Co-enzyme Q10, the spark of life (Pt. 2)

CoQ10 in clinical cardiovascular disease

Myocardial biopsies have confirmed that CoQ10 deficiency is quite common in cardiac patients: congestive heart failure, coronary artery disease, angina pectoris, cardiomyopathy, hypertension, and mitral valve prolapse as well as patients of coronary bypass surgery. All these conditions can share common symptoms such as extreme fatigue, chest discomfort, shortness of breath even when at rest.

CoQ10 can be administered in clinical settings for a wide variety of cardiovascular disease, including:

  • Angina pectoris
  • Unstable anginal syndrome
  • Myocardial preservation during mechanical or pharmacological thrombosis
  • Before, during and after cardiac surgery
  • Congestive heart failure
  • Diastolic dysfunction
  • Toxin induced cardiotoxicity
  • Essential and renovascular hypertension
  • Ventricular arrhythmia
  • Mitral valve prolapse

Many studies have shown a strong correlation between low blood levels and tissue levels of CoQ10. As well as the improvement seen with CoQ10 like in the heart’s pumping ability, improved left ventricular function, ejection fraction, exercise tolerance, diastolic dysfunction, clinical outcome and quality of life.

How Coq10 supports the failing heart

More energy is needed to fill the heart than to empty it, this makes CoQ10 a great supplement to improve diastolic cardiac function. Several studies have proven this fact. In one study of 109 patients with hypertension and isolated diastolic dysfunction, CoQ10 supplementation resulted in clinical improvement, lower high blood pressure, enhanced diastolic cardiac function, and decreased myocardial thickness in 53% of hypertensive patients.

In another study, a group of 424 patients with systolic and/or dyastolic dysfunction was administered 240 mg of CoQ10 for an 8 year period. The subjects were followed for 18 months. Only one side effect was noticed only, mild nausea, clearly demonstrating that CoQ10 is safe and effective for a different number of cardiovascular diseases including CHF and dilated cardiomyopathy, systolic and/or diastolic dysfunction in patients with hypertensive heart disease.

Dr Sinatra recommends that if any patient fails to respond to standard levels of CoQ10, it is essential to obtain a blood level of CoQ10. If this is not available, he recommends to double the standard dose of 90-150 mg, even triple it until the desired result happens.

Congestive heart failure (CHF)

CHF, together with dilated cardiomyopathy (end stage CHF), is one of the most challenging issues cardiologists have to deal with today. Most CHF patients have a low quality of life with a low survival rate, and in most cases drug therapy does not provide any relief.

CHF is a condition in which the heart muscle is so weak that is cannot pump effectively to the various areas of the body. This causes the blood to back up in the lungs and lower extremities and the space around the heart causing congestion. A heart like that is literally energy starved and patients experience fatigue and shortness of breath even with minimal exertion. The most common cause of CHF is coronary artery disease and the blockage of the arteries of the heart which can result in heart attacks. Longstanding untreated high blood pressure, toxic drugs, alcohol abuse, valvular heart disease etc can also cause CHF.

Dr. Sinatra treats cases of CHF with CoQ10 because it supports ATP recycling in the mitochondria of the cell, acts as an antioxidant, stabilizes cell membranes, and reduced platelet size.

Several studies have proven the efficacy of CoQ10 for treating CHF. In a study, the administration of CoQ10 decreased edema (fluid retention) by 79%, pulmonary edema by 78%, liver enlargement by 49%, venous congestion by 72%, shortness of breath by 53%, and heart palpitations by 75%. Improvements in at least three symptoms were noted in 54% of patients.

All this is key information that allow us to conclude that CoQ10 alleviates symptoms of CHF and improves quality of life.

A most recent investigation in the treatment of heart failure came out of the Lancisi Heart Institute in Italy. The team of investigators evaluated 21 patients with moderate to severe heart failure. All of them were assigned to four weeks of oral CoQ10 or a placebo with or without exercise training five times a week. They found that when the patients took CoQ10, the heart assessment test results and their ability to exercise without discomfort improved. This study also showed that in participants with heart failure the heart size decreased by 12% while the blood flow to the heart improved by 38% and the protective cholesterol levels increased as well.

The aging heart

Aging increases the death rate by 3 times, specially at the age of 70. CHF is also a bigger concern in these patients because the older the heart is the more prone it is to lack of oxygen and other stressors. What makes the aging heart more vulnerable is the low levels of coQ10., this is because aging depletes CoQ10.

During the first 20 years of life quantities of CoQ10 rise steadily 3 to 5 times, then they plateau if health is good. After the age of 40 there is a gradual decline in the amount of Coq10 a healthy body produces and it falls very rapidly at the age of 80. This is when congestive heart failure is most predominant. Fortunately our brains keep some level of CoQ10 stability so it is not until the age of 90 that CoQ10 levels really plummet, affecting brain functions such as memory, problem-solving ability and coordination.

So to the question, can CoQ10 help the aging heart? The answer was found in a research which demonstrated the overwhelming cardio protective benefit of CoQ10. In one clinical trial, researchers demonstrated that a daily regiment of 300 mg of CoQ10 for two weeks prior to cardiac surgery increased the CoQ10 content in cardiac muscle, mitochondrial energy production and offered myocardial protection during heart surgery.

In another study the same group of researchers demonstrated that in the older heart, CoQ10 helped in the ability of the heart to sustain cardiac workload by 28% compared to non-treated hearts.

All this evidence proves that although the aging heart is very vulnerable to lack of oxygen, it responds very well to CoQ10 supplementation. This includes all those patients recovering from any cardiac procedure, heart attacks. For this reason, even if there is not an evident stressor, anyone after the age of 70 should supplement with CoQ10.


Patients with this condition are particularly more vulnerable to CoQ10 deficiency. Cardiomyopathy is a condition in which the muscle tissue of the heart has become damaged, diseased, enlarged or stretched out, leaving the muscle fibers weakened. Like congestive heart failure, cardiomyopathy is associated with major CoQ10 deficiency.

In a study by the ‘European Journal of Nuclear Medicine’, researchers were able to document and measure a significant therapeutic effect of CoQ10, proving that even small doses can have great implications for some patients with dilated cardiomyopathy.

Other studies done on patients awaiting cardiac transplantation, was done to determine if CoQ10 could improve the pharmacological bridge to transplantation. The results showed three different findings:

  1. A significant increase in CoQ10 blood levels
  2. Increases in exercise tolerance and less shortness of breath
  3. Fewer episodes of nocturnal urination.


Systolic blood pressure reflects the amount of pressure needed to open the aortic valve for each contraction of the heart, and diastolic pressure is a measurement of the pressure (resistance to blood flow) on the other side of the aortic valve against which the heart pumps. Diastolic pressure also reflects the amount of muscle tone in the vascular walls that press the blood through the arteries. Both these pressure levels need to be balanced: high enough for optimum circulation but not so high that excess wear and tear of the cardiovascular system occurs.

Research done in the 1980’s showed that hypertensive patients have low levels of CoQ10. Several years later follow-up studies confirmed that just 100 mg of CoQ10 a day lowered both diastolic and systolic blood pressure following 12 weeks of administration.

In another study, 46 men and 35 women with systolic hypertension and normal diastolic blood pressure underwent a 12 week trial in which they received either a 60 mg/day of hydrosoluble COQ10 Gel containing 150 IU of vitamin E or a placebo containing only vitamin E. Some subjects without hypertension were enrolled as controls and were also given CoQ10 therapy. Over the study period the group receiving CoQ10 experienced a drop in hypertension, and no change was observed in the group that received only vitamin E alone or in the control group. And there was a significant rise in CoQ10 levels in the blood. 55% of the patients in the CoQ10 group responded by achieving a reduction in systolic blood pressure of 25 mm Hg. The absence of response in the remaining 45% suggests the possibility of a threshold effect in CoQ10 ‘s mechanism of action. It is possible that a higher dose of CoQ10 may have increased the number of responders in the study.

These and other studies have confirmed what Dr. Sinatra has been practicing with his patients, CoQ10 is a great addition to a high blood pressure health protocol. He was even able to reduce at least half of their cardiac medications.

Dr. Sinatra considers CoQ10 the best way to lower hypertension. It all the studies CoQ10 has consistently been proven to lower high blood pressure in both systolic and diastolic pressure in patients with uncontrolled or poorly controlled blood pressure. What is in CoQ10 that makes this possible? CoQ10 may indirectly influence vascular function by preventing the oxidative damage to LDL, as well as by improving blood sugar control. Since oxidative damage to LDL, insulin resistance and elevation in plasma glucose concentrations can increase oxidative stress, the damage within the arterial wall is a critical event in the development of vascular dysfunction and even atherosclerosis. In a study with type 2 diabetics treated with 200 mg of CoQ10 a day, there was a significant reduction in glycated hemoglobin which is suggestive of improved sugar control and insulin resistance. More researchers have found impressive reductions in fasting glucose and insulin concentrations in patients treated with CoQ10, especially hypertensive patients who also suffered diabetes. This evidence suggests that coQ10 can reduce oxidative stress within the arterial wall via its antioxidant mechanism.

CoQ10 is also protective of the lining of small vessels and serves as an endothelial cell protector.

Angina pectoris

This condition, known for a ‘squeezing’, pressure or burning-like chest pain , or ‘heart cramp’, is caused by an insufficient supply of oxygen to the heart tissues, which drains them of energy and makes them vulnerable. This deprivation of oxygen is almost always caused by atherosclerotic plaque formation in the blood vessels feeding the heart, called coronary artery disease. Intense cold, physical exertion, or emotional stress may cause an increased need for oxygen and result in symptoms of angina too. Dr. Sinatra also treats patients with angina with CoQ10. It has been found to be effective in several small studies of patients with angina. Just 150 ml of Coq10 a day decreased the frequency of anginal episodes, a 54% reduction in the number of times nitroglycerin was needed and an increase of exercise time during treadmill test.

One study stands out in proving how CoQ10 increases exercise tolerance and decreases the frequency of anginal attacks. In this study, 15 patients with chronic stable angina were enrolled in a double blind placebo controlled crossover trial. Participants took 600 mg of CoQ10, a placebo or a combination of anti-anginal drugs. Results of the three interventions were compared. CoQ10 was shown to provide a significant reduction of exercise induced electrocardiographic abnormalities during stress testing when compared to placebo. A reduction in exercise systolic blood pressure without any changes in diastolic blood pressure or heart rate.

The mechanisms by which CoQ10 improves exercise capacity are not fully understood. But some possible explanations are that CoQ10 has beneficial effects on increasing energy metabolism delaying the onset of anginal symptoms. Also it is possible that its free radical reduction, or a combination of both had to do with the results. CoQ10 is an excellent adjunct strategy to angina pectoris sufferers. A dose of 180-360 mg/day is a good start or higher if there are no results.


Arrhythmia frequently occurs in the setting of a heart attack because the oxygen deprived heart is electrically unstable and heart cells then fire randomly.

By stabilizing the membranes of the electrical conduction system, CoQ10 can make it harder for arrhythmia to start in the first place. All the studies done have been on animal models. But the results have proven promising: reduced free radical stress, for blood clotting dissolving therapy during an acute heart attack, angioplasty, and coronary artery bypass surgery.

In one study of 27 patients with abnormal heart beat, reduction in premature ventricular contraction activity was significantly greater after four to five weeks of CoQ10 administration, 60 mg/day. This reduction of palpitations was also seen in diabetics, and hypertensives.

CoQ10 can have an effect on shortening the interval between heartbeats on the electrocardiogram, that may be of benefit for the period immediatly after a heart attack.

The good effects of CoQ10 on reducing oxidative damage, while at the same time controlling arrhythmia potential, suggests coQ10 is a logical treatment of choice in acute heart attack.

CoQ10 appears to be of great value in any case of acute coronary insufficiency, whether from angina, heart attack, congestive heart failure or any coronary heart procedures.

Myocardial protection in cardiac surgery

Pretreating surgical candidates with CoQ10 during cardiac operations has been proven to provide a great deal of protection because the heart is placed under a great deal of metabolic stress that significantly affects the function of the heart following surgery. This has resulted in proven improvement in right and left ventricular myocardial structure.

CoQ10 is effective in preserving heart function following CABG (coronary artery bypass graft surgery) and valve repair surgery and protects the heart against injury. In CABG patients, CoQ10 was proven to have higher myocardial performance and lower requirements for cardiac drugs that help support the heart while coming off heart lung-bypass.

Coronary artery disease and fat oxidation

Coronary artery disease is a condition in which the arteries that supply blood to the heart muscle become clogged by atherosclerotic plaque that is deposited on the walls of the artery by oxidized low density lipoprotein (LDL). If plaque buildup is allowed to proceed, coronary artery disease can eventually lead to heart attacks that will kill portions of the heart. Heart attacks are the direct result of energy starvation, caused by the inability of the heart to supply enough oxygen-rich blood to keep the energy furnaces burning. This reduction of blood supply is called ischemia.

Several studies have proven that CoQ10, because it is a fat soluble nutrient, can act as a potent antioxidant of fats, including cholesterol and its components.

In a study by the ‘Heart Research Institute’ in Sidney, Australia researchers found that CoQ10, 100mg 3 times a day, for 11 days increased resistance of LDL to the oxidation process. This has enormous implications since the oxidation of LDL appears to be the key step in atherosclerosis.

