of being tired?
by James South MA
According to Dr. Michael Schmidt in his book Tired of Being Tired,
chronic fatigue, tiredness and low energy plague millions of people in the
Western world. Indeed, fatigue, chronic tiredness and low energy are the most
common reasons which lead people to seek medical care. Dr. Schmidt notes that a
1987 survey found that 24% of adults who visit primary care health clinics
"always feel tired". (1)
Constant fatigue and low energy are not restricted to those who suffer the
relatively uncommon "Chronic Fatigue Syndrome," nor are they direct
indicators of any specific disease. Dr. Schmidt lists a host of factors or
conditions associated with chronic fatigue and low vitality: vitamin/mineral
insufficiency; food allergy/intolerance; blood sugar disorders; hidden
infections; depression; thyroid problems; physical inactivity; poor
sleep/insomnia; cancer, heart or lung disease; antibiotic/prescription drug
overuse; stress; chemical toxicity... and more! (1)
Yet more people suffering chronic low energy receive thorough medical exams
which rule out these conditions and more, and then are told by their physicians
that there is nothing medically wrong with them, with the barely (if at all)
hidden implication that perhaps "It's all in your head", or that
they're just neurotic hypochondriacs.
Fortunately for the "energetically-challenged," scientific research
has uncovered a cluster of issues relating to nutrition, cellular energy
metabolism, and free radical/antioxidant biochemistry, which offers both
explanation and remedy for the modern epidemic of the "low energy
Energy is needed at all levels of our being - from the microscopic to the
macroscopic. At the cellular level, energy is used to make new proteins, to
bring nutrients into a cell and expel cellular wastes, to repair damaged DNA, to
synthesize neurotransmitters, etc. At the organ level, the heart uses energy to
pump blood, the kidneys use energy to filter wastes while recycling precious
nutrients, the brain uses energy to conduct electrical nerve impulses, the lungs
use energy to take in oxygen and expel carbon dioxide and so on. At the level of
the whole person, we use energy to walk, run, talk, chop wood, lift objects,
work a computer keyboard, ad infinitum. The energy source for all these levels
is the same - it is the bio-energy molecule ATP (adenosine triphosphate) the
"universal energy currency of the cell." As Mathews and van Holde
point out, "The processes of photosynthesis and metabolism of foodstuffs
are used mainly to produce ATP. It is probably no exaggeration to call ATP the
single most important substance in bio-chemistry." (2,p.83) ATP is the
energy of life. Where there is no ATP, there is no life. Where ATP is low,
energy is low. It's that simple.
FROM FOOD TO ENERGY
ATP does not come ready-made in the food we eat.
Rather, the trillions of
cells which make up the human body must each generate their own ATP from the
glucose, fatty acids and amino acids derived from digestion of the
carbohydrates, fats and proteins provided by the food we eat. After
digestion/absorption by the stomach/small intestine and processing by the liver,
molecules of glucose, fatty acids and amino acids are transported through the
bloodstream to the trillions of ever-hungry cells waiting to convert these
nutrient molecules into the ATP the cells/organs need to power their every
Cells primarily "burn" glucose and fatty acids to make ATP, but
amino acids - especially alanine and the branch-chained amino acids - may also
be used as fuel during intense exercise, hard physical labor, starvation, or
even during periods of low blood sugar between meals.
Once inside the cell, these fuel molecules are processed through three
interlocking ATP-energy production cycles. The first cycle is the glycolytic
cycle. This nine-step cycle "burns" only glucose, and is driven by
enzymes that exist in the cytoplasm of the cell - the gel-like watery fluid
between the cell's outer membrane and the nucleus. If the glucose is metabolized
in the absence of oxygen (anaerobic glycolysis), then one molecule of glucose
generates two molecules of ATP-bioenergy, as well as two molecules of lactic
acid - a "waste product" that may cause the "muscle burn"
and skin redness associated with intense exercise.
If glucose is "burned" with oxygen (aerobic glycolysis), then one
molecule of glucose yields two ATP's, but two "bonus products" are
also made that serve as further ATP-producing fuels in the next two
ATP-generation cycles: the Kreb's or citric acid cycle and the electron
The first "bonus product" is two molecules of NADH - the reduced
(energy rich) coenzyme form of vitamin B3, which will make six ATP's when
successfully processed through the electron transport chain. The other
"aerobic bonus" is pyruvic acid, which can then be converted by the
multi-enzyme pyruvate dehydrogenase complex into acetyl coenzyme A, the starting
fuel for the Krebs'/citric acid cycle, which in turn feeds the electron
transport chain with more NADH , altogether, if every step of the complex,
interlocking ATP "tri-cycle" works perfectly (it doesn't always
happen), in the presence of adequate oxygen, then one molecule of glucose
starting through aerobic glycolysis can ultimately generate 38 ATP molecules.
Thus anaerobic glycolysis is only about 5% as energy efficient (2/38) as the
combined aerobic glycolysis/citric acid cycle/ETC energy metabolism
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MITOCHONDRIA: WHERE THE (ATP) ACTION IS
Mitochondria are tiny, sausage-shaped organelles that exist inside virtually
all cells, except for red blood cells. Their number may range from 50-2500 per
cell, and they may account for 20% of the cell volume in high-energy cells
(brain, heart, liver).
