I'd like to add that there are some specific applications where
getting enough of the substance to the right place is critical, even
if the body makes enough for normal purposes and even if additional
supplements are taken beyond that.  Co-Enzyme Q10 is remarkably
effective at reducing inflamation of the gums caused by gingivitas.
But you won't see much effect at all if you merely swallow a 50 mg
supplement every day.  That gets spread out throughout the body and
very little actually gets to the gums.  But if you take that 50 mg
capsule, puncture the end and use the liquid to brush your teeth you
will see dramatic results far quicker than simply brushing with
toothpaste.  

I believe that current research has shown that inflamations almost
anywhere in the body produce chemicals that are linked to triggering
insulin resistance and thus type 2 diabetes.  That appears to be why
they are getting promising results with aspirin therapy.  But while it
is a good idea for anyone with gingivitas to correct that situation
quickly, it is especially important for people with diabetes or
pre-diabetes.  But you have to get enough COQ10 to the right spot to
do some good.

Sharon,

Almost all of the anecdotal reports on Co-Q have different doses.  The
original patent from Merck suggested they were going to try 35mg.

Co-Q has a long history of being the "non-vitamin". As you pointed out, most
people can synthesize sufficient quantities of Co-Q, thus purists reject the
using the term "Vitamin" with it. The theory is that it can't be a vitamin
if you can make it yourself. Vitamins are only nutrients you can't make
yourself.

Of course, the fact that Vitamin D is manufactured in the body as well is
rarely mentioned by the purists....

William C Biggs, MD

Thanks for the excellent and informative post.

FYI -for severe statin muscle damage, with mitochondrial damage, there are
doctors and mitochondrial specialists who are using as much as 800 mg to
1200 mg per day, concurrent with halting the statin.

Charly,

Co-Q is readily available OTC. Even Sam's Warehouse Club carries it now.

If a patient on a statin complains of any myalgia or muscle weakness, I
usually have them try 150mg a day.

Depending on the severity of the complaints, I might check a CK level to
look for muscle inflammation. If the CK is high, I will stop the statin.
Statins can cause myalgias or muscle weakness even with a normal CK level.
In that scenario Co-Q is often very beneficial, and can relieve the muscle
complaints.

I haven't heard of any adverse effects of Co-Q , other than some people have
found their BG was lower while taking it.

BTW, one of my attendings from medical school , Michael Brown, and Merck
patented the concept of adding Co-Q to a statin back in 1990.

Dr Brown shared the Nobel prize in Medicine with Joseph Goldstein for their
discovery of the statin drugs. Look at patent  4,933,165 at  www.uspto.gov .

IMHO, the incidence of myalgia while taking statins is WAY under-reported.
That's why I wrote the letter published in the Wall Street Journal
criticizing Pfizer for its plans to only market torcetrapib in combination
with atorvastatin (Lipitor). Those persons with muscle problems on statins
will not be able to get torcetrapib.

This scenario reminds me of the mid 80's when patients were telling their
doctors that meds like Prozac reduced their libido, and the drug companies
claimed it was no different than placebo.

The concept of a combination Co-Q / statin drug makes a lot of sense to me.
It makes a lot more sense than "Caduet" which is combines Norvasc and
Lipitor, or the 2002 winner of "Stupidest Drug Marketing Idea of the Year
Award".... Pravagard , which was simply a package with Pravachol and an
aspirin tablet. Not in the same pill mind you, it was two separate tablets.

Cheers,

William C Biggs, MD

What are the criteria, if that doesn't push the limits of medical advice
over the net?

Tiger Lily,

If you mean Arturo Rolla's cocktail, that was CAFE. Vitamin C, Aspirin,
Folate, and Vitamin E.

IMHO, the Vitamin E should be dropped. The evidence for E was always very
flimsy, and more recent studies suggest that it actually increases cardiac
risk above 400 IU per day.

Aspirin is the best documented...Once you get started...don't stop!!
Stopping the aspirin increases your risk of a heart attack or stroke by a
factor of 3 over the next month.

I haven't seen Co-Q on any cocktail lists, but I do recommend it for
selected people on statins.

I have never seen any published data about metformin affecting Co-Q levels.
A quick PubMed search didn't pick up any hits, while there are plenty on
statins and Co-Q.

Perhaps we can suggest another acronym to Arturo, such as Q-FAC.

Cheers,

William C Biggs, MD

just other Dr's words

i believe its in the Harvard Cocktail for diabetics

kate

only CoQ10,

I am skeptical of the claim that Glucophage (metformin) depletes CoQ10
(ubiquitin.)  I couldn't find any such thing in PubMed.  When I
googled, I found several naturopathic sites making the same claim, but
nothing that looked like an authorative site.
Does anybody know more about this claim?

