In The News: CoQ10 Proves Its Worth Again

Heart To Heart: News & Tips For A Healthy Heart

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.

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New FDA warnings on statins; NYBC reviews supplements to support cardiovascular health

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:

–Plant products called sterols have been shown to inhibit cholesterol. See, for example, Douglas Labs’ Cardio-Edge.

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:

CoQ10

Vitamin D3

Cholesterol-lowering dietary supplements: views from the Mayo Clinic

NOTE: The Mayo Clinic has updated some of its recommendations on cholesterol-lowering supplements. See our Blog post at

http://wp.me/p7pqN-sb

The Mayo Clinic has posted on its website an interesting podcast entitled “Cholesterol-lowering supplements: which work and which don’t.” This broadcast interview features the views of Dr. Brent Bauer, director of the Complementary and Integrated Medicine Program at Mayo Clinic.

Here are some of the highlights from the podcast:

–Plant sterols, particularly beta-sitosterol and sitostanol. These plant products act much like cholesterol and can reduce the absorption of cholesterol. Can be found in margarine or spreads. (Also included in some supplements, such as Douglas Labs’ Cardio-Edge.)

–Fish oil (omega-3 fatty acids). Strong effect on lowering triglycerides, one measure associated with cardiovascular risk.

–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.

–Policosanol, a waxy residue from sugar cane. Much positive data from Cuban researchers a few years ago, but no one outside Cuba has been able to replicate these studies, so there is now a great deal of skepticism about its effectiveness.

— Garlic. Once regarded as interesting for reducing cholesterol, but subsequent studies have shown its value to be very limited.

–Dr. Bauer has some good advice concerning mixing supplements and prescription drugs: “whenever you mix a dietary supplement and a medication, there’s always potential for interactions, what we call drug-herb interactions, so we’re very cautious about doing that. The one exception in this realm would be using one of those plant sterols that we talked about earlier — beta-sitosterol or sitostanol. Those have been studied in conjunction with statin medications, and what those studies show is that you can achieve further reduction, beyond what you’ve got just with the statin medication, by adding one of those plant sterols to your regimen.” We would also add that, among the dietary supplements, niacin has also been studied in conjunction with statins as a means to manage cholesterol. (Niacin is especially noteworthy in that it can help to raise levels of HDL (“good cholesterol”), which, in more recent years, has come to be seen as an important part of reducing cardiovascular risk.)

Listen to the Mayo Clinic podcast at

http://www.mayoclinic.com/health/cholesterol-lowering/CL00038

Sterinols (or “sterols”) for cholesterol control and other applications

The Canadian AIDS Treatment Information Exchange (CATIE) provides this background on “sterinols” (or “sterols”), which are plant-derived fats. We’ve encountered sterinols in recent years as applied to cholesterol control. (See, for example, the NYBC entry on the Douglas Labs product Cardio-Edge, which contains sterinols along with other components that can support healthy cholesterol levels.) But, as this CATIE fact sheet reminds us, there was an earlier wave of interest in sterinols to support immune function. And, sterinol-based products have also been studied for their anti-cancer properties, and have been used to support prostate health.

Sterinols, or sterols, are plant fats. They can be derived from virtually all plants, but their concentrations vary. Sterinols are found in fairly high concentrations in the oils of unprocessed seeds and nuts and, to a lesser extent, in fruits and vegetables. Unfortunately, modern diets are often deficient in these foods, and the refining of food products reduces the amount of sterinols present. These nutrients can’t be manufactured by the human body, and you must eat them daily to maintain a stable amount in the body. These plant fats are structurally similar to cholesterol and may reduce cholesterol levels by decreasing the body’s cholesterol absorption. They may also be important for maintaining the health of the immune system. Certain sterols look promising in breast and prostate cancer cell line studies.

In the late nineties there was some interest in the application of sterinols to the treatment of HIV. Mostly this interest was in resource limited settings with no access to antiretroviral drugs. A preliminary study, conducted in South Africa, found some changes in immune system functions as a result of the sterinol beta-sitosterol (sold under the brand name Moducare), although the clinical implications were not clear. Unfortunately, for people with severe immune suppression (fewer than 200 CD4 cells/μl), this sterinol did not improve their health. The South African study was not a controlled clinical trial. Therefore it is not known what role sterinols may have, if any, in the management of HIV infection without further study. Despite the lack of clear clinical evidence, Sterinol products are being widely marketed to PHAs.

Some PHAs are incorporating oils rich in sterinols into their diet, including the oils of sesame and pumpkin seeds that, preferably, are organically grown. In general, high-quality oils are those that are cold-pressed and then packaged in dark containers. Sterinol supplements have been used in Germany for many years for prostate problems and reportedly have no side effects other than an occasional mild irritation of the stomach.

