insomnia, poor concentration and impaired memory.
Turning to the alternatives, we describe below supplements that NYBC has highlighted over the years for sleep and mood disorders. Note cautions about their use, but also note that some of these products may actually carry added benefits, rather than unwanted side effects.
1. Melatonin is a hormone occurring naturally in the body, but some people who have trouble sleeping have low melatonin levels. Melatonin has been used for jet lag, for adjusting sleep-wake cycles for people doing shift work on varying schedules, and for insomnia, including insomnia due to high blood pressure medications called beta-blockers. It is also used as a sleep aid when discontinuing benzodiazepines (Klonopin, Xanax, etc.) and to reduce side effects when quitting smoking.
2. Fish Oil. Epidemiologists have noted that populations that eat fish regularly have low rates of depression. And research has found that omega-3 fatty acids in fish oil supplements can be of benefit in treating depression and bipolar disorder. Fish oil can also be taken with other anti-depressants as an adjunct therapy. Doses found effective in treating depression are quite high, 3 to 9 grams per day, so be aware of potential problems related to the supplement’s blood-thinning properties. Added benefit: fish oil can help manage cholesterol, and supports cardiovascular health.
3. Deficiencies in the B Vitamins, especially B12 and folate, can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as memory loss, confusion, disorientation, depression, irrational anger and paranoia. A number of studies have shown that vitamin B12 is deficient in a large percentage of people with HIV, and the deficiency can begin early in the disease. Supplementing with a B complex protects against deficiency and supports cognitive health and mental function.
4. Vitamin D deficiency has also been linked to depressed states. Lack of the “sunshine vitamin” may be especially associated with Seasonal Affective Disorder (SAD), the “winter blues.” Vitamin D also supports bone health, and may protect against colds and flus.
5. Theanine, an amino acid found in green tea, acts as a relaxing agent by increasing levels of certain neurotransmitters (=brain chemicals that shape your mood), including serotonin, dopamine, and GABA (gamma amino butyric acid). Human studies have been limited to date, but one small study showed that theanine decreases stress responses such as elevated heart rate. Another investigation compared theanine’s calming effect to that of a standard anti-anxiety prescription drug, and found that theanine performed somewhat better. Note that NYBC stocks Theanine Serene (Source Naturals), a combination supplement that includes theanine and GABA.
6. Probiotics. Very recent research has looked into the communication between the digestive system and the brain, with a goal of understanding how gut health may influence chronic conditions, including mood disorders like depression and anxiety. For example, it has been shown that certain probiotics promote production of the calming, anti-stress neurotransmitter GABA in the body, pointing to a direct influence of probiotics on mood. Other potential links between the gastrointestinal system’s microorganisms and brain function are currently being explored.
7. L-Tryptophan and 5-HTP (5-hydroxy L-tryptophan). These closely related supplements are converted in the body to serotonin and to melatonin. (Take L-tryptophan with carbohydrates to make it effective.) Their use as antidepressants has been studied, and they have also been found to aid sleep and suppress appetite. (To minimize appetite suppression, take the supplement an hour before bedtime.) Although L-Tryptophan and 5-HTP are close relatives, people may respond somewhat differently to them, so it may be worthwhile to try the other if the first doesn’t produce an effect An added benefit: 5-HTP may also decrease symptoms of fibromyalgia and migraine headaches.
8. In research funded by the National Institute of Mental Health, DHEA (dehydroepiandrosterone) was found to be an effective therapy for mild-to-moderate or severe midlife depression, on par with some prescription drugs. Moreover, the research showed that taking DHEA promoted both a significant lifting of depressive symptoms and an improvement in sexual functioning. Note that dosing recommendations vary for men versus women, and DHEA is not recommended for those diagnosed with prostate conditions or cancer.
