Health, Healing & Hummingbirds

Scientific information on improving serious disease through nutrition and treating the causes of disease
 – summarised from 100 of the world’s most cutting-edge health books

CoQ10 (ubiquinol), L carnitine, D ribose and Magnesium

Metabolic cardiologist Dr Stephen T. Sinatra considers coenzyme Q10 (CoQ10), L carnitine, D ribose and magnesium the ‘awesome foursome’ of cardiovascular health.

 

Dr Sinatra explains that while 1 + 1 will always equal 2 in mathematics, in metabolic cardiology and nutritional medicine, when you are talking about substances that are synergistic with each other such as the ‘awesome foursome’, 1 + 1 might equal 5 or even 10. In other words, the benefits of taking more than one of these substances at a time may far outweigh the benefits seen from taking any of them alone.

 

The heart and the brain are especially rich in mitochondria. This makes them especially vulnerable to mitochondrial damage and the resulting decrease in energy output. Both the brain and the heart (with its extraordinary non-stop work) need an enormous amount of energy.

 

Dr Sinatra explains that,

 

It’s all about ATP (adenosine triphosphate). Hearts, skeletal muscles and every other tissue in our bodies have an absolute need for ATP as their primary energy currency. Cells and tissues will cease to function if they are not provided with a constant and stable supply of energy. Both the total pool of energy substrates (ATP) in the cell and the cell’s ability to recycle these compounds are fundamental to healthy energy metabolism and cell function.

     When hearts are stressed by disease, energy substrates, called purines, wash out of the cell and the total pool of cellular energy becomes severely depleted. Disease also disrupts the heart’s ability to recycle its remaining energy through the oxidative phosphorylation mechanisms. The combination of energy pool depletion and metabolic dysfunction contributes to the severity of the disease and impacts the physiological health of the heart. The same is true for skeletal muscles that are stressed through disease or high-intensity exercise.

 

CoQ10 and L carnitine are major players in the energy recycling metabolic pathways. D ribose is the only compound used by the body to replenish depleted energy stores and rebuild energy pools. Magnesium is a vital mineral used by the enzymes that make energy synthesis and recycling possible.

 

Or as Dr Sinatra explains; D ribose fills the tank, CoQ10 and L carnitine helps convert this fuel to energy (helps the engine run properly) and magnesium is the glue that holds it all together.

 

 

Coenzyme Q10

CoQ10 is an enzyme that occurs naturally in the mitochondria of every cell in your body. It plays a key part in metabolizing energy from food. CoQ10 was first isolated in 1957. Since then, scientists have studied its effects on a wide variety of illnesses and conditions.

CoQ10 plays an important role in stabilising cell membranes.

CoQ10 is essential in directly supporting ATP recycling in the mitochondria of the cells. This is especially important for tissues that use a lot of energy, such as the heart and the brain.

Dr Sinatra explains that CoQ10 helps any type of cardiomyopathy, congestive or even hypertropic. It impacts on both systolic and diastolic dysfunction, improving quality of life.
     (This is an important distinction for M.E. patients as Dr Cheney recently explained the type of cardiac insufficiency that lies at the heart of M.E. is best described as diastolic heart failure or (‘compensated’) diastolic cardiomyopathy.
     The right ventricle circulates blood to the lungs, while the left ventricle circulates blood to the rest of the body. The ventricles empty when the heart contracts to pump out blood (the systole), and fill when the heart relaxes (the diastole). Diastolic dysfunction means that the heart does not have enough energy to relax between contractions and so the ventricles fill with blood in a dysfunctional way and an inadequate amount of blood is pumped by the heart with each contraction. (Dr Sinatra explains that a great deal more energy is needed for the heart muscles to relax, than for them to contract. It requires immense cellular energy.) This diastolic dysfunction is best measured using an impedance cardiograph machine. Note that Dr Cheney is not an M.E. expert as such. See the Dr Paul Cheney page on HFME for more information.)

Without CoQ10 the electron transport chain would completely break down. This loss would be catastrophic. There has to be an EXCESS of CoQ10 in the mitochondria to be maximally effective.

