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BioActive CoEnzyme Q10 with cardiologist, Dr Ross Walker

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BioActive CoEnzyme Q10 with Cardiologist: Dr Ross Walker

Not all coenzyme Q10 is created equal. Dr Ross Walker is an eminent practising cardiologist with a passion for people and health, with over 35 years experience as a clinician.

For the past 20 years he has been focusing on preventative cardiology & is one of Australia’s leading preventative health experts.

Today he talks to FX Medicine to talk about the many different forms of coenzyme Q10 and the evidence for their use.

Covered in this episode:

[00:53] Introducing Dr Ross Walker
[01:50] Today's Topic - CoQ10 
[02:20] Integrative Medicine vs. Standardised Cardiology
[03:17] Why not just use medicine for cardio health?
[06:54] Reduce disease by 70% with these 5 things
[08:40] What is CoQ10 and how do we benefit?
[12:24] Flaws with randomised control trial designs
[13:20] Statins and CoQ10 use
[16:01] What does Dr Walker take daily?
[16:19] Calcium Score vs. CT Coronary Angiography
[18:54] Ubiquinol vs. Ubiquinone: stability?
[21:19] Ubiquinol vs. Ubiquinone: bio-availability
[22:29] Australian supplement quality
[23:40] U.S based research
[23:56] Evidence for multivitamins in cardiovascular disease
[26:25] More on statin safety and efficacy
[28:47] Cholesterol: Size Matters
[29:33] Managing residual risk
[32:52] Other applications for ubiquinol?
[38:04] Caveats and side effects for CoQ10 use?
[43:05] Dr Walker's final comments on CoQ10


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. And joining me in the studio today is Dr. Ross Walker, who really needs no introduction for anybody in Australia, but I will for our overseas listeners. Dr. Ross Walker is an eminent practicing cardiologist with a passion for people and health, with over 35 years' experience as a clinician. 

For the past 20 years, he's been focusing on preventative cardiology and is one of Australia's leading preventative health experts. Considered one of the world's best keynote speakers and life coaches, he's the author of seven best-selling books, a health presenter in the Australian media, including regular appearances on Nine Network’s Today Show and A Current Affair. You've got Sky NewsSwitzer Business. He also has weekly radio show on Sydney's 2UE, 4BC, and 2CC, with other regular segments on 2UE, 6PR, 4BC, and 3AW. You're all over everywhere, Ross.

Ross: Yeah, all over the place, mate.

Andrew: Welcome to FX Medicine.

Ross: Thanks, Andrew.

Andrew: I can't be more honoured to have you on the show.

Ross: It's great to be here.

Andrew: Now, today we're going to be talking about CoEnzyme Q10 (CoQ10), which I've gotta say is like the poster child of cardiac natural medicine, let's say.

Ross: Yeah, you could say that, that and fish oil.

Andrew: That and fish oil, but fish oil's had a little bit of a downturn as of late.

Ross: No, it shouldn't. I think that's all nonsense, the downturn of fish oil, but that's another subject. Let's talk about CoQ10.

Andrew: That's another subject. But CoQ10 has not been without its controversy. And I've seen even like, high-dose studies, you know, having "no effect," depending on what they diagnose. But I think first, can you take us through why you first looked at integrative medicine as opposed to standardised cardiology? What changed your mind?

Ross: Well, look, I think the Buddhists talk about the middle path. And I think that anyone who goes to extremes of anything, whether it's the extremes of orthodox medicine or the extremes of complementary medicine, the answer to me is always somewhere in the middle. And so, I really get a bit disturbed about medicine, orthodox medicine, in many ways because if you can't fix it with a script pad or a scalpel, then it doesn't work, which is the basic premise of medicine. And I don't agree with it.

Because I've had some enormous benefits over the years using various aspects of complementary medicine - all evidence-based. And this is the issue which I'd be delighted to talk about as we go on. But to me, you've got to have some solid science behind what you do, but just because it's not in a script pad or a scalpel, doesn't mean there isn't solid science, which I certainly think there is for Coenzyme Q10.

Andrew: Now, you've done a lot of work with a plethora of nutrients in your career for cardiovascular outcomes. Why is there still so much to learn? And why should we be bothering, given the recent improvements in, and there have been real improvements in, say the new, you know, the sartins and things like that, so the new cardiovascular pharmacological agents?

Ross: Yeah. Well, the sartins, that's the ARBs, the angiotensin receptor blockers, it's a big deal, but statins are being the focus of most cardiologists. And I personally believe they're the most over-prescribed drugs on the planet. And the reason they're over-prescribed is, it's all been a bit of a con-job going back to the Ancel Keys years where, Ancel Keys in the '50s, he was this strange biochemist from Minnesota. And what he did was look at the link between cholesterol, fat, and heart disease in 22 countries. He ignored the results of 16, came out with the results of 6 in a thing called the ‘Seven Country Study’. Now, if you can figure that one out, you're a lot smarter than I am. 