9. SAMe (S-adenosyl-l-methionine) is produced naturally in the body from the amino acid methionine. Supplementing with SAMe increases concentrations of the neurotransmitters serotonin and dopamine. Several studies show SAMe having an antidepressant effect comparable to that of some prescription drugs. SAMe should be avoided in people with bipolar disorder, and should be used cautiously with other antidepressants, because the combination may push serotonin levels too high. Taking a B-complex vitamin while using SAMe can counter build-up of homocysteine, which has been linked to heart disease SAMe may also support joint health and liver function. Caution: the National Center for Complementary and Alternative Medicine has posted a warning that SAMe may increase likelihood of pneumocystis infection in immune-compromised people. Note: see also Trimethylglycine (TMG), which includes the raw materials that the body uses to manufacture SAMe. TMG is much less expensive than SAMe.
10. St. John’s Wort is a widely used herb with clinically demonstrated (multiple, well-controlled studies, mostly in Europe) anti-depressant effects for mild to moderate depression – generally without the side effects of prescription antidepressants. High doses of the herb may cause a sensitivity to light (phototoxicity), so avoid direct sunlight or sunbathing while using. Do not take St. John’s Wort with 5-HTP, serotonin re-uptake inhibitors (like Prozac), or with protease inhibitors, as it may affect beneficial liver enzymes. St. John’s Wort may also have activity against Epstein-Barr and herpes infections.
11. Finally, we’ll mention another combination supplement that NYBC has stocked: GABA Soothe (Jarrow). The GABA in this supplement is the neurotransmitter that promotes calmness coupled with mental focus. Also included is theanine (see above for a description of its anti-anxiety effects) and an extract of ashwagandha, an herb which has long been used in the Ayurvedic tradition of India to reduce fatigue and tension associated with stress.
Turner, E et al. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. New England Journal of Medicine, 2008; 358:252-260 January 17, 2008 doi: 10.1056/NEJMsa065779
Logan, A.. Omega-3 fatty acids and major depression: A primer for the mental health professional. Lipids Health Dis. 2004; 3: 25; doi: 10.1186/1476-511X-3-25
Sudden cardiac death secondary to antidepressant and antipsychotic drugs, Expert Opinion on Drug Safety, March 2008; 7(2):1081-194
Alramadhan E et al. Dietary and botanical anxiolytics Med Sci Monit. 2012 Apr;18(4):RA40-8.
Rogers PJ, Smith JE, Heatherley SV, Pleydell-Pearce CW. Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together. Psychopharmacology (Berl) 2008;195(4):569–77.
Kimura, K et al. L-Theanine reduces psychological and physiological stress responses. Biol Psychol. 2007 Jan;74(1):39-45.
Carpenter, D J. St. John’s wort and S-adenosyl methionine as “natural” alternatives to conventional antidepressants in the era of the suicidality boxed warning: what is the evidence for clinically relevant benefit? Altern Med Rev. 2011 Mar;16(1):17-39.
Foster, J A et al. Gut-brain axis: how the microbiome influences anxiety and depression Trends in Neuroscience. 2013 May;36(5):305-12. doi: 10.1016/j.tins.2013.01.005.
Rao, A V & Bested, A. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009; 1: 6 doi: 10.1186/1757-4749-1-6
The Mayo Clinic has a post, updated in 2012, on the topic of “Cholesterol-lowering supplements: Lower your numbers without prescription medication.” As always, we advise you to check with your healthcare provider before starting to use any of these for cholesterol management.
Most of these suggestions have been in the New York Buyers’ Club repertory for quite a while, but we are happy to repeat them here:
Green tea: some research on its cholesterol-lowering capacity; epidemiologic evidence suggests that green tea may lower stroke and cardiovascular disease risk. There are several choices for green tea supplements: see Green Tea; Green Tea Decaffeinated; and Green Tea Organic.
Plant sterols: see Cardio Edge for a supplement featuring plant sterols in a formula designed to support healthy cholesterol levels
Garlic extracts: contact NYBC for information on allicin, a garlic extract that has been studied for cardiovascular health
The Mayo Clinic guide also mentions grains, including oat bran and flaxseed, which can lower cholesterol.
Last, the guide discusses red yeast rice, a supplement that can lower LDL cholesterol. Note the caution that some forms of red yeast rice may contain a naturally occurring form of the prescription medication lovastatin. Lovastatin in the supplement may present some dangers to the user, because there is no way to know the quantity or quality of this prescription medication equivalent. For that reason, it is especially important to consult with your healthcare provider and monitor your usage of this supplement.
