An imperfect (Q) ten

This has been another of those fortnights of “deja-vu all over again” (in baseball legend Yogi_Berra’s famous phrase), as the newspapers have been full of plugs for “Miracle Supplement” Coenzyme_Q10.

Boots are having a big marketing push for their latest formulation of CoQ10, claiming that it will give you lots of energy, and even offering “your money back if not satisfied” (Boots apparently have confidence in the power of wishful thinking and the placebo effect).

Boots’ press release and promo campaign seems to have generated the usual crop of dim features in the “Health and Beauty” or “Lifestyle” sections of several of the UK national papers. Most of these features, as both Ben Goldacre and David Colquhoun have deconstructed, revolve about deliberate overuse of that misunderstood word, and favourite Alt Health trope, “energy”.

[The mention of “Energy” is, of course, a surefire stand-by for a good dose of health page waffle. The very word drips waffle, and probably scores you a Canard or two on the Quackometer. Wikipedia lists a bunch of usages for “energy”. It is no accident that half of them relate to favourite Alt Health Woo-themes like “spirituality”.]

If you are especially unlucky, your newspaper may have leavened the energy-waffle with what we call a “Media doc filler”, or “MDF” for short. For those that are unfamiliar with this genre of newspaper space-filling, an MDF often accompanies a feature on a new supplement , or heavily marketed medicine, and goes something like this:

——————————————————————————————–

NanoNutri LipoBalls – A Doctor Writes:

“As a national newspaper doctor I am frequently asked by the nice chaps and chap-ettes on the “Nutrition and Health“ pages: “can we have a quick 300 words to pad out this press release – sorry, story – about some expensive supplement?”

My answer is always “Only if it will help tackle my low financial energy levels, sunshine”. And aren’t low energy levels something we all increasingly suffer from in today’s non-stop energy-sapping 24-hr world?

It is amazing these days how often my patients seem to wish they had more energy.

I don’t know how many times I have heard a patient say to me “I feel worn out, doctor”. To which I usually respond: “That sounds very much like what we doctors call an “Energy Deficiency” – fifty pounds, thank you, pay the receptionist on your way out. Next!”

Twenty thousand or so years ago, a quick sabre-toothed tiger hunt would have left primitive man with a huge appetite, but after a haunch of roast mammoth and 12 hrs solid sleep he would have been ready for anything. However, nowadays we work so much we hardly have time to eat, or to sleep more than five hrs a night – and when we do eat it’s more likely to be a hurried prawn sandwich than mammoth supreme.

Faced with that, who couldn’t do with a bit of a pick-me-up? And new NanoNutri LipoBalls® are formulated with EnergyNano’s patented Fast Liposome Intra-Mitochondrial Formula Liquid-energy AntioxidantMax technology, or “FLIM-FLAM” for short, to get extra-fast to the parts other Energy supplements cannot reach.

So how were the results? Well, within a few days of first encountering NanoNutri LipoBalls®, things were certainly looking up. Having banked a pleasingly large cheque, I found that my energy levels had been dramatically improved. A spring had returned to my step, a twinkle to my eye, and a satisfying bulge to my wallet.

(Is that enough?)

A Doctor”

——————————————————————————-

Now, while I may have been mysteriously “channeling” Private Eye’s fictional Dr Utterfraud here, I am not exaggerating by all that much. If you don’t believe me, read this.

Where does all this hype come from? Well, you can find plenty about CoQ10 and what it does on Wikipedia, but a brief summary would be that it is a chemical substance that is important for how your mitochondria work. Mitochondria are your cells’ “powerhouses”, converting chemical energy (substrates, a posh biochemical word for “fuel substances”) into carbon dioxide and water, with the concomitant production of the cell’s “energy currency” molecule ATP.

 

Here you see the beauty of the CoQ10 sales spin. The description above mentions energy – here in its scientific sense. So voila – mention that CoQ10 helps produce “energy” and it is an instant sell. Everyone would like to have more “energy” (in its non-scientific sense of “get up and go”, the sort that parents wonder at in their small children while bemoaning that they don’t have themselves).

All you have to do is plant in peoples’ minds the two ideas that:

 

  1. CoQ10 has something to do with energy (true)

  1. Energy (scientific sense) = energy (vernacular sense) (false)

 

and the result is Ker-chinggg – cash registers jingle.

