Lies, Damned Lies, and Medical Science

[Gumby]

Severe motor vehicle accident, or  pneumonia: western medicine does really good job.  Other cases e.g. chronic illnesses  not so much.

Sometimes it almost seems like Western medicine is designed to generate more paying customers over a longer period of time. Save a victim from severe trauma, but allow them to fall into a chronic state of disease to increase revenue. I'm sure it's not that cynical, in reality, but it's hard not to notice the lack of enthusiasm or progress to preventing or curing revenue-producing chronic diseases.

In any case, Benko, it's very refreshing to hear your perspective on medicine.

[MachineGhost]

Can you provide a little more detailed information about how CoQ10 is outdated?

What does that mean?  Did it used to be a good supplement, but now isn't?  Why is it unethical that it is still being sold?

An analogy would be comparing the NVIDIA RIVA NT to a NVIDIA GTS 450 or a Pentium I to a iCore 7.  The Japanese company that originally invented ubiquinone (CoQ10) took two decades or so to successfully formulate a shelf-stable version of the bioactive form of ubiquinone in the body (ubiquinol).  Ubiquinone is poorly absorbed and poorly bioavailable.

If we take it a given that older folks are not especially astute about supplements anymore than they are about technology, then I find it disturbingly unethical for companies to still be manufacturing and retailers to still be selling CoQ10 supplements when ubiquinol is vastly superior and costs the same or less.  Who the hell would still be selling a RIVA NT?  Grrrr!

[MachineGhost]

Thanks, MG. I appreciate it. I'll check it out. Are there any particular brands or qualities of Ubiquinol worth looking into? My initial research suggests that some Ubiquinols contain soy!

I would stick with name brands that have a long-standing reputation for assaying their products regularly and proving that it contains what is stated on the label.  A Certificate of Analysis from a Chinese supplier can be easily counterfeited and just isn't good enough.  I think this may have changed this year or last due to the FDA imposing Good Manufacturing Practices (GMP) on the supplement industry, but that seems like security theatre to me if J&J can get away with a filthy Tylenol production plant for who knows how long. 

Anyway, my personal preference for "power without the price" is in this order: Swanson Vitamin's in-house brand, VitaCost's in-house brand, NOW Foods, Jarrow Formulas.  NOW Foods was the original "health foods store" back in the 40's or 50's and now contract manufactures a lot of other company's supplements, so its not necessary to pay the extra middleman markup.  Only in very extenuating circumstances do I ever consider Life Extension's absurdly overpriced supplements (they avoid Chinese sources).  A case could be made for them with ubiquinol if one doesn't want to take a separate shilajit supplement (it acts as a traffic cop to direct ubiquinol into the mitochondria) or theres an issue with fillers.  I've got my own 93-year old grandmother on exactly that now, 200mg of ubiquinol along with 200mg of shilajit (two 100mg softgels as a single 200mg softgel was too large/long for her).  There's also another bioagent that works along with those two but the name totally escapes me at the moment.  Must be all that uranium!

If you use Mr. Rebates, you can get 6%-8% back on your VitaCost purchases.

[MediumTex]

Thanks, MG. I appreciate it. I'll check it out. Are there any particular brands or qualities of Ubiquinol worth looking into? My initial research suggests that some Ubiquinols contain soy!

I would stick with name brands that have a long-standing reputation for assaying their products regularly and proving that it contains what is stated on the label.  A Certificate of Analysis from a Chinese supplier can be easily counterfeited and just isn't good enough.  I think this may have changed this year or last due to the FDA imposing Good Manufacturing Practices (GMP) on the supplement industry, but that seems like security theatre to me if J&J can get away with a filthy Tylenol production plant for who knows how long. 

Anyway, my personal preference for "power without the price" is in this order: Swanson Vitamin's in-house brand, VitaCost's in-house brand, NOW Foods, Jarrow Formulas.  NOW Foods was the original "health foods store" back in the 40's or 50's and now contract manufactures a lot of other company's supplements, so its not necessary to pay the extra middleman markup.  Only in very extenuating circumstances do I ever consider Life Extension's absurdly overpriced supplements (they avoid Chinese sources).  A case could be made for them with ubiquinol if one doesn't want to take a separate shilajit supplement (it acts as a traffic cop to direct ubiquinol into the mitochondria) or theres an issue with fillers.  I've got my own 93-year old grandmother on exactly that now, 200mg of ubiquinol along with 200mg of shilajit (two 100mg softgels as a single 200mg softgel was too large/long for her).  There's also another bioagent that works along with those two but the name totally escapes me at the moment.  Must be all that uranium!

