Healthy Andy

A study published in the Journal of the American Medical Association suggests that drinking green tea can help you live longer.  Many studies in the past have examined the specific health benefits of either green tea, or the active antioxidants in green tea, but this study examined the actual consumption of tea and compared it to mortality rates in Japanese adults.

The Ohsaki National Health Insurance Cohort Study

This study began back in the ’90s in Japan, following over forty thousand adults over the age of 40 without any history of major chronic disease (heart disease, cancer, that sort of nasty stuff).  Individuals were followed up on over the course of the next eleven years to see how many had died from any cause. Participants filled out a questionnaire that asked some basic questions about daily nutrition habits, including the consumption of green tea.  This makes this study very similiar to the Nurse’s Health Study, a study that has followed over 100,000 nurses over the course of decades (except, since it’s an American study, they don’t specifically ask about green tea).

For the Ohsaki study, participants were asked if they drank green tea never, occasionally, 1-2 cups per day, 3-4 cups per day, and 5 or more cups per day.  The authors noted that the typical “cup” of green tea is about 100 milliliters (about 3.5 ounces).

By the way, one of the nice things about this study is, the researchers took the time to see if their questionnarie was at all accurate.  They picked a sample of people and had them do a more comprehensive food diary for three days on four seperate occasions.  They found that there was a moderate to strong correlation between reported intake and actual intake.

The Results: Green Tea Makes You Live Longer

After accounting for potentially confounding variables like age or physical activity, the researchers found that the more green tea people drank, the less likely they were to die from any cause.  The effect was obviously most noticeable in the 5 or more cups of tea per day group; if you used non-tea drinkers as a baseline, the hazard ratio was 0.88 for the 5 cups a day drinkers.  This means that for every 1 non-tea drinker, 0.88 tea drinkers died… which basically means green tea makes you live longer.

The effect was even MORE pronounced among women; the hazard ratio was 0.77 for the heavy tea-drinkers.  So for every 100 non-tea drinkers who died, only 77 tea drinkers died of any cause.  The researchers followed these effects for eleven years.

Then, they took a look at more specific causes of death (they reviewed data for seven years for this). They found that green tea consumption significantly reduced the risk of death from cardiovascular disease, but didn’t reduce the risk of death by cancer.  After looking even closer into the data, they found that when it came to cardiovascular disease, the greatest protection was from stroke.  Once again, the effect was most pronounced in women, who had a 42% less chance of death by stroke if they were drinking 5 or more cups per day of green tea (compared to one or less).

This shouldn’t be a big shock to readers of this website- we’ve talked before about how antioxidants make arteries more elastic and pliable (and therefore healthier).  Since strokes are caused by either blockage or rupture of an artery in the brain, healthier arteries are going to be less prone to those kinds of problems.  And I don’t know about you, but I have no deep and burning desire to experience a stroke, so I’m going to keep drinking green tea and live longer than I would have otherwise!

Stay healthy!

By the way, the full text of this study is available online for free at this link:  http://jama.ama-assn.org/content/296/10/1255.long

“Fish Oil May Not Prevent Depression, Says Study”, says the headline on a leading news website, even though the study isn’t about taking fish oil. Lies and misrepresentations tend to make me froth at the mouth in furious anger, so I just can’t let this go unanswered.

The latest in a long tradition of crappy science mixed with crappy journalism, this MSNBC article summarizes the results of a poorly-designed study which leaps to incorrect conclusions, and in the process, misleads the reader even more by interchanging the words “fish” and “fish oil”. Well, let’s see if Healthy Andy can’t untangle this mess for you.

First off, the study is question was published in the American Journal of Clinical Nutrition, and was based off of a large nutritional survey that followed over 50,000 nurses over ten years. To sum up, the researchers checked to see who was eating fish, compared that to who ended up getting depressed, and found no correlation. Then, they declared that EPA and DHA, the main active ingredients in fish oil, have no effect on preventing depression.

Hang on, buster. Not so fast.

Let’s start by correcting the journalist who wrote that misleading headline. This study did NOT study the effect of taking fish oils. It studied the effect of eating fish. It’s not the same thing.

Does it sound like I’m splitting hairs? Here’s why there’s a difference: dosage. Eating fish obviously will provide EPA and DHA from the oils naturally present in the fish. However, it’s nowhere near as much as you get by taking a fish oil supplement.

In fact, dosage is the big reason why this entire study and subsequent news article should be kicked in the head and shown the door. If you eat some high Omega-3 fish every day, you MIGHT end up with a gram or two of EPA and DHA. And while that’s the dosage range I recommend for people without any problems to use as a basic health maintenance dose, if you look at the dosage used to actually treat depression, that’s a whole other story.

If you want to actually treat depression or similar mood disorders, you need to think bigger than a gram or two a day.  Try more like nine or ten grams a day of EPA and DHA.

So, not surprisingly, if you only give someone about one tenth the required dose to make a certain change in the body, YOU’RE NOT GOING TO SEE ANY CHANGE.

Plus, how much fish were these women eating?  What counts as “eating fish”?  Do shellfish count?  Farm-raised fish (which has very little Omega-3)? Did they calculate out the EPA and DHA content of the fish?  That would be pretty hard to do in this case, seeing as how they are relying on a recall survey (“what did you eat yesterday?”), and people really suck at estimating portion size.  Did these women eat fish every day?  Every other day?  How much and what kind (since different varieties of fish have differing Omega-3 contents)?

The bottom line is, the researchers really can’t tell how much EPA and DHA these people were ingesting on a regular basis.  Which means, they really can’t reach any conclusions about anything.

At best… at BEST… if you ignore the  fact that the researchers couldn’t accurately estimate Omega-3 intake, this study suggests that it’s hard to eat enough fish to improve mental health.  Which, I could’ve told you before, simply by looking at the dosage used to treat depression (nine to ten grams daily… you’re talking several pounds of high-quality fish here).  But to use a headline stating that fish OIL doesn’t have any effect on depression, is just plain wrong and misleading.

