Plaquology

Plaquology: A new term.

Plaquology: def: (plaque-: atherosclerotic plaque; -ology: study of.) The study of atherosclerotic plaque, originating in the early 21st century during the time period when the material underlying atherosclerosis gained recognition as a measure superior to "risk factors" for cardiovascular disease. Previous to the plaque concept, blood measures of cholesterol and adverse lifestyle habits, such as smoking and sedentary lifestyle, alone had been used to predict potential for cardiovascular events. With acceptance of the concept of plaque measurement, the concept of risk factors was abandoned.


Look it up in the current Oxford Dictionary of the English Language, or Webster's Dictionary, and I'm afraid that you still won't find plaquology . . . but you should.

I'm currently rewriting many parts of the Track Your Plaque book. The rewriting process has caused me to review just how much we've learned these past few years. One of the phenomena that fascinates me is that we now have non-medical people--teachers, software people, engineers, bankers, bed and breakfast owners, retired businesspeople, etc.--all discussing the finer points of coronary atherosclerotic plaque--plaquology--what constitutes plaque, what triggers plaque inflammation, how to quantify potential for plaque rupture or plaque quiescence, what effect various treatments have on plaque composition and behavior, etc.

We now have a legion of Plaquologists!

I'm very proud of our Plaquologists. Having devoted themselves to the study of plaque, their level of knowledge now exceeds that of 99% of practicing physicians, including my colleagues, the cardiologists. While cardiologists spend their day squashing/cutting/vaporizing plaque, they are no more experts in plaquology than a carpenter is an expert in trees. More often than not, cardiologists view plaque as just something that gets in their way, rather than the quantifiable, modifiable, reversible material that we can exert control over.

One of the software tools currently in the works for the Track Your Plaque website is a certification process. Members will be able to gain a "certification" in various topics relevant to plaquology, such as plaque quantification, lipoprotein testing, and nutritional supplements.

How about a Doctor of Plaquology?

Thyroid perspective update

Since the publication of the extraordinary HUNT Study relating the entire spectrum of thyroid function and heart issues, I have been vigorously and systematically examining thyroid function in numerous patients.

While there's no news in relating flagrant low thyroid function with triggering heart disease in several forms, the cut-off between low thyroid and normal thyroid has been a matter of dispute for decades.

In the early 20th century, low thyroid function wasn't diagnosed until someone gained 40 lbs, displayed extravagant amounts of edema (water retention) in the legs and huge bags under the eyes, hair fell out in clumps, and often eventually proved fatal. At autopsy, these unfortunates also showed advanced and extensive quantities of coronary atherosclerotic plaque.

Low thyroid is usually diagnosed on the basis of the blood test, thyroid stimulating hormone, or TSH. TSH is a pituitary gland hormone responsible for stimulation of thyroid function. When thyroid function flags, the pituitary increases TSH release. Thus, a high TSH signals lower thyroid hormone levels.

The difficulty is in distinguishing normal thyroid function from low thyroid function judged by TSH levels. As the years have passed, in fact, the cut-off for "normal" TSH has drifted lower and lower.

The HUNT Study, I believe, clinches the argument: A TSH of 1.5 or lower, perhaps even 1.0 or lower, is desirable to eliminate the excess cardiovascular risk provided by an underactive thyroid, not to mention feel better: more energetic, clearer thinking, greater well-being.

Having now applied this renewed appreciation for thyroid, I have come to believe that:

--Low thyroid function, even subtle levels, are rampant and far more common than ever previously thought. In my office practice, the case could be made that several people per day are marginally or mildly hypothyroid (low in thyroid).
--Restoration of optimal thyroid levels facilitates correction of lipid measures, especially LDL cholesterol and, to a lesser degree, lipoprotein patterns dependent on the insulin axis such as triglycerides and small LDL. It's a lot happier way to correct lipids than statins.

I don't discount the value of feeling better. People who feel better--more energetic, more upbeat, clearer thinking--tend to do better in health overall. If thyroid restoration is a part of that equation, then greater attention should be paid to this facet of health on our way to optimal heart health.

Though I sometimes feel like an endocrinologist dispensing desiccated thyroid (rarely the synthetic T4), I believe that this has been a previously neglected and important part of our effort to achieve coronary plaque stabilization and reversal.

Accidental Health


"I shall never have smallpox for I have had cowpox; I shall never
have an ugly pockmarked face."

Such was the idle comment made by a milkmaid to Edward Jenner in 1768 when Jenner was 19, a remark that later prompted his investigations into using isolates of cowpox injected into humans as the first vaccination against the devastations of the European epidemic of smallpox.

(A caricature of Jenner administering cowpox vaccine to people, causing them to sprout bovine appendages. Image courtesy Wikipedia and the Library of Congress.)

When I look back, something similar has happened here.

Although the Track Your Plaque program is intended to stop and reverse coronary plaque using the only available means of tracking coronary plaque, i.e., heart scans, an unintended panel of benefits follow:

--People lose weight, often dramatically
--People gain greater energy
--Thinking is clearer, emotions more stable
--Sleep is deeper
--Bone density increases
--Physical strength and coordination improve
--Winter blues dissipate
--Blood sugar drops dramatically
--Blood pressure drops

Cholesterol (lipid) panels also settle to values that most physicians deem impossible or impractical, given our target of 60:60:60, i.e., LDL 60 mg/dl or less, HDL 60 mg/dl or higher, triglycerides 60 mg/dl or less. And medications are not always necessary to achieve these values. (When I show these values to my colleagues, they declare them flukes, unobtainable only in select people with high doses of medications.)

I didn’t set out to find the next weight loss solution, nor the key to boundless energy. My goal was "simpler": create a program of heart health. I am, after all, a cardiologist.

I was so intently focused on achieving incremental improvements over the steps leading to heart disease prevention that I failed to recognize the profound phenomena that accompanied it: people were quicker, smarter, thinner, and healthier.

In other words, I believe that we have inadvertently created a program of super health and performance.

Ironically, most people don't want to talk about heart disease, let alone reversal of heart disease. They do want to talk about getting thinner, feeling more energetic, living longer, better cholesterol values, etc.

Perhaps there's a lesson in this.

Livin' La Vida Low Carb interview


I recently provided an interview for Livin' La Vida Low Carb's irrepressible Jimmy Moore.

Jimmy runs a fun set of blogs, webcasts, and the like to broadcast this message of reducing carbohydrates in the diet. He credits his 210 lb weight loss to a strict low-carbohydrate and exercise program.

For the interview, just go to The Livin' the Vida Low Carb Show, Episode 185, or click here.

And click here for Part 2


For more of Jimmy Moore's spin on the entire low-carbohydrate diet experience, he maintains several popular blogs, including Carb Wire and The Livin' La Vida Low-Carb Blog.

Wheat withdrawal: How common?

In response to the recent Heart Scan Blog poll,

Have you experienced fatigue and mental fogginess with stopping wheat, i.e., "wheat withdrawal"?

the 104 respondents said:


Yes, I have experienced it: 26 (25%)

No, I stopped wheat and did not experience it: 65 (62%)

I'm not sure: 3 (2%)

I haven't tried it but plan to: 7 (6%)

I haven't tried it and don't plan to: 3 (2%)



So 25% of respondents reported experiencing the fatigue and mental fogginess of wheat withdrawal. This is similar to what I observe in my practice.