These results were taken even further in a 2003 report in the scientific journal Molecular and Cellular Biochemistry, this study studied 144 patients with classic symptoms of acute myocardial infarction (AMI), or heart attack. Patients were followed for one year. This study showed for the first time that treatment with CoQ10 was associated with significant decline in total cardiac events, including nonfatal heart attacks and cardiac deaths, probably because of its rapid protective effects on blood clot formation (thrombosis), endothelial function, and prevention of oxidative damage (free radicals).

No other study has researched this, and it is highly significant because studies like these indicate that treatment with CoQ10 within 72 hours of infarction may be associated with a significant decline in total cardiac events, decreased risk of atherosclerosis, increased blood levels of vitamin E helping inhibit LDL oxidation and reduced oxidative damage to the heart by fighting free radicals and reducing injury.

Concluding, Co-enzyme Q10 has proven to be of great importance in the energy production of the heart. It is so important that the body will make its own under healthy circumstances. However, since there are many factors that can influence its availability, it is important to consider supplementing with CoQ10, as part of a health regiment that includes the other vital nutrients: D-Ribose, L-Carnitine, and magnesium, together with the Heart and Body Extract, a sensible diet and moderate exercise.

Thank you for reading.


(1) Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 59-100. Print.


Co-enzyme Q10, the spark of life (Pt. 1)

As the heart is the most metabolically active organ in the body, a constant supply of energy is required to allow it to pump out blood to the rest of the body. If there is something we can do to improve the heart’s energy production, it is key that we learn about it. The good news is that the heart is highly responsive to supplementation. So far we have explained how good circulation is key because it allows nutrients to be transported where they are needed for heart cells to make energy. We have also explained that key nutrients for energy are L-Carnitine, D-Ribose, and magnesium. But there is another molecule that is essential in the energy cycle of the heart. This is the case of Co-enzyme Q10 (CoQ10).

Dr. Stephen Sinatra believes the discovery of CoQ10 was one of the greatest advancements of the 20th century for the treatment of heart disease. He has seen the great improvement CoQ10 offers for many heart conditions like congestive heart failure, high blood pressure, angina, and arrhythmia, but also for non-cardiological issues like periodontal disease, cancer, diabetes, neurological disorders, male infertility, immune support in HIV/AIDS, even aging. In his practice he has used CoQ10 with his patients with a lot of success, even two of his patients were able to come off the transplant list. Despite all this, he still feels this nutrient is being ignored by many cardiologists. This is the reason he has dedicated much on his work to bringing awareness about it.

In today’s blog we will explain with detail what CoQ10 is, and how it can be used as part of a nutritional protocol that includes the Heart and Body Extract, L-carnitine, D-Ribose, and magnesium, together with a sensitive diet and moderate exercise. We will focus on the work of cardiologist Dr. Stephen Sinatra and his many years of experience in heart health.

Definition and biochemistry of CoQ10

CoQ10, also known as ubiquinone, is a fat soluble vitamin-like compound that is found and manufactured in virtually every cell and tissue of the human body. The highest concentrations are found in the liver, the kidneys and the lungs, but the heart requires the highest amounts.

Generally speaking, energy manufacture is a second by second process that depends on some necessary steps: oxygen, essential nutrients, vitamins and co-factors. A deficiency or imbalance in any of these may contribute over time to impaired functioning of the cells, tissues, organs and the entire body.

Specifically, manufacture of CoQ10 is a complex process that needs the aminoacid tyrosine and multiple vitamins: folic acid, vitamin C, B 12, B 6, B 5, co-factors, aminoacids, trace elements and a few essential nutrients. A deficiency in any of these will impair the cells’ ability to make CoQ10, and without CoQ10 our body cannot survive.

In terms of cellular energy production (ATP) ‘CoQ10 is a vital component of the mitochondrial respiratory chain supporting heart energy at the cellular level’ (1). In fact, cellular energy metabolism is CoQ10’s most important function. This is how it happens: Inside the mitochondria, electrons are transported in order to give up their energy to generate ATP, fueling every cellular function. CoQ10 is vital in the electron transport chain because it picks up electrons from one member of the chain and drops them at the feet of another. And the key aspect to understand here is that Co Q10 is constantly in motion: it picks up electron and delivers them along the chain over and over. Without CoQ10 doing this, the activity of the electron transport chain would slow or cease altogether. CoQ10 is like the spark in the mitochondria of each cell that initiates the energy process, making it vital to life. Deficiency in CoQ10 can translate into a failing heart or a declining immune system, both of which will put us at risk for disease and premature aging.

This step by step energy process dependent on oxygen and essential nutrients like CoQ10 is also why the Heart and Body Extract is a key player in the energy production of the heart. Without proper circulation, oxygen and nutrients cannot reach the cell and this process then is hindered. Dr. Sinatra recommends a health protocol that includes key nutritional supplements like CoQ10 (around 360 mg/day), potassium, magnesium, garlic, 2-3 grams of fish oil, and 1-2 grams of L-carnitine. With this program, together with a sensible diet and exercise, he has been able to wean his patients off of anti-hypertensive drugs or at least reduce them.

CoQ10s role as an antioxidant

CoQ10’s key role in energy production in every cell of the body also gives it a powerful antioxidant activity. Its properties as antioxidant are:

  • It reduces oxidation of fats in the cell membrane
  • It reduces oxidation of LDL
  • It protects proteins and DNA from oxidation
  • It assists the body in combating free radical stress: In this sense, CoQ10 is a powerful antioxidant molecule which can be used throughout the body but specifically for the prevention of atherosclerosis, and coronary heart disease. Coq10 accomplishes this by engulfing free radicals before they do damage. CoQ10 also recycles vitamin E, another key antioxidant nutrient.

How and when to supplement with CoQ10

As long as we are healthy and eat a diet high in vitamins, aminoacids, and minerals and as long as we are not exposed to many environmental toxins that lead to free radical formation, our bodies can make all the CoQ10 they need. But in the case of an ailing heart, supplementation is key. Just a 25% reduction of CoQ10 can cause our organs to become deficient and impaired. When levels decline by 75% serious tissue damage and even death may occur. Nutritional deficiencies, disease, stressors like high intensity exercise, cholesterol lowering drugs and aging can lead to deficiencies in CoQ10.

Dietary sources of CoQ10 are vegetables (like broccoli and spinach), nuts, ocean fish and shellfish, and meats (pork, chicken and beef). However, we usually only get around 2-5 mg per day from food.

In cases of disease, supplementation is needed because dietary sources might not be enough. Something that needs to be understood about CoQ10 is that it is not uncommon to find it hard to absorb. Dr Sinatra explains that the relative large size of the CoQ10 molecule can impede its absorption. The powder forms of CoQ10 are almost totally unabsorbed by the intestine, while the fatty forms are more readily absorbed. This is because CoQ10 is a fatty substance and as such it needs a working digestive system.

Another important factor to consider is the kind of CoQ10 administered, as not all of them are the same. Some are more bioavailable than others. There are commercially available coQ10 capsules that contain either oil-based suspensions (soft gels) or dry power blends. Most have proven to be very poorly absorbed. CoQ10 may not be absorbed by the body for a number of reasons. The person may not be absorbing because of digestive problems, or the product may be of low quality, either because it doesn’t contain pure CoQ10 or because it may contain fillers.

Since CoQ10 is fat soluble it is poorly absorbed in water and is absorbed the same way as any regular fatty food is. It is therefore ingested better with fatty foods. And it requires a working liver and gallbladder. This also means that the fat soluble form is better than the powder. The largest producer of coenzyme Q10 in the world is the Japanese fermentation technology leader named Kaneka. The brand name is ‘Q-Gel’.

Deficiencies are more prominent in tissues that are more metabolically active, such as the heart, immune system, gingiva (soft tissue around the teeth) and an over active thyroid.


The usual dosage is 100mg, but Dr. Sinatra has observed that higher doses might be needed. This is the when there is no evident improvement with the usual dose, in which case the dosage always needs to be increased until obvious improvement is seen. The sickest patients obviously will need more.

When it comes to the amount, it is important to consider how it is absorbed and how much is delivered to the tissues. Whether capsules, cap-tabs, or regular oil based Co-Q10 Dr. Sinatra’s recommendations are as follows:

  • 90-150 mg daily as preventive in cardiovascular disease or periodontal disease
  • 180-360 mg daily for the treatment of angina, cardiac arrhythmia, high blood pressure, and moderate gingival disease and for patients taking statin drugs
  • 300-360 m daily for mild/moderate congestive heart failure
  • 360-600 mg daily for severe congestive heart failure and dilated cardiomyopahy
  • 600-1,200 mg daily for an improvement in quality of life in Parkinson’s disease

For severely impaired immune system as in cancer even higher doses of coQ10 may be required.

15 mg of Q-Gel softgel capsules, a water-soluble form of Co-Q10 is the equivalent of about 50 mg of standard coQ10. Once a therapeutic effect is obtained, that is, when there is improved well-being, lowered blood pressure, improved shortness of breath, better gum tissues, etc maintenance dose may be adjusted.

The most accurate way to assess how CoQ10 is being absorbed and delivered to tissues and organs is by blood test. When CoQ10 is delivered in sufficient dosages, it will support the tissues in need.

Ubiquinol, the other form of CoQ10

Ubiquinone is a stable form of CoQ10. Once ingested in the form of food or supplements, enzymes in the body called reductase reduce ubiquinone to ubiquinol, the antioxidant form that makes up practically all the circulating coQ10 in the body. More than 90% of the circulating CoQ10 in our body is present as ubiquinol. It is during the transport of electrons process in the mitochondrial membrane that this conversion from -none to -nol is done.

Ubiquinol has been developed as a commercial supplement only recently, and one small study has shown it has an excellent absorption rate when compared to the non-soluble form of CoQ10.

Is ubiquinol really better than ubiquinone?

Most ubiquinone has to be reduced to ubiquinol in order to be used by the body, so it would make sense that the best way is to supplement with its reduced or ubiquinol form. After years of research, Japan’s largest producer of CoQ10 in the world has recently developed a patented method to manufacture ubiquinol so that it can be used in supplements.

Dr. Sinatra recommends this form for patients with severely depleted energy such as patients with advanced end stage heart failure, liver failure, renal failure, or in patients with advanced, relentless chronic fatigue. In these cases there might be an advantage in using ubiquinol over ubiquinone since it does not need to be converted.

Also, those with a genetic mutation known as NQO1 lack the enzyme necessary to make the conversion. In these cases it might be more appropriate to use the ubiquinol form. Also for patients for which ubiquinone is not yielding results, Dr. Sinatra recommends ubiquinol.

The importance of magnesium for heart health (Pt. 2)

Heart benefits of magnesium

Some of the many benefits of magnesium in heart disease are as follows:

  • Antiarrhythmic properties
  • Controls flow of calcium into the heart cell ( like a calcium channel blocker effect)
  • Improvement of cholesterol
  • Improvement of vasodilation of coronary arteries
  • Inhibition of clot formation in coronary arteries
  • Protection against free-radical damage
  • Reduction of blood lipid levels
  • Maintenance of vascular tone
  • Improvement in energy synthesis and turnover

Similarly, Dr. Sinatra asserts there is a direct link between magnesium intake and a lower incidence of diseases, like type 2 diabetes and a variety of heart conditions:

  • Angina
  • Arrhythmias and sudden death
  • Atrial fibrillation
  • Arterioesclerotic heart disease
  • Cardiomyopathy
  • Stroke
  • Congestive heart failure
  • Heart attack
  • High blood pressure
  • Mitral valve prolapse

According to him, magnesium, because it improves the metabolic efficiency of heart cells, alleviates chest pain and other symptoms of angina that are due to lack of oxygen and energy in the heart. It is particularly helpful when ischemia is caused by spasm of the coronary vessels, because it helps to relax the muscle walls of the arteries directly. It works as a natural calcium channel blocker, it nurtures the heart during the acute phase of a heart attack, lowers blood pressure, and eases many dangerous cardiac arrhythmias. Dr. Sinatra has even used intravenous magnesium for his patients with migraine headaches.

Cardiac and non-cardiac concerns

Clinical conditions in which magnesium has been found to have an important role are: Angina, arrhythmias, atherosclerotic heart disease, cerebrovascular atherosclerosis and stroke, congestive heart failure, hypertension, ischemic heart disease, pre-eclampsia, eclampsia, asthma, insulin resistance and diabetes. We will look at each individually:


Magnesium deficiency is associated with a higher risk of angina. Some researchers from Japan studied 12 women with different levels of this condition. Results from this study demonstrated that women with more angina attacks had lower magnesium levels in their red blood cells than those experiencing fewer attacks. This indicated two things: one, deficiency in magnesium was directly linked to more angina attacks and two, the level of deficiency was directly related to the frequency of chest pain.

Arrhythmia and sudden death

In a double-blinded placebo controlled crossover study conducted by the U.S. Department of Agriculture, 22 post-menopausal women were given a diet with different amounts of magnesium. Patients’ heartbeats were constantly being monitored for 21 hours and magnesium levels were analyzed in red blood cells, blood plasma and urine. The patients that were on a low magnesium diet, had an increase in both supraventricular and ventricular ectopic hearts. The conclusion of this study suggested that 130 mg is a very low dose but 320 mg was acceptable.

