Acta Cardiol: Heart Failure, Ubiquinol and Carnitine

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Heart Failure, Ubiquinol and Carnitine

Dr. R. B. Singh

Halberg Hospital and Research Institute

Civil Lines, Moradabad, 10 (UP) 244001, India

icn2005@...

0437 (TEL/FAX)

http://www.vitasearch.com/CP/experts/RBSinghAT10-31-07.pdf

" Effect of Carni Q-gel (Ubiquinol and Carnitine) on Cytokines

in Patients with Heart Failure in the Tishcon Study, "

Acta Cardiol, 2007; 62(4): 349-54. 45731 (12/2007)

Kirk Hamilton: Can you please share with us your educational background

and current position?

R. B. Singh: After passing MBBS from Institute of Medical Sciences,

Benaras Hindu University, Varanasi,

India, I specialized in internal medicine from this great Institute. I

also studied biochemistry and nutrition in

relation to digoxin toxicity in heart failure patients for my MD thesis.

I have published about 25 research papers

in the Am Heart J, Brit Heart J, Acta Cardiol, Lancet and in several

Indian journals from 1974 to 1977. I

presented a novel concept of hyperlipidemia in tuberculosis at the 5th

International Congress on Atherosclerosis

at Houston, Texas USA in 1979 and also did a clinical rotation at the

Ashington Hospital, Ashington, UK in the

same year. I established the Medical Clinics and Hospital at Moradabad,

India as Director of this center and

continued research in nutrition in cardiovascular disease, resulting in

330 publications presently. I have been

Professor of Medicine at Subharti Medical College, Meerut since 2004 and

am now the Director of the Halberg

Hospital and Research Institute, Moradabad, India and Fellow at the

Halberg Chronobiology Centre, University

of Minnesota Medical School, Minneapolis, USA.

KH: What got you interested in studying the role of ubiquinol and

carnitine in heart failure patients?

RBS: Since both the agents help in the energy production in the

mitochondria, which is depleted in heart

failure, it seems logical to consider better results with their combined

use. These agents have been used

independently by us, and other experts, in treating acute coronary

syndromes and heart failure with beneficial

effects. Therefore, we considered it possible that their combined use

might be significantly synergistic and

clinically better.

KH: Why did you choose hydrosoluble ubiquinol (reduced form) versus

CoQ10 as ubiquinone (oxidized

form)? What is the reported advantage to using ubiquinol? Where did you

come up with the dose of 270 mg/d?

Was it given in a single dose or divided dose? With meals or away from

meals?

RBS: We used hydrosoluble ubiquinol because of its extraordinary

bioavailability and bioactivity. The dosage

was determined from earlier studies among heart failure patients showing

maximum beneficial effects between

200-300mg/d of ubiquinol. We administered 3 soft gel capsules three

times daily of Carni-Qgel (Tishcon Corp),

immediately after meals or with fatty foods as CoQ10 is better absorbed

due to its solubility in fat.

KH: Why did you choose to give L-carnitine with ubiquinol? Why did you

choose L-carnitine versus other

forms of carnitine? Where did you come up with the dose of 2250 mg/d?

How was it given? With the ubiquinol?

With meals or without? In a single dose or divided dose?

RBS: Both the agents were combined in a hydrosoluble soft gel capsule,

which was administered with meals

as mentioned above. The dosage and form of L-carnitine was used because

of its high bioactivity and superior

beneficial effects on ejection fraction and quality of life compared to

other forms of carnitine in patients with

heart failure in earlier studies.

KH: Were CoQ10 levels taken before during or after this study? Did they

correlate with symptoms and

supplementation?

RBS: Yes, plasma CoQ10 was studied at baseline and after 12 weeks of

follow up, showing a 10 fold increase

in its levels in the intervention group with a modest increase in the

placebo group. The quality of life, visual

analogue scale revealed that dyspnea, palpitations and fatigue (NYHA

class II-IV heart failure) which were

present at rest in all the patients at baseline, showed beneficial

effects in the intervention group compared to the

placebo group. The six-minute walk test also showed that there was a

significantly greater benefit in distance

walking from baseline, in the intervention group than the placebo group.

KH: Were plasma carnitine levels assessed? Did they correlate with

symptoms and supplementation?

RBS: We did not do so because we did not consider it necessary.

KH: Can you tell us about your study and the basic results?

RBS: As mentioned above, our study indicated that treatment of heart

failure, with ubiquinol + L-carnitine can

cause a marked improvement in the quality of life parameters and NYHA

class II-IV heart failure. There was a

significant reduction in the proinflammatory cytokines that are

neurohumoural precursors, related to

sympathetic and parasympathetic activity which is impaired in patients

with heart failure. We are not aware of

any other study showing reduction in cytokines with either of the agents

used by us.

KH: Were there any side effects with the L-carnitine and ubiquinol

combination therapy? How was the

patient compliance?

RBS: Nausea and vomiting are common side effects with CoQ administration

in Indian patients but these were

controlled by antiemetics and antacids. The compliance was excellent.

KH: I have use ubiquinone at 300-600 mg per day from this same company

and there has never been nausea

or emesis. Is this do to the carnitine or the reduced form of CoQ10

ubiquinol or their combination?

RBS: I think patients with heart failure are different than those

subjects having no heart failure because in

heart failure, there may be congestion of the stomach and liver

enlargement causing gastritis which predisposes

them to nausea and vomiting.

KH: How can you be sure that ubiquinone in combination with L-carnitine

would not have the same

beneficial effect as ubiquinol and L-carnitine? There has been a lot of

publicity about this reduced form of

CoQ10 (ubiquinol) being so much more efficacious than the oxidized form

of C0Q10 (ubiquinone). Is ubiquinol

worth the increased attention? How do we know which is better? Can you

comment on the efficacy between the

two?

RBS: Randomized, controlled intervention trials with both combinations

would be necessary to answer your

question regarding which combination of the different forms of CoQ10

with carnitine is better.

KH: Who is a candidate for carnitine and ubiquinol therapy? All heart

failure patients? Why not if there is

no harm?

RBS: Yes, all the patients with heart failure of all etiologies.

KH: Do you have any opinion yet of the advantage of hydrosoluble

ubiquinol versus ubiquinone?

RBS: Yes, research has shown that ubiquinol is definitely more

efficacious than ubiquinone.

KH: Do you have any further comments you would like to make about this

very interesting and clinically

relevant subject?

RBS: If funds are available, we would like to prove the synergistic

effects of this combination by

administering them independently and combined in various groups. We

would also like to confirm the effects on

cytokines as this is the first study showing these beneficial effects. I

am pleased to congratulate especially; Drs

Adarsh Kumar (patient care) and Dr Manoj Saxena (cytokine assay) as well

as other coauthors; Drs Niaz, Joshi,

Chattopadhya, Mechirova, Pella and Fedacko f or their help in this work.

It was not possible to conduct this

study without financial and technical support from Mr. Raj Chopra, Kamal

Chopra and Patels of Tishcon

Corporation, Westbury, NY, USA.

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