I counsel many patients to consider the elimination of wheat, as well as cornstarch products, in an effort to regain control over:

--Weight
--Appetite
--Low HDL
--High triglycerides
--Small LDL
--High blood sugar
--High blood pressure

All of these issues respond--often dramatically--to elimination of wheat and cornstarch.

Why would there be undesirable effects of eliminating wheat?

One clear issue is that elimination of wheat and other sugar-equivalents deprives your body of glucose. Your body then needs to resort to fatty acid metabolism to generate energy. Apparently, some people are inefficient at this conversion, having subsisted on carbohydrates for the last few decades of their lives. However, as fatty acid metabolism kicks in, energy generation improves. That is my (over-)simplified way of reasoning it through.

However, are there other explanations behind the mental fogginess, drop in energy, and overwhelming sleepiness? Some readers of this blog have suggested that, since opioid-like sequences (i.e., amino acide sequences that activate opiate receptors) are present in wheat, perhaps withdrawal from wheat represents a lesser form of opiate withdrawal. I find this a fascinating possibility, though I know of no literature devoted to establishing a cause-effect relationship.

Whatever the mechanism, I find it very peculiar that this food widely touted by the USDA, American Heart Association, and other agencies actually triggers a withdrawal syndrome in approximately 25% of people. Spinach does not trigger withdrawal. Nor does flaxseed, olive oil, almonds, and countless other healthy foods.

Then why would whole wheat grains be lumped with other healthy foods?

Treat the patient, not the test

"Treat the patient, not the test."

That is a common "pearl" of medical wisdom often passed on during medical training.

It refers to the fact that we should always view any laboratory or imaging test in the context of the live, human patient and not just treat any unexpected value that doesn't seem to make sense.

I raise this issue because it recently came up on a discussion on the Track Your Plaque Forum. A Member with a high heart scan score of around 1100 was advised by his doctor that it should be ignored, because he'd prefer to treat the patient, not the test. The patient is apparently slender, physically active, and entirely without symptoms, with favorable cholesterol values as well. The high heart scan score didn't seem to jive with the appearance of the patient, as viewed by this doctor.

This common phrase is meant to impart wisdom. It is a reminder that we treat real people, not just a jumble of laboratory values.

But the unspoken part of the equation is that judgment needs to be applied. A well looking person who shows an unexpected rise in white blood cell count could just have a screwy result, or could have leukemia. Liver tests (AST, ALT) that top 400 could represent a fluke, or dehydration incurred during a long workout, or hepatitis from a long ago blood transfusion.

Yes, treat the patient. But don't be an idiot and entirely dismiss the signficance of an unexpected laboratory or imaging test. A heart scan score of 1100 should be as readily dismissed as discovering a white blood cell count of 90,000 (normal is less than 12,000), or a 5 cm mass in the lung. The absence of symptoms or the failure of conventional risk factors to suggest causation is insufficient reason to dismiss the concrete findings of a test.

In this particular person, dismissing the significance of the heart scan finding by suggesting that the doctor should treat the patient, not the test, is tantamount to:

--Colossal ignorance
--Malpractice
--A certain sentencing of the hapless patient to future major heart procedures, heart attack or death (20-25% likelihood every year, or a virtual certainty over the next 5 years).

There is an ounce of wisdom in this old medical pearl. But there's also plenty of room for a knuckleheaded doctor to misconstrue and abuse its meaning for the sake of covering up his/her ignorance, laziness, or lack of caring.

Does high cholesterol cause heart disease?

How often does someone develop coronary heart disease from high cholesterol alone?

Believe drug industry propaganda and you'd think that everyone does. Physicians have bought into this concept also, driving the $27 billion annual sales in statin cholesterol drugs.

In my experience, I can count the number of people who develop coronary disease from high cholesterol alone on one hand. It happens--but rarely.

That's not to say that cholesterol is not an issue. That rant populates many of the kook websites and conversations on the internet that argue that high cholesterol is a surrogate for some other health issue, or that it is part of a medical conspiracy.

The problem with conventional measurement of cholesterol is that it ignores the particle size issue: whether particles are large or small. Small LDL are flagrant causes of coronary atherosclerotic plaque. Large LDL is a rather meager cause. Simple cholesterol measurement also ignores the presence of other factors that lead to heart disease, like lipoprotein(a) and vitamin D deficiency.

Conventional total and LDL cholesterol do not distinguish between large and small particles, nor reveal the presence of other hidden patterns. An LDL cholesterol of 150 mg/dl, for instance, may contain 100% large LDL--a relatively good situation that by itself is unlikely to cause heart disease, or it might contain 100% small LDL--a very bad situation that is likely to cause heart disease. Just knowing that LDL is 150 mg/dl tells you almost nothing. In 2008, most people have some mixture of the two, particularly with the proliferation of "healthy whole grains" in the American diet, foods that trigger formation of small LDL.

The imprecision and uncertainty of conventional total and LDL cholesterol has provided ammunition for some to discount the entire cholesterol concept. And they are right to a degree: cholesterol by itself is indeed a lousy predictor of heart disease. But small LDL is a very reliable predictor of potential for heart disease. Dismissing the entire concept because the standard measurement stinks is not right, either.

It is therefore an unfortunate oversimplification to say that high cholesterol causes heart disease or that it doesn't. It can--but not always, depending on size and other factors. In my view, it is therefore irreponsible to treat total or LDL cholesterol without knowledge of particle size. I've seen this play out many times: Someone with an LDL cholesterol of 150 mg/dl but all large still gets prescribed a statin drug by his/her doctor. Or someone with an LDL of 100 mg/dl--generally "favorable" by most standards--is not treated but it is all small and the person is truly at high risk. (Also, knowledge that all LDL particles are small does not mean that statins are the preferred agent. In my view, they are not.)

Are humans meant to be omnivores?

Are humans meant to be omnivores?

Does the ideal human diet include animal products like meat, fish, cheese, eggs, and dairy products?

Or should the ideal diet be devoid of all animal products?a vegetarian diet?

Though the argument is distorted by modern food processing methods (e.g., factory farming, long-term administration of antibiotics), convenience foods, and pseudo-foods crafted by food manufacturers, there are, obviously, proponents of both extremes.

The Atkins’ diet, for instance, advocates unrestricted intake of animal products, regardless of production methods or curing (sausage and bacon). At the opposite extreme are diets like Ornish (Dr. Dean Ornish’s Program for Reversal of Heart Disease) and the experiences of Dr. Colin Campbell, articulated in his studies and book, The China Study, in which he lambasts animal products, including dairy, as triggers for cancer and heart disease.

So which end of the spectrum is correct? Or ideal?

For the sake of argument, let's put aside philosophical questions (like not wanting eat animal products because of aversion to killing any living being) or ethical concerns (inhumane treatment of farm animals, cruel slaughtering practices, etc.). Does the inclusion of animal products provide advantage? Disadvantage?