It is inside the mitochondria that both the Kreb's/citric acid cycle and
electron transport chain occur. Fatty acids are metabolized inside the matrix,
or innermost part of the mitochondria, producing acetyl coenzyme A to feed the
Kreb's cycle. The Kreb's cycle enzymes are also found in the matrix. The
electron transport chain is a chain of five enzyme complexes embedded in the
inner mitochondrial membrane, where NADH and FADH2 (the energy-rich coenzyme
form of vitamin B2, produced in the Kreb's cycle) are processed to generate ATP.
Each NADH can yield 3 ATPs, with each FADH2 yielding 2 ATPs]
A phenomenon unique to the mitochondria is the existence of mitochondrial DNA
(mtDNA), located inside the matrix. MtDNA encodes for 13 of the proteins that
make up the five electron transport chain enzyme complexes, while the DNA of the
cell nucleus encodes for about 60 of the proteins that make up the electron
Research of the past decade has shown that mtDNA is one of the
"Achilles' heels" of ATP energy generation (3,4,5,6) - more on that
ACTIVE ENZYMES: THE MITOCHONDRIAL SPARK PLUGS
In order for food-derived fuels to be broken down step-by-step through the
glycolytic cycle and mitochondrial citric acid cycle/electron transport chain to
yield ATP, they must be processed by enzymes. Enzymes are catalysts that
facilitate and radically speed up these steparise breakdowns. Enzymes are
analogous to spark plugs in a gasoline engine. If the fuel were pumped into a
gas engine without working spark plugs, no combustion and hence no energy
release would occur. Similarly, if the multiple enzymes involved in the three
interlocking ATP cycles are working poorly, ATP will be underproduced or not
produced at all. A functional enzyme is called a "holoenzyme". It is
composed of two parts - the "apoenzyme" and the "coenzyme".
The apoenzyme is a specific protein, with a unique shape and composition that
enables it to process a specific biochemical in a specific way. For example, the
succinate dehydrogenase apoenzyme, when activated by its appropriate coenzyme,
helps convert succinic acid in the Krebs' cycle into the next phase of the cycle
- fumaric acid, and simultaneously produces FADH2 as a fuel for the electron
transport chain. With few exceptions, enzymes are ultraspecialists - they act on
only one or a few substances, in only one or a few ways.
The coenzyme is the "activator" of the apoenzyme. Without its
proper coenzyme, even the most perfectly formed apoenzyme will be inert, and
will not do its catalyst job. And it turns out that coenzymes are always made of
the active form of vitamins, or of vitamin-like substances, such as lipoic acid
or coenzyme Q10. A coenzyme form of a vitamin is always more complex than its
basic form, the form which we get from food or supplements. For example, the
basic form of vitamin B1 is thiamin, while the coenzyme form is thiamin
pyrophosphate (TPP). The basic form of vitamin B3 is niacin or niacinamide,
while the coenzyme form is nicotinamide adenine dinucleotide (NADH). Coenzymes
often have a mineral partner that serves as a "co-activator" of the
apoenzyme. For many of the enzymes of the glycolytic cycle and Krebs' cycles,
the mineral co-activator is magnesium. (7,p.159)
Once ATP is formed, it is
normally complexed with magnesium. (2,p.84)
The vitamins used as coenzymes in the three interlocking ATP cycles are
vitamin B1 (thiamin), B2 (riboflavin), B3 (niacin/amide), B5 (pantothenic acid),
biotin, and the B vitamin-like substance lipoic acid, as well as Coenzyme Q10.
Other vitamins, such as B6 (pyridoxine), B12 (cobalamin) and folic acid are used
to transform various amino acids into forms that allow them to be
"burned" in the glycolytic and Kreb's cycles (8,pp. 423-427, 463-478)].
VITAMIN-COENZYMES: THE LINK BETWEEN FOOD & ENERGY
When a person suffers a severe enough nutritional deficiency of a specific
nutrient for a long enough period of time, a classic nutritional deficiency
disease will usually result. In east Asia earlier in this century, the vitamin
B1-deficiency disease "beriberi" was widespread due to the reliance on
polished white rice, low in B1, as the chief foodstuff. In the American South in
the late 1800's-early 1900's, the B3 deficiency disease "pellagra" was
common due to the low-B3 corn-based diet, with 10,000 people dying from pellagra
every year. During long sailing voyages in the period 1500-1780, often as much
as 1/3 to 1/2 of a ship's crew would sicken or perish from scurvy, the vitamin C
deficiency disease, due to the lack of C-containing fresh fruits and vegetables
in the shipboard diet.
