Dr. Andrew Weil on Using CoQ10 to Slow PD, etc

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This will be of interest to those taking CoQ10 or considering taking CoQ10.

These two short Q&As were published on Dr. Andrew Weil’s website. The first is from March ’07 and specifically addresses PD (Parkinson’s Disease). The second is from August ’06 and is on the benefits of CoQ10 generally. I read about these today on an MSA-related online discussion group. Here are the web links and the text of the Q&As:

http://www.drweil.com/drw/u/id/QAA400173

Q Slowing Parkinson’s Symptoms?
What do you think about using CoQ10 to reverse Parkinson’s disease? I have been using a CoQ10 product that I’m told can noticeably reverse symptoms in days.

A Answer (Published 3/28/2007)

Parkinson’s disease is a neurological disease affecting the “substantia nigra,” a small area of cells in the mid-brain. Degeneration of these cells results in a reduction in levels of the neurotransmitter dopamine and upsets the balance between dopamine and another brain chemical, acetylcholine. The most familiar signs of the disease are tremor, or trembling in hands, arms, legs, jaw, and face; a generalized slowness of movement, stiff limbs, rigid facial expressions, and problems with balance or gait. Mental function can deteriorate in advanced cases.

There’s no cure for Parkinson’s but progression can be slowed and symptoms managed with a variety of drugs including L-Dopa (Levodopa) and Sinemet (Carbidopa). L-Dopa is converted to dopamine in the brain. Sinemet prevents L-Dopa from being broken down before it reaches the brain.

Coenzyme Q or CoQ10, a natural compound made by the body and found in most foods, improves use of oxygen at the cellular level, particularly in heart muscle cells. It is being studied as a treatment for a number of disorders including Alzheimer’s disease, breast cancer, and migraine, as well as Parkinson’s disease. Results from the first Parkinson’s study suggest that CoQ10 can slow the progression of the disease in its early stages. But this was a small trial, involving only 80 patients, and its findings must be confirmed in larger studies before we can say for sure that CoQ10 helps.

In the small study, the patients were divided into four groups: one group received a placebo, the others were given one of three doses: 300 mg, 600 mg or 1,200 mg of CoQ10 per day. All of the groups also took vitamin E. The patients who took 1,200 mg had 44 percent less decline in mental function, movement function, and the ability to carry out such everyday activities as dressing themselves and feeding themselves. The two groups that used the lower doses developed slightly less disability than the placebo group, but the progression of their disease wasn’t slowed as much as it was among those who took 1,200 mg daily. The placebo group had the greatest increase in disability.

While this research is promising, it falls far short of any claimed ability to “noticeably reverse symptoms in days.” A contention that CoQ10 can do this is unproven and irresponsible. Also note the 1,200 mg is a very large dose of CoQ10, which is an expensive supplement to begin with.

I recommend CoQ10 to anyone concerned about heart health (and I take 120 mg daily myself). Anyone taking statin drugs to lower cholesterol should take at least 60 to 90 mg of CoQ10 daily because statins suppress the body’s natural production of CoQ10 as well as that of cholesterol. I recommend it to Parkinson’s patients as well, but have to tell them that we have nothing but suggestive evidence at the moment that it will slow progression of the disease.

If your symptoms are troubling, try breath work, yoga and biofeedback to reduce stress; stress always worsens tremors. Acupuncture may also temporarily improve muscle function, and bodywork (I particularly recommend Trager and Feldenkrais work) can relieve stiffness.

Andrew Weil, M.D.

http://www.drweil.com/drw/u/id/QAA400021

Q What’s with CoQ10?
I recently read an article that indicated that CoQ10 is no longer considered safe. What is your current position on CoQ10?

A Answer (Published 8/24/2006)

Coenzyme Q10, more widely known as CoQ10, is a natural antioxidant made by the body and found in most foods. Among its other effects, it improves use of oxygen at the cellular level, particularly in heart muscle cells. I recommend coenzyme Q10 to anyone concerned about heart health, and I take 120 mg daily myself. CoQ10 helps protect LDL (“bad”) cholesterol from oxidation, maintains healthy blood vessels, reduces the risk of plaque rupture and supports optimal functioning of the heart muscle. There is also some evidence that CoQ10 can help lower blood pressure. Anyone taking statins to lower cholesterol should take 60 to 90 mg daily because the drugs suppress production of CoQ10 as well as cholesterol. (Low CoQ10 levels in patients on statins can contribute to the common side effects of fatigue and aching joints and muscles.)

I haven’t heard of or seen any reports suggesting that CoQ10 is unsafe. On the contrary, the safety of this supplement has been well established over many years.

