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December 2014 - January 2015


Physical activity lowers Parkinson’s risk
Mediterranean diet and metabolic syndrome
Coenzyme Q10 helps Gulf War syndrome
CoQ10 lowers heart surgery complications
Carnitine for treatment of heart attacks
General Information

Physical activity lowers Parkinson’s risk

Exercise is beneficial to the brain and neurological system, and not just because it releases endorphins to make you feel good. Earlier research showed that exercise is associated with neuroprotective effects in particular regions of the brain related to dopamine, which is involved with Parkinson’s disease. Some research has shown that agricultural chemicals might damage this neurological system.

In a newly published study, researchers followed 43,368 subjects for an average of 12.6 years. During this follow-up period, they identified 286 Parkinson’s disease cases. In men, compared to those with low levels of exercise, those with medium levels had a 45 percent reduction in the risk of developing Parkinson’s disease. The physical activity consisted of household activity, commuting, and leisure-time exercise. When they excluded the leisure-time exercise, just comparing commuting and household work, they found a 50 percent risk reduction for medium activity levels compared to low levels. (Yang F, et al., Physical activity and risk of Parkinson's disease in the Swedish National March Cohort. Brain. 2014 Nov 18. pii: awu323. [Epub ahead of print])

When the researchers pooled their data with five previous studies in a meta-analysis, they found that those with the highest level of physical activity had a 34 percent reduced risk of Parkinson’s disease compared to those with the lowest level of physical activity. The medium level of activity that they described worked out to six hours per week of household chores and commuting, while the low levels were less than two hours per week.

Practical guidelines:

Physical activity is helpful in many ways, and this does not necessarily mean a designed program at the gym. Any physical activity at home, including housework and gardening can be of value. However, you need a minimum amount per week to get the benefits.

Commuting in Sweden must be different than in the United States, where people get into their cars in the garage, drive to the parking garage at work, and take the elevator up to their offices. I am sure that in Sweden many commuters walk or take their bicycles, and they probably have to walk more to and from their cars, or they take public transit, and this also involves walking. While leisure time exercise did not appear to make as much difference in this study, this may just be an indicator that low levels of such activity (two hours a week) is pretty effective, and higher levels did not add to the benefits.

Mediterranean diet and metabolic syndrome

The Mediterranean (MD) diet is rich in fruits, vegetables, beans (legumes), whole grains, nuts, seeds, and fish, and lower amounts of meat and dairy products than found in many other diets in industrialized countries. A recent study from Spain on metabolic syndrome analyzed data from the PREDIMED trial that involved men and women who were 55 to 80 years old. The metabolic syndrome (MtS) consists of a collection of conditions including abdominal obesity, high blood pressure, elevated blood glucose, high triglycerides, and low levels of HDL-cholesterol (it has also been called syndrome X and insulin resistance).

Of the 5801 total participants, they found that 3392 of the participants had MtS at the start of the study. They were then randomly assigned to 1 of 3 dietary interventions: an MD diet plus additional extra virgin olive oil, a similar diet supplemented with nuts, or the control group who were just given advice on following a low-fat diet. At the end of the study, there were significant differences between the groups. Compared to those in the control group, subjects on either MD diet were more likely to revert to more normal metabolic conditions. Those on the control diet had a 28 to 35 percent higher likelihood of continuing with their MtS. The MD diets led to a reduction in abdominal obesity and a lowering of fasting blood glucose.

Of the 1919 participants who did not have MtS at the start of the study in 2003, over 4.8 years, 960 of these participants developed the condition. In this group, the diets did not appear to make a difference in the likelihood of developing MtS. In other words, the low fat diet was just as good at preventing the onset of MtS, but not as good as the MD diets in leading to reversion to more normal metabolism. (Babio N, et al., Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014 Oct 14. pii: cmaj.140764. [Epub ahead of print])

Practical guidelines:

The MD diet is very close to my guidelines for healthy living. I think that one does not need extra olive oil in general compared to a baseline diet that might include some. I also use flaxseed oil in salad dressing (simply with lime juice, oregano, garlic, and cumin), as this is rich in omega-3 fatty acids. The participants in this study had a very high rate of MtS, and that is typical of diets in industrialized countries, and in this case it may reflect changes related to becoming sedentary, menopause, and the lack of caloric restriction. A lot of research shows that people have fewer health risks on diets that consist of whole, natural, mostly vegetarian foods with small amounts of fish. No matter what diet you choose, overeating is still the biggest danger.