Read the entire CATIE info sheet, with references, at
http://www.catie.ca/herb_e.nsf/TOC/3D57CBD44F40DB188525697A0077858F?OpenDocument

Nutritional supplements to reduce cardiovascular risk

Here’s an excerpt from the Fall 2008 issue of the New York Buyers’ Club SUPPLEMENT . (You can read the full issue online at http://www.newyorkbuyersclub.org/supplement/, where you’ll also find an archive of past numbers.)

It’s all about managing risk.

People try to control risk all the time, whether it’s kids learning to cross the street on green, people buckling their seat belts when getting into the car, or a smoker looking at the statistics relating tobacco use to cancer and heart disease and deciding that now is the time to quit.

Earlier this year, a group of experts on HIV and heart disease recommended that people with HIV pay special attention to monitoring and controlling cardiovascular risk factors like high cholesterol and diabetes. Overall, according to currently available evidence, the risk of heart attack is approximately 70% to 80% higher for HIV-positive people than for HIV-negative people. This increased level of risk is likely due in part to HIV itself, and in part to HIV medications. Some typical cardiovascular warning signs for people with HIV include reduced levels of HDL (“good cholesterol”) and high triglycerides, or a tendency toward pre-diabetes. The panel of experts, which was convened by the American Heart Association and the American Academy of HIV Medicine, found indications that even HIV+ children on meds have early development of these kinds of cardiovascular risk factors.

You may also have heard recent news stories about the HIV medication abacavir and elevated risk of heart attack. A commonly used HIV med in the family of drugs called nucleoside analogs (“nukes”), abacavir is part of the combination drugs Ziagen and Trizivir. Two studies based on large databases have detected an association between abacavir and increased risk of heart attack. Although there isn’t an exact understanding of how abacavir (or another nuke, ddI) could cause higher risk of heart attack, the research does suggest that people with other cardiovascular risk factors, such as smoking or high cholesterol, are at the greatest risk.

Which brings us back to our original point: it’s all about managing risk—knowing the risk factors, then lowering them as much as you can. And that’s where nutritional supplements can be helpful.
At the top of the list of supplements to support cardiovascular health is fish oil, with its key component being the omega-3 fatty acids. Since 2005, the American Heart Association, following a hefty accumulation of scientific evidence, has recommended daily intake of fish oil for people with cardiovascular disease. And there has been research specifically looking at fish oil for people with HIV who have elevated cardiovascular risk. For example, a 2007 study of HIV+ people who had high triglyceride levels found that fish oil supplementation reduced these levels by 25% or more. Also of note: fish oil supplementation for people with HIV is being studied in federally funded research that examines how this supplement might counter the effects of lipodystrophy, a syndrome that includes blood lipid abnormalities.

People with HIV are often prescribed statin drugs like Lipitor to lower cholesterol and reduce cardiovascular risk, and while these drugs can be effective, they may also produce side effects, including joint and muscle pain and changes in mood and thinking ability. Many integrative health specialists endorse the idea of taking the supplement CoQ10 along with statins, since depletion of this nutrient by statins may be linked to some of the drug’s major side effects. Moreover, research suggests that, due to its antioxidant and blood-thinning properties, CoQ10 when combined with a statin decreases heart disease risk more than just the statin alone. Similarly, there is important research indicating that statins together with niacin can be more effective at reducing cardiovascular risk over the long term than just the statins. Though niacin dosage may have to be slowly increased in order to avoid “flushing” (redness, itchiness), strong scientific evidence for this supplement’s effectiveness and safety dates back to the 1970s, and indicates that it may be especially helpful in bringing up levels of HDL (“good cholesterol”), which is now regarded as a very significant marker for assessing cardiovascular risk.

A few months ago we were impressed by a talk given by Dr Jon Kaiser, an HIV physician with extensive experience in integrating nutrition and nutritional supplementation into his health care practice. While Dr. Kaiser ranged over several topics, including his well-known interest in the benefits of general micronutrient support for people with HIV, he also had much to say about controlling cholesterol levels with nutritional supplements. His approach consists of low-dose niacin (low dose to minimize flushing), fish oil, plant sterols and pantethine. As he’s started to follow case histories over the past few years, he’s become quite encouraged by the results, and believes that many people with HIV could achieve good results (comparable to those offered by statins, but without the side effects) by adopting this kind of combination therapy.