And so, only in 6 out of 22 countries was there a spurious link between cholesterol, saturated fat, and heart disease, but then the food companies got onto it. And the food companies says, "Ah ha. We can now put this processed package muck, masquerading as food with graffiti written on it, like low fat or no cholesterol, and sit it on a shelf for months and make squillions of dollars out of that." And then the pharmaceutical companies got the antidote to cholesterol, i.e. statins. So what they did was block the major step in cholesterol production with a drug. And they've done studies and studies over the years by curing this so-called non-disease, i.e. cholesterol, high cholesterol, with a drug. 

So people go into a doctor. And here's how it works, Andrew. They go into the doctor say, "Doctor, I've got cholesterol." "Oh, I can fix that. Lipitor. NEXT." And the person walks out and goes, "Oh, phew. I didn't get a lecture about being fat." And the doctor goes, "Oh, phew. I didn't have to spend 15, 20 minutes talking to the people about lifestyle."

It's the perfect solution. The problem is, that perfect solution doesn't work as well as everyone thinks. And also, that perfect solution has a bucket of side effects, which have also been downplayed as recently as a big article in "The Lancet" that came out from Oxford suggesting that all of this hoo-ha about statins causing problems was nonsense. And all of the benefits haven't been portrayed to the public as much as they should have been. And to me, that was very disturbing. 

There was also some...and I'm not accusing anyone of anything here, but there was a strong suggestion...a big article came out in the "UK Mail" suggesting that the lead author of the study was paid millions of dollars by the pharmaceutical companies involved. He didn't deny that. He said, "Ah, yes, but I put it all back into research." So, you can make up your own minds about that. So, I get very disturbed about the whole focus on cholesterol and the nonsense that taking a statin is really the most important aspect of preventative cardiology. 

Because here's the deal, if I give you a statin in a standard dose, I reduce your risk for a cardiovascular event by about 20 to 30%. But, I think with the potential of about a 10 to 20% side effect rate, the randomised controlled clinical trials that weed out all the people that are gonna make the drugs look bad maybe have a 5% side effect rate. But in the real world where I live and I practice, I can tell you it's much more than that, much more than that. So that's the first thing. 

But if I then get you to practice what I call the five keys of being healthy. You cannot be healthy and have any addictions. So anyone who smokes is unhealthy. Anyone who drinks too much grog is unhealthy. Anyone who snorts cocaine is unhealthy. Number two, good quality sleep. Seven to eight hours of good-quality sleep every night is as good for your body as not smoking. Number three, good-quality eating and less of it. That's all we need to know. We all eat too much food.

Andrew: Absolutely.

Ross: And often, we eat the wrong food. And the best food that we need is natural food. If you can kill it and eat it straight away or grow it in your back yard, it's good for you and after that, all bets are off. Number four, second-best drug on the planet, three to five hours every week of some form of testing exercise. And number five, beats everything else to hands down, is a thing called happiness. Now, if you do those five things well, all of the data that's been done over the years on combining those five different keys to a healthy life reduce your risk for all diseases, not just heart disease, all diseases by 70%. 

So lifestyle modification is twice as powerful as anything a doctor can do for you.

And that's why I say to my patients, "Don't give me too much power. All the power is on that side of the table. It's your decision." That's really important. So, I looked at that and I thought, "Well, that's important, but is there anything else we can do for people that has less harm?" And that's where I went into integrative medicine because I think it's integrative. Let's not discard the very good bits of orthodox medicine that you remembered at the start. We've had enormous advances in cardiology, my specialty. With statin therapy, to some extent, but also with stenting and with better techniques to by-pass, other medications, as well. There's tremendous things we can do for people. But if my patients aren't going to put their effort in, why should I bother?

Andrew: Now, I've already got five different questions or five lines of questioning. And so, I guess, one of them was, with the good bits of complementary medicine, you mentioned fish oil just before, there's been some good work done on magnesium orotate. There's some interesting work coming out in Vitamin K2.

Ross: Absolutely.

Andrew: All of these sort of different, dare I say the word antioxidant or polyphenols or whatever, but there's a specific one. And we mentioned it first, Coenzyme Q10.

Ross: Yes.

Andrew: But it's not one entity. And we always thought that it was one entity, at least in Australia, for many, many years. We started off with extremely low dosage. I think it was 10mg that we first had. Then we were allowed 150mg. Now we're allowed the ‘new kid on the block’. So, I think we need to go through first, what's CoQ10?

Ross: Sure. Okay. CoQ10 is basically a fat-soluble antioxidant, so fat-soluble energy producer that works very much in the mitochondria. So, we all know that the mitochondria are the fuel packs in the cell. And I say to my patients all the time, "It doesn't matter what sort of flash car you drive. If you take the petrol tank out and you have no petrol, the car won't move." And it's the same thing with the cell. 

The mitochondria makes a thing called ATP, adenosine triphosphate. And without that ATP, your cell doesn't work. So when you breathe, the oxygen, the glucose combines in the mitochondria to make this ATP. Now, one of the main drivers of that ATP production in the mitochondria is Coenzyme Q10. It works on the mitochondrial electron transport chain. And it is vital for normal functioning of your mitochondria. 