Now, an interesting aspect of the current “Q10 buzz” is that CoQ10 was discovered fifty years ago. It is not new. And it has been around, as a supplement, for at least 15 and probably closer to 25 years. Very “Not new”, in fact. And it has been tried as a therapy or “performance enhancer” in all sorts of studies - on various diseases, from receding gums to cardiovascular problems to Alzheimer’s, on exercise tolerance and performance etc etc.

So what were the results of these studies? Did they show Q10 was the miracle supplement the current crop of stories seem to be claiming?

The answer is “No”. The studies are inconsistent, with the usual problem of small sample size and lack of “blinding”. But the scientific / medical consensus, which you can find a good summary of here, is that there is basically no indication to take CoQ10 even if you are ill, let alone if you are well.

This is actually an object lesson in the different kinds of evidence that one can have for therapies, including pills, and why some types of evidence are more reliable than others. The “hierarcy” of evidence often used nowadays to decide if treatments can be viewed as actually working (and hence can be recommended for widespread adoption as part of medicine), is shown below. This hierarchy allots higher “levels” (essentially “greater reliability”) of evidence to randomized controlled trials (RCTs), and the highest level of all to “Systematic review (with homogeneity) of RCTs”. This last means when you look systematically at all the RCTs together, if you find that the treatment is consistently coming out as effective then it is a very good bet that it really works.

Various other kinds of studies are less convincing than this - a single, but good trial scores grade 1b, a not-so-well-done RCT scores grade 2b.

Figure: Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)

(via Dr Kimball Attwood’s wonderful post on evidence based medicine and Alternative medicine here)

Level

Therapy/Prevention, Aetiology/Harm

1a

Systematic Review (with homogeneity*) of RCTs

1b

Individual RCT (with narrow Confidence Interval‡)

1c

All or none§

2a

SR (with homogeneity*) of cohort studies

2b

Individual cohort study (including low quality RCT; e.g., <80% follow-up)

2c

“Outcomes” Research; Ecological studies

3a

SR (with homogeneity*) of case-control studies

3b

Individual Case-Control Study

4

Case-series (and poor quality cohort and case-control studies§§)

5

Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”

Studies which have designs OTHER than a randomized controlled trial score lower. In particular, studies whose design means they tend to be relatively UNreliable (often because they are contaminated by ”expectancy_effects”, by selection_bias relating to the participants, or by regression_toward_the_mean) are down in grade 4. Here the way the trials is done is often “give people the pill, with no control group and no placebo, and then ask if they think taking it made them feel better”.

The similarity between this last one and a “money back guarantee” if you didn’t think Q10 supplements gave you more energy is not a coincidence.

Finally, the idea that “because this works in a dish it will work in people”, much used to plug Alternative medicines, is down at grade 5, as is another familiar one, “this works because this or that expert guru says it does, regardless of the lack of any critical appraisal of the evidence to back it up”.

The talking-up of CoQ10 in leaflets, and on websites, and now in the papers, is mostly a fancy example of the “because it works in a dish” (level 5) argument down at the bottom of the pile. And most of the existing CoQ10 trials in humans, which some of the stories refer to en passant, are down at grade 4. Reviews of the trial evidence on CoQ10 tend to be (at best) in grade 3a, since the trials usually lack “homogeneity” (i.e. the results are inconsistent).

The upshot is that Q10 would not get licenced for use as a medicine in any common condition, because the evidence that it produces benefits simply is not good enough. The only exceptions, thus far, are very rare, mostly genetic, and specifically mitochondrial diseases.

 

Repeat: For all the other stuff, the evidence simply is not there.

Incidentally, this is true even if you take something where there seems to be a really appealingly plausible scientific rationale for using CoQ10 (grade 5). The best-known example is probably in people taking statins. Your cells make their own CoQ10 – another reason why the need for supplements is very dubious – and the biosynthetic pathway leading to CoQ10 is “shared” (part of it) with cholesterol biosynthesis. Hence the common website claim that if you are taking cholesterol-lowering statins (which partially inhibit a key enzyme in the pathway) then you “need” to supplement your CoQ10.