In addition to recommending CoQ10 for the heart problems mentioned above, I often advise people with diabetes to take it because they’re at greater-than-normal risk of cardiovascular disease. I also believe it maintains the health of gums, and emerging scientific evidence suggests that it may prove useful for other conditions:

Alzheimer’s disease: More research is needed, but there are indications that CoQ10 may slow the progression of dementia in Alzheimer’s patients.

Breast cancer: High doses (300 mg daily) may increase survival in breast cancer patients. Low sperm motility: A study published in the January 2004 issue of Fertility and Sterility suggests that CoQ10 may increase sperm motility in infertile men.

Migraine: A study from Switzerland published in the February 22, 2005, issue of Neurology suggests that CoQ10 can help prevent and treat migraine headaches.

Muscular dystrophy: More research is needed here, but CoQ10 seems to improve patients’ exercise capacity, heart function, and quality of life.

Parkinson’s disease: Preliminary but promising evidence indicates that high-doses of CoQ10 (1,200 mg a day) can be beneficial.

Take CoQ10 with a meal containing fat for best absorption. The best form to use is a softgel capsule. I continue to recommend at least 90-120 mg to anyone with a family history of heart problems or who is otherwise at risk for cardiovascular disease. Further, I see no reason why an otherwise healthy man, or woman, should not take CoQ10 preventively.

Andrew Weil, M.D.

Short article on Mississippi politician who had PSP

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Tuesday, December 25, 2007

Ex-Mississippi Lt. Gov. Evelyn Gandy dies
Associated Press

JACKSON, Miss. — Evelyn Gandy, the first woman in Mississippi ever elected to the offices of state representative, state treasurer, insurance commissioner and lieutenant governor, died yesterday at her home near Hattiesburg. She was 87.

In a time when few Mississippi women earned law degrees or entered politics, Gandy did both successfully.

Former colleagues said she was determined to be fair to those she served, and she displayed a quiet demeanor that belied her political strength.

“She was absolutely a public servant in the classic sense of the words,” said Jackson attorney John Corlew, who served in the Senate from 1976-80 when Gandy, a Democrat, was lieutenant governor. “She had no interest in doing anything but the utmost for the public good.”

Gandy had suffered from Progressive Supranuclear Palsy, a disease similar to Parkinson’s disease, said Carroll Ingram, a law partner of Gandy’s.

Wayne Dowdy, chairman of the Mississippi Democratic Party, said Gandy “left behind a legacy of major achievements.”

In 1943, Gandy was the only woman in her graduating class at the University of Mississippi School of Law. She was elected to the Mississippi House in 1947.

In 1960, she became the first woman elected state treasurer; 12 years later she became the first female state insurance commissioner. In 1976, she became the state’s first female lieutenant governor.

She fell short in two bids for the governorship, in 1979 and 1983.

Gandy is survived by several cousins. Funeral arrangements were incomplete yesterday.

Rare variant of PSP – pallido-nigro-luysial degeneration

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Here’s an abstract about a very rare variant of progressive supranuclear palsy (PSP) – pallido-nigro-luysial atrophy (PNLA).  The article is based on brain bank research from Mayo Jacksonville and Mayo Rochester.  Researchers found:

“The clinical course of PSP-PNLA, however, was different, with earlier gait abnormalities and difficulty with handwriting, but later falls, rigidity and dysphagia than PSP.”

According to the full article, dizziness can also be a symptom of PSP-PNLA.

The abstract is copied below.

Robin

——————–

Brain. 2007 Dec 24 [Epub ahead of print]

Clinical and neuropathologic features of progressive supranuclear palsy with severe pallido-nigro-luysial degeneration and axonal dystrophy.

Ahmed Z, Josephs KA, Gonzalez J, Delledonne A, Dickson DW.
Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, FL and Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Pallido-nigro-luysial atrophy (PNLA) is a rare disorder that in many cases has histopathological features similar to progressive supranuclear palsy (PSP). In a pathological series of over 400 cases of PSP, eight cases were noted to have features similar to those described in PNLA, including severe atrophy and neuronal loss in the globus pallidus, substantia nigra and subthalamic nucleus, in addition to many axonal spheroids in the globus pallidus and substantia nigra. These eight cases of PSP-PNLA were compared to 11 typical PSP cases with quantitative neuropathologic indices and assessment of demographics, clinical features and the timing of clinical features. PSP-PNLA cases were younger, had longer disease duration and more often were not initially diagnosed with PSP; in the end, they did not differ from PSP with respect to any major clinical feature. The clinical course of PSP-PNLA, however, was different, with earlier gait abnormalities and difficulty with handwriting, but later falls, rigidity and dysphagia than PSP. Pathologically, the same types of lesions were detected in both PSP and PSP-PNLA, but there were differences in the distribution and density of tau-pathology, with less tau-pathology in motor cortex, striatum, pontine nuclei and cerebellum in PSP-PNLA. These clinical and pathological findings suggest that PSP-PNLA should be considered a variant of PSP.

