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For many years, I have been teaching patients, and doctors, about the life-giving benefits of Coenzyme Q10 and L-carnitine. Looking back, using them in my practice represented our first steps into the world of metabolic cardiology—the treatment of heart disease on a cellular level by improving individual cell function and energy production. The effect of these nutrients on cellular energy has now been experienced by thousands of heart patients, who improved the quality of their lives by the simple supplementation with these “Twin Pillars” of cardiac health.

Now a new nutrient, D-ribose, has arrived on the scene, heralding a second generation of metabolic cardiology. In combination, these nutrients provide the metabolic support hearts and other body tissues need to generate and maintain the energy required to promote health and vitality. I’ve watched nutritional interventions improve and literally save lives when traditional medicine just wasn’t enough. Now, I employ them as my first line approach whenever I can.

One of the most important discoveries physicians and scientists have made in recent years is the evolving study of cellular energy, or bioenergetics, and the impact cellular energy metabolism has on heart function. In her recent book, ATP and the Heart, Dr. Joanne Ingwall writes about the role of ATP (adenosine triphosphate, a biochemical required for cellular energy) in heart function:

“A major clinical challenge today is to develop strategies to preserve or improve [heart] pump function while maintaining cell viability. To achieve this goal, an understanding of the metabolic machinery for ATP supply and demand is required . . . Every event in the cell, directly or indirectly, requires ATP. Myocytes [heart cells] need ATP to maintain normal heart rates, pump blood and support increased work, i.e., recruit its contractile reserve. The myocyte needs ATP to grow, to repair itself, to survive. The requirement for ATP is absolute.”

Dr. Ingwall's credentials are impressive, and she is particularly well qualified to make these statements. As a professor of medicine (physiology) at Harvard Medical School, and senior biochemist and director of the nuclear magnetic resonance (NMR) laboratory in the cardiovascular department of Boston's Brigham and Women’s Hospital, Dr. Ingwall has spent her professional life studying the role of energy metabolism in the heart. Her book, published in 2002, supports the need for understanding the complex mechanisms of cellular energy metabolism when devising therapies for treating cardiovascular disease. ATP and the Heart should be required reading for any professional working in this field.

To supply this absolute and continuing need for energy, the body’s many complex systems rely on a variety of nutrients that are used within the cell to drive, control, and facilitate the myriad biochemical reactions that provide energy to the cell. Because none of these nutrients works independently, a “synergy” of nutrients is oftentimes what’s needed to offer results superior to that of any single nutrient. Improving the function of one cog in the wheel of metabolic machinery for energy production increases overall efficiency when the other cogs in the machinery are also working at their peak. It’s not “fuzzy math” at all.

Think of it this way: in simple math, things are additive; one plus one clearly equals two. But when you combine the right nutrients together to work synergistically, the advanced math results can be exponential; one plus one can equal five or even ten! You don’t merely add up the benefits of each nutrient in sequential fashion. Instead, these synergistic effects mean that an explosive combination of nutrients can have an exciting, positive impact on one’s well-being, and even on life itself.

Unfortunately, the understanding of the metabolic role of energy in heart function is not well-known by medical practitioners, and the impact of supplementing the heart with energy-supplying nutrients is not appreciated. Here is an example of how this lack of understanding caused one man unnecessary despair, as well as a delay in treatment.

Jim was a 76-year-old living with congestive heart failure and ischemic heart disease. In 2003, his disease worsened to the point that he could hardly walk. Jim’s examination and testing at his cardiologist revealed an ejection fraction of only 14 percent.

Jim had heard about D-ribose, L-carnitine, and Coenzyme Q10, so he asked his doctor if he should try these supplements to improve the energy in his heart. Jim was told, “No. There simply isn’t enough science to show that these work.” Undaunted, Jim made an appointment with a second, and then a third, cardiologist to seek advice on taking these important, life-giving nutrients.

In every case, Jim’s request was refuted and he was either advised that there was “insufficient science” to show their effectiveness, or that “these supplements don’t work,” by physicians who just weren’t doing their homework. Clearly, these strongly biased doctors failed to understand the vital role that energy metabolism plays in heart function.