CoQ10 is an antioxidant and reduces cancer risk.

ATP supports such as CoQ10 support immunity, as the immune system has high ATP needs.

CoQ10 has neuroprotective effects against mitochondrial toxins.

CoQ10 plays an important role in reducing platelet size, distribution, stickiness and limiting platelet aggregation and activation. CoQ10 helps prevent blood clot formation.

Diseased gums may be a sign of low CoQ10 levels.

Spontaneous abortion is linked with low CoQ10 levels.

Research indicates that if levels of CoQ10 decline by 25% our organs may become deficient and impaired. If levels decline by 75% serious tissue damage and even death may occur.

CoQ10 decreases cardiac mortality.

 

Dr Sinatra found that while 85% of his cardiac patients responded to CoQ10 alone, 15% needed to take CoQ10 and L carnitine before significant benefits were seen (even where blood levels of CoQ10 were shown to be high).

 

Although CoQ10 comes in two forms, ubiquinone and ubiquinol, for many years ubiquinone was the only CoQ10 supplement available. Advances in CoQ10 manufacturing processes in Japan have recently led to ubiquinol supplements becoming widely available. According to Dr Sinatra, 15 mg of the (reduced) ubiquinol form of CoQ10, is equal to 50 mg of the ubiquinone form of CoQ10. So ubiquinol raises blood levels of CoQ10 just over three times as well as standard ubiquinone.

 

(To create cellular energy, the body has to convert ubiquinone into ubiquinol.  Aging and other factors however slow down or stop this conversion from happening, leading to low CoQ10 levels. If you are one of these that has a problem converting ubiquinone, then ubiquinol will have an even stronger effect, in comparison with ubiquinone. The ability to convert ubiquinones into its usable form decreases with age. Some studies show ubiquinol as being up to 8 times as bioavailable as ubiquinone. The contradictions in some CoQ10 clinical research are mostly due to the reduced bioavailability of some types of CoQ10. Water miscible forms are best absorbed, while powder forms are least well absorbed. The other problem is that many studies use only very low doses of ubiquinone, such as 200 mg.)

 

Ubiquinol is the preferred form of CoQ10 and is better value than ubiquinone, per absorbed milligram. Ubiquinone may cause some side effects at high doses (eg. 1200 mg), however, as ubiquinol supplementation can give these same high blood levels at much lower doses, the potential for side effects is also much reduced. Ubiquinol has been shown to peak blood levels 6 hours after ingestion.

 

 

L carnitine

The name carnitine is derived form the latin ‘camus’ for flesh as carnitine was first isolated form meat sources. Nutritionist Robert Crayhon, author of The Carnitine Miracle, explains that strictly speaking, carnitine is not an amino acid and that carnitine does not in fact contain the amino group (NH2). He explains that carnitine is a coenzyme, a water-soluble vitamin-like compound. And that carnitine is similar to choline, one of the B vitamins-and, like various B vitamins, carnitine helps us turn food into energy. More specifically, it is essential for the burning of long-chain fatty acids.

 

The heart depends on adequate concentrations of carnitine for normal heart function.

 

The primary role of carnitine is to help transport fatty acids into the energy producing units in the cells - the mitochondria, where they can be converted to energy. This is a major source of energy for the muscles, including those of the heart. Carnitine increases the use of fat as an energy source.

Carnitine is useful in clearing the bloodstream of ammonia and aids in creating glycogen, used to store essential glucose. Carnitine transports waste products out of the mitochondria, thus ensuring that toxic metabolic waste products do not accumulate. Carnitine reduces the accumulation of lactic acid, which is responsible for the burn felt inside the muscles with exercise.

Carnitine can help to prevent muscle atrophy.

Carnitine protects the heart from damage when a heart attack or a spasm cuts off the oxygen supply. Recent research has shown that carnitine can aid in recovery after a heart attack. Michael Murray N.D., author of ‘The Pill Book: Guide to Natural Medicines’ writes, ‘Subjects taking carnitine showed significant improvements in heart rate, blood pressure, angina attacks, rhythm disturbances, and clinical signs of impaired heart function compared to the subjects taking placebo.’