And here's the problem. The problem is, there's a lot of foods that have CoQ10, but you've gotta have a huge dose of those foods every day to keep the levels up, to keep the cells working well. And here's the key essence of my work over the years. And this is just an obvious fact, Andrew. Our body was physiologically designed to wander around a jungle with a spear for 30, 40 years looking for food. So natural environment, constant movement, but being a hunter/gatherer sucks. You died about age 30, 40 because a saber-toothed tiger ripped your head off or you died of some infection. 

So, what's happening now, we're living on average double our "use by" date, which is age 40. So, when you get beyond the age of 40, things break down in the body. So, there's a key enzyme as far as CoQ10 goes called diaphorase. And what does diaphorase do? It converts your Ubiquinone, which is the oxidised, inactive form of CoQ10, to Ubiquinol, which is the reduced active form of CoQ10. The only thing that actually drives that mitochondria. So, for years, we've been pushing the whole Ubiquinone line, which has a very weak effect, especially as you get older, whereas really what we should be doing is focusing on Ubiquinol, the active form that actually does the stuff that you want it to do.

Andrew: So, just doing back to Ubiquinone, the oxidised form. Like, you know, the early work from [Peter] Langsjoen and Karl Folkers, the original researcher. I remember speaking to a cardiologist and he was saying he was really disappointed in that level of research that was coming out because nobody looked at things like ejection fractions and things like that. I also think that there was a real issue with dose in those days as well though? 

Ross: Yeah.

Andrew: So, can you take us through what the early work was showing in a positive frame and why maybe there were some shortfalls in that early research?

Ross: Well, the early work, which, again, as you say, people were being under-dosed with the inactive form. So, I'm not surprised that a lot of the work showed it didn't do much anyhow. Now, a cardiologist saying, "I'm disappointed it didn't show an improvement in ejection fraction," again, there are many more subtle things that happen in cardiology. And this is the problem, to sort of digress, but bring this into the Ubiquinol discussion. 

This is the problem with when you look at randomised controlled trials. They're very applicable to pharmaceutical therapy. Because I see pharmaceutical therapy like a high-performance motor car. It gets you from A to B very quickly, but with the potential of crashing and killing yourself. I see supplements like a bicycle. A to B, much slower, but you get some exercise along the way, much better for you, but it takes you longer to get there. So you can't have the same rules for the car that you have for the bicycle. And in the same way, you can't have the same rules for the supplements that you have for pharmaceutical medicine. 

And so, when you look at a lot of these trials, they're actually bringing in the same randomised controlled, evidence-based attitude for supplements. And it doesn't work like that. And especially when you're using small doses of something like Ubiquinone, you're not going to see much benefit against a powerful statin drug, as an example, or with people who've got severe heart failure, as an example as well. But even then, some of the studies, the early studies using Ubiquinone, and even some of the recent studies haven't been that bad. Whereas when you use the stronger Ubiquinol, the studies I think are quite spectacular, and even then some of the recent studies, for example, that have shown a reduction in statin myopathy, I think everyone's missing the point there, you see. Again, doctors make the diagnosis of statin myopathy when the CK, the muscle enzyme level, rises at least three times.

Now, that might be the case for some people who are reacting very badly to statins, but I can assure you, 10 to 20% of people who take a statin drug get problems with muscle pain, stiffness, weakness, cramping, and sometimes even atrophy, loss of muscle bulk, but it isn't always related to a higher CK level. So doctors say, "Ah, there's low CK level, so, therefore, this has got nothing to do with statins, the person's aches and pains." And look, there's a reasonable argument. As you get older, we all get aches and pains. That's pretty common as you age. But I've seen so many people put onto a statin where the statin makes the aches and pains that they already have so much worse, but they mightn’t have a rising CK. So doctors are ignoring the fact that that could be the statin. And within a few days of stopping the statin, the aches go away. 

Now, here's what I do. I give people Ubiquinol. All my patients on statins, I give them at least 150mg of Ubiquinol, sometimes 300mg. And I'll tell you where I go to the 300mg in a second. And I give them magnesium orotate with that. And it's not the magnesium that's important. It's the orotate because the orotate works in the mitochondria on a thing called orotic, not, for some people listening, ‘erotic’. It's orotic acid metabolism. Which then lifts the CoQ10 levels in the mitochondria. So, that's why I use the two things in combination. 

I've got to say to you, I would still say that about 10% of patients who are given statins are intolerant. And even then, with the bigger doses, they can't. Now why? Because around 10% of people have a genetic abnormality in their muscles that predisposes them to myopathy, to statin-induced myopathy, to other forms of myopathy, to polymyalgia rheumatica. So, again, those people just cannot tolerate statins anyhow, no matter what you do. 

But if you want to minimise the risk of muscle issues in all the other people, use a good dose of Ubiquinol. Not 50mg a day, not 100mg a day, 150mg a day. Now, I've got to say, I take Ubiquinol and Pharma Mag Forte, which is my favoured version of magnesium orotate. I take them myself purely for energy. I'm not on a statin. I'm 60 years old. I've got a zero calcium score. So I don't need statins. I don't care about my cholesterol levels because I have a zero calcium score. All males at 50, all females at 60, should have a calcium score, not an intravenous CT angiogram. Now, this is another shonk that should be absolutely forgotten by people is the intravenous CT coronary angiogram.