Thanks in part to the government-mandated fortification of basic foodstuffs
such as flour and cereals with small amounts of vitamins B1, B2 and B3, and with
C added to other foods such as fruit juices, the classic nutritional deficiency
diseases are a mostly historical curiosity in the Western world. Western
governments, often with the aid of scientific Food and Nutrition Boards, have
set RDAs (Recommended Dietary Allowance) for most of the major vitamin and
mineral nutrients, and have even required food packaging to provide detailed
information on the nutrient levels of various foods, to aid choosing a
nutrient-adequate diet. Given the widespread availability of cheap food in the
Western world, so that even poor people can easily obtain calorie-adequate
diets, it is usually assumed that a dietary/cellular deficiency of key
energy-promoting nutrients (such as the B vitamins and magnesium) is rarely, if
ever, a cause of inadequate cellular ATP production. Yet an examination of
various lines of evidence, both conceptual and scientific, will show that such
assumption is dubious at best. To put it simply, the evidence of near-universal
absence of classic nutritional deficiency diseases does not equal evidence for a
near-universal optimum level (both dietary and cellular) of energy-enhancing
The first problem to be considered is the RDAs.
Numerous dietary studies in
recent years have shown that most Americans fail to consume the US RDA for
various nutrients. For example, Kant and Block reported in 1990 that "71%
of males and 90% of females consumed less than 1980 RDA of vitamin B-6" (9)
With regard to the B vitamin folic acid, Subar et al stated in 1989 that
"Based on the Recommended Dietary Allowance of 400 mcg/d, our results
suggest that folate intake in the United States is low...." (10)
Ironically, the very fact that Americans consume less than the (1980) RDAs
has led the Food and Nutrition Board, which sets the RDAs, to lower them in the
1989 RDA revisions, and again in the recent late 1990s RDA revisions. Thus the
1989 folate RDA was halved to 200mcg/day, a level more in line with the actual
average US consumption of folate (10). The 1989 vitamin E RDA was halved from 30
IU to 15 IU, with typical US intakes being 10-15 IU (7-10 mg). (11,p.33)
even the conservative, establishment researcher A.T. Diplock had argued in 1987
in the prestigious journal Free Radical Biology & Medicine that "It
appears likely that the present  RDA will prove too low and the evidence
suggests that an increase of between three and five-fold [i.e. to 90-150 IU]
would be expected to be beneficial...." (12)
The general lowering of
(already modest) RDAs in the last two US RDA revisions has been based in part on
the question-begging "logic" that since Americans are a basically
healthy people, and since they routinely fail to consume the earlier higher RDAs
of most nutrients, therefore the new lower RDAs are more appropriate. In a land
where over $1 trillion (1/7 of the total national income) is spent annually on
"health" - i.e. disease-care; where cancer is one of the leading
causes of death of children; where half the adult population is medically obese;
where tens of millions suffer diabetes, asthma, allergies, arthritis,
ulcers/heartburn, chronic insomnia, depression, alcoholism, drug addiction,
vision disorders, etc., to assume that Americans are healthy just because they
don't suffer classic nutritional deficiency diseases is rather
Alice-in-Wonderland "logic," indeed.
However, there is a deeper conceptual and scientific falseness to the RDAs
beyond their recent specious downward revisions. Part of the problem stems from
the conceptual framework of the RDAs as such. The 1980 Recommended Dietary
Allowances states that "RDA are recommendations for healthy populations.
Special needs for nutrients arising from such problems as premature birth,
inherited metabolic disorders, infections, chronic diseases and the use of
medications require special dietary and therapeutic measures. These conditions
are not covered by the RDAs.... The requirement for a nutrient is the minimum
intake that will maintain normal function and health.... For certain nutrients,
the requirements may be assessed as the amount that will just prevent failure of
a specific function or the development of specific deficiency signs - an amount
that may differ greatly from that required to maintain maximum [i.e. optimum]
body stores," [author's note]. (13,
With regard to the first statement, since the majority of Western peoples
(especially Americans) suffer either chronic diseases such as diabetes,
arthritis, asthma, allergies, depression etc or routinely take both
over-the-counter and prescription medications, such as
aspirin/ibuprofen/acetaminophen, allergy medications, Zantac, Maalox, laxatives,
Prozac, heart drugs, cholesterol-lowering statin drugs etc. Then by the National
Research Council's own statement the RDAs are irrelevant to their required (for
optimum health) nutrient intake. The second two RDA statements focus on minimum
nutrient intake, and on just [i.e. barely] avoiding specific physiologic
function failure and/or specific nutritional deficiency symptoms. This makes it
clear that the RDAs were never formulated as a guide to maintaining robust,
vibrant, high energy, optimal health, but are merely intended to keep a person
"healthy" enough to (barely) avoid classical nutritional deficiency
diseases like scurvy and pellagra, or to avoid their heart or brain or liver
failing today or tomorrow - but who knows about next week or next month?
In 1964 Myron Brin published a classic analysis of the five stages of the
development of a vitamin or nutrient deficiency. He illustrated this scheme with
reference to vitamin B1. In the first, or preliminary stage, inadequate thiamin
availability due to faulty diet, malabsorption or abnormal metabolism leads to a
greatly reduced urinary thiamin loss. In the second, or biochemical stage, the
activity of a blood cell enzyme - transketolase - for which thiamin is the
coenzyme, is significantly reduced; adding thiamine to a blood sample from the
developing-deficiency person increases their transketolase activity. In the
third, or physiologic stage, various general symptoms develop, such as lessened
appetite, insomnia, increased irritability, and malaise develop. In the fourth,
or clinical stage, a constellation of symptoms classically specific to thiamine
deficiency disease (beriberi) develops - e.g. intermittent claudication,
polyneuritis, bradycardia, peripheral edema, cardiac enlargement and
ophthalmoplegia. In the fifth, or anatomical stage, histopathological changes
due to cellular structural damage are seen, such as cardiac hypertrophy,
degeneration of the granular layer of the cerebellum, and swelling of the
Although Brin's five-stage deficiency scheme is exemplified with regard to
thiamin, it is in principle applicable to any nutrient, as Brin himself notes.
