Brain Bundle

Nutritional Therapy of Mitochondrial Dysfunction

For 20 years as a biochemical geneticist at Children’s Hospital Los Angeles, I treated many children and young adults with metabolic (biochemical) and mitochondrial (energy deficiency) disorders. I am a recognized expert in Mitochondrial Medicine with multiple medical and scientific papers published as well as numerous lectures given in the field around the USA and the world. Most of the treatment options for mitochondrial and metabolic disorders are dietary/nutritional in nature. Because of the common link to energy metabolism, I developed a personal focus on both the functional (e.g. chronic pain, fatigue, or nausea) and the neurodevelopmental disorders (e.g. autism, ADHD, epilepsy), including many of the conditions in the above list. Standard drug therapies are oftentimes inadequate for these conditions, and since biochemical abnormalities are frequently present, I learned how to use the nutritional tools of biochemical genetics to help my patients. Over the years, including in my current private practice, I have witnessed the power that nutritional-based therapies can have for children with a wide range of functional and neurodevelopmental conditions.

For 30 years, my clinical experience has informed me that nutritional therapy of mitochondrial dysfunction can make a powerful difference in people with functional and neurodevelopmental disorders, especially those with two or more of the conditions.

There are several other physicians in communities across the nation, who like myself, have witnessed that a comprehensive approach to nutrition is often associated with patient improvement. Like energy metabolism/production, nutrition is a basic aspect of biology that is important in nearly all aspects of health and disease. Often, physicians focused on good nutrition in their patients label themselves as “integrative”, “functional medicine”, “biomed”, or “naturopaths”. In my opinion, all health care providers should focus on nutrition in all of their patients, not as the sole or an “alternative” treatment, but as basic “complementary” treatment, in addition to standard medical practice. Regardless on the label we go by, many of us “proactive” providers have had the consistent observation that nutritional therapies can lead to substantial improvement in many patients, and especially in those with functional and neurodevelopmental conditions. Thus, nutritional management is part of our core therapeutic recommendations for our patients with these disorders.

Diet (foods and drinks) is a critical part of nutrition, yet even with people on excellent diets, dietary supplements are also generally recommended by proactive care providers. The reason is that several key nutrients demonstrate health benefits at levels far higher than anyone could reach by diet alone. There are multiple nutrients that are important for health, including many that are known as vitamins, minerals, cofactors, and/or antioxidants. Some of these nutrients the human body cannot make, and must obtained from outside. Other nutrients we can make, yet in insufficient quantities for optimal health. Many of these nutrients in both categories have important functions in the mitochondria.

Mitochondrial Cocktail

The “mitochondrial cocktail” refers to dietary supplementation with specific nutrients that have important roles in energy metabolism, generally at higher dosing than that achievable by diet. There are many such nutrients, and the components recommended by different physicians often differ. Some of the key components of the mitochondrial cocktail are nutrients well known to most people, such as riboflavin (vitamin B2), vitamin C, and magnesium. Others key components are lesser-known, including coenzyme Q10, carnitine, and alpha-lipoic acid. Mitochondrial cocktail is commonly used in the treatment of a wide-range of disorders associated with mitochondrial dysfunction, including the various functional and neurodevelopmental conditions.

As multiple nutrients are necessary for optimal mitochondrial function, many patients take 10 or more different supplement products as their mitochondrial cocktail, sometimes as many as 20 or 30 products in a single individual. Generally, these products are provided by several different supplement companies. This has several disadvantages including:

Logistics: Getting anyone to take 10-30 different products is not easy and is time consuming.
Costs: The price for the individual products varies widely, but a typical mitochondrial cocktail “a la carte” typically costs about $200 to $500 per month.
Tolerability: Combined, the volume of the supplements, mostly filler, is a lot for a person’s stomach and intestines to handle, and frequently leads to nausea and/or other GI symptoms.

EnergyNeeds®

EnergyNeeds® was created to be a baseline comprehensive nutritional supplement for patients with any condition associated with mitochondrial dysfunction. In essence, EnergyNeeds® is designed to offer optimized general nutrition combined with a high-powered mitochondrial cocktail. EnergyNeeds® is designed to be a safe nutritional supplement for anyone regardless of the underlying genetics, signs or symptoms, severity of disease, age, and/or general health.

