With permission of the CVSA please see the changes in dosages and combination of dosages for the Supplements. Dr. Boles has been working with these supplements for years and has updated the information we previously had.
Submitted by: Dr. Richard Boles
Dr. Boles currently uses the following dosage guidelines for cofactor (supplement) therapy in CVS, but strongly advises consulting with your own physician before beginning to take any of these supplements:
Coenzyme 010 (CoQ10):
CoQ10 is an excellent antioxidant as well as helps in the making of energy through the electron transport chain.
Under age 4 years: 20 mg/kg/day, divided into 2 doses (but not more than 400 mg daily to start)
Ages 4-7: 200 mg twice daily (400 mg a day)
Ages 8+ including adults: 300 mg twice daily (600 mg a day)
Get a CoQ10 plasma (blood) level at least one week later as blood levels are frequently too low even on these relatively-high doses. This test is widely available.
The blood level should be higher than 3 mg/L, better if higher than 4 mg/L; otherwise increase the dosage and test again. Note than the normal range in most laboratories is about 0.5-i .4 mg/L, so the levels considered to be optimal are much higher than "normal". If very high dosing fails to. reach optimal blood levels, which is due to poor intestinal absorption, change the brand ani or give more frequently (3 or 4 times a day).
Side effects are very uncommon. If the added energy interferes with sleep at night, take the last dose of the day with dinner in stead of at bedtime.
Carnitine facilitates the use of fat as an energy source and assists in removing toxic intermediates of metabolism from mitochor dria.
Dose for all people less than 20 kg (40 lbs): 100 mg/kg/day, divided over 2 doses.
Dose for all people greater than 20 kg (40 lbs): 1,000 mg (one gram) twice daily
Get "carnitine blood levels, free and total" at least one week later. This test is widely available. The "free" blood level should be higher than 30 mcg/L, better if higher than 40 mg/L; otherwise increase the dosage and test again. Note than the normal range for free carnitine in most laboratories is about 25-60 mcg/L, so the levels considered to be optimal are on the higher side of the "normal" range.
Side effects are uncommon at this dosing, but more common at much higher dosing. In my patients, the most common side ef fects are stomach upset, loose stools, and a fish-like odor. Decreasing the supplement dosage in about one-half generally take care of the side effects. The fish-lil e odor is less common if one is also taking riboflavin (see below}.
Mega dose B vitamins:
Several B vitamins are important in energy metabolism including B1 (thiamine), B2 (riboflavin), B3 (niacinamide), B5 (pantothenate}, B6 (pyridoxine}, B7 (biotin}, B9 (folate), and B12 (cobalamin). While all of these can be supplemented separately, it is more convenient and economical to supplement them in a single product often labeled as a "B complex". I generally recommend a "B100", which is offered by several companies and the products all differ to some degree. Since riboflavin is possibly the key B vitamin for the treatment of CVS and migraine, check that the specific B100 brand has 100 mg of riboflavin.
Ages 0-2: consult a physician, although 100 mg of riboflavin alone is generally well tolerated
Ages 3-7: B100 tablet, cut in half and give one-half tablet per day (or buy a "B50") - start at one-quarter tablet a day for the first week, see below.
Ages 8+: B100 tablet, give one tablet per day - start at one-half tablet a day for the first week, see below.
I am not aware of any utility in getting riboflavin or other 8 vitamin blood levels beyond checking if teenagers are really taking it. The side effect of GI upset (nausea mostly) is common at this dosing, and as stated above I generally recommend starting at half the above dosing for a week. Riboflavin tastes horrible and turns the urine bright yellow and malodorous. The taste can be dealt with by brushing teeth/mouthwash/favorite drink immediately after swallowing. Liquid preparations are available on line, but check the dosages carefully as many are quite low. For those unable to swallow pills, crushing and mixing the resultant powder in a favorite drink often works.
Additional supplements:Most of my CVS patients are on additional supplements, which are dictated by the specific gene variants (on DNA testing) and symptoms unique to each patient. Only a physician can assist you in this