Still skeptical, but anxious about going against the advice of these medical professionals, Jim contacted me for an appointment and was evaluated by my associate, Dr. Sun King Wan, an invasive interventional cardiologist. Following a complete cardiovascular workup, my “first-knight” nurse, Rosie—who’s been with me for thirty years—started Jim on a cocktail of nutrients, including D-ribose, L-carnitine, Coenzyme Q10, and a mixture of B vitamins. Jim simply mixed what he refers to as “Rosie’s cocktail,” in orange juice three times per day. Within four days, Jim could walk farther than he’d been able to in months. A couple of weeks later, Jim was painting the rails on his porch, and within four weeks his ejection fraction had improved to 24 percent.

While there’s still improvement for Jim to make, within a month his heart function had improved by over 50 percent simply because his heart was able to restore the energy—on a cellular level—that was being sapped by his disease. Following Jim’s progress, my clinic partner, with his modest prior understanding of the importance of energy metabolism in heart function, was so impressed that he now recommends these nutrients to all his heart patients, too.

When it comes to heart disease, D-ribose, L-carnitine, and Coenzyme Q10 have become the triad of nutrients we rely on for healing and prevention. You will soon see that these nutrients can rocket your heart and muscle energy to new heights. They do this by maximizing the amount of oxygen that your heart and skeletal muscle can extract from your blood, by accelerating the rate at which the food you eat is converted to energy in your cells, and by keeping your cellular energy pool healthy.

This book reflects a twenty-year learning curve in my practice of integrative cardiology. I’ve been using Coenzyme Q10 during that entire twenty year period, L-carnitine for the past ten years, and D-ribose these last couple of years.

The synergistic combination of D-ribose, L-carnitine, and Coenzyme Q10 has been a tremendous breakthrough in the treatment of heart disease, and has become my personal nutritional arsenal for boosting the heart’s energy. You see, whatever the patient’s cardiac condition, getting back to a healthy heart is about supporting each individual heart cell and encouraging them to join forces and strengthen the heart as an energy pump. So the bottom line for your heart is always about ENERGY!

Because L-carnitine and Coenzyme Q10 both work in the inner mitochondrial membrane, the clinical purpose of these nutrients is to complement one another in accelerating energy supply to heart cells. D-ribose works to maintain the healthy pool of energy substrates needed by L-carnitine and Coenzyme Q10 to work effectively. Clinically, working together these nutrients can help assuage cardiac arrhythmia, reduce the risk of heart failure, overcome the severe weakness and fatigue of coronary artery disease, increase exercise tolerance, relieve cramping and soreness in the lower extremities (claudication), T and improve the quality of life for patients suffering with these conditions.

This triad is not only remarkably effective in preserving heart health, but is also outstanding in the treatment of neuromuscular diseases, such as fibromyalgia, that are also affected by failures in cellular energy metabolism.

Although hundreds of scientific papers have been published in noteworthy scientific and medical journals describing the individual roles of these naturally occurring compounds in preserving the energy health of your heart, skeletal muscle, and other tissues, you've probably never heard or read about the exciting combination of D-ribose, L-carnitine, and Coenzyme Q10.

Nor are you likely to have heard about these revolutionary treatments from your doctor. Why? Because even though the scientific literature clearly presents the science, and thousands of clinical applications have documented that these compounds have proven beneficial for treating a wide variety of clinical cardiac conditions, therapies like D-ribose, L-carnitine, and Coenzyme Q10 are still largely ignored by a majority of clinical cardiologists as well as most of the conventional medical establishment. Despite the fact that these three nutrients are used by many board-certified cardiologists in the United States, Europe, and Japan, most clinical cardiologists generally remain biased by ignorance or a deep-rooted reliance on pharmaceuticals. Unfortunately, the many patients who are not helped by conventional treatments alone or whose treatment could be greatly enhanced by the addition of D-ribose, L-carnitine, and Coenzyme Q10 will never be offered the chance to receive them.

