Mitochondria are tiny powerhouses that create a portable fuel for all the energy-consuming elements of human cells. Cells would die without the vital roles that mitochondria play. Insufficient or dysfunctional mitochondria are associated with difficult-to-diagnose symptoms that can negatively affect one’s quality of life, including extreme muscle weakness, chronic fatigue, gastrointestinal disorders, and even neurological dysfunction (1). Compounding the confusion is the fact that mitochondrial dysfunction can be either the cause or the result of chronic health issues, each of which requires different treatment approaches.
This second part of our mitochondrial health series examines functional nutrition strategies that can revive or maintain cellular mitochondria.
Functional Medicine considers the whole person’s health, looking at their diet, emotional and physical environment, exercise level, and sleep quality. People are different and have unique challenges, so functional nutrition strategies are tailored for that individual. (This is especially important to consider when dysfunctional mitochondria could be the cause or the result of a severe health condition.) However, some common approaches to treating mitochondrial dysfunction through nutrition will be covered in this article.
What Causes Mitochondria to Fail?
One way to understand mitochondria is to know how they fail. Here is a short list of factors that commonly hinder mitochondrial function:
Disruption of the mitochondrial membrane
A lack of necessary chemicals to function, such as NAD+, which is a form of vitamin B3 (niacin), and coenzyme Q10 (CoQ10)
Being overwhelmed by free radicals, which are unstable molecules that can steal electrons from other molecules, causing damage
Being overwhelmed by oxidative stress, which is a buildup of damaging reactive oxygen species (ROS) that cannot be neutralized or detoxified quickly enough
Infections that can cause excess inflammation or oxidative stress
Exposure to toxins such as heavy metals
What do Mitochondria Need to Flourish?
Mitochondria need many specific inputs and a stable environment to function properly. Below are a few things they require for proper functioning:
Chemicals: NAD+, CoQ10, oxygen, nutrients
An intact, functioning mitochondrial membrane
Antioxidants to use for neutralizing and detoxifying ROS
Available energy such as NADH (a form of vitamin B3/niacin), FADH2 (which is riboflavin plus adenine), or ATP (adenosine triphosphate, a form of energy for cells)
Strategies for the Care of Mitochondria
Treat underlying causes. If mitochondrial dysfunction is the secondary result of a health condition such as diabetes or a neurological condition, it is essential to treat those conditions. Stress can be an underlying cause of mitochondria dysfunction and should not be discounted as a factor.
Master the five pillars of health, which include getting consistent quality sleep and regular moderate exercise, consuming a healthy diet with plenty of fruits and vegetables, managing stress, and maintaining strong relationships. Note: Use caution with intense exercise. Because mitochondrial dysfunction is a cellular energy crisis, some people experience extreme post-exertional fatigue. Exercise becomes a tricky prospect for those suffering from mitochondrial disorders. Being active is essential to keep healthy, but endurance sports or hard training may have to be put aside until the mitochondria are restored.
Examine medications to identify those that can affect mitochondria. Statins, which treat cholesterol issues, can negatively affect mitochondria (2). The same enzyme involved in creating cholesterol in the body helps create Coenzyme Q10 (CoQ10). By reducing cholesterol, statins also reduce CoQ10, potentially causing a deficiency in a small percentage of people. Deficiency in CoQ10 has been linked to mitochondrial dysfunction, and studies show that CoQ10 supplementation helps treat mitochondrial dysfunction. Even over-the-counter non-steroidal anti-inflammatories (NSAIDs) such as aspirin can negatively impact mitochondrial membranes, reducing energy production (3).
Test for nutritional deficiencies and correct them. Nutritional deficiencies are easy to detect through blood and urine tests. Most nutritional deficiencies can be corrected by eating specific foods or taking nutritional supplements. Mitochondria depend on macronutrients (protein, carbohydrates, fats) and are vulnerable to harm if digestion malfunctions or a deficiency occurs.