Andrew: Yeah, they can now do the…

Ross: Yeah, but you have the intravenous injection. And it doesn't give you any extra prognostic advice over the calcium score. But it involves an injection. It involves, obviously, dye.

Andrew: Possible reactions.

Ross: Possible reactions to the dye, but it also involves, in most cases, unless you're using a very high-powered modern machine, a 320 slicer or a 120 dual-chambered slicer. Unless it involves those sort of machines, it does involve sometimes up to 300 chest X-rays of radiation as opposed to 4 or 5 from a calcium score. And it makes your wallet $500 lighter. 

So, you don't do intravenous CT coronary angiography as a screening test for heart disease because it isn't. But coronary calcium scoring is. It's simple, low radiation, low cost, and males at 50, females at 60. So if you've got a zero score like me, you don't need a statin.

Andrew: First off, for the general punter out there, if they wanted to pay for this, do they have to see a cardiologist before they can get the full benefit?

Ross: No, no, no. It's outside of Medicare. They can actually go and get one without a referral if they want to. But I think it's worthwhile discussing it with their doctor first. But a lot of the doctors still don't understand calcium scoring as opposed to intravenous CT coronary angiography as opposed to cholesterol. 

Now, there was a big study in the U.S. last year, 5,000 people followed for 10 years. 77% of the people in that trial fitted the U.S. criteria to be on a statin. Half of them had a zero calcium score. And over the 10 years, their event rate, their heart attack rate, was so low that the conclusion of the trial was the statins were worthless in those people.

Andrew: In primary prevention?

Ross: Yeah, in primary patients. Oh look, I have no dispute. If you've had a heart attack, a stent, or a bypass or on a coronary calcium score, you have a calcium score that places you in the highest 25th percentile of risk, so above the 75th percentile range, you should be on a statin, as part of your management.

Andrew: Part.

Ross: Part. But the five keys of being healthy and some supplements are a good thing. So, as far as statins go, everyone goes onto 150mg Ubiquinol, Pharma Mag Forte, one pill twice a day, just to keep up the CoQ10 levels in the mitochondria. And I take it purely to give me energy. So, that's where I use it in that situation.

Andrew: Now, I have to ask about Ubiquinol, Ubiquinone. We're taking it as a tablet.

Ross: Or a Capsule…

Andrew: Or a Capsule, you’re right. We’re taking this supplement as a form that's inside the cell, but we're taking it as a capsule, is that stable?

Ross: Oh, yeah. Yeah, yeah. It's stable. It's very well absorbed. It all comes from the one supplier. So it's not as if you're getting varying amounts of stuff. You're getting it from the one supplier. It's all high-quality stuff. Ubiquinol is a very good stable, very bio-available compound. And it's something that I think we should all be thinking about. I just think there's no further place to be using Ubiquinone when you've got such good data. 

But to give Ubiquinone its due, I don't wanna be totally biased for one thing, I'm just giving you the science. There was a thing called Q-symbio, which was released a few years ago. Q-symbio looked at, I think it was over 200 people with significant heart failure, gave them Ubiquinone, a big dose, 300mg a day. And over two years, there was a 50% reduction in all-cause mortality and cardiovascular events. That's pretty good for a supplement. And that's randomised control trial. 

Just recently, a big study's come out of North America where they took people over the age of 70, gave them 200mg a day of Ubiquinone, and 200mcg a day of selenium for 4 years, and then followed them for 10 years. Same information. 50% reduction in all-cause mortality and cardiovascular death just by taking two supplements for four years.

Andrew: Now, that's really interesting because that sort of talking about the blending of CoQ10 with selenium, that sort of goes into the work of Frank Rosenfeldt.

Ross: Can I say about Frank Rosenfeldt, this man is a genius. He's done some seminal work over the years on all of this. Frank's a real thinker. And he's done some amazing work with...I mean, he's Mr. CoQ10, along with Peter Langsjoen in the U.S. And so, Frank understood before anyone else, the rest of us did, he understood that you need to blend things. It's a bit like taking one big thing. It does affect all the other things, if you're not taking other things with it. That's why multivitamins are good for you. Because multivitamins have a blend of different supplements, rather than one thing. So I don't think anyone should ever just take the one thing and think that's the be all and end all to anything, because there is no miracle drug.

Andrew: So, how greater an activity does Ubiquinol have over Ubiquinone? I remember some, you know, some touts of eight times more bio-available, but is it really that much a difference clinically in patients?

Ross: No, it's more bio-available, but it's also the active version. You don't to have to rely on your own body's dying enzymes systems, the diaphorase, to do the conversion for you because it's the only thing that works. Ubiquinone doesn't work until it's activated to Ubiquinol. So therefore, it is much stronger. And so, that's why I'm saying I don't think there's any real place for Ubiquinone anymore.

Andrew: Yeah, well, now that it's available. It was always like, "We'd like it, but we could never have it.” [in Australia]

Ross: Yeah, but I see the analogy here with synthetic versus natural Vitamin E. So if you take synthetic Vitamin E, it's a weak antioxidant with...and that's where all the anti-Vitamin E stuff started from the meta-analysis of Edgar Miller in 2004 in the "Journal of American Medical Association." Most of it was done on synthetic Vitamin E, which I agree is useless and shouldn't be used. Use the natural one, which is stronger and does work. And there is good strong evidence-base around that, as well.