If you use Mr. Rebates, you can get 6%-8% back on your VitaCost purchases.

MG,

What is your daily supplement regimen?

With respect to CoQ10, I thought that 100-200 mg a day was the suggested dose, but it sounds like you are suggesting the equivalent of more like 1400+ mg per day through the ubiquinol dose you are describing.

[Benko]

COENZYME Q-10

Powdered ubiquinone (the original version) is poorly absorbed.  My recommendation was therefore to buy it in gelcaps with oil in the cap which dramatically increases absorption.   ALternatively there are numerous  companies selling their own special higher absorption form, many of which have data to back this up.

Ubiquinol is more more expensive.  I should say, that I am taking this form.  I'm going to get my blood levels done and perhaps I'll then switch to the old  form and get blood levels done again and I'll see what the blood levels are.

In the supplement world there is no shortage of supplements which someone claims is the newer all singing all dancing vastly improved version which you have to take, and oh by the way it is 5 times more expensive. MG could certainly be correct but I used to be overly "trendy" and enthusiastic about supplements and am more conservative these days e.g. I don't know how critical supplemental coenzyme Q-10 is for most adults  and have a difficult time justifying to them the price of taking the ol version.  

I'd love to see MGs source (care to post a reference MG?) to see if everyone in the study had the vastly increased blood levels and how many patients it was done with.  

I will second the recommendation for Now and Jarrow.  Iherb.com has good discounts and almost never screws up.
------------------------------------------------------------------

I was researching "Shilajit" in a totally different context recently and did not realize it had anything to do with Co Q-10, but MG appears to be correct.  I have no idea if it is mandatory to take Shijalet, with Co Q-10, but all I'll say is Shijalet is  an unusual supplement (google it) and I WOULD BE SUPER CAREFUL WHICH BRAND YOU BUY given the physical origin of this stuff.  I personally would only buy it from jarrow or an ayurvedic supplier that I trust e.g. Banyan botanicals (if they carry it) or Himalayan institute.  More than 99% of other supps, if you take it, be careful of your supplier.

PQQ is likely the other supplement related to Co Q-10 that MG was trying to think of.  

I suspect most people would vastly benefit more from eating more veggies than worrying about shijalet or PQQ.

[Benko]

Sometimes it almost seems like Western medicine is designed to generate more paying customers over a longer period of time.

Never ascribe to malice that which is adequately explained by incompetence. And keep in mind:

Ma Planck nobel prize winning physicist:
A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.

[MachineGhost]

What is your daily supplement regimen?

With respect to CoQ10, I thought that 100-200 mg a day was the suggested dose, but it sounds like you are suggesting the equivalent of more like 1400+ mg per day through the ubiquinol dose you are describing.

That's a loaded question.   I don't think it necessarily for me to publically list the 35+ supplements I take as it is unlikely to convince anyone.  One's supplement regime is a highly personal thing.

But I will say that I take two major groups: anti-aging supplements and nutritional supplements.  There is a bit of overlap, but the latter is to supplement what I can't get enough of through food or I'm deficient in.

I don't give much weight to "suggested doses" of anything.  Any manufacturer can make up what they think is a suggested dose for the label that then has to be vetted by the lawyers.  So what is an optimal dose -- usually from clinical studies -- for whatever specific purpose is usually entirely different than what is suggested on the label.

CoQ10 is like a hormone.  Levels in the body decline with age.  If you want to take the approach that you dont need to take CoQ10 or significant doses until after you develop some kind of disease that it has evidence of palliating, that's certainly a valid approach, but it's not one I personally believe in.

[MachineGhost]

I'd love to see MGs source (care to post a reference MG?) to see if everyone in the study had the vastly increased blood levels and how many patients it was done with.

Here's one: http://iospress.metapress.com/content/2555q517442p006m/

I don't think Kaneka would risk their reputation on formulating a huckster product.