Consider testing for and correcting heavy metal toxicities. Heavy metals such as lead, mercury, and cadmium negatively affect how mitochondria function (4). As time passes, these metals can accumulate in the body, resulting in more severely compromised mitochondria. A heavy metal cleanse can help reduce the burden on the body and allow mitochondria to flourish.
Eat a diet of natural, unprocessed foods. Refined sugars, processed flours, alcohol, and preservatives (such as MSG) cause inflammation and burden the body’s energy needs, making mitochondria work harder. A diet high in leafy green vegetables provides the nutrient chlorophyll, which plays a positive role in maintaining CoQ10 antioxidant levels in the blood. Foods rich in antioxidants, such as berries and nuts, protect mitochondria by reducing free radicals that cause oxidative damage.
Nutritional Supplements for Mitochondrial Dysfunction
Mitochondrial dysfunction or disease can result in a very long list of symptoms, and there is no “one size fits all” treatment for all the expressions of symptoms. However, a handful of nutritional supplements have shown promise for helping mitochondria recover function, alleviate various symptoms, or reduce their physiological burden. Working with a skilled healthcare practitioner to determine the best supplements to address unique symptoms, determine dosages, and vet any potential contraindications with medications is vital. Let’s review some of the most common nutritional supplements that can be used in cases of mitochondrial dysfunction (5-9):
1. Coenzyme Q10 (CoQ10) – CoQ10 is a vitamin-like substance produced naturally by the body but can be obtained through the diet and taken in supplement form. CoQ10 (10-12):
Helped cells grow and detoxify themselves by neutralizing free radicals and ROS due to their antioxidant nature
Has been shown to reverse mitochondrial oxidative stress, preserve the physical structure of mitochondria, and return mitochondrial oxygen consumption to normal in a mouse study
Was shown to reverse statin-related myopathy (muscle pain and cramping)
Relieved the severity of fatigue symptoms in chronic fatigue syndrome (CFS) patients when combined with selenium (CFS is correlated strongly with mitochondrial dysfunction)
Acted as an electron donor for cellular energy production
Food sources of CoQ10: nuts, fish, meat (10)
Potential risks: makes blood thinners such as Warfarin less effective (10, 14)
2. Alpha-lipoic Acid (ALA) – ALA acts as a cofactor for enzymes that ultimately help produce ATP in the mitochondria. One form of ALA has an antioxidant action and helps reduce ROS buildup. The mitochondria make ALA in small amounts, but supplementation allows dosages that drive the antioxidant actions that assist mitochondria. Supplementation of ALA has a positive impact on the following (15, 16):
Energy metabolism in muscle and brain tissue
Lowering oxidative stress and thereby relieving diabetic neuropathy (nerve pain)
Food sources of ALA: meats (including liver), vegetables (especially spinach and broccoli), fruits, and nutritional yeast (15)
Potential risks: ALA toxicity may occur in the presence of a vitamin B1 deficiency (15). (Vitamin B1 deficiencies are common in heavy drinkers of alcohol.)
3. L-Carnitine – L-carnitine is an amino acid that can be made by the body, obtained through the diet, or supplemented. L-carnitine transports and delivers fatty acids to the mitochondria, which then turns the fatty acids into energy Research shows that L-carnitine provides (15):
Increased muscle strength
Better recovery from exercise
Improved cardiac function
Food sources of L-carnitine: fish, dairy, red meat, chicken (15)
Potential risks: with very high doses, watery bowel movements, gastrointestinal upsets, or fatigue have been reported (15).
4. NADH – NAD stands for Nicotinamide Adenine Dinucleotide. It’s a form of niacin (vitamin b3) that exists in two states, NAD+ (the oxidized state) and NADH (the reduced form). These help transport electrons, donating and accepting them, which are vital cellular processes that drive much of the action, including mitochondrial ATP production. Supplemented NADH combined with CoQ10 has been shown to increase levels of ATP production in chronic fatigue patients (17).
