APS Program Community Q&A Series
Although there are no consensus recommendations regarding dietary supplements for people with APS, research has shown that some supplements may be beneficial in preventing APS-related complications. In this edition of the APS Program Community Q&A Series, Dr. Yu (Ray) Zuo reviews the benefits of two supplements, vitamin D and coenzyme Q10.
Vitamin D is a fat-soluble vitamin that plays many important roles in our body including regulating bone growth, reducing inflammation, and modifying immune cell functions . It can be produced by our skin upon sun exposure or absorbed from food and dietary supplements . Given that uncontrolled inﬂammation plays an important role in APS blood clotting, vitamin D has the potential to help APS patients via its anti-inflammatory and immune system-supportive properties. Low vitamin D levels were observed in up to 70% of APS patients, with up to half of those patients having severe deficiency [2, 3]. Notably, not only were vitamin D levels shown to be lower in APS patients as compared with people without APS, but low vitamin D levels within the APS group tended to predict those patients who developed blood clots . While the ideal supplementation dose of vitamin D for patients with antiphospholipid antibodies remains unknown, a Task Force convened at the 16th International Congress on Antiphospholipid Antibodies (which included Dr. Knight) did recommend that vitamin D deficiency should be screened for and corrected in individuals who are antiphospholipid antibody-positive .
Coenzyme Q10 (CoQ10) is an essential compound of our body that is synthesized by organelles inside our cells called mitochondria. As the most important producers of energy molecules, mitochondria are often called the “power house” of our cells . CoQ10 plays an important role in maintaining the supply chain that is necessary for energy production, and perhaps most importantly protects mitochondria from damage during this process. Supplementation of CoQ10 has been tried in patients with heart disease, where it decreases the production of damaging inflammatory molecules. One small study evaluated the effects of ubiquinol—a form of CoQ10—among 36 APS patients . The study found that ubiquinol improved the health of endothelial cells (the cells that line our blood vessels) while also decreasing inflammation produced by various immune cells. No significant side effects were observed in the ubiquinol-treated patients, and the authors suggested that ubiquinol might have a role in complementing current standard APS therapies. A Task Force convened at the 16th International Congress on Antiphospholipid Antibodies suggested that further studies are warranted before making any formal recommendations .
More studies are needed before I can make any definite recommendations on dietary supplements for APS patients. Having said that, supplementary vitamin D and CoQ10 are very safe and some supplementation studies in the general population have suggested beneficial effects. I can say that I definitely believe low vitamin D levels should be screened for and corrected. CoQ10 supplementation may also be considered for APS patients with other cardiovascular risk factors such as high blood pressure, high blood sugar, and high cholesterol. Beyond supplements, having a healthy life style including being physically active, avoiding smoking, following a healthy diet, and maintaining a healthy weight is also very important for lowering the overall risk of APS-related complications.
Contributed by Yu (Ray) Zuo, MD, MSCS
- Illescas-Montes, R., et al., Vitamin D and autoimmune diseases. Life Sci, 2019. 233: p. 116744.
- Riancho-Zarrabeitia, L., et al., Vitamin D and antiphospholipid syndrome: A retrospective cohort study and meta-analysis. Semin Arthritis Rheum, 2018. 47(6): p. 877-882.
- Garcia-Carrasco, M., et al., The anti-thrombotic effects of vitamin D and their possible relationship with antiphospholipid syndrome. Lupus, 2018. 27(14): p. 2181-2189.
- Piantoni, S., et al., Low levels of vitamin D are common in primary antiphospholipid syndrome with thrombotic disease. Reumatismo, 2012. 64(5): p. 307-13.
- Cohen, H., et al., 16th International Congress on Antiphospholipid Antibodies Task Force Report on Antiphospholipid Syndrome Treatment Trends. Lupus, 2020. 29(12): p. 1571-1593.
- Zozina, V.I., et al., Coenzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem. Curr Cardiol Rev, 2018. 14(3): p. 164-174.
- Perez-Sanchez, C., et al., Ubiquinol Effects on Antiphospholipid Syndrome Prothrombotic Profile: A Randomized, Placebo-Controlled Trial. Arterioscler Thromb Vasc Biol, 2017. 37(10): p. 1923-1932.