Low thyroid function may indicate a need for carnitine to help overcome low energy levels and the tendency to gain weight.

Carnitine can improve insulin sensitivity in those with type 2 diabetes.

Kidney dialysis rinses away amino acids, causing weak, tired condition, which is threatened by high triglycerides. Carnitine supplements may be advisable in such situations.

At doses of 1 – 3 g carnitine reduces blood triglycerides. (As the LEF website explains, ‘Carnitine combines with enzymes found in the mitochondrial membrane to transport fatty acids into the interior of the mitochondria, where they are oxidized to provide fuel for the generation of energy. In the absence of carnitine, fatty acids are not oxidized, but, instead, are transformed into dangerous triglycerides.’)

Carnitine is an antioxidant and enhances the effectiveness of antioxidant vitamins C and E. Carnitine is synergistic with pantethine (vitamin B5).

 

Carnitine is manufactured by the body if sufficient amounts of iron, vitamin B1, vitamin C, niacin, vitamin B6, lysine, and methionine are available. Food sources of carntine include meat, poultry, fish, and dairy products are the richest sources of L-carnitine. Grains, fruits, and vegetables contain little or no carnitine. Robert Crayhon points out that due to high consumption of red meat, the Stone Age hunter probably got at least 500 mg of carnitine a day, and possibly as much as 2 grams. Today the average carnitine intake is estimated at a mere 30 to 50 mg a day. Strict vegetarians consume practically no carnitine.

 

L carnitine is generally not well absorbed, and is best absorbed on an empty stomach.  There are several different forms of carnitine;

 

L carnitine fumarate is absorbed at a slightly higher rate than pure L carnitine and L carnitine tartrate. It is stable enough to be available in capsule form. L carnitine fumarate has a double effect as the fumarate is a free radical scavenger and also plays a part in the krebs energy cycle.

Pure L carnitine draws moisture and so is not suitable for use in capsules and tablets. It is commonly used in liquid carnitine products and pure carnitine powders. It has a very mild taste when mixed with water and is a good choice of carnitine.

For angina and other cardiovascular applications, a new form of carnitine known as L-propionylcarnitine appears to be the most effective form of carnitine, although it may also be the most expensive and difficult to source. (Look for products labelled Glycocarn.)

L carnitine tartrate is an adequate form of L carnitine. When mixed with water it has an unpleasant tart taste.

 

L carnitine is thought to be one of the safest nutritional supplements on earth, according to Dr Sinatra.

 

A special warning about buying low quality carnitine supplements: If you are using a Chinese made product, you could be putting your health in danger. Products containing the D isomer can cause cells to not function properly and possibly die. If you cannot find out the D isomer content of a product, then do not buy that brand of carnitine. D-carnitine supplements should be avoided. The D isomer, which is not biologically active, can compete with the L isomer. To ensure a safe product, buy only Sigma Tau or Lonza carnitine products.

 

Information on acetyl L carnitine: Nutritionist Robert Crayhon, author of The Carnitine Miracle, explains that for neurological disorders it appears that acetyl L carnitine (ALC) is the best form of carnitine. ALC improves cognitive function and increases mitochondrial energy output (especially when combined with lipoic acid). Besides enhancing fatty acid transport and utilization, ALC also increases the density of neurotransmitter receptors, the levels of neurotransmitters such as acetylcholine and dopamine. It also reduces the accumulation of lipofuscin (a metabolic waste product related to lipid peroxidation, seen at particularly high levels in dementia), counteracts glycation and promotes melatonin production. Acetyl-l-carnitine also restores cortisol receptors, acts as an antioxidant and boosts the levels of glutathione and CoQ10.

 

Supplementation with ALC has been shown to reduce degenerative processes in the nervous system, and improve memory and learning ability. According to Nutritionist Robert Crayhon, ‘acetyl-l-carnitine qualifies as the superstar of neuroprotection.’

