Nutrition & Dieting/Confusion Over CoQ10 effectiveness
AF wrote at 2012-10-19 08:36:03
I wish I had the time to answer this question - but I'm preparing for a therapeutics midterm at the moment and ran across this thread. I am studying pharmaceutical sciences at the University of British Columbia, and a lot of the questions you've addressed here interest me - and i can guarantee you that there are answers.
since i Lack the time to properly address this question i will try to summarize VERY VERY VERY briefly. What you ask is realy openign Many cans of worms and has taken me nearly a decade of studies to even begin to comprehend.
1) To take CoQ10 or not. Should anyone: The short: Find a Doctor of pharmacy (pharmacist) who is well versed in cardiology, or a cardiologist who is well versed in biochem, statins and preferably is doing research in the area. The answer we'd all say is - we dont really know - maybe.
-Should YOU take it: Find a competent pharmacist or cardiologist, or several doctors. Discuss the issue to get an understanding of its potential role as a supplement for you. The question of whether or not to take CoQ10 comes down to a multifactorial process - not least of which is - "Are you deficient in CoQ10" - which is usually identified by IDing risk factors and clinical symptoms of deficiency (such as myalgia, fatigue, statin use etc..
What is it?
CoQ10 Ubiquitin, is a small molecule/chemical protein cofactor - specifically a co-enzyme- that is produced by every nucleated cell in your body - it functions in the mitochondria as an integral part of the energy cycle. It joins specific enzymes (at least one) (with varying degrees of affinity and action) which catalyse specific chemical reactions in your body. Enzyme activity is a HIGHLY REGULATED process with up regulation down regulation of various substrates. Ok.. trying not to get into details. For it to do its job as a cofactor it must be at the site of action, with the enzyme(s) have the necessary substate(s) and as far as i know for ubiquitin and ubiquinone - that is exclusively INSIDE a mitochondria, inside a cell. - Details alone here are enough to justify a very indepth and specialized PhD - in several fields (Biochem, Medicinal Chem - to make the point) so i will spare you - as the details here are incredible, but studied and its importance is great, but far from well understood. That is not to say we dont know anything about it. In fact everything from here on in is highly summarized state of how i understand it today and the details necessary in answering these questions are astounding. Not least of which is the pharmacogenomic (Gene expression-Drug action) implications of coQ10 in a specific person.
if you want the end answer i summarize thus: It Depends.
is CoQ10 good for you - YES - like water, and millions of other things, we'd die without it. Should you take it? See above.
2:. Re: Researching on the Net. Take it with a grain of salt. The internet sucks for any kind of medical info. In fact, its the worst source for research possible. Theres a reason why everything says talk to a Doctor or a Pharmacist. Because just to get our feet running it takes nearly 10 years of the most intense university education one could hope to imagine.. And even still, id say. its a crap-shoot because we all have our own areas and levels of expertise, experience and knowledge - all at varying degrees of currency. Trusting the internet is to trust a total stranger talking about something in which they have no identifiable or credible experience or knowledge or information in.. its a way to get opinions from people. Everyone has one, but damn sweet few have ANY idea what they are even dealing with before they try and answer. In fact, most people's opinions (in my opnion) are bloody dangerous when it comes to medicine - because 99.999% of people dont have a flipping clue about what they're talking about. Medicine and allied fields are not some postage collecting study of pop-facts, opinion, or current culture. We have a Term we like here at UBC "Personalized Medicine" - because its just that.. TV doctors and internet lobbys cant do medicine any justice. Research is a highly trained skill that necessitates access to resources at universities that 99.999% (whimsical estimate) of the public do not have access to, and for those who do have access, it takes considerable time (potentially years) and skill to collect trials, critically appraise them, boil down findings, compare to the state of practise, understand and compare with current text book (tertiary references -aka - overly simpified textbook explanations of dated compiled info.) It takes significant scientific training and practise to find and interpret scientific literature, RCTs, Cohorts, Analyses, Peer reviews, Cochrane Reviews, Meta-analysis, and various other types of studies .. and interpret them. Plus we have issues with "publication bias" - only seeing some of the studies ( for example - fewer studies are published which show zero effect. Also, we dont have access to read studies in another language unless we speak it fluently and are trained in it)
Allow me to clarify - Google Scholar might be a good shot at finding SOME of these studies, but thats the easy part mate. Its the critical apprasal that takes time and makes the bulk of difference.
I beg you to critically appraise any info you read online.
The type of research needed to answer your question is beyond the majority of people - and for those of us who can even approach the idea of answering these questions - ultimately it comes down to "probably this or probably that"
Statins and CoQ10.
These drugs work in a variety of ways effectively to reduce relative risk of primary and sometimes secondary cardiac events by several pharmacological mechanisms. Reduce LDL, increase HDL, Reduce VLDL (TGs), reduce C-reative Protein, Decrease prenylation of proteins, decrease cholesterol synthesis by decreasing mevalonate precursos by inhibiting HMG coA reductase.. blah blah blah..
Thats a massive amount of info i could get into but will spare the exhausting details.
