RAY D. STRAND, M.D.

Specialist in Nutritional Medicine

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Specific Recommendations

Cardiomyopathy
or Congestive Heart Failure

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The heart is not a complicated organ. It is primarily a muscle whose main job is to pump blood throughout the body. It has its own electrical system, which allows it to beat in an efficient manner. And the heart's valves keep the blood flowing in the right direction. It's about that simple, as long as it remains healthy.

Though elementary in its function, this primary muscle's responsibility for pumping life-giving blood to every organ in the body means it must continue beating consistently at all times and therefore has remarkably high energy requirements. It also needs a blood supply to provide itself with an adequate amount of oxygen and nutrients to perform its job. This is accomplished via the coronary arteries.

Here we are going to discuss congestive heart failure and cardiomyopathy, two diseases involving the heart muscle. When the heart muscle becomes weak it is not able to pump all the blood that it receives from the body and the lungs. It then attempts to compensate for its weakened state by dilating and beating faster, but blood backs up into the lungs, filling them with fluid. Essentially the person begins to drown. This is called congestive heart failure. Cardiomyopathy is a more severe form of heart failure; it's hallmark being an uncommonly large, dilated heart.

Congestive heart failure and cardiomyopathy have numerous causes: hypertension, coronary artery disease, repeated or severe heart attacks, and viral infections, to name a few. The standard medical treatment for this disease is diuretics, digitalis, and angiotensin converting enzyme inhibitors known more commonly as ACE inhibitors, and more recently Beta blockers. Patients with cardiomyopathy usually have only minimal improvement on these traditional medical regiments. Therefore, the only option for many of these people is to be placed on a heart transplant list.

Heart muscle cells have a remarkably high-energy requirement. Biochemical research in recent years has demonstrated that the heart muscles in patients with congestive heart failure and cardiomyopathy are deficient in a nutrient called Coenzyme Q10. The more severe the heart failure, the more severe is the depletion of Coenzyme Q10 (CoQ10). This has been a consistent finding no matter what the underlying cause of the heart failure happens to be. In fact, there is speculation among researchers that CoQ10 deficiency may well be an underlying cause of heart failure.

WHAT IS COENZYME Q10?

Coenzyme Q10 (CoQ10) or ubiquinone is a fat-soluble vitamin or vitamin-like substance that is also a potent antioxidant. Trace amounts of CoQ10 exist in a variety of foods such as organ meats, beef, soy oil, sardines, mackerel, and peanuts. The body also has the ability to make CoQ10 from the amino acid, tyrosine, but this requires a seventeen step process needing at least eight vitamins and several trace minerals to complete. A deficiency in any one of these nutrients can hinder the body's natural production of CoQ10.

Coenzymes as a group are cofactors essential for a large number of enzymatic reactions within the body. Coenzyme Q10 is the cofactor for at least three very important enzymes used within the mitochondria of the cell. Remember, the mitochondria is the battery or furnace of the cell where the energy is produced. Mitochondrial enzymes are essential for the production of the high-energy phosphate called adenosine triphosphate (ATP), upon which all cellular function depends.

COENZYME Q10 DEFICIENCY AND HEART FAILURE

The normal blood levels of CoQ10 have been well established by numerous investigators. Significantly decreased amounts of CoQ10 have also been noted in several diseases. This deficiency can be caused by: 1) poor dietary intake 2) impairment of the body's ability to synthesize CoQ10 3) excessive utilization of CoQ10 by the body or a combination of these factors.

Because Coenzyme Q10 has been noted to be significantly depleted in the blood and heart muscle of patients with heart failure, investigators in the early 1980's began supplementing these patients with CoQ10 to test possible improvement. These clinical trials were made possible by the availability of pure CoQ10 in large quantities from pharmaceutical companies in Japan and the ability to directly measure the level of CoQ10 within the blood and tissue.

Several clinical trials have now been done comparing the effect of supplementing medication with CoQ10 for cardiomyopathy or congestive heart failure patients' and comparing them with those who took a placebo. No fewer than nine placebo controlled clinical trials have taken place around the world to evaluate the treatment of heart failure with CoQ10. There have also been eight international symposia on the biomedical and clinical aspects of CoQ10 wherein physicians and scientists from eighteen different countries presented over 300 papers.

The largest of these international studies was the Italian multi-center trial by Baggio involving 2,664 patients with heart failure. In the United States the leading investigator has been Peter Langsjoen, M.D. who is not only a cardiologist but also a biochemist. He has reported several studies in the medical literature showing the beneficial effects of CoQ10 in cardiomyopathy.

The patients tested continued their conventional medical treatment and CoQ10 was added to their regime. Comparison was then made with those who either received a placebo or conventional medical therapy. Heart function was determined by the percent of blood that the heart was able to pump during a contraction (ejection fraction). In most cases, this was established by echocardiography, which is a sound wave study of the heart.

