Old age creeps up on you. So does the weight that comes with it, stealthy as a sly fox. A pound or two a year, over five years, over ten, and the next thing you know you have loosened your belt a notch, then another, and one day you find yourself in a store holding up a pair of trousers with a waist size you do not recognize, wondering when exactly this happened. It happened while you weren’t looking. That is the fox’s whole method.
So I decided to do something about it. I went on a diet. The current fashion is the keto diet, whose philosophy, once you scrape away the marketing, is stranger than it first sounds: you get most of your calories from fat, you keep your protein moderate, and you cut the carbohydrates down to almost nothing. Fat is the point, not the enemy. Keep the protein reined in, too, because pile on too much and the body quietly turns the surplus into sugar and undoes the whole enterprise. No bread, no pasta, no rice, no potatoes, and above all none of the sweet, convenient, shrink-wrapped things that make modern life bearable. Piece of cake, I thought. Which, it turns out, is precisely the wrong expression, because cake was now forbidden.
Three days in, I was sticking to it and feeling rather pleased with myself. No weight loss yet, but these things take time, and virtue is its own reward, or so I told myself while eyeing a bagel with the longing of a man watching an old flame board a train. Then, on the fourth morning, I woke up with cramps in my legs. Not the gentle twinge that reminds you you’re alive, but the full seize-up that reminds you you’re old. In my self-induced state of ketosis, I had knocked my electrolytes clean out of whack. Cut the carbohydrates hard enough and your insulin falls, and when insulin falls the kidneys stop holding on to sodium and water; it all goes down the drain, and the other electrolytes follow it out the door. Nobody warns you that the first reward of dieting is a leg cramp at dawn.
I was semi-prepared for this. I guzzled orange juice, ate a big avocado and a couple of bananas, and was soon right as rain. But not wanting to tempt fate a second time, I headed to my local Costco to procure some magnesium.
Now, anyone who has been to Costco knows you do not simply buy magnesium at Costco. My pharmacy down the street would have sold me a modest bottle of thirty pills. Costco does not deal in modesty. Costco offered me a bottle of five hundred magnesium capsules for a couple of dollars more than I’d have paid for thirty at the shop. Five hundred. At my age, this is what financial advisors delicately call a long-term investment with uncertain maturity. But that is the peculiar thrill of Costco: walking out having bought considerably more than you need, or ever intended to, and feeling like you’ve won something.
The magnesium helped. No more cramps. And, glory be, I dropped three pounds.
Here is where the trouble started. The magnesium lives in the nutritional supplement aisle of the Costco pharmacy, and while I was standing there congratulating myself, my eye wandered, as eyes do, to what sat on the shelf beside it. Several handsome, brand-named bottles of Coenzyme Q10.
My curiosity, once piqued, is not easily un-piqued. So I filed it away, and sure enough, that evening I got home, turned on the television, and there she was: a very attractive, very slim, very blonde cardiologist, radiating reassurance, letting me know in the warmest possible terms that her brand of CoQ10 was the best one a discerning heart could want. Flip the channel, and there was another brand making the same promise. The universe, it seemed, was determined to sell me CoQ10.
Digging deep into the distant past, back to biochemistry lectures I had not thought about in half a century, and later confirming it with the modern student’s shortcut of an internet search, I recalled that Coenzyme Q10 is genuinely useful stuff. Your body needs it to make ATP, the little battery pack that powers every cell you own, and it earns its keep by ferrying electrons down the assembly line inside your mitochondria. It’s also an antioxidant. All true. So why the hype, and why the glamorous cardiologist? Because CoQ10 is sold as a nutritional supplement, available over the counter, and nobody has to prove it works before it goes on the shelf. It isn’t something your doctor writes a prescription for so much as something the television prescribes on his behalf.
Every one of the ads promoted CoQ10 for the same reason: it “supports heart health.” Now what, exactly, does that mean? Does it dispatch a tiny Hercules into your chest to hold the old pump up by main strength? Or does it send in a miniature Elon Musk, who leans against your ventricle and says, “Don’t worry, big guy, you keep beating, I’ll cover the bills until I figure this out, and if I run short I’ll just do another IPO”?
And here is the part I love. Because “supports heart health” is a claim about structure and function rather than a promise to treat any actual disease, the law obliges the manufacturer to print a small confession on the very same bottle: This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. In other words, the label spends its large print assuring you it supports your heart, and its small print admitting that nobody has checked. The blonde cardiologist does not read you that part.
The rest of the label is not much clearer. It informs me, in the careful language of a document written by lawyers, that CoQ10:
- Supports overall cardiovascular function and mitochondrial energy in heart tissue.
- Aids cells in converting food into energy, especially in highly active organs like the heart and liver.
- Protects the body from oxidative damage caused by free radicals.
Ah, the free radicals. The mustache-twirling villains of every supplement label ever written. But those scoundrels are another breed of cat, and another essay.
Now suppose you belong to the No Harm, No Foul school of thought. Where’s the harm, you say, and you take the CoQ10 anyway, along with the fifteen other little bottles promising support to every organ you can name. One for the heart, one for the brain, one for the kidneys, one for the gut, one for the prostate, and a few more for organs you’d forgotten you had. What actually happens to all of it?
Here is the unglamorous truth, and it is worse for the wallet than you’d think. CoQ10 is a big, fat-loving, water-hating molecule, and your gut regards it with deep suspicion. Of the handsome dose you just swallowed, only a small fraction ever makes it across the intestinal wall and into your blood. The studies put it at a few percent, sometimes as little as two or three, and in the sorriest formulations less than that. The great bulk of that expensive capsule never gets in at all. It simply travels the length of you and departs, having accomplished nothing but the journey. In a real sense the stool was expensive before the liver ever got involved.
And the modest remainder that does squeak through? Your body, sensible thing that it is, skims off the little it actually needs and sends the rest along to the liver. The liver, equally sensible, packs the surplus into bile, ships it down the bile duct, and out it goes with the next bowel movement.
So follow the money to its natural conclusion. Most of the capsule was never absorbed. What little was absorbed, past what you needed, got shown the exit. After all that expense, all that television, all that reassurance from the blonde cardiologist, you have accomplished exactly one measurable thing.
You have made more expensive stools.
Which brings me back, as these things do, to that bottle of five hundred magnesium capsules still standing sentinel in my cupboard. Magnesium has a well-earned reputation for loosening the bowels; it is the quiet engine inside many a laxative. And so I had to laugh at the shape of it all. I set out to take in my belt a single notch, and I have ended up the owner of two supplements at once. One of them, the magnesium, I paid good money for and it moves things briskly along. The other, the CoQ10, I would have paid good money for so that it could pass through me barely touched and move things along just the same. Two bottles, two exits, one destination.
Old age creeps up on you. And it appears the plumbing is the last thing still running ahead of schedule.