Sounds plausible. However, it turns out that the trial evidence is not running in favour of CoQ10 supplementation even when people are taking statins, and even in the subgroup of people on statins who have symptoms suggestive of statin side effects (Coracle has written about this at length). So if CoQ10 were to be marketed as a medicine for this statin setting there would not be nearly enough evidence to approve it. This points up – again – the difference between the efficacy standards required for drugs (there are some) and supplements (there aren’t any).

Of course, if there isn’t convincing evidence that CoQ10 makes a difference even in a situation where using it might seem biochemically highly “plausible”, you can bet your mortgage there is bugger all reason for normal people to take it on the off chance that it will do something. Apart from making the supplement peddlers considerably richer,

But…. To keep repeating the obvious, you don’t need any evidence to market a supplement. You only need to show that it doesn’t seem to be toxic.

 

Plus ca change, plus c’est la meme chose

Getting back to “déjà vu all over again”, the CoQ10 thing prompted me to have a dig through my own files. Back in the mid 1990s – about 1995 or 96, I think – I remember seeing a big display of CoQ10 pills in Boots. (Yes, amazingly they already sold them back then). As a ”recovering Biochemist”, this piqued my interest, so a year or two later I started setting medical student dissertation topics (i.e. reviews of the scientific literature) about supplements and alternative remedies.

Which leads me to this: lurking in my files is a dissertation a first year medical student wrote for me back in 1999 (sic) on:

 

“Coenzyme Q10: snake oil or medicine?”

[The student would have graduated in 2003 and is now, I guess, a junior doctor]

A couple of sample quotations:

”While some adverts for CoQ10 make use of anecdotal evidence from individuals testifying to “the miracle of Q10”, others make weightier-sounding allusions to scientific studies. But to what extent are claims made by the supplement industry upheld by scientific studies?”

A question Dr Thomas Stuttaford, Boots, and various health page journalists appear to have forgotten how to formulate. The answer, as we have already seen above, is “Not very much, if at all”.

Another bit from the student’s work discussing the “lifestyle-enhancing” claims for Q10:

”…What constitutes “normal” levels [of CoQ10] is of course open to debate. While no frank CoQ10 deficiency has yet been described, Folkers claims that suboptimal levels of CoQ10 are universal. There is, however, little current evidence to suggest that CoQ10 supplementation benefits the healthy individual.

Despite this, many people do take CoQ10, seemingly unconcerned about the lack of scientific evidence to support the anti-ageing, energy-boosting, flab-fighting, brain-stimulating and sex-life enhancing claims the adverts boast.

Adverts on the Internet may allude to scientific studies but generally fail to provide references and information is sometimes presented in a misleading way. They generally use a didactic tone and sometimes warp information to [persuade people] to buy their product, as demonstrated by the following advert:

”The body’s levels of CoQ10 decline with age; therefore it is necessary to supplement the diet. Food does not contain significant amounts of CoQ10 and the body des not produce enough CoQ10 on its own, so supplementation is imperative in order to have adequate amounts of it” (Emphasis added).

[Furthermore], findings of low levels of CoQ10 in disease states do not necessarily imply that low levels will lead to these diseases, as some adverts claim.

All [this] renders consumers vulnerable, all the more worrying since direct-to-consumer advertising of [nutriceutical] products is now big business. …”

 

Hmmm. Now, it is fair to say this was a bright student, even by the normal bright standards of first year medics. But… armed with essentially A level-plus-a-bit scientific knowledge, a first-rate brain, and a questioning mindset, s/he could see through the claims of the supplement peddlers. So one might expect that Boots’ “panel of experts”, Ann Walker PhD, and even Dr Stuttaford ought to be able to take a slightly more balanced view.

 

…If they wanted to.

And there’s the catch.

If they wanted to.

 

Boots, remember, are trying to sell you something. So is Ann Walker. Why should a seller tell the truth if spin sells better? And Dr Stuttaford is making a living cranking out re-worded press release bumpf.

Plus – there is nothing to stop them. Provided they avoid making directly and demonstrably false claims – as opposed to writing ambiguous things that will merely encourage readers to draw obvious but erroneous conclusions – they can say what they like.

As ever, caveat emptor. And that means you.