In fact, fish oil does seem to have a positive effect on depression.  You just have to take a sufficient dosage.  So shut your face, MSNBC, and do your homework before you go writing headlines.

Is green tea a weight loss supplement?  A surprising number of studies suggest that there is evidence to belive this to be the case.

First off, a couple of side notes.  Green tea has a huge number of health benefits far beyond mere weight loss, from antioxidant and anti-cancer properties to helping you keep your teeth.  I’ve discussed a few of them on this site in the past.  So I consider it a good addition to your health routine irregardless of any weight loss effects.  However, I also feel the need to point out that no weight loss supplement ever invented will beat good old fashioned diet and exercise habits for turning your bulging belly into a flat one.

At best…. at BEST… you can hope for a supplement to enhance your diet and exercise changes by MAYBE 10%.  If you’re trying to get more than that out of a supplement, you’re probably doing a mildly glorified version of smoking crystal meth. 

In case you’re wondering, I do not advise smoking crystal meth for weight loss, or any other reason, really.

Okay, back to green tea and weight loss. A recent meta-analysis out of the University of Connecticut suggests that green tea catechins (these are the antioxidants in green tea) can indeed help with weight loss, but only if there’s caffeine involved.

First off, for those of you unfamiliar with the term “meta-analysis“, that just refers to taking a whole bunch of studies and sort of summing up their results into one bigger group study.  The researchers don’t actually perform a scientific study of their own; they just borrow other people’s data.

They’re nice because you get to pool data into a much larger pile than one study alone can hope to do.  And, they’re cheap and relatively easy, because hey, somebody else did all the hard work of finding subjects and measuring them and poking them with a pointy stick (okay, not that last one). 

The bad news is, they are really, really vulnerable to researcher bias, in that if I’m a researcher and I really, really feel strongly that green tea is a super-fantastic weight loss supplement, I might (consciously or subsconsciously) only select those studies which will support my opinion.  This happens a lot more than you might think, so be aware of this particular limitation.

The Green Tea Weight Loss Meta-Study

In this case, the researchers found 15 studies that compared the use of green tea catechins with caffeiene to the use of the same green tea stuff without caffeine.  Added together, this provided a total of over 1,200 subjects, and when it comes to scientific analysis, more subjects is more better-er, as my Pappy used to say (not really). 

What they found, was that you pretty much had to have green tea plus caffeine in order to see any effect.  Green tea catechins alone didn’t seem to do much, and while caffeiene had some effect, it worked far better if you had green tea added in.  The effects were measurable for body weight, BMI (body mass index), and waist circumference.

Here’s the bad news.  When you read the fine print, this study doesn’t seem quite as strong.  Not every study measured the same things.  The dosages varied (of green tea as well as caffeine), as did the length of time the subjects were followed.  Basically, this was a real patchwork quilt of studies that didn’t seem to fit well together into a meta-analysis.

Still, it gives a crude indication that there’s probably something going on in the whole green tea- weight loss arena.  So let’s look at some more evidence.

The Green Tea Air Chamber Study

One study measured acutal energy expenditure in ten subjects with either placebo, caffeiene, or green tea extract (with caffeine).  Each subject was tested on three seperate occasions under three different conditions.  The researchers found a 4% increase in energy expenditure in the green tea group.  

How did they measure energy expenditure, you ask?  By sealing the subjects in a “respiratory chamber” for 24 hrs and measuring the changes in oxygen and cardon dioxide levels, and then using a fancy-schmancy equation to indirectly guess at how much energy the subjects were burning off.  Frankly, I’m not very familiar with that technique, so I can’t tell you how accurate it is or isn’t.

If we take it as a given that this technique is accurate for estimating energy expenditure, this is a nifty study, but ten subjects is a really small sample size.  This alone put this research more in the “pilot study” category, which is kind of a mini-study that checks to see if we should bother to make a bigger, more expensive study on the subject.  But by itself, it’s not too convincing.

The Bigger, More Expensive Green Tea Weight Loss Study

Okay, here’s a really good one.  A study published in the Journal of Nutrition in 2009 took a bunch of people, had them keep their caloric intake consistent, and had them exercise for three hours a week (some of it supervised).  Half of them got a caffeiene only supplement, the other had a green tea extract/caffeiene mix (the caffeiene level was the same as the other group).  Twelve weeks later, they checked the results.

What they basically found was that the green tea extract enhanced the exercise-induced weight loss.  Not a lot, but since they had over a hundred subjects, it was enough to be noticed.  What was most interesting was the effect on abdominal fat distribution.

You see, they didn’t just weigh these people.  They used CT scans to find out exactly how fat their bellies were before and after.  While the effects of green tea on body weight were only mildly noticeable, there was a much more obvious effect in abdominal fat distribution.  Specifically, the caffeiene only group had an average total abdominal fat area decrease of 0.3%, while the green tea group had a total abdominal fat loss of 7.7% on average.

I like this study because it directly measures what we really care about (does green tea make my big belly get smaller) rather than indirectly measuring something that maybe, kinda-sorta, somehow has something to do with what we want (like the energy expenditure air chamber thing).  Plus, they had a good sample size and simple-but-solid study design… the kind that’s harder to screw up.

And, they confirm what I told you up at the top of the page.  Supplements don’t do THAT much.  It’s the diet and exercise that will pull the heavy weight.  Even with large levels of green tea supplements (over 600 mg/day), there was only a small difference in fat loss over control… and these people were exercising, as well. 

So, in the great green tea weight loss supplement debate, remember that supplements only nudge you in the right direction… diet and exercise are going to do the real work in fat loss.

Article citations:

Meta-Study:

Effect of green tea catechins with or without caffeine on anthropometric measures: a systematic review and meta-analysis.Phung OJ, Baker WL, Matthews LJ, Lanosa M, Thorne A, Coleman CI.Am J Clin Nutr. 2010 Jan;91(1):73-81. Epub 2009 Nov 11. Review.

