Dr. Stephen Sinatra - Statins, CoQ10, and Carnitine

Statins, CoQ10, and Carnitine - What Doctors Don't Tell Patients

stephen_sinatra_136One of the main problems with statin drugs, as Dr. Graveline has reported in his writings, is that they deplete the body of CoQ10. 

This is well known to integrative physicians like myself who use both conventional and alternative treatments and who keep their antennas up for nutrient deficiencies commonly caused by medications. 

Statins deplete CoQ10, a critical raw material in cellular energy, and a major antioxidant.  This singular depletion accounts for a good deal of the side effects of statin drugs. 

If I had to prescribe a statin, I always made sure the patient took an ample amount of supplemental CoQ10 - at least 100 mg daily and taken with a meal. I would avoid CoQ10 sold in the capsule form, that is, capsules containing powder.  They do not absorb particularly well. 

The best form, according to research and my own clinical experience, is hydrosoluble CoQ10 (Q-Gel) contained in soft gels. These superior products are available in health food stores.  

Most of my patients, whether they took statins or not, took CoQ10 because it provides a solid boost to energy and wellbeing.

Along those same lines I also encouraged patients to supplement routinely with carnitine.  This amino acid, one of my top five supplements, produces a jackpot of cardiac, muscle, energy, and anti-aging benefits.  I was already so impressed ten years ago that I wrote a book on it: L-Carnitine and the Heart (Keats).

Fast forward to 2007 and imagine how good I felt about recommending carnitine all these years when I read a fascinating study from Italy.  In the study, researchers randomly divided in half a group of 66 men and women over the age of 100.  For six months, one group was assigned to take a 2 gram carnitine supplement daily and the other an inert placebo pill. 

At the end of the experiment, the researchers reported that the carnitine-loaded centenarians registered significant improvements in energy, mental function, and muscle mass, along with a reduction of fatigue and fat mass.  Among the placebo bunch, no such benefits were seen.
The mental function finding here supports a previous analysis of controlled studies suggesting that acetyl-L-carnitine (one of several forms of carnitine) improves cognitive ability and reduces deterioration in older adults with mild Alzheimer's disease.

On average the carnitine takers in the study gained 8.4 pounds in muscle mass and lost about 4 pounds of fat.  That's a powerful result when you consider that loss of muscle - called sarcopenia - accompanies aging.  Unchecked sarcopenia progressively undermines the muscular strength needed to handle everyday chores and activities.  In sarcopenia, muscle fibers lose their volume, strength, and overall integrity.  People over 60 or 70 generally start noticing this as increased flabbiness and decreased strength. 
The new study was very encouraging because it was conducted among an end-of-life population struggling with loss of strength, mental acuity, mobility, and endurance.  I just hope that gerontologists paid heed to the study, published in the American Journal of Clinical Nutrition. It sure caught my attention.
How can carnitine score so many points?  Think about carnitine as an "MVP" inside the mitochondria, the "power plants" within cells where adenosine triphosphate (ATP), the body's basic fuel, is produced.  CoQ10 is a raw material directly involved in energy production.

Carnitine's role is to exclusively ferry fatty acids to be oxidized to make ATP.  So the body needs a lot of it to be optimally energized.  A normal heart muscle derives 60-70 percent of its fuel from fat.

That means anyone with heart disease or a weak heart will have a hard time getting better without addressing the problem of fat delivery inside the heart muscle.  

This process is actually critical for all muscles, which also largely depend on fatty acids for energy.  Thus a central metabolic activity depends on the quantity of available carnitine. 

An increased concentration accelerates energy metabolism.  Low concentration impairs it.  And over the age of 70, the concentration declines. Among people with heart disease the decline occurs even earlier.
Equally important, carnitine transports waste material out of the mitochondria, such as toxic metabolites that could otherwise disturb the burning of fats and cause disruption inside of cells. 

I have seen the power of carnitine help hundreds of patients, young and old.  Among the lesser known benefits I've witnessed time and time again is how it relieves the muscle pain, cramps, and fatigue due to toxic burdens and chemical sensitivities. 

Toxins - such as from chemicals or heavy metals - infiltrate cells, build up over time, and sabotage ATP production. As a result, cellular activities suffer. 