Food sources of NADH: dairy, nuts, seeds, meats (fish, poultry, beef), whole grains, and legumes
Potential Risks: Some forms of niacin can cause flushing, but those in the reduced NADH form are less likely to cause flushing.
5. B vitamins - B vitamins help derive energy from food and have long been proven to have roles in maintaining health in multiple systems of the body, including the nervous system, cardiovascular system, and metabolism. Many forms of B vitamins aid those with symptoms of mitochondrial dysfunction.
Thiamine (vitamin B1) – Thiamine improves the aerobic glycolysis process in the mitochondria, which helps break pyruvate molecules into energy. Research shows that thiamine supplementation can help reduce fatigue in some patients (15).
Riboflavin (vitamin B2) – This water-soluble vitamin becomes a part of two different molecules (FAD and FMN) in the mitochondria that help break down fatty acids and produce energy in the form of ATP. Research shows that riboflavin helps those with mitochondrial issues by reducing fatigue, increasing muscle strength, and increasing the ability to tolerate exercise (15).
Folate (vitamin B9) – This water-soluble B vitamin helps create DNA, form red blood cells, and participate in the methylation process. Methylation helps modify the expression of genes (epigenetics) and produce proteins and neurotransmitters (chemicals of communication in the nervous system). Mitochondria uses the end products of the folate cycle, which are lipids, proteins, and nucleic acids. Folate is believed to halt the degradation of white matter in the brain, reduce cognitive decline, and through methylation, reduce oxidative stress and the effect of inflammation (which benefits mitochondria) (15).
Food sources of folate: dark leafy greens and vegetables, nuts, beans, seafood, dairy, egg, meats, grains
Potential risks: Low doses appear very safe, but hypersensitivity can cause skin rashes or a severe allergic reaction.
6. Creatine – The liver and kidneys produce creatine, an organic acid vital to mitochondria because it protects mitochondrial DNA from oxidative stress. Creatine can be derived from food or taken as a nutritional supplement. Athletes may be familiar with this substance because it is touted as a muscle-bulking agent. Phosphate and creatine combine to form phosphocreatine (PCr) in the tissues. The breakdown of PCr can create ATP, a portable energy source for cells. Patients with mitochondrial dysfunction in their skeletal muscles often have low amounts of PCr. Studies of supplementing with creatine have had mixed results, but anecdotally, patients have improved muscle and exercise-related symptoms. Creatine appears helpful in blends of multiple nutrients designed to relieve symptoms of mitochondrial dysfunction (15).
Food sources of creatine: fish, meat (15)
Potential risks: High doses (over 20g a day) may cause muscle cramps or spasms, gastrointestinal distress, or weight gain (15).
7. L-arginine – The amino acid arginine can be made in the body, obtained in the diet, or taken as a nutritional supplement. Many supplements provide the L-arginine form because it is more bioavailable (more easily absorbed) than regular arginine. Research indicates L-arginine can reduce stroke-like symptoms in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). L-arginine is involved in many processes in the body that can have a positive impact on mitochondria, including the (15):
Creation of creatine
Utilization of protein
Detoxifying of urea (a waste that can build up in the blood)
Provision of itself as a precursor of nitric oxide (NO, which acts as a vasodilator
Food sources of L-arginine: meats, nuts (15)
Potential risks: Over 9g a day can cause nausea, loose bowels, or low blood pressure (15).
There are many options available to patients who experience repercussions from mitochondrial dysfunction. Experienced integrative healthcare practitioners can not only find the correct diagnosis through advanced testing but can pick from an extensive range of natural and integrative treatments to customize a program.
In the final part of our mitochondrial health series, we will cover biohacking strategies for regaining cellular energy levels. In the meantime, if you have been struggling without a diagnosis and an effective treatment program for your odd symptoms, please make an appointment with one of the doctors at Temecula Center for Integrative Medicine. We would be privileged to help you improve your health!
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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