The traditional argument against animal products has been saturated fat. If we accept that we’ve demoted the saturated fat question to a place far down the list of importance (though this is yet another argument to discuss another time), several questions emerge:

• If humans were meant to be vegetarian, why do omega-3 fatty acids (mostly from wild game and fish) yield such substantial health benefits, including dramatic reduction in sudden death from heart disease?

• Why would vitamin K2 (from meats and milk, as well as fermented foods like natto and cheese), obtainable in only the tiniest amounts on a vegetarian diet, provide such significant benefits on bone and cardiovascular health?

• Why would vitamin B12 (from meats) be necessary to maintain a normal blood count, prevent anemia, keep homocysteine at bay, and lead to profound neurologic dysfunction when deficient?


Omega-3 fatty acids and vitamins K2 and B12 cannot be obtained in satisfactory quantities from a pure vegetarian diet. The consequences of deficiency are not measured in decades, but in a few years. The conclusion is unavoidable: Evolutionarily, humans are meant to consume at least some foods from animal sources.

That's not to say that we should gorge ourselves on animal products. Gout (excessive uric acid) and kidney stones are among the unhealthy consequences of excessive quantities of meats in our diets.

It pains me to say this, since I’ve always favored a vegetarian lifestyle, mostly because of philosophical concerns, as well as worries about the safety of our factory farm-raised livestock and rampant inhumane practices.

But, stepping back and objectively examining what nutritional approach appears to stack the odds in favor of optimal health, I believe that only one conclusion is possible: Humans are meant to be omnivorous, meant to consume some quantity of animal products in addition to vegetables, fruits, nuts, and other non-animal products.

The question is how much?

Are you wheat-free?

According to the recent Heart Scan Blog poll, Are you wheat-free?, the 173 respondents said:

Yes, I am free of wheat products.
87 (50%)

No, I include wheat products in my diet.
73 (42%)

I'm not sure.
1 (0%)

I think you're nuts.
12 (6%)


That's kind of what I expected.

There are people who have eliminated wheat and experienced nothing except a feeling of deprivation. These people are in the minority. Though the poll was not set up to reflect this (i.e., asked who tried it and experienced no perceptible benefit), in my experience, this applies to about 20% of people. Little happens with elimination of wheat beyond modest weight loss. Those are the people who generally think I'm nuts.

Or, these people may have been brainwashed by "official" agencies like the USDA, the American Diabetes Association, and American Heart Association and the constant marketing of (high markup) grain products like Cheerios and Shredded Wheat . Some people are really uncomfortable going against the "grain" of popular public opinion.

Then there are the people who try to eliminate wheat and fail. They can't deal with the overwhelming fatigue, mental fog, and moodiness that comes with withdrawal from wheat, the phenomenon of converting from a sugar-burning metabolism to a fat-burning metabolism. Although wheat withdrawal usually runs its course in 2-5 days, some people find it intolerable. (That would be another fun poll to run: Have you experienced wheat-withdrawal?) Occasionally, the withdrawal is replaced by endless cravings, a phenomenon that applies to only about 10% of people. These are the true "wheat addicts." These are the people who eliminate wheat, lose 40 lbs, then regain it when they have one cracker and the floodgates of impulse control crumble.

Then there are the majority, 50% in the poll, though more like 70% in my face-to-face experience. Why is my experience skewed? Well, the people I deal with every day come because of coronary disease in some form (abnormal heart scan score, for instance) or because of lipid or lipoprotein abnormalities. So my experienced is skewed towards people who are likely to have something abnormal, such as high triglycerides or small LDL particles, both of which are created by including wheat in the diet.

This last group also shows unexpected effects of wheat elimination: substantial weight loss, dramatic reductions in blood sugar and triglycerides, increase in HDL, reductions in small LDL, reduction in c-reactive protein and other inflammatory measures. Appetite shrinks considerably. Not uncommonly, improved well-being, reduction in bowel complaints like cramping or "irritable bowel syndrome" is experienced, some rashes clear, occasionally arthritis will improve. See below for some of the testimonials to this experience.

When I first set out to advise people to eliminate wheat, I did it because I reasoned that it would be a quick and simple way to get people to reduce blood sugars and help correct the ubiquitous metabolic syndrome that afflicts nearly 50 million Americans now. And it did indeed accomplish that simple goal. But I did not expect all the other benefits to develop, the dramatic weight loss, improved well-being, reduction in hunger, etc.

I view wheat elimination as an easy-to-remember, digestible way to obtain enormous health benefits in a coronary plaque-control program, one that works for most--but not all--people. And I relate this experience not to sell you something, but to simply relate what I see as the truth, a way that is contrary to conventional advice yet works enormously well.



Unsolicited testimonials of people who have successfully been wheat-free:

Barbara W said:

It's true! We've done it. My husband and I stopped eating all grains and sugar in February. At this point, we really don't miss them any more. It was a huge change, but it's worth the effort. I've lost over 20 pounds (10 to go)and my husband has lost 45 pounds (20 to go). On top of it, our body shapes have changed drastically. It is really amazing. I've got my waist back (and a whole wardrobe of clothes) - I'm thrilled.

I'm also very happy to be eating foods that I always loved like eggs, avocados, and meats - without feeling guilty that they're not good for me.

With the extremely hot weather this week in our area, we thought we'd "treat" ourselves to small ice cream cones. To our surprise, it wasn't that much of a treat. Didn't even taste as good as we'd anticipated. I know I would have been much more satisfied with a snack of smoked salmon with fresh dill, capers, chopped onion and drizzled with lemon juice.

Aside from weight changes, we both feel so much better in general - feel much more alert and move around with much greater flexibility, sleep well, never have any indigestion. We're really enjoying this. It's like feeling younger.

It's not a diet for us. This will be the way we eat from now on. Actually, we think our food has become more interesting and varied since giving up all the "white stuff". I guess we felt compelled to get a little more creative.

Eating out (or at other peoples' places) has probably been the hardest part of this adjustment. But now we're getting pretty comfortable saying what we won't eat. I'm starting to enjoy the reactions it produces.


Weight loss, increased energy, less abdominal bloating, better sleep--I've seen it many times, as well.


Dotslady said:

I was a victim of the '80s lowfat diet craze - doc told me I was obese, gave me the Standard American Diet and said to watch my fat (I'm not a big meat eater, didn't like mayo ... couldn't figure out where my fat was coming from! maybe the fries - I will admit I liked fries). I looked to the USDA food pyramid and to increase my fiber for the constipation I was experiencing. Bread with 3 grams of fiber wasn't good enough; I turned to Kashi cereals for 11 years. My constipation turned to steattorrhea and a celiac disease diagnosis! *No gut pains!* My PCP sent me to the gastroenterologist for a colonscopy because my ferritin was a 5 (20 is low range). Good thing I googled around and asked him to do an endoscopy or I'd be a zombie by now.

My symptoms were depression & anxiety, eczema, GERD, hypothyroidism, mild dizziness, tripping, Alzheimer's-like memory problems, insomnia, heart palpitations, fibromyalgia, worsening eyesight, mild cardiomyopathy, to name a few.

After six months gluten-free, I asked my gastroenterologist about feeling full early ... he said he didn't know what I was talking about! *shrug*

But *I* knew -- it was the gluten/starches! My satiety level has totally changed, and for the first time in my life I feel NORMAL!