 

One side effect of acetyl L carnitine is vivid dreams, possibly due to increases melatonin production. Too much ALC can also cause neurological overstimulation for those with neurological diseases involving seizure states such as M.E. and so a small dose of just 500 mg is recommended. ALC is not recommended where seizure problems are severe.

 

ALC is one of the most important supplements to be taken after a stroke, to help speed recovery. For stroke patients, the recommended dosage is usually 1500 mg.

 

 

D ribose

D ribose (or ribose) is a simple 5-carbon sugar found in all living cells. Dr Sinatra explains that,

 

Until 1944, D-ribose was thought to be primarily a structural component of DNA and RNA with little physiological significance. But a series of studies, culminating in 1957, revealed that this sugar molecule played an intermediate role in an important metabolic reaction called the pentose phosphate pathway. This reaction is central to energy synthesis, the production of genetic material, and for providing substances used by certain tissues to make fatty acids and hormones.
     Several notable papers were published in 2003. One study showed that D-ribose improved diastolic functional performance of the heart, increased exercise tolerance, and significantly improved the quality of life of patients.

     Research continues here and abroad. Yet, despite the powerful scientific evidence, very few US physicians have even heard of D-ribose outside of their first-year medical school biochemistry class, and fewer still recommend it to patients. We lucky ones who are familiar with it have the wonderful gratification of seeing it help our patients on a regular basis.

 

Ribose is a very well studied product. More than 100 papers have been completed or published on its cardiovascular health benefits. In short:

 

Ribose plays a role in the manufacture of glucose, which is used in the body in metabolic processes, including energy production and, cyclically, production of ribose. Ribose also converts to pyruvate, which can combine with oxygen in the metabolic pathways to produce adenosine triphosphate (ATP) - the energy source for all muscles. Ribose is the prime ingredient in the production of ATP.

Ribose is found in heart and muscle cells, but the body cannot manufacture it quickly enough to meet the demands of metabolic stress experienced during strenuous exercise or diminished blood flow or where there is metabolic insufficiency.

Ribose improves the relaxation of the heart that allows it to fill properly with blood. Thus ribose improves diastolic heart function. (As explained previously, this has special relevance and importance for M.E.)

Ribose is vital in the formation of nucleotides, compounds needed by the heart and skeletal muscles, as well as other body cells. Nucleotides are required for the body to produce energy for muscle cells; manufacture protein, glycogen and nucleic acids (RNA and DNA); form the cyclic nucleotides responsible for controlling calcium and other electrolytes; and relax the heart and muscle cells

 

Dr Sinatra goes on to write,

 

Supplemental D-ribose absorbs easily and quickly through the gut and into the bloodstream. About 97% gets through. Studies have shown that any amount of D-ribose you give to energy-starved cells gives them an energy boost. At the University of Missouri, researcher Ronald Terjung has shown that even very small doses (the equivalent of about 500 mg) of D-ribose increase energy salvage in muscles by more than 100%. Larger doses increase the production of energy compounds by 340-430%, depending on the type of muscle tested, and improve the salvage of energy compounds by up to 650%. Most amazing is that when muscles are supplemented with D-ribose, they continue to add to their energy stores even while they actively work! Until this study was reported, it was thought that muscle energy stores were only refilled in muscles at rest.

     An adequate dose of D-ribose usually results in symptom improvement very quickly—sometimes within a few days. If the initial response is poor, the dose should be increased until the patient feels relief. Logically, the sickest patients stand to gain the most.

 

The half-life of ribose is only 30 minutes.

 

 

Magnesium

See the main Minerals paper for information on all aspects of magnesium.