Itty-Bitty Respiratory Chamber Study:

Dulloo AG, Duret C, Rohrer D, et al Efficacy of green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans. Am J Clin Nutr 1999;70:1040–5

Green tea catechin consumption enhances exercise-induced abdominal fat loss in overweight and obese adults.Maki KC, Reeves MS, Farmer M, Yasunaga K, Matsuo N, Katsuragi Y, Komikado M, Tokimitsu I, Wilder D, Jones F, Blumberg JB, Cartwright Y.J Nutr. 2009 Feb;139(2):264-70. Epub 2008 Dec 11.

A recent question arose concerning fish oil side effects, and since I discuss so much about the value of fish oil supplements, it only seems right to specifically address any safety concerns people may have.  The good news is, there really isn’t much to worry about.

This is NOT how to take fish oil.

In fact, when it comes to fish oil and safety, the main concern is not side effects from the fish oil, but a concern about potential toxins contaminating the supplements.  As I’ve mentioned in previous posts, the very first thing to check when buying fish oil is to insure that it is filtered, particularly for mercury and dioxins. 

The oceans of the world are horribly, horribly polluted… there’s apparently a giant swirling pile of garbage the size of Texas floating around out there… and if you’re a fish swimming around in those nasty chemicals 24/7, it isn’t such a stretch to recognize that some of those chemicals are going to find their way inside of that fish.  And if another fish eats that polluted fish, or many polluted fish, then all of those chemcials will become concentrated in the bigger fish as a result.

And if another, even BIGGER fish, comes along and eats that super-polluted fish… well, you get the idea.  The point is, toxins tend to get concentrated as you move up the food chain.  Then, you add in the fact that fish oil is basically a concentrated fish product, and you really, really concentrate a lot of the industrial pollutants into this product.

Most repuatable brands filter their oils for just this reason, so there’s no worry.  But, some of the real cheap-o brands out there don’t bother (it’s the most expensive step in the filtering process), so if you’re buying your fish oils at Walmart or Target or some other bargain basement place, be sure to double check on the label to be sure your fish oils are filtered.  In fact, just check regardless of where you get them.  I’d hate to see you grow a second, evil head from something so easily prevented.

Mild Side Effects Of Fish Oil

So other than extra evil heads, what other potential fish oil side effects are out there?  Well, there’s a couple of mild ones.  If you’re not used to fish oils and you start taking too much, too fast, you might start burping up fish taste (that’s called “fishy repeat”).  Kind of gross but harmless, and fairly easy to avoid.  Just ease gradually into your dosage over time, stick to good quality products, and take your fish oils with food (preferably something with fat in it).  You can also split the dosage up over the course of the day.

Related to that same idea is gastric upset, also known as “sore tummy”.  Again, the same things that cause fishy repeat are behind an upset stomach.  You may just be taking too much, too fast, or taking a particular brand that your body has an issue with.

These are relatively mild concerns.  Some more serious concerns are allergic reactions, blood thinning, and issues with pacemakers.

Allergic reactions are pretty self-explanatory.  If you’re allergic to fish… don’t take fish oil.  There’s unclear evidence on the interaction of fish oil with an increased irregular heartbeat for those people with pacemakers.  If this is you, talk to your doctor before supplementing with fish oils.

Blood Thinning From Fish Oils

Blood thinning effects are the most common concern.  Really, the blood thinning effect of fish oils is extremely mild, and are probably unnoticeable at dosages under 3 grams a day.   It’s not like fish oil capsules are going to turn a healthy person into a hemophiliac.

The real concern here is for people who are on medications for either blood thinning (such as Warfarin or other blood thinners) or medication for lowering blood pressure.  Those medications exert a very powerful effect, and large doses of fish oils might just bump you into a danger zone if you mix the two.  Again, it doesn’t happen often, usually only at high doses. 

My advice if you’re on blood thinners or blood pressure lowering medications is this:  talk to your physician about your interest in fish oils, and once you get the okay, gradually increase your dose.  I’m talking start at 500 mg a day for a couple of weeks, then up to one gram a day for several weeks, and so on and so forth.  If you start feeling light-headed or have any other symptoms, cut back your dosage. 

Fish Oil Side Effects:  Medications

The other major thing you need to look out for when it comes to fish oil side effects isn’t really a side effect per se.  It’s actually good news.

Here’s what I mean.  Fish oils have an amazing amount of research showing impressive effects in a variety of chronic diseases, from diabetes to depression and all kinds of other things you might never think of.  So if you start supplementing with fish oils at a therapeutic dosage, you may find some of these chronic conditions becoming more mild.

Nice, right?  Except if you’re taking medications for these conditions, all of a sudden, you’ll find that you’re now taking more than you need!  For example, if you’re a diabetic who requires a certain amount of insulin per day, and the severity of your diabetes reduces (and your need for insulin reduces along with it), if you continue taking your typical dose, you’ll actually be over-doing it.

Like I said, this doesn’t really qualify in the fish oil side effects category, and is actually good news… the less medication you need to take, the better… but still, you need to keep an eye on this.  Taking too much of a medication is just as bad as too little (actually, it’s usually worse).  Another reason to keep your doctor in the loop; monitor any improvement in your condition and whether or not that allows you to reduce the dosage of  your medication.

Notice you handle a lot of these issues the same way.  Ease into your fish oil dose (click here for more on fish oil dosage)  over time.  This will help you to avoid any digestive issues and also anticipate any problems you may have with side effects from fish oils with any medications you may be taking.

It’s worth saying that overall, the massive health benefits of fish oils far outweigh any potential side effects.  Just be smart, go slow, stick to the filtered stuff, and keep your doctor informed.

Stay healthy!

Those living with heart failure have an interesting new potential addition to their treatment regimen… the potent antioxidants Pycnogenol and CoQ10. While the use of CoQ10 with heart failure has been getting kicked around for a while (it is an extremely common therapy for congestive heart failure in Japan), the addition of pycnogenol (which we’ve talked about quite a bit on this site) seems to make for a potent one-two punch.