Andrew: So, there's still a lot of controversy though in the orthodox medical circles with regards to CoQ10 and statin use. Indeed, there was a Mayo Clinic paper that said, I think it was 600mg of Ubiquinol didn't work. But I thought what was interesting is that there was a little line under it that said, "You've gotta be wary of pharmaceutically-funded papers." And it's in that paper.

Ross: Well, you see, I've gotta say, and this is my own personal view, and look, the Four Corners expose on this a few months ago backed this up. I wouldn't take supplements out of America. And the reason I wouldn't is that American supplements are made to food standard, whereas Australian supplements are made to pharmaceutical grade. And that's the difference to me. When they did a study of...and I'm not saying all American supplements, but I'm just saying the vast majority.

Andrew: There's a risk, yeah.

Ross: They looked at 300 different supplement companies in America. The vast majority had contaminants in the supplements. The vast majority, you weren't getting what it said on the side of the bottle. Whereas in Australia, it's completely different because we do have the pharmaceutical grade supplements. So you do know that what you're taking, you're going to get the right dose. So, I worry about studies on supplements coming out from the U.S. 

Now, some of the U.S. researchers are some of the greatest researchers in the world, incredibly great work that they do, but I don't think a lot of the conservative researchers in the U.S. understand supplementation, as was shown by, for example, the heart protection study where they looked at Vitamin E, Vitamin C, and a multivitamin. And they used synthetic vitamins. They used synthetic Vitamin E. So, therefore, to me, that study was nonsense.

Andrew: Is that the one that talked about that a multivitamin had no improvement on cardiovascular risk?

Ross: Yes, exactly.

Andrew: I'm sorry, but when would any natural healthcare practitioner use a multivitamin to reduce cardiovascular risk?

Ross: Well, you should. And let me tell you why. There's this little-known university in the U.S. called Harvard, which for the last... It's one of the greatest institutions in the world, but I'm only joking. But for the last 30 years have been doing the Males Physicians' Trial and the Nurses' Health Study. And when they looked at multivitamin use up to 10 years, it did nothing, absolutely nothing. So you can't take a multivitamin for a few months and go, "Well, I didn't feel any better, so therefore, it's useless."

Andrew: That's right. Yeah.

Ross: But when they got to 10 years in the males, there was an 8% reduction in cataract and common cancers. Now, that's not much, but 8% from taking multivitamin everyday, that's pretty good. When they got to 15 years in the nurses, there was a 75% reduction in bowel cancer, a 25% reduction in breast cancer, a 23% reduction in cardiovascular disease, at 15 years. 

But they've just released the 20-year data in the males, a randomised control trial for male physicians who didn't start with cardiovascular disease and looked at the incidence over 20 years. 44% reduction in cardiovascular disease in the males taking a multivitamin every day. But you’ve got to have commitment. You gotta be in it for the long haul. You gotta take it for 20 years and beyond. 

So what I'm saying to people is that, I think the evidence is there for all supplements, whether it be multivitamins, fish oil, and certainly, with things like Ubiquinol. So, getting back to Ubiquinol, there was a study done where they gave people 50mg or it could have been 60mg of Ubiquinol for 12 weeks who had mild statin muscle pain, with a rising CK. And there was a 44% reduction in their pain scores over that period of time just by taking the Ubiquinol at what I believe is a substandard dose.

So I think, if we started doing proper trials, and the trials have not been done yet, where they've used 150 milligrams of Ubiquinol. I thought the Marcoff paper was using Ubiquinone. I didn't see the Ubiquinol there. So the Marcoff paper I thought used Ubiquinone, which, again, I'm not surprised that doesn't work. So, I would like to see a very good well-done randomised controlled trial of 150mg of Ubiquinol in people taking statins. And here's another thing. One of those papers looked at Zocor or Simvastatin, 40mg. Now, Simvastatin being a fat-soluble statin, which I personally don't use, Lipitor...

Andrew: You prefer the water solubles.

Ross: Atorvastatin and Simvastatin, in my view, cause more side effects. That's my own personal opinion. So, I don't use those at all. And I think they cause more myopathy, more problems with the brain. The blood brain barrier is a very fatty membrane. So you take a fat-soluble statin, it gets straight across into the brain. And I think Ubiquinol doesn't stop the neuro-cognitive effects, but it certainly stops the muscle effects. And it also stops the increased risk for diabetes from some of these, as well, for some of the statins, as well, by its effect on the GLUT-4 pathways within the mitochondria. So, there's a lot of things that you can do to minimise the risk of statins. And I think Ubiquinol and magnesium orotate are a very important part of that.

Andrew: So the water-soluble statins, can we list those off?

Ross: Yeah. It's Rosuvastatin Crestor or Pravastatin Pravachol. So what I do, the way I do this is, if I've got somebody who's got a very high cholesterol, Crestor is the strongest, then Lipitor, then Zocor, then Pravachol. So very high cholesterol, I go for Crestor or Rosuvastatin first. 

