Preserving our Cognitive Skills with Coenzyme Q10 Plus Selenium

BACKGROUND: Coenzyme Q10 (CoQ10) has been studied as a useful treatment for patients with congestive heart failure.  Selenium has been studied in in relation to brain related disorders. We now explore possible benefits of combining both of these in a study related to brain fog.

SUBJECT OF STUDY: Does a combination of CoQ10 and selenium increase longevity and quality of life? Might they help reduce “brain fog”?

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selenium and brain fog

SUMMARY: A high quality double-blind study from Sweden found that older persons who took CoQ10 plus selenium for four years had fewer heart attacks, fewer total deaths and a better quality of life compared to matched controls who took a placebo. Over ten years, heart disease related deaths among those on CoQ10/selenium were only about half the rate compared to those taking placebo. Overall death rates were 18% lower.

Coenzyme Q10 plays a crucial role in energy metabolism. CoQ10 blood levels fall, often dramatically, as we age. The mineral selenium helps activate Coenzyme Q’s antioxidant effects. Therefore, scientists recruited 443 health individuals for a long term study. Half took supplemental Coenzyme Q10 and selenium for 4 years. The others took a placebo.    

The graph below illustrates cardiovascular mortality over ten years. The top (red) line is the coenzyme Q10/selenium group. The lower (blue) line is for those on placebo.

Q10 vs placebo

Quality of Life (QoL) using standard questionnaires was measured at the start of the study and again after four years. After adjusting for baseline heart disease risk factors including age, sex and a biochemical measure called brain natiuretic peptide (BNP) quality of life for the active treatment group was superior to that for those on placebo. This difference was probably not due to chance as the P value was <0.001 (that is, less than one chance in one thousand).

STUDY STRENGTHS: This study has major strengths. It began with 443 volunteers, a fairly large number. They were treated for four years.  Death rates were tracked for ten years.

STUDY WEAKNESS:  There was one major weakness: 29% of the participants (129 persons) dropped out of the study during the four-year treatment period.  This might have compromised the four year Quality of Life data. However, since tracking of medical records is excellent in Sweden, it should not have affected the mortality rates.

TAKEAWAY:  This high quality Swedish study provides strong evidence that Coenzyme Q10 plus selenium lowered heart disease and total deaths rates for elderly Swedish men and women.  An important qualification is that since we have only this single study, so this must be considered tentative until confirmed by other studies.

RECOMENDATION: Should people consider adding Coenzyme Q and selenium to their daily program, especially persons who are older, and/or suffer from mild cognitive impairment/“brain fog” such as we see with  ME/CFS and Fibromyalgia? While no treatment is side effect-free for everyone, at the doses used in this study both COQ10 and selenium are usually considered to be relatively safe. Therefore, if both physician and patient understand the limitations of the data, and acquaint themselves with potential side effects, then adding COQ10+selenium could be a reasonable option.

How Not to Treat Brain Fog

Q: Does Resveratrol Help Cognition? A: It Might Actually Do Harm.

Key Points:

  1. Resveratrol, a nutritional supplement, extends life span in animals; but, no studies clearly prove benefit for humans.
  2. A placebo controlled study using Resveratrol to treat Alzheimer’s found possible benefit, but not certain benefit for cognition. But, the Resveratrol group had more atrophy of the brain than those taking the placebo.
  3. My advice: Until we know more, remove Resveratrol from your wish-list of nutrients.

Resveratrol is a natural product found at low doses in grape skin and wine–especially red wine. Animals treated with Resveratrol might live longer and be less prone to cancer. But, we have no controlled studies in humans that show clear benefit for any health problems. Many people take Resveratrol hoping for health benefits. Several of my chronic fatigue and fibromyalgia patients take Resveratrol hoping it will reduce their “brain fog”.

Resveratrol molecule

New Published Research: Clinical scientists from Georgetown and other prestigious medical schools reported the first placebo controlled study using Resveratrol to treat people with mild to moderate Alzheimer’s disease. After one year on Resveratrol, cognitive decline was modestly less than among subjects who were taking placebo. But, the difference was not statistically significant.
And now the bad news, those taking Resveratrol had MORE atrophy (shrinkage) of their brains compared to those on placebo. This difference was statistically significant. Some atrophy of the brain “normally” occurs as we age. Atrophy gets worse among persons with Alzheimer’s.

I was alarmed that Resveratrol might shrink the brain. But to my surprise, the Georgetown researchers were not too concerned. They wrote, The etiology and interpretation of brain volume loss observed here and in other studies are unclear, but they are not associated with cognitive or functional decline.” (I think this means that the degree of brain atrophy did not track closely with the amount of cognitive decline.)

Still it’s very hard to see brain shrinkage as a virtue. Add in the fact that no human studies have yet shown clear benefit from taking Resveratrol, my advice for now is– Don’t Take Resveratrol.

Strengths of the Study: This was a well designed study done by reputable scientists.
Weaknesses: The number of subjects was fairly small—just 119 persons split between Resveratrol and placebo. The study ‘s one year duration is reasonably long, but might not be long enough to judge the long term benefits (or harms) caused by the treatment.
A counter argument: People who regularly drink modest amounts of wine are less likely to have heart attacks compared to those who never drink alcohol and also to people who drink to excess. Might the Resveratrol in wine contribute to this benefit? Possibly, though wine also contains many kinds of polyphenols and other components.

More important, the dose of Resveratrol available from wine, grapes and other foods is very much less than the dose sold in health food stores. Five ounces of red wine has just one or two milligrams (mgs) of Resveratrol. The Georgetown study treated with 500 to 2000 mgs per day. These extremely different dose levels should not be expected to create the same biological effects.

Can the Mediterranean Diet Help Clear “Brain Fog”?

Key Points:

  1. We have good evidence from a very large Spanish study that a “Mediterranean” Style Diet lowers heart attack rates compared to the low-fat American Heart Association Style Diet
  2. A recent study suggests that the Mediterranean Diet also helps prevent the cognitive decline that often occurs as we age.
  3. Would a Mediterranean style diet also help the “brain fog” that occurs with ME/CFS and Fibromyalgia? There’s been no formal research. Reports from patients who adopt this diet for several months would help us all learn more.

Patients often ask me, “Doctor, what should I eat to help me feel better?” Usually they have a specific diet in mind, for example, organic, gluten free, allergy elimination, anti-Candida yeast, and most often of late a Paleo(lithic)/cave man type diet. Patients with ME/CFS and Fibromyalgia (FM) are especially likely to say what can I do to help my “foggy” brain?

Now to the above list I’d like to add one more diet choice, a “Mediterranean” style diet. It almost certainly reduces the risk of heart attacks and stroke. It might also help prevent failing cognition as we age. Will it also help the “brain fog” of ME/CFS and FM? We can’t say yes or no. But, the evidence for it is at least as strong as or better than the diets listed above.

What is the Mediterranean Diet?

Mediterranean Diet

The Mediterranean Diet emphasizes eating “good fats”—mainly from olive oil and/or nuts.  It encourages fruits, vegetables, whole grain cereals and moderate portions of wine. Red meat (high in saturated fat) and high sugar junk foods are kept to a minimum. (See specific recommendations below.) There are two studies of note that focus on cognitive improvement and the Mediterranean diet: PREDIMED and MIND studies.

The PREDIMED Study
In 2013, Spanish researchers recruited 7,000 middle aged and older men and women for a long-term diet study called the PREDIMED study. Each volunteer agreed to be randomly assigned to either a high fat Mediterranean style diet with the main fat source being from either olive oil or nuts or to a diet modeled after the American Heart Association’s low fat recommendations. After 5 years, the rate of heart attacks was about 25% lower among those on the Mediterranean diet compared to those eating the American Heart Association style relatively low fat diet.

Among the several PREDIMED study centers, the research group in Barcelona selected 447 participants who were given a battery of cognitive skill tests at the start of the study. Most, but not all of these volunteers returned for repeat cognitive testing after about four years on their assigned diets. The initial scores on nine detailed cognitive tests were about the same for both groups. But at follow-up, the Mediterranean Diet group scored significantly higher than the low-fat-diet group for four of the nine cognitive tests—including two that were the most challenging and complex. The Mediterranean Diet group also outperformed the low-fat-diet group on the other five test scores, though these differences were not statistically significant. This suggests that the Mediterranean Diet might also prevent mild cognitive impairment (MC1).

Strengths of the recent study: The cognitive arm of the PREDIMED study was well designed. Its 4 year long follow up is also a plus.

Weaknesses: 447 patients are “small potatoes” compared to the 7,000 followed by all the PREDIMED study sites. Also about 100 of the original 447 subjects were not willing to come back for repeat cognitive testing after 4 years. So, the best we can say for now is that these results are encouraging and it seems fairly likely but not certain, that the high fat olive oil/nut Mediterranean style diet improves cognition among people as they age.

Caution: The Barcelona PREDIMED report is the only well designed long term controlled study where formal cognitive testing was done both before and after adopting the Mediterranean Diet. So, clearly, we need additional controlled trials before firmly accepting any conclusions.
Continue reading Can the Mediterranean Diet Help Clear “Brain Fog”?

Natural Treatments For Mild Cognitive Impairment– Might these also help the “fog” of FM and CFS?

brain fog and vitamin B

People who have chronic fatigue syndrome (CFS) and Fibromyalgia (FM) often struggle with a kind of mental “fog”. We don’t understand why and there’s been little research on how to think more clearly. Mild Cognitive Impairment or MCI presents with a different kind of cognitive “fog” but it’s form might feel familiar. MCI affects some 15-20% of Americans, aged 65 and older. While anyone can develop MCI, the risk is higher among people who have a high blood level of the amino acid homocysteine. High homocysteine also predicts a higher risk for developing full-fledged Alzheimer’s Disease.

Continue reading Natural Treatments For Mild Cognitive Impairment– Might these also help the “fog” of FM and CFS?

Powerful Proof that Symptoms of Chronic Fatigue Syndrome and Fibromyalgia are REAL and MAINLY PHYSICAL

I interviewed Dr. ALan Light, Ph. D by Skype in a three part video series. His research is among the very most innovative and important in the fields of chronic fatigue syndrome and Fibromyalgia. He, along with Lucinda Bateman, M.D. and colleagues from the University of Utah School of Medicine, has successfully conducted one study out of a very few that identify an objective laboratory marker which closely correlates with the patients’ “subjective” complaint of prolonged fatigue after modest exertion. This proves that the patients’ subjective reports of post-exertional malaise (PEM) are honest, real and based on physical events. More details on this study and its significance can be found on the following three 10-minute videos and text below.

Segment 1: Provides background on why and how this research was developed

Segment 2: Provides details about this critical study

Segment 3: Reactions from the scientific study and next steps

Details of Study

Dr. Light, Lucinda Bateman, M.D. and colleagues from the University of Utah School of Medicine measured output of messenger RNA output from 13 selected genes. They did this just before, shortly after, and for 48 hours following very modest exercise on a stationary bicycle. The subjects included 48 patients with CFS with or without co-occurring FM, 18 patients who had FM but not CFS, and 49 healthy controls. The 13 genes monitored related to sensory nerve signaling, cytokine and immune function and the sympathetic nervous system.

Results

All CFS and FM patients reported increased symptoms of pain or fatigue for a full 48 hours following the exercise. In controls, there was no reported fatigue and no significant change in gene expression. All subjects showed objective changes in the RNA output from key genes which also lasted a full 48 hours.

There were two distinct patterns of response: In 71% of patients with CFS moderate exercise increased messenger RNA output from 12 of the 13 genes. This was true whether or not they also had FM. Most of these genes related to inflammation or nerve signaling. In the other 29% of CFS patients, exercise caused a decrease in output of messenger RNA from an adrenalin related gene. Many of these patients also had a clinical history of orthostatic intolerance (low blood pressure with prolonged standing). In contrast, the FM-only patients showed no post exercise changes in gene expression.  Text on the full study and results can be found at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02405.x/full
Significance

By showing changes in gene output this objectively proves that the fatigue and pain are real and are mainly physical., Dr. Light’s work appears to identify two different subgroups of CFS patients—one where pro-inflammatory genes turn on, and a second type where blood pressure tends to fall and an adrenalin related gene turns down its activity.  Dr. Light’s work also suggests that Fibromyalgia can occur in two different forms—one that is closely associated with CFS and one which is not.

Psychotherapy for ME/CFS Does Not Help Fatigue (much)

option 3
psychotherapy for ME/CFS

Background
In the U.S., few physicians or scientists still believe that ME/CFS is mostly “all in your mind”. At last, the National Institutes of Health (NIH) has also come on board. NIH has charged the National Institute of Neurological Disorders and Stroke with the (not yet budgeted) task of advancing research on ME/CFS. But, in Europe, influential elements remain committed to the view that ME/CFS is mainly a problem of psychological distress. This stress, they argue, causes people to become inactive. Inactivity then causes physical deconditioning—much like the astronaut who can barely stand up when she first returns from space.

The PACE Study
Sadly, promoting this “psychosomatic” view tends to discourage research institutions, aspiring scientists, drug companies and philanthropies from committing to research toward understand our illness.  The PACE study, done in England, is often cited to justify the “all in your mind” hypothesis.  This study created three groups of patients with a chronic fatigue like illness. The researchers gave patients in one group a cognitive behavioral psychotherapy program. A second group did a gradually graded exercise program. The control group had no exercise or psychotherapy program. Instead they were treated by physicians who were said to specialize in ME/CFS but did not receive psychotherapy or graded exercise.

Issues with PACE
The PACE study has flaws.  Some of these flaws could undermine the study’s conclusions. For example, it’s not at all clear that all the study subjects actually had what we would agree is either ME or CFS. Serious questions have been raised as to potential bias in how the authors’ decided which patients had improved and which patients had not. Nor is the claimed degree of improvement anywhere close to what one might view as a “cure”.   But, even more troublesome is the false extrapolation from the PACE data that people who should know better have made—even if the study’s reported results were perfectly correct.

Cognitive behavioral therapy is a useful technique to help train people into the habit of positive thinking. Basically, this means seeing the glass as half full instead of half empty. Cognitive therapy has been shown to help people cope better with many different forms of indisputably physical health problems including heart disease, cancer, rheumatoid arthritis and others. Similarly, carefully monitored exercise reconditioning, if done within a patient’s limits, can modestly help people with physical illness of many types somewhat improve how they feel and function.

What’s mischievous about how the PACE study has been used is that by implying that better coping through psychological support and/or reconditioning is the answer gives the impression that the illness involved is substantially psychosomatic. No one would claim that for a patient with angina, emphysema, rheumatoid arthritis or cancer. Why assign that blame to patients with ME/CFS? But, since PACE study-related debate continues, it might be refreshing to review a study, also from England, where a psychological intervention for chronic fatigue indisputably FAILED.

Contradictory Study
298 patients with long term chronic fatigue (not clearly defined as ME/CFS) received either one of two forms of psychological counseling—“pragmatic rehabilitation” or “supportive listening”. The “control group” had routine treatment with their general practitioner.  The “pragmatic rehabilitation” therapy taught patients about physical deconditioning, coping with anxiety, improving sleep and “overcoming impediments to change”. “Supportive listening” focused on “creating an emotional and physical environment conducive to helping relationship”.

Researchers scored each patient’s fatigue and related symptoms, using the Chalder fatigue scale (an 11 questions survey asking about people’s symptoms and activities) at entry, after 20 weeks and then again about a year later.  After 20 weeks the average score in all three groups improved but only modestly. Scores in the pragmatic rehabilitation group were modestly better than either the “supportive listening” or the general practitioner groups. At 20 weeks the advantage to pragmatic rehabilitation was statistically significant.  But, by 70 weeks no further improvement had occurred in any of the 3 groups. And the difference between pragmatic rehabilitation treatment and the general practitioner group was no longer statistically significant. Basically, the two different forms of behavioral/psychological counseling had at best a very modest short term impact on the severity of illness. Over the long run the psychological component had no meaningful impact.

Take Away Thoughts
Why is this important? So as long as those who matter believe ME/CFS is mainly “all in your mind”, everyone suffers—patients, their families, aspiring scientists, health care budgets and society in general. (Well maybe not the disability insurance companies.)  But our patients’ battle is far from won even in the USA.

NIH has committed itself to look seriously at ME/CFS. But, no increase in budget has yet been set. Please recall this. For 2015 and 2016 NIH budgeted only about $5 million a year to study ME/CFS, while the Centers for Disease Control estimates that more than one million Americans suffer from chronic fatigue syndrome. In contrast, an estimated 400,000 Americans have Multiple Sclerosis. NIH’s budget for MS? About $98 million a year. This isn’t a knock against MS research; just a comparison.

NIH has not yet committed to a new and presumably higher budget for ME/CFS. As all such decisions reflect a mix of political and scientific issues, those among us who have any credibility with federal legislators or bureaucrats—this might be a good time to employ some of our clout.

We welcome any comments you have especially your experiences with psychological counseling.  Thank you.

 

Can Mold Cause Chronic Fatigue Syndrome? Is Mold a “Breakthrough” or Just a False Lead?

When we talk with Chronic Fatigue Syndrome patients we learn that before they became ill, some were exposed to water-damaged buildings (WDB) or other mold sources.  This raises two questions:

  1. Are people with CFS more likely to have been exposed to WDB or mold than are healthy persons?
  2. If we reduce a CFS patient’s mold burden would this improve their symptoms?
mold and chronic fatigue syndrome
mold and CFS

We can’t answer either question definitively yet.  But, both questions are highly relevant–especially the first.  One reason is the commercial availability of a new test that measures the amount of mold toxin (mycotoxin) in a person’s urine.

Dr. Joseph Brewer, an infectious disease specialist from St. Louis, addressed the first question. Dr. Brewer reports that chronic fatigue syndrome patients are much more likely than healthy people to have mold toxin in their urine. This suggests that mold exposure might be an important causal contributor to CFS.

Dr. Brewer studied 112 patients all of whom met the Center for Disease Control’s 1994 criteria for Chronic Fatigue Syndrome. Using RealTime Lab’s urine test for a panel of three mycotoxins,  Brewer found that 94% of his CFS patients had at least one kind of mycotoxin detected in their urine. Most importantly, these patients were NOT selected because they were already known to have a history of mold or WDB exposure. They were selected for this study only because they had presented with CFS.  However, as it turned out, 90% of these patients did have exposure to a water damaged building.

But, wait! Might many healthy people also have mold toxins in their urine?  Dr. Brewer did not recruit healthy controls to compare with his patients.  Instead he relied on an earlier study done by RealTime Laboratories. RealTime tested 51 healthy persons who had no history of exposure to water damaged buildings. Among these not even one tested positive for mycotoxins.

My thoughts:  The validity of RealTime’s study is critical.

If this “stand in” for a control group reasonably represents the general population then Dr. Brewer’s finding that almost all CFS patients had mold toxin in their urine strongly supports a causal connection between mold exposure in this illness. Therefore, it is a critical priority to confirm or deny RealTimes report that healthy people rarely have mycotoxin in their urine.  

Others are skeptical. The Center for Disease Control and several “mainstream” environmental specialists I spoke to doubt the usefulness of urine mycotoxin testing. From CDC’s Morbidity and Mortality report:

Low levels of mycotoxins are found in many foods; therefore, mycotoxins are found in the urine of healthy persons.  Mycotoxin levels that predict disease have not been established. Urine mycotoxin tests are not approved by FDA for accuracy or for clinical use … Persons using direct-to-consumer laboratory tests that have not been approved by FDA for diagnostic purposes and their health care providers need to understand that these tests might not be valid or clinically useful. Additional information about molds and their health effects is available at www.cdc.gov/mold/faqs.htm#mold.

Paradigmchange.me, a resource which focuses on mold problems, is also skeptical about the use of the mycotoxin test especially the claim that people who have not lived in sick buildings almost never have urine mycotoxins. But, they do believe that mold is an important trigger for ME/CFS.

Dr. Brewer understands these issues and welcomes further research that can confirm our deny his findings. 

Dr. Brewer also addressed the second question – Does treating for mold help CFS patients feel better?  Brewer treated 151 mycotoxin positive CFS patients with intra-nasal Amphotericin, a potent anti-fungal agent.

Ninety-four patients of the original 151 tolerated Amphotericin and remained on treatment for six months or more. Among these 88 out of 94 reported an improvement in their symptoms of at least 25%. Twenty six patients (30%) rated themselves as between 75-100% improved. If confirmed, these are very impressive results. Brewer reported similar benefits with intra-nasal Nystatin.

Sadly, neither of Brewer’s treatment trials had a placebo arm. So, we cannot say for sure whether the reported benefits are real.  Perhaps  patients told Dr. Brewer what they thought he wanted to hear. Perhaps they felt better because Dr. Brewer took them seriously. Perhaps a placebo effect, etc.

link of mold to CFS
mold damaged building

For now, all we can say is that Brewer’s results are encouraging, but not conclusive. And the mainstream literature is discouraging. For example, patients with chronic sinusitis often have fungal infections. But 3 double blind studies found that treatment with Amphotericin was no more effective than was using a placebo.

 

My Bottom Line: Dr. Brewer’s work is strong enough to justify that the CFS-advocacy community invest time and money to do a rigorous controlled study testing whether Dr. Brewer’s potentially critical findings can be reproduced.

I suggest that until more evidence appears:

  1. Dr. Brewer should be praised for his great effort in launching his studies. Doing research from a private practice base is very demanding.
  2. Since there are no proven treatments for ME/CFS and since preliminary evidence favors a role for mold, it’s not unreasonable for CFS patients to consider consulting Dr. Brewer or other “alternative medicine” minded  health specialists such as Ritchie Shoemaker, M.D. who have experience treating CFS patients for mold.
  3. BUT be aware that these treatments might or might not in fact be useful. Without better research we cannot know for sure.  Mainstream environmental specialists, including CDC, doubt the clinical value of urine mycotoxin testing.
  4. Evaluation for mold can be expensive. RealTimes Laboratories’ urine panel for 4 mycotoxins costs about $700.  Most insurance plans don’t cover it. However, Medicare has started covering the test –if the physician submits a proper set of codes. (Physicians may contact me directly for advice on coding.) Cleaning up a home or office can be extremely expensive.. Let the buyer beware.
  5. A controlled study to confirm or refute RealTime Laboratories and Dr. Brewer’s data should be fairly simple and relatively inexpensive. Therefore,  we should all pray that an Angel or NIH or CDC will be inspired to fund this critical study: Compare the rate of urine mycotoxin and sick building exposure among chronic fatigue syndrome patients with that for appropriate controls. Such a study should quickly decide whether the fungal hypothesis for CFS is or is not truly a breakthrough. 
  6. If the fungal hypothesis has merit, it might also affect a broader spectrum of illness.  For example, a Spanish research group did autopsies on ten Alzheimer’s patients. They claim to have seen fungus within the brains of all ten. No fungus was seen in the brains of 15 controls.  (Additional information can be found on www.alzforum.org/news/research-news/dementia-la-mold-fungi-may-lurk-alzheimers-brains.)  A similar study reported fungus in the brains of patients with ALS (Lou Gehrig’s disease.)

We welcome comments from anyone with experience with mold testing and any health issues, especially CFS, related to mold.