Monday, October 17, 2011

CoQ10 for CFS

A Note of Caution: Always consult with a physician before taking any
kind of supplement or medication. Not only can chemical compounds
cause reactions when taken alone, some side effects may occur in
combination with other chemical compounds including dietary
supplements. Pregnenolone is an over the counter hormone pill
considered a Dietary Supplement. It is thought to be a building block
for all other steroid hormones. The cells in the central nervous
system and adrenal gland produce pregnenolone. Generally there is a
significantly higher concentration of the hormone in the tissue of the
central nervous system than in the bloodstream. Production decreases
with age.

Pregnenolone supplements are synthetically made using substances found
in soybeans and wild yam. They can typically be purchased in capsule
form at health food stores and pharmacies. Like any chemical compound
whether "natural" supplement or synthetic supplement or drug, some
people may experience side effects including over-stimulation and
insomnia - areas where patients already have issues.  Anger, anxiety
and irritability have also been reported when higher amounts were
taken. Headaches might also occur with higher doses. Because
pregnenolone can convert into androgens, there is a possibility that
acne might occur. Scalp hair loss can also occur if the hormone is
used daily for a prolonged amount of time. Pregnenolone has also been
known to cause irregular heart rhythms, even with low doses.

Treating CFS, fibromyalgia with statins, coenzyme Q10 and pregnenolone
Published on May 26, 2011 by Jacob Teitelbaum, MD in Complementary Medicine

An Important Cautionary Note

I usually prefer to have broader research and more direct clinical and
personal experience exploring new treatment theories before I start
reporting on them (which would take 1-2 years). I have chosen instead
to put the theory out there to invite discussion. Bringing many expert
perspectives to bear will help it get tempered closer to the truth
more quickly. Much of what I discuss below is new, controversial and
hypothetical, and should be discussed with your holistic practitioner
or CFS specialist before attempting a trial of the statin


Many infections have been implicated in CFS, including the recent
reporting of XMRV. As part of their reproductive cycle, many viruses
require cholesterol-related molecules for many different functions,
including making their protective coat. As part of your body's
defensive functioning, your cells make an important family of immune
molecules called interferon, which seems to work in part by decreasing
the cholesterol production pathway and starving the virus.

Interferon levels (there are 27 different types) can be both high or
low in CFS. In CFS patients, interferon alpha tends to be low while
interferon beta is elevated. Interestingly, interferon injections can
trigger symptoms that feel like CFS. Paradoxically, in a small subset
of CFS patients interferon treatment helped (though not a lot).3-4

So what to do? You might be able to "eat your cake, and have it too"
by starving the virus while giving your body the natural support it
needs. This new research opens possible ways to suppress the many
viral infections in CFS, even retroviruses such as XMRV!

Found - A Key Missing Piece of the CFS Puzzle!

Although the energy crisis and associated hypothalamic dysfunction,
along with direct gland failure (e.g., low thyroid adrenal exhaustion)
explained most of the abnormalities we see in CFS and fibromyalgia,
there have been a few missing pieces over the years that were not
explained by these - which frankly left us puzzled. Here are a couple
items I've scratched my head over in CFS:

Very low cholesterol levels are often seen in CFS (sometimes high
levels are seen, but these are usually due to low thyroid function).
Dramatically low levels of a hormone called pregnenolone (made from
cholesterol, pregnenolone is the critical building block for steroid
hormones such as estrogen and testosterone).

This new study now explains why cholesterol and pregnenolone are
sometimes very low in CFS. Viral infections cause your body to make
interferon, which suppresses the mevalonic acid pathway that makes
cholesterol and pregnenolone.

This is likely another key reason - along with the hypothalamic
dysfunction, gland dysfunction and receptor resistance - for the
widespread hormonal disorders we see in CFS/FMS.

This finding is significant in that it not only suggests that low
cholesterol or pregnenolone in CFS may be caused by a viral infection,
it also suggests new possible treatments!