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13 Responses to “An imperfect (Q) ten”

  1. jdc325 Says:

    Excellent post Dr Aust.
    This canard: “Energy (scientific sense) = energy (vernacular sense) (false)” is behind a lot of false claims for ‘Alternative Medicines’ – for example most Vitamin B supplements are pushed on the basis that they will somehow give you extra energy.

  2. John C. Campbell III Says:

    I would suggest that the good doctor google for ‘UCSD Statin study’ for starters. Then “Duane Graveline” (aka SPACEDOC) and enter into a discussion with two of his own colleagues on this matter. Myself being in the real sciences (physics) not the psuedo science / discipline / ‘art of medicine’ (particularly when they’re being sued) deal in the world of observable phenomena … and scientific observation / examination. The liver produces ubiquinol … and uses it to change it into ATP. As we age, it produces less.
    I assume the good doctor knows what ATP is and is used for by the body? for those of you who do not, Dr. Golomb at the Statin Study, and my Johns Hopkins doctors, cardiologists, neurologists, pulmonologists ..(you’ve perhaps heard of the place?) believe that I have a mitochondrial problem (caused by lipitor which doesn’t JUST block cholesterol.) If I have mitochondrial dysfunction/ damage that further stops turning O2 into the nucleotide Adenosine triphosphate (ATP) for energy. Or more precisely,O2 “burns” ATP into ADP, and releases energy. `Hydrocarbon bonds (through an “electron transport process”) transfer energy from your intake of “sugars” into ADP to add on the third phosphate to become ATP which is the stored form of energy. Mitochondrial dysfunction would likely be the inability or impairment of mitochondria to break the third P off by adding O2 And thus releasing energy.The lack of which, would be causing tiredness, weakness, inability to exercise and cognitive dysfunction..
    A little over a decade ago (post heart attack) a medical quack put me on Lipitor, for 7 years, and now I take (spread out) a gram of fat soluable Coq10 a day. Statin drugs being derived from a poison it’s not surprising. Again, the good doctor could search for ” THE HIDDEN ORIGIN OF STATIN DRUGS Shane Ellison M. Sc. ”
    Personally, I invite the doctor to come to Annapolis, Md. and observe what happens if I do NOT take it for 8 hours (talk being ‘cheap’ as they say). Feel free to contact me at my gmail account jccampb@gmail.com to discuss this off line.
    jccampb

  3. anonymous4 Says:

    Large doses of coenzyme Q10 are currently being utilized in Phase III trials in early stages of Parkinson’s disease, in Alzheimer’s and ALS. Mitochondrial dysfunction is theorized to be etiopathologic in these neurodegenerative disease. (see Shults, et al. “Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline.” Archives of Neurology , October 2002, Vol. 59, No. 10, pp. 1541-1550. Though underpowered, study concluded that the use of megadose CoQ10 resulted in decrease in progression of symptoms in individuals with early stage PD)
    CoQ10 is also a mainstay of therapy for individuals with mitochondrial cytopathies. It also is depleted by the ubiquitous statin drugs; seems depleted coq10 is found in plasma, platelet levals and muscle tissue in individuals who take statin drugs. CoQ10 is an integral part of he electron transport chain which produces ATP.
    It is also essential in the formation of the apoptosome, along with other adapter proteins. The loss of trophic factors activates pro-apoptotic enzymes, causing the breakdown of mitochondria.

    and coq10 is a very potent antioxidant.
    No, I do not sell the product.

  4. coracle Says:

    Thanks for the link DrAust. I do like the discussions that go around with statins and cholesterol. In my ignorance, I used to think that the pathogenesis of heart disease and cholesterol’s role in it was pretty well worked out. It is interesting how much we don’t know about the roles of the different forms of cholesterol. The UCSD Statin Study group certainly looks very interesting and I will be interested to read what they have found when they publish something more than conference abstracts.

    Spacedoc is interesting in another way. Anyone who claims “we now know that cholesterol is not our enemy, it is the most vital substance in our bodies.” should be taken with a pinch of salt. I don’t think I would claim a single substance is the most vital, but I think things like water, O2, Na+, K+ and Cl- are quite important too. Spacedoc’s claims on nutritional supplements are well worthy of a blog-post in themselves. Sadly, it looks like the most recent research doesn’t support his claims. More research needed certainly, but I don’t think anyone should be advocating them on the balance of evidence. Homocysteine lowering and cardiovascular events after acute myocardial infarction.