I was researching "Shilajit" in a totally different context recently and did not realize it had anything to do with Co Q-10, but MG appears to be correct.  I have no idea if it is mandatory to take Shijalet, with Co Q-10, but all I'll say is Shijalet is  an unusual supplement (google it) and I WOULD BE SUPER CAREFUL WHICH BRAND YOU BUY given the physical origin of this stuff.  I personally would only buy it from jarrow or an ayurvedic supplier that I trust e.g. Banyan botanicals (if they carry it) or Himalayan institute.  More than 99% of other supps, if you take it, be careful of your supplier.

Also good to stick with trademarked ingredients.  There's usually science and research behind such ingredients as well as strict quality control.  Some factory in China selling generic powder just isn't the same.

I wouldn't say shilajit is mandatory, but I have noticed it leverages the effect of ubiquinol on my grandma.  Since she hates swallowing capsules, I opted for the two-birds with one-stone approach even if its a heck of a lot more expensive.  I figure at some point you've got to have one Porsche supplement to go along with all the KIAs.

I suspect most people would vastly benefit more from eating more veggies than worrying about shijalet or PQQ.

That's it.  I think the current PQQ doses being sold are just too low to have a significant effect, especially in light of the lack of any evidence showing what the dose should be.  I really don't like to be a pioneer for [expensive] new stuff as they are the ones that get all the arrows in their backs...

[MediumTex]

What is your daily supplement regimen?

With respect to CoQ10, I thought that 100-200 mg a day was the suggested dose, but it sounds like you are suggesting the equivalent of more like 1400+ mg per day through the ubiquinol dose you are describing.

That's a loaded question.    I don't think it necessarily for me to publically list the 35+ supplements I take as it is unlikely to convince anyone.  One's supplement regime is a highly personal thing.

But I will say that I take two major groups: anti-aging supplements and nutritional supplements.  There is a bit of overlap, but the latter is to supplement what I can't get enough of through food or I'm deficient in.

I don't give much weight to "suggested doses" of anything.  Any manufacturer can make up what they think is a suggested dose for the label that then has to be vetted by the lawyers.  So what is an optimal dose -- usually from clinical studies -- for whatever specific purpose is usually entirely different than what is suggested on the label.

CoQ10 is like a hormone.  Levels in the body decline with age.  If you want to take the approach that you dont need to take CoQ10 or significant doses until after you develop some kind of disease that it has evidence of palliating, that's certainly a valid approach, but it's not one I personally believe in.

Let me approach it like this:

Let's say that you (MachineGhost) had a 40 year old male friend who was in good health that you were willing to help out from time to time and who came to you and said "MachineGhost, I really appreciate your insight and intelligence, can you suggest a simple supplement regimen for overall good health and longevity?  My daily limit is probably about 10-15 pills and capsules." 

What would you say to this person?

[MachineGhost]

Let me approach it like this:

Let's say that you (MachineGhost) had a 40 year old male friend who was in good health that you were willing to help out from time to time and who came to you and said "MachineGhost, I really appreciate your insight and intelligence, can you suggest a simple supplement regimen for overall good health and longevity?  My daily limit is probably about 10-15 pills and capsules." 

What would you say to this person?

Hmm, with a limit of 10-15 pills, I would refer the person to the core regime list I published under "What supplements do you take?" thread.  From there, the person can go as crazy as that person's tin foil hat dictates. 

[Benko]

MG

1. reference on blood levels of ubiquinol vs ubuiquinone

Here's one: http://iospress.metapress.com/content/2555q517442p006m/
I don't think Kaneka would risk their reputation on formulating a huckster product.

That reference uses people all who have congestive heart failure.  These people per the abstract are thought to have a special reason to poorly absorb the Co Q-10.  So you can't apply the findings of that reference to anyone without congestive heart failure as their bodies may behave differently i.e. the increased blood levels might not be so pronounced. It is not a matter of huckster product, but of a high quality product which is expensive and might not be worth the added expense (vs regular Co Q-10) for people who do not have congestive heart failure.

2. FYI: Shilajit is gunk which oozes out of cracks in rocks in the mountains mainly in central asia.

3. 

I wouldn't say shilajit is mandatory, but I have noticed it leverages the effect of ubiquinol on my grandma.

I totally believe that.  I'm 52 and have trashed my adrenals over the years and might take it at some point.  But because it is helpful to your grandmother doesn't mean that it would necessarily be useful for someone on this board in their 20s or 30s.

