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CardioFuel—another magic pill

I get a lot of email asking me about various alternative therapies and supplements. A recurring theme on this blog has been the hyperbolic claims of alternative practitioners and supplement makers, and while I can’t answer every email, I can at least address some of them in the blog. Supplements are often marketed using unsupported health claims to which is appended the Quack Miranda Warning, essentially allowing the makers to say that the pill will have such and such a benefit, while simultaneously denying any responsibility for the claim.  Since the FDA isn’t examining these claims, it’s worth while to ask our own questions.

The latest email concerned a product called CardioFuel. Let’s take a closer look at this stuff.

According to the distributor:

CardioFuel is the most profound energy producing supplement on the market today! It does something like no other can: Increase energy at the most basic metabolic level, by increasing ATP (the biochemical energy unit of transfer) production. More ATP means more energy reserves to overcome chronic disease, beat the competition, and handle the everyday stressors of today’s fast paced world!

So to be taken seriously, there should be evidence that this product: 1) increases ATP, 2) increases “energy reserves”, and 3) helps overcome chronic disease and “the competition”. First, it is not possible to directly measure ATP in a human being under normal clinical conditions, so any claims about this must be an inference from markers of ATP metabolism, or a guess. We’ll see what the literature says about this below. Second, we need an operational definition of “energy reserves”. Does this mean fat stores? Glycogen stores? These things are measurable to an extent.  Finally, we can do a literature search to see if CardioFuel or an acceptable analog has been tested for its effect on relevant outcomes.

First, what is ATP?

ATP is adenosine triphosphate, a biological molecule with many functions, among them the transfer of energy. ATP is produced in several ways, most famously in the Krebs cycle, a complicated biochemical process which premeds are mercilessly forced to memorize. ATP contains three phosphate bonds, and the third bond contains a great deal of energy, energy that the body uses to fuel many biochemical processes. Each molecule of ATP contains a d-ribose moiety, a simple sugar upon which the molecule is built. One of the claims being made by the CardioFuel folks is that if we ingest more d-ribose, we can make more ATP and be more “energetic”.

First, ATP synthesis, like most biochemical processes, is subject to feedback regulation; ATP production and its byproducts feed back to reduce further ATP production. Second, it is not clear to me that simply providing more of this particular substrate would significantly boost ATP production. But with my limited knowledge of biochemistry, it seems like an interesting question to investigate.

CardioFuel claims that its “ATP boosting” properties are  not just from ribose, but also from other molecules such as carnitine and coenzyme Q10.  There is nothing in the published literature that I can find to support these claims.

From my perspective as a physician, I want to see results.  Regardless of what is posited to happen at the cellular level, I want to see outcomes studies supporting the claims that d-ribose, or preferably CardioFuel itself actually does what is claimed, which the marketer further specifies:

I created CardioFuel to help my patients who suffer serious energy-depleting chronic diseases, such as: heart disease (PVD), diabetes, neuromuscular disease, fibromyalgia, lung disease, Chronic Fatigue Syndrome, kidney disease, HIV/AIDS, etc. These diseases deplete ATP, which CardioFuel rapidly replaces, dramatically improving health, vitality, and Quality of Life (QOL).

A PubMed search for “CardioFuel” turned up nothing.  Of the ingredients claimed to boost energy, d-ribose is the one with the most literature—literature which is not favorable.  There are a number of pilot studies looking at d-ribose in exercise.  For example, one study of twelve cyclists found that, “D-ribose supplementation has no impact on anaerobic exercise capacity and metabolic markers after high-intensity cycling exercise.”  A slightly larger study of rowers compared dextrose (d-glucose) with ribose and found that, “…the dextrose group showed significantly more improvement at 8 weeks than the ribose group.”  Another small study found that,” ribose had no effect on performance when taken orally, at the dose suggested by the distributor.”Since I couldn’t find literature specific to CardioFuel, and my literature search failed to find significant support for claims of the ingredients of CardioFuel, I went to the CardioFuel website for further guidance.  Tellingly, there are no references to studies of CardioFuel itself but only for its purported ingredients. There are some chaotic lists of incomplete references.  For example, for coenzyme Q10, some of the references are listed, some just quoted without citation, and there is little data related to the claims of CardioFuel.  The section on “elite athletes” addresses ribose directly, but not with outcomes studies.