    I think the great cholesterol debate is a target rich environment. I did google for THE HIDDEN ORIGIN OF STATIN DRUGS and thought it was an interesting site. Interestingly enough where the author states: “No one would care to look twice – or even once – at the origin of statin drugs.” I did, because that sort of thing interests me. Ellison seems to use deliberately provocative language to describe statins, including poison. This stretch in particular caught my eye:
    “In a natural response to the threat of a predator, red yeast produces the drug known as lovastatin”
    The ‘predator’ in question would be bacteria, not humans, and it’s distortive to use such prejudicial language.

    Still, the denialism rumbles on and those of us concerned with evidence will have to take what we can from the published literature.

  5. anonymous4 Says:

    coracle–you did not address any of the points i made. have you no comments upon the use of coq10 for neurodegernerative diseases or mt cytopathies?
    how about the use of statins in pts with neurodegenerative diseases in which depleted coq10 is ALREADY part of the disease process itself–pts with Parkinson’s, ALS and alzheimer”s, whether having taken a statin or not, have evidence of depleted serum, platelet and muscle tissue levels of coenzyme q10–thought to be part of the mitochondrial dysfunction in those disease states. seems rather counterintuitive to give statins to ANY patients with a disease state in which the result is further depletion of a substance that is thought to be depleted by the disease process itself

  6. Boots reaches new level of dishonesty with CoQ10 promotion Says:

    [...] articles on CoQ10 by Ben Goldacre in the Guardian, and at badscience.net, and at Holfordwatch and Dr Aust’s Spleen Aha Boots have repeated their mendacious claims in newspaper [...]

  7. David Colquhoun Says:

    Anonymous4 is missing the point. The Boots advertisement is not selling the stuff for any of the conditions that he/she mentions. But even for the things he mentions, the evidence that CoQ10 does much good is lousy (see the excellent summary on the Mayo Clinic site, for example).

  8. coracle Says:

    Annonymous4,

    You’re absolutely right, that’s because I was addressing the issues raised in John C. Campbell III’s comment, not yours.

    I don’t really have much to comment about the use of CoQ10 in neurodegenerative diseases. I don’t know enough about it, so I’ll hold back. The use of statins in Alzheimer’s is interesting. The involvement of ApoE4 in the putative pathogenesis of Alzheimer’s disease may suggest that the use of statins may be beneficial. Similarly, cardiovascular risk factors, such as high cholesterol and high blood pressure may also be risk factors for Alzheimer’s disease. Therefore the use of statins may be beneficial. What is important is to wait until the evidence is available. Alzheimer’s is a the sort of disease where the evidence is slow to accumulate and so it is likely to be some time before high quality evidence is available. There is however, already some evidence that statins may protect against congnitive decline: Statins and cognitive function. However, a more recent study suggests that there is no effect of statins on alzheimer’s disease, neither positive or negative. See Statins, incident Alzheimer disease, change in cognitive function, and neuropathology.

    It’s interesting that you mention the Shults 2002 article, which admittedly shows a trend to benefit for CoQ10, but the more recent, and larger, trial by Storch et al (2007) fails to show a benefit of CoQ10 against placebo in Parkinson’s disease. Now I haven’t read either paper, so I don’t know how comparable they are, but larger and more recent trials tend to be more reliable. Randomized, double-blind, placebo-controlled trial on symptomatic effects of coenzyme Q(10) in Parkinson disease.

    As David says the original point of Dr Aust’s post is not about the possible benefit of CoQ10 in neurodegenerative disease, but the promotion of an unnecessary supplement to a healthy population on spurious well-being claims.