Coenzyme Q10 helps Gulf War syndrome

Veterans of the Gulf War (1990-1991) sometimes developed a collection of symptoms called Gulf War syndrome, or Gulf War illness. Symptoms are varied, but can include fatigue, muscle pain, joint pain, diarrhea, headaches, mental confusion and memory loss, sleep disorders, post-traumatic stress disorder, and others. The causes are unclear, but a number have been considered, such as chemical exposures, smoke inhalation from oil-well fires, combat stress, and underlying psychological issues.

A recent study of 46 veterans who met the criteria for Gulf War illness evaluated the effect of dietary supplements of coenzyme Q10 (Q10) on their symptoms. They were randomized to receive 100 mg of Q10, 300 mg of Q10, or an identical appearing placebo. They were treated for 3.5 months and evaluated using an index called “General self-reported health” (GSRH).

Among the subjects, 15 percent were women. At the end of the study, those on 100 mg of Q10 had a significant reduction in the GSRH, compared to placebo. They were also evaluated for physical function, using a Summary Performance Score (SPS). Supplementing with 100 mg of Q10 also helped improve the SPS. The improvements were correlated with an increase in blood levels of Q10. (Golomb BA, et al., Coenzyme Q10 benefits symptoms in Gulf War veterans: results of a randomized double-blind study. Neural Comput. 2014 Nov;26(11):2594-651. doi: 10.1162/NECO_a_00659. Epub 2014 Aug 22.)

Practical guidelines:

Coenzyme Q10 has a great number of health benefits (see the next article also). Typical doses are 100 to 400 mg per day, of either ubiquinone or ubiquinol (the reduced form). Up to 1200 mg have been shown to be quite safe, and possibly beneficial in slowing the progression of neurological conditions, such as Alzheimer’s dementia and Parkinson’s disease.

In the body, ubiquinone is converted to ubiquinol, which is the active form. Ubiquinol is also the more absorbable form of Q10. It is a potent lipid-soluble antioxidant, and helps with congestive heart failure, hypertension, and arrhythmias (as shown in the next article). I personally take 400 mg per day of the ubiquinol.

CoQ10 lowers heart surgery complications

As I noted above, Q10 has a number of other benefits. A recent meta-analysis from Spain showed benefits for patients undergoing open-heart surgery (Coronary Artery Bypass Graft, or CABG). They performed separate analyses for different outcomes, and these included the need for heart-strengthening medications (inotropic drugs), the incidence of ventricular arrhythmias (the most dangerous kinds), atrial fibrillation, cardiac index 24 hours after surgery, and length of hospital stay. Overall, the researchers found 8 clinical trials that met their criteria for inclusion in this meta-analysis.

Patients treated with Q10 were 53 percent less likely to require inotropic drugs after surgery compared to no Q10 treatment. The risk of ventricular arrhythmias (tachycardia and fibrillation, the kind that can lead to sudden death) was also markedly reduced by 95 percent. However, the cardiac index, the length of hospital stay, and the incidence of atrial fibrillation were not changed in the subjects on Q10 compared to those who were not. (de Frutos F, et al., Prophylactic treatment with coenzyme Q10 in patients undergoing cardiac surgery: could an antioxidant reduce complications? A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2014 Oct 24. pii: ivu334. [Epub ahead of print])

None of the clinical trials they evaluated reported any adverse effects of Q10. They noted that much higher doses have been used in other studies and found to be safe. In a 2008 study, patients with severe congestive heart failure did not respond adequately to supplements of 150-600 mg of Q10 (ubiquinone) because they did not achieve significant increases in their blood level, possibly due to poor absorption. They studied 7 patients with advanced heart failure (ejection fraction of 22 percent). When these patients were switched to ubiquinol, at doses of 450 to 900 mg per day, their blood levels rose from 1.6 mcg/ml up to 6.5 mcg/ml. Their heart muscle function went from 22 percent ejection fraction to 39 percent, and their heart failure classification went down from class IV to class II. (Langsjoen PH, Langsjoen AM, Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors. 2008;32(1-4):119-28.)

