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Welcome to the Wonderful New World of Mitochondrial Energy Medicine Part 1 Michael Rath ND DCAc DCHM MANTA MAACHMA Over the last 20 years, there has been a gradual change in the treatment of various disease conditions. Previously treatment would be based on a person’s symptoms and specific vitamins, minerals or amino acids for the symptoms would be given. New knowledge has now changed that approach forever. When you consider that problems with energy production are a major part of the cause of most disease conditions, you’ll start to realise that faulty energy production must to be remedied if success is to be achieved. Practitioners armed with this new knowledge are now successfully treating many conditions that have previously proven difficult or impossible to treat by conventional means. For instance Chronic Fatigue Syndrome, which is reaching epidemic levels in most western countries, is just one of these difficult to treat conditions. Many patients have had severe and debilitating symptoms that have gone on for years. Chronic yeast infection by Candida Albicans is another such condition. These conditions and many more can now be successfully treated using the Energy Medicine approach. Many conditions are a result of poor energy production in particular parts of the body. For instance, if there is poor energy production in the brain, depression, anxiety, anger, crying, moodiness often results. Not only emotional problems but also physical problems can result from poor energy production in those parts of the brain which form the co-ordination system for your body’s hormonal production, the thalamus, hypothalamus and the pituitary gland. This can give you major problems with hormonal balance and health. Most doctors will treat hormonal imbalance conditions by giving the hormone that’s lacking, but as many people have found that doesn’t really solve the problem. Because if you only give hormonal treatment, and don’t treat the underlying cause of the problem, then you are stuck with continually taking the hormone treatment. But if you treat the thalamus, hypothalamus and pituitary gland and improve their energy production, everything resets back to normal and the hormone production will again be in balance and health restored. This is the thinking behind the new science of Energy Medicine. There are now available formulations that act specifically on the energy cycle. Some formulas contain nutrients that are directly involved in the production of energy. Other formulas are designed to support and protect the nutrients and cell components that are directly involved with the production of energy, allowing the energy production process to be maintained at a high and continuous level. In summary you need to do two things at the same time – Provide all the nutrients that are directly involved in the production of energy. Protect and support the energy production process and its components. The support process may be just as simple as improving the circulation to the various tissues. Improved circulation will bring in the oxygen and nutrients needed for the energy production cycle, and helps in getting rid of wastes and toxins via the liver, kidneys and lungs. Just as a lack of the right nutrients and oxygen will cause a drop in energy production, an excessive build up in wastes and toxins will overload and poison the cells’ energy production pathways causing a lowering of energy production. Chronic Fatigue Syndrome (CFS) is a classic example of both of these problems occurring at the same time. The initial triggers for CFS are many and varied – severe infections, illness, injury and exposure to pesticides and toxins. But they all have similar outcomes … a person’s defence and detoxification systems become overloaded and as a result, the body’s energy production goes down. With lower energy available, circulation slows down, digestion and absorption is reduced, and therefore circulating oxygen and nutrient levels go down. As a result of lower nutrient and oxygen levels available to the cells, energy production goes down. The lower levels of energy available for clearing the cells of toxins allows the toxin levels go up, further poisoning the cells and reduces their ability to produce energy. And so it goes, round and round. 1 Therefore, it is important to improve circulation to the cells to provide the oxygen, anti-oxidants and nutrients the cells need to produce energy – this is one of the core issues. absorbing all the nutrients we need for the body’s energy production process. Poor digestion results in fewer nutrients being absorbed and affects energy production. We should use nutrients that are specifically for mitochondrial function. Things like Lipoic acid, Activated B3 (NAD - Nicotinamide adenine dinucleotide), Phosphatydal Serine (which improves the cells’ function by improving the operation of the communication receptors on the cell surface) and Acetyl L Carnitine. Carbohydrates We all know that we require energy to live and function. Without energy we virtually don’t exist, and there is a certain critical amount of energy that we require to maintain life. Below that you just get degeneration, decay and loss of life. So, the big question is – What is this energy story all about and how do we produce it? Just as in our society we need