If they've got lowish cholesterol, but a lot of coronary disease, I'd use Pravastatin with Ubiquinol. Something else I use is a thing called BergaMet. And BergaMet comes from Calabrian oranges. So this is oranges grown on the southern Ionic strip of Italy. And I'm one of the lead researchers in this in the world. And we've done a study, Professor Mollace from Italy and myself have done a study where we took people with high cholesterol, gave them Rosuvastatin, dropped their cholesterol 56.5%. We cut that in half, added BergaMet. We dropped their LDL cholesterol 52.5%, but a bigger rise in HDL, and a much bigger drop in triglycerides.

Andrew: So half the dose of Crestor...

Ross: Half the dose.

Andrew: ...including the BergaMet.

Ross: The BergaMet twice a day.

Andrew: And you get better cardiovascular indices.

Ross: Absolutely. So I think all people who are on statin should be taking water-soluble statin at as low a dose as you can, to get a targeted cholesterol. So, if they have cardiovascular disease, clinical cardiovascular disease or a high calcium score, then I want to get their cholesterol below four. I wanna get their LDL below 1.8. I wanna get their HDL above 1.5. And I wanna get their triglycerides below one. 

Because you do that, once you lower triglycerides, even though the triglycerides themselves may not be an issue, they're a marker for small LDL. And this is that where size is important, Andrew. Small is better.

Andrew: People keep telling me, Ross.

Ross: Yeah, and me. Small is bad. Large is good. And that's with LDL cholesterol and with HDL. And that's the basic way of thinking of this now. And BergaMet, nicotinic acid, and also Ubiquinol changes you from small to large LDL, which is exactly what you want to do. So I think it's a combined approach here, rather than just looking at one thing.

Andrew: Does this combined approach answer the issue of residual risk when you just achieve target levels with a statin, sort of thing?

Ross: Well, look, can I say to you about residual risk? I think one of the problems with residual risk is that we rely too much on statins to do the job. Residual risk doesn't include all the people who put an effort into their lifestyle. So to me, it's putting that effort in. It's 70% of your management, 70%. And how many people are really getting those five keys of...I'll say them quickly again. No addictions, good sleep, good eating, regular exercise, and being happy. How many people are really doing those things well? I don't think too many. 

And I've been doing this job for over 35 years. And I can tell you I've got two groups of patients. There's a line in the sand. I've got the people who follow my advice and the people who don't. And the people who follow my advice, I cannot tell you the last time one person had a problem who followed my advice to the letter. I mean, I'm not saying absolutely perfect, but did all the lifestyle stuff, took their low-dose statin, took their BergaMet, took their nicotinic acid, took their Ubiquinol, Pharma Mag Forte, Vitamin K2, as you mentioned, all of these things.

And I can't remember the last time someone like that did that, and went on to have a significant vascular problem. But I can tell you buckets of people who couldn't lose weight, who couldn't throw away the cigarettes, and weren't that good at taking their pills. These people just wipe away bits of their heart, whittle away bits of their heart, to their premature death. It's so obvious to me. 

So, when people talk about residual risk, I just think it's because they're not doing all the stuff they should be doing. I don't think there's anything magic about this, but we do know, for example, there's about 43 different loci in your DNA. And with those 43 different loci, any 28 are coded for blood pressure and cholesterol. So there's a whole lot of other things that are missed out that we don't see in a typical blood test or we're checking someone's blood pressure. And we can't do anything about those things that might be affecting myeloperoxidase or your nitric oxide synthase or any of those sort of things, endothelial function, etc. 

We can't specifically treat those things at the moment. We may be able to in the near future, but we just can't do it at the moment. So, what I'm saying is, use every trick you have. That's why I use all of those things combined targeted for people. And we haven't even discussed the MTHFR gene, which is another story.

Andrew: No. Now, I have to ask because obviously, you know, people come to see you because they know about you. They know who you are. So I've got to ask you this question. You drew the line in the sand. What's the percentage of people that follow the stuff compared to those that don't?

Ross: I'd say probably 40/60 people who follow, 60 who don't. Because, look, they're coming to me for a particular reason. It's a self-selected population. So, a lot of the people who just want standard orthodox medicine go to standard orthodox cardiologists. That's fine. And they still do pretty well with that. I'm not saying there's nothing good about standard cardiology. It's fantastic what it does for people, but the people who come to me already come to me knowing that I'm gonna talk to them about lifestyle. They've heard me on the radio or seen me on TV. They know I'm going to talk to them about supplements. So they are self-selected. So it's hard to say what would happen in the general population because I don't know. I just see the self-selected people who come and see me.

Andrew: And back onto CoQ10. Obviously, CoQ10's in almost every cell of the body. Indeed, is it not in any? Are there any cells where CoQ10 is not? ATP, I guess.

Ross: No.

Andrew: Then there's membrane protection, correct, in RBC’s?

Ross: Yeah.

Andrew: So what other uses does Ubiquinol have, apart from cardiovascular?