It seems this way because of a recent study in which researchers studied the effects of a pycnogenol/CoQ10 combo used as an adjunct (additional therapy) to a standard treatment regimen for those with congestive heart failure.  This sort of experimental design is nice, because you’re not withholding treatment from anybody… you essentially find a bunch of people who are doing the standard therapy, split them in two, and give half of them a little something extra (rather than give one group a treatment, the other a placebo, and sit back and cackle evilly as you wait to see if the sugar pill group dies).

First a quick overview of the condition, and then we’ll go over the study in detail.

Congestive Heart Failure

CoQ10 and Pycnogenol can help the symptoms of heart failure

CHF or just plain old “heart failure” is pretty much what is sounds like… a condition in which the heart isn’t able to keep up with the demands on it.  It isn’t sudden like a heart attack; it’s a slow, grinding sort of process, in which the heart keeps trying and trying to keep up, but lags behind just a little bit.

Don’t forget, the heart has to push your blood forward against an already existing pressure from the fluid that’s sitting just in front of the valves.  If the heart is damaged, or perhaps has some issues with the valves being damaged, it may not be able to move that blood around as well, and so fluid tends to accumulate in various areas as the blood flow starts to stagnate.  

For example, one sign of heart failure is swelling in the lower legs, since the heart can’t push that fluid back up the legs (against gravity) to the torso to be dealt with properly.  It’s called distal edema (edema just means swelling, distal just means further away from the torso), or if it gets really bad, pitting edema (because if you push it in with your finger it stays dented in for a bit).

It tends to get worse over time, at varying rates, depending on the patient.  As the heart tries harder and harder to pump enough blood through the system, it starts to enlarge, like a bodybuilder’s bicep.  This can make the underlying cause even worse. 

For example, if it’s a faulty heart valve that’s caused all this mess to start with, as the heart enlarges, the valves will be spread out more, making it even harder for those valves to come back together and form a seal… leading to more leakage, which makes the job of the heart harder, which leads to more heart failure, which makes the heart get bigger, which makes the valves spread out even more… you’re getting the picture.

Of course, exertion becomes harder and harder, to the point where the patient can be exhausted even at rest.  The swelling can start to occur in the abdomen or around/inside the lungs.  Overall, this is a condition that causes a massive decrease in quality of life, as well as posing a risk of mortality.

Depressing, hunh?  Okay, now for the good news.

Pycnogenol and CoQ10 Help Heart Failure

In this study, the researchers took a bunch of people with fairly advanced heart failure, and gave half of them a Pycnogenol and CoQ10 supplement in addition to their regular treatment.  The other half got a placebo in additon to their regular treatment.  This went on for twelve weeks.

What they found was encouraging.  Blood pressure was reduced in the pycnogenol group.  Heart ejection fraction (that’s a measure of how much blood you squirt out of your heart on each beat) increased in the pycogenol group by nearly 25% compared to only about 4% in the placebo group.  That’s a pretty obvious sign of heart failure improvement.

Further, the pycnogenol and CoQ10 group had an increase in their walking distance (remember, people with advanced heart failure have trouble even just walking what most people would think of as a trivial distance) and also a reduction in distal edema (that’s the swelling of the legs we mentioned earlier).  The placebo group… not so much.

The first thing this study tells me is that conventional treatment of heart failure, by itself, doesn’t accomplish very much.  However, with the addition of the potent antioxidants Pycnogenol and CoQ10, some real progress starts to get made.

How Antioxdidants Help Heart Failure

So how come?  What’s so great about Pycnogenol and Co Q10 that people are seeing such a significant benefit with their heart failure symptoms? 

First off, there’s CoQ10.  Like any other antioxidant, it protects the cells of the body from damage caused by toxins or toxic metabolic by-products (more on how antioxidants work here).  However, in the case of CoQ10, it seems to do its best work in the area of the mitochondria, which are the power generators of the cell.  As you can imagine, since the heart keeps beating, beating, beating (we hope), it uses up a ton of energy, so the mitochondria are extra important to a heart muscle cell.  Protect the generator from rusting, basically speaking, and the cell can keep doing its work without trouble.

Plus, CoQ10 pulls double duty and is also used inside of that mitochondria (cell generator) as a chemical used in the actual production of energy for the cell.  So it’s almost like a self-cleaning fuel additive (experts will find that metaphor a bit strained, but hey, it’s close enough). For more on how CoQ10 helps generate energy, there’s this article on CoQ10 and statins or this video on the benefits of CoQ10.

Since heart failure is basically a tuckered-out, overworked heart failing due to chronic fatigue, anything that supports energy production in the heart cells is going to be helpful.  Makes sense, right?

Now let’s talk Pycnogenol.  This extra-powerful antioxidant has a well-documented and interesting side effect beyond protecting the cells from toxins:  it seems to keep arteries elastic.

Keeps what, hunh? you ask.  Your arteries aren’t just static, inflexible, glorified garden hoses.  Quite the contrary.  Each one is surrounded by a circular smooth muscle wall that contracts or relaxes to make the hole in the middle bigger or smaller (according to the changing needs for blood flow in that area).  They’re surprisingly responsive… or at least, they’re supposed to be. 

Years of a typical American crap-food diet tends to make those responsive, springy, flexible arteries turn into stiff, lazy, inefficient lumps.  And if the downstream delivery system for your blood isn’t very responsive, that means the heart has to push that much harder to get blood where it needs to go… contributing to exhausting what may be an already failing heart.

On the other hand, responsive arteries will not only make the heart’s job easier, but it will feed the heart more effectively as well… the heart has a blood supply too!  That may seem weird… there’s tons of blood shooting through the middle of the heart, after all… but the heart itself is fed by a system of coronary arteries.  These are the guys that get clogged up and trigger a heart attack for those of us who love bacon just a little too much.  As you can imagine, the more pliable and responsive these arteries are, the better the blood flow to your heart, which will combat the effects of fatigue and overworking. Read more on antioxidants and elastic arteries.