energy for conducting our daily lives and business in the body we have a special form of energy that is used to run our body. The energy currency of our body’s cells is a substance called Adenosine TriPhosphate or ATP for short. ATP is the molecule that provides the stored energy that the cell uses to get things done. We initially get our energy from the food we eat. Carbohydrates – pasta, bread, vegetables and fruit which are full of various kinds of starches and sugars Oils – fat, lard, butter, margarine, safflower oil, sunflower oil and olive oil etc. Proteins – meats, fish, cheeses, milk, chicken, eggs. These foods are broken down in the digestive system into smaller and smaller pieces (molecules) that your cell can take up and use. It needs to have very small pieces to go inside a cell, so your digestive system is used to provide the small pieces needed by the body for absorption into the bloodstream and then into the cells. If we look at carbohydrates as an example, they are initially broken down in the digestive system to glucose (a sugar) which is then absorbed into circulation. Glucose goes into the cells where it is acted on by a number of enzymes (substances or catalysts that break down the sugar molecule even further). The sugar molecule, which is made up from a chain of six carbon atoms, is broken down to smaller chains of three carbon atoms. The breaking of the bond from six carbon atoms to three atoms is just like releasing a compressed spring. A compressed spring has stored energy and if you cut the string binding it, it releases its energy and springs outward with some force. So that’s in effect what our cells do with the glucose molecules. In releasing the springs or the bonds binding the glucose molecule our cells provide us with energy. The energy can be released as heat to keep us warm, or do mechanical work to move our muscles. In the case of our cells’ energy production from glucose, the “spring” energy from the glucose is captured and stored in the form of Adenosine Triphosphate (ATP), which in turn is then used as an energy currency wherever and whenever needed by the body. The vital step between the breaking down of the sugar molecule within the cells’ mitochondria and the production of energy of our energy currency ATP, is called oxidative phosphorylation. Think of a cell as a fatty bag - an enclosed fatty bag. The outer layer of the cell is a fatty membrane, which prevents water and other substances coming in until required. There is water inside the cell providing a liquid for cell function and circulation. It has a nucleus, which is the cell’s brain. It has energy production powerhouses and furnaces, which we call Mitochondria. It has a stomach, called Lysosomes. So you can see that if we improve digestion and absorption, we go a long way towards improving energy production by ensuring that we are 2 It has a factory with an assembly line called the Endoplasmic reticulum, for the production of proteins, hormones, enzymes etc. It has a storage area called the Golgi apparatus where substances made within the cell are stored until needed for release. So as you can see every cell in a way is a miniature human, segmented into a one cell compartment. And the start of the fuel production cycle occurs in the liquid phase when glucose first enters the cell. Once the glucose comes inside the cell it can then be acted on immediately through a process that we call Glycolysis. (gly–col–a–sis) Glyco means glycogen or glucose Lysis means breaking down This process produces 3 units of energy. It doesn’t require any oxygen, and is known as anaerobic (without oxygen) glycolysis (breaking down of glucose). To have vibrant health and energy, we need a lot more energy than just 3 units of energy from a single molecule of glucose. The cells have a much more efficient way of producing energy from the breakdown of glucose using aerobic glycolysis (with oxygen) … In fact - 86 Units are produced. This process is named the Kreb’s Cycle after the person who first discovered and described the operation of this vital cycle of life. The Kreb’s cycle occurs within the mitochondria, and is the process where the body’s heat is produced and the energy molecule ATP is formed. This is where the chemical reactions, the breakdown of the hydrocarbon atoms from glucose to produce energy occurs. In effect what is happening is the splitting up of the glucose molecule into smaller pieces that in turn undergo further breakdown, until finally electrons are produced which are then sent through a cascade known as the electron-chain transport system. The transport system captures electrons produced by the breakdown of glucose in the Kreb’s cycle, and as they are carried down the electron transport system the electrons provide the energy to force a chemical reaction that produces our energy molecules, Adenosine Tri-Phosphate or ATP for short. Using the energy produced in the electron chain transfer at the end of the Kreb’s cycle, Adenosine DiPhosphate or ADP is joined with a Phosphate ion to form Adenosine Tri-Phosphate (ATP). But wait, there’s more … that is only part of the story. In the second stage of the Kreb’s cycle carbon ions that are of no further use are combined with oxygen (that has been transported from our lungs to the cells by our bloodstream), to form carbon dioxide. And at the end of the