All of these studies have confirmed the effectiveness of Coenzyme Q10 in congestive heart failure and cardiomyopathy along with its safety. Clinical improvement was determined by using the New York Heart Association classification (NYHA) for functional capacity. The function of the heart showed gradual and sustained improvement in the muscle contraction as noted by improved ejection fraction, heart wall motion, and heart size. The overwhelming majority of these patients showed improvement in their symptoms of fatigue, chest pain, shortness of breath, exercise ability, and palpitations. The improvement in some patients was dramatic, with the heart size and heart function returning to normal.

The patients who started CoQ10 in supplementation shortly after developing their disease seemed to have the most dramatic improvement. For those who had suffered with their heart disease for a longer time improved but usually not to the same degree. In marked contrast, individuals with the worse heart failure actually had the greatest percentage of improvement. These amazing results were coupled with the fact that the CoQ10 did not create any serious side-effects even at the highest doses. An eight-year follow up study has shown that improvements were sustained as long as the patients continued taking CoQ10.

Approximately 20,000 patients under the age of 65 are eligible for a heart transplant that will cost in the area of $250,000 to $400,000. Thousands more patients over 65 have cardiomyopathy but are ineligible for a heart transplant due to their age. They are receiving maximal medical treatment but most are still totally disabled. Only one in ten who are eligible for a heart transplant will actually receive one; the other nine will most likely die from their disease. These numbers don't include the hundreds of thousands of patients who suffer from congestive heart failure who are not able to function normally because of their disease, but whose conditions are not severe enough to be placed on a heart transplant list.

Dr. Folkers and Peter Langsjoen, M.D. reported a study in the medical literature in 1992 that I believe brings all of this to an obvious conclusion. They placed eleven exemplary transplant candidates on Coenzyme Q10. All patients improved remarkably and would have all been taken off the heart transplant list. Folkers and Langsjoen concluded that with these case histories and the substantial clinical trials already reported in the medical literature show proof that all patients with end stage heart failure awaiting transplantation should receive CoQ10.

CoQ10 is a prime example of a natural vitamin/antioxidant shown in several clinical trials to be effective and safe. This is nutritional medicine at its core. When the heart muscle is weakened, for whatever reason, it places an increased demand on the nutrients needed by the heart cells in order to create energy. Because of excessive utilization of these nutrients, the heart muscle eventually becomes depleted of CoQ10, which is the most important nutrient needed to create energy. When patients take this nutrient as a supplement, the weakened heart muscle is able to replenish its stores of CoQ10, generate more energy, and compensate for its weakened state.

A note of caution: Doctors should use CoQ10 in support of traditional medical treatment, not in place of it. This is complementary medicine, not alternative medicine. Although in many studies patients improved so much they were able to stop taking several of their medications, they were nevertheless not cured of their underlying disease.

It is important to also note that patients should continue taking supplemental CoQ10 long term. Clinical studies report that when patients discontinue using supplemental CoQ10, the needed fuel source becomes depleted again and heart function slowly decreases back to its previous poor level. On the other hand, Dr. Langsjoen reported after a six-year follow-up study of patients, those who maintained their supplemental dosage maintained their heart function improvement.

WHY AREN'T PHYSICIANS RECOMMENDING COENZYME Q10?

Here we have a life-threatening disease for which traditional medical therapy offers little hope for improvement. The cost of taking CoQ10 in supplementation is approximately two to three dollars a day. That is substantially less than a $250,000 to $400,000 heart transplant for which most of these patients are waiting! Furthermore, the use of CoQ10 has never shown any side effects or problems and most of the studies show marked improvement within four months. So why don't physicians recommend a trial of CoQ10 to their cardiomyopathy patients?

I have never heard a discussion of the use of CoQ10 at any medical meeting or with any cardiologist. And I've never heard of a cardiologist placing any of my patients with congestive heart failure or cardiomyopathy on CoQ10. After reviewing these studies, I too am amazed at the unwillingness of the medical profession to offer this option to patients. It is not as if they have good alternative therapy. (I don't consider a heart transplant as a great option even if you are able to get one).

The National Institute of Health has funded most of the studies involving CoQ10 in the United States. But unlike the plethora of synthetic drugs, Coenzyme Q10 is a natural product. As such, it cannot be patented through the FDA. Pharmaceutical companies are not going to spend the hundreds of millions of dollars required to get a drug or natural product approved by the FDA if there is little economic incentive. Why don't doctors recommend CoQ10? Pharmaceutical reps are not presenting it to them--there is simply no money in it.

Physicians must become the patient's advocate. I cannot emphasize a basic principle here too much: when we support the natural functioning of the body and try to elevate this function to its optimal level, then and only then have we done everything possible to promote healing. The lives of several of my patients give testimony to this. After following the recommendation below, they too have been removed from the heart transplant list. Your doctor won't recommend it, so you must be especially assertive in obtaining CoQ10 for treatment. Below you will find guidelines to help you.

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