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Nutrition Q&A with Dan Lukaczer, N.D.

Q. I take a statin drug to lower my cholesterol, but I?ve heard that statins inhibit the production of Co-Q10. Should I take a Co-Q10 supplement along with this medication, and if so, how much?

A. Coenzyme Q10 is a nutrient that is produced in small amounts by the body and also is obtained from food. It plays a key role in helping the body convert food into energy and also acts as an important antioxidant. Lowered blood and tissue concentrations of Co-Q10 have been reported in a number of diseases, although whether this deficiency is a cause or an effect of the diseases remains unclear.1

Co-Q10?s relationship with statin drugs is fairly well-established. Statins work by inhibiting an enzyme called 3-hydroxy-HMG-CoA reductase, which blocks cholesterol synthesis. However, this is also the enzyme that is involved in the synthesis of Co-Q10. Both animal and human studies suggest that statins do deplete Co-Q10.2 Even taking some statins for as little as two weeks causes a marked decrease in blood Co-Q10 concentrations.3 It also is thought that some of the side effects of statins, such as exercise intolerance and muscle pain, may be associated with this depletion. So yes, I do think you should be taking Co-Q10.

What the dose should be is a bit harder to answer. I have generally given my patients 100 mg daily and checked their serum Co-Q10 levels. The amount appears adequate, although I think a daily dose of 30 mg to 50 mg may be sufficient as well.

Q. Are there any effective natural treatments for the foot pain associated with diabetes?

A. You are referring to what is called diabetic neuropathy, a complication where peripheral nerve fibers become damaged, then atrophy and degenerate. This can cause significant pain (and/or loss of sensation), particularly in the feet. An amino acid called acetyl-L-carnitine has been studied for the past dozen years as a possible treatment. In animal studies, it was first noted that there were marked reductions of ALC in the peripheral nerves of rats induced with experimental diabetes.4 Since then, evidence has been gathering that ALC may have a positive effect in humans.

Two recent studies showed encouraging results. In the first, patients were given 2 g/day of ALC. After 12 months of treatment, pain scores were reduced by 39 percent in treated patients versus 8 percent in those on placebo.5 A later study found that after one year, significant improvements in nerve fiber numbers occurred, suggesting some nerve regeneration. Pain showed improvement in this trial as well, and the conclusion was that 1 g of ALC taken three times daily was effective.6 ALC is generally well-tolerated at these levels. A key point is that these were long-term studies, with positive effects seen after 6 months to a year.

Q. I am concerned about taking prescriptions. What are the chances that I?m going to have a reaction?

A. That depends on a lot of factors—your sex, age, general health and the medication. There was quite a bit of press a few years ago when it was reported that hospitalized patients? reactions to medications, if extrapolated out to the entire population, would be somewhere between the fourth to sixth leading cause of death in the United States.7 For nonhospitalized patients getting prescriptions from their doctor, the risk of side effects has not been well documented historically. However, a recent study conducted at four adult primary-care practices in Boston shed some needed light on this subject.

Using a post-prescription survey and phone follow-up, the researchers queried 661 patients and found 162 had adverse drug events—which comes to about 25 percent.8 They found that almost half of those reactions could have been prevented or ameliorated if the patient had discussed the symptom(s) with their doctors or if the doctors had reviewed the prescription and the patient?s history more carefully.

The medication classes most frequently involved in these reactions were antidepressants (selective serotonin-reuptake inhibitors), antihypertensives (beta-blockers and angiotensin-converting-enzyme inhibitors) and anti-inflammatories. These are surprisingly high figures, and while one obvious conclusion is that doctors need to be more careful in prescribing, this study was undertaken in a large metropolitan area where some of the finest health care in the country is available.Unfortunately, we can?t take human error entirely out of the equation. These are powerful medications that don?t always work in exactly the way the doctor expects. The only factor that seemed to predict a higher likelihood of a drug reaction was the number of medications a person was already taking.

The bottom line: Don?t go on a prescription medication unless you need to. Be your own advocate—know the drugs? side effects. And, lastly, talk to your doctor if you think you are having a negative reaction. There is a good chance you are.

1. Hargreaves IP. Ubiquinone: cholesterol?s reclusive cousin. Ann Clin Biochem 2003;40(Pt 3):207-18.
2. Langsjoen PH, Langsjoen AM. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications. Biofactors 2003;18(1-4):101-11.
3. Rundek T, et al. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol 2004;61(6):889-92.
4. Scarpini E, et al. L-carnitine and acetyl-L-carnitine in human nerves from normal and diabetic subjects. J Peripher Nerv Syst 1996;1(2):157-63.
5. De Grandis D, Minardi C. Acetyl-L-carnitine (levacecarnine) in the treatment of diabetic neuropathy. A long-term, randomised, double blind, placebo-controlled study. Drugs R D 2002;3(4):223-31.
6. Sima AA, et al. Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials. Diabetes Care 2005;28(1):89-94.
7. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279(15):1200-5.
8. Gandhi TK, et al. Adverse drug events in ambulatory care. N Engl J Med 2003;348(16):1556-64.

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