  9. livebetter Says:

    Here’s one of those much derided anecdotes from one of those patronised laypeople who, not knowing what they’re talking about, should just shut up and take the prescription medicine even though it seems to make your heart less stable and therefore more prone to atrial fibrillation and even though there’s a debilitating side effect of extreme tiredness and a very frightening one of heart pauses which can last 2 to 3 seconds which believe me are only marginally more amusing than a heart attack, especially when they wake you up at 3.00 o’clock in the morning: in desperation I went to my local health food shop and asked the manager what his customers with heart conditions bought. He replied: CoQ10. I therefore bought a bottle and within just an hour or so of starting to take the capsules, maybe less, I started feeling stronger and that feeling of my heart acting like a faulty starter motor about to throw a wobbly any second started to ease. That was about four years ago. It was the moment when my PAF instead of getting progressively worse, as per the grimly satisfied prediction of the cardiologist, started getting progressively better. It’s not a complete cure: I still have to be very careful what I eat and drink and I have had PAF episodes since then, the last one in late 2006, but my exercise tolerance has improved from 100 yards walking on eggshells to an average 10 miles a day striding up and down hills and over rough ground walking my dog. I didn’t have any expectation that CoQ10 would help me but it evidently has and I would wholeheartedly (no pun intended) recommend it to anyone suffering from PAF. At least, unlike prescription medicine, there’s no risk of it doing you any harm

  10. draust Says:

    Thanks for the comments, John C Campbell III, anonymous4 and Livebetter.

    In response:

    John and Anon4:

    I actually know a fair bit about mitochondria and a lot more about ATP; my first job in science was making mitochondria and mitochondrial proteins and membranes, and I spent six years actually measuring ATP levels day in, day out, with 31P NMR spectroscopy. I have been studying cellular metabolism in various ways for a quarter of a century. I don’t want to go into detail, largely since for day-job-related reasons I am trying to maintain at least a veneer of anonymity on this site. So you’ll have to take my word for it that I am not a total duffer in this sort of area.

    John:

    Your Hopkins doctors, who I am sure are top of the line, doubtless have a view on why CoQ10 seems to help you. One possibility, I have to say, would be that it is an expensive placebo. I know you don’t believe this, and are sure you get real “withdrawal” effects, but without a properly blinded test it is impossible to rule out.

    Another possibility would be that you have some kind of unusual mitochondrial problem. Remember that I said:

    “..the evidence [that CoQ10] produces benefits simply is not good enough. The only exceptions, thus far, are very rare, mostly genetic, and specifically mitochondrial diseases.”

    Your case being unusual in some way is a more likely explanation of your success with CoQ10 than “everyone, including me, who has statin side-effects would benefit from taking CoQ10” (which the trials disagree with – the key review is by Marcoff and Thompson here and there is another summary here).

    It needs to be stressed that one case does not make an overthrow of the body of medical and scientific evidence. But one case – like yours – is (a single piece of) scientific evidence – it is a (potential) case report. A bunch of similar case reports make a case series. Then a bigger trial, say comparing groups of people with and without CoQ10, makes a cohort study… and so we gradually move on up the “evidence hierarchy” I gave in the post. If enough evidence accrues to contradict the current consensus view, then the overall view on something changes. That is how science works.

    Anyway, the negative trial verdict on CoQ10 with statins does not mean “no patient taking statins can possibly exist for whom CoQ10 might be helpful”. It just means “the current evidence, taken together, does not support the idea that we should automatically give CoQ10 to people who don’t tolerate statins and that it will help.”

    Finally, you’re lucky to live in such a nice town. I spent a few happy afternoons in Annapolis when I worked at the NIH, and it is a beautiful spot. Checking out this made me nostalgic for crab cakes and microbrew. Of course, one problem I had visiting Annapolis was getting stuck in the Rams Head Tavern’s garden with the beer list.

    Anonymous 4:

    No-one is disputing that CoQ10 is an important molecule within mitochondria. But the biochemical stuff (paras 2-4) you list comes back to my point about the “underlying scientific rationale does not show it will work as a drug”. This one has been done so much that we often don’t bother re-stating it, though as a bench scientist doing cellular studies I am intimately familiar with the problem. I think this general idea is worth a post on its own, to follow

    Re the phase 3 Alzheimer’s trial of CoQ10, I agree that these are the nearest thing yet to a real large-scale therapeutic use for CoQ10. And I will be interested to see the results… but until the data are in it is just another interesting idea, see above. I repeat, I didn’t say “absolutely no evidence of any kind for CoQ10” – I said “not enough evidence”, which is also what the Mayo Clinic site on Q10 says that both David Colquhoun and I gave a link to.