Feeling satisfied with less is a prominent effect in my experience, too. You need to eat less, you're driven to snack less, less likely to give in to those evil little bedtime or middle-of-the-night impulses that make you feel ashamed and guilty.



An anonymous (female) commenter said:

My life changed when I cut not only all wheat, but all grains from my diet.

For the first time in my life, I was no longer hungry -no hunger pangs between meals; no overwhelming desire to snack. Now I eat at mealtimes without even thinking about food in between.

I've dropped 70 pounds, effortlessly, come off high blood pressure meds and control my blood sugar without medication.

I don't know whether it was just the elimination of grain, especially wheat, or whether it was a combination of grain elimnation along with a number of other changes, but I do know that mere reduction of grain consumption still left me hungry. It wasn't until I elimnated it that the overwhelming redution in appetite kicked in.

As a former wheat-addicted vegetarian, who thought she was eating healthily according to all the expert advice out there at the time, I can only shake my head at how mistaken I was.




Stan said:

It's worth it and you won't look back!

Many things will improve, not just weight reduction: you will think clearer, your reflexes will improve, your breathing rate will go down, your blood pressure will normalize. You will never or rarely have a fever or viral infections like cold or flu. You will become more resistant to cold temperature and you will rarely feel tired, ever!



Ortcloud said:

Whenever I go out to breakfast I look around and I am in shock at what people eat for breakfast. Big stack of pancakes, fruit, fruit juice syrup, just like you said. This is not breakfast, this is dessert ! It has the same sugar and nutrition as a birthday cake, would anyone think cake is ok for breakfast ? No, but that is exactly the equivalent of what they are eating. Somehow we have been duped to think this is ok. For me, I typically eat an omelette when I go out, low carb and no sugar. I dont eat wheat but invariably it comes with the meal and I try to tell the waitress no thanks, they are stunned. They try to push some other type of wheat or sugar product on me instead, finally I have to tell them I dont eat wheat and they are doubly stunned. They cant comprehend it. We have a long way to go in terms of re-education.

Yes. Don't be surprised at the incomprehension, the rolled eyes, even the anger that can sometimes result. Imagine that told you that the food you've come to rely on and love is killing you!



Anne said:

I was overweight by only about 15lbs and I was having pitting edema in my legs and shortness of breath. My cardiologist and I were discussing the possible need of an angiogram. I was three years out from heart bypass surgery.

Before we could schedule the procedure, I tested positive for gluten sensitivity through www.enterolab.com. I eliminated not only wheat but also barley and rye and oats(very contaminated with wheat) from my diet. Within a few weeks my edema was gone, my energy was up and I was no longer short of breath. I lost about 10 lbs. The main reason I gave up gluten was to see if I could stop the progression of my peripheral neuropathy. Getting off wheat and other gluten grains has given me back my life. I have been gluten free for 4 years and feel younger than I have in many years.

There are many gluten free processed foods, but I have found I feel my best when I stick with whole foods.



Ann has a different reason (gluten enteropathy, or celiac disease) for wanting to be wheat-free. But I've seen similar improvements that go beyond just relief of the symptoms attributable to the inflammatory intestinal effects of gluten elimination.



Wccaguy said:

I have relatively successfully cut carbs and grains from my diet thus far.

Because I've got some weight to lose, I have tried to keep the carb count low and I've lost 15 pounds since then.

I have also been very surprised at the significant reduction in my appetite. I've read about the experience of others with regard to appetite reduction and couldn't really imagine that it could happen for me too. But it has.

A few weeks ago, I attended a party catered by one of my favorite italian restaurants and got myself offtrack for two days. Then it took me a couple of days to get back on track because my appetite returned.

Check out Jimmy Moore's website for lots of ideas about variations of foods to try. The latest thing I picked up from Jimmy is the good old-fashioned hard boiled egg. Two or three eggs with some spicy hot sauce for breakfast and a handful of almonds mid-morning plus a couple glasses of water and I'm good for the morning no problem.

I find myself thinking about lunch not because I'm really hungry but out of habit.

The cool thing too now is that the more I do this, the more I'm just not tempted much to do anything but this diet.

No more canned foods

If you haven't already caught the news, it's time to eliminate canned foods and exposure to plastics that contain the chemical, bisphenol A (BPA). A worrisome and unexpected association with heart disease and diabetes has been found.

This issue has been debated for some years ever since scientists at the NIH detected BPA in the blood samples of 93-95% of Americans, with consumer protection advocates calling for more research or even the outright banning of BPA , while industry representatives have argued that the data fail to conclusively prove adverse health effects.

Well, the argument has been tilted heavily in favor of increased consumer protection with the publication of a study in the Journal of the American Medical Association by Dr. Iain Lang and associates at the University of Exeter, UK, and the University of Iowa. Their study, released Sept. 17, 2008, Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults, persuasively demonstrated a 40% increased incidence of coronary heart disease, heart attack, and diabetes with increasing exposure to BPA (as judged by urine levels) among the nearly 1500 adults aged 18-74 years. People with coronary heart disease had double the blood level of BPA compared to those without.

In addition, higher urine levels of BPA were associated with abnormalities of two liver tests, GGT and alkaline phosphatase.

Interestingly, although much of the debate over adverse health effects of BPA have centered around concern over cancer and reproductive risks, an association with cancer did not hold. (No analysis for reproductive issues was conducted in these adults, since most of the concern is for children exposed through polycarbonate baby bottle use. Some BPA critics have raised questions like low birth weight developing from exposure.) No relationship to thyroid disease was identified, also.

The editorial accompanying the study added some sharp commentary:

"Subsequent to an unexpected observation in 1997, numerous laboratory animal studies have identified low-dose drug-like effects of BPA at levels less than the dose used by the US Food and Drug Administration and the Environmental Protection Agency to estimate the current human acceptable daily intake dose (ADI) deemed safe for humans. These studies have shown adverse effects of BPA on the brain, reproductive system, and--most relevant to the findings of Lang et al--metabolic processes, including alterations in insulin homeostasis and liver enzymes. . . For example, when adults rats were fed a 0.2 microgram/kg per day dose of BPA for 1 month (a dose 250 times lower than the current ADI), BPA significantly decreased the activities of antioxidant enzymes and increased lipid peroxidation, thereby increasing oxidative stress. When adult mice were administered a 10 microgram/kg dose of BPA once a day for 2 days ( a dose 5 times lower than the ADI), BPA stimulated pancreatic beta cells to release insulin."

This study, piled on top of the worrisome literature that precede it, are enough for me: No more tin cans (which are lined with BPA), no more hard plastics labeled with recycling code #7 or #3, no more polycarbonate water bottles (the hard ones, often brightly colored). Microwaveable-safe may also mean human-unsafe, as highlighted by this damning assurance from the Tupperware people that BPA is not a health hazard.

The National Toxicology Program also issued these advice in response to the Lang study to reduce BPA exposure (reported by the Washington Post) :

· Don't microwave polycarbonate plastic food containers. Polycarbonate may break down from overuse at high temperatures and release BPA. (Manufacturers are not required to disclose whether an item contains BPA, but polycarbonate containers that do usually have a No. 7 on the bottom.)