[MachineGhost]

be so pronounced. It is not a matter of huckster product, but of a high quality product which is expensive and might not be worth the added expense (vs regular Co Q-10) for people who do not have congestive heart failure.

I'm not sure why you think ubiquinol is more expensive.  60 50mg pill of ubiquinol cost $11.89.  60 400mg pills of ubiquinone costs $17.98.  As both are of equivalent potency, the ubiquinol costs .50 per gram and ubiquinone costs $.75 per gram.  And the price gap grows greater with the higher potencies of ubiquinol.

I totally believe that.  I'm 52 and have trashed my adrenals over the years and might take it at some point.  But because it is helpful to your grandmother doesn't mean that it would necessarily be useful for someone on this board in their 20s or 30s.

That's true, but I wasn't advocating that someone that young would need to be taking 200mg of ubiquinol!  I can't take more than 50 mg myself or I get too much energy.  But, that is how it should be in my book.  Restoration should be to the levels of a 25 year old.

BTW, apparantly CoQ10 attaches to LDL to prevent its oxidation.

[Gumby]

And the price gap grows greater with the higher potencies of ubiquinol.

MG, I could have sworn in the supplements thread you said that you have to take a small amount early in the morning, otherwise it gives you insomnia. Could you (or benko) be more specific about how ubiquinol makes one feel and any side effects it can have, if any?.

[MachineGhost]

And the price gap grows greater with the higher potencies of ubiquinol.

MG, I could have sworn in the supplements thread you said that you have to take a small amount early in the morning, otherwise it gives you insomnia. Could you (or benko) be more specific about how ubiquinol makes one feel and any side effects it can have, if any?.

That's true.  Its an internal energy but its not a borrowed energy stimulant like caffeine.  Since your mitochondria becomes more efficient at burning calories for energy, you could say you are running close to optimal with the right dose and you will be able to improve endurance, focus and concentration.  I would not say it has a primary effect on the mind or memory like a nootropic though.  Negative effects from too high a dose would be obsessive thinking, not being able to wind down your mind while falling asleep, insomina (staying asleep), restless legs.  There's also fatigue in a few days (lasts about a week) if you suddenly run out and don't resume, but that also applies to other mitochondrial enhancers.

[AdamA]

Never ascribe to malice that which is adequately explained by incompetence. And keep in mind:

[/quote]

Incompetence, or maybe naiveté.  I don't think physicians what Gumby is describing intentionally for the most part, but I do think they are affected by conflicts of interest of which they may not even aware. 

[MediumTex]

I'm 52 and have trashed my adrenals over the years and might take it at some point.  But because it is helpful to your grandmother doesn't mean that it would necessarily be useful for someone on this board in their 20s or 30s.

How do you know when your adrenals are trashed?

I have been exposed to many stressful and exciting events over the last 41 years.  I may have trashed my adrenals without even realizing it.

[WiseOne]

Just managed to read through this thread, and was debating whether I really wanted to post because I doubt anything I say would be read objectively.  Still it is worth a try.

First off, I'll just say that fortunately for all of us, medical practice requires tempering "evidence-based" principles with good old common sense. Like any profession there is a wide range of competence among doctors, and it isn't always easy to tell from the outside perspective where a given individual falls on that range.  For example, most of the really good physicians I know are wise enough to realize on their own that giving a 90 year old a medication to slightly reduce their chances of a stroke or heart attack over the next 20 years makes no sense.

Gumby, your point about the side effects of cholesterol-lowering agents is a good one.  Realize though, that EVERY medication has negative effects, even ones that are over the counter and that you think are benign. Tylenol, for example, is probably the most dangerous item in your medicine cabinet.  It is responsible for over 300 liver transplants per year.  The art of medicine is in balancing the benefits and risks of any therapy for each individual, and that's a very inexact science.

However....why don't you compare your chart of increasing CHF deaths with the following plot of the U.S. population over 65 since 1950:

http://esa.un.org/wpp/P-WPP/htm/PWPP_Po ... 65Plus.htm

I'll leave you to ponder the fact that you fell into the very trap you were railing against.  It's easy to do, isn't it?