So, it’s probably not too surprising that a combination of these two antioxidants can help in the treatment of congestive heart failure.  What is surprising, is that it isn’t used more often!  So if you or someone you know is having troubles with CHF, tell your doctor about this study (a link to the official study is supplied below) and give yourself the best chance possible for recovery!

Stay healthy!

Article source: http://www.ncbi.nlm.nih.gov/pubmed/20657530

Chemotherapy is notoriously rough on the body, so I’d thought I’d share a little info on chemotherapy supplements, Co Q 10 in particular, that may help take a little of the edge off.  Now, I’m not an oncologist, so don’t go ignoring your doctor’s advice or anything crazy like that.  In fact, quite the opposite… always make sure you keep your physician informed of any supplements you are taking or intend to start taking.

Chemotherapy Supplements: Help or Harm?

The first concern, of course, is to make sure CoQ10 isn’t going to cause some sort of problem by interfering with any of the chemotherapy medications.  The good news is, the evidence for any negative interaction is extremely weak.  There’s only one negative study, as compared to many positive studies, and when you take a closer look at it, this one negative study isn’t a large concern.  Let me explain why.

The study in question (1) concerned the effects of large doses of CoQ10 on the effects of radiation therapy.  Radiation, not chemo.  The study was done on mice and involved extraordinarily high levels of Co Q10… 40 mg/kg was the dosage needed to see significant reductions in  how effective the radiation was.  Doses as high as 10mg/kg seemed to have no effect. 

To put that into perspective, even if I took around 700 mg of CoQ10, I would still be in the “safe”, non- interfering range.  Considering the most I’ve ever seen recommended is in the 300-400 mg range, it’s extremely unlikely you’d ever get to that “interfering” level… and again, that’s for radiation, not chemo.

CoQ10 and Chemotherapy:  The Benefits

Okay, now that safety concerns are pretty much settled, let’s ask if this stuff actually does us any good.  There’s a number of studies out there on this, and I’m going to divide them into two camps:  increasing the effectiveness of the chemo, and protecting the body from the detrimental effects of chemotherapy.

A couple of different researchers have found a benefit to adding CoQ10 supplementation to chemotherapy medications, specifically to the use of tamoxifen.  This was found to be true in a general sense for rats (2) but some more specific clinical markers of increased chemotherapy effectiveness were found by another team of researchers.

In those studies, researchers found that breast cancer patients undergoing chemotherapy who were also supplementing with a mix of CoQ10, riboflavin, and niacin (they called it CoRN, which I found mildly amusing), gained two interesting benefits.  First off, they had a decrease in markers of tumor angiogenesis, or new blood vessel formation.

This is a big deal because tumors require a serious blood supply to multiply, grow, and cause all the problems they like to cause.  Choke off the blood supply, and you starve the tumor.  This study found that the supplementation of 100 mg CoQ10, 10 mg riboflavin and 50 mg niacin reduced the indicators of new blood vessel formation (3).

Second, the same group of folks discovered their nifty CoRN mix (I can’t help reaching for puns here) also helps prevent recurrence of cancer.  They found that tamoxifen helped prevent recurrence by itself (using blood markers commonly used to gauge an upcoming recurrence), but that adding their CoQ10 supplement mix reduced those blood markers of recurrence even more (4).

So to sum up, these supplements seem to enchance the effects of chemotherapy in a couple of ways.  But what about the toxic effects of chemo?  Can we do anything about that?

Helping Chemo Symptoms With CoQ10

One of the major side effects of chemo is cardiotoxicity, which is fancy talk for damage to the heart.  It seems the mechanism of this damage is the destruction of the heart’s mitochondria, which are the energy generators for the individual cells.  Obviously, if the generators powering your heart cells start to die off, your ticker isn’t going to do so well.

Why heart cells?  There’s a particular, unique enzyme in the heart mitochondria that react with the anthracylcine family of chemo drugs to produce a ton of free radicals (more on the subject of free radicals and antioxidants here) and the end result is damage to the mitochondrial DNA.  The short version is, chemo turns into battery acid in your heart (metaphorically speaking).

That’s the bad news.  The good news is, CoQ10 seems to have a pretty decent protective effect in this area (5).  That shouldn’t be too surprising… CoQ10 does all of its best work in the area of the mitochondria, including as an antioxidant (anti- free radical), so I actually would’ve been surprised to NOT see a beneficial effect in this area.

There’s more.  Some of the same researchers working with that CoRN supplement (jeesh, I REALLY want to make a corn-related pun here, but I’ve got nothing!) found some additional beneficial effects of CoQ10 supplementation.   The study that really caught my eye was on the increase in DNA repair enzymes associated with taking CoQ10 (6), again studying breast cancer patients taking tamoxifen.

Additionally, there were two more studies showing improvement in a number of blood chemistry markers (7) and for a reduction in hyperlipidemia in particular (8).  Tamoxifen induces an increases in blood lipid profiles (think cholesterol), and CoQ10 appears to reduce that effect and return blood chemistry back to more-normal levels.

All in all, CoQ10 (along with riboflavin and niacin, particularly) has been shown in a number of recent studies to be a safe and beneficial adjunctive therapy for those undergoing the rigors of chemotherapy.  As I mentioned earlier, though, don’t just go gobbling the stuff down on your own.  Be sure to consult with your physician.  All of the references cited in this article are cited in a format so that your doctor can easily look them up on PubMed or other resources, so feel free to copy, paste, and email them for your doctor’s review.

Stay healthy!