· Reduce use of canned foods, especially acidic foods such as tomatoes that can accelerate leaching of BPA from plastic can linings. Opt for soups, vegetables and other items packaged in cardboard "brick" cartons, made of safer layers of aluminum and polyethylene plastic (labeled No. 2).

· Switch to glass, porcelain or stainless-steel containers, particularly for hot food or liquids.

· Use baby bottles that are BPA-free; in the past year, most major manufacturers have developed bottles made without BPA.
Bad news on CoQ10?

Bad news on CoQ10?

A review of the effects of Coenzyme Q10 (CoQ10) on the muscle aches and weakness (myopathy) of statin drug therapy was just published in the Journal of the American College of Cardiology.

(Marcoff L, Thompson PD. The role of coenzyme Q10 in statin-associated myopathy. J Amer Coll Cardiol 2007;49(23):2231-2237.)

This is not a study, but a review of the existing scientific and clinical data available on this topic. The study authors conclude with a lukewarm statement:

". . .there is insufficient evidence to prove the etiologic [causal] role of CoQ10 deficiency in statin-associated myopathy and that large, well-designed clinical trials are required to address this issue. The routine use of CoQ10 cannot be recommended in statin-treated patients. Nevertheless, there are no known risks to this supplement and there is some anecdotal and preliminary trial evidence of its effectiveness. Consequently, CoQ10 can be tested in patients requiring statin treatment, who develop statin myalgia, and who cannot besatisfactorily treated with other agents. Some patients may respond, if only via placebo effect."

Should the media get hold of this report, be prepared for the usual "Nutritional supplement no help for drug toxicity" headlines, or "Yet another nutritional supplement shows no benefit" with parallels drawn to vitamin C or E.

There are several issue that need to be factored into the discussion:

1) This is not a study, just a review. Thus, any biases of the authors are more likely to exert themselves.

2) The understanding of CoQ10 absorption among different preparations may be an issue. I just received a mailing from Life Extension that made extravagant claims about the superior absorption of ubiquinol, to be distinguished from ubiquinone, the more common form. They claim that eight-fold increased absorption and blood levels of CoQ10 are achievable with ubiquinol. Unfortunately, virtually all the supportive data are unpublished, proprietary observations, i.e., generated by companies who make or sell it. This is as reliable as drug manufacturers who publish glowing reports on their own drugs--perhaps it's true, but it requires unbiased corroboration.

3) Despite the lack of a large, well-funded clinical trial (all are small), the issue continues to live and breathe because of the powerful anecdotal experience.

In our experience, CoQ10 does work. It doesn't work all of the time, perhaps just 80-90% of the time. It does generally require higher doses (100 mg per day, occasionally more). It very clearly must be an oil-based gelcap (just like vitamin D) to work; capsules containing powder do not work.

It's difficult to doubt when someone starts a statin drug, develops the muscle aches and weakness, begins CoQ10 and obtains distinct relief, stops CoQ10 and aches and weakness return, then only to go away again with resumption of CoQ10 . I've seen this countless times.

We do need better information on CoQ10. There's no doubt about it. For people who obtain benefit from statin therapy, I think CoQ10 remains a useful solution. A better solution would be to get rid of the offending drug. But that's not always possible--e.g., LDL cholesterol 190 mg/dl despite the best diet and "adjunctive" food effort. Then CoQ10 can be very useful.

Comments (8) -

  • DietKing2

    6/14/2007 7:01:00 PM |

    Just found your blog from Regina at Weight of the Evidence. Boy, am I glad to read your stuff. You are fair, balanced, and quite in tune with what's going on with the hearts of humanity. I take Coenzyme Q10, 100mgs. twice a day--I was taking it all along so I wasn't that upset when my doctor added Lipitor to my regimen because of a bad family history. And I don't care what the media plasters all over the airwaves down the road (as you indicated in your post as a possibility) I'm sticking with this stuff for peace of mind alone.
    Nice to meet you.
    Adam Wilk

  • Theresa

    6/21/2007 7:52:00 PM |

    The biggest thing I found about Ubiquinol is that yes it is up to 8 x more absorbable however, the claim is that the body is skipping a step.  "Regular" ubiquinone is broken down in the body into Ubiquinol which is what the body absorbs.  So if you take Ubiquinol, then your body doesn't need to break anything down to absorb it.  People over the age of 40 have a harder time breaking down and absorbing ubiquinone so Ubiquinol might be better for them.  You are right, most of my information has come from retailers or manufacturer's but they aren't trying to sway people from buying regular CoQ10 because they all still sell it, they are just offering another option for people who don't see any benefits from CoQ10.  Good info on the blog!

  • Sander

    6/26/2007 3:43:00 PM |

    Why has QH not been launched in Japan, the home country of the manufacturer?

    You cannot assume that any of the CoQ10 research applies to ubiquinol.

    Enhanced bioavailability does not necessarily mean enhanced bioactivity. They have to show what their supplement does in a clinical setting.

    What is the shelf life stability data for when the ubiquinol oxidizes to ubiquinone.

    Marketing shows 8x (Swanson), 62% (Integrative Therapy), 400% (Jarrow), 8x (Life Extension)  What is the truth?

    There has been a lot of clinical research on CoQ10. I think most if not all of it has been on ubiquinone. You cannot assume that any of those results are the same for ubiquinol supplements. People use products because they work, or they don't. What does the evidence support?

    The clinical study was performed by the manufacturer not a third party.  The results has not been published in a peer-reviewed journal, escaping criticism

  • Todd

    6/30/2007 5:13:00 PM |

    Just FYI regarding Sander's comment about which of the many stats to believe...

    Keep in mind that a claim of 100% increase is the same as a factor of 2X. That given, 8X is the same as 400%. So, 3 out of the 4 examples of 8X, 62%, 400% and 8X are are equivalent to one another.

    I haven't found any information about "Integrative Therapy", though I'd tend to err on the conservative side with regards to most any claim, as it seems they have done.

  • Concerned

    8/29/2007 5:42:00 PM |

    Todd, here is a link to the claims from Integrative Theraputics http://www.naturalgreens.com/ProdDetail.asp/ProdID/244

  • Anonymous

    11/1/2007 4:31:00 PM |

    Coenzyme Q10 Facts or Fabrications
    William V. Judy, Ph.D., Willis W. Stogsdill, M.D., Daniel S. Judy, M.D. and Janet S. Judy, R.N. CRC