 

 

Restrictions and cautions on the use of CoQ10, L carnitine and D ribose

Certain drugs, such as those that are used to lower cholesterol or blood sugar levels, may reduce the effects of CoQ10. The LEF explains that,

 

A large number of drugs deplete Coenzyme Q10. These include such widely used tricyclic antidepressants as Elavil (amitriptyline) and Tofranil (imipramine), the anti-psychotic drug Haloperidol, cholesterol-lowering statin drugs such as Lovastatin and Pravastatin, beta-blockers, anti-diabetic sulfonylurea drugs such as Glucotrol (glipizide) and Micronase (glyburide), and the anti-hypertension drug Clonidine. These common drugs, as well as several others, interfere with the body's synthesis of CoQ10 and may cause a deficiency of this crucial compound, so important for energy production and protection against free radicals. This drug-induced depletion can be particularly serious in the elderly, who already suffer from aging-related CoQ10 deficiency.
     It is particularly ironic that drugs prescribed to heart patients result in lower levels of CoQ10, since the heart has an enormous need for CoQ10 for its energy production. In fact, a CoQ10 deficiency first manifests itself in cardiovascular symptoms. The authors warn, "The results of some studies suggest that congestive heart failure is primarily a coenzyme Q10 deficiency disease." The same may be true of cardiomyopathy, heart muscle impairment which may lead to heart failure. The authors also list other symptoms of CoQ10 deficiency, including angina, cardiac arrhythmias, mitral valve prolapse, high blood pressure (which may lead to stroke), gum disease, low energy and a weak immune system (which may result in greater susceptibility to cancer). Recently it has also been discovered that CoQ10 is very important for brain health, and may help prevent Parkinson's disease and Alzheimer's disease. The importance of CoQ10 can hardly be overemphasized.

 

To reiterate; statin drugs, tricyclic antidepressants and beta blockers deplete CoQ10 and if CoQ10 is not given at the same time as these drugs, cardiomyopaghy or CHF may result. Overactive thyroid or a pulsating heart requires additional CoQ10. CoQ10 may alter the body’s response to warfarin and insulin.

 

CoQ10 shows very few significant side effects, though some patients report insomnia and restlessness when treated with high doses of CoQ10 supplements. If this occurs, the dose should be lowered until the symptoms resolve. No serious side effects have been reported from the use of coenzyme Q10. Some patients using CoQ10 have experienced Other possible side effects include rashes, nausea, upper abdominal pain, dizziness, visual sensitivity to light, irritability, headache, heartburn, and fatigue. Generally CoQ10 is well tolerated in M.E. However, some M.E. patients say they can only tolerate low doses of CoQ10, while others find they need very high doses to see the full benefits of CoQ10.

 

The effects of CoQ10 on pregnant and nursing women and very young children have not been studied and so this supplement is not recommended for these patient groups.

 

Patients being treated with AZT, Doxorubicin, Isotretinoin or Valproic acid should speak to a physician before taking any L carnitine supplements. Anticonvulsant drugs may lower the effectiveness of carnitine supplements. Renal patients may need a lower dose of carnitine. Carnitine supplementation will often mean that the dosages of various heart drugs will need to be lowered; this process should always involve the doctor that prescribed the drugs and be very gradual – do not stop taking any medication suddenly.

 

Carnitine is a very well tolerated and safe supplement. It does not appear that L carnitine causes significant side effects, although high doses taken on an empty stomach may cause diarrhea. Other possible but rare side effects include body odor, rash, and increased appetite. This supplement is generally very well tolerated in M.E.

 

Dr Sinatra explains that,

 

The toxicology and safety of D-ribose have been exhaustively studied. The supplement is 100% safe when taken as directed. There are no known adverse drug or nutritional interactions associated with D-ribose use. Thousands of patients have taken D-ribose at dosages up to 60 grams per day with minimal side effects. However, even though there are no known contraindications of D-ribose therapy, we recommend that pregnant women, nursing mothers, and very young children refrain from taking D-ribose simply because there is not enough research on its use in these populations. D-ribose can actually lower blood glucose levels; therefore, insulin-dependent diabetics should check with their physicians before starting on the supplement.

 

The only problems usually mentioned with regard to D ribose (in books are articles) are infrequent minor gastrointestinal side-effects or feelings of faintness where a large dose is taken on an empty stomach. However, of all the supplements listed here D ribose by far the one most likely to cause problems or to not be tolerated even at lower doses in M.E. (Unfortunately many D ribose experts seem to not have encountered many or any M.E. patients and are unaware of this problem.)