Adam Becker

Statins, Dymelor, Micronase and Tolinase deplete coq10
Glucophage depletes coq10 and B12
Adapin, Aventyl, Elavil, Tofranil, Pamelor, Sinequan and Norpramin
Elavil and some pain killers prescribed for peripheal neuropathy

~~~~~~~~~~~~~~~~~~

02/02/05

Ken Baker Column

Are the risks of nutrient depletion by statins excessive?

Maintenance of healthy heart, nerve, brain, liver, and skeletal muscles
requires CoQ10. Deficiencies have reportedly given rise to congestive
heard failure, weakening of the heart muscles, attention problems,
delayed reflexes, cognitive decline and memory impairment. There is no
serious debate, CoQ10 is absolutely essential to the conversion inside
each cell of nutrients and oxygen to energy. Don't leave home without
it.

Last week we reviewed how Walter, a reader of this column, avoided the
statin drug, Lipitor, by letting food be his medicine. That, coupled
with vigorous exercise, kept him drug free and enabled him to avoid the
risks of CoQ10 depletion.

The average healthy body has stored approximately 2,000 mg of CoQ10.
Each adult uses about 500 mg a day. The average diet provides 5 mg
daily. Where does the rest come from? We make it ourselves.

Our body synthesizes CoQ10. If there is not enough, supplements can
bring up the slack. Internal synthesis of CoQ10 takes place in the
liver, peaking at about age 21-- and by 30, the rate begins to decline.
The process is similar to how the liver manufactures cholesterol. When
a statin reduces cholesterol production, it also restricts production
of CoQ10.

Most of the 67 million people that orthodox medicine estimates are in
need of lifelong statin therapy are over age 50. Many were at risk for
CoQ10 deficiency even before they started on the drug. The statins
increase the prospect of harm. Last summer, the "Archives of Neurology"
published a study from Columbia University College of Physicians &
Surgeons reporting patients on Lipitor for 30 days had a 50 percent
fall in CoQ10 blood plasma levels.

The drug company studies claim the risk is low, between .5 and 2.3
percent, depending on dose. That is somewhere between 335,000 and
1,540,000 people experiencing adverse events. Given that the drug
companies only select healthy people for their drug studies, it is
highly unlikely any of them were taking other drugs known to deplete
CoQ10. The risk of serious adverse effects is almost certainly grossly
understated.

When assessing the risks of statins, the cumulative effect of all drugs
prescribed for the patient must be the focus of attention. It rarely
is.

Heart disease is an especially serious problem for patients with Type
II diabetes. Common drugs for diabetics that deplete CoQ10 include
Dymelor, Micronase and Tolinase. Another commonly prescribed diabetic
drug, Glucophage, depletes not only CoQ10, but also vitamin B12, a
second risk factor for heart disease.

The cumulative effect of these diabetic drugs recently became a matter
for more concern. Last summer, in the "Annals of Internal Medicine," a
prestigious journal with approximately 115,000 subscribers, it was
recommended that virtually all diabetics over 45 be prescribed a
lifetime regimen of statin drugs. Should we be surprised if diabetics'
rates of heart disease grow ever greater?

People who are depressed may also be prescribed statins. Several drugs
commonly prescribed for depression deplete CoQ10: Adapin, Aventyl,
Elavil, Tofranil, Pamelor, Sinequan and Norpramin. Another reader,
suffering from neuropathy, was prescribed Elavil and two other pain
killers that deplete B12. Her doctor mentioned neither CoQ10 nor B12.
Yet these nutritional deficiencies are risk factors for the very
disease he was treating.

Patients that are claimed to be at high risk because of elevated
cholesterol may also be taking other drugs targeting cardiovascular
disease. The following heart disease drugs may provide benefits, but
they may also have adverse effects on heart health. When combined with
statins, the total CoQ10 depletion could shift the balance from a net
benefit to an unacceptable risk. Those drugs include: Corgard, Inderal,
Lopressor, Betapac, Tenormin, Sectral, Biocardren, Aldomet, Catapres
and Apresoline.

Orthodox medicine seems to have turned a blind eye to risks brought on
by nutrient depletion. Drug companies do not test for or report on its
consequences. The National Institutes of Health appears to be doing
little. The FDA is oblivious. It has been petitioned twice to require a
CoQ10 depletion warning for statins. So far, nothing.

Of the near-dozen statin takers who wrote in response to last week's
column, only one reported being advised to supplement with CoQ10. More
broadly, last summer's Clinical Practice Guidelines for diabetics from
the American College of Physicians make no mention of CoQ10
supplements.

What to do? When prescribed a drug, always ask your doctor if it
depletes any nutrients and, if so, what are the long term consequences.
Certainly, if prescribed a statin, ask, "Is CoQ10 right for me?"

If you draw a blank with the doctor, try your pharmacist.

Author and lawyer, Ken Baker is currently writing a book on
20th-century psychiatry.

http://www.rxpgnews.com/printer_297.shtml

E-mail Ken Baker at kenbaker@andso.com.
By KEN BAKER

New Perspectives Columnist