Tuesday, February 15, 2005

Statins, and a Not-well-publicized Side Effect

You have to love the way our bodies repackage and reuse chemicals. The efficiency of the human body, or any living system, is hardly rivaled by the efficiency of a machine or other inanimate system. It amazes me. Whenever I look inside, I just see one big recycling center.

An example of efficiency

An average internal combustion engine converts its fuel to work with about 25% efficiency. The energy the engine makes that doesn't get used to propel a car is given off as heat. Our bodies convert fuel (carbohydrates and fats) to work with about 35% efficiency. The energy our bodies make that fails to get harnessed and used to propel us is also given off as heat. But we use that heat to maintain our internal temperature, which assists lots of enzymatic processes and keeps us up and running in a range of cold weather conditions. So, in this case, not only is the living system more efficient at harnessing energy from fuel than the nonliving system, but it capitalizes on the heat loss. (Hibernation wouldn't be possible without this capitalization of heat loss.)

Let me get back to the reason I'm writing this post.

Another place our bodies capitalize on the production of a process is in the making of cholesterol.

To the right is a simplified flow chart of how cholesterol is made in our cells. You don't have to understand names or symbols, just notice that it starts with a little 2-carbon compound (Acetyl CoA) and it ends with a more complex 30-carbon compound (Cholesterol). By the way, that little Acetyl CoA can come from the breakdown of carbohydrates, which is one way overconsumption of carbs drives production of cholesterol.

Reducing the amount of cholesterol that roams the bloodstream may be a good idea for anyone whose arteries are narrowing because of cholesterol-ridden plaque. Since most of our cholesterol comes from what we make in our cells (not what we eat), it makes sense that slowing the production of that cholesterol would lessen its contribution to those plaques. Statin drugs (Lipitor, Mevachor, Crestor, Pravachol, Zocor) inhibit the production of cholesterol by halting the process where I've drawn an arrow.

Unfortunately, our bodies recycle one of the compounds further down to make a very strong antioxidant called CoQ10 (other names: Coenzyme Q, ubiquinone). But since the process is halted above this in the presence of statins, quantities of not only cholesterol, but CoQ10 are diminished. It would therefore behoove people taking statin medications to make sure they're getting adequate amounts of CoQ10.

What does CoQ10 do?

Two basic functions: It's integral in producing energy and it's a strong antioxidant. It's present in every cell in the body, affects just about every organ, and the miracle cures its touted to perform are, well, beyond the scope of your author since she's a miracle non-believer. Still, there are scientifically-based and well documented functions for CoQ10, not least of which is its indispensable use in cardiac function. Paradoxically, the statin medications that are employed to protect the heart result in lower levels of CoQ10. Too little CoQ10 can damage the heart. (Supplementation with CoQ10 has been shown to improve cardiac function in those taking statins.1)

A number of years ago Merck considered adding CoQ10 to its statin medications to prevent the muscle wasting (including that indispensable muscle: the heart) typical of low CoQ10 levels. It never came to pass.

Although CoQ10 is a natural substance, one we not only make in our cells but get in foods, boosting intake through supplements shows benefits even for healthy non-statin takers. CoQ10 may increase performance during aerobic activity (because it generates energy), and may benefit conditions involving oxidative stress, such as respiratory illnesses from smoking or working in a polluted environment (because it scavenges free radicals). Its antioxidant properties are being shown to enhance immunity and protect against cancers. It looks like CoQ10 has the potential to become the next vitamin E or C.

Why it's not more advocated has, in the opinion of Peter Langsjoen2, more to do with politics and economics than it does with science. Production and distribution of CoQ10 does not generate, as Mr. Langsjoen says "patent protected profit" for a revenue-minded pharmaceutical company.

Age and stress both deplete it. If I was ever obliged to take a statin, you had better believe I'd be taking CoQ10 with it.

1 Silver MA, Langsjoen PH, Szabo S, Patil H, Zelinger A. Effect of atorvastatin on left ventricular diastolic function and ability of coenzyme Q10 to reverse that dysfunction. Am J Cardiol: 2004,94(10);1306-10.

2 Who wrote a nice synopsis of CoQ10 here

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