Brin's scheme is especially illuminating with regard to the RDAs, since the
"just preventing failure of specific functions" or "just
preventing specific deficiency signs" criteria of nutrient requirement,
which underlies the RDA concept, are only evidenced in the fourth (clinical) and
fifth (anatomical) stages of developing nutrient deficiency disease. The first
three stages, although they are objectively, empirically measurable and
observable phases of a developing nutrient deficiency, do not involve either
"specific deficiency signs" or "failure of a specific
nutrient-related function." Furthermore, it should be noted that
"malaise," which developed in the third (physiologic) stage of B1 (and
which is common to many illnesses and nutrient deficiency diseases), is a
general bodily weakness - i.e. a felt experience of low energy and vitality.
This is hardly surprising, given the key roles of coenzyme B1 in the glycolytic
and Kreb's cycles and a demonstrable failure of an apoenzyme - transketolase -
to be fully saturated with - i.e. activated by - B1, is measurable in the early
second (biochemical) stage.
What follows from this is quite simple. The RDA level of nutrients may keep
most people out of the severe illness-leading-to-death fourth and fifth nutrient
deficiency stages, but RDA nutrient levels cannot be presumed to be adequate to
keep one out of the first three stages of "subclinical" deficiency
disease, let alone in a more optimal, vibrant, energized state of health.
Drawing upon and extending Brin's work, Dr. Karl Folkers, M.D., Ph.D., the
"godfather" of CoQ10 research, developed a methodology to determine a
more realistic RDA for vitamin B6, pyridoxine (the official RDA is 2mg), and
published his research in 1993. (15)
Folkers noted that 16 years of ongoing
biochemical and clinical research had strongly confirmed the existence of a B6
deficiency in carpal tunnel syndrome, and had also shown B6 to be a
specific and successful prophylactic and therapy for carpal tunnel syndrome.
Folkers had also
discovered an easily measurable enzyme - EGOT (erythrocyte glutamine oxaloacetic
transaminase) - whose specific activity (SA) could be correlated both with carpal tunnel syndrome
remission and with varying B6-intake levels. Folkers discovered that a maximally
B6-saturated EGOT apoenzyme specific activity level is approximately 0.7. Folkers tested 17 patients who had no overt symptoms of carpal tunnel syndrome
(which Folkers and
others believe to be a specific B6-deficiency sign) and determined their EGOT SA
levels before and after dosages of 2, 25 and 50mg of B6. The initial mean level
of EGOT SA was 0.35 +/- 0.06. After 12 weeks dosage of 2mg B6 (the typical
period established for response to B6), the EGOT SA increased to only 0.45 +/-
0.07. With a dose of 25mg B6, EGOT SA rose to 0.64+/-0.08, but 6 of 13 subjects
at that dose had a SA of only 0.5-0.6. At a dose of 50mg B6 for 7 subjects,
every one showed an EGOT SA very close to 0.7, the "ideal" level.
Folkers' research established that even for "well" patients a more
realistic B6 RDA is 25-50mg (12-25 times the US RDA), while carpal tunnel syndrome
require 100mg or more to achieve the "ideal" EGOT SA and to achieve
complete and ongoing symptom remission. (15).
Based upon the previous reasoning, as well as my own clinical experience
working with hundreds of fatigue/low energy clients over the past 25 years, as
well as the published clinical experience of colleagues such as Robert Crayhon
(11) and Dr. Robert Atkins
(16), my first and basic recommendation for a
"super-energy" regime is the following: 25-150mg of the "basic
Bs" - B1, B2, B3, B5, B6; 300-10,000mcg biotin; 100-1,000mcg B12;
400-2,000mcg folic acid. Magnesium, ideally as malate, succinate, aspartate,
glycinate, or chloride; 400-800mg daily. Bs to be taken in divided dose with
breakfast and lunch; magnesium 100-200mg with each of three meals and at bedtime
(magnesium is anti-stress/relaxing, as well as energizing). Reduce magnesium
dose if diarrhea should develop.
THE "METAVITAMIN" METABOLIC ENERGY ENHANCERS
In his 1981 article "Toward a Bio-Energy Supplement," (17) M.F.
McCarty provides a persuasive rationale for including what he terms "metavitamins,"
and which I call "metabolic enhancers," in a comprehensive energy
supplement. The key "metavitamins" are alpha-lipoic acid, carnitine/acetyl
and coenzyme Q10.
All four of these substances are life-critical cellular vitamin-like
nutrients, even though they are not, strictly speaking, vitamins. A vitamin is
generally considered to be an organic substance that an organism requires for
its normal health and metabolism, in relatively small amounts, and which it
cannot make itself, but must get preformed from diet (or supplements). Yet three
classic vitamins - A, D, B3 - can be made within the human body (from
beta-carotene, cholesterol and tryptophan, respectively), and are still
considered vitamins. Carnitine, lipoic acid and CoQ10 are all normal dietary
constituents, and are absolutely essential for life, yet they are (somewhat
arbitrarily) not considered vitamins, since they can be made within the body.
