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.