electron transport train, oxygen from the air we breath combines with the hydrogen to form water. The water once again enters the circulation and the carbon dioxide is carried back to our lungs via the bloodstream and we breathe it out. Without the ever present oxygen to convert the hydrogen and carbon ions to water and carbon dioxide, the cells will rapidly die within minutes. So, we eat our carbohydrates from plants and produce glucose. Glucose in broken down via the energy cycle. The released energy is used to form our energy currency Adenosine Tri-Phosphate (ATP) and carbon dioxide and water are given off as waste products. We breathe out the carbon dioxide through our lungs, the plants take up the carbon dioxide and produce more carbohydrates, which we in turn eat to get glucose, and this beautiful cycle starts all over again. In the mitochondrial energy cycle or Kreb’s cycle, there are additional co-factors or energy type factors that are required. If you don’t have them the energy system just limps along. Imagine that you have a roaring fire in a box with lots of holes in it. Sparks would be flying out all over the place causing fires and damage all around the surrounding area. The same thing can happen within the cell. If you have leaky mitochondria, the ability to concentrate, control and store the mitochondrial energy production is going to be limited. You’re not producing a great deal of energy that is usable, you will produce mostly heat. That is exactly what happens in a fever. When there are high-energy components within the cell, we have to make sure that we have protective agents available that regulate and control the energy production. 3 Just as in a nuclear power plant, we regulate and control the nuclear fuel in a reactor using moderator cores - we must do the same thing within the mitochondria. Within the mitochondria the regulating substances are called catalysts. block, fuelling the energy cycle and getting the cogs in the energy cycle moving again. If you take a urine or blood sample of a person suffering from Chronic Fatigue Syndrome for example and find high levels of any of the substances found in the Kreb’s cycle, you will have a very good idea where the blockage has occurred. Just for a minute, imagine that the mitochondrial energy production process is like a little factory with various machines and cogs. When all is working well and the production line runs smoothly we have raw materials going in one end, and we get high quality products coming off the other end. But what would happen if a rock or stick happens to jam up one of the important cogs in the machinery? The plant would not run smoothly, the quality of the finished product would suffer and By using nutrients that are further down the cycle than the blockage, it is possible to get the cycle producing energy more efficiently. The cell then will have the energy that is needed to help heal itself back to full operating capacity. If the block is early on the cycle you will see raised Acetyl CoA Oxaloacetate Citrate Malate Isocitrate Alpha Ketoglutarate Fumarate Succinate Succinyl-CoA **** * **** NADH production would go down as well. The same thing can happen within the mitochondrial cycle. The thing that jams up the machines and cogs of the Kreb’s cycle could be a virus, bacteria, toxin, pesticide or some type of heavy metal. The body tries to either remove or bypass the block. It can bypass the block to a certain degree because each is cog is like an independent wheel. If there is a seized cog at the beginning of the cycle, and you can bypass that stuck cog and get the other cogs moving, you would be able to produce energy efficiently once more. Some people say that when they have a grapefruit or orange juice for breakfast that it picks them up a bit. That is because citrus fruit is rich in citric acid and if their energy block is higher up in the cycle, the citric acid in the grapefruit or orange juice will bypass the levels of Lactic Acid and Pyruvic acid. If the blockage is further down, we will see higher levels of Citric acid as well. The person will feel weak and chronically fatigued and often have painful, aching muscles. In chronic fatigue there is often a block at the Isoconate level, just before the Alpha Ketoglutarate level. If you take a sample of the urine or the blood of those individuals - guess what you’ll find? High levels of Lactic acid, Pyruvic acid and Citric acid indicating that there’s a block there. We can bypass the block by giving Alphaketoglutarate and Malic acid. And as was previously mentioned, once you boost up the energy production, the body has the energy and the ability to fix itself. 