In the past year, NYBC has begun stocking a Douglas Labs product called CardioEdge, which, like Dr Kaiser’s approach, involves a combination of supplements (including plant sterols) to manage cholesterol. We’ve also recently added a Jarrow product, Pressure Optimizer, which combines several supplements (including theanine from green tea) that are useful in maintaining normal blood pressure. (High blood pressure is a major risk factor for cardiovascular disease, and it’s one of the first issues anyone should address in bringing down heart attack risk.)

We find that physicians who are knowledgeable about nutrition and nutritional supplements have a lot of useful advice to offer when it comes to controlling cardiovascular risk. For example, Dr Hyla Cass, author of the book Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (recently reviewed on the NYBC blog), calls attention to the fact that metformin, the most frequently prescribed diabetes drug in the US, depletes the B vitamins and thus can cause a spike in the body’s levels of homocysteine, a substance linked in recent research to high cardiovascular risk. To counter this danger, she emphasizes the need to supplement with B vitamins when taking metformin.

In line with much current scientific thinking, Dr Cass also believes that cholesterol level by itself is not an adequate measure for assessing cardiovascular risk. In addition, it’s necessary to look at underlying inflammatory processes in order to comprehend the threats to heart and circulatory system health. That’s why Dr. Cass recommends that people who want to reduce their risk of cardiovascular disease should develop a diet plan centering on anti-inflammatory nutrients. She suggests a diet high in antioxidant-rich foods—colorful fruits and vegetables, curry, rosemary, ginger, green tea, dark chocolate, and low-toxin fish like salmon or sardines. (Actually could make for quite a tasty menu, don’t you think?)

To conclude: yes, it’s sobering when researchers warn about increased cardiovascular risk for people with HIV. But there’s also general agreement that cardiovascular risk is very susceptible to management by choices in diet and nutrition. (Exercise and quitting smoking are also important!) So, while you can’t control everything in life, remember that there are many choices you can make to significantly reduce your cardiovascular risk.

Nutritional supplements discussed in this article: fish oil, CoQ10, niacin, plant sterols, pantethine, B vitamins; and the proprietary formulas CardioEdge and Pressure Optimizer.

Cardio-Edge (Douglas Labs): a plant sterol, Sytrinol and pomegranate-based supplement to maintain cardiovascular health and support healthy cholesterol levels

The NYBC co-op has recently added this item in the category of cholesterol management. For a while now we have been interested in the potential of plant sterols for maintaining healthy cholesterol levels, and we noted that our well-regarded supplier Douglas had formulated a supplement that incorporates both plant sterols and two other plant-based components that show a potential benefit in cholesterol management.


Cardio-Edge (Douglas Labs). Cardio-Edge is designed to help maintain cardiovascular health and support healthy cholesterol levels. Its significant components are:

Plant sterols (phytosterols) from soy – 200 mg
Sytrinol – 75 mg
Standardized pomegranate extract (fruit; standardized to 40% ellagic acid) – 25 mg

Plant Sterols
Blood cholesterol is derived from the diet and synthesized in the liver. Sterols work by reducing the absorption of both forms of cholesterol–sterols compete with cholesterol for absorption. Sterols and sterol esters can now be found in many foods including orange juice, rice drink, and margarine.

Sytrinol
This is a proprietary extract of polymethoxylated flavones and tocotrienols from citrus and palm fruits. Sytrinol is intended to have the following effects, some of which you can monitor with routine bloodwork to assess its effect for you. These include:

1) Decrease apoprotein B, needed for LDL synthesis
2) Decrease action of an enzyme in the liver that makes triglycerides
3) Inhibit HMG-CoA reductase in the liver

Sytrinol includes a patented combination of citrus PMFs and alpha, delta and gamma tocotrienols derived from palm fruit. Palm tocotrienols have been shown to inhibit HMG CoA reductase, the enzyme responsible for regulating cholesterol synthesis in the liver. Clinical studies in both animals and humans support Sytrinol’s role in reducing total and LDL-cholesterol as well as triglycerides.

In human clinical studies involving hypercholesterolemic subjects, no side effects were observed with four weeks of supplementing with a daily dose of 300 mg of Sytrinol.

Pomegranate
Recent science has been focusing on the cardioprotective aspects of pomegranate. This brightly colored fruit contains numerous cornpounds known for their antioxidant capabilities, including anthocyanidins, catechins, tannins, and gallic and ellagic acids. Research has shown that supplementation with pomegranate juice can decrease macrophage lipid accumulation and cellular cholesterol accumulation in mice. Recently, research in humans has confirmed a beneficial effect of consuming pomegranate juice on parameters such as LDL oxidation, blood pressure, and blood vessel health.

Please let us know if you have questions or comments about this new item on the NYBC list–emails are welcomed at contact@newyorkbuyersclub.org.