Atherosclerotic heart disease

Research in this area has shown that magnesium intake provides some kind of protection, depending on how much was ingested. Studies have proved that increased intake of dietary magnesium was associated with a reduced risk of coronary heart disease, while those who consumed the least magnesium were almost twice as likely to develop heart disease compared to those who consumed the most magnesium. Other studies have also confirmed the protective effect of dietary magnesium in developing heart disease.

Cerebrovascular atherosclerosis and stroke

Cerebrovascular atherosclerosis refers to blocked blood vessels in the brain and it is also associated with magnesium deficiency. Low levels of cellular magnesium in the brain increases the risk of neurological events. In one study, 323 patients with peripheral artery disease and poor circulation in the extremities were followed for an average of 20 months as the atherosclerotic plaque from the carotid artery was being removed. Over the 20 month period, 35 of the 323 patients suffered a stroke and/or underwent a carotid revascularization procedure. Those patients supplementing with the lowest amount of magnesium had 3 times increased risk for neurological events compared to the patients in the highest spectrum.

Congestive heart failure

A study done with 404 congestive heart failure patients, who had been treated with a diuretic for at least 3 months, were included in the study. 12% of the participants were found to be deficient in magnesium, only 4 % had high levels. Factors associated with magnesium deficiency were female gender, diabetes, calcium deficiency and high fever.

High blood pressure

We have seen how increased resistance in the peripheral blood vessels is the main contributing factor for the development of high blood pressure. Small changes in magnesium levels may have large effects on vascular tone, which directly affects blood pressure.

In an animal study the effects of low magnesium on high blood pressure were studied. In the low magnesium group, after 5 weeks, blood pressure was severely elevated, blood vessels had constricted and showed high levels of free radical formation. The conclusion from this study was that chronic magnesium deficiency leads to the development of severe hypertension, endothelial dysfunction and free-radical stress.

The results of this study were extended to a human study involving childbearing aged women, who were divided into 3 groups: 12 were non-pregnant, 11 in the third trimester of pregnancy and seven women had pre-eclempsia. Compared with the non-pregnant women, brain and muscle magnesium levels were lower both in those who were pregnant and those with pre-eclempsia, the latter had the lowest levels of all. In all groups blood pressure was inversely related to brain magnesium levels. This study although small, supports the observations Dr. Sinatra has made connecting low magnesium to high blood pressure.

Insulin resistance/metabolic syndrome

Unstable blood sugar is another condition that is becoming very prevalent. This simple nutrient, magnesium, can protect against blood sugar fluctuations, and type 2 diabetes. More and more studies document a high occurrence of low magnesium in people with diabetes, as well as those with insulin resistance (also known as Syndrome X). In a recent trial study of 63 patients with type 2 diabetics with decreased magnesium blood levels, oral supplementation improved both conditions.

The ‘Women’s Health Study‘ involved a population of 39,345 women in the US age 45 or older, with no previous history of heart disease, cancer or type 2 diabetes. For 2 years of follow-up, 920 women developed diabetes, an inverse result was seen with those that supplemented with magnesium. As magnesium levels went down, the cases of diabetes went up. There was also a direct correlation in the amount of magnesium taken and the level of protection obtained.

Another similar studies, the ‘Nurses Health Study’ and the ‘Health professional follow-up study’ provide us with similar data. In these two, 85,060 women and 42,872 men with no history of heart disease, cancer or diabetes, were followed for 18 to 12 years respectively. Evidence from this study showed that increasing the intake of magnesium slashed the risk for diabetes by 33-34%.

Many patients with insulin resistance also have what is considered the typical metabolic trio of insulin resistance, high blood pressure, and high triglycerides. Dr. Sinatra has found that magnesium can lower high risk triglycerides and is associated with a ‘modestly lower risk of coronary heart disease, type 2 diabetes, …(and) mitral valve prolapse.’

Mitral valve prolapse

Mitral valve prolapse is a benign condition of the mitral valve, which is between the left atrium and the left ventricle which is named after its shape (like a bishop’s mitre). Sometimes the mitral valves become thickened, or stretched causing a slight to severe leakage of the valve. This can cause symptoms ranging from chest discomforts to irregular heartbeat. Magnesium has also shown considerable efficacy in relieving symptoms of mitral valve prolapse. Participants in a study with low levels of magnesium were randomly assigned to receive magnesium supplement or a placebo. The results of the magnesium group were dramatic, showing a reduction of the number of symptoms: less weakness, chest pain, shortness of breath, palpitations and even anxiety. Decreases in the amount of adrenalin-like substances in the urine were noted as well.

The conclusions from this study were as follows: many patients with severe symptoms have a low serum of magnesium levels. Supplementation with magnesium leads to an improvement in symptoms and a decrease in adrenalin-like hormones. For these individuals, magnesium supplementation may be the solution for reducing symptomatology and improving quality of life.

Dr. Sinatra has seen an improvement in symptoms such as chest pain, shortness of breath, fatigue and palpitations up to 70-80%, this might be due to an improvement in diastolic dysfunction.

In another study with 49 patients compared to 30 healthy individuals, the effect of magnesium was studied. The concentration of magnesium was measured in blood plasma and in lymphocytes isolated from venous blood. The blood plasma level of magnesium was similar in both groups, but in patients with MVP the lymphocyte magnesium concentration was much lower than it was for healthy subjects, suggesting that magnesium deficiency was part of the MVP syndrome.

This study also points to the fact that blood measurement for magnesium might miss a deficiency in the cells of tissues. For patients with MVP, ischemic heart disease, congestive heart failure or hypertension Dr. Sinatra recommends to supplement with magnesium as well as a diet in green leafy vegetables.

Concluding, magnesium is a very important mineral not only for heart health but for the whole body. Together with a healthy diet, D-Ribose, L-Carnitine and the ‘Heart and Body Extract’ we can greatly improve energy manufacture in heart cells. Without energy the heart cannot properly keep the rest of the body running. Take your heart to a new level by incorporating these into your routine. Thanks for reading.



(2) Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 179-192. Print.





The importance of magnesium for heart health (Pt. 1)

We have been talking about energy production in the body and more specifically in heart cells. As we saw, ATP is the energy molecule for every cell in the body and optimizing its production has an incredible impact on our overall well being (1).

One way to optimize energy production is by improving circulation. Healthy circulation is essential to carry key heart nutrients for energy manufacture, which is why the ‘Heart and Body Extract’ is so important. The other way is by providing these nutrients. L-Carnitine and D-Ribose are the ones we have looked at, but there are others that are needed as well. This is the case of the mineral magnesium. Like L-carnitine, and D-ribose, magnesium is a necessary ingredient in maintaining healthy levels of cellular energy (2).

In what follows we will look with detail at this mineral, its main functions in heart health and how to obtain it in our diet.

What is so important about magnesium?

Primarily, magnesium is a co-factor that contributes to over 300 enzymatic systems in the body. One of these enzymatic reactions has to do with ATP (production of energy). This is how it happens: Inside the cell, magnesium appears to be concentrated in the mitochondria, where it attaches to proteins, co-factors and ATP to aid energy transfer. All enzymatic reactions involving ATP have an absolute requirement for magnesium. This includes the heart, making it another great addition to our health protocol (2). It also makes magnesium a true energy mineral, but it is more than that.

To understand magnesium we need to say that all human tissue contains some amounts. In total, the human body contains from 20 to 25 grams. It is the most common intracellular ion in the human body, second only to potassium.

Magnesium is distributed in three major body compartments:

  • Approximately 65% is in the mineral phase of bone. From the bones it can be transported to other tissues where there might be a shortage
  • 34% is sequestered in muscle
  • 1% resides in blood plasma and interstitial fluids (2)

The fact that there is only 1% in the blood means that blood tests are not very reliable in terms of showing magnesium deficiency. Which is also the reason why magnesium deficiency is an “invisible deficiency” (3). Mononuclear blood level analysis is much more predictive (2).

Benefits of magnesium

From all this we can infer how magnesium is a mineral used through the body, specially by the heart, muscles, and kidneys. However, recently, researchers have discovered 3,751 magnesium-binding sites on human proteins, indicating that its role in human health and disease may have been vastly underestimated (3). This makes magnesium even more important than we thought. Some health care professionals, like neurosurgeon Norman Shealy , M.D, PhD, goes as far as to say that almost every disease we know can be associated with magnesium deficiency (1).

This means that magnesium is not only critical for energy requiring processes, but also for:

  • Protein synthesis: Helping digest proteins, as well as carbohydrates, and fats
  • Membrane integrity
  • Nervous tissue conduction: Activating nerves
  • Muscle contraction: Activating muscles
  • Hormone secretion
  • Maintenance of vascular tone
  • Intermediary metabolism
  • Body’s detoxification processes, making it important for helping prevent damage from environmental chemicals, heavy metals, and other toxins
  • Serving as a building block for RNA and DNA synthesis
  • Acting as a precursor for neurotransmitters like serotonin
  • Blood sugar balance
  • Improving circulation and blood pressure
  • Helping cellular energy production
  • Relaxing the nervous system
  • Relieving pain and relaxing muscles
  • Bone density and calcium balance
  • Regulating heart contractility by blocking calcium from heart muscle. The heart has twenty times higher concentration of magnesium

New research is giving us additional information about this important mineral. Dr. Dean’s work of more than 15 years points to the fact that there are 22 medical areas that magnesium deficiency can trigger, all of which have all been scientifically proven. This includes, among others:

  • Anxiety and panic attacks
  • Blood clots
  • Diabetes
  • Heart disease
  • Insomnia
  • Hypertension
  • Fatigue
  • Hypoglycemia
  • Liver disease
  • Musculoskeletal conditions: fibromyalgia, cramps, chronic back pain, etc.
  • Nerve problems
  • Migraine
  • Obstetrics and gynecology (PMS, infertility, and preeclampsia)
  • Tooth decay
  • Osteoporosis

Magnesium and stress

The prevalence of individuals with anxiety has grown significantly over recent years. Anxiety typically manifests due to the perception of unmanageable stress. This can sometimes be due to chemical imbalances in the brain, such as the balance between glutamate and GABA.

Chronic stress can influence glutamate-GABA balance and lead to the development of anxiety over time. A deficiency of magnesium can quickly build up stress within the body and drain energy reserves (ATP), making the sufferer feel chronically fatigued. With regular intake of magnesium, one can increase resilience to stress, effectively combat anxiety and increase energy. Because magnesium is an absolute requirement to make energy and since it is needed for so many processes in the body, keeping its stores full is a great way to help overall health function smoother.

Dr. Jockers mentions several ways to incorporate this vital mineral into our daily routine. One very important way is to control blood sugar and reduce stress, since these two are some of the most common factors that drain magnesium stores. Another way is to add magnesium rich foods. When it comes to getting nutrients into our body, food should always be the first strategy, he asserts. Foods that are high in magnesium are:

  • Dark leafy greens
  • Avocados
  • Pumpkin seeds
  • Sea vegetables
  • Wild-caught fish
  • Grass-fed butter
  • Sprouts

Another way is to have Epsom salts baths (magnesium sulfate). Soaking in an epsom salt bath is an easy and relaxing way to get magnesium into the body. This method is especially helpful for people with digestive disorders as it bypasses the GI tract altogether by absorbing through the skin (1).

Magnesium deficiency

A high percentage of the American population is magnesium deficient (2). By some estimates, up to 80% of Americans are not getting enough magnesium (3). Low levels of magnesium in the blood are known as hypomagnesemia. Several factors have contributed to this:

  • Depleted soils are becoming more and more prevalent and as they do, our food and water are also being depleted
  • Emotional and physical stress also deplete the body’s magnesium stores. This is because with stress more cortisol, (the ‘aging hormone’) is secreted from our adrenals which overtime leads to subtle magnesium depletion
  • Dehydrating drinks like alcohol or coffee, diuretic medications, etc can promote excessive loss of this mineral through urine
  • Several bowel diseases and some medications impede the intestinal absorption of magnesium, this is the case of acid blockers
  • Poor dietary habits such as high sugar intake, over consumption of processed goods and too little intake of plant based nutrients
  • What is so troubling about this loss of magnesium is that excessive loss has a strong link to diabetes and insulin resistance. What is more, magnesium loss is more prevalent in women, the elderly and those with various disease syndromes
  • Deficiencies may lead to changes in neuromuscular, cardiovascular, immune and hormonal function, impaired energy metabolism, and reduced capacity for physical work. Magnesium deficiency is now considered to contribute to many diseases, and the role of magnesium as therapy is being tested in many clinical trials.