4 And that’s the key - you bypass the energy block with the right nutrient and give the body the energy it needs to fix itself through its own self-healing mechanism. That is a very, very important thing to understand. Lets now look at our little energy factory with all of its little engines, cogs and wheels. For those of you who prefer a more technical picture, I have included one at the end of this article. Glucose from Carbohydrates Ye Olde Kreb’s Factory FOOD Clank, Clank Chug Pyruvate Beep Acetyl CoA Clank Oxaloacetate Citrate Whirrr Malate Isocitrate Whirrr Alpha Ketoglutarate Fumarate Succinate Succinyl-CoA * *** * **** Tinkle Tinkle NADH Adenosine Di-Phosphate ADP ADP A D P Phosphate ions BzzzzzZT! P ion P ion BzzzzzZT! Pion (Put in your) (Own sound (effects!) Electron Transport Cascade ATP Adenosine Tri-Phosphate ATP ENERGY ATP ATP ATP ATP ATP 5 When a country goes to war, it gathers up all of its energy resources in order to survive. That includes human resources, machinery, armoury and supplies. At the same time it sacrifices certain other resources, such as music, the arts or social services to free up more resources for defence. The same thing happens in the body. When a serious infection attacks the body, the body switches off or brings to a much lower level of activity many of its maintenance type functions so that more energy is available for defence, for fighting off the illness. Everything is focussed on survival. If the electrical potential or cellular force field drops, various substances can find their way into the cells producing a spasm or a cramp. If the spasm is in a coronary vessel it can cause a heart attack. If the spasm is in the brain an epileptic seizure can result. If it happens in the muscle twitching or cramping can occur. If it happens in a kidney, kidney function will be affected. If there is enough energy the cells will be able to maintain the bilge pumps on the cellular membranes preventing the cells from swelling and become toxic and under-functioning. Good energy levels enable cells to maintain the electrical voltage across a cell membrane (the cellular force field) that prevents the wrong substances getting into the cells at the wrong time. So far we have we’ve talked about some of the larger molecules of the mitochondrial energy cycle. In addition to these, there are a lot of co-factors, vitamins and minerals involved in the production of energy. One of them of great interest is Lipoic acid. LIPOIC ACID is a very important co-factor and a powerful anti-oxidant. As an anti-oxidant it protects the mitochondrial membrane from any “flying sparks” that result from the operation of the energy production cycle. Lipoic acid is a universal anti-oxidant that helps to protect the mitochondria from damage and unlike other anti-oxidants, is able to function in both the fatty and watery layers of cells. That is very important in the maintenance of a healthy energy cycle. Heavy metals such as mercury, cadmium and lead can cause major damage to cell and mitochondrial function. Lipoic acid is able to bind up the heavy metals for safe excretion from the body. In addition, Lipoic acid restores and regenerates other vital anti-oxidants such as vitamins C & E and Glutathione. With Glutathione this is doubly important as in addition to its’ anti-oxidant role, Glutathione is a powerful detoxification agent involved in removing harmful toxins from the body. Less toxins equals better mitochondrial function and more energy. Another role for Lipoic acid is in the regulation of blood sugar. As mentioned previously, the cells use blood sugar or glucose in the Kreb’s cycle for the production of energy. If there are problems with blood sugar levels, energy production is affected. Lipoic acid greatly improves blood sugar regulation, helping to maintain steady blood sugar levels which in turn makes sure that glucose is available to the cells for energy production whenever needed. Lipoic acid also plays a vital role in stage 1 of the Kreb’s cycle as a controlling co-factor. Alpha Ketoglutarate Alpha-Ketoglutarate (AKG-Athletic Performance) is one of the most important nutrients in the Kreb’s cycle. It is found ½ way through stage 2 of the energy cycle. When levels are down energy production is greatly impaired. Another vital role that AKG plays is in the reduction of the levels of ammonia in the body and brain. When the body is under high physical stress such as vigorous and extended sporting activities or as a result of conditions such as chronic fatigue, and other illnesses, breakdown down of muscle tissue to provide energy occurs. This leads to increasing levels of Ammonia building up in the body. Ammonia is a toxic substance that must be removed from the tissues as soon as possible. The first step in getting rid of the ammonia is to bind it with Alpha Ketoglutarate. The main source of the AKG is guess where? That’s right, from within the Mitochondria. 6 As mitochondrial levels of AKG drop, energy production goes down, toxin and ammonia levels go up, the mitochondria are further overloaded with toxins and waste products and are robbed of more AKG to try to get rid of the rising ammonia. By supplying AKG in the form of Athletic Performance we can replace the AKG lost from the mitochondria improving cellular energy production and detoxification, and at the same time provide extra AKG for clearing the ammonia from the body. Once the AKG binds the ammonia it undergoes further processing to eventually be converted to Glutamine, which can be used as a fuel by the cells. Particularly the brain cells. The more ammonia you produce as a result of conditions such as chronic fatigue, other diseases and high physical stress, the lower go your levels of AKG and therefore the lower energy you have. Other nutritional co-factors that are important are Magnesium, Manganese, Vitamins Biotin, B2 & B3, Activated B3 - NAD (Nicotinamide adenine dinucleotide), and Co Enzyme Q10 and amino acids. The bottom end of the Kreb’s cycle is the electron transport cascade. The electron transport