PubMed ID#: 18158316  (see pubmed.gov for the abstract only – available at no charge)

 

Another WSJ article on antipsychotics (12/20/07)

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The Wall Street Journal is really hitting hard on this topic — nursing home use of antipsychotics. They’ve had two front page articles in 2 weeks. Here are some excerpts from today’s article:

* “Use of a new generation of antipsychotic drugs to control the behavior of dementia patients has surged in recent years, despite the Food and Drug Administration’s ‘black box’ warning labels that these drugs can increase the risk of death for elderly dementia sufferers.”

* “About 30% of nursing-home residents are on antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, most of them on newer ones called atypical antipsychotics.”

* “The challenge of caring for rising numbers of seniors who suffer from dementia and the behavior problems that can stem from it has provoked a wrenching debate among nursing-home operators, regulators and families. There are few effective medicines to manage the outbursts of Alzheimer’s patients — behavior that can overwhelm family members trying to care for a loved one at home, and strain the resources of those trying to maintain order in nursing facilities.”

* “Medicaid in 2005 spent $5.4 billion on atypical antipsychotic medicines — more than it spent on any other class of drugs… Atypical antipsychotics are approved for schizophrenia and bipolar disorder. But in what is known as ‘off label’ use, doctors often prescribe the drugs to elderly people with dementia.”

* “According to CMS, nearly 21% of nursing-home patients who don’t have a psychosis diagnosis are on antipsychotic drugs. A 2005 study, published in the Archives of Internal Medicine, found antipsychotics were prescribed not only for psychosis, but for depression, confusion, memory loss and feelings of isolation, says the study’s author Becky Briesacher.”

* “Family members can object to the use of such drugs. But they risk having the facility threaten to discharge their relative on grounds that they pose a danger to themselves or others.”

Here’s the link to the article:

http://online.wsj.com/article/SB119811286789841083.html

ALTERNATIVE MEDICINE
Nursing Homes Struggle To Kick Drug Habit
New Therapies Sought For Dementia Sufferers;
Music and Massages
Wall Street Journal
By Lucette Lagnado
December 20, 2007; Page A1

Robin

Article on use of antipsychotics (WSJ 12-4-07)

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This will be of interest to those who are taking or those whose loved ones are taking antipsychotic medication. (Traditional antipsychotics include Haldol; atypical antipsychotics include Seroquel, Zyprexa, Risperdal, and Clozaril). This is a recent front-page Wall Street Journal article on the subject that has been getting a lot of attention. Here are a few excerpts from the article:

* “In recent years, Medicaid has spent more money on antipsychotic drugs for Americans than on any other class of pharmaceuticals — including antibiotics, AIDS drugs or medicine to treat high-blood pressure.”

* “Nearly 30% of the total nursing-home population is receiving antipsychotic drugs, according to the Centers for Medicare & Medicaid Services, known as CMS. In a practice known as ‘off label’ use of prescription drugs, patients can get these powerful medicines whether they are psychotic or not.”

* “Nursing homes often find it difficult to balance the demands of caring for certain patients against the pressure to keep staff costs down. The economics of elderly care can work in favor of drugs, because federal insurance programs reimburse more readily for pills than people.”

* “America is facing a public health crisis over the care of those with dementia, Dr. Pollock says. ‘We are left with the atypicals because we have nothing else,’ he says. These drugs have a role to play, he says, but ‘nonpharmacologic treatments’ should be tried first.”

* “The Food and Drug Administration issued a ‘black box’ warning on using the drugs for dementia patients in 2005. … Some doctors are now switching back to older, cheaper antipsychotics, such as Haldol, the FDA says. The older drugs had fallen into disuse, but don’t have a black-box warning. Now, the FDA says it’s weighing putting a black-box warning on those drugs, too.”

Here’s a link to the article:

http://online.wsj.com/article/SB119672919018312521.html

Prescription Abuse Seen In U.S. Nursing Homes
Powerful Antipsychotics Used to Subdue Elderly; Huge Medicaid Expense
By Lucette Lagnado
Wall Street Journal
December 4, 2007; Page A1

Robin