References:

1.  Lund EL, Quistorff B, Spang-Thomsen M, Kristjansen PE.      Folia Microbiol (Praha). 1998;43(5):505-6

2.   Perumal SS, Shanthi P, Sachdanandam P    Chem Biol Interact. 2005 Feb 28;152(1):49-58.

3.   Anti-angiogenic potential of CoenzymeQ10, riboflavin and niacin in breast cancer patients undergoing tamoxifen therapy.  Premkumar VG, Yuvaraj S, Sathish S, Shanthi P, Sachdanandam P.    Vascul Pharmacol. 2008 Apr-Jun;48(4-6):191-201. Epub 2008 Mar 5

4. Effect of coenzyme Q10, riboflavin and niacin on serum CEA and CA 15-3 levels in breast cancer patients undergoing tamoxifen therapy.    Premkumar VG, Yuvaraj S, Vijayasarathy K, Gangadaran SG, Sachdanandam P.   Biol Pharm Bull. 2007 Feb;30(2):367-70

5. Coenzyme q10 for prevention of anthracycline-induced cardiotoxicity.   Conklin KA.  Integr Cancer Ther. 2005 Jun;4(2):110-30. Review

6.  Co-enzyme Q10, riboflavin and niacin supplementation on alteration of DNA repair enzyme and DNA methylation in breast cancer patients undergoing tamoxifen therapy.     Premkumar VG, Yuvaraj S, Shanthi P, Sachdanandam P.  Br J Nutr. 2008 Dec;100(6):1179-82

7.  Effect of Coenzyme Q(10), Riboflavin and Niacin on Tamoxifen treated postmenopausal breast cancer women with special reference to blood chemistry profiles.  Yuvaraj S, Premkumar VG, Shanthi P, Vijayasarathy K, Gangadaran SG, Sachdanandam P.  Breast Cancer Res Treat. 2009 Mar;114(2):377-84. Epub 2008 Apr 22

8. Ameliorating effect of coenzyme Q10, riboflavin and niacin in tamoxifen-treated postmenopausal breast cancer patients with special reference to lipids and lipoproteins. Yuvaraj S, Premkumar VG, Vijayasarathy K, Gangadaran SG, Sachdanandam P.Clin Biochem. 2007 Jun;40(9-10):623-8. Epub 2007 Mar 19

There’s a lot of info on this site about the powerful antioxidant CoQ10, but I’ve gotten some questions concerning CoQ10 side effects and if there’s anything to worry about.  The short answer is, not really.  But let me go into detail for you.

As a quick reminder, Co Q10 is a vital substance created by the body and supplemented by the diet that is used in energy metabolism and as anitoxidant protection, particularly in the energy generators of the cells (called the mitochondria).  It’s especially important for those taking cholesterol-lowering statin drugs (which deplete the body of CoQ10- more on this topic in this article on CoQ10 and statins), but is also taken by athletes, for anti-aging purposes, and for overall health.  Some other promising areas of CoQ10 use are in cancer (to reduce the side effects of chemotherapy) and to reduce the symptoms of heart failure.

CoQ10 Side Effects

Okay, that’s all great, but can it hurt you?  Again, the short answer is no.  This is a substance that is created by the body, so in and of inself, it is obviously non-toxic.  At typical doses (30 to 200 mg/day), side effects are very rare.  There’s some report of insomnia for those taking over 100 mg/day, but I’ve never seen it or even heard any such report from any other practictioner using CoQ10.  In other words, really rare… so rare that I wonder if there isn’t a confounding variable involved other than CoQ10 on these reports.

There’s unclear evidence concerning increased liver enzymes with very high (300+ mg/day) doses of CoQ10.  Not full-blown liver disease, just elevated liver enzymes.  Again, the evidence on this is so weak and contradictory that I strongly discount it.

What is uncommon, but occasionally reported are mild complaints like heartburn and nausea, which are most likely attributable to the quality of the product itself.  If you buy junk CoQ10 from a manufacturer with poor quality control, you may get a product that has impurities in it as a result of those poor manufacturing guidelines.  Look for reputable manufacturers who adhere to GMP (Good Manufacturing Practices) guidelines, and remember that you get what you pay for.

The only real side effects of CoQ10 that I think you need to worry about are those in which Co Q10 reacts or interferes with a medication you may be taking.  The big ones to pay attention to here are Warfarin (Coumadin) and insulin.  Specifically, CoQ10 may reduce the effects of Coumadin (a blood thinner), and reduce the need for insulin by diabetics.

Notice that the second of those two “side effects” is actually a benefit!  But, if taking CoQ10 does improve your diabetic symptoms, then your current level of medication may actually end up being more than you now require, so if you are diabetic and you begin taking CoQ10, just be sure to keep your doctor aware of this and monitor your blood sugar levels in case you need to adjust your insulin dosage.  Again, I call this a good thing, because the less medication you need to take, the better!

One more side effect that rarely reported is dizziness.  This is probably due to the fact that CoQ10 lowers blood pressure in some people, so if you already have low blood pressure and are looking to start taking CoQ10, I’d start off with a low dosage (30 mg/day) and work your way up after a few weeks at that level just to be on the safe side.

On an overall note about Coq10 side effects, I will tell you from an individual perspective that I have never encountered any of these side effects or even had another practitioner mention any of these side effects from their practice.  In other words, the incidence of any of these effects are extremely rare.  However, it never hurts to be informed.

My recommendation is, make sure you buy a quality product and take it with a fat-containing meal (since CoQ10 is fat soluble), and you’ll avoid any unlikely nausea or heartburn.  If you take one of the medications listed above, be sure to keep your doctor informed that you are going to start taking CoQ10 and that you want to monitor your medication levels if necessary.

More on the benefits of CoQ10 here.

Stay healthy!

Pretty much everybody has heard of the benefits of fish oil, but I do get a lot of questions about what the best fish oil dosage is.  It actually gets a little tricky figuring out your dosage properly; it isn’t just a matter of giving you a simple number.  But, don’t worry, we’ll walk through it by steps and you’ll be taking the right amount of fish oils in no time.

Essential Fatty Acids

How much is enough?

The most important thing to remember when you’re buying fish oils and calculating the correct dosage is to understand that you’re taking fish oils for the essential fatty acids (EFAs) in them.  EFAs are what they sound like; fats that are necessary (essential) to the proper biochemistry of your body.

In this case, we’re talking about two EFAs: DHA (Docosahexaenoic acid) and EPA (Eicosapentaenoic acid).  You don’t need to remember the big ugly hairy names, that’s why we use acronyms.  In fact, you barely need to remember EPA and DHA… it’s the only acronyms that will be listed on the label in the dosage section.