The advantages of EnergyNeeds® are:

Relatively-high doses of several key ingredients of the mitochondrial cocktail, such as carnitine, alpha lipoic acid, key minerals (Mg, Se), vitamin A/beta-carotene, multiple B vitamins, and vitamins C, E, all aimed at a high-level of mitochondrial support.
The flavinoids quercetin and rutin, as well as vitamins D and zinc, for better support of the immune system.
Addition nutrients with specific purposes:
glycine, carnitine, and taurine to assist in metabolic detoxification.
arginine for increased small vessel circulation.
chromium for insulin response.
multiple addition vitamins and minerals to double as a high-powered multi-vitamin.
Much lower amounts of activated/methylated vitamins B6, B9 (folate) and B12 than in SpectrumNeeds® and in many competitor’s products, since some individuals are sensitive to these. Of course, if desired, the higher dosages can be supplemented additionally.
Capsules, so easy to take.
All of these ingredients in a single product* which:
greatly improves the ease of getting people onto combination nutritional therapy.
saves families money versus taking the components separately.
reduced the likelihood of GI issues due to reduced filler/volume from multiple individual products.

*Additional coenzyme Q10 as ubiquinol is highly recommended in addition, see below.

EnergyNeeds® is designed primarily to facilitate cellular energy metabolism. This product can be used by all individuals regardless of age, gender, presence or type of mitochondrial dysfunction/disease, common comorbidities, severity of disease, DNA sequence information, medications, or other supplements taken.

EnergyNeeds® can be taken by all individuals who desire:

A baseline product meeting the core nutritional needs of most such people.
Very-high dosing of key nutrients (e.g. vitamin D, vitamin B12, zinc, beta-carotene) to promote optimized health and immunity.
A high-level mitochondrial cocktail, providing additional nutritional support to boost mitochondrial function (increase energy production), and to de-toxify abnormally-metabolizing mitochondria.
To provide all of this in a single product* and thereby reducing the costs, time, hassles, and side effects of taking multiple different supplement products.

*Additional coenzyme Q10 as ubiquinol is highly recommended in addition, see here.

EnergyNeeds® is in particular tailored to individuals with any condition associated with mitochondrial dysfunction (energy metabolism), including:

Functional disorders, including chronic fatigue, migraine, chronic pain of any type, irritable bowel and other conditions of GI dysmotility, POTS, frequent urination, and/or dysautonomia.
Neurodevelopmental disorders, including autism and autism-like conditions, ADHD, epilepsy, and/or non-epileptic “spells”. While SpectrumNeeds® is marketed primarily for neurodevelopmental disorders, EnergyNeeds® is similar and can be substituted in most settings. Especially, consider EnergyNeeds® in the following situations:
Powder is not palatable or convenient, and a capsule form is preferred.
Rare individuals with side effects to high dosing of methylated B vitamins.
Neuropsychiatric disorders, including anxiety, depression, bipolar, panic, and/or OCD.
Aging, which is the most-common of all conditions related to mitochondrial dysfunction.

To learn more, see The Common Link of Energy Metabolism in Health.

EnergyNeeds® is labelled primarily for adults, but this does not mean that the product is not also intended and appropriate for children and adolescents.

As is always the case with any dietary/nutritional supplement, it is recommended to take EnergyNeeds® with the knowledge and approval of your health care provider/physician. EnergyNeeds® is not designed to be a medical treatment for any condition, but to provide excellent nutritional support for a wide variety of conditions often associated with mitochondrial dysfunction. Ideally, this nutritional support would be part of a comprehensive management plan under a physician’s care, along with appropriate diet.

Adults and adolescents 133 lbs (60 kg) or over: 5 capsules twice daily. This is 10 capsules a day.

Smaller/younger individuals can take this product as well:

Children and adolescents 88-132 lbs (40-60 kg): 4 capsules twice daily.
Children 44-88 lbs (20-40 kg): 3 capsules twice daily.
Children under 44 lbs (20 kg): Consult your physician.
Suggestion: One capsule for every 22 lbs (10 kg) of body weight, twice daily.

Best if taken with food. Capsules can be opened and added to any food or beverage.

It is recommended to give less product in the first few days, in order to reduce the possibility of nausea. Taking with a meal can also help.

There are 300 capsules in a container of EnergyNeeds®. At the full recommended adult dose of 5 capsules twice a day (10 capsules a day), one container will last 30 days.

For individuals who weigh less than 132 lbs (60 kg), lesser amounts are recommended, and a container will last longer.

EnergyNeeds® has a “shelf life” or expiration date of 2 years and is located on the bottom of each container.  Once opened, If you seal the container after each use, EnergyNeeds® should last at least a year. Once opened, store EnergyNeeds® in a cool dry place and keep EnergyNeeds® away from warm, humid environments to help ensure effectiveness for longer periods after opening.

