The "Awesome Foursome," which includes Coenzyme Q10, L-Carnitine, D-Ribose, and Magnesium, assists our hearts to better metabolize energy and protects them from the stress of cardiovascular disease. This combination goes straight to the basic biochemistry of cellular energy metabolism. In order to see how Coenzyme Q10, L-carnitine, D-Ribose, and magnesium work together to promote cardiovascular health, we must first the affects of each one in particular.

Coenzyme Q10, a powerful antioxidant that helps to protect the mitochondrial membrane, mitochondrial membrane, mitochondrial DNA, and cell walls from free-radical attack, is most important in the body for its central role in energy metabolism. About ninety percent of the ATP is used by the cells for food and oxidized in the mitochondria. Fatty acids, carbohydrates, and proteins enter the Krebs' cycle and move from step to step spinning off electrons after being carried across the mitochondrial membrane. These electrons are sent to the electron transport chain where the energy is captured as a phosphate group is added to ADP, forming ATP. By recycling ATP, CO2 and water are produced in the process called oxidative phosphorylation. Through this, Coenzyme Q10 makes sure that the electrons are carried to just the right place to pass on their energy. Without Coenzyme Q10, the electron transport chain would completely break down. Because the electron transport chain is the largest contributor to cellular energy turnover, losing it would be catastrophic to the body. It is necessary for there to be an excess of Coenzyme Q10 in the mitochondria to be maximally effective. Only having enough is not sufficient in order for the job to be done properly, while a deficiency greatly affects the mitochondria's ability to supply the cell with energy. Coenzyme Q10 deficiency can be caused by cellular stress, as it places a great deal of strain on Coenzyme Q10 availability. Those with heart disease, hypertension, gingival disease, and Parkinson's disease are known to be deficient in Coenzyme Q10. Although it is not determined whether the deficiencies are the cause or the effect of these medical problems, the result is that they sap the life out of the mitochondria and reduce energy supplies. Coenzyme Q10 cannot function properly if there are no electrons coming out of the Krebs' cycle and the Krebs' cycle does not work without the fuel transported into the mitochondria by L-carnitine.

Because fatty acids are the preferred energy fuel for hearts and most other cells in the body, L-carnitine is necessary for its ability to facilitate beta oxidation of fatty acids as energy fuel. This action is critical to cell and tissue function because fatty acids are the preferred fuel for energy recycling in cells. L-carnitine is deficient in people with heart disease, peripheral vascular disease, lipid metabolic disorders, mitochondrial disorders, which disrupts the normal metabolism of fatty acids and reduces available energy supplies and leads to the accumulation of toxic by-products from fatty acid metabolism. Through L-carnitine supplementation, fatty acid metabolism can be revived and normal mitochondrial function can be restored. However, this improvement in cellular energy metabolism can't make up for the energy drain that comes from the loss of energy that is caused by low oxygen delivery to the tissue. But, D-Ribose can make up for the energy drain.

As long as there is enough L-carnitine and Coenzyme Q10 in the body, the process of energy utilization and supply can proceed, allowing cells and tissues to have plenty of oxygen and leaving the pool of energy substrates in the cell high. The cellular supply of oxygen can be restricted by acute or chronic heart disease, peripheral vascular disease, many skeletal or neuromuscular diseases and even high-intensity exercise. Cells that are deprived of oxygen cause the mitochondrial energy turnover to become inefficient. Because oxygen is required to let the oxidative pathway of energy recycling to work properly, the cellular energy supply cannot keep up with the demand if the mitochondria can not recycle energy efficiently. However, the cell has a constant need for energy, causing it to use all its ATP stores and then continue to break down the by-product ADP, leaving AMP which is quickly broken apart by the by-products and washed out of the cell. This results in depletion in the cellular pool of energy substrates. Ribose is the only compound that is used by the body to refill the energy pool. It is made naturally in the cells from glucose. Although every cell in the body has the capacity to make ribose, the heart, muscles, and most other tissues lack the metabolic machinery to make ribose rapidly when the cells are stressed from oxygen depletion. When oxygen deprivation is chronic or when energy metabolism is disrupted by disease, there may be so much strain on the energy supply pool that the pool cannot refill without the assistance of supplemental ribose. With supplemental ribose, the cell is able to keep up with the energy drain.

Magnesium, an essential mineral that is critical for energy requiring processes, protein synthesis, membrane integrity, nervous tissue conduction, neuromuscular excitation, muscle contraction, hormone secretion, maintenance of vascular tone, and intermediary metabolism, can lead to changes in neuromuscular, cardiovascular, immune, and hormonal function; impaired energy metabolism, and reduced capacity for physical work when there is a deficiency. A deficiency of magnesium may reduce the activity of important enzymes that are used in energy metabolism. Without adequate levels of magnesium in our cells, the cellular processes of energy metabolism can not function. Even the slightest changes in magnesium levels can have a great effect on heart and blood vessel function. Although magnesium is found in most food, deficiencies are increasing due to softened water and a trend in lower vegetable consumption.

Each member of the "Awesome Foursome" is fundamental to energy metabolism on its own, playing a vital role in supplying the heart with the energy needed to preserve its contractile force. Each is effective independently in helping hearts work through the stress of disease, but together they are unbeatable. In order to fuel all its metabolic functions, the cell needs a large, healthy pool of energy. To keep the pool vibrant and healthy, the cell needs ribose. Even with supplemental ribose, the cell needs the efficient turnover of its energy stores to balance ongoing energy utilization and supply, which is where Coenzyme Q10 and L-carnitine come in. These two nutrients keep mitochondrial operations running at peak efficiency. Magnesium acts as the glue, holding energy metabolism together by turning on the enzymes that drive metabolic reactions. Together, these four nutrients reduce suffering and improve the quality of life for thousands of people. Coenzyme Q10, L-Carnitine, D-Ribose, and Magnesium can be found at your local or internet health food store.