Lipoic acid is an essential part of the enzyme complex that feeds pyruvic
acid from the glycolytic cycle into the Kreb's cycle enzyme.
(18) No lipoic acid
= no ATP from the Kreb's cycle or electron transport chain; not enough cellular
lipoic acid = not enough cellular ATP. Lipoic acid has been in medical use in
Germany for decades, both to treat liver diseases and to treat diabetic
Dr. Lester Packer, a lipoic acid "enthusiast"
recommends 50mg twice daily. (19)
I have found 50-100mg twice daily with meals
to be an excellent energy aid - I have used it for the past 13 years as a key
part of my own energy regimen.
Coenzyme Q10 (CoQ10) is an absolutely energy-critical cellular nutrient. When
one molecule of glucose is aerobically metabolized through the glycolytic and
Kreb's cycles, only 4 ATPs are directly produced by these cycles. Their main
contribution is to send NADH (reduced coenzyme B3) and FADH2 (reduced coenzyme
B2) to the electron transport chain, where 5 enzyme complexes use these
substances to generate the other 34 ATPs that can arise from
"combusting" one molecule of glucose. Complex I (NADH dehydrogenase)
uses NADH to pass electrons on to CoQ10. Complex II (succinate dehydrogenase)
uses Kreb's cycle-generated FADH2 to pass electrons on to CoQ10. CoQ10 then
passes these electrons to Complex III (cytochrome b). From there cytochrome c
passes the electrons on to Complex IV (cytochrome oxidase), where they combine
with oxygen and hydrogen ions to make water. This electron transport chain
enzyme complex activity in turn operates Complex V - ATP synthase, which
produces the actual ATP that powers everything we do. (20,
pp.66-73) CoQ10 is
obviously the "linch-pin" of the electron transport chain, uniting 3
of the 5 enzyme complexes that ultimately make most of our ATP.
Like many other substances produced by the body, levels of CoQ10 decline with
age. Although CoQ10 is found in food such as salmon, liver and other organ
meats, it is nearly impossible to get enough CoQ10 from diet alone, especially
in our later years.... Dr. Karl Folkers was the first to suggest that the
age-related decline in CoQ10 was a contributing factor to... Cancer, heart
disease and Alzheimer's disease.... Since CoQ10 is involved in the production of
ATP, it made sense that a decline in the production of this antioxidant would
disrupt the body's energy-producing system.... In fact, heart muscle biopsies in
patients with various heart diseases showed a CoQ10 deficiency in 50 to 75
percent of all cases". (19, pp.94-96)
Idebenone is a synthetic derivative of
CoQ10. Various studies have shown that Idebenone may function even better as an
antioxidant and electron transport chain agent than CoQ10. Thus Latini et al
report that "A stimulation of respiratory and phosphorylating activity
[i.e. ATP production] has been observed in mitochondria prepared from rats
treated with Idebenone.... Our experiments suggest that Idebenone, by increasing
brain adenosine levels and nucleotide phosphorylation [i.e. ATP production], may
be beneficial in ischemic [low oxygen] disorders". (21) Wieland et al note
that "idebenone, a synthetic CoQ10 derivative, is known to have
greater antioxidative capacity than CoQ10, which is not restricted to the reduced
form of the molecule [only reduced - i.e. non-oxidized - CoQ10 is an effective
antioxidant]. In our experiments, idebenone was far more effective than CoQ10 in
preventing oxygen radical-mediated damage to microsome lipids and proteins....
It is noteworthy that after oral administration idebenone can preserve the
electron transfer activity in the terminal respiratory chain [ETC] of
mitochondria, thus stimulating ATP formation. debenone is non-toxic to humans and
has been used successfully in the therapy of patients suffering from a variety
of neurological disorders". (22)
suppressed by about 10% the non-respiratory oxygen consumption [i.e. oxygen
which generates toxic free radicals rather than ATP]..., which [is] closely
associated with non-enzymatic [free radical] reactions such as lipid
peroxidation, membrane lysis and swelling of mitochondria. Thus, idebenone
contribute to stimulate the net ATP formation by the well-coupling of electron
and energy transfer, and by the reduction of [toxic] non-respiratory oxygen
consumption in cerebral metabolism." (23) Thus a combination of CoQ10
(50-100mg) and Idebenone (45-90mg), taken with fat-containing meals, may provide
effective enhancement to the electron transport chain production of ATP.
