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TreatmentUpdate 118
Volume 13 Issue 2 2001 June Extra co-enzyme Q10 for statin-users?
Summary
Co-enzyme Q10, or ubiquinone, is a nutrient that is produced in small amounts by the body and is also obtained from food. It plays a key role in helping the body convert food into energy. Co-enzyme Q10 is also an important antioxidant, the need for which increases during HIV infection and in people who use certain lipid-lowering drugs called statins.
What does co-enzyme Q10 do?
Many of the body's functions rely on a series of chemical reactions called oxidation. During these reactions, molecules called free radicals are produced. Free radicals can damage the body in much the same way that rust damages a car. To prevent this damage, the body uses antioxidants such as vitamins C and E as well as co-enzyme Q10. In this report, we will shorten this nutrient's name to Q10.
Power generation
Co-enzyme Q10 plays a critical role inside a cell's power plant, or mitochondria. This nutrient helps to protect the power plant from damage caused by free radicals. Inside the power plant, sugar or glucose is "burnt" to release energy. Q10 helps to capture the energy so that it can be used to power cells.
Q10 also protects cells and fatty substances, including vitamin E, from free radicals. Q10 can also help to "recharge" or "recycle" vitamin E.
HIV positive people use Q10 for several reasons:
1. To restore levels of Q10 in the body to normal
At least one study has found that HIV positive people have significantly less Q10 in their bodies than do HIV negative people. Moreover, Q10 levels continue to decline as the immune system degrades. Supplements of Q10 ? 200 mg/day ? can restore levels of this nutrient to within the normal range.
2. For protection from drug-related toxicity
Drugs such as AZT, ddI, ddC, 3TC, d4T and ABC (abacavir, Ziagen) are called nucleoside analogues (nukes). These drugs can damage the energy-producing parts (mitochondria) of cells. Damaged mitochondria produce less-than-normal amounts of energy. When cells don't have enough energy, they don't work properly and can die. When many cells inside an organ, such as the liver, die, this can cause health problems.
Prolonged use of nukes can lead to lactic acidosis. In this condition, high levels of lactic acid, or lactate, are released into the blood. This can lead to the following symptoms:
feeling weak or tired
nausea and/or vomiting
painful inflammation of the pancreas gland (pancreatitis)
swollen, fatty liver
Other problems that may be caused by nukes include:
damage to the nerves in the hands and feet (peripheral neuropathy)
loss of hearing
bone loss
loss of fat
muscle wasting
These problems may occur, in part, because of damage to mitochondria. Antioxidants such as vitamins C and E can delay or prevent some of these complications. Because Q10 plays such an important role within mitochondria, it is possible that this nutrient taken with other antioxidants may help prevent some of these nuke-related complications.
3. For protection from some forms of cardiovascular illness
In HIV negative people, results from small studies suggest that Q10 has the potential to do the following:
help reduce high blood pressure (hypertension)
help people recover from heart failure
protect the heart from damage for brief periods when its blood supply is interrupted
In the body, Q10 is often found attached to a form of cholesterol called low-density lipoprotein (LDL). Q10 helps to prevent LDL from being oxidized or damaged by free radicals. As a result, supplements of Q10 may help to reduce the risk of developing cardiovascular disease.
4. For protection from the side effects of lipid-lowering drugs
One common side effect of highly active antiretroviral therapy (HAART) is increased levels of fatty substances or lipids in the blood. Examples of the lipid changes that can occur in HAART-users include the following:
increased levels of triglycerides
increased levels of cholesterol
increased levels of LDL (bad cholesterol)
decreased levels of HDL (high-density lipoprotein ? good cholesterol)
These lipid changes increase the risk of cardiovascular disease in HAART-users. To decrease this risk, doctors may encourage people with HIV/AIDS (PHAs) to make changes to their diet and engage in a programme of regular aerobic exercise. If these steps don't work, then lipid-lowering agents ? commonly called statins ? can be prescribed. These drugs work by lowering the levels of triglycerides and LDL while raising HDL. Thus, statins can greatly reduce, but do not eliminate, the risk of developing cardiovascular disease. Examples of statins include the following:
Baycol (cerivastatin)
Crestor (rosuvastatin)
Lescol (fluvastatin)
Lipitor (atorvastatin)
NK-104 (pitavastatin)
Mevacor (lovastatin)
Pravachol (pravastatin)
Zocor (simvastatin)
These drugs exert their lipid-lowering effect by reducing the body's ability to produce cholesterol. Unfortunately, Q10 production is also affected by statins. Not surprisingly, the body's production of Q10 can fall between 25% and 40% with the use of statins. Reduced production of Q10 means that there is less of this important antioxidant to protect cells from free radicals. It is possible that with less Q10 available, there may be an increased risk of developing certain side effects associated with use of statins, including the following:
muscle inflammation, pain and weakness
fatigue
liver damage
Some PHAs who use statins also take supplements of Q10 and vitamin E.
Side effects
Most clinical trials of Q10 have used doses ranging between 30 mg/day to 800 mg/day. At these doses, no serious side effects have been published.
Warning
Warfarin (Coumadin) is a blood-thinning drug that is used to increase the time blood takes to form clots. Q10 taken with warfarin may intensify this effect.
Available forms and usage
The body can make Q10 using the amino-acid tyrosine, B-complex vitamins and vitamin C. Foods that are good sources of Q10 are usually cholesterol-rich and include the following:
pork
beef
chicken
herring
Bear in mind that it is almost impossible to obtain a high level ? 200 mg ? of Q10 in one day from food sources alone. This is why some PHAs take supplements of this nutrient. Q10 is sold in capsules, mainly in health food stores. The dose used in clinical trials involving PHAs is 200 mg/day. Because Q10 dissolves in fat, it is best taken with meals to increase absorption. Some Canadian health food stores sell capsules containing a mix of Q10 and flaxseed oil.
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Created on: 2001 July 17
Author: Hosein SR
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