Besides the widespread ignorance about supplemental treatment with this triad, it is equally tragic that there is so much negative bias against these nutritional therapies. One of the major obstacles to evaluating the benefit of nutritional therapies is the claim by many physicians that there is a lack of scientific data on the subject. Although most conventional wisdom is subject to the current "gold standard" of evidence-based scientific controlled studies, there are literally scores of studies on Coenzyme Q10, L-carnitine, and D-ribose demonstrating this exact rigorous standard of controlled analysis. For example, if you go to the Internet and type in “Coenzyme Q10” as a search word on the Pub Med site, you will see 1,254 published articles in various scientific and medical journals. Type in Q10's generic name “ubiquinone,” and the count rises to 5,769, most of which represent sound science-based inquiry. L-carnitine and D-ribose will bring up thousands of results. So, I'm confused when my peers say “there's no data.”

The rejection of D-ribose, L-carnitine, and Coenzyme Q10 as potent, nonprescription treatment defies imagination. It's apparently difficult for highly trained medical personnel, well versed in pharmacology and technology, to believe that anything so simple and so natural could be as effective as the highly engineered drugs modern medicine has to offer.

Most American cardiologists cannot acknowledge that a natural substance not manufactured by pharmaceutical industry giants could be so valuable. These factors have rendered therapies including D-ribose, L-carnitine, and Coenzyme Q10 victims of politics, bias, insufficient marketing, economics, and ignorance regarding the results of real science.

That is not to say that the nutritional supplement industry is blameless. Too many dietary supplements—claiming to treat everything from heart health to weight loss to male sexual enhancement—have hit the market with major media campaigns, plenty of claims, and a host of promises, with little, if any, science behind them. There can be no doubt that this “hype versus science” attitude in the nutritional supplement industry has placed major roadblocks in the path of acceptance of those natural therapies that do have solid science and demonstrable clinical benefit, and has encouraged many morethan- skeptical attitudes among health care providers.

Another dilemma is the not-all-are-created-equal issue regarding nutritional supplements. While many products are pure, many others fail to live up to the ingredients and dosages listed on their labels. The FDA monitors our pharmaceuticals, but not the supplement industry. While FDA involvement would spuriously skyrocket the cost of many vitamins and supplements and place them outside the affordability range for many people, it is not easy to know which products are worthy of your financial investments at present. This darkens the cloak of suspicion for many physicians. For now, I can only advise you on the products I've tested and found to be of high quality, and hope for some standards to be developed in the future.

It is also true that manufacturers and distributors of D-ribose, L-carnitine, and Coenzyme Q10 do not have the financial and physical resources to “detail” these products to physicians as major medicinals, as the pharmaceutical companies do with their new drugs. These companies have thousands of sales representatives on the street visiting doctors everyday, and they are able to start and run campaigns to educate physicians about new products. Such campaigns can cost tens, or even hundreds, of millions of dollars. This effort is simply too costly for smaller companies trying to reach the broad and highly diverse audience of health care professionals suffering from a complete lack of knowledge about these revolutionary treatments.

This book will specifically discuss the importance of energy metabolism for cardiovascular health and the impact of these three nutrients on the cardiovascular system. But the story should not end there. All three of these miracle ingredients—D-ribose, L-carnitine, and Coenzyme Q10—are being used right now in a wide variety of serious degenerative diseases, including heart disease, high blood pressure, cancer, periodontal disease, chronic obstructive pulmonary disease, diabetes, neurological disorders, neuromuscular disease, male infertility, and even aging itself.

Part three of the series from The Sinatra Solution, Metabolic Cardiology will appear in the next issue of totalhealth.

Stephen T Sinatra, MD

Dr. Sinatra is a board-certified cardiologist and certified bioenergetics analyst who also uses complementary nutritional and psychological therapies at his New England Heart Center in Manchester, CT. He is the author of Lose to Win: A Cardiologist’s Guide to Weight Loss, Optimum Health, The CoenzymeQ10 Phenomenon and, Heart Sense for Women, published by LifeLine Press.