As CoQ10 increases the energy production in all the cells in the body, it should not be surprising that studies have shown its benefits in a wide variety of diseases. Low levels have been documented in many medical conditions, along with evidence of its clear benefits when properly supplemented or administered. Such conditions include the following:
As CoQ10 is one of few vital antioxidants that is synthesized in the body, aging accounts for much of its deficiency in the body. Older people make less CoQ10, generally have less of it in their diet, and have other medical conditions excessively consuming it. The average 80-year-old has only about 50% of the cardiac CoQ10 content as the average 20-year-old. [183,184] But its importance in cardiac function is the same regardless of age. Just as deficient hormone levels need to be restored to optimize health in the aging patient, CoQ10 needs to be similarly addressed as well, as it is essential for the optimal health of all cells. [185]
Additional supplementation can specifically target complexes I, II, and IV in the mitochondrial ETC to help optimize ATP production. Not only will such supplementation be of benefit in all the cells of the body, the increased ATP demands of the heart make them especially suited to help support and improve the failing heart. [186]
NAD (nicotinamide adenine dinucleotide) is the primary substrate fueling complex I. The primary way to keep NAD levels high, in addition to directly supplementing NAD itself, is to take large amounts of its primary precursor for being synthesized in the body. This role is served by niacin (vitamin B3) and its vitamers (like niacinamide). [199] Levels of both NAD and ATP have been documented to be significantly depressed in cardiomyopathy biopsy specimens. [187] Like CoQ10, niacin significantly improves all cardiovascular conditions, not just cardiomyopathy. [188-198]
A severe niacin deficiency state has also been documented to be the root pathology in schizophrenia and other brain disorders, consistent with the high ATP requirements of the central nervous system for normal function. [199] Severe niacin deficiency results in pellagra, a life-threatening condition that is also associated with diminished heart contractility. [200-202]
Riboflavin (vitamin B2) also plays a critical role in optimizing mitochondrial ATP production. It serves as a precursor, or building block, for FAD, the primary electron-transferring substrate in complex II of the ETC. [203] An animal study demonstrated that riboflavin can alleviate heart failure and improve cardiac metabolism. [204] It can also lessen the amount of damage that reduced blood flow, or ischemia, will inflict on the heart. [205] A genetic deficiency of complex II results in an advanced congestive cardiomyopathy, indicating its importance in this condition. [206] When FAD is targeted as an antigen by anti-mitochondrial antibodies, a dilated cardiomyopathy results as well. [207]
Complex IV of the ETC, involving the transfer of electrons via cytochrome c oxidase to oxygen, the terminal electron acceptor, is supported strongly by methylene blue (MB). [208] MB is a powerful redox dye that has been shown to benefit neurodegenerative diseases by increasing mitochondrial energy production. [209-212] Promoting ETC ATP production by directly supporting complex IV is especially significant since the oxidative stress generated in the first three complexes is avoided. This means that less net oxidative stress in generated in the cell without compromising ATP production, a rarely achieved therapeutic goal. [213] This effect is also why MB has been promoted as an anti-aging agent, as cumulative oxidative stress is the reason for all aspects of aging. [214] In cellular studies, MB clearly delays the process of aging. [215]
The proper treatment of any form of cardiomyopathy, but especially advanced congestive heart failure due to an enlarged and poorly contracting heart, needs to be directed primarily at:
Toxin Elimination: A thorough diagnostic work-up is always optimal, although currently unlikely to occur as endomyocardial biopsy is rarely done, except to monitor for microscopic evidence of organ rejection following a heart transplant. And when it is performed, the measurement of heavy metal content is never a routine part of the examination. A provoked urine challenge test with an established chelation agent such as EDTA (ethylenediaminetetraacetic acid), DMSA (dimercaptosuccinic acid) or DMPS (dimercaptopropanesulfonate) often results in a significant release of multiple heavy metals, and it should be routinely be part of a cardiac failure workup. [224]
Mercury is detected in most people although it is often given little regard because no "obvious" mercury exposures are evident. However, the number of people exposed for many years to outgassing mercury amalgam dental fillings is enormous, and the astronomical levels of mercury found in many IDCM patients are nearly always secondary to these fillings. [225-228] Furthermore, a brisk release of mercury on urine chelation challenge should never be disregarded as inconsequential.
Hair analysis can also be very useful in evaluating heavy metal content in the body and should be done along with the provoked urine challenge. For example, autistic children had significantly higher levels of mercury, lead, arsenic, antimony, and cadmium compared to controls. [229] In another study, DMSA was shown to be effective in increasing mercury and antimony excretion in children with autism spectrum disorders. [230]