There are 300 capsules in a container of EnergyNeeds®. At the full recommended adult dose of 5 capsules twice a day (10 capsules a day), one container will last 30 days.

For individuals who weigh less than 132 lbs (60 kg), lesser amounts are recommended, and a container will last longer.

NeuroNeeds® also markets another product called SpectrumNeeds®, which is similar to EnergyNeeds® The main difference is that EnergyNeeds® is a capsule marketed mostly to adults with functional symptoms (fatigue, pain, etc.), while SpectrumNeeds® is a powder marketed mostly to children with neurodevelopmental conditions (autism, ADHD, etc.). However, either product can be taken in children or adults with a wide variety of conditions.

There are some additional differences between the products. EnergyNeeds® has:

Higher doses of several key ingredients, such as carnitine, vitamin D, and vitamin E, aimed at a higher-level of mitochondrial support.
Additional antioxidants for even more-robust mitochondrial support, including vitamin A/beta-carotene and vitamin K.
The flavinoids quercetin and rutin for better support of the immune system.
Additional nutrients, including glycine, taurine, and carnosine to assist in metabolism and detoxification.
More product, so that each unit contains a one month supply for an adult, instead of for a child.
Much lower amounts of activated/methylated vitamins B6, B9 (folate) and B12. Of course, if desired, the higher dosages can be supplemented additionally.

There are multiple other products made by other companies that contain a variety of vitamins and minerals, but no others quite like EnergyNeeds® and SpectrumNeeds®. What makes our products unique is the addition of a high-powered mitochondrial cocktail in addition to a comprehensive multi-vitamin and mineral supplement.

All ingredients in EnergyNeeds®, both active and inactive, are natural, and are components found in a variety of natural foods. The dosing for all ingredients are Generally Considered As Safe (GRAS) by regulatory agencies in both the United States and the European Union.  Any product can cause nausea on ingestion, and occasional cases of nausea with EnergyNeeds® are mitigated by taking lower dosing at first and working up, and/or ingesting with a meal. Rare cases of insomnia are mitigated by moving the second dose earlier in the day.

Any vitamin product taken into the stomach can result in nausea, and is best if taken with food, at least at first until the body adapts to it. Additionally, it may be advisable to give less product in the first few days, in order to reduce the possibility of nausea. One approach is to start at one capsule, twice daily, and every day add another capsule per dose until at the desired amount (5 capsules twice daily in adults over 132 lbs or 60 kg).

Capsules can be opened and added to any food or beverage.

This question is best asked to your health care provider, but some general guidance is provided herein for you and your provider.

If the amount of the nutrient currently taken is less or about the same as that provided by EnergyNeeds®, consider stopping the supplement at the time you start EnergyNeeds®. For example, if you currently are taking 1,000 mg a day of vitamin C a day, since the amount of vitamin C in EnergyNeeds® is 1,000 mg a day, you can stop the vitamin C supplement.

Most standard multivitamin tablets have quite low dosing of every nutrient, and can be discontinued when you start EnergyNeeds® without additional supplementation. Consult your physician and compare the amounts of each nutrient before making a decision.

Yes, EnergyNeeds® capsules can be opened can be mixed in with formula for tube feedings, especially if that tube goes to the stomach. Most of the ingredients are absorbed in the small intestine, and may or may not be adequately absorbed with jejunal (intestinal) feedings.

Your physician may wish to add additional dietary supplementation beyond EnergyNeeds®, tailored to each unique person. In particular, additional coenzyme Q10 (CoQ10) in the form of ubiquinol is highly recommended. CoQ10 plays a pivotal role in energy metabolism. CoQ10 comes in two different forms, ubiquinone (the common form) and ubiquinol (a highly bioavailable form). It is the strong opinion of Dr. Boles that ubiquinol is a necessary addition for many of his patients, and EnergyNeeds® is designed to be taken with additional ubiquinol.

NeuroNeeds® markets our own brand of ubiquinol, called QNeeds®, which has excellent bioavailability, even above most ubiquinol products. However, there are other good ubiquinol products on the market. For an article on the importance of CoQ10, ubiquinol versus ubiquinone, and to compare some brands that Dr. Boles recommends to my patients, click here.

Dr. Boles recommends genetic testing in patients with significant or multiple functional conditions, as many times such testing can be helpful in determining the underlying biological factors leading for disease in that individual. Understanding these underlying factors often allows for targeting therapies. Even in patients with known mitochondrial disease, genetic testing can often identify factors leading to this disease that suggest specific therapies. For more information, see genetic testing on Dr. Boles’ private practice website.