    CoEnzymeQl0 has been researched for years by scientists around the world, and its importance to the human body and its reported health benefits are widely known. For more than 30 years, people have been taking CoQ10 supplements in its oxidized form, ubquinone. When ubiquinol — the reduced form of CoQ10 — entered the US commercial market, manufacturers claimed that they had discovered a way to make the product stable so it could be used as a food or nutritional supplement in various delivery forms including softgels and free CoQ10 molecules in water and/or lipid based solutions such as liposomes, micelles, or nanoparticles. Several marketers also claimed that ubiquinol was the most bioactive and preferred form of CoQ10 in that 90-95% of the total body CoQ10 was in the form of ubiquinol. The absorption and bioavailability was claimed to be 300% better than of the oxidized (ubiquinone) forms of CoQ10. The information provided to the consumers led to a general feeling or understanding that the oxidized form that had been in the market for three decades was an inferior compound and not the product form the body preferred — and thus consumers should consider switching to the new reduced and "bioactive" product form.
    Obviously, this marketing approach, and the claims made, created controversies among and between CoQ10 scientists around the world and the marketing groups. These controversies led to editorials written by a scientist to explain the differences between Ubiquinone and Ubiquinol, and resulted in rebuttals from marketing groups regarding their opinions in the accuracy of the editorials. The opinions in the editorials were from the scientist who discovered CoQ10 in 1957 and from the President of the International Coenzyme Q10 Association. Those opinions in the rebuttal referenced one study on the absorption of Ubiquinone and several papers on the antioxidant capacity of Ubiquinol along with the conversion of one form to the other in response to oxidative or metabolic stress. In evaluating the claims made relative to Ubiquinol, we have judged many to be factual yet not functional. Other claims appear to be mere fabrications to meet marketing needs and confusing many consumers.
    The following is a list of claims made by various CoQ10 marketing groups relative to CoQ10, in the oxidized Ubiquinone and the reduced Ubiquinol forms. We have evaluated many of these claims based on scientific FACT or marketing group FABRICATIONS. The areas to be discussed are:
    1. The CoQ10 molecule
    2. CoQ10 absorption
    3. CoQ10 transport
    4. Conversion of Ubiquinone to Ubiquinol and vice versa
    5. CoQ10 bioavailability
    6. Functions of Ubiquinone and Ubiquinol
    1. The CoQ1O Molecule
    The characteristics of the CoQ10 molecule in many ways control its absorption and thus its bioavailability to the body cells. Ubiquinone (oxidized form) has a molecular weight of 864 Dalton's whereas Ubiquinol (reduced form) has two more hydrogen molecules and forms with the oxygen, a hydroxyl unit on the head of the molecule, thus having an 866 molecular weight. Both forms are highly lipid soluble due to the predominance of the 10 unit isoprene tail. Ubiquinone is bright yellow in color and Ubiquinol is milky white in color. Ubiquinone and Ubiquinol form a redox (Oxidation - Reduction) pair and can be readily converted from one form to the other in the cells, lymph or blood when their respective functions are in demand.
    In the cell, CoQ10 is predominantly found in the outside of the mitochondria inner membrane in the Ubiquinol form (90-95%). CoQ10 in man and large animals has 10 isoprene units in its tail (CoQ10), while smaller vertebrates have 9 isoprene units (CoQ9). The body synthesizes Ubiquinone in all living cells. Commercial CoQ10 is manufactured by two different processes: 1) partial synthesis of CoQ9 to CoQ10 and 2) a yeast fermentation extraction process from which CoQ10 is made by a friendly bacterium. CoQ10 has two isomers (Trans and Cis). The trans isomer makes up 99.95 to 100 percent of the CoQ10 in both commercial product types.
                                                  The following is a list of claims made about the CoQ10 molecules or crystals.
    • CoQ10 is a vitamin like substance produced in all living human body cells. FACT
    • CoQ10 is commercially made from sugar beets. FABRICATION CoQ10 is made by a partial synthesis from CoQ9 or by a yeast fermentation extraction process. The microorganisms which make the CoQ10 in the fermentation process could be fed sugar beets.
    • Dr Karl Folkers discovered CoQ10 in beef heart Mitochondria in 1957. FABRICATION
    Dr. Fred Crane discovered CoQ10 and Dr. Folkers determined its chemical structure.
    • CoQ10 is a lipid-soluble molecule. FACT
    • Converting or placing lipid-soluble CoQ10 molecules into liposomes, micelles or nanoparticles make CoQ10 molecules soluble in water. FABRICATION
    The particles formed are dispersible in water due to the hydrophilic heads of the CoQ10 molecules forming the outer shell of the particles, and usually with the help of some surfactants. The CoQ10 molecule is still lipid-soluble and is absorbed in the body as such.
    • Reducing the size of the CoQ10 molecule makes it more water soluble. FACT
    Reducing CoQ10 to CoQ 9, 8, 7 by cutting off its lipophilic tail will make it more water-soluble, however it then is no longer CoQ10.
    • Making the CoQ10 molecule smaller and thus more water-soluble will allow it to be rapidly absorbed through water filled pores in the absorption cell membrane. FABRICATION
    Small lipid soluble molecules with 5-12 carbon atoms can be absorbed passively through water filled pores; however CoQ10 with 54 carbon atoms can not be absorbed through these hydrophilic pores.
    • Ubiquinol, the reduced form of CoQ10, is synthesized in the body cells. FABRICATION
    The oxidized Ubiquinone form of CoQ10 is synthesized in the body's cells.
    • Ubiquinone is yellow in color while Ubiquinol is a milky white color. FACT
    • The term hydrophilic means readily dissolved in water, water-soluble, or absorbable. FABRICATION
    In fact, water-soluble molecules can be rapidly dissolved in water, however, if they are very large in size, their absorption may be poor. Water-soluble does not always equate or mean high absorption. Some molecules are simply too large to be absorbed well. CoQ10 cannot be converted into a water-soluble molecule.
    • All CoQ10 product types must be placed in colored capsules or dark containers because CoQ10 is sensitive to light. FABRICATION Independent laboratory testing has dearly shown that crystal free CoQ10 in clear gelatin softgel capsules or crystalline CoQ10 have less than 1% by weight loss and no significant sensitivity to light. The primary reason for colored softgel capsules is to prevent the consumer from seeing crystals being formed inside the product.
    2. CoQ1O Absorption
    CoQ10, being a rather large molecule, is absorbed through the absorption cells in the small intestines by a "simple passive facilitated diffusion" process. Passive means that the process does not require energy. Facilitated means that the process requires a lipid molecule to act as a carrier for the CoQ10 molecules. Passive diffusion is down-hill transport and requires a greater CoQ10 concentration in the water phase adjacent to the side of the absorption cell