In the summer, I reported on a conference presentation that had not yet been published in a peer-reviewed journal. It showed that, after two years, those treated with 300 mg of Q10 had a 15 percent incidence of major adverse cardiac events, while the placebo group had a 26 percent incidence. All of the other endpoints of the study were significantly lower with Q10 supplements. This study has now been published in the Journal of the American College of Cardiology (Mortensen SA, et al., The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: Results from Q-SYMBIO: A randomized double-blind trial. JACC Heart Fail. 2014 Dec;2(6):641-9.)

Practical guidelines:

Q10 is worth taking at almost any dose, but it is quite expensive, especially in the ubiquinol form. However, based on my own cardiac function, I am increasing my dose to 800 mg of ubiquinol (as you may know, I had a congenitally defective heart valve replaced in 2003, so this is a particular concern of mine). I encourage heart patients and those with neurological disorders to consider higher doses than the typical 100 to 300 mg daily, and if you can afford it to take the ubiquinol form.

Carnitine for treatment of heart attacks

L-carnitine is a combination of two amino acids, lysine and methionine. It functions in the body as a carrier of free fatty acids across the inner mitochondrial membrane, where they can be metabolized to create energy (the mitochondria also require Q10 to complete this process). While your body makes L-carnitine, with age and certain conditions the production declines. This may make supplements helpful with some health conditions or even essential. Supplements can help reduce heart failure, chest pain or tightness with exercise (angina), arrhythmias of the heart, and all-cause mortality.

In a new review article, L-carnitine has been shown to be helpful for patients with heart attacks (acute myocardial infarction, or AMI). The authors report that L-carnitine supplements can reduce the extent of the heart muscle death, reduce ventricular arrhythmias, lessen the stretching of the left ventricle, lower the incidence of heart failure, and improve mortality rates. (DiNicolantonio JJ, et al., L-carnitine for the treatment of acute myocardial infarction. Rev Cardiovasc Med. 2014;15(1):52-62.

In a previous meta-analysis, these researchers evaluated 13 controlled trials with a total of 3629 subjects, and examined the effects of L-carnitine administration after an AMI compared to placebo on mortality, ventricular arrhythmias, angina, heart failure, and the likelihood of re-infarction.
Compared to placebo or a control group, they noted a 27 percent reduction in all-cause mortality, a highly significant 65 percent reduction in ventricular arrhythmias, and a 40 percent reduction in the development of angina. Heart failure and re-infarction rates were lower also, but these numbers did not reach statistical significance. (DiNicolantonio JJ, et al., L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Mayo Clin Proc. 2013 Jun;88(6):544-51.)

In a much earlier study, researchers did a randomized, double-blind, placebo-controlled trial of the administration of 2000 mg per day of L-carnitine to 51 patients, with 50 patients receiving a placebo. All of  the subjects were suspected of having an AMI. They were treated for 28 days. At the start, they had comparable conditions based on clinical and laboratory evaluations.
At the end of the study, the L-carnitine group had smaller infarcts, less angina (17.6 vs 36 percent), lower rates of heart failure and ventricular enlargement (23.4 vs 36 percent), and fewer arrhythmias (13.7 vs 28 percent). Total cardiac events, including deaths and new AMIs were 15.6 percent for the L-carnitine group compared to 26 percent for the placebo patients.

Practical guidelines:

L-carnitine is a safe and relatively inexpensive treatment for heart disease, although it is not covered by insurance. I routinely take 1500 to 2000 mg per day. This is in addition to my other supplements, including coenzyme Q10, as they all work together, especially these two.

General Information


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From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.

Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.