Bone health has been a growing concern for people with HIV, since studies have indicated that HIVers experience higher than expected rates of osteopenia (bone mineral density lower than normal) and osteoporosis (bone mineral density very low, with heightened risk of fractures). A 2012 review from Johns Hopkins researchers, for example, concluded that the “increasing prevalence of osteoporosis in HIV-infected persons translates into a higher risk of fracture, likely leading to excess morbidity and mortality as the HIV-infected population ages.”
The Johns Hopkins study urged more attention to Vitamin D deficiency and supplementation as one way to counter these HIV-related bone issues. But we think it’s also worth looking at recent Canadian research, not focused especially on people with HIV, but with some striking findings about the value of multiple supplements to support healthy bone mineral density levels. The supplements investigated included vitamin D(3), vitamin K(2), strontium, magnesium and docosahexaenoic acid (DHA), all chosen because of previous evidence about their benefit to bone health. Following a year-long study of patients with varying levels of bone loss, the Canadian researchers determined that this supplement regimen was as effective as a class of drugs often prescribed for osteoporosis (bisphosphonates, such as Fosamax or Boniva). And, they found that the combination of supplements was even effective for people who had failed to benefit from the prescription osteoporosis drugs.
We hope to see further study of supplement combinations for bone loss in people with HIV. It’s an acknowledged problem as HIVers get older, and if there’s a potential way to lower this health risk over the long run, let’s take a serious look at it!
Note: NYBC stocks Jarrow’s Bone Up or Ultra Bone Up, plus Max DHA or EPA-DHA Balance, which provide most of the micronutrients in the Canadian study (missing is the Strontium, but NYBC hopes to have a recommendation for that in the near future).
The Johns Hopkins study: Walker Harris V, Brown TT. Bone loss in the HIV-infected patient: evidence, clinical implications, and treatment strategies. J Infect Dis. 2012 Jun;205 Suppl 3:S391-8. doi: 10.1093/infdis/jis199.
The Canadian study: Genuis SJ, Bouchard TP. Combination of Micronutrients for Bone (COMB) Study: bone density after micronutrient intervention. J Environ Public Health. 2012;2012:354151. doi: 10.1155/2012/354151.
Omega-3 fatty acids (for example, the EPA and the DHA in your fish oil supplements) have an anti-inflammatory effect, of interest to researchers in a recent study of inflammatory bowel disease, specifically ulcerative colitis. This large study, which focused on people from 45 to 74 years old, found that those with the highest consumption of DHA (410 mg to 2,000 mg per day) had a 77% reduction in the risk of developing ulcerative colitis over an average period of four years than those consuming the lowest amount (up to 110 mg per day). On the basis of their research, the study authors suggest that higher intake of omega-3 fatty acids, especially DHA, could have a protective effect against development of ulcerative colitis.
For more information on DHA, EPA and other fatty acid supplements, see the NYBC category: Fatty acid supplements
Note that NYBC stocks a variety of these supplements, both from fish oil (Nordic Naturals and Jarrow), and from vegetarian (algae) sources.
John, S et al. Dietary n-3 polyunsaturated fatty acids and the aetiology of ulcerative colitis: a UK prospective cohort study. Eur J Gastroenterol Hepatol. 2010 May; 22(5):602-6
In February 2012 the FDA added new safety warnings about statins, the cholesterol-lowering medications that are among the most widely prescribed drugs in the world. The side effects cited by the FDA include memory loss, muscle pain (myopathy), and now a significant diabetes risk as well. Reports of memory loss, confusion, and forgetfulness were found in all types of patients taking statins, according to the new warnings.
In addition, a 2011 review in the Cleveland Clinic Journal of Medicine concluded that statin-related muscle pain was much more common than previously reported. (The main reason: clinical trials of statins often eliminated patients more likely to develop muscle pain as a side effect of the medication.) The same article estimated that muscle pain as a side effect may help explain why up to 25% of adults stop taking statins within six months, and up to 60% stop taking them within two years.