Finally, just had to answer MT's question:  don't worry, you WILL know if your adrenals are "trashed".  Look up "adrenal insufficiency."  You would be profoundly weak (as in unable to get out of bed), hypotensive, and hypoglycemic.  Over time, your skin would start to darken. 

Realize that all of you are essentially healthy and not really in need of intensive medical services.  What you're talking about here is how to optimize your health by applying the same zeal with which you have optimized your financial lives.  This is very understandable, and you're all correct that the answers you seek aren't really the focus of traditional medicine.  You might be better served by looking elsewhere, such as chiropractic.  Benko, am I correct in guessing that you are a chiropractor?

[AdamA]

Tylenol, for example, is probably the most dangerous item in your medicine cabinet.  It is responsible for over 300 liver transplants per year. 

Tylenol is probably the safest, most effective pain medication available, if taken as directed on the package insert.  The cases of liver toxicity you mention are almost all from intentional overdose or because someone took over-the-counter Tylenol with another medication that also contained acetaminophen (for a prolonged period of time). 

Tylenol has been trashed a lot in the press and even in certain medical journals lately (the FDA placed a black box warning on it in 2009) and the conspiracy theorist in me wonders if there is a new pain medication on the horizon that is going to come along an purport to be better in the near future. 

Benko, am I correct in guessing that you are a chiropractor?

If I recall, Benko is not a chiropractor, but a very progressive radiologist. 

[Gumby]

However....why don't you compare your chart of increasing CHF deaths with the following plot of the U.S. population over 65 since 1950:

http://esa.un.org/wpp/P-WPP/htm/PWPP_Po ... 65Plus.htm

I'll leave you to ponder the fact that you fell into the very trap you were railing against.  It's easy to do, isn't it?

WiseOne. Thanks for the reply. But, I don't see the "trap" that you think I fell into.

CHF deaths increased by 2X between 1989 and 1995. During that same period, the population over 65 in the US increased by about 0.2X.

Where is the "trap"?

Something is clearly causing a sharp increase in CHF in our population. There are a growing number of doctors who think it's related to statins (which were approved in 1987). For instance, NASA Astonaut Dr. Duane Graveline, (MD, MPH) has documented an extensive list of health problems caused by statins...

http://www.spacedoc.com/statin_side_effects

Interference with the production of CoQ10, by statins, is a very likely explanation for the increase in CHF. The heart cannot work properly when deprived of CoQ10.

[WiseOne]

Thanks for the reply. But, I don't see the "trap" that you think I fell into.

I found the source for that plot you posted (NHLBI website on CHF).  If the increase in CHF deaths is due to the introduction of statins, then how do you explain the 4-fold rise from the mid-1970's to 1990?  Pravachol wasn't introduced in the U.S. until 1991.  And, wouldn't you expect a delay before the increase in deaths?  It's not like every patient at risk for CHF started Pravachol the instant it was introduced, or that there was no time delay between starting the medicine and experiencing the hypothesized effect.

Turns out there are many other factors involved in CHF...hypertension, obesity, diabetes, plus the fact that people with cardiovascular disease have become more likely to survive heart attacks and get coronary bypass grafts, thus giving them the opportunity to live longer and develop CHF.  I'd at least hesitate before laying all the blame on the doorstep of one of the several classes of drugs used to treat these patients.

Journal peer-review isn't perfect to be sure, but it's often quite effective at screening out crud that doesn't belong in print.  I review journal articles and grants on a regular basis (in fact I'm avoiding having to deal with one right now), and of course I've been on the receiving end of these critiques plenty of times.  Yes, it is possible for faulty data or logic to slip by, but both reviewers plus the editor would have to miss it.

Stuff that appears on websites, on the other hand, isn't subject to the same level of scrutiny.  Try reading them as if you were a reviewer, and if you can't poke holes in it, see if someone else can.  If it passes both of those tests, then go for it!

If I recall, Benko is not a chiropractor, but a very progressive radiologist.

I stand corrected 

[Benko]

How do you know when your adrenals are trashed?

I have been exposed to many stressful and exciting events over the last 41 years.  I may have trashed my adrenals without even realizing it.

I would not worry about it from what you are describing. 

I know because A. I had many many periods with much less sleep than optimal and B. I'ved had TCM diagnosed by a good acupuncturist (they use different terms by same idea).