    And remember – the supplement pushers I am writing about are not proposing CoQ10 here for something where the pathophysiology might suggest the stuff has a rationale – like ALS where an oxidative neuronal damage mechanism has been proposed. They are suggesting that anyone who feels “a bit run down” take the stuff.

    To re-state the obvious: if the evidence that CoQ10 helps in possibly-mitochondrial-linked diseases like ALS is tenuous (which it currently is), then the idea that normal people should be popping the stuff, at 55 pence / 1 $ a pill, is plain silly.

    By the way, one has to take the upbeat verdicts in some of the reviews on CoQ10 with a pinch of salt. No scientist or clinical scientist who works mostly on CoQ10 is going to tell you “this stuff probably isn’t going to pan out as a therapy”. That is human nature, because s/he hopes it will pan out. So they are “professionally upbeat”.

    When a scientist writes “new formulations of Q10 should enable us to target it more rationally into different cells” what s/he means is “at the moment it is damn hard to get this stuff into cells, and we don’t really know if it goes in at all… but I’m hoping we can solve that somehow”. We all do this, so people in the business know how to read between the lines.

    Livebetter:

    You think CoQ10 has helped you. But there are a bunch of other plausible explanations. In paroxysmal atrial fibrillation (PAF) the “paroxysmal” refers to the fact that the AF comes and goes. It can be worsened by “sympathetic drive” (your sympathetic nervous system), or if you prefer “you feeling stressed out”. It is often worsened by people drinking more, which of course commonly goes along with feeling stressed out.

    I think from what you wrote that you are discounting the placebo effect because you went to the health shop not believing an alternative remedy would help. But regardless of the belief, you hoped it might. I have taken alternative remedies, and I don’t really believe in them either – but I did hope they might do something .

    Anyway, suppose that for some reason – even just the hope that it might work – you felt less stressed and your PAF eased – or maybe it simply had a good week that week, see “paroxysmal”. Anyway, suppose the good week coincided with the first week taking the CoQ10 pills. Now you begin to half believe it, so you feel calmer. Your PAF stays away for longer, and you are more and more convinced that it was the CoQ10. But it could have just gone away spontaneously. These things happen. It could be you were less stressed. It could be that you had been drinking more as you felt stressed, and when you felt calmer you cut back.

    What I am really saying is that there are all sorts of possible reasons. How do we tell which one is real? Well, we do placebo-controlled scientific trials. There is no other way to work out cause and effect.

    I hope I don’t sounds like I’m being condescending, or dismissive. Like I said, I have taken several herbal remedies, even though I don’t know if they have real effects or work by placebo. For instance, when I can’t sleep, I sometimes take valerian / hops tablets. They do seem to make me feel sleepy (some of the time). But is that real pharmacological effect, or expectation? I can’t tell. And without a placebo trial, nor can anyone else.

    Apologies – that has all got rather verbose. But I thought the three of you deserved a reply.

  11. Ashley Says:

    My child may have Mitochondrial Disease and I would love to see your detailed opinion on Co Q10 R/T Mito. So far a mucsle biopsy showed a small -less than normal level of CoQ10, but the neurolgist could not make a factual diagnosis based on that. She contacted one of the leading experts on Mito, Dr Devito at Columbia U and he also thinks it appears to be Mito. There are just so many variations that do not even have a diagnostic test yet. Anyway, I have read that often CoQ10 is combined with L Carnitine, Vit B, Vit C…etc. I am very interested in the combinations of these and what role they play to each other in Mito Disease. Please email me if you ever write on such. Rowellfoxworth@aol.com

  12. More eleutherococcus « Northern Doctor Says:

    [...] Elagen Sport capsules also have Coenzyme Q10 in them. Dr Aust can advise you further on this here.They will supply you with 90 capsules of their Elagen Sport version for £14.95 here. I [...]

  13. Kelly Crawford Says:

    I wanted to try taking CoQ10 supplements but can’t decided which to buy. A friend of mine suggested that I should try this: http://products.mercola.com/coq10-ubiquinol/ Has anyone tried it before? If not, any recommendations?

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