Return to The Basic Concept of Bioenergetic Support

Bioenergetic Support - Basic Concepts

Bioenergetic support involves supplementation with Co-Enzyme Q10, Carnitine, Ribose, and related agents involved in the generation of human biochemical energy, or better stated, the conversion of chemical energy stored in food into the biochemical energy that fuels all useful chemical reactions carried out by the body. Bioenergetic Support is the "heart" of nutritional medicine. Rather than memorizing what to take and at what dose, it makes more sense to understand the role that each substance plays in human energy metabolism.

Energy metabolism takes place in the mitochondria, the powerhouse organelle, the cell center where energy is generated. The carbon chains that comprise sugar are broken down, within the cell fluid, into two carbon fragments, whether oxygen is present or not; these two carbon fragments diffuse into the mitochondria for further processing. In a step that requires carnitine, the longer carbon chain fatty acids are transported from the cell fluid into the mitochondria, where they are cleaved into two carbon fragments. Two carbon fragments derived from sugar and fat then enter the Citric Acid Cycle, where in a step by step, oxygen dependent fashion, electrons are stripped from the individual carbon atoms. The stripped electrons are then transported along the Electron Transport Chain, which includes Co-Enzyme Q10, to the inner mitochondrial membrane, where the energy that in food was stored within the chemical bond between carbon and its electron is converted into the "high energy" bond between adenosine diphosphate (ADP) and phosphate in adenosine triphosphate (ATP). When the cell needs to do work, this high energy bond is broken, its stored energy is used to carry out a useful chemical reaction, leaving behind ADP. ADP is converted back into ATP with the energy obtained from another carbon-electron bond. Each ATP molecule in the heart cycles back and forth from ADP + phosphorus to ATP ten million times a day. If we ever run short of ADP (a common problem in heart disease), we need Ribose to rapidly regenerate it.

Mother Nature designed us to burn an average amount of sugar and fat, to process an average amount of carbon-electron food energy into an average amount of ATP biochemical energy, to meet the average needs of the average heart. If we need more energy, say to help us run away from a saber tooth tiger, then if the heart's oxygen supply is adequate we can temporarily upregulate the conversion of sugar and fat energy into ATP energy (in the graphic, RPP refers to rate-pressure product, which increases with exercise) - the heart consumes more oxygen and is able to keep up with energy production and ATP levels do not fall.

She did not, however, design us to generate an above average quantity of ATP long term. Mother Nature designed us to obtain from our diet enough Co-Enzyme Q10, Carnitine, and Ribose to meet the average needs of the average heart. When the heart is chronically overworked, recycling ATP over and over, beyond the usual 10 million times a day, above average quantities of Co-Enzyme Q10 and Carnitine are required. However, we can't obtain more from our diet; we just weren't designed for energy production overdrive. The chronically overworked, overtaxed, strained heart soon finds itself short of Co-Q and Carnitine, and then it can no longer make enough ATP energy to meet the its needs. The heart can be supplied with all the oxygen, sugar, and fat that it can assimilate, but without adequate Co-Q and carnitine, ATP cannot be produced. Without adequate ATP, the cell falters, and then it dies.

If you have sustained a heart attack, you will be left with fewer functioning heart cells. These cells must "pick up the slack" and work harder than before the heart attack, if the heart is to pump enough blood to meet the needs of the body. If your blood pressure is chronically elevated, your heart will be working overtime too, and eventually your heart will run short of Co-Q and Carnitine. If you suffer from cardiomyopathy, if you have a toxin or virus in your heart, if heart cells are lost by any means, the remaining cells will overwork, they will run low in Co-Q and Carnitine, and eventually they will not be able to make enough ATP to fuel the cell's normal work. The pumping function of the entire heart will begin to falter. The flow of oxygenated blood to the cells of the body will decrease. The cells of our other internal organs will not like this and will cry foul as their blood supply is compromised. They will release hormones such as adrenalin and angiotensin, hormones that whip the heart and increase the blood pressure, such that blood supply to the internal organs is restored. The problem is that the heart can't work any harder, so when you whip it, you damage it, and as it cannot make much ATP, the damaged heart cannot repair itself. Raising the blood pressure may improve blood flow to the kidney, but it adds to the the heart's workload, and the heart can't keep up with its own work. The tired, whipped heart, the heart that can't make enough ATP because it doesn't have enough Co-Q and Carnitine to make enough ATP, begins to dilate. When the heart dilates, it gives its individual muscle fibers a mechanical advantage, and cardiac output will temporarily improve. The problem here is that the stretched cells of the dilated heart need more ATP energy to function in this stretched state. The tired, whipped, and now stretched heart cells don't have this ATP, and they begin to die off (a process called apoptosis - basically cell suicide under pressure). As more cells die, the remaining cells are called upon to work even harder, which they cannot do as they cannot make much ATP. More cells die, then the heart fails, then your physiology collapses, and you know what happens next.

A key point is that this secondary bioenergetic failure, cell dysfunction leading to cell destruction, can and will occur in any situation where the heart is chronically overworked, whenever the myocytes attempt to regenerate more ATP than their stores of Co-Q and Carnitine will permit. Now, if we could get more Co-Q and Carnitine into these overworked, energy starved cells, then we could re-boot the enzyme systems involved in energy production. We could make more ATP, even more than Mother Nature designed us to make. Myocyte function would improve, heart function would improve, the adrenalin whip would be sheathed, and cardiac performance would improve, and with this your quality of life. As the heart cells would stop dying, your quantity of life would also be lengthened. This seems like a good idea to us, and thus we offer Bioenergetic Support to all of our patients with strained, overworked hearts. I also need to point out that oxygen deficiency, as occurs in the patient with coronary artery disease, deranges and strains cardiac energy metabolism, producing a secondary deficiency of Co-Q and Carnitine. Thus the oxygen starved heart, just like the overworked heart, will be low in Co-Q and Carnitine, and therefore low in ATP (discussed in the next section).

James C. Roberts MD FACC
1/01/07