There is good evidence that statins can be valuable in preventing heart disease, and there is widespread consensus that they remain a crucial option for many dealing with cardiovascular disease and risk. However, it’s also more evident than ever that statin side effects are significant. And given the side effects, there is some disagreement among doctors about what cholesterol levels should call for treatment with statins, and what levels can better be dealt with through changes in diet or exercise habits.
It’s a complex subject and of course involves many individual factors including age, family history and blood pressure, so, as you’d expect, NYBC advocates that everyone make decisions about how best to manage cardiovascular risk and disease in consultation with their healthcare provider.
Given the new FDA warnings about statins, NYBC also believes that it’s more important than ever for people to be aware of the potential of dietary supplements in supporting cardiovascular health. Here are some of the supplements we often recommend for consideration:
—Fish oil (omega-3 fatty acids).Research has found a strong effect on lowering triglycerides, one measure associated with cardiovascular risk. Recommended to support cardiovascular health by the American Heart Association.
—Flaxseed: 40-50 grams per day can have a substantial impact on cholesterol.
—Pomegranate concentrate. Needs more study, though recent research found that diabetic patients taking pomegranate concentrate were able to lower their cholesterol significantly.
Finally, if you are taking statins, consider supplementing to lessen the risk of certain side effects. A 2011 research report suggested that Vitamin D deficiency might contribute to muscle pain caused as a side effect of statins, and that supplementing with the sunshine vitamin could reverse that side effect. (Reference: Glueck, C J et al. Curr Med Res Opin. (2011 Sep). “Vitamin D deficiency, myositis-myalgia, and reversible statin intolerance”) Also, a 2007 pilot study suggested that the supplement CoQ10, used to support cardiovascular health in a variety of contexts, could diminish statin-related myopathy and improve a person’s ability to continue normal daily activities. (Reference: Caso, Giuseppe. Am J Cardiol. 2007 May 15. “Effect of coenzyme q10 on myopathic symptoms in patients treated with statins”)
For more on Vitamin D and CoQ10 see the NYBC entries:
The American Psychiatric Association recently commissioned a task force to study the state of “alternative and complementary” therapies for major depression. This follows widespread interest from the scientific community and a considerable accumulation of research to date. The Task Force reported in a 2010 article that focused special attention on these supplements: omega-3 fatty acids (commonly taken as fish oil supplements), St John’s Wort (the botanical Hypericum), Folic acid (a synthetic form of folate, a B vitamin found in leafy green vegetables, citrus fruits, beans, and fortified breads and cereals), and S-adenosyl-L-methionine (SAMe).
We welcome this acknowledgment by the mainstream US medical establishment that supplements have a role to play in treating a disabling condition that affects millions of people per year, and is not always easily treatable. (Only one-third of adult patients newly diagnosed with major depression achieve complete symptom relief when taking one antidepressant, so there is often an extended search for the right combination of drug and other treatment needed for remission.)
Below is a brief recap of some of the latest thinking on these key supplements for depression. Of course NYBC recommends that you use these supplements in consultation with your healthcare provider. More information on these supplements can be found by following the links to the NYBC website.
Omega-3 Fatty Acids (fish oil) recommended as a stand-alone treatment for people concerned about side effects, such as those with multiple medical conditions. It has also been combined with other antidepressants as an adjunct therapy. Fish oil’s blood-thinning property makes it problematic for doses above 3g/day. Added benefit: fish oil supports cardiovascular health.
St. John’s Wort is an herb widely studied and used, especially in Europe, for mild to moderate depression, though it hasn’t proved effective for major depression. Those taking protease inhibitors or certain other drugs should avoid St. John’s Wort because it interferes with their action.
SAMe (S-adenosyl-l-methionine). Supplementing with SAMe increases concentrations of neurotransmitters that influence mood, and multiple studies have confirmed its antidepressant effect. A dose of 400-800mg/day has been studied for mild-to-moderate depression, and 800-1600mg/day for moderate-to-severe. Studied as a stand-alone treatment, or as an adjunct treatment. Added benefit: SAMe supports joint health and liver function.
When combined with an antidepressant, folic acid supplements can improve symptoms, particularly in women. However, folic acid supplements are not a stand-alone treatment for depression. The safe upper limit is 1,000 mcg per day.