The short of it is unfortunately mevalonate is also needed for your body to make CoQ10, so a side effect of statins is reduction of CoQ10 (as evidenced by decreased plasma levels - and we know it doesnt work there, but in the cell so is it relevant.. probably but we dont know for sure yet)
About all this and Clotting - one other modifiable risk factor for Cardiovascular risk.
First you must know that clotting is a very complicated concerted process which is highly regulated, very sensitive, dynamic and involves (lets say) hundreds of chemicals, substrates and mechanisms all working in balance.
This is to say that changing one thing results in a shift in all the other things to compensate to re-equilibreate this chemical reaction balance.
CoQ10 is a coenzyme.
Vitamin K is a coenzyme
they activate or are necessary in the function of enzymes - because of their physical properties and roles in their respective enzymes binding to their substrates to ensure catalysis of the ligand.
In blood clotting, CoQ i speculate MAY have some antagonistic(rate slowing) or agonistic (rate increaseing) effects upon certain proteins such as Prothromin and at least several other enzymatic factors. These effects MAY cause up regulation or down regulation of other necessary processes to re-equilibreate balance. All of these processes produce a variety of products which must be in a specific dynamic balance to ensure effective clotting. When blood is "thinned" the balance of these factors favours longer prothrombin times and is assessed in part by INR ratios. The result is we bleed longer before clotting. .. or the opposite is possible - clotting factors may be greater, increasing clotting efficiency and decreasing prothrombin time. - bleeding stops faster.
For these meachnisms to Start clotting, there needs to be a signal cascade. Messenger molecules from burst cells start the process. with each step occuring at a specific rate/speed depending on its own set of variables (can of worms). All of these acumulate in the function of cotting.
In atherosclerosis, a disease state, clots form as a result of another multifactorial pathophysiological process involving macrophages (part of the immune system), excess Apolipoproteins delivered by LDL cholesterol miscalls, and inflammatory mediators. Other prostaglandins and mediators effect the tissue behind the blood vessel. Infact.. all of this occurs OUTside the blood vessel - not inside. UNLESS one throws a clot due to the rupture of a bloodvessel wall - starting the clotting.
Coumadin (warfarin) shifts the balance to slow the clotting rate to decrease the size of the clot IF this burst happens.
In a person with a disease state caused by or exacerbated by inadequate blood clotting balance (very delicate dynamic processes) taking coQ10 MAY have the potential to shift this prothrombin time in one direction or the other - away from targeted normal levels - it is for this speculative reason that it is suggested we do not recommend CoQ10 in this general population, as it may alter the balance and necessitate changing of doses/therapy to re-establish favorable balance. We want to slow the clotting process just enough to reduce risk of thrombus formation, but not enough to cause hemorrhaging. A fine balance indeed - so changes in either direction by the added CoQ10 variable are not wanted. Drug monographs and patient pamphlets highly over simplify this - just as i have. Essentially boiling it down to .. um.. come talk to a dr or pharmacist first.
CoQ10 and the heart. The body chemistry is incredibly complicated - well beyond belief. CoQ10's actions on the heart have more to do with the heart muscle - in some people with low coQ10 levels, muscle function/power may be decreased because of the inadeqaute rate of production of energy in the muscle cells. As i mentioned above CoQ10 is an electron carrier in the mitochondiron in every cell, playing an integral part in shuttling electrons to the ETC for the production of energy carring molecules such as ATP GTP from catabolic metabolism of sugar or proteins etc..
For these people with specific types of heart issues, taking coQ10 can restore/increase Ventricular Free fraction/force by making up for that decrease in energy production rate. .. Muscle growth can compensate (bad). etc..
This really is highly over simplified.. but .. i dont know what I can say...
If your on statins and are experiencing myalgia, or if you have a specific type of heart failure, you MAY benefit from coQ10... otherwise your body is likely making enough of it on its own.
As for the bleeding friend taking warfarin. Sounds like their dose was increased too fast - thats all. We dose stabilize patients on coumadin while taking other drugs with blood thinning effects all the time if it is necessary. Bleeding is an unavoidable risk of anticoagulants. But as with any drug, Risk:Benefit must be favourable before there is intention to treat.
"It worked for me" or "it didnt work for me" or "it did this to me"
is never evidence. Heres a few reasons
-Genomics/Patient demographics un identified
-comorbidities/aggrevatign factors unquantified
-Not compared or statistically valid.
-No control or placebo.
-Insufficient evidence to establish causality/cause.
-retrospective self reporting
-Clinical assessment of self questionable
-identification of symptoms and physiological cause
-Why did the pt bleed can be explained by a multitude of other more probable and verifiable causes. - not least of which - both the condition and the medication increase the potential of bleeding.
I dunno. Hope that helped.
Ed wrote at 2013-07-19 11:07:10
I followed your answers in relation to Dominic's concern about taking CoQ10 giving rise to forming clots.
I am going to menopause soon I think as I feel v tired and slso cholesterol slightly high at 5.5.
Taking Q is a good one I heard. However on hearing the incidents from Dominic, I would like to know more about the effect of Q.
I have a blood disorder called deficiency in protein S, which means my blood is slightly thick. But i don't need to take medication except a clexane injection if i fly more than 7 hours. Can I take coq10 then since i am not on any medication except daily gastric pills and when i fly just clexane injection. Thank you.