Early signs of magnesium deficiency include:

  • Loss of appetite
  • Headache
  • Nausea
  • Fatigue and weakness

An ongoing magnesium deficiency can lead to more serious symptoms, including:

  • Numbness and tingling
  • Personality changes
  • Muscle spasms and cramps, even eye twitches
  • Abnormal heart rhythms: Irregular heart beats, this includes rapid heartbeats, slow heartbeats, and sudden changes in heart rhythm for no apparent reason
  • Seizures
  • Coronary spams
  • Unexplained fatigue or weakness (3)
  • Chronic Headaches/Migraines
  • Constipation
  • IBS
  • Muscle Spasms and cramping: Because magnesium is so important for proper nerve transmission, it comes as no surprise that it also plays a vital role in muscle contraction. When magnesium is depleted, muscle contractions can become weak and uncoordinated, leading to involuntary spasms and painful cramps. This is actually one of the most common early signs of magnesium deficiency. Spasms typically occur in the legs, feet, and sometimes even in places like the eyelids. Women may also experience worsened PMS-related cramping when magnesium stores are low.
  • Mood Disorders
  • ADD/ADHD symptoms (1)

Magnesium levels in women

Dr. Carolyn Dean, author of ‘The Magnesium Miracle’, who shares her expert insights with us says: “Fluctuating sex hormones affect magnesium levels, making women more sensitive to magnesium deficiency than men… Magnesium levels fluctuate during a woman’s cycle. The higher the estrogen or progesterone, the lower the magnesium. During the second half of the menstrual cycle, when both estrogen and progesterone are elevated, magnesium plummets. This can result in spasms in the brain arteries, a prelude to PMS and migraines. Increasing dietary and supplemental magnesium can help relieve PMS-related symptoms, such as headaches, bloating, low blood sugar, dizziness, fluid retention and sugar cravings.’ (4)

Magnesium supplementation and dosage

Research shows only 25 % of adults in the USA are getting the recommended daily amount of magnesium. When it comes to dosages some health care professionals recommend 310-320 milligrams for women and 400- 420 for men (3). However, others believe we need 1,500-2,000 milligrams of magnesium a day (6).

Dr. Sinatra recommends to supplement with 400 milligrams of magnesium once or twice a day and consume magnesium rich foods. Those on certain medications, like diuretics should make sure they follow this recommendation as these drugs excrete excessive amounts of magnesium, he also recommends supplementing with magnesium for type 2 diabetes patients.

Top food sources high in magnesium are:

  • Swiss chard
  • Spinach
  • Grass fed dairy
  • Avocados
  • Pumpkin seeds
  • Pink salts
  • Nuts
  • Dark chocolate
  • Wild caught fish
  • Sprouts
  • Sea vegetables (5)

Types of supplemental magnesium

In addition to what can be obtained through the diet, many health professionals often recommend supplemental magnesium. There are many different types of supplemental magnesium:

  • Magnesium glycinate is a chelated form of magnesium that tends to provide the highest levels of absorption and bioavailability and is typically considered ideal for those who are trying to correct a deficiency
  • Magnesium chloride/magnesium lactate contain only 12% magnesium, but has better absorption than others such as magnesium oxide, which contains 5 times more magnesium
  • Magnesium oxide is a non-chelated type of magnesium, bound to an organic acid or a fatty acid. Contains 60% magnesium, and has stool softening properties
  • Magnesium sulfate/magnesium hydroxide (milk of magnesia) are usually used as laxatives. It can be easy to overdose so only take as directed
  • Magnesium carbonate, which has antiacid properties, contains 45% magnesium
  • Magnesium taurate, contains a combination of magnesium and taurine, an amino acid. Together, they tend to provide a calming effect on body and mind
  • Magnesium citrate is a magnesium with citric acid, which like most magnesium supplements has laxative properties but is well absorbed and cost effective
  • Magnesium threonate is a newer, emerging type of magnesium supplement that appears promising, primarily due to its laxative properties but superior abilities to penetrate the mitochondrial membrane and may be the best supplemental magnesium on the market (3). Magnesium threonate is the only form found in studies to easily cross into the brain to exert its effects. Dr. Jockers typically recommends 1-2 grams of this magnesium every day. If the person is having digestive issues or is wanting to use magnesium for the relief of joint pain, Dr. Jockers recommends a topical magnesium, like magnesium oil with MSM and if the person is also experiencing trouble falling asleep, topical magnesium with melatonin (1).

Calcium to Magnesium Ratio

The heart is a muscle that is constantly contracting. Just as with other muscles in the body, the heart relies heavily on magnesium for proper contractility. This is thought to be due to its role in regulating calcium and potassium concentrations in the muscle tissue (5).

Unlike our ancestors whose balance of calcium to magnesium levels were equal, our lifestyle habits today lead to an imbalance in this key electrical gradient. The result is a 10:1 calcium to magnesium ratio. This ratio disrupts the healthy balance of electrolytes within cells making nerves more susceptible to stress and pain perception.

Taking high amounts of calcium without adequate magnesium, will make the muscle contract involuntarily. This is known as hypercalcemia and it can contribute to significant changes in heart rhythms. Magnesium helps to balance out excess calcium to coordinate muscle contractions and reduced unwanted tension.



(2) Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 179-192. Print.







Ribose, the sugar of life (Pt. 2)

D-Ribose in cardiovascular disease

The heart could be said to be the most metabolically active organ in the body, requiring a large volume of oxygenated blood flow to continually supply its tremendous demand for ATP. Oxygen deprivation due to heart disease or stress depletes energy from the heart and will quickly empty the heart’s energy reserves. The good news is that the heart is also the most responsive organ to supplementation. D-Ribose is particularly effective in this respect and the reason why it shows such promise in treating heart patients. D-Ribose increases the energy pool and promotes the metabolic health of the tissue (1). Medical and scientific literature has repeatedly confirmed that D-Ribose can be effective in treating patients with congestive heart failure, coronary artery disease, angina, ischemic cardiomyopathies and for those recovering from cardiac intervention such as aortic valve repair, coronary artery bypass graft surgery and angioplasty.

D-Ribose in congestive heart failure

Hearts with congestive heart failure are severely energy depleted, in many occasions up to 30%. Because the loss of energy is progressive, it is not evident until there is severe failure. Congestive heart failure is also characterized by the loss of the more efficient energy pathway in favor of the less efficient, which causes:

  1. Stress in the heart
  2. Ventricular pump failure caused by diastolic dysfunction
  3. Thickening of ventricular walls

Because D-Ribose supports the heart’s ability to preserve and rebuild its energy pool, it helps provide the heart with the energy it needs to do its job. D-Ribose also helps reduce free radical formation by salvaging ATP breakdown products. Both of these actions are critical for congestive heart failure patients in which low energy output, free radical stress and cardiac arrhythmia dominate.

The effectiveness of D-Ribose in treating congestive heart failure was proven in a study done in 2003 reported in the ‘European Journal of Heart Failure’. In this study D-Ribose supplementation resulted in a highly significant improvement in:

  1. Atrial contribution to left ventricular filling: More blood was able to flow into the relaxed ventricle, making it possible for more blood to pump to the rest of the body.
  2. Reduced left atrial dimension: Less back-up of blood that is associated with congestion.
  3. Greater flow rate across the valve separating the left atrium and the left ventricle: More blood flow to the ventricle.
  4. Ventricle relaxation, which allows it to fill more easily and reduces diastolic dysfunction.

This study showed that D-Ribose supplementation improved diastolic heart function (less shortness of breath), quality of life and exercise capacity in coronary artery disease and congestive heart failure in 90% of patients.

D-Ribose in coronary artery disease

Vascular disease has a profound effect on energy metabolism, with a reduction of as much as 40% in patients with chronic cardiac ischemia. Heart attacks or surgery can deplete the energy pool even further, by 50% or more. Since normal heart function requires large amounts of energy and since the energy stores of the heart are limited to sustain only a few seconds of contraction, supplementation is key.

In myocardial ischemia there is a severe and chronic depletion of the energy stores due to inadequate oxygenated blood flow that can take up to ten days to rebuild. Even when normal circulation is restored through surgery, this can lead to extended post-ischemic heart dysfunction. This energy strain depletes ATP and it is ironically exacerbated when blood flow is restored. The new blood flow pulls these energy substrates out of the cell leaving it energy deprived. Dr. Sinatra has seen how many patients who have surgery to open their coronary arteries get actually worse for up to two weeks after the surgery. These patients become very fatigued, and during this time of recovery, the lack of energy reserves puts them at great risk.

On the other hand, those patients that are not candidates for this kind of surgery, remain in a chronic stage of energy depletion   and their heart function worsens progressively to congestive heart failure if the energy metabolism does not improve. “Restoration of the energy pool ….can only be accomplished through the pathway of energy metabolism regulated by the availability of D-Ribose” (1). This reduces fatigue, increases exercise tolerance and enhances quality of life. All this information was first reported in a 1992 study published by the British medical journal ‘The Lancet’. The subjects in this study had chronic coronary artery disease in at least one main coronary artery and a history of angina induced by normal daily activities. Three of them had had heart attacks. These patients were randomly given either D-Ribose or a placebo of glucose for three days. The group that were given D-Ribose performed significantly better when compared to baseline tests, while there was no improvement in the group that was given glucose. The conclusion of this study was clear: D-Ribose supplementation effectively increased cardiac energy metabolism in only three days, controlled the onset of angina and improved exercise tolerance in chronically diseased patients.

Another study from the University of Minnesota showed that D-Ribose is valuable after a heart attack. The study was conducted in animals because it was too invasive to be done in humans. After four weeks of treatment with D-Ribose, animals showed better heart function than those given a placebo. This study showed that by increasing the energy level of the heart, the heart muscle could function better and be less affected by the stress of a heart attack.

Another study showed that D-Ribose also helps reduce the development of pulmonary hypertension in ischemic hearts. The study showed that D-Ribose significantly reduced the development of heart failure on the right side of the heart, allowing the heart to pump blood to the lungs more easily.

D-Ribose in Peripheral vascular disease

Peripheral vascular disease (PVD) results from arterial clogging, especially in the arteries feeding blood to the legs. It leads to severe leg pain even with mild exercise. The same pain that patients with congestive heart failure feel due to the heart being unable to pump blood out to the extremities.

Similar energy depletion occurs in leg muscles during PVD, in congestive heart failure and in coronary artery disease. In all three cases oxygen deprivation leads to a depletion of the tissue energy pool because an adequate volume of oxygenated blood cannot be supplied to the heart muscle. This energy depletion disrupts the normal function of the muscle, leading to fatigue, soreness, and stiffness that can become so severe that patients cannot stand and walk.

D-Ribose has been shown both in human and animal studies to greatly accelerate energy synthesis in skeletal muscle. By accelerating energy synthesis muscles are better equipped to keep up with the energy demand, improve their physiology and reduce pain. While D-Ribose supplementation will not increase blood flow to the tissues, it allows muscles to manage the balance between energy supply and demand more effectively.

Myocardial protection and recovery in cardiac surgery

There are three major cardiac interventions that have to do with restoring blood flow to the heart:

  1. Traditional coronary artery bypass graft (CABG) surgery: During this kind of cardiac surgery, the body’s temperature is lowered to decrease metabolism and reduce cardiac energy loss. The body’s blood supply is then rerouted to the bypass pump so the heart can be stopped for surgery, while the body continues to receive oxygenated blood from the pump.
  2. “Off pump” CABG: During ‘off pump’ procedures, on the contrary, the body is cooled, but the blood is not rerouted to the bypass pump and the heart is not stopped. This is also called ‘beating heart surgery’ and it places less metabolic strain on the heart, muscles and brain.
  3. Percutaneous transluminal coronary angioplasty (PTCA): PTCA is a procedure where a balloon is placed into the clogged artery and expanded, which breaks apart the plaque and eliminates the clog. While the balloon is expanded, blood flow stops to a portion of the heart and an ischemic event is the immediate result. This ischemic event, although short, also stressed cardiac energy metabolism to the limit.

All these three interventions cause the heart to become ischemic and put it under extreme metabolic stress. All of them also provide an immediate restoration of highly oxygenated blood to the heart which can cause some issues.

There have been numerous animal and human studies that researched the role of D-Ribose in protecting the heart during surgery and helping it recover after cardiac intervention. Some research has shown that bathing the stopped heart in a solution with D-Ribose preserves energy metabolites and slows the energy drain during traditional CABG surgery. Other studies have shown that the metabolic state of the heart prior to surgery is the main factor affecting functional cardiac recovery following the procedure and that the preservation of the energy pool in the heart before surgery is crucial for a successful outcome. Still other studies have shown that keeping donor hearts for transplant bathed in a D-Ribose solution can be an effective way to preserve the tissue energy pool and promote cardiac function following transplant.

Giving patients D-Ribose before and after cardiac intervention has proven very effective. In one study, giving it intravenously to patients following aortic valve repair enhanced cardiac recovery. Other studies show that giving energy to the heart before surgery improves the surgical outcome and helps the heart pump blood more easily and completely following the surgical intervention.


It is defined as the restoration of blood flow to the heart. In this technique, massive amounts of oxygen-rich blood flow into regions of the heart that previously had been deficient. Reperfusion can happen spontaneously if an arterial clog or blood clot breaks away from the vessel wall or it can be done surgically when a surgeon ‘replumbs’ the heart during CABG, opens a clogged vessel , or when a clog-buster agent is used to dissolve away the clots.

There is a downside to reperfusion, when this fresh supply of oxygenated blood is delivered under high-oxygen tension, it brings an excessive amount of oxygen to the previously starved tissue. All this oxygen must be broken down by the cells, creating inevitable and harmful byproducts called ‘reactive oxygen species’ (ROS). What is more, the increased flow of blood that comes with reperfusion washes huge amounts of energy substrates away from the cell and some of these energy metabolic byproducts contribute to free-radical formation in the presence of too much oxygen.

