Health for life

Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality in over a decade and should be added to standard treatment, according to lead author Professor Svend Aage Mortensen (Copenhagen, Denmark).

Heart Failure 2013 is being held from 25-28 May in Lisbon, Portugal. It is the main annual meeting of the Heart Failure Association of the European Society of Cardiology.

Coenzyme Q10 (CoQ10) occurs naturally in the body and is essential to survival. CoQ10 works as an electron carrier in the mitochondria, the powerhouse of the cells, to produce energy and is also a powerful antioxidant. It is the only antioxidant that humans synthesise in the body.

CoQ10 levels are decreased in the heart muscle of patients with heart failure, with the deficiency becoming more pronounced as heart failure severity worsens. Statins are used to treat many patients with heart failure because they block the synthesis of cholesterol, but these drugs also block the synthesis of CoQ10, which further decreases levels in the body.

Double blind controlled trials have shown that CoQ10 improves symptoms, functional capacity and quality of life in patients with heart failure with no side effects. But until now, no trials have been statistically powered to address effects on survival.

The Q-SYMBIO study (2) randomised 420 patients with severe heart failure (New York Heart Association (NYHA) Class III or IV) to CoQ10 or placebo and followed them for 2 years. The primary endpoint was time to first major adverse cardiovascular event (MACE) which included unplanned hospitalisation due to worsening of heart failure, cardiovascular death, urgent cardiac transplantation and mechanical circulatory support. Participating centres were in Denmark, Sweden, Austria, Slovakia, Poland, Hungary, India, Malaysia and Australia.

CoQ10 halved the risk of MACE, with 29 (14%) patients in the CoQ10 group reaching the primary endpoint compared to 55 (25%) patients in the placebo group (hazard ratio=2; p=0.003). CoQ10 also halved the risk of dying from all causes, which occurred in 18 (9%) patients in the CoQ10 group compared to 36 (17%) patients in the placebo group (hazard ratio=2.1; p=0.01).

CoQ10 treated patients had significantly lower cardiovascular mortality (p=0,02) and lower occurrence of hospitalisations for heart failure (p=0.05). There were fewer adverse events in the CoQ10 group compared to the placebo group (p=0.073).

Professor Mortensen said: "CoQ10 is the first medication to improve survival in chronic heart failure since ACE inhibitors and beta blockers more than a decade ago and should be added to standard heart failure therapy."

He added: "Other heart failure medications block rather than enhance cellular processes and may have side effects. Supplementation with CoQ10, which is a natural and safe substance, corrects a deficiency in the body and blocks the vicious metabolic cycle in chronic heart failure called the energy starved heart."

CoQ10 is present in food, including red meat, plants and fish, but levels are insufficient to impact on heart failure. CoQ10 is also sold over the counter as a food supplement but Professor Mortensen said: "Food supplements can influence the effect of other medications including anticoagulants and patients should seek advice from their doctor before taking them."

Patients with ischaemic heart disease who use statins could also benefit from CoQ10 supplementation. Professor Mortensen said: "We have no controlled trials demonstrating that statin therapy plus CoQ10 improves mortality more than statins alone. But statins reduce CoQ10, and circulating CoQ10 prevents the oxidation of LDL effectively, so I think ischaemic patients should supplement statin therapy with CoQ10."

New research shows for the first time a link between vitamin D levels and muscle efficiency. Vitamin D supplementation may also be effective in improving skeletal muscle function. This study is presented today at the Society for Endocrinology annual conference in Harrogate, UK. The findings may explain the physical fatigue commonly experienced by patients with vitamin D deficiency, with broad implications for a large section of society

Vitamin D is a hormone produced in the skin using energy from sunlight, and to a lesser extent derived from dietary sources. Vitamin D deficiency is a significant public health problem as diagnosed cases are on the rise and the hormone is essential for good bone health. Alongside poor bone health, muscle fatigue is a common symptom in vitamin D deficient patients. This fatigue could be due to a problem in the mitochondria: the power stations within each cell of the body. Mitochondria use glucose and oxygen to make energy in a form that can be used to run the cell (an energy-rich molecule called ATP). Muscle cells need large amounts of ATP for movement and they use phosphocreatine as a ready and available energy source to make ATP. The mitochondria also replenish this phosphocreatine store after muscle contraction. Measurement of the time taken to replenish the phosphocreatine store is a measure of mitochondrial efficiency: better mitochondrial function is associated with shorter phosphocreatine recovery times.

Researchers from Newcastle University, led by Dr Akash Sinha who also works within the Newcastle upon Tyne Hospitals NHS Foundation Trust, investigated phosphocreatine recovery times in patients with vitamin D deficiency. They employed a non-invasive magnetic resonance scan to measure phosphocreatine dynamics in response to exercise in the calf muscles of 12 patients with severe vitamin D deficiency before and after treatment with vitamin D. This is the first time a study of this kind has been conducted.