 

Many M.E. patients become very ill when trialling D ribose and so it is very important to start at doses much lower than the 5 g usually recommended as a starting dose. D ribose can cause far more than gastrointestinal upset in M.E., it can cause severe relapse and loss of quality of life. (A short improvement in function maybe also followed by a ‘crash.’) Dr Cheney has commented that in a small number of patients ribose seems to be metabolised as a sugar rather than a component of ATP production, or metabolised anaerobically which results in lactic acid build up in the body – rather than the ribose being used primarily to make more ATP, which is the idea behind ribose supplementation.

 

Thankfully, the negative affects from D ribose do pass quickly, usually within a few days. D ribose should be taken with meals (or at least mixed into juice, milk, or fruit) to offset the blood-glucose-lowering effect.

 

D ribose should be discontinued if no benefits are seen or only very small benefits are seen as there is a possibility that the sugar content could feed ‘bad’ bacteria and contribute to Candidasis or gas and bloating. Dr Cheney made a complete turnaround in 2009 on ribose, commenting that it is ‘toxic’ to patients and makes problems worse. While Dr Cheney should by no means be assumed to always be absolutely correct in his every comment (he does NOT study a 100% M.E. patient group after all and is not what one might call politically aware), this is a another reason to cease ribose supplementation unless it is very clearly helping significantly. Where D ribose is not helpful, patients may want to instead try sublingual NADH or ATP lozenges.

 

There are still enormous benefits to be had from the combination of CoQ10, L carnitine and magnesium, with or without additional D ribose supplementation.


(For me, ribose made me feel awful and it felt very different in effect to how these other three work. It felt like just taking a ton of caffeine rather than anything actually helping my cells or heart work better. It made me ill. So I am not at all a ribose fan but have included this information here for anyone that is interested in it.)

 

 

CoQ10, L carnitine and D ribose tests

Testing the blood levels of CoQ10 may be very helpful, both in determining the correct dose of CoQ10 needed and to determine, where there is a lack of response to CoQ10, if this may be caused due to a lack of absorption (or perhaps a product not containing the amount of CoQ10 stated on the label, and so on). This test is widely available.

 

Dr Sinatra explains that researchers agree that CoQ10 blood levels of 2.5 ng/ml and preferably 3.5 ng/ml are required to have an impact on severely diseased hearts. Dr Sinatra recommends Quest labs for CoQ10 tests. The LEF also offers a CoQ10 blood test, for US patients.

 

Testing of carnitine levels is not usually necessary before carnitine supplementation according to Dr Sinatra. (For information on the tests necessary to diagnose carnitine deficiency see the eMedicine/Web MD website)

 

Testing D ribose levels is useless as ribose has such a short half life in the body.

 

 

Dosage recommendations

CoQ10/ubiquinol:  Dr Sinatra recommends the following daily CoQ10 dosages (note that the ubiquinol figures have been rounded to the nearest 25 mg):

CoQ10 dosages table
 
 
Ubiquinol dosage
Ubiquinone dosage
Recommended
 25 - 50 mg
90 – 150 mg
 As a cardiac disease preventative.
 75 - 100 mg
240 – 360 mg
 For cardiac arrhythmia, angina and those taking statin drugs.
100 - 175 mg
360 – 600 mg
For dilated cardiomyopathy and congestive heart failure.
175 – 350 mg

600 – 1200 mg

To improve quality of life in Parkinson’s disease. Where there is greatly reduced immunity, such as in cancer.

 

Although there is no specific dosage given for M.E. (nor for many other diseases) by Dr Sinatra this is not necessarily a significant problem. Dosage will depend on disease severity which can vary considerably in M.E. etc. and there are also significant differences in the dose needed from person to person and so dosage recommendation can only ever be general guidelines, as Dr Sinatra explains.