This process can place so much oxidative stress on the tissue being rescued that causes a condition called ‘reperfusion injury’. D-Ribose can counter-balance this harmful effect because it helps control free radical formation by salvaging some of the energy substrates before they can be washed away, not allowing them to escape the cell.

Adverse reactions

When taken as directed, D-Ribose has been proven to be safe. However, because there is not enough published data on pregnant women, nursing mothers and very young children, Dr. Sinatra recommends these populations to refrain from taking D-Ribose.

Also, because D-Ribose lowers blood sugar levels temporarily, insulin dependent diabetics should have their blood sugar monitored so they do not accidentally overdose with insulin.

On an empty stomach, D-Ribose can cause minor light-headedness in a large dose (10 mg.), therefore, it is best taken with food.

Summing up

Because the heart is in such a need for energy, D-Ribose, together with a heart healthy diet and the products you can find in the ‘Healthy Hearts Club’, can make a great difference in energy levels, as we have seen. This is especially important in the case of heart disease, which depletes energy in heart cells.


(1) Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 145-177. Print.

D-Ribose, the sugar of life (Pt. 1)

We have seen how proper circulation is key for heart health. Good circulation carries nutrients and oxygen, both of which are essential for energy production. L-carnitine assists the body in taking fats into the part of the cell that manufactures ATP (the energy provider for all cells in the body). Another nutrient that is essential for energy metabolism is D-Ribose, which we already saw is one of the components of ATP.

Dr. Sinatra, in his many years as a cardiologist has seen how D-Ribose has helped his patients. He explains that D-Ribose can be used by the body to rebuild the energy pool once it has been depleted. It can also accelerate energy recovery during and following cardiac ischemia because it “supplies the energy needed by the heart to allow full ventricular relaxation during the diastolic phase of the heartbeat.” (1)

Something like stress and heart disease can cause lack of oxygen and blood flow, conditions under which D-Ribose cannot be made fast enough to replace the lost energy in our organs. This is the reason why improving circulation is key to energy production, and the reason why the ‘Heart and Body Extract’ is such an important piece of the puzzle in restoring energy metabolism. Taken together with D-Ribose and L-carnitine, it can bring our heart health protocol to a whole new level.

In today’s blog, we will look at D-Ribose, what it is and all the functions it has in the body.

Ribose in energy metabolism

Depletion of cellular energy is well known in cardiovascular diseases like congestive heart failure, coronary artery disease, aortic valvular disease, peripheral vascular disease and certain types of cardiomyopathy. When considering heart and circulatory diseases, the effect of D-Ribose supplementation on maintaining energy levels cannot be overstated. Let us remember some basics of energy metabolism.

Every cell in our body uses up a great deal of energy. The energy unit is known as ATP as we saw in previous blogs, and it has D-Ribose as one of its components. Exercise, stress and disease can put a burden in the body’s energy metabolism, especially the heart, depriving it of oxygen. Without oxygen, the energy pathways do not work efficiently to make energy. The heart cells then must rely on glucose to fulfill their entire energy requirements, and they become very reluctant to change from glucose metabolism to D-Ribose synthesis. This is further complicated by the fact that the cell has no glucose to spare. Until the mechanisms of energy metabolism return to normal and take pressure off glycolysis, and until the cells develop the enzymes needed for D-Ribose synthesis, the process of making D-Ribose is slowed down, especially under stress. This translates in severe weakness and fatigue for up to a week after exercise. However, when D-Ribose is added to the health routine, the cells are able to recover well enough to make energy at a faster rate.

What exactly is D-Ribose?

The chemical name of D-Ribose is ‘D-ribofuranose’, a simple five-carbon sugar made in every cell in the body. Because of this chemical composition, D-Ribose cannot be used by the body in the normal carbohydrate metabolism pathway, which uses a six-carbon sugar like glucose. Instead D-Ribose, is conserved by the cell for its primary role: rebuilding the energy pool. D-Ribose is unique among sugars because it is the only sugar used by the body to regulate and control this vital metabolic pathway.

D-Ribose synthesis happens in every cell in the body but it is a slow process and varies according to the tissue. At the cell level the manufacture of D-Ribose begins with glucose and involves a series of biochemical reactions that follow a complex metabolic pathway known as ‘pentose phosphate pathway’ (PPP).

Although D-Ribose is found naturally in the body, it cannot be stored, instead, cells must make it every time it is needed. Several organs make their own D-Ribose to manage their own needs, like the heart, skeletal muscle, nerve tissue, brain, etc. However, under stress there is a reduction in oxygen and blood flow. Under conditions of low oxygen, D-Ribose cannot be made fast enough to replace lost energy in each of the organs. If this oxygen and/or blood flow deficits become chronic, as is the case of heart disease, tissues can never can make enough D-Ribose and cellular energy levels are constantly depleted. This is the reason why improving circulation is key to energy production, and the reason why the ‘Heart and Body Extract’ is such an important piece of the puzzle to restore energy metabolism.

According to Dr. Sinatra, D-Ribose has been shown to be beneficial by reducing the time the heart needs to rebuild cellular energy and normalizing diastolic cardiac function from 10 days to 1-2 days. Without D-Ribose supplementation, hearts are forced to slowly make their own D-Ribose before energy synthesis can proceed. Once D-Ribose is present in the cell, energy recovery can proceed quickly.

When it comes to food sources, D-Ribose is found in meats, especially veal, but not in enough quantities to contribute to its role. Therefore, for those people suffering from any heart condition, neuromuscular disease, peripheral vascular disease, etc supplementation is key. When D-Ribose is ingested, it is quickly and easily absorbed through the digestive tract and into the blood and then the tissues. About 97% of supplemental D-Ribose is absorbed and it reaches steady state in the blood in 3-12 minutes, depending on the dose. It also moves easily from blood to tissue. Virtually all of the D-Ribose absorbed into the blood is used by tissues, only 5% is excreted through urine.

D-Ribose in the cell has several very important functions:

  1. Drives the synthesis of energy compounds
  2. Controls the production of DNA and RNA (the genetic materials)
  3. Influences the synthesis of certain vitamins and co-enzymes crucial to cellular function

Of all the sugars in nature, D-Ribose is the only one that performs these functions.

A brief history of D-Ribose

Although D-Ribose is one of the most widespread substances in the body, it took several decades for scientists to pinpoint what its role was. It was in 1944 when Japanese researchers, doing some experimentation with laboratory mice and rabbits, discovered that D-ribose was converted in the liver. This first discovery triggered further research in other laboratories in the world and it was reported that D-Ribose was a primary intermediate in an important metabolic pathway, the ‘pentose phosphate pathway’ (PPP). The PPP is of great importance for:

  1. The body ‘s energy synthesis
  2. The production of genetic material
  3. To provide material used by certain tissues to make fatty acids and hormones

This information led to the isolation of a purified enzyme called ribokinase from calf liver. This enzyme is key in allowing D-Ribose to enter the ‘pentose phosphate pathway’.

In 1969 researchers in the ‘Department of Anatomy’ at McGill University, Montreal used radioactively labeled D-Ribose injected into young rats to finally determine that D-Ribose could be removed from the blood tissue and metabolized into physiologically important compounds in the cell. Techniques for analyzing blood D-Ribose levels were developed at about the same time, revealing normal circulation levels of D-Ribose to be between 0.5 and 1.0 mg per 100 milliliter of blood.

Many years of research had to follow before researchers in Munich, Germany reported that energy-starved hearts could recover their energy levels if D-Ribose was given prior to, or immediately after ischemia (oxygen deprivation). In 1978 these researchers reported that a similar phenomenon occurred in skeletal muscle. At the same time, it was learned for the first time that the energy draining effects of some drugs that make the heart beat more strongly (isotropic drugs) could be lessened if D-Ribose was given along with the drug. These researchers proved that D-Ribose assisted the body in energy synthesis. More research proved that D-Ribose administration greatly improved the energy recovery in ischemic, hypoxic, or cardiomyopathic hearts and muscles and improved functional performance of the tissue. In addition, studies showed that L-Carnitine helped the action of many heart drugs.

The most significant studies showed that D-Ribose supplementation played a key role in energy restoration and return of diastolic cardiac function. The results of these studies led to the first two U.S patents issued for the use of D-Ribose to treat ischemic tissue.

In 1989, the first organized clinical trial of D-Ribose in human subjects was conducted, which showed the great effect of D-Ribose has on a muscular disorders.

All these new discoveries created a torrent of worldwide clinical investigations on the possible benefits of D-Ribose on heart disease, disorders affecting muscle energy metabolism, arthritis, athletic performance and neuromuscular disease. The first clinical study on the role of D-Ribose for heart disease was published in 1991. In this study, it was theorized that D-Ribose could be used to enhance the diagnosis of cardiovascular disease, and that portions of the heart that were alive but not functional could be assisted by increasing their energy level. It was known that these portions of the heart simply hibernate, and they conserve energy until they have enough blood flow and oxygen to turn up their energy metabolism. This discovery allowed cardiologists to wake up hibernating segments of the heart and allowed them to locate them better by giving them a ‘roadmap’ to follow during surgery.

In 1992 another clinical study was published showing that D-Ribose supplementation to patients with severe stable coronary artery disease increased exercise tolerance and delayed the onset of moderate angina. This study included 27 men with heart disease for 3 days only. Even in that short period of time, D-Ribose increased the amount of time they could exercise on a treadmill before they had ischemic changes or before the onset of moderate exercise related angina. Since this study, the benefits of D-Ribose administration have been reported for cardiac surgical recovery, treating congestive heart failure and neuromuscular disease, restoring energy to stressed skeletal muscle , controlling free radical formation in hypoxia. Other benefits that were reported were improved oxygen utilization efficiency of heart and muscles.

Other studies done by the ‘European Journal of Heart Failure’ investigated the effects of D-Ribose administration in patients with congestive heart failure. They showed that D-Ribose improved diastolic functional performance of the heart, increased exercise tolerance and significantly improved the quality of life of patients participating in the study.

Another study reported on the benefits of D-Ribose in both healthy and sick hearts. In healthy individuals, D-Ribose increased the anaerobic energy reserves of the heart and delayed the onset of irreversible ischemic injury by 25%. It also proved that giving D-Ribose to hypertrophied hearts improved ventricular function and normalized contractility of the ventricle.

In 2004, a study conducted by two of the leading muscle physiologists in the world, Jens Bangsbo and Ylva Hellsten, proved that D-Ribose increased energy metabolism in stressed skeletal muscle and accelerated recovery of the energy pool once it was depleted. This is significant in congestive heart failure and peripheral vascular disease because they relate to the heart muscle.

Research continues today.

How and when to supplement with D-Ribose

Since D-Ribose is not stored in cells in its free form, there is no normal levels in tissue, and therefore D-Ribose deficiency does not exist. Instead, cells are faced with the task of making it in response to a specific metabolic demand. And this is where the problem is, because making D-Ribose is a slow time-consuming and rate limited process.

Factors that have to be taken into account to know whether or not to supplement with D-Ribose are:

  1. Exercise: Athletes place a great amount of strain on their muscle energy metabolism. Repeated exercise drains energy in the muscles, promoting free radical production. Exercise tolerance is also very personal, someone who has a sedentary life will become more oxygen deprived with just a little exercise in which case the energy reserves of the muscle will be depleted.
  2. Age: With age the health of the mitochondria suffers, therefore even a minor level of stress can have a dramatic effect on cellular energy stores. A great percentage of the population over the age of 45 both male and female shows signs of diastolic cardiac dysfunction. This is specially the case of patients with high blood pressure and women with severe mitral valve prolapse. D-Ribose supplementation increases the cardiac energy reserve and can help the heart restore normal diastolic cardiac function if early signs of diastolic dysfunction exist.
  3. Use of certain drugs: Inotropic drugs, which work by making the heart beat harder put a big strain in the heart by limiting its ability to supply enough energy to support the extra metabolic stress placed on it by the drug. This kind of drug has been shown to drain the heart’s energy reserve, making it run out of energy. Research shows that supplementing with D-Ribose can reduce the energy drain common with inotropic agents without having any negative impact on the activity of the drug.

Studies have shown that any amount of D-Ribose given to an energy starved cell will give it an energy boost. Even a small dose of 500 mg can increase energy by 100%. Larger doses have been shown to increase the synthesis of energy in muscle between 340% and 430%. This increase was even the case when muscles were actively working.

The amount of D-Ribose needed depends on the type of condition we are dealing with. For chronic fatigue and shortness of breath as a result of heart disease the amount is different than for cases of poor peripheral blood flow, soreness from strenuous exercise, chronic fatigue syndrome or fibromyalgia.

An adequate dose of D-Ribose usually results in symptom improvement very quickly, within a day or a few days. If the relief is not immediate, the dosage should be increased until the patient feels better. Dr. Sinatra often takes into consideration the following in order to determine the right dose:

  1. How energy depleted are the cells: Have they been depleted for long as in the case of chronic disease or is it a temporary cause like is the case of exercise?
  2. What is the circulatory status of the patient? Are they healthy or do they have heart disease, peripheral vascular disease, fibromyalgia, neuromuscular disease or other conditions that affect the delivery of oxygen to the cells?