Ross: Ah, look. I think it has a broad range of uses. One thing we haven't really spoken about, which I'd like to mention before we just move onto the other uses, is in specific cardiac failure. Peter Langsjoen's done a lot of very elegant work, as has Frank, Frank Rosenfeldt, elegant work looking at left ventricular dysfunction, which is a big killer. If you've got heart failure, that's bad news. Now, Peter hasn't done a randomised controlled clinical trial. Peter Langsjoen hasn't done the randomised controlled trial, but he's shown enormous increases in ejection fraction with big doses of Ubiquinol linked to the serum levels of CoQ10. 

So, if I've got patients I've put onto Ubiquinol, I wanna see that I'm getting their serum levels up to a higher level and not just sort of running around the one or two range. I wanna get up to the three to four range in their bloodstream. So, I will measure CoQ10 levels in those people. And you see the big jumps-up with Ubiquinol and I'm seeing in my practice. See, I've been doing this for the last few years that Ubiquinol's been freely available in Australia. I see in my practice now significant improvements in ejection fraction, which is the end-game in fixing up the heart. But there are other subtle things you look for, as well. 

So when I hear a cardiologist say, "Oh, I didn't do much to ejection fraction, but it may be affecting diastolic function and systolic volume and all these other things," that really are out of the realm of general practice. But certainly, things we look for as cardiologists. So to me, Ubiquinol is very, very, very good for heart failure. And I put all my patients on standard anti-failure therapy, the cardio-directed beta blockers, the ACE inhibitors or the ARBs, but I also put them on Ubiquinol and Pharma Mag Forte, magnesium orotate. So I do that for there. 

But what else can Ubiquinol do? Well, it drives the mitochondria. And as you say, the mitochondria's in a whole lot of other cells. I think it's good for people who have muscle disease. So if I've got people on steroids for polymyalgia rheumatica, I'll also give them Ubiquinol and Pharma Mag Forte to lift up the CoQ10 to protect those mitochondria. But we also know that, for example, that there's a big aspect of mitochondrial disease in Parkinson's disease.

Andrew: They use huge doses in that?

Ross: Oh, absolutely, 1,200mg of Ubiquinol a day. And they got some significant benefit. Now, I interviewed recently on my radio show Professor Carolyn Sue from the Kolling Institute of Royal North Shore Hospital. And she was talking about all the varying different types of mitochondrial disease we're seeing, whether that's causing epilepsy or some sort of neuro-degenerative disease like Parkinson's or Alzheimer's or anything like that. 

The big group of myopathies, that haven't been really well-characterised, even just the whole concept of chronic fatigue syndrome and fibromyalgia, I'm now using Ubiquinol, Pharma Mag Forte in all my patients who have those conditions, as well. So to me, and diabetes, juvenile rheumatoid arthritis, there's been a lot of different studies with ubiquitous conditions for Ubiquinol. So ubiquitous, Ubiquinol, I think it's a good mix.

Andrew: Now, I have to ask. There's been quite a few pharmacists getting in trouble from doctors, usually GPs, who are saying people taking a statin, but they haven't necessarily got myalgia. And why are you giving them CoQ10? There's no evidence for that. 

Tell me what's the ethical line? What's the responsible line for practitioners to recommend, prescribe, CoEnzyme Q10 Ubiquinol with a statin or to refrain from such?

Ross: Well, this, to me, is the issue about medicine. I mean, are doctor's in charge? I don't think so. Who's in charge is the patient. Now, again, I have a cup that sits on my desk that says, "Do not confuse your Google search with my medical degree." And it's a great cup, but equally, I think that people are now so much better educated about matters medical. There are plenty of TV shows, radio shows, and a whole lot of other educational areas like Google where people can get information. And people are reading this stuff. 

And, again, to get away from the bias that many orthodox doctors have, that if you can't fix it with a script pad or a scalpel, then it doesn't work. I think a pharmacist is well within their rights to say, "Well, look. It's my view as a pharmacist that you should take Ubiquinol with the statin." Now, that's the pharmacist's opinion. The doctor has no right to tell the pharmacist he has no right to do it. But, again, with many aspects of complementary medicine, you don't have the very, very solid randomised controlled trials. But I'm saying, the evidence to date is pointing to a huge benefit from this. And as a practicing clinical cardiologist, I see so many people who are getting subtle and not-so-subtle side effects from being on statins.

Andrew: Any caveats from using CoQ10? There was an old...I think it's been debunked now for mostly, at least, despite the consistent warning on the CoQ10 bottle. And that is to use it with Warfarin.

Ross: Yeah. Look, again, I've never seen any issues combining Ubiquinol with Warfarin. There's all this theoretical nonsense that goes on. It's a bit like saying to somebody who's having an operation, "Oh, you've got to stop your complimentary medicines because you're gonna bleed."

Andrew: Well, hang on. Frank showed that one...what is it, the day before he stopped fish oil, the day before.

Ross: Yeah, but I don't know that I'd even do that anyhow because I don't think there is any good evidence, clinical evidence, that people do have increasing bleeding. 

If you look at all the work on all of these supplements, the bleeding risk, the side effect rates are so low that I think we're really losing it when we do that. It's a bit like suggesting that when someone's on chemotherapy that they should stop all their supplements. Now, I hear that all the time. 

Now, there are definite interactions between some things and so, for example, we all know about grapefruit and statins. That's one thing, but there's little-known interaction between green tea and a thing called velcade, which is used for myeloma. The green tea can block the action of velcade. So, people who are given specific things, it's important that your complimentary medicine won't affect the benefits of the treatment you're on. 