    membrane compared to that inside the cell membrane. To a point, the greater this gradient is, the faster and greater the absorption.
    CoQ10 crystals cannot be absorbed. Thus, crystalline compounds must be dissolved to single molecules before absorption. Intestinal absorption occurs on a molecular level; meaning only single molecules can be absorbed. CoQ10 in its crystallized form has poor dissolution within the chyme of the intestines, because its melting point is 10 degrees centigrade above body temperature. Without the addition of a lipid carrier molecule to facillate the absorption of CoQ10, even single molecules are poorly absorbed. This is evidenced by the poor absorption of CoQ10 plain powder: less than 1%.
    The following is a list of claims about CoQ10 absorption:
    • For crystals of CoQ10 to be absorbed, they have to be dissolved to single molecules. FACT
    The body's intestinal absorption cells can not absorb crystals of any type.
    • CoQ10 is absorbed through an active transport mechanism like that of sugar. FABRICATION
    CoQ10 being a large lipid-soluble molecule, is absorbed by a process called "simple passive facilitated diffusion" through the phospholipid cell membranes, not the active transport process.
    • Combining CoQ10 with a sugar will allow the CoQ10 to be absorbed with sugar directly into the blood. FABRICATION
    Membrane proteins are involved in the absorption of sugar and sodium via an active transport mechanism. If CoQ10 was absorbed while being bound to sugar, its Cmax (maximum concentration in blood) would peak with sugar in about two hours instead of 5-8 hours as for most lipids.
    • CoQ10 is absorbed across the intestinal cells directly into the venous blood. FABRICATION
    CoQ10 is absorbed across the intestinal cell membranes into the lymph vessels in the intestinal microvillus, not into the bloodstream.
    • The poor dissolution of powder based CoQ10 tablets and lipid filled softgels in simulated gastric juice is a good indicator of poor absorption. FACT
    However, since CoQ10 is not soluble in water but is soluble in a lipid, shouldn't the solubility test for lipid soluble molecules be done in a lipid solution?
    • Ubiquinol has far greater water solubility and much better absorption into the blood stream than does Ubiquinone. FABRICATION
    The addition of two hydrogen ions on the polar head of the Ubuquinol molecule will not make the molecule highly water-soluble or absorbed as a water-soluble molecule.
    • Ubiquinol is more water-soluble than Ubiquinone. FACT
    When two hydrogen's atoms are added to the polar (water-soluble) head of the CoQ10 molecule, the increased mass will make Ubiquinol slightly more water-soluble than Ubiquinone. However, due to the larger total mass of the nonpolar tail of the molecule, it is still more lipid-soluble than water-soluble.
    • Liposomes, micelles and nanoparticle CoQ10 products are absorbed, transported in lymph, blood and to the target body cells as liposomes, micelles or nanoparticles. FABRICATION
    The microspheres can not be absorbed. They are simply transport vehicles for ingested CoQ10, to be delivered to the intestinal absorption cells.
    • Reduced CoQ10, an antioxidant, remains in the reduced form when ingested and absorbed. FABRICATION
    Reduced CoQ10 is highly unstable in the contents of the stomach and is converted to oxidized CoQ10 before absorption.
    • The rapid dissolution of a liposome, micelle or nanoparticle CoQ10 products in water is a good indicator of high CoQ10 absorption. FABRICATION
    The rapid dissolution of these CoQ10 products types tells that these polar particles (water-soluble microspheres) will disperse rapidly in water. This does not mean that they are better absorbed. Only the CoQ10 molecules are absorbed, not the liposomes, micelles or nanoparticles.
    3. CoQ10 Transport
    Absorbed nutrients are transported from the intestines by two routes.
    Small water-soluble and some small lipid-soluble nutrients, after absorption, enter the capillary blood in the intestinal microvillus and are transported by the blood to the liver. From the liver these small molecules are transported through the hepatic vein to the inferior vena cava, then to the heart and then into systemic circulation.
    Large lipid-soluble nutrients such as CoQ10, after absorption, diffuse into the lymph capillary in the intestinal microvillus, and are transported in the lymph through the abdominal and thoracic lymph duct to the subclavian vein and then into the systemic circulation. In the lymph and blood, CoQ10 molecules are predominately in the reduced form and are bound to the low density lipoproteins (LIM.). The delayed peak concentration of CoQ10 in the blood is due to the very slow lymph flow compared to that of blood. The portal venous blood is a delivery system to the liver, but the lymph is not.
    The following is a list of claims about CoQ10 transport:
    • After CoQ10 absorption, it is transported by the lymph to the liver where it is reduced and bound to phospholipids. FABRICATION The lymph is not a delivery system to the liver.
    • CoQ10 is transported from the absorption cells to the venous blood by the lymphatic system. FACT
    The lymph is the delivery system for absorbed CoQ10 molecules to the systemic blood. Large animal studies show that CoQ10 peaks in the abdominal lymph duct in 2-3 hours after ingestion where as it peaks in venous blood in 6-8 hours. The reason for the delayed appearance in the venous blood is due to slow lymph flow.
    • In the absorption cell, the lymph or the blood oxidized CoQ10 is converted to the reduced form of CoQ10. FACT
    Circulating CoQ10 in the blood is 90-95% in the reduced (Ubiquinol) form.
    • CoQ10 is rapidly absorbed in the small intestines and is slowly transported by the lymph to the venous blood. FACT
    Total lymph flow is about 100 ml/minute whereas blood flow is 5,000 ml/minute.
    4. Conversion of Ubiquinol to Ubiquinone and Vice-Versa
    Ubiquinone and Ubiquinol, being redox pairs, are easily converted from one form to the other in the body. For example, when exogenous Ubiquinone is absorbed in the intestines it is converted to Ubiquinol in the absorption cells, the lymph, or the blood. Since CoQ10 is not used to produce energy in the lymph system or blood, it is understandable why this conversion takes place to fulfill the need for antioxidant protection in the circulation. On the other hand, in the inner membrane of the mitochondria where energy is made, the oxidized form of CoQ10 (Ubiquinone) is in great demand. Here the reduced Ubiquinol form is rapidly converted to the oxidized Ubiquinone form. In the mitochondria this conversion creates a Q-Cycle. It was once felt by the late Sir Peter Mitchell (Nobel prize, 1978) that the Q-Cycle would maintain the proportion of Ubiquione and Ubiquinol required for energy synthesis available forever. Little did he know at the time of his discovery that with age and disease the body's ability to produce Ubiquinone and to convert it to Ubiquinol would diminish and true CoQ10 deficiencies would be prevalent in an aging society.
    The following is a list of claims about CoQ10 conversion:
    • CQ10 can be converted from the reduced to oxidized form and vise versa in the body as needed. FACT
    This is a unique characteristic of redox pairs.
    • CoQ10 in the foods we eat is in the reduced form. FACT & FABRICATION The CoQ10 in fresh uncooked animal protein in is the reduced form. However, when cooked, it is converted to the oxidized form. Even when ingested uncooked (such as sushi or steak tartar), CoQ10 will be converted in the stomach to the oxidized form.
    • CoQ10's ability to cycle back and forth between Ubiquinone and Ubiquinol accounts for many of its unique properties. FACT


