The Awesome Foursome

By Angela Hartley on 13 May 2021

Boosting Your Energy

Today we are talking about boosting your energy, particularly when you are a heart patient. And who doesn’t want more energy? 


The Awesome Foursome is a group of nutrients first grouped together and promoted as useful for his heart patients by Dr Stephen Sinatra. These nutrients are used in the USA regularly and can be found easily in health food stores there. In the UK, they aren't promoted so much by doctors and most cardiologists will look at you blankly if you ask about Coq10, magnesium, D-Ribose or L-Carnitine. So I wanted to look a bit deeper into what the nutrients are, whether they can help heart patients and in what dosages they would become useful.

I would say that 9 out of 10 of the people who come to see me for exercise sessions or join in my Healthy Hearties classes have low energy. And I dare say all of my face to face clients in the UK have suffered with fatigued.

And there are plenty of things that I start with to help increase their energy – improving sleep habits, increasing water intake, having sleep apnoea diagnosed and treated (a massive improvement in energy if you suffer from this) removing rubbish from their diet, having an underactive thyroid treated and adding exercise (of course!). These things definitely help and are a great place to start. But for some people, the energy is just low, all the time. And it’s often too low to get into a regular exercise routine, too low to have the energy to eat healthily (a vicious cycle) and too low to be bothered to try anything else.


But there is something else that can help, and that is targeted nutrients and in particular, my favourite four nutrients that after hundreds of journal articles and reading countless books on the topic I'm convinced these CAN help improve energy along with other symptoms. And these 4 nutrients together are coined the ‘Awesome Foursome’.

The Awesome Foursome


Photo by: Mika Baumeister


The ‘Awesome Foursome’ is a combination of 4 different nutritional supplements recommended by the US based Cardiologist Dr Stephen Sinatra ( He discovered after many years of treating his cardiac patients with the usual mix of medications, that they’d often reappear needing further treatment, higher doses of medications and more interventions.


Dr Sinatra was frustrated that his patients never seemed to get ‘better’ and he wanted to help improve both their quality of life and also stop practicing ‘revolving door medicine’. He researched a wide range of nutrients and treated his own patients with nutritional supplements that were backed by research and are in fact widely known to be beneficial to the heart in medical textbooks, however are rarely used or promoted by doctors.


The “Awesome Foursome,” consists of 4 nutrients - Coenzyme Q10 (which I've written about HERE), L-Carnitine, D-Ribose and Magnesium.

All four of these nutrients help with energy production in the cells of the body by assisting the production of ATP (Adenosine Tri-Phosphat) in the mitochondria of your cells. And why is that so important... Well let's think of our body as a car and we want it to run like a top end Audi, rather than a clapped out bomb from 1984...

Think of Your Body Like a Car

Photo by: Erik Mclean

Think of ATP like the fuel (energy) of that car.

We all need a constant, sustained and healthy pool of ATP to fuel bodily functions. Every cell in the body requires large amounts of ATP to cope with all of the body’s processes, including contracting and relaxing the heart muscle, maintaining cellular ion balance, and synthesizing macronutrