Tuesday, December 16, 2008

Coenzyme Q10 and Mepron

A lot of theories seem to float around in the land of Lyme and then become woven into the fabric of the paradigm. DON'T TAKE Q10 IF YOU ARE TREATING BABESIA! Is this right?
First of all, does coenzyme Q10 work? Apparently it does. It is even mentioned in lectures at Harvard as possibly effective for a variety of conditions. It's efficacy in heart failure is pretty well established. It works in the mitochondria of the cell. This is the cell's power house which generates ATP- energy- through the KREBS cycle.
It appears to help cells produce more energy. Patients taking the supplement claim they have increased energy and less fatigue. By the same token, creatine- which I previously discounted- of weight lifter fame, may also improve energy by providing a vehicle for storing ATP.

Atovaquone- Mepron and Malarone also appears to work through a mitochondrial mechanism. It interferes with electron transport- the final stage of the KREBS cycle necessary for cellular energy production. This is considered a possible mechanism of action. It does not involve the coenzyme Q10 pathway. And even if it did, it inhibits an enzymatic conversion in the cell. It's effect would be independent of the amount of Q10 present. And furthermore- there is nothing to suggest that oral Q10 supplements would have any way of getting into bacterial mitochondria.

Q10 and Mepron both have effects in the mitochondria of cells. That is all they have in common. They work on different cellular mechanisms. If Q10 is an effective supplement for Lyme symptoms, then there is no scientific rationale for stopping it when anti-Babesia therapy is prescribed.

I know this contradicts advice I have given patients in the past. But not having the time to research every recommendation, I had taken this on faith. I think it was incorrect advice.

21 comments:

girl mark said...

hey, while on the topic of babesia, sir- could you address what you think about air hunger at some point in this blog?

I've been trying to gather info about it to make a Lymenet post- it seems like every few weeks we get a horribly panicked person on the Lyme forums who doesn't know what's happening to them.

It doesn't seem like there's a huge amount of information out on the internet about what might cause air hunger.

It's also one of the common 'truisms' of Lyme treatment that air hunger is specifically a sign of babesia, though I know that LLMD's say that other infections can cause it. I'd love to see your opinion on this stuff...

Claire said...

So does Mepron increase energy like Q10? What is its effect on the Mitochondria?

Lyme report: Montgomery County, MD said...

Mepron has no effect on your energy.
It inhibits the ability of the parasite to produce energy, thereby killing it- hopefully.

Lyme report: Montgomery County, MD said...

Yep.
Air hunger, neck pain and sweats are always listed as the top three for Babesia.

I have found that only sweating and flu like symptoms which recur in a cycle can be reliably associated with Babesia infection.

The list comes from Burrascano's guidelines. I do not know what the basis is.

Perhaps Babesia can inflitrate into pulmonary tissues. Perhaps it causes a central-brain event which decreases the respiratory drive.

Perhaps it is none of the above.

Unfortunately there is no science or medical literature to support these beliefs.

All you can report is that this association has been reported.
Keep in mind that there are many causes for breathlessness. Lyme can cause pleurisy: there may be an asthmatic or wheezing disorder: there may be anxiety or cardiac issues. Babesia would/should be the last thing on the rule out list.

dogdoc said...

? I thought mepron was a competitive analog of coQ10.
From prescribing information ... "Atovaquone is a hydroxy-1-4-napthoquinone, an analog of ubiquinione... In plasmodium species, the site of action appears to be cytochrome bc1 complex. Several metabolic enzymes are linked to the mitochrondrial electron transport chain via ubiquinone. Inhibition of electron transport by atovaquone will result in direct inhibition of these enzymes. The ultimate metabolic effects of such blockade may include inhibition nucleic acid and ATP synthesis."

sickofit said...

I have heard, at lectures, that when taking Mepron you should not use Q10. That has been standard advice. I don't know exactly why. On the air hunger and Babesia. When I had severe sweats, fever, excruitating headache and other typical Babesia symptoms, I did experience air hunger to the point that I could only manage a very light breathing pattern with a dry cough. No sinus symptoms and never a wet cough. This did cycle about every 4 weeks. It went away along with other Babesia symptoms after treatment with Mepron, Zithromax and the Artmenisan so I believe that, at least for some of us, it is a valid symptom to look for with Babesia.

jenbooks13 said...

Hi--LymeMD or dogdoc; on lymenet someone is reporting Clongen finding babesia in muscle biopsies. Can either of you provide more insight or detail? Thanks.

girl mark said...

I mentioned something about this in an old post of yours from this summer:

- I heard somewhere that air hunger is related to vagus nerve damage

-does anyone here have any substantiating information about that?

(and I seem to have the soft palate damage that comes with vagus nerve issues, and have some of the symptoms you've written about earlier in the summertime: http://lymemd.blogspot.com/2008/06/lyme-and-sleep.html )


Just trying to connect my own pieces of the puzzle... and find some journal references or something else to base more reading off of.

MariaA

Lyme report: Montgomery County, MD said...

I thought Q10 involved a different part of the electron transport system. At any rate, it still doesn't make sense that oral supplements will increase levels in the parasites. If enzymatic pathways are inhibited, the concentration of Q10 may be irrelevant. If patients respond just as well while taking Q10, I suppose that is the best clinical answer we can get at this time.

Lyme report: Montgomery County, MD said...

Rumors run rampant. I do not believe that Clongen is looking at muscle biopsies. They are working on sequencing the bacteria causing dramatic bacteremia in many very sick patients. It is resistant to most antibiotics- or all the commonly used ones as far as I can tell. Once it is sequenced the bacteria will need to be cloned and cultured on an appropriate medium so that antibiotic sensitivity testing can be done.

It is not: Bartonella- BLO- Mycoplasma or any other known co-infection. It may be a very rare genus. This process may take weeks or months. It may be a very exciting finding.

jenbooks13 said...

Thanks for clearing that up about muscle biopsies etc. I appreciate it.

You will have to have celebratory balloons on your blogsite the day you can post the Clongen news.

Now here *is* what may seem a stupid question--but why wouldn't this bacteria be visible on blood cultures--the kind you take often in hospitals while you try to figure out what is causing trouble in a patient? If its swarming and swimming through the blood you'd think it would be visible, right? Even if it was mistaken for some other organism it is not. I don't know much about this so if you could explain more, thanks.

Lyme report: Montgomery County, MD said...

To culture something you have to streak it on an agar plate and incubate it. Bacteria, if present should show up as discrete colonies. If you don't have the right kind of culture medium with the right nutrients nothing will grow. For example, Mycoplasma won't grow in culture and Bb is hard to culture. Anerobic bacteria will only grow if incubated under low oxygen tension.
Growing germs in the labs is not as easy as it sounds. It helps if you first know what you are trying to grow.

jenbooks13 said...

It's beginning to sound like The Purloined Letter (hidden in plain sight).

jenbooks13 said...

I should add it still doesn't make sense to me so I will study a little. It still seems to me that lots of highly motile bacteria in the blood shouldn't evade regular sfnears off slides ie cultures.

UPYRS said...

Dear Doctor,

I don't understand why in Heaven's name is there not a specific protocol all practicing lyme doctors should follow...Help me out, please. I was seeing a Doctor for months before I was tested for Babs for which I was positive for Duncani..Then upon seeing another Doctor I also found out I have mycoplamsma, CPn, Thyroid ABs and CIDP. If a Doctor put himself out to be a lyme Doctor why do we as patients have to be our own advocates until we search and hunt around for that doctor who takes nothing for granted and tests for these?

Most chronic lymees have a host of symptoms like I, weird to say the least. They don't fit neatly in Doc B's box...Can't the treating Doctors agree on a protocol that must be followed in the very least? I have spent money and time along with traveing to NYC sick as can be to help with a diagnosis. I think it's time to get our act together and unify.

Everyone worries about the IDSA, ok but like Lincoln said "a house divided can not stand".

Thanks for the vent

Brian said...

I don't know the mechanism that creatine would use in the Krebs cycle however I know it works because my wife has fibromyalgia and and taking creatine makes her muscles less tense and sore. When I was taking Anatomy and Physiology I theorized that this was because creatine phosphate is a secondary energy storage in muscle cells. When you use your muscles the first energy that is used is ATP which is turned into ADP when a phosphate is removed. To reenergize the ADP, creatine phosphate gives up its phosphate. Following that sugar is broken down in the Krebs cycle to reenergize both ADP and creatine. ATP provides about 4-6 seconds of energy for muscles, creatine phosphate provides another 4-6 seconds of energy then energy has to come from breaking down glucose. Muscle biopsies of fibromyalgia patients shows a decrease in the levels of both ATP and creatine phosphate. Ingesting creatine monohydrate has been shown to increase muscle levels of creatine phosphate.

This is my understanding of how creatine increases available cellular energy. I don't know that creatine helps other cells besides muscles since it is outside the Krebs cycle. Meat eaters should also get plenty of creatine from their diets as there are high levels of creatine in meat.

Lyme report: Montgomery County, MD said...

Bryan-
You are correct. Creatine is not a Krebs cycle factor. It is vehicle for the storage of Krebs cycle produced ATP. Thanks for the correction.

Lyme report: Montgomery County, MD said...

It is easy to be an IDSA doctor. They are the same. ILADS doctors are all different.

It has been said that all functional families are the same. All dysfunctional families are dysfunctional in their own unique way.
Point: There are no functional families.
ILADS docs are doing their level best managing an illness which is complex and still poorly understood.

Rich said...

Hi,

This is my second time on Mepron. I was on for 5 months and started feeling better, but was then taken off thinking it was enough. I then switched to Lyme treatment....I slowly got worse and never recovered. I still have all postive Babesia tests, standard tests and the FISH test. I rarely ever have air hunger, but notice it once in a while. My doctor says this is most likely dude to the fact that I have always eaten a healthy diet and been involvecd in sports and exercised daily for years...so I assume I am well oxygenated...hence why she feels I have little to no air hunger. I never noticed night sweats either. But, I know with these diseases, the clinical picture is different for each of us. I still have positive tests so i am back on Mepron, Zith and alo Ceftin.

Now, I was told Vitamin E, Alpha Lapoic Acid and CoQ-10 should be avoided since they are fat soluble.

This is what I read:
Precautions: There are important precautions related to atovaquone. The first is that it can cause temporary liver damage, and for that reason, blood tests for liver function must be followed on a regular basis while using either of these medications. The second precaution concerns the use of supplement doses of coenzyme Q10, alpha lipoic acid, and vitamin E while on atovaquone. These should not be used while taking atovaquone because they are all fat-soluble antioxidants that tend to neutralize the pro-oxidant effects of atovaquone against Babesia.

ladybug said...

There are two of us on Mepron and Zithromax and have been for two months now. We were never told by our MD ... hopefully we have not wasted 3K and health because of the co q10, vitamin e and alpha lapoic acid. Curious as to why an MD would not mention this especially since the medication is being ordered by his office. Very grateful though that he is attacking Lyme Disease, etc.
Mepron has caused severe mood swings and psychotic episodes that come and go, is this normal? Of course, during my treatment with Bartonella and Lyme Disease ... had similar issues. Probably the Chlamydia Pneumonia? Difficult to know. Thank you for all your information, I am glad I found the site.

BAM said...

I think the original poster may be on to something.
My doctor, a notable LLMD, has been researching this, and feels that the mepron goes after the babesia's CoQ10 and not ours.

Therefore, it shouldn't work against mepron to take CoQ10 as long as you space them at least 2 hours apart when taking them.

That way, you won't have any issues absorbing the mepron, but you still get the benefit of the CoQ10.

Also, remember that statins and related drugs can be dangerous because they lower your CoQ10 levels. And I haven't gotten a clear answer from anyone if mepron lowers your CoQ10 as well. If it does, you'd be better off taking the CoQ10, rather than risk your heart, imo.