In general, athletes can benefit from a small dose before and after exercise to attenuate soreness in the muscles and stiffness. Before exercise, D-Ribose gives muscle a boost needed to salvage energy compounds as they are being broken down by the muscle. After exercise it allows new energy synthesis to proceed quickly, aids in recovery and improves the physiological health of the muscle. A usual dose is 1 tsp (5 grams).

For patients with heart disease or circulatory conditions that chronically affect oxygen delivery the answer is not that straightforward. Because D-Ribose does not stay in the blood long, around 30 minutes only, the amount of D-Ribose must be large enough to get into the affected tissue. This is not a problem if the person has normal blood flow, because D-Ribose is quickly delivered to stressed tissue. However, if heart or muscles are low in oxygen due to poor circulation or clogged arteries, more D-Ribose will be needed to allow enough of it to work its way through into the energy starved portions of the heart.

Another concern to consider is the energy drain in cells and tissues. Increasing oxygen delivery and maintaining it is key to D-Ribose supplementation because without oxygen energy metabolism cannot be kept. This is why improving circulation is crucial, without proper circulation the patient will continue to run out of oxygen. This also means that D-Ribose must be taken everyday. According to Dr. Sinatra, it is not enough to take it until the patient feels better. Missing just one or two days will have a serious impact on cellular energy levels, which will quickly feel as fatigue, weakness, and loss of quality of life.

The dosage will be very personal as every patient has his or her own pathological conditions, but a general recommendation can be made as follows:

5-7 grams (1 tablespoon) daily as a preventative measure for cardiovascular disease, or for athletes or healthy people doing strenuous activity.

7-10 grams daily for patients with congestive heart failure, ischemic cardiovascular disease, peripheral vascular disease, patients recovering from heart surgery or heart attack, for treatment of stable angina pectoris, and for athletes working out in chronic high intensity exercise.

10-15 grams daily in divided doses of about 5 grams each, for patients with advanced congestive heart failure, patients awaiting heart transplant, patients with dilated cardiomyopathy , frequent angina, fibromyalgia or neuromuscular disease.

Once the patient starts seeing results, the dose can be lowered slightly until a maintenance level is reached, taking into account that changes in lifestyle like increased exercise will require the dose to be adjusted.

L-Carnitine (Pt. 2)

L-Carnitine and the heart

As we have seen, the main job of L-carnitine is to transport fatty acids to the inner mitochondrial membrane where they are burned as fuel. A healthy heart obtains 60% of its fuel from fat, therefore, maximizing the burning of this fat is crucial for heart function.

The more advanced the heart disease is the harder it is to get oxygen, and the more blood congestion backing up into the lungs and tissues occurs. When this is the case, a thorough nutritional program can make a great difference. L-Carnitine, with the help of the ‘Heart and Body Extract’ and other nutrients that we will look at in following blogs, can be life altering.

Atherosclerosis sufferers with various degrees of congestive heart failure are the most compromised in their symptoms, all of which are related to a heart that is starved of oxygen, struggling to pump hard enough to keep the blood moving forward. Dr. Sinatra recalls how much improvement he saw when he combined L-carnitine with nutrients like CoQ10, D-Ribose and hawthorn for the most symptomatic of his patients. Hawthorn is one of the ingredients found in the ‘Heart and Body Extract’, making it a great addition to your heart protocol for its circulation enhancing properties. All of these nutrients can be used to treat any of the following heart conditions quite effectively.

L-Carnitine and angina

Angina is caused by insufficient supply of oxygen to the heart tissue due to blockages or spasms of the coronary arteries. Symptoms of angina are pressure, burning discomfort on the chest or pain from shoulder to shoulder or up into the neck, radiating into the back and left arm. Shortness of breath is also a sign because the body is trying to get more oxygen to compensate for the shortage. This symptom may be the only warning for someone with diabetes because their nerve endings have lost sensitivity. Other less typical signs of angina are throat tightness, soreness or pain in the jaw, a tooth, the back or the forearms.

Regardless of the cause, the source is always a lack of oxygen in the heart muscle, due to coronary arteries that have become blocked either from a build-up of inflammatory cholesterol plaque that progresses with age. As these blockages increase in size, they crowd the artery opening and limit the flow of oxygen to the heart muscle. This lack of oxygen leads to the symptoms, because lack of oxygen leads to energy depletion, which kills the cell, resulting in numbness and pain.

While the traditional treatment for angina works by reducing the workload of the heart and oxygen demand and can widen the arterial walls, these drugs can’t improve the oxygen demand ratio and do little to affect the energy imbalance. L-carnitine, on the contrary, can alleviate the symptoms of angina most effectively.

Many double-blinded placebo controlled research studies in the cardiovascular literature show the efficacy of L-carnitine and its cousin propionyl-L-carnitine (PLC) in treating angina and other cardiovascular disorders. PLC is taken into the myocardial cells more readily than other forms of carnitine. While acetyl-L-carnitine is taken up more widely by the brain.

As we have seen, L-carnitine enhances fatty acid metabolism and prevents the accumulation of toxic fatty acid metabolites inside the heart. In angina it improves overall oxygen use by the heart cells, allowing the heart to do more things with less oxygen.

L-carnitine was found to be helpful in angina and myocardial ischemia. Ischemia is defined as the lack of oxygenated blood flow to a tissue. When this happens it triggers other effects that compound the problem:

  1. Toxic levels of fatty acids and their metabolites start accumulating, which paralyze mitochondria.
  2. ATP levels crash.
  3. ATP breakdown products form and leave the cell, depleting the energy pool.

Studies have shown the effectiveness of L-Carnitine for all these conditions.

L-carnitine and myocardial infarction

Myocardial infarction is another term used to refer to a heart attack; infarction refers to tissue death. Dr. Sinatra explains that a heart attack can start when a clot coming from an artery plaque rupture site gets stuck in a coronary artery. Sometimes a clot can form somewhere else and it becomes stuck where it can not get through, creating a blocked artery. Another cause is a spasm that lasts so long that the blood congeals in an open area of circulation. In any case, it always results in an emergency, because without blood supply the heart muscle will die.

A lot of research has been done on the role of L-carnitine in heart attacks. In one study researchers tried to determine whether L-carnitine would protect the heart and micro-circulation against heart attack damage when given immediately during the acute phase of a heart attack. The results indicated that L-carnitine slows down the progression of a heart disease and limits its size.

Another study tried to determine whether propionyl-L-carnitine could improve exercise tolerance and physical function following a heart attack. They observed that 100 mg a day increased the level of total L-carnitine in both the blood serum and the heart muscle by 15-23%. Exercise capacity also increased by 3%, while in the group that didn’t receive L-carnitine it decreased by 16%.

In a third study researchers measured energy levels in the heart following a heart attack, the three different forms of L-carnitine were used in three different groups to check if there was a difference. All three forms markedly improved recovery of energy in the tissue, increasing energy levels for an hour. Acetyl-L-carnitine was even stronger in its early response, but did not keep the energy level as high as L-carnitine. Propionyl-L-carnitine didn’t provide very early recovery as compared with the other two forms but by the end the recovery was greater.

All this information helps us conclude that all three forms of L-carnitine protect the heart against the intracellular damage associated with the buildup of lactic acid that normally happens during heart attacks. Heart patients that were given any of the forms of L-carnitine were able to withstand four induced heart attacks in succession.

In yet another study, researchers observed that L-carnitine was able to reduce infarct size, limiting tissue damage. There was also a reduction of ischemic arrhythmias and heart enlargement as well as the number of deaths.

Another study from the ‘Journal of the American College of Cardiology’ confirmed that supplementing with L-carnitine after an acute heart attack had a beneficial effect on the preservation of the left ventricle, where most heart attacks happen, by preventing an increase in heart size. Increased left ventricle during the first year of a heart attack is a very good predictor of future adverse cardiac events according to Dr. Sinatra.

L-Carnitine and congestive heart failure

In congestive heart failure the heart cannot contract with enough force to pump blood around the body. This is the reason for the congestion through the body: ankles, lungs and heart. One of the ways to help the heart is to supplement the diet with nutrients that strengthen heart contractions and help the heart fully relax so it can fill up again. L-carnitine is one of them.

One of the major problems with congestive heart failure is the scar tissue present after repeated heart attacks, which limits muscle function. Another side effect is a heart muscle that is stretched out, dilated and enlarged due to long standing high blood pressure. In any case, the research shows that in patients with end stage congestive heart failure and donor hearts, concentrations of L-carnitine in heart muscle was significantly lower and it correlated with ejection fraction. Ejection fraction measures the amount of blood volume pumped from the heart with each heartbeat. In congestive heart failure ejection fraction is reduced sometimes to 10-15%. Research showed that this condition made patients lose L-carnitine from the heart itself, creating a deficiency. This is evidence that a diseased heart has difficulty holding on to its L-carnitine. Conclusions of these studies showed that supplementation with L-carnitine was able to reverse this deadly trend. Advantages included improvement in arterial blood pressure, cholesterol levels, rhythm disorders and signs of congestive heart failure, but above all a reduction in mortality. Dr. Sinatra, working with his patients, has observed less shortness of breath, less fatigue, less ankle swelling, more energy, better sleep and increased appetite.

L-carnitine and peripheral vascular disease

Also known as intermittent claudication, peripheral vascular disease is a condition that mimics angina but the pain occurs in the calf instead of the heart. It is characterized by poor circulation in the legs with obstructed blood flow in a large artery, such as the femoral, due to loss of energy in the muscle tissue of the leg. It may happen after a bypass operation and the pain is due to reduced oxygen delivery to the legs, which encourages increased production of free radicals. Both angina and peripheral vascular disease share the fact that the pain can occur with normal everyday activities like walking. L-carnitine works for this condition as well as for angina, because it can help maximize cellular energy production if blood flow is compromised.

Research showed that propionyl-L-carnitine supplementation could increase exercise tolerance and reduce the pain associated with physical activity. Walking time increased by 54%, in walking time, distance and speed, muscle strength increased, pain was reduced and resulted in higher quality of life.

Cardiac arrhythmia

Two of the most frequent types of arrhythmia are ‘premature ventricular contractions’ (PVCs) and ‘premature arterial contractions’ (PACs). Both of these start with an early beat followed by a pause, often described as a palpitation. This pause is actually allowing more blood to enter the heart so that the next contraction feels more pronounced, creating a sensation like the heart is palpitating. These two conditions usually happen due to the accumulation of fatty acid metabolites that weaken the contraction of the heart and make the sufferer more vulnerable to irregular heartbeats, eventually injuring heart tissue, and interrupting electrical transmission of impulses. Supplementing with L-carnitine can help the heart keep the beat energetically. Research has shown that L-carnitine assists the body in free fatty acid metabolism and high grade ventricular arrhythmia. Dr. Sinatra also recommends to add magnesium, potassium, calcium and hawthorn berry, fish oil, CoQ10 and D-ribose as adjunct therapy.

Concluding, research has shown repeatedly the remarkable properties of L-carnitine in treating various heart disorders. Taken together with other nutrients like the ones present in the ‘Heart and Body Extract’ can add to its benefits and make a complete health protocol.


Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 101-143. Print.

L-carnitine (Pt. 1)

We have seen how good circulation is essential to deliver the nutrients our cells need to produce energy. The heart in particular is so metabolically active that it requires a constant supply of energy to pump 60 to 100 times a minute everyday for years. By improving circulation, the ‘Heart and Body Extract’ ensures that the nutrients in the food we consume reach the cell where they can be turned into energy the heart can use. In the words of Dr. Stephen Sinatra, “Our heart muscle is one of the most responsive organs in the body for targeted nutritional supplementation” (1).

In this blog, we will look at a nutrient that is essential to make this conversion from food to energy. We are talking about L-carnitine, a vitamin like nutrient that, while it doesn’t have a direct effect on blood flow, it can help maximize cellular energy production. Together, the ‘Heart and Body Extract’ and L-carnitine can be considered a powerful combination that can benefit our heart health greatly, as we will see. First, we will look at how the body converts our food into energy. Then, we will discuss the different conditions in which L-carnitine has been found to be helpful.

How does the cell convert nutrients into energy?

When it comes to heart health, energy metabolism is critical. Both the food we consume and oxygen are essential for the production of energy. Our food choices should be have this principle in mind. After all, we do not eat only for the sake of pleasure, but to provide the building blocks our body needs to thrive. It is important then to understand how the body converts food and oxygen into energy.

Energy metabolism occurs via three metabolic pathways:

  1. The glycolytic pathway
  2. The krebs cycle
  3. The Electron transport chain of oxidative phosphorylation

All of these are extremely important for cellular health. In the glycolytic pathway, glucose, a simple sugar made by the body from carbohydrates, becomes the body’s main source of energy. However,

glucose only provides short bursts of energy and cannot keep the cell working for long periods of time. Only three molecules of ATP are formed this way. What is more, under conditions of oxygen deprivation, like is the case of ischemic heart disease, the energy that is produced from glucose turns into lactic acid quickly, increasing acid levels in the cell. This can cause cellular stress and a burning sensation in heart muscles like is the case of angina. This form of energy, though important, is not the preferred source of energy for the heart.

Via the other two metabolic pathways, the body can obtain great amounts of energy from fatty acids. When oxygen is present, fatty acids become the preferred energy fuel, producing an astounding 129 molecules of ATP. The burning of fats contributes to 60-70% the heart’s energy. And this is when L-carnitine comes into play, because L-carnitine is the only nutrient that can transport fatty acids across the inner membrane of the mitochondria to begin a process called ‘beta-oxidation’. Without it the body could not metabolize fats, and the heart would suffer for lack of energy.