    5. CoQ10 Bioavailability
    After absorption, CoQ10 accumulates in the blood and becomes bioavailable to all body cells. Bioavailability reflects absorption but it is not the actual absorption and should not be used as an accurate measure of such, It does, however, give a good estimate of the amount of CoQ10 available as an antioxidant in the blood and that available to the body cells. CoQ10 is accumulated and is stored in the cell membranes and in the membranes of the organelles in the cell.
    It has been known for two decades that the bioavailability of the pure crystalline CoQ10 is less than that of liposome, micelle, and dissolved CoQ10 products. The current commercial and scientific issue is the bioavailability of the Ubiquinol form compared to that of the Ubiquinone form of CoQ10.
    The following is a list of claims about CoQ10 bioavailability:
    • Ubiquinol has a much higher bioavailability then the Ubiquinone used in other commercial CoQ10 supplements. FABRICATION
    In fact, the data on ubiquinol state that its bioavailability is 300 percent more than that of the oxidized dry powder products. Most dissolved, liposome, micelle and nanoparticle CoQ10 products claim to have a 260 to 350 percent greater bioavailability than oxidized dry powder CoQ10.
    • The two hydroxyl groups on the Ubiquinol compound results in its stronger bonding with water and helps explain why it is so much more bioavailable than Ubiquinone. FACT
    This bonding does make Ubiquinol slightly more water soluble than Ubiquinone. However, the molecule is still lipophilic and is absorbed as a lipid.
    6. Functions of Ubiquinone and Ubiquinol
    Currently CoQ10 has two main functions in the body: it is used for energy production and functions as an antioxidant in the body.
    Ubiquinone is a cofactor in the inner membrane of the mitochondria for the synthesis of energy (ATP). Since the body does not store energy (ATP), it must be rapidly produced through an oxidative phosphorlation process. CoQ10 is positioned between NADH and Cyto-Chrome C in the inner membrane and acts as cofactor stimulation to all three mediators to give up electrons to run the electron transport through complexes I-IV in this system. This function is specific to Ubiquinone in that no other molecule can replace Ubiquinone in this process. However, Ubiquinone and Ubiquinol as a redox pair form the Q Cycle in which they act to conserve each other in this process.
    Ubiquinol is an antioxidant throughout the body. This is especially true in the cell membranes and those of the cell organelles. In these membranes CoQ10 may well be the primary lipophilic molecule essential for the prevention of lipid peroxidation resulting in cell damage and eventually cell death. Outside the cell and organelle membrane and in the presence of other lipophilic and hydrophilic antioxidants, Ubiquinol may recycle other antioxidants such as vitamin E and C.
    The following is a list of claims about the functions of CoQ10
    • Ubiquinol protects the body against toxic oxidative reactions. FACT
    Yes, but equally beneficial it also recycles Ubiquinone in the synthesis of energy.
    • The functions of Ubiquinol in the body are more diverse than those of Ubiquinone. FABRICATION
    Ubiquinol functions in the body as an antioxidant and in the recycling of Ubiquinone, Vitamin E and Vitamin C. Ubiquinone, through its synthesis of energy, is involved in all body processes requiring energy: energy synthesis, active transport, membrane and nucleotide stability, synthesis of enzymes, coenzymes, hormones, neuro-transmitter synthesis and reuptake, cillary activity in the upper respiratory systems, all muscle contractile functions, sperm production and motility, deactivation of muscle contraction, pumping action of sweat and other cutaneous glands, etc. In fact, Ubiquinone is possibly the hub around which life processes revolve in the human body.
    • Clinical studies with Ubiquinol show it is superior to Ubiquinone. FABRICATION
    In fact, Ubiquinol became available in 2006 and to date, no clinical studies in human beings using Ubiquinol have been published in the

    peer-reviewed scientific literature. An anti-aging study in genetic mutated mice has been described, but the role of the genetic mutations in these mice as they pertain to CoQ10 conversion are not understood. This is a concern since mice use CoQ9 as an energizer and antioxidant whereas human beings use CoQ10.
    • Ubiquinol supplements make Ubiquinone supplements
    obsolete. FABRICATION
    In fact, hundreds of clinical studies show that Ubiquinone is effective and is still the choice of practicing cardiologists. Ubiquinone and Ubiquinol are rapidly inter-converted back and forth as needed, regardless of which form is ingested.
    The existence of CoQ10 in two forms and structures, having two separate but essential functions, and its ability to act as a redox pair to recycle each other as needed is the beauty of this molecule. Although Ubiquinone was discovered first and found to be essential for life, the discovery of Ubiquinol broadened the overall scope of this molecule relative to the health characteristics and benefits to man. Without Ubiquinone life is not possible in that the body can not survive without energy. On the other hand, the life sustaining feature of energy has to be maintained and protected. Since Ubiquinol recycles Ubiquinone, the life cycle is maintained for about 8 decades in man. This would not be possible if it was not for Ubiquinol and other antioxidants. The antioxidants act as part of the host defense system and thus, prevent the toxic by-products (free radicals and super oxides) from the synthesis of energy and all substances produced by the body from rapidly aging all cells and shortening and reducing the quality of life.
    CoQ10 as a scientific entity is 50 years old. As a commercial food supplement it has been around for about 37 years. The basic and clinical science is still growing. It is now presented in basic and graduate level text books of the biomedical sciences. Its entry into clinical text and its acceptance in the clinical societies will eventually occur with more well controlled clinical trials. These clinical trials are currently a world wide effort. CoQ10 as a supplemental nutrient to standard clinical therapy is here now. Its use as a stand alone nutrient to insure and maintain normal health characteristics of man is rapidly growing throughout the world. This will continue to grow with continued and more advanced research.
    In summary, many aggressive marketing campaigns introducing Ubiquinol have created false and misleading claims that have only generated more confusion about CoQ10.
    The apparent lack of superior absorption, instability in the stomach, no clinical efficacy studies and the high cost of Ubiquinol have to be considered when making a decision as to which CoQ10 form should be sourced. Millions of consumers experience its many benefits each day. Ubiquinone and Ubiquinol are redox pairs in that one can be rapidly converted to the other and vice versa in areas where their specific functions are required. Thus, does it really matter which form is taken as a supplement? Yes, it does matter.
    First, there is a cost comparison in that consumers still look for the lowest cost and effective products. Since the forms of CoQ10 can be easily converted from one form to another, it makes sense to choose a form that is more affordable. It was previously mentioned that Ubiquinol molecule becomes oxidized in the stomach. Consequently, taking Ubiquinol as a nutrient is essentially the same as taking the more stable and less expensive oxidized form.
    Second, regardless of the product type, the most critical aspect of CoQ10 supplementation is absorption. Due to the high cost of CoQ10, an understanding of the best delivery system to maximumize absorption becomes the critical component in an effective and successful CoQ10 supplement. Based on the current CoQ10 research, the consumer's best bet is a CoQ10 product with superior absorption properties because dosage levels can be reduced to attain the same effective blood levels and health benefits.
    References available upon request.
    About the Author:
    Dr. William Judy is a retired Professor of Physiology and Biophysics at the Indiana University School of Medicine and the Founder and President SIBR Research, Inc. SIBR Research, Inc. is a contract research center that conducts clinical trials on natural products for the international community. Dr. Judy has researched Ubiquinone (CoQ10) and used it with patients for over 35 years. His initial work was in collaboration with Dr. Karl Folkers, University of Texas. He was one of the first researchers to run long-term clinical trials, spanning 10 years or longer, on hundreds of cardiac patients, many of whom had been "left to die' by the medical establishment. Dr. Judy's articles, reports and reviews have appeared in multiple publications, and he has traveled the world, lecturing to physicians, health care professionals and scientists about the benefits o f CoQ10 in health maintenance and disease prevention. Dr. Judy can be reached at sibrinc@cs.com.

  • Anonymous

    2/21/2008 3:11:00 AM |

    This works for me, period, really life, honest to goodness works.  I was having muscle cramps quite a bit, and tried 30mg first, not enough, then 100mg, and bingo, maybe one mild cramp in the last year.  Powder or gel, don't know, I used both, and they worked for me.

  • buy jeans

    11/3/2010 2:22:54 PM |

    In our experience, CoQ10 does work. It doesn't work all of the time, perhaps just 80-90% of the time. It does generally require higher doses (100 mg per day, occasionally more). It very clearly must be an oil-based gelcap (just like vitamin D) to work; capsules containing powder do not work.

Loading