Carnitine is a B vitamin-like substance the body makes from the aminos lysine
and methionine, with the help of vitamins B3, B6 and C. (24) Carnitine is
generally found in the same animal foods that are rich in CoQ10. Carnitine is
the only substance that will serve to transport fats (fatty acids) into the
mitochondrial matrix, where they can be converted to acetyl coenzyme A and
"plugged in" to the Kreb's cycle to produce ATP. Without a carnitine
"escort," the fatty acids cannot pass through the inner mitochondrial
Carnitine also functions to couple pyruvic acid
from the glycolytic cycle to the Kreb's cycle, especially in conditions of
maximal physical exertion, thus enhancing ATP production when it is most in
Carnitine expert Brian Leibovitz in a 1993 review article wrote that
"...studies of endurance athletes have revealed that subjects given 2g of
carnitine (twice daily) had higher levels of electron transport system [ETC]
components. Specifically, carnitine supplements increased the activities of NADH,
cytochrome c reductase, succinate cytochrome c reductase, and cytochrome oxidase....
Carnitine supplements are also important in maintaining optimal health.
Available evidence strongly suggests that one cannot achieve optimal health
without taking carnitine supplements" (24).
Acetyl l-carnitine is carnitine's "alter ego."
and Acetyl l-carnitine can interconvert to each other under some circumstances. (25)
their excellent review "Oxidative damage and mitochondrial decay in
aging" Shigenaga, Hagen and Ames state that "A rapidly growing body of
evidence suggests that the apparent age-related deficits in mitochondrial
function can be slowed or reversed by Acetyl l-carnitine, a normal component of the inner
mitochondrial membrane that serves as a precursor from acetyl-CoA as well as the
neurotransmitter acetylcholine.... Acetyl l-carnitine has been shown to reverse the
age-related decrease in the levels of mitochondrial membrane phospholipid
cardiolipin and the activity of the phosphate carrier in rat heart
mitochondria.... Acetyl l-carnitine's function in the aging brain is supported by its ability
to create a shift in ATP production from [anaerobic] glycolytic pathways to
mitochondria.... It is plausible that Acetyl l-carnitine can increase the metabolic
efficiency [of ATP production] of compromised sub-population of mitochondria and
cause a redistribution of the metabolic workload, resulting in increased
cellular efficiency...." (3)
The various performance studies cited by Leibovitz typically use 2-4 grams
per day of carnitine. (24)
Robert Crayhon in his book The Carnitine Miracle
recommends 1-4 grams daily. He writes that "Acetyl l-carnitine in
particular appears to be important in maximizing carbohydrate metabolism....
Older adults benefit greatly from carnitine during exercise. Carnitine levels
decline with age.... For these and many other reasons, carnitine is a must
supplement for those over forty who want to maximize their energy and exercise
For those who wish to gain both the energy enhancing and mitochondrial
rejuvenation effects of carnitine/Acetyl l-carnitine, a regimen of 1 gram carnitine plus
500mg Acetyl l-carnitine twice daily will probably be a reasonable dose.
NADH: THE ENERGIZING COENZYME
As discussed earlier, NADH is the key molecule used in the electron transport
chain to generate ATP. Both the aerobic glycolytic and Kreb's cycle generate
NADH that the electron transport chain then "converts" to ATP through
its five enzyme assemblies. It is almost literally true to say that, given a
healthy glycolytic system and mitochondrial citric acid cycle/electron transport
chain, NADH=ATP. It is then a major breakthrough in energy supplementation that
has occurred in the 1990's. The first stabilized, absorbable NADH supplement was
developed by George Birkmayer, M.D., Ph.D., in 1993. Birkmayer has used his oral
NADH successfully in a published open-label trial as medication in 205 patients
suffering from depression (of which fatigue is a common symptom). (26)
has also successfully used a daily 5mg NADH dose in both an open-label trial
with 470 Parkinson patients, as well as with 60 Parkinson patients at a German
clinic in a double blind trial. (26)
In a 1995 study conducted with
competitive-level cyclists and long-distance runners using 5mg NADH daily, a
significant range of performance improvements was found, including increased
oxygen capacity, decreased reaction time, and greater mental activity and
In a recent study performed with a European soccer team, players
were given 5mg NADH for one month. Blood levels of L-dopa and noradrenaline were
increased, and vigilance, alertness, concentration, and stress capacity improved. (26)
Birkmayer points out that "A deficiency of NADH will result
in an energy deficit at the cellular level, the symptom of which is fatigue....
The more NADH a cell has available, the more [ATP] energy it can produce. Unfortunately, the level of NADH in our body declines with aging and so do the
NADH-dependent enzymes, in particular those for energy production". (26)
daily dose of 5-10mg NADH, taken upon arising on an empty stomach, should be a
key part of any serious energy-enhancement program.
ATP: THE ULTIMATE ENERGY SUPPLEMENT?
In his 1981 bio-energy supplement article, McCarty points out that various
nucleosides (adenosine, inosine) and nucleotides (ATP, inosine monophosphate)
have been used clinically in Europe for decades. Adenosine and ATP have been the
preferred German nucleoside/tides. They have been used to reduce angina pain and
lower/eliminate nitoglycerin requirements in angina heart patients, and to
improve psychological status in cerebral atherosclerosis patients. (17)
"Although all tissues require [adenosine] nucleotides for an energy source
(ATP)..., not all tissues have an optimal capacity for de novo nucleotide
production. Indeed it appears that many tissues have an absolute or partial
dependence on an external source. If they are to function optimally.... most
cell membranes possess transport mechanisms enabling the transfer of nucleosides
(the non-phosphorylated form of nucleotides) from the extracellular space [i.e.