[Benko]

  What you're talking about here is how to optimize your health by applying the same zeal with which you have optimized your financial lives.  You might be better served by looking elsewhere, such as chiropractic.  Benko, am I correct in guessing that you are a chiropractor?

I am indeed a radiologist (MD).  No worries, no one is ever going to guess my occupation given my views,but I did get a good chuckle out your comment.

Chiropractic (and the other tools that some chiropractors know) is great in certain applications e.g. trauma from sprained ankles to car accidents and  ART (active release technique) many kinds of musculoskeletal issues.

TCM traditional chinese medicine from acupuncture to chinese herbs to diet recommendations is my choice for overall health optimizing i.e. addressing weak areas, etc.  NB: while a good acupuncturist can diagnose you and perform the acupuncture and recommend chinese herbs, you will likely have to get your TCM diagnosis from them and do some research on your own to find the TCM diet recommendations for your particular make up.

MG,

My apologies, thanks for correcting me.  My fallible memory remembered the price difference between the two forms of coenzyme Q-10 to be greater than that.  At that price difference, probably worth going for the superior form.

[MachineGhost]

Realize that all of you are essentially healthy and not really in need of intensive medical services.  What you're talking about here is how to optimize your health by applying the same zeal with which you have optimized your financial lives.  This is very understandable, and you're all correct that the answers you seek aren't really the focus of traditional medicine.  You might be better served by looking elsewhere, such as chiropractic.  Benko, am I correct in guessing that you are a chiropractor?

I think it is rather difficult to find a locally available, alternative practitioner that has an "evidence based" mindset, especially bleeding-edge ones that accept insurance, or avoiding the more New Agey touchy-feely psuedo-quacks.  That old saying that "if you want something done right, do it yourself", certainly seems to largely apply.  I realize most "mainstream" people don't have the same zeal or time available as I do about optimizing their health, so I think your advice is certainly warranted for them.  But to expect a high standard from a medical or alternative doctor akin to the PP is just not realistic with our over-statist system.  As long as you utilize a third-party service with both eyes open, your expectations should be lowered enough so you don't get depressed/disappointed.

Benko is like an anomaly.  It seems to me the real problem is in identifying exceptional practitioners, no matter what the field.  So much of the curriculum and protectionist licensing laws allow for "shit to float to the top".  I do not think this sad reality will change all that much until the old "Greatest Generation" farts die off, because they are the ones that support the status quo, never question the holier than thou "authority", demand better service and treatment, billing and price transparency, free enterprise solutions, etc..  It's a pathetic lack of consumer demand.  Those people simply do not change.

[MachineGhost]

Tylenol is probably the safest, most effective pain medication available, if taken as directed on the package insert.  The cases of liver toxicity you mention are almost all from intentional overdose or because someone took over-the-counter Tylenol with another medication that also contained acetaminophen (for a prolonged period of time). 

Tylenol has been trashed a lot in the press and even in certain medical journals lately (the FDA placed a black box warning on it in 2009) and the conspiracy theorist in me wonders if there is a new pain medication on the horizon that is going to come along an purport to be better in the near future. 

It's not necessary to overdose Tylenol to achieve acute liver failure or kidney toxicity.  Taking it on an empty stomach after a fast (i.e. 8 hours of sleep) is often enough.  It would never be approved as a new drug by the current FDA if it was not grandfathered (leaving aside the crony capitalism).  You are downplaying exactly how toxic the stuff is for sake of convenience or pecuniary financial interest...  as do a massive amount of other people.  Can you always and irrevocably say beyond any shadow of a doubt that you will not personally experience acute liver failure before popping it into your mouth?  If one must still foolishly take it, then be smart and do so along with 600mg of N-Acetyl Cysteine (NAC) to help protect the liver from the toxicity.

I don't think Tylenol gets trashed enough.  Certainly none of the consumer reporting organizations trash it.  Instead, they go off about the supposed dangers of supplements for which I couldn't roll my eyes up far enough in my eye sockets for.  But, I digress...

[AdamA]

It's not necessary to overdose Tylenol to achieve acute liver failure or kidney toxicity.  Taking it on an empty stomach after a fast (i.e. 8 hours of sleep) is often enough. 

Where are you getting this information? 

I don't think Tylenol gets trashed enough. 

Can you name a safer pain medication?