cascade is like water falling down a hill powering a hydro-electric generator. The falling water releases its’ energy by pushing against the hydro-generator paddle wheel, turning the generator and generating electricity. The electricity can then be used in our homes to provide light, cook our food and provide power for our washing machine, TV and computers etc. With our Kreb’s cycle, electrons are produced over 3 hills in the cascade. The energy that results is captured and stored in the form of ATP which can then be used to power all of the body’s processes. The first hill is formed by NADH, the next by Co Q10 and the last by Cytochrome C. As an electron is released at each stage, the energy provided is used to bind a phosphate ion to an Adenosine Di-Phosphate molecule to produce our energy molecule, Adenosine Tri-Phosphate - ATP. When needed, the ATP is unbound and releases its energy to make hormones, move muscles, energise our immune system, power our thinking processes etc. When ATP is unbound we are left with Adenosine Di-Phosphate and Phosphate ions that are ready to go through the Kreb’s cycle once again to be turned into ATP. The body normally produces NAD and Co Q10, but if it doesn’t produce them in sufficient quantities energy levels will go down. If someone has problems with energy production and we give CoQ10 or NAD we re-energise the cell, so it can heal itself and start to function properly once more. If the cells happen to be in the brain, re-energising the cells allows them to produce more Dopamine or Serotonin in the brain and that means the neurotransmission and communication is improved in the brain. Depression for example from recent American research has now been shown to be a problem of low energy production in the front part of the brain known as the prefrontal cortex. Improve brain energy levels and supply the building blocks for Serotonin and the depression goes away. It is a easy as that! If the problem is within the cells of the heart and a person has problems with heart failure, and you give Co Q10, you will improve the heart cells energy production and the heart can pump more strongly, improving circulation, health and energy. As CoQ10 is part of the electron chain transport system, and it is down the line from the NADH it is vitally involved in the production of energy that is required for the pumping of the heart. Burning Fat for Energy Now that we’ve pretty well covered the story of glucose going down the Kreb’s cycle, lets look at how Fat can be used instead of Carbohydrate to create energy. This process allows us to burn fat, get more energy and lose weight all at the same time! Now fat requires a shovel to force it into the energy production system, and this is where Acetyl-L Carnitine comes in. Acetyl L Carnitine acts as a shovel, getting the fatty acids into the mitochondria for energy production. Basically it gets the acectate group from the fatty acid and it breaks up into smaller carbon groups. This is known as Beta oxidation of fats. 7 What that means is that a fatty acid which may have as many as 18 carbon molecules in its structure, from the food we eat or from our body fat stores, is chopped off by 2 carbons each time and is then transported by the Acetyl L Carnitine into the Kreb’s cycle for energy production. Acetyl L Carnitine stabilises and improves the function the inner mitochondrial membrane. The health of the inner membrane is VITAL to energy production. It helps in clearing toxic build-up of fatty acids from within the mitochondria. Essential Fatty Acids, important building blocks of cellular and mitochondrial membranes, like fish oil and linseed oil contain special fats and should be used to make sure the cells and mitochondria perform at their best. Acetyl L Carnitine is able to bypass enzyme blocks present in the brains of Alzheimers patients and helps to improves their brain function and living quality. Acetyl L Carnitine is so important that the body produces it continually. But in many illnesses, including heart failure, liver failure or some types of brain conditions, the cells may not be able to produce sufficient quantities of it. What then happens is that your energy levels will begin to fall. Taking Acetyl L Carnitine will promote energy production and mitochondrial health. In order to maintain energy levels the body will start to burn up its’ fat stores and will also start to break down the muscles in order to get amino acids to fuel the Kreb’s cycle. This creates further long-term problems as muscle tissue is needed to maintain a good metabolic rate. If you lose muscle you will lower your metabolic rate and store more fat when you go off the diet. In addition, as your protein stores run low you will not be able to burn the fat you are trying to lose at a good rate and weight loss slows down. Sound familiar? You need a broad range of readily available amino acids from protein to control and regulate the Kreb’s cycle. Within the Kreb’s cycle there are many different co-factors needed for healthy and sustained energy production. You need formulations specifically designed to fill all of the cells energy production needs. These formulations are now currently available. If you haven’t got energy everything is an effort, you are not well and life is hardly worth living. If you’ve got plenty of energy, the body will utilise it