 

In addition, we do know that M.E. has some similarities to Parkinson’s and can be a similarly disabling neurological disease and that (anecdotally) those with moderate – severe M.E. will most often need doses the same as those listed for Parkinson’s disease, in order to experience an improvement in quality of life. (1200 mg of ubiquinone daily is often quoted as a standard dosage for Parkinson’s patients.)

 

The dosage of CoQ10 in M.E. can be guided by blood levels of CoQ10 or by raising the dose until the patient experiences significant improvement, or both. The maintenance dose of CoQ10 should then be adjusted downwards as much as possible, without losing the benefits. For patients that are severely affected the maintenance dose may need to stay the same as the initial dose, in order to prevent relapse.

 

CoQ10 should be taken in 2 – 3 divided doses (with food). Do not take medium - large doses all at once.

 

Dr Sinatra recommends that patients be pre-treated with CoQ10 prior to any type of cardiac surgery. He also comments that very severely ill patients may need three times as much CoQ10 as others. Benefits from CoQ10 will often be seen in 1 – 4 weeks but it may take several months for the full effect to become apparent.

 

 

L carnitine: For those with serious cardiac issues, as in M.E., pure L carnitine should be trialled at 250 – 750 mg taken 4 times daily, according to Dr Sinatra. (For a total intake of 1 to 3 grams daily).

 

If improvement is not seen at 3 g, the dose may need to be raised to 4 g or in severe cases, 5 or 6 g. The maintenance dose may be able to be significantly lower than the initial or pharmacologic dose, although in severe cases the initial dose will need to be maintained long-term to prevent relapse. How you feel should be your guide to determining your best L carnitine dosage long-term.

 

Do not take doses larger than 1 – 1.5 g at a time as absorption is greatly reduced with large doses. L carnitine is best taken in 3 – 4 divided doses.

 

 

D ribose: The usual recommendation for D ribose where there are serious cardiac issues is to take 5 g (roughly 1 heaped teaspoon), two or three times daily, according to Dr Sinatra, for a total intake of 10 to 15 grams daily.

 

In very severe cases doses of 15 – 30 g may be recommended.

 

A very cautious starting dose in M.E. may be 550 mg (1/8th of a teaspoon) taken daily, in divided doses, for the first week and raised 550 mg a week or a fortnight until a dose of 5 g (or more) is safely reached or the treatment must be stopped due to its causing relapse. Note that having smaller doses less often may increase your tolerance of D ribose and that buying powders rather than tablets may make taking (and measuring) smaller doses easier to manage.

 

Make sure to take D ribose with food to minimise its effect on blood sugar levels. D ribose is best taken in 2 – 3 or more divided doses. Ribose gives improvements in a few days.

 

 

Magnesium: See the Minerals paper for information on all aspects of magnesium.

 

 

All four of these supplements are very safe to take long-term.

 

 

Antioxidants and mitochondrial and other supports

Nutritionist Robert Crayhon explains that mitochondrial supports ‘should be combined with antioxidants to compensate for the increased production of free radicals that is a by-product of greater energy output. Older people especially need to take extra antioxidants to compensate for this.’ Lipoic acid is one of the most important antioxidants, along with vitamin E and vitamin C. CoQ10 is also an antioxidant.

 

Dr Sinatra recommends that 50 -100 mg of lipoic acid (and also a daily multivitamin, extra vitamin C and fish oil) always be taken along with the ‘awesome foursome.’ He states that to help neutralise free radicals, nurture your mitochondria and delay aging, life-long supplementation with CoQ10, L carnitine, lipoic acid and vitamins C and E is essential.

 

Another important supplement for vascular health is the amino acid L arginine. The dosage is usually 2 to 5 grams daily, taken in divided doses. Some doctors prefer to recommend sustained released arginine.

Further reading

“Both carnitine and CoQ10 promote energy to cardiac muscle cells. It is important to note that this action is physiological and is not similar to the pharmacological effects of drugs that affect the heart rate and contractibility of the heart.” Dr Sinatra in ‘The Sinatra Solution’