The team found that phosphocreatine recovery significantly improved after the patients took a fixed dose of oral vitamin D for 10-12 weeks (average phosphocreatine recovery half time decreased from 34.4sec to 27.8sec, p<0.001). All patients reported an improvement in symptoms of fatigue following supplementation. In a parallel study, the group demonstrated that low Vitamin D levels were associated with reduced mitochondrial function (r=-0.41, p=0.009).

The research shows for the first time that vitamin D levels are correlated with muscle efficiency, and that muscle aerobic metabolism improves with Vitamin D supplementation. Whilst this is a small study, it establishes clear proof of principle and (for the first time) a link between vitamin D and mitochondria in man. The mechanisms underpinning this effect are an avenue for future research by the group, who also aim to establish whether vitamin D supplementation could alleviate frailty in the elderly or improve the exercise capacity of athletes.

Study leader Dr Akash Sinha, Clinical Research Fellow at Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust said: "This is the first time a link has been shown between vitamin D status and muscle aerobic function. To do so we used a non-invasive scan to get a unique biochemical perspective on muscle mitochondrial metabolism during exercise: a window into what is really going on in the muscle as it works

"Patients with vitamin D deficiency often experience symptoms of muscle fatigue. Our findings in a small group of patients with very low vitamin D levels show that muscle efficiency significantly improves when vitamin D status is improved.

"Well need further research in more patients to work out how this is happening and whether non-deficient patients can benefit from this too."

Take off those Thanksgiving pounds with a week at a spa retreat. A new study shows that not only are they relaxing and nourishing, but they are safe and a week-long spa stay can correspond with changes in our physical and emotional well-being.

New research from Thomas Jefferson University Hospital evaluated 15 participants before and after their visit to We Care Spa, a health and wellness spa in Desert Hot Springs California, and found the program safe and helped to improve the participants health. Their complete findings will be available in the December issue of Integrative Medicine, A Clinicians Journal.

"Programs such as these have never before been formally evaluated for their safety and physiological effects," says Andrew Newberg, MD, director of research at the Jefferson-Myrna Brind Center of Integrative Medicine and lead author on the study. The authors pilot study is one of the first to attach scientific data to the outcomes of a health and wellness spa stay.

The week-long program included diet modification, meditation and colonic hydrotherapy, voluntarily participation in low-risk hatha and Vishnu flow-yoga programs, and a juice-fast cleansing very low calorie diet of approximately 800 calories per day. Stress management was provided through daily structured meditation and yoga programs as well as time for personal meditation encouraging deep breathing, heightened awareness and a calming effect.

In preparation, participants were asked to modify their diet three to four days prior to arrival by replacing a normal diet with fruit, sprouts, raw and steamed vegetables, salads, vegetables, herbal teas, prune juice in the morning, laxative teas or herbal laxatives nightly and avoiding pasta, meat, cheese, caffeine, alcohol and processed foods.

The participants, 13 women and two men between the ages of 21 and 85, with no history of significant medical, neurological or psychological conditions each underwent a physical evaluation including weight, height, Body Mass Index (BMI), blood pressure and an EKG test. They also received a complete blood count (CBC), liver function tests, tests measuring cholesterol and triglycerides, thyroid hormone testing, and the concentration of metals such as mercury and lead. In addition, psychological and spiritual measures before and after their arrival were measured.

An evaluation of the results showed that undergoing a spa program resulted in a weight decline of an average of 6.8 lbs., a 7.7 percent decrease in diastolic blood pressure as well as a decrease in mercury, sodium and chloride levels and a 5.2 percent decline in cholesterol level and mean BMI. Cholesterol level decline seemed to be curiously associated with a decline in HDLs, the good-for-you high density lipoproteins, which is of some concern, though they remained within the range regarded as beneficial. Hemoglobin increased 5.9 percent. No statistically significant changes in liver or thyroid function and no EKG changes were noted.

No serious adverse effects were reported by any individual, but the study noted changes in the participants sodium and chloride concentrations, suggesting that those interested in going to a spa program should check with their physician to make sure they do not have any medical problems or medications that could put them at risk for electrolyte disturbances.

Improvements in anger, tension, vigor, fatigue and confusion were also noted as was a statistically significant improvement in anxiety and depression levels measured by the Speilberger Anxiety Scale and the Beck Depression Index. Participants also reported significant changes in their feelings about spirituality and religiosity.

While beneficial, it is not possible to differentiate the effects of each of the individual elements of the program to determine which components were responsible for the changes observed. "This," says Newberg "will require an evaluation of one or more elements—such as yoga, very low calorie diet or colonics—in isolation to determine which elements have the most significant effects." In the future Newberg and colleagues look to study the effects of a spa stay on specific disease population, i.e. diabetics. The authors also encourage spa participants to consult their physician before attending this or similar programs and research the center vigorously for safety and efficaciousness.