Adequate carnitine keeps the ATP operation humming and the mitochondrial environment clean.  This in turn enables cells to function as they should, and that includes giving the boot to toxic infiltrators.
The human body is a high energy machine.  It creates a lot of toxic waste and accumulates outside toxins as well.  In the interest of getting rid of the gunk and maintaining good health over a lifetime, carnitine gives you a huge detoxification weapon.  

It can also come to the rescue in acute situations, as it did for my son Step who had been hospitalized with a life threatening parasite infection.  Among his problems was terrible muscle pain.  

I convinced his doctors that the pain could be a result of a toxic buildup and that IV carnitine could be effective for relieving it.  My hunch paid off and thankfully Step got major relief.
The word carnitine comes from the Latin carnus, meaning flesh or meat.  We get carnitine in our food, most abundantly in meat.  The diet also provides lysine and methionine, two amino acids that the liver blends with niacin, vitamin B-6, and vitamin C, to make carnitine.

Although deficiency is rare in healthy, well-nourished people consuming adequate protein, many vegetarians, and particularly pure vegetarians, become deficient to some degree.  They lack enough carnitine from the diet, and the methionine and lysine components needed for synthesizing carnitine in their bodies. 

The typical non-vegetarian, Western diet provides around 100-300 mg of carnitine per day.  The amount has decreased by an estimated 20 percent over the last decade, mainly as a result of people eating less red meat.  Ovo-lacto-vegetarians (egg and dairy eating vegetarians) have an intake of about 10-40 mg, and strict vegetarians, maybe around 1-4 mg.

The consequences of lesser carnitine among vegetarians have received scant research attention, however I can tell you frankly that I've seen severe deficiencies among vegetarian patients who had heart failure and/or extreme fatigue. 

Supplementing with carnitine, as well as CoQ10 and magnesium, all so very important for ATP production, always made an enormous difference in these patients.

Recently, both Dr. Graveline and I have reported on a newly discovered source of carnitine problems: statin drugs.  For years I had seen many new patients who complained of crushing muscle pain, the obvious result of taking statin drugs.

Some of them continued to have muscle pain even when I took them off the medication and prescribed CoQ10. The CoQ10 usually eliminated the problem. In these stubborn cases, improvement didn't occur until I added L-carnitine to the program.  The carnitine enabled the muscles to rebound.  
I recalled these cases as I recently came across the research of Georgirene Vladutiu, Ph.D., an expert on muscle disease at State University of New York at Buffalo. She has intensively investigated an area I was not familiar with: the presence of a genetic enzyme disorder called carnitine palmitoyltransferase deficiency, or CPT II for short.

The researcher believes that because of lack of recognition by doctors this defect is far more common than had been previously thought.  Moreover, she has found a higher prevalence of underlying metabolic muscle diseases related to this problem among patients taking cholesterol-lowering drugs than among the general population.  Statins negatively impact CoQ10 and now, her research brings to light, carnitine as well.

I'm obviously a big drum beater for carnitine supplementation. That's why, in fact, I've developed nutritional supplements around it, including recently a broad spectrum carnitine with several different forms of this nutrient: L-carnitine, the most inexpensive and most widely researched type; acetyl-L-carnitine, the best absorbed and most efficient form for reaching brain tissue and boosting mental function; and propionyl-L-carnitine, particularly good for heart and other muscle tissue.

The amount of carnitine used in the Italian study - 2 grams - is a solid dosage for seniors and vegetarians.  Meat eaters can take 250-500 mg.  Always take your carnitine supplement on an empty stomach for improved absorption. 

Malaguarnera M, Cammalleri L, Gargante MP, et al. L-Carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centenarians: a randomized and controlled clinical trial. Am J Clin Nutr, 2007;86(6):1738-44.
Montgomery SA, Thal LJ, Amrein R. Meta-analysis of double blind randomized controlled clinical trials of acetyl-L-carnitine versus placebo in the treatment of mild cognitive impairment and mild Alzheimer's disease. Int Clin Psychopharmacol, 2003;18:61-71.
Vladutiu GD, Simmons Z, Isackson PJ, et al.  Genetic risk factors associated with lipid-lowering drug-induced myopathies. Muscle Nerve, 2006;34(2):153-62.

Dr. Stephen Sinatra, M.D., F.A.C.C., F.A.C.N.
Dr. Sinatra is a retired board-certified cardiologist who integrated conventional medical treatments for heart disease with complementary nutritional, anti-aging, and psychological therapies.
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November 2010

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