I can find no support for the claims made by the sellers of CardioFuel. But under the Dietary Supplement Health and Education Act of 1994 they are allowed to make these claims as long as they use the Quack Miranda Warning. I couldn’t find such a warning on any page of the website so I guess I must assume that all of the claims made by the company are verifiable. I can’t seem to verify them myself, but the data must be somewhere. Right?

Posted in: Science and Medicine

Leave a Comment (9) ↓

9 thoughts on “CardioFuel—another magic pill

  1. EricG says:

    now *THIS* is the epitome of skepticism. taking a claim, evaluating its merit based on the evidence available and coming to a conclusion; a conclusion that is tentative based on the introduction of more evidence.

    now to be fair, you have obviously given more than due diligence to a fairly obviously bogus supplement. But I seriously wish that this was to be the way the common “lay skeptic” would approach their various inquiries (of course, to the extent of their access to information, intellectual abilities etc.)

    Likewise, i could seriously read stuff like this all day: “the plausibility and evidence for pretty much obviously bogus stuff.” care to take a stab at “body brushing” or “infrared hair growth treatment” next? :)

  2. clgood says:

    Excellent post. And I love the Quack Miranda Warning. I shall refer to it as such from now on.

  3. Babochka says:

    Thanks for the claims breakdown. I’m not sure how familiar you are with DSHEA (besides the fact that it’s a bad law) but supplement makers cannot legally make claims such as these:

    “I created CardioFuel to help my patients who suffer serious energy-depleting chronic diseases, such as: heart disease (PVD), diabetes, neuromuscular disease, fibromyalgia, lung disease, Chronic Fatigue Syndrome, kidney disease, HIV/AIDS, etc. These diseases deplete ATP, which CardioFuel rapidly replaces, dramatically improving health, vitality, and Quality of Life (QOL).”

    Not that it stops them from making disease claims about a supplement. The most that the FDA would do is send them a warning letter telling them to make their claim language compliant. It would take the FTC to step in and examine the scientific evidence behind the claims for them to get in any really trouble. Besides, CardioFuel type supplements aren’t high priority. H1N1 and cancer cures are what the FDA is concentrating their efforts on.

    Supplement makers that are compliant with DSHEA use structure/function claims language. This is why you often see vague statements like “boosts immune system” and “supports heart health” on supplement bottles and in marketing coupled with the Quack Miranda Warning. I’m not saying this is right or ethical, just that it’s what’s legal.

  4. DavidCT says:

    It’s probably closed minded but any product that must protect itself with the Quack Miranda Warning is highly suspect. The hyperbolic claims only confirm the reasons for doubt. Thanks for the effort to confirm my suspicions with actual facts.

  5. BillyJoe says:

    Babooshka,

    (I take it you are one and the same – either that or I’ve mistaken youi for a Kate Bush fan, sorry)

    “I’m not sure how familiar you are with DSHEA (besides the fact that it’s a bad law) but supplement makers cannot legally make claims such as these”:

    The only claim he makes is that he “created CardioFuel to help my patients who suffer…”. He doen’t say that it actually helps his patients, just that he created it to help his patients. You would have to prove that he did not have that intention. Granted his intention was probably to make money out of his patients, but you would be uphill proving that.

  6. Babochka says:

    @BillyJoe– Well, I am a Kate Bush fan but babochka is Russian for “butterfly” : ) If there is someone else here that goes by “babooshka” I am not that person.

    True, he doesn’t directly say that CardioFuel treats those dieases. That’s a bit of legal hair splitting and probably what the CardioFuel people would argue in court. But the implied claims are there and a supplement also can’t legally claim to be an adjunct therapy. It would be interesting to see how a case such as this would turn out.

  7. BillyJoe says:

    butterfly ;)

    “It would be interesting to see how a case such as this would turn out.”

    I’m betting he would win. :(
    (In a resent case in Australia, an [obviously quilty] policeman got off because the technicality that the investigator in the Office of Police Investigations was sworn in the day before he was made the investigator instead of the other way round!)

  8. BillyJoe says:

    …oops, sorry, that first smily was supposed to be one of these: :)

  9. A snake oil visualization: which “supplements” have most (and least) evidence for which conditions, scaled for popularity.

    http://www.informationisbeautiful.net/play/snake-oil-supplements/

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