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.

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.

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.

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