Key Points

This work uncovers a potential novel cause of CFS involving the
process your body uses to make cholesterol.  Here are the key points
to this:

The production of cholesterol, coenzyme Q10 (CoQ10, a key energy
metabolite), and other key hormones relies on your body's mevalonate
pathway. The new research suggests that viral infections "hijack" this
pathway to make their protective outer coats. In response, your body
makes interferon, which suppresses the mevalonate pathway, which in
turn suppresses the virus.
Acute infections respond well to this, as the interferon production is
helpful short term.  But long term, this can lead to starving your
body of CoQ10 and key hormones.  This appears to be part of what
happens in CFS.
Cholesterol blockers mildly block the same pathway and can actually
have a mild antiviral effect at low dose (and a strong effect at high
dose). These medications are used long term to treat high cholesterol.
But this may starve the body of CoQ10 and pregnenolone and can,
therefore, flare CFS/FMS. So I recommend against statins unless you
also give the body the CoQ10 and pregnenolone it is being starved of
at the same time.

Implications for Diagnosis

The presence of a low or low-normal pregnenolone level in someone not
taking statins suggests your body is making elevated levels of
interferon to fight a chronic viral infection, which also uggests a
high risk of inadequate hormone production and CoQ10 deficiency. Low
cholesterol levels may suggest the same thing.

Implication for Treatments

Have the pregnenolone and cholesterol blood tests performed. If either
is low or low normal, add CoQ10 and pregnenolone supplementation to
your diet.  Also add an Omega 3 fish oil to help give your cell walls
what they need while your body is blocking cholesterol production.

I also suspect the low pregnenolone is a marker for a viral infection.
Though it does not identify which infection, it does offer a
potentially powerful new way to stop the virus from growing. It might
not kill them, but it will make it hard for them to reproduce.

So here is an overall treatment regimen to consider - especially if
your CFS began with flu-like symptoms and has not improved adequately
with other treatments:

Take zinc 25 mg a day for 3 months, then 15 mg daily from then on, as
chronic infections will routinely cause zinc deficiency and immune
For 4-6 weeks, also take the pregnenolone, CoQ10 and fish oil as
described above. Continue these for at least 3 months after taking the
medication described below. These by themselves may leave you feeling
a lot better at 6 weeks.
Here is the more experimental part that you will need to discuss with
your physician Your physician may consider adding a statin medication.
Take 20 mg a day for 2-4 weeks (to make sure it does not cause side
effects - it usually will not, but if it does, stop it), then 40 mg a
day for 3-4 weeks. If you feel OK on the medication, they can raise
the dose to 80 mg a day. Continue for 3-4 months more and check or
recheck your lab numbers.  If this is not helping after 4-5 months,
stop taking the statin - statins can cause liver and muscle
inflammation. This is unusual, but it is why the testing is important.

Which Viruses Have Been Shown to Be Suppressed by Statins?

Many different families of viruses, suggesting a broad antiviral
effect. These include:

Epstein Barr Virus (inhibits its triggering lymphoma)6
West Nile Virus7 - An RNA Virus
Rotavirus - In this FDA "test tube" study, the authors noted an
approximately 99% drop in some viral tests, and a bunch of deformed
inactive viruses8
Hepatitis C - but effects were mixed10-12
HIV 1 (a cousin to the AIDS and XMRV viruses)13
RSV - Respiratory syncytial virus14
And perhaps even the flu virus15

Does This Mean I Need to Avoid Cholesterol in Food?

No. The studies I've seen suggest that the branch of the chemical
pathway that needs to be blocked for the antiviral effects occur
before the cholesterol step, and adding cholesterol did not impact the
statins antiviral activity. In fact, adding an egg or two a day (a
good cholesterol source along with other nutrients) may be helpful to
protect your cell membrane production.

Still to Be Answered

A lot. For example, with this theory if cholesterol levels are high,
pregnenolone should not be low. But in real life, we often see a
mismatch. So there are other pathways and issues going on here, and
this is reflected in the studies referenced below. In addition, there
are many members of the interferon family, and some are low while
others are high in CFS. Also, dozens of other immune chemicals may be
altered in CFS - though interferon may be a key "conductor of the
cytokine orchestra," and the theory I am discussing today is meant to
be an oversimplification. In addition, normal pregnenolone and
cholesterol do not mean there is no virus or that the treatment above
won't help. But low levels are suggestive of a viral issue.

But we do know CoQ10 helps. We know pregnenolone is often low (and is
very important). And we know that statins show antiviral effects in
many studies. So we have a really good start!

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