What you DO need to remember is, to add these amounts up on the label to see exactly how much useable fish oil you’re getting.  You see, fish oil isn’t 100% EPA and DHA.  The  purity varies wildly from brand to brand.  So, in order to accurately assess your fish oil dosage, you need to check the label of whatever product you’re buying.  The good quality products go about 50% purity; that is, if you take 1000 mg of fish oils, you’ll get 500 mg of EPA and DHA (total).

So the question is not, what should my fish oil dosage be, but what dosage of EPA and DHA should I be taking?

Fish Oil Dosage = EPA and DHA Total

Now that we have that sorted out, just how much EPA and DHA do we need?  As usual, the answer is, it depends.  How good is your diet?  People eating a whole foods diet get some EFAs from their food, and don’t need as much Omega-3 fatty acids (that’s the name of the kind of essential fats fish oils provide) as someone who’s living off of processed foods.

Are you taking fish oils for simple health maintenance, or do you have a symptomatic condition you’re hoping to ease with Omega-3 fatty acids?  Your fish oil dosage will need to go up considerably if your health has already deteriorated enough that you are having symptoms.

General Rule For Fish Oil Dosage

• If you’ve got a pretty good diet, you want to keep your costs down, and you merely want to take fish oils for general health maintenace, a total EPA + DHA dosage of about a gram to a gram and a half a day is generally sufficient.
• If you need to take it up a notch because you have a mild to moderate condition you’re hoping to help with Omega-3s, or you have a lousy diet, or you don’t mind a little extra cost to have even more benefit from your fish oils, your fish oil dosage should be more like 3 grams a day (again, EPA and DHA combined).
• Highly symptomatic individuals may need 6 grams or more a day to get their problems under control.  For example, my patients with arthritic symptoms work their way up to six grams a day until their symptoms start to subside, and then they slowly reduce their dosage (so long as they still have reduced symptoms) until they reach a maintenance level of more like 1 to 3 grams/day of EPA and DHA.

I strongly advise that anyone just starting out on fish oils makes it a point to SLOWLY add them in to their diet.  Trying to gobble down large amounts of fish oil capsules right away will usually result in something called “fishy repeat”, which is a fancy way of saying you burp up fish oil taste.  It’s as gross as it sounds. 

Avoid that by gradually increasing your fish oil dosage over time. Start with one capsule a day for a week, add a second for a week, and so on until you reach your desired dosage level.

Remember, your fish oil dosage is determined by your diet and your goals, and is calculated by adding the amounts of EPA and DHA on the label (NOT the number the company claims is “fish oils”).

Stay healthy!

A new meta-study suggests that taking zinc for colds can actually be helpful, but don’t expect miracles.  For a typical cold length of about one week, the effect was to reduce symptoms by one day.  Still, I’ll take it.

The study itself was what’s called a meta-study, which is when researchers don’t feel like going out and generating a huge amount of data themselves, so they go back and find a bunch of old studies that have already been conducted on the subject.  Then, they pick out the ones they feel are most relevant and add up all the data from those old studies, and presto!  Whole bunch of data to work with.

The advantage of this method is, first, it’s dirt cheap and fast, because hey, you don’t have to actually do anything other than find a lot of old studies.  Second, you get a big ol’ pile of data, because you’re summing up data across many studies.

The disadvantage is, these kinds of studies are SERIOUSLY vulnerable to selection bias.  Meaning, researchers have a sneaky tendency to cherry-pick only those studies that support their personal beliefs, and reject those studies that contradict those findings.

In this case, I’m inclined to trust these researchers, because they actually ditched two studies that showed a positive link between zinc and colds, but the quality of the studies weren’t so good.  Even with that, the remaining data showed favorable results with zinc supplementation.

Take Zinc For Colds Early

Here’s the thing.  If you’re going to take zinc to improve cold and flu symptoms, be sure to take it within 24 hours of first showing symptoms.  Otherwise, you’re probably not going to accomplish much.

My preference for zinc supplementation is a chewable that has about 30 mg of zinc and a nice little jolt of Vitamin C as well. I find, however, that if I take it on an empty stomach, I’ll get a little nauseous, which is common for zinc supplements, so take your zinc with a meal to avoid that.

Why is zinc effective for colds?  Probably due to the mineral’s role in the immune system’s ability to create T-cells, which help fight infection.  That’s probably also why you have to take it in the first 24 hours… just like the easiest way to stop an invasion is to fight it on the beaches, the easiest way to stop an infection is to beat it down before it can take hold in the body and spread. 

Of course, other immune-enhancing strategies can help too, like avoiding sugar (you did know that sugar kills your immune system, right?).  Keeping your immune system strong year-round is the best strategy to avoid as many colds and flu as possible… think of using zinc like a last-minute boost to the system if all else fails.

Take a little zinc for colds (early!) and stay healthy!

I’ve mentioned CoQ10 in a previous post, but I want to discuss more specifically the importance of CoQ10 and statin drugs.

One of the best benefits of CoQ10 is for those individuals who are taking statin type drugs (such as Lipitor) to lower their cholesterol. I’m not interested in discussing the controversies over whether or not these drugs are actually effective for preventing heart disease- not in this post, at least.  What is clear, is that although these drugs do seem to be effective in lowering a person’s cholesterol levels, they also have the nasty side effect of dramatically reducing that same individual’s levels of a vital nutrient called CoQ10.

CoQ10 and Statins

How does that link work?  What is it about a statin drug that also greatly depletes this nutrient as well?  The answer lies in the mechanism of how a statin works.

The first thing to understand is that the body manufactures its own cholesterol.  Yes, even though cholesterol has been dragged out as some sort of heart disease bogeyman over the last few decades, it’s also true that your body NEEDS cholesterol.  It forms the basis for many vital structures in the body, like cell membranes, certain hormones, and Vitamin D.

So your body makes its own.  Most of that goes on in the liver, but this stuff is manufactured all over the body and then converted into whatever structure is necessary. 