to do whatever is needed to maintain its function, maintain its integrity, maintain its immune system, its consciousness, its health and wellbeing. Protein Amino acids are another vital part of the energy cycle. Amino acids are produced as a result of the breakdown of protein in our digestive system. If you are not eating enough protein, or if you have a faulty digestive system and you are not able to break down protein properly, you will lack many of the amino acids that you need for a healthy and fully functioning Kreb’s cycle. Most Weight Loss Programs don’t work terribly well in the long-term. People tend to regain the weight that they lost plus a little more in addition. The main reason for this is that as they reduce their calorie intake from fat and carbohydrates, they reduce their protein intake as well. Radiation Exposure Radiation exposure from the UV lights or from the lack of ozone in the atmosphere, the exposure to radiation from computer screens and from cellular phones will damage mitochondrial function. Radiation affects the lipid membranes or fatty covering of the cells and the membrane of the mitochondria within the cells. This makes the membranes a little bit more rancid, more rigid, not as effective and not as flexible. Damage to the cell and mitochondrial membranes interferes with the passage of nutrients and oxygen into the cells and waste products out of the cells. The result is toxic, under-functioning cells producing little energy. 8 So what we have to be aware of is that factors from outside the body are continually affecting and damaging the energy cycle. We have to put in protective mechanisms like the anti-oxidants Gluthathione, Lipoic acid, Vitamin E and Vitamin C to provide a barrier against radiation and other toxins so we can function fully energised. CANCER Once cells have enough energy to repair themselves, vast improvements and even remission from the cancer can result. Once the cells forming the body’s immune system is repaired, cells’ self healing ability is restored and cellular function improved and the immune cells like good little Pac Men can go and gobble up damaged cells. This is vitally important with cancer. A healthy and vigorous and fully energised immune system is vital if the cancer is to be beaten and full remission established. Energy Medicine is vitally important with cancer therapy. Medical studies have shown for example that 300 to 600 mg of Co Enzyme Q10 per day has helped women with rapidly spreading breast cancer to go into full remission. Many other studies have shown the link between the destruction of cancer and nutritional medicine. ENERGY MEDICINE - is all about REVIVAL With all this in mind powerful and safe formulas have been developed to help produce more energy and reduce toxin loads. Some of these formulas are – Activated B3 Acetyl-L-Carnitine formula Athletic Performance (Alpha Ketoglutarate) BioEnhanced Magnesium formula Co- Enzyme Q10 Lipoic Acid LipoACE with Selenium Mitochondrial Support formula DHA / EPA essential fatty acids Which formulas are used and the amount used is determined by the problems that a person has within their system Can we manipulate the energy once there is enough and to direct it to a particular area organ, and stimulate it to do our bidding? Guess what? We can. We most certainly can. This is what energy medicine is all about!! For those who would like to view a more detailed view of the Kreb’s cycle including nutrients required and where they work, I have included one for you. Our current Formulations are designed especially for revival of energy production, cellular healing and health. Many people with chronic fatigue using these new strategies are now feeling much better. Fatigue is involved with all diseases from colds, to depression, to schizophrenia, to surgery, to poisoning. It’s all about energy. Other factors such as diet, life-style and supplying nutrients for specific conditions are important but if we concentrate on energy production then we are going to the core of the problem. The Entire Dr Vera’s and Orthoplex Ranges are now available throughout Australia from Quest For Health. Detailed but simple information sheets on all the new formulas and treatment programs for CFS, Depression and many other conditions are also available. Please Contact 9 Quest For Health 55 Snow Wood Drive Eatons Hill Qld 4037 Tel: 0500 818 555 Fax: 0500 869 555 Email: [email protected] Web: http://www.quest4health.com.au The Energy ( Kreb’s) Cycle Stage 1 Carbohydrate Fat s Protein Glucose & other Sugars Fatty acids , Glycerol Cholesterol Amino Acids Pyruvate Lipoic acid, B3, Biotin, B2 Acetyl L Carnitine – 1x3 Acetyl CoA Nutri 21- ½ teas x 2 Lipoic Acid 1 x 3 Stage 2 Acetyl CoA B5, Carnitine Aspartate BioEnhanced Magnesium - 1/2 teas x 3 Citrate Oxaloacetate B3, Mg, Mn B3 Isocitrate Malate CO2 Athletic Performance - 1 x 2 Tyrosine Phenylalanine a-Ketoglutarate Fumarate B2 CO2 B1, B2, B3, B5, Lipoic Mg Activated B3 – 1 x 3 Lysine Valine Methionine Succinyl-CoA Succinate Glutamine Histidine Arginine Proline Glycine Nutri 21 NADH Stage 3 Proline Glutamine BioEnhanced Malate Magnesium Isocitrate a-Hydroxybutrate NADH NADH dehydrogenase ADP + Pi Co Q10 90mg - 1 x 2 Co-enzyme Q10 Succinate Choline DMG Sarcosine Ubiquinol-cytochrome oxidoreductase ATP ADP + Pi ATP ADP + Pi ATP Cytochrome oxidase 2H + ½ O2 10 H20