blood] to the cytosol, where these nucleosides can then be phosphorylated to
nucleotides [e.g. AMP, ADP, ATP] by special kinases.... Hepatocyte [liver cell]
ATP levels can indeed be substantially raised by adenosine." (17)
notes that nucleotides such as ATP are quickly converted into nucleosides by
blood phosphatase enzymes, when given by injection or sublingually. Nucleosides
are digested when swallowed. But since cells can absorb blood-carried adenosine
and convert it to AMP and ADP, the precursors of ATP and sublingual ATP
supplements promise a "short-cut" way to quickly raise cellular ATP
levels. Indeed, when AMP and ADP levels build up inside cells, this serves as a
signal to activate mitochondrial ATP production via the electron transport
chain, using the ADP as substrate for ATP. (2,pp.83-85)
That is why the 1975
paper by Lund et al was able to report a 3-fold increase in ATP and adenosine
nucleotides in liver cells (in vitro) 60 minutes after adding 0.5mM of adenosine. (27)
In the various German studies McCarty reported on, modest doses of adenosine
(12mg intramuscularly 3 times weekly, plus 2-3mg sublingually per day) brought
significant clinical benefit. Thus taking one - three 10mg sublingual ATP tabs
daily may prove an effective way to boost cellular ATP levels, especially when
combined with previously discussed energy-enhancing measures.
FREE RADICALS: MITOCHONDRIA'S WORST NIGHTMARE
So far this article has focused on "offensive" ways to boost ATP
energy levels. However, it pays to "play defense" as well, due to the
unique susceptibility of mitochondria to free radical damage.
"Oxidants [free radicals] are produced continuously at a high rate as a
by-product of aerobic metabolism. These oxidants include superoxide..., H2O2
[hydrogen peroxide], and hydroxyl radicals... (the same oxidants produced by
radiation) and possibly singlet oxygen.... They damage cellular macromolecules,
including DNA, protein and lipid.... Mitochondria constitute the greatest source
of oxidants.... Cross-links of inner mitochondrial membrane proteins by
oxidants, or reactive aldehydes generated from lipid peroxidation, may also
result in increased [superoxide] and hydrogen peroxide production, thus further increasing
the damage that can lead to mitochondrial dysfunction....
Studies in mammalian cell culture show that oxidative stress can adversely
affect the activity of key mitochondrial enzymes and subsequently lead to a
decline in ATP production.... Oxidant-induced damage to inner mitochondrial
membrane proteins can lead to increased leakage of [superoxide] and hydrogen
may cause [mitochondrial] DNA mutations,"
It thus turns out that by increasing mitochondrial ATP production, we are
increasing our risk of mitochondrial oxidative/free radical damage, since
"a small percentage of electrons leak away from the main stream of the
mitochondrial respiratory chain [electron transport chain],..." (28) And
superoxide begat hydrogen peroxide and hydrogen peroxide begat hydroxyl radicals, and hydroxyl radicals
begat mitochondrial mayhem!
Thus it is essential to any serious energy-enhancement program to provide a
suitable range of antioxidants to quench the electron transport chain-produced
free radicals before they can spread and do serious damage to mitochondrial DNA,
proteins and lipids - the very substances which make up our mitochondria.
It is important not to rely on just one or two "pet favorite"
antioxidants, such as vitamin C or vitamin E, for several reasons. Some
antioxidants (e.g. vitamin C) work best in the watery portions of cells and
tissues, while others (e.g. vitamin E) work best in the lipid-rich membranes of
cells, mitochondria, ribsomes, etc. Also, different antioxidants quench
different free radicals - vitamin E (tocopherol) quenches singlet oxygen and
polyunsaturated fatty acid radicals, while vitamin C (ascorbate) neutralizes
hydroxyl and superoxide radicals. (29, p.48)
Another important aspect of antioxidants is their ability to regenerate each
other. When tocopherol quenches a free radical, it itself becomes a (weak)
radical - the tocopheryl quinone radical. But fortunately ascorbate can
regenerate tocopheryl radical back to tocopherol for reuse. But the ascorbate
becomes oxidized into dehydroascorbic acid (DHA).
Fortunately along comes glutathione to reconvert DHA back to C; but now glutathione is oxidized.
Lipoic acid, in its reduced from DHLA, can then regenerate
oxidized glutathione. (18)
And NADH can regenerate oxidized lipoic acid. (18)
Lester Packer, one of the world's foremost free radical/antioxidant
researchers, has discovered a network of 5 chief antioxidants which mutually
reinforce and regenerate each other. They are lipoic acid, vitamin E, vitamin C,
CoQ10, and glutathione. (19)
Birkmayer notes that NADH is the most powerful
antioxidant of all, in addition to being the chief fuel for ATP production. (26)
Thus three of the chief ATP-enhancers - CoQ10, lipoic acid, and NADH - are
also three of the key mitochondria-protecting antioxidants. And as noted
earlier, Idebenone is an even more effective CoQ10-like antioxidant than CoQ10
itself. Packer has also reported that lipoic acid supplements can boost cellular
GSH levels "an astounding 30%" (19,
Thus, by adding 100-400 IU vitamin E as mixed tocopherols or d-alpha
tocopheryl succinate (taken with a fat-containing meal) and 250-500mg vitamin C
(ascorbic acid or magnesium ascorbate) three or four times daily to the
previously described ATP-enhancement regimen, one has safely "covered all
the bases" in preventing the very mitochondrial damage that might otherwise
ensue from successfully increasing ATP-production through energy-enhancement
The energy-supplement program described in this article is intended for
"reasonably healthy" people. Those suffering any serious illness,
especially liver, kidney, or intestinal disease, may need to modify and/or use
it under medical supervision.