We also get cholesterol from dietary sources, as well.  It’s interesting to note that breast milk has a high concentration of cholesterol in it (again indicating it is an important substance for the body).

The Mevalonic Acid Pathway; "ubiquinone" is another name for CoQ10

If a person’s blood chemistry shows excessive cholesterol levels, doctors will often prescribe a statin drug to try to lower those levels.  Here’s the idea behind that.

Statin drugs block a chemical precursor to cholesterol called mevalonic acid; the name isn’t important to remember.  Just recognize that, like anything else, cholesterol is made up of precursors or building blocks.  If I want to make a cake, I need flour and eggs and other stuff.  If I don’t  have any flour, I’m not making any cake.  If I don’t have any mevalonic acid, I’m not going to make any cholesterol.

Once you shut down the body’s own synthesis of cholesterol (or reduce it), those pesky blood test results should fall back into line the way the textbooks tell us they should.  Hooray!  Except, as is generally the case any time you start messing around with the body’s physiology, there’s a nasty side effect.

You see, the exact same chemical precursors that lead to the creation of cholesterol, also lead to the creation of CoQ10.  Like cholesterol, your body makes a certain amount of this stuff itself, and when you shut down the spigot that lets the body make cholesterol, you shut off the CoQ10 supply as well.  If I don’t have flour, not only can I not make cake, I can not make bread, either.

Benefits of CoQ10

So what?  What’s so extra-super special about CoQ10 that we should care about not having it?  Plenty, actually.

There’s two major benefits of CoQ10 that we’re currently aware of:

• It is a vital part of the electron transport chain (hang on, hang on, I’ll get to explaining that, I promise)
• It is a potent antioxidant in the mitochondria, the energy generator of the cell.

Let’s start with the first one:  the electron transport chain.

CoQ10 and Energy

The electron transport chain is a fancy-schwancy name for the way in which the cells of your body create energy.  You see, the cells don’t use glucose (sugar) for energy.  They use a refined form called ATP (adenosine triphosphate, you don’t need to remember that), which is created by… you guessed it… the electron transport chain.

This isn’t as complicated as it sounds.  It’s really just a series of chemical reactions orchestrated by your body to refine one thing into another.  As I like to explain it, if you have a gasoline generator, you can’t just pour crude oil in it and expect it to go vrooom.

No, you need to use a refined product of crude oil called gasoline, and you make that refined produt by doing various chemcial shenanigans to crude oil.  Similarly, your cells use some nifty chemical manuevers to turn glucose into the chemical form they can actually use (that ATP stuff).  CoQ10 is one of the chemicals used in those nifty manuevers.

Just like if you’re missing a key gasoline-refining chemical, you’re not going to be able to turn crude oil into gas, so too if you’re missing CoQ10,  you’re not going to be making much ATP.  And if that sounds bad, it should, considering it’s the main fuel source for every cell in your body. 

So, CoQ10 = pretty important.  But wait! There’s more.

Antioxidant Properties of CoQ10

In addition to actively participating in the generation energy in the cell, CoQ10 also acts as an antioxidant at the site of that energy creation.  Here’s what all that means.

That electron transport thing-a-ma-gig happens in a little chunk of your cell called the mitochondria.  It’s not terribly important to remember the name.  But it is important to know that there is a little mini-generator in each and every cell of our body, supplying that cell with the energy it needs to keep chugging along.

Most communities have a central power plant creating a huge amount of electrical energy that is then distributed over wires to individual households.  But imagine if each seperate household had its own generator?  That’s how it works inside your body.

Anyway, like any other piece of machinery, that generator can get rusty and fall apart over time.  In the body, we call it oxidative damage, and we prevent it with… all together now… anti-oxidants.

You’ve probably heard of antioxidants at some point in your life.  I’m not going to go into the details of how antioxidants protect the cell in this article… if you want to know more about that, you can read this article about how antioxidants work.

Suffice it to say that antioxidants kind of work like oiling a steel sword so it doesn’t rust.  There’s lot of different kinds of antioxidants, each of which seems to work best for certain kinds of areas of the body.  CoQ10 acts as a protective antioxidant in the mitochondria.

So not only does it work IN the generator as a part of the energy generation process itself, it also acts ON the generator as an anti-rusting protective agent.  Once again, we see CoQ10 = important.

Consequences of Lack Of CoQ10

Now that you know what CoQ10 does in the body, it’s not to hard to imagine what the result of a severe depletion of CoQ10 would be. Obviously, it’s going to be hard to create energy in the cell.  More specifically, it’s going to be hard to break sugar down into energy.

Additionally, the generators themselves are going to become more vulnerable to that ugly oxidative damage, also known as “rusting”… or, if you prefer, “aging”.  That’s right, oxidative damage is a big part of aging, and if you don’t protect your cell’s generators from it, they will rust up and fall apart, aging at an accelerated rate.

Knowing all that, it probably isn’t too surprising to hear that one of the major side effects of statins is muscle cramps (and other muscle problems).  If your muscle cells can’t create energy for themselves, they’re going to run into problems pretty quickly. I actually worry more about cardiac muscle than skeletal muscle when it comes to this, but hey, that’s just me.

CoQ10 Dosage for Statins

Luckily, CoQ10 is available in supplement form.  Actually, it’s also in most foods, it’s just that it’s in such tiny amounts that you’ll never eat enough to make a difference if you’re taking statins (so don’t even try).

Most people taking statins should at bare minimum take 100 mg a day to counteract the effects of that medication on their body.  If you’re taking a high dose of statins, go for more like 200 mg a day.

CoQ10 is a fat-soluble nutrient, so look for gelcaps filled with oil (soybean oil is a common choice).  There are some companies out there who have come up with a water-soluble way to provide CoQ10, but I suggest sticking with the oil-based, since that’s how it happens in Nature.

Either way, if someone you’re fond of is taking statins, be sure to pass on this article on the link between CoQ10 and statins… the health consequences are pretty stiff! 

Stay healthy!