But the Warfarin/Ubiquinol interaction, I think, is very spurious. And I've never clinically seen it cause any issues at all. And the point is, with that, you can always have your INR measured anyhow, just to see what that's doing. That's not difficult.

Andrew: Hmm. I think the issue is, Warfarin will never be down-regulated in preference to ceasing a supplement, which is an interesting rule, but anyway...

Ross: Yeah, but and look. Let me say about something like Warfarin. Warfarin is one of the best drugs we have in cardiology. It's just very, very difficult to use and very, very difficult to take. So, we now have the newer oral anticoagulants which I'm using quite a bit, rather than Warfarin, because the patients don't like being on Warfarin. 

In the same way, the patients don't like being on statins, even though doctors love them. I think doctors give statins far too much power. Patients probably give them far too much pain. And I think with everything, the answer's in the middle.

Andrew: I've got to ask about side effects. So, you know, there's been noted, very rare, but that they do occur, things like rashes with CoQ10. But an interesting thing that I've seen, and it's extremely rare, I would have seen it five times in my life, would have been this upon taking CoQ10, reasonable dose, within an hour, two hours, an extreme fatigue. 

Can you explain that from any biochemistry? I've seen it and these people say, "No, it's definitely that." And they're are supporters of CoQ10..

Ross: I suspect the reason for that is the same reason that if you have gout and I give you allopurinol, I bring out the uric acid from the tissues, mobilise it, and it goes straight into your joints. 

Probably the same way. If your CoQ10 levels are extremely low, what then happens is you're putting an imbalance by taking CoQ10. It's all in the serum. You're getting an imbalance to the CoQ10 and it hasn't yet gone into your mitochondria to do the stuff. So probably there's some imbalance in the body that acutely causes fatigue. And I do know, for example, one of the theories of chronic fatigue is that it's a brain disorder, not a psychologic disorder, but it's a disorder of the centre in the brain that monitors fatigue levels. And that centre's very important. 

So, for example, if you look at people who run a marathon, at the end of the marathon, everyone collapses, apart from the guy who won. What does he do? A victory lap. 

Now, why is everyone collapsing? Because their fatigue centre is protecting the rest of their body because they know if they keep running, those muscles are going to be destroyed. So the fatigue centre says, "Look, stop. I've had enough," but the guy who's won, he's overriding that fatigue centre because he's so excited about winning, he can run around again. 

So, it's not that the muscles have said, "I can't do any more." The brain's saying to the muscles, "I've got to protect you by saying you're incredibly tired." And that's one of the theories of chronic fatigue. So, maybe when people take acutely Ubiquinol, it does something to that fatigue centre to say, "I'm even more tired," until you get an equilibration. And it's a bit like anything. I started meditating in 1994. And I've been meditating every day since. And I couldn't imagine a life without meditation. But for the first six weeks, it drove me nuts. I was getting more anxious meditating because I think all of my stresses and anxieties came up to the surface with the meditation, but now I couldn't imagine a life without it. 

So I think if people do get that response with their first few doses, stick with it because you'll probably find you'll get the best response to it in the long term.

Andrew: Any last hints, tips, warnings, or red flags, or anything that practitioners need to look out for when instituting CoEnzyme Q10 as Ubiquinol?

Ross: Yeah. Look, I don't think there is anything, apart from what you said about the potential for fatigue. I just think it's one of the big step forwards now in integrative medicine. I think it's something everyone should be thinking about because as we get older, our Ubiquinol levels drop in our cells. 

So, I think probably, if you say, "Well, who should be taking it?" That would be the final thing I'd like to add in there, everyone over the age of 50 who wants to get a bit more energy. That's number one. Anyone who's on a statin. Anyone with cardiac failure. Anyone with any of the other conditions we've discussed. It can help a lot of these things, sportsmen, for example. One of my mates just finished a marathon, did a personal best. And I told him, "Before the marathon, take 600mg of Ubiquinol." And he got his personal best. I'm not saying it was the Ubiquinol, but I'm just saying it was a pretty good advice, I think. And he did very well. 

So, I think it's something we should all be thinking about now as part of our armamentarium to treat people.

Andrew: Dr. Ross Walker, I can't thank you enough for joining us on FX Medicine today. It's so great to have somebody that's dedicated their life to not just the heart health, but the whole health, of their patients for, dare I say, decades. And I'm just so honoured to have you on the show and take us through the real clinical uses and the benefits of taking Ubiquinol. So, thanks very much for joining us on "FX Medicine."

Ross: Thanks, Andrew. I hope everyone's found it very useful.

Andrew: This is FX Medicine and I'm Andrew Whitfield-Cook. 

Additional Resources

Dr Ross Walker
Ancel Keys: Seven Countries Study
Q-Symbio Study
Prof Frank Rosenfeldt: Integrative Cardiac Wellness Group | Alfred Hospital
 

Research explored in this podcast

Begley S. Records found in dusty basement undermine decades of dietary advice. Scientific American 19 April 2017

 



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FX Medicine Podcast
FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.