THE ENERGY PROGRAM AT A GLANCE
Vitamin B1, B2, B6
breakfast and/or lunch
Vitamin B3, B5
breakfast and/or lunch
breakfast and/or lunch
breakfast and/or lunch
two to four times daily
breakfast and/or lunch
breakfast and/or lunch
AM and PM - empty stomach
daily with fat-containing
1) Scmidt, M.A. Tired of Being Tired. Berkeley: Frog, Ltd./North Atlantic
2) Mathews, C. & van Holde, K. Biochemistry. Redwood City, CA:
Benjamin/Cummings Pub. Co. 1990.
3) Shigenaga, M.; Hagen, T. & Ames, B. (1994) "Oxidative damage and
mitochondrial decay in aging" Proc. Nat. Acad. Sci. USA 91: 10771-78.
4) Linnane, A.; Zhang, C; Baumer, A; & Nagley, P. (1992) "Mitochondrial
DNA mutation and the aging process: bioenergy and pharmacological
intervention" Mutation Res. 275: 195-208.
5) Linnane, A. et al (1995) "the universality of bioenergetic disease and
amelioration with redox therapy" Biochim Biophys Acta 1271: 191-194.
6) Tzu-Chen, Y. et al (1989) "Liver mitochondrial respiratory function
decline with age" Biochem Biophys Res Comm 165: 994-1003.
7) Garrison, R. & Somer, E. The Nutrition Desk Reference. New Canaan:
8) Pike, R. & Brown, M. Nutrition -
An Integrated Approach. NYC: Macmillan. 1984.
9) Kant, A. & Block, G. (1990) "Dietary vitamin B-6 intake and food
stores in the US population" Am J Clin Nutr 52: 707-16.
10) Subar, A; Block, G. & Denise James, L. (1989) "Folate intake and
food sources in the US population" Am J Clin Nutr 50: 508-16.
11) Crayhon, R. The Carnitine Miracle. NYC: M. Evans, 1998.
12) Diplock, A. (1987) "Dietary supplementation with antioxidants. Is
there a case for exceeding the Recommended Dietary Allowance?" Free Rad
Biol Med 3: 199-201.
13) National Academy of Sciences. Recommended Dietary Allowances. Washington
D.C.: Nat. Acad. Sci. Press. 1980-9th ed.
14) Brin, M. (1964) "Erythrocyte as a biopsy tissue for functional
evaluation of thiamine adequacy" JAMA 187: 762-66.
15) Folkers, K. (1993) "Evidence for a clinically significant deficiency
of vitamin B6 in populations" J Opt Nutr 2: 239-43.
16) Atkins, R. Dr. Atkins' Vita-Nutrient Solution. NYC: Simon & Schuster.
17) McCarty, M. (1981) "Toward a 'bio-energy supplement" Med Hypoth
18) Packer, L. & Tritschler, H. (1996) "Alpha-lipoic acid: the
metabolic antioxidant" Free Rad Biol Med 20: 625-26.
19) Packer, L. & Colman, C. The Antioxidant Miracle. NYC: John Wiley.
20) Champe, P. & Harvey, R. Lippincott's Illustrated Reviews:
Biochemistry. Philadelphia: J.B. Lippincott. 1994.
21) Latini, S. ; Pedata, F.; & Pepeu, G. (1993) "Effect of idebenone
on adenosine outflow and adenine nucleotide level in hippocampal slices under
ischemia-like conditions" Eur J Pharmacol 249: 65-70.
22) Weiland, E. et al (1995) "Idebenone protects hepatic microsomes
against oxygen radical-mediated damage in organ preservation solutions"
Transplantation 60: 444-51.
23) Sugiyama, Y. & Fujita, T. (1985) "Stimulation of the respiratory
and phosphorylating activities in rat brain mitochondria by idebenone (CV-2619),
a new agent improving cerebral metabolism" FEBS Letters 184: 48-51.
24) Leibovitz, B. & Mueller, J. (1993) "Carnitine" J Opt Nutr
25) Siliprandi, N. et al (1990)
"Metabolic changes induced by maximal exercise in human subjects following
l-carnitine administration" Biochim Biophys Acta 1034: 17-21.
26) Birkmayer, G. NADH - The Energizing Coenzyme. New Canaan: Keats. 1998.
27) Lund, P.; Cornell, N. & Krebs, H. (1975) "Effect of adenosine on
the adenine nucleotide content and metabolism of hepatocytes" Biochem J
28) Lttarru, G. Energy and Defense. Rome: Casa Editrice Scientifica
29) Levine, S. & Kidd, P. Antioxidant Adaptation. S.F.C.A: Biocurrents.