It is in the krebs cycle that fatty acid metabolism occurs. First, electrons from fatty acids are removed, the electrons then travel through the electron transport chain and make ATP. The energy taken from the electrons is used to attach inorganic phosphate to ATP in order to reform it; oxygen is required for this pathway to function. Co-enzyme A also helps to move energy substrates into the mitochondria by binding to fatty acids and other molecules, thus helping them be transported across lipid membranes.

The importance of oxygen is vital, without it, like is the case of ischemia (lack of oxygenated blood flow to the tissue), or hypoxia (oxygen deprivation to the cell) the recycling of energy slows down and this causes ATP to be used faster than it can be replaced.

What is L-carnitine?

L-carnitine is a vitamin-like nutrient, which means that it can be obtained through diet and it is made by the body too. The word ‘carnitine’ comes from the latin word ‘carnis’ which means ‘meat’. L-Carnitine, therefore, is mainly found in protein. The highest sources are mutton, lamb, beef, other red meat and pork in that order. The quantities in plants are rather low, 90% lower than in meat, so vegetarians may show a higher deficiency of this nutrient. Plants also are low in the other nutrients that are needed to metabolize L-carnitine, methionine and lysine. It is important then for vegetarians to supplement with these nutrients. It is also significant that its production slows down with age, so it is important to obtain it through supplementation as we age.

Biosynthesis of L-carnitine

L-carnitine is derived from two amino acids, lysine and methionine. The body synthesizes these via a series of metabolic reactions involving these two amino acids together with niacin, vitamin B 6, vitamin C and iron.

To make L-carnitine, the body goes through different steps and needs the following nutrients to synthesize it: the amino acids L-methionine and L-lysine , vitamin C, B 6, niacin, and iron. Without these nutrients L-carnitine will not be synthesized properly, thereby the importance of obtaining these from the diet. Apart from this, L-carnitine is produced in the kidneys and liver.

Functions of L-carnitine

Generally speaking, L-carnitine helps maximize efficient metabolic activity by mobilizing ATP and promoting better use of oxygen. The main function of L-carnitine is to facilitate the transport of long-chain fatty acids across the inner mitochondrial membrane to begin the process called ‘beta-oxidation’. Most importantly, L-carnitine is the only carrier that can do this, so its presence in the cell is an absolute requirement for heart health. Energy recycling, like the one we explained in the manufacturing of ATP, is dependent directly on the amount of L-carnitine available in the cell accelerating energy metabolism.

Another function of L-carnitine is the removal of ammonia, and lactic acid from our tissues which have shown to have negative effects in the brain and heart. For this reason L-carnitine is recommended after strenuous exercise. Exercise can lead to high levels of lactic acid in the body, and L-carnitine can help the body clear high levels of lactic acid from tissues and blood.

L-carnitine is also an antioxidant and free radical scavenger and has the ability to chelate iron.


L-carnitine is the most available and least expensive of all forms. However, because the free form of L-carnitine is very unstable, it makes it not suitable for tablets or capsules. This has led to research to find ways to make it more stable. Several forms have been synthesized: fumarate, tartrate, citrate, lactate and amino carnitines (new molecules with specific amino acids attached to L-carnitine molecules). Between the fumarate and the tartrate versions, the former appears to be absorbed better than the latter. L-carnitine fumarate has a 58% content of L-carnitine and 42% of fumaric. Both of these compounds are naturally occurring substances in living organisms.

A newer version of the L-carnitine is the amino-carnitines, they are the result of bonding certain amino-acids like glycine, arginine, lysine, and taurine with L-carnitine derivatives. These combinations have been found to increase L-carnitine’s metabolic performance. The resulting molecule is being called amino-carnitine. Combining L-carnitine with these amino-acids provides an interesting synergistic effect on how much of each nutrient is made available, making both more readily used by the body.

Two of these amino-carnitines are acetyl-L-carnitine arginate and acetyl-L-carnitine taurinate. These amino-carnitine combinations are effective because, in general terms, when our bodies are low on L-carnitine they are also low on its amino-acid precursors. Since these precursors are also essential they must be obtained from the diet. In addition, they help us synthesize L-carnitine.

Another reason why these new forms of L-carnitine are so effective is that they have similar properties, therefore they can get better results when bonded together. Arginine taken with L-carnitine aids in the delivery of L-carnitine to ischemic regions of the heart and muscles. The amino-carnitines also work together with D-ribose. The combinations enhance each of the nutrients properties and assist in energy recycling in heart cells. This makes them suitable for heart disease, peripheral vascular disease, diabetes, fibromyalgia and chronic fatigue. For athletes it can also be beneficial because they increase exercise capacity by reducing muscle fatigue, increasing recovery and overall energy.

A specific form of L-carnitine known as propionyl-L-carnitine (PLC) is an L-carnitine derivative that along with the base L-carnitine and acetyl-L-carnitine forms a component of the body’s L-carnitine pool. A dietary version of this PLC is called Glycine-Propionyl-L-Carnitine (or GlycoCarn). It has been shown to be a powerful vasodilator, improving the blood supply to the heart, muscles and other tissues. In some studies it was shown that this form of L-carnitine is rapidly taken up by heart, muscle, kidney and other tissue and what is not needed is secreted through urine.

In a study done with 42 subjects, results showed that supplementation with GPLC helped muscles retain L-carnitine during and after physical activity, as well as the levels of nitric oxide (a powerful vasodilator).


Dr. Sinatra recommends 3,000 mg of GPLC a day, or 500-1000 mg capsules three times a day, between meals. This dosage of GPLC showed to reduce oxidative damage (free radical stress) and triglyceride levels, while increasing nitric oxide levels.

Why carnitine deficiency?

Although L-carnitine is found throughout the diet and is synthesized by the body, it is very common to find deficiencies in this very important nutrient. Deficiencies can be caused by genetic defects, poor diet, co-factor deficiencies of vitamin B 6, folic acid, iron, niacin and vitamin C, liver or kidney disease, and use of some drugs, especially the anti-convulsants.

People with deficiencies can have symptoms like muscle fatigue, muscle cramps, and muscle pain following exercise, also, muscle disease, or cardio-myopathy. This can be seen under the microscope in the presence of fat deposition and abnormal mitochondria in the cells because that is where L-carnitine has its greatest efficacy. Renal failure is also associated with deficiencies, severe malnutrition, and liver cirrhosis and of course, heart disease. Dr. Sinatra believes L-carnitine offers its most greatest use for the heart.

Concluding, “L-carnitine is a heart and muscle specific supplement that must be considered if you have any cardiac or vascular conditions” (1). Together with its derivative, propionyl-L-carnitine , L-carnitine is a key nutrient for the heart. These co-factors not only enhance free fatty acid metabolism but also reduce the intra-cellular buildup of toxic metabolites, particularly where the heart muscle is not getting enough oxygen.

In what follows, we will look at how L-carnitine can improve different heart conditions that have to do with energy metabolism malfunctions.


(1) Sinatra, Stephen T. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health, 2011. 101-143. Print.

Basics of cellular energy (Pt. 2)

Extraction of energy from food, the mitochondria

Of all the different structures that comprise the cell, we will focus on the mitochondria. The mitochondria is where the cellular energy known as ATP is manufactured out of nutrients (oxygen and food). The mitochondria is contained inside the cytosol, the fluid portion of the cell (4).

The main substances from which cells extract energy are oxygen and the food we ingest: carbohydrates, fats, and proteins. Carbohydrates are converted into glucose by the digestive tract and liver before they reach the cell, proteins are converted into amino acids and fats into fatty acids. Then they all enter the cell. Inside the cell the food reacts chemically with the oxygen under the influence of various enzymes. Almost all of these oxidative reactions occur in the mitochondria, and the energy that is released is used to form the very high energy compound known as ATP (Adenosine triphosphate). ATP then is used throughout the cell to energize almost all the intracellular metabolic reactions.

What is ATP?

ATP is a small simple compound that supplies all the energy used by every cell in the body, including the heart. It is for this reason that it is known as the‘powerhouse of the cell’. As long as the cell is given two basic ingredients: food and oxygen, the cycle of energy utilization and supply goes on unimpeded millions of times per second in every cell in the body. This continual cycle of energy supply and demands keeps the cell fully charged with energy and maintains a constant level of ATP no matter how hard the heart is working.

When one of these ingredients is missing, sickness follows. A good example of this is lack of oxygen; oxygen starvation always results in a heart attack. Blocked arteries can deprive the heart cells of oxygenated blood flow, causing the tissues to consume their energy supplies faster than they can be restored (1).

The human heart has approximately 700 milligrams of ATP and this is enough to pulsate at a rate of one beat per second for 60 seconds. This may sound like a lot but it is a considerable slow rate for a healthy person. For this, 6,000 grams of ATP will need to be generated per day.

Magnesium is always found attached to ATP in cells. It has important functions like helping ATP move around within the cell, and attracting various structures in the cell that require energy to function.

ATP composition

ATP is composed of adenine, ribose and three phosphate radicals connected by high energy phosphate bonds. Each of these bonds are known as ‘high energy bonds’ because they contain about 12,000 calories of energy per mole of ATP. When ATP releases its energy, a radical is split away and ADP is formed (adenosine diphosphate), which recombines over and over to form new ATP. Because ATP can be spent and remade again and again, it is called the ‘energy currency of the cell’.

Uses of ATP

ATP is then used to:

  1. Supply energy for the transport of sodium, calcium, magnesium, phosphate, and chloride ions through the cell membrane, among other substances. This transport of ions is so important for the cell that some use as much as 80% of the ATP made by the cells for this purpose alone.
  2. Promote protein synthesis as well as phospholipids, cholesterol, etc. The synthesis of all these nutrients require thousand of molecules of ATP.
  3. Supply energy needed during muscle contraction.

Because of all these important functions, ATP must always be available to release its energy rapidly and almost explosively whenever it is needed in the cell. To replace ATP used by the cell other much slower chemical reactions break down carbohydrates, fats and proteins and use the energy derived from these to form new ATP (2).

ATP keeps the heart beating. With each heartbeat ions of potassium, sodium, and calcium move in and out of the cell and in and out of different organelles inside the cell. The continual flow of ions keeps the heart beating rhythmically and allows the heart to fully relax between beats and able to refill with blood for each contraction.

ATP also allows the heart to build important cellular constituents such as proteins and genetic material. These allow the heart to be repaired whenever there is enough wear.

Mitochondria, the cellular energy powerhouse

The mitochondria is considered the powerhouse because it produces most of the energy needed by the cell. Mitocondria generates more than 90% of the body’s need for energy to sustain life and they take approximately 35% of the space within the heart cell.

The way energy is produced is called ‘respiration’because it requires oxygen. It happens as follows: carbon fragments like fats and pyruvate are oxidized by oxygen that is delivered by the blood and used to make ATP. This process releases electrons, which recycle ADP back into ATP, thereby restoring energy to the cell.

ATP formed inside the mitochondria must be moved into the cytosol of the cell to release its life-giving energy. ADP from the cytosol must be moved into the michochondria, where it can recycle to ATP. Because the mitochondrial membrane is permeable to both ATP and ADP, they can be exchanged across the mitochondrial membrane, with ATP moving out and ADP moving in. Then an enzyme called ‘ATP-ADP translocase’ moves ATP and ADP across the mitochondrial membrane, keeping ATP flowing to the cell and ADP flowing to the mitochondria. This process supplies the vital energy needed to sustain life.

Oxygen does not contribute to the process directly, but acts as a metabolic garbage can, gathering up the spent electrons after they have flowed through the process, then releasing carbon dioxide (CO2) and water. Some of this is released when we exhale, and the rest is transported by the blood to the kidneys to be excreted as urine.

Around 2-5% of this oxygen is turned into free radicals. These free radicals are formed inside the mitochondrial membrane and they can accumulate rapidly because oxygen utilization occurs constantly within the mitochondria.

While an abundance of free radicals can accelerate aging and degenerative diseases,and be the major unexplained cause of congestive heart failure, research has shown that a small percentage of free radicals may play an important part in supporting life processes, like mitochondrial respiration.

Recent research has shown that we can enrich our mitochondria with nutrients. Since our diets are not balanced, supplementation has become ‘ necessary way of life’ (1). Dr. Stephen Sinatra, considers mitochondria to be the key to how we age, why we get disease any why we die prematurely.

Something else important about mitochodria is that they contain their own set of DNA, from 2 to 10 copies of DNA called mtDNA. All of this genetic material is obtained from the mother , not the father. Mitochondrial DNA makes the proteins needed for energy metabolism. Because this mitochondrial DNA is not isolated from its environment by a membrane, it is exposed to free radicals, rendering it unable to pass on genetic information. It it for this reason that we must supplement with antioxidant nutrients.

Roles of the mitochondria

The majority of the ATP is formed in the mitochondria.This is how it happens, step by step: When glucose enters the cell it is acted on by enzymes and becomes ‘pyruvic acid’ by a process known as ‘glycolysis’. The pyruvic acid derived from carbohydrates, fatty acids and amino acids are all converted into a compound known as ‘acetyl-CoA’. Another set of enzymes act on this compound in order to extract its energy through a process known as ‘Krebs cycle’.

In the ‘citric acid cycle’, acetyl-CoA is split into its components: hydrogen atoms and carbon dioxide, the latter eventually comes out of the cell, while the hydrogen atoms are highly reactive and combine with oxygen. This releases a tremendous amount of energy which is used by the mitochondria to convert large amounts of ADP to ATP. The newly formed ATP is transported out of the mitochondria into all parts of the cell and used as energy for the cell functions.

Hearts need a constant supply of energy

As long as the cell is supplied with two basic ingredients: food and oxygen, the cycle of energy use and supply goes on unimpeded millions of times per second in every cell in the body. Since the amount of ATP available is small compared with the demand, the cells must continue manufacturing energy. The continual supply of ATP is necessary to maintaining cardiac function.

In heart cells most of the ATP is present in the cell in two cellular structures: the cytosol and the mitochondria. The cytosol is the fluid portion of the cell that contains main constituents of the cell including the mitochondria.Each heart cell can contain as many as 5,000 mitochondria, If the heart works extra hard, like it is the case of ischemic heart disease, the ATP pool may increase in order to get more energy (1).

Once ATP releases its energy most of the ADP that is generated returns to the mitochondria to be recycled back into ATP. After ATP forms again it leaves the mitochondria and moves to the region of the cell needing energy. A small amount of the ADP remains in the cytosol, where it is reformed into ATP more slowly. This ATP is generally associated with cell membranes and provides the energy needed to control ion movement into and out of the cell (1).

There is ATP also outside the cell that is important for cell energy but it is small compared with the amount of ATP found inside the cell. In diseased hearts, the amount of ATP found outside the cell can be up to ten times higher than in healthy hearts.This extracellular ATP has a major function of forming adenosine, a strong vasodilator. ‘In ischemic heart conditions, the vasodilatory effect of adenosine helps open blood vessels, allowing more blood and oxygen to flow to the heart’(1).

Measuring cellular energy

In the cell there are hundreds of different enzymes whose job is to accelerate biochemical reactions. For this reason, they can be compared to spark plugs in a car, and the amount of energy generating material available to gasoline. Enough energy is needed for the spark to act on it and speed up these reactions. Enzymes that release the chemical energy in ATP are called ‘ATPases’.

How energy translates to work in the body

The human heart has four chambers, two upper chambers, called ‘left and right atria’, two lower chambers, called ‘left and right ventricles’. When the heart beats there are several stages that involve energy within the ventricular muscles.

‘Systolic function’ refers to the stage of the heartbeat when the lower chambers contract, squeezing blood out of the arteries . This requires adequate ATP energy in cells of the heart muscle and a strong muscle to respond and contract effectively. Contraction empties most of the blood out of the heart chambers, but requires the least amount of cellular energy.This means that even in cases of exhaustion there is still energy left in the heart to allow our body to rest. In terms of blood pressure, contraction corresponds to the upper number in blood pressure measurement.

After the contraction phase there is a brief period of rest, 1/3 of a second long. This is the ‘relaxation’ or ‘diastolic phase’, where the heart refills with blood for the next contraction.The relaxation stage also depends on energy and on the ability of the heart to ‘stretch without sagging, fill and accommodate adequate blood volume. (1)’ A lot more energy is needed for the heart to relax than to force it to contract for two reasons:

  1. A lot of energy is needed to separate the bonds (called ‘rigor bonds’)formed during contraction in order to allow the muscle to return to its relaxed state.
  2. During relaxation, energy is also needed to remove the calcium ions from the cell following contraction. This is how it works: When the heart is preparing to contract, large amounts of calcium rush into the cell, helping the heart contract. When contraction is over, calcium must be pumped out of the cytosol, this requires ATP. The calcium pump has two sites for ATP and both have to be attached to ATP before the pump can work. This process is similar to what is known as ‘writer’s cramp in which the muscles of the finger get so tight after being used without pause that they cannot relax. This is caused by the fact that all the energy has been used to contract the muscle holding the pencil. Because there is no energy left, calcium cannot be discharged from the cytosol and the rigor bonds formed in the muscle fibers cannot be broken. In the case of the heart, the heart will not be able to fully relax, which means that it cannot be filled with blood properly and pump it to the whole body.This is what is called ‘dyastolic dysfunction’. It is characterized by a thickening and stiffening of the walls of the ventricles, which increases blood pressure, reduces the amount of blood discharged from the heart and makes it harder for the heart to fill.It is an early sign of cardiac problems that around 25% of the population over the age of 45, both male and female have. Around 50% of this percentage does not know they have this condition which puts them at risk for congestive heart failure.

Concluding, the heart needs a constant supply of energy. A key player in this supply of energy is a circulatory system that is fluid enough to deliver nutrients and oxygen to the heart cells. Only when this is the case can cells manufacture ATP to keep the cycle of energy use and supply unimpeded millions of times per second in every cell in the body to keep the cell fully charged, no matter how hard the heart is working.

The Heart and Body Extract, because of its role in improving circulation can help carry oxygen and nutrients to the cell. Make sure you add Heart and Body Extract to your health protocol today!

Thank you for reading.





Basics of cellular energy (Pt. 1)

We have seen how the health of the body depends on fluidity and pressure. Fluidity allows the blood to circulate unimpeded and easily under the pressure exerted by the heart. Only when this is the case can our cells be oxygenated, receive nutrition and detoxify themselves. Proper circulation, therefore, could be said to be one the most important aspects of our health, and the reason why the Heart and Body Extract is such a great addition to our health protocol.

Good circulation is also key because it allows the movement of intracellular and extracellular fluids to be transported throughout the body, allowing nutrients to be carried to the cells so they can manufacture the energy they need to do their job. Many health care professionals believe it is the ability of the cell to manufacture energy that is at the core of many cardiac disease disorders. This is the case of ischemic heart disease, congestive heart failure and ‘cardiomyopathy (1).

In today’s blog, we will focus on the role of circulation in the cell’s ability to manufacture energy.We will look at the microscopic cell, its main functions and parts and how its ability to make energy influences heart health.

The microscopic cell

When we consider the health of our body, it is easy to think of only organs, like the heart. But we need to remember that each organ in our body is ‘an aggregate of many different cells’(2). Because of this, the health of our organs depends on the health of each microscopic cell.

So, what is a cell? Cells are the ‘basic structural, functional, and biological unit of all known living organisms’(3). Each of the 100 trillion cells in the human body is a ‘living structure that can survive indefinitely and even reproduce itself, provided its surrounding fluids contain appropriate nutrients’ (2).

Each specific cell is specially adapted to perform one or more functions, like the heart cells. However, despite the differences, all cells have the same basic characteristics. For instance, in all cells oxygen combines with the breakdown products of carbohydrates, fat or protein to release the energy required for cell function. What is more, the basic mechanism for turning nutrients into energy is basically the same in all cells. In this sense, all cells deliver the end products of their chemical reactions into the surrounding fluids.

Composition of the cell

The cell is a complex unit composed of highly organized physical structures called ‘organelles’. The two major parts of the cell are the ‘nucleus’ and the ‘cytoplasm’, both separated from each other and the surrounding fluids by a barrier called ‘membrane’. They are all equally important to the functioning of the cell, but the mitochondria provides 95% of the cell’s total energy supply(2).

The substances that make up the cell are called ‘protoplasm’ and they are: water, electrolytes, proteins, lipids and carbohydrates.

  1. Water: It is the main fluid medium in cells at a concentration of 70-85%. Many cellular chemicals are dissolved in water and this allows many chemical reactions to take place.
  2. Electrolytes: The main electrolytes in the cell are potassium, magnesium, phosphate, sulfate, bicarbonate, and small amounts of sodium, chloride, and calcium. Electrolytes provide inorganic chemicals for cellular reactions. On the cell membrane, for example, they allow transmission of electrochemical impulses in nerve and muscle fibers.
  3. Proteins: They are 10-20% of the total cell mass. They are divided into ‘structural proteins’ and ‘globular proteins’. The structural proteins are present in hair, collagen and elastin fibers of connective tissue, blood vessels, tendons, ligaments, etc. The globular proteins are the enzymes of the cell and are soluble in the cell fluid. Enzymes catalyze chemical reactions, an example is the chemical reaction that splits glucose into component parts and combine these with oxygen to form carbon dioxide and water, providing energy for cellular functions.
  4. Lipids: They are soluble in fat solvents. The most important ones are phospholipids and cholesterol, which together add up to 2% of the cell’s total mass. Because they are insoluble in water they make up the cell membrane and the intracellular membranous barriers that separate the different cell compartments.
  5. Apart from cholesterol and phospholipids, we can also find triglycerides, which make up 95% of the cell’s mass. The fat stored in these cells are the body’s main storehouse of energy-giving nutrients that can be dissolved and used for energy when the body needs it.
  6. Carbohydrates: They play a major role in the nutrition of the cell. Carbohydrates in the form of dissolved glucose are always present in the surrounding extracellular fluid as a form of readily available energy for the cell. A small amount is always stored in the cell in the form of glycogen, which is a source of quick energy. Most human cells do not contain large stores of carbohydrates, only around 1%. 3% is found in muscle cells and sometimes up to 6% in liver cells (2).

Extracellular fluid, the internal environment

We have seen how our body is mostly made out of water, and how water balance is very important. When it comes to the health of our cells, it is key to understand how fluid is kept in the right places. Some of this fluid is inside the cells and is known as intracellular fluid, but some other is in the spaces outside the cells, known as extracellular fluid.

In the extracellular fluid are the ions and nutrients needed by the cells for maintenance of cellular life. Because this extracellular fluid is in constant motion, its contents are rapidly being transported in the general circulation and then mixed between the blood and the tissue fluids through the capillary walls.

Basically, all the cells in our body live in this extracellular fluid, and because of this it is called internal environment of the body. The key aspect to understand here is that this internal environment determines the health of the cells and their ability to make energy,‘As long as the proper concentrations of oxygen, glucose, ions, amino acids, fatty substances and other constituents are available in this internal environment’(2).

Differences between the extracellular and intracellular fluid

The extracellular fluid contains large amounts of sodium, chloride, and bicarbonate ions, plus nutrients for the cell: oxygen, glucose, fatty acids, and amino acids. It also contains carbon dioxide that is being transported from the cells to the lungs to be excreted, plus other cellular products that are being transported to the kidneys for excretion.

The intracellular fluid differs from the extracellular because it contains large amounts of potassium, magnesium,and phosphate ions instead of the sodium and chloride ions found in the extracellular fluid. Special mechanisms for transporting ions through the cell membranes maintain these differences. In other words, the extracellular fluid contains a large amount of sodium but only a small amount of potassium, and the exact opposite is true of the intracellular fluid. These differences between the inside and the outside of a cell are extremely important for the life of a cell.

Maintaining the ion balance requires energy. The proper flow of ions into and out of the heart is required to keep the heart cell from filling with water (cardiac edema) and to keep the electrolytes present that allow the heart to beat avoiding irregular heartbeats.

The role of circulation in cell health

Extracellular fluid is transported through all parts of the body in two stages:

During the first stage, the extracellular fluid is transported in the circulatory system as the blood moves around in a circular motion from heart to the lower parts of the body and back up again. All the blood in the circulation moves through the entire circulatory system an average of once every minute when the body is at rest and as many as six times each minute when a person becomes extremely active.

During the second stage, the extracellular fluid is transported via the movement of fluid between the blood capillaries and the cells: As blood passes through the capillaries there is a continual exchange of extracellular fluid between the blood and the interstitial fluid in the intercellular spaces. This is possible because the capillaries are porous and allow large amounts of fluid and its dissolved nutrients to diffuse back and forth between the blood and the tissue spaces. The fluid and dissolved molecules are continually moving and bouncing in all directions within the fluid themselves and through the pores and through the tissue spaces.

How nutrients are distributed through the different organs

As the extracellular fluid, both that of the plasma and that in interstitial spaces is continually being mixed, it allows complete homogeneity throughout the body.Then, as blood circulates through the different organs, nutrients are distributed in the following way:

1) Respiratory system: Every time the blood circulates through the body it also flows through the lungs. There, the blood picks up oxygen that the cells need. Carbon dioxide is released from the blood into the lungs and the respiratory movement of air into and out of the alveoli carries the carbon dioxide to the atmosphere.

2) Gastrointestinal tract: A large portion of the blood pumped by the heart also passes through the walls of the gastrointestinal organs. Here, different dissolved nutrients like carbohydrates, fatty acids, and amino acids are absorbed from the ingested food into the extracellular fluid.

3) Liver: Not all substances absorbed from the gastrointestinal tract can be used in their absorbed form by the cells. The liver changes the chemical compositions of many of these substances to more usable forms; then other tissues of the body, fat cells, kidneys, etc help to modify the absorbed substances or store them until they are needed.

4) Kidneys: Passage of blood through the kidneys removes most of the other substances besides carbon dioxide from the plasma that are not needed by the cells, such as urea and uric acid. They include excesses of ions and water from the food that might have accumulated in the extracellular fluid. The kidneys perform their function by first filtering large quantities of plasma then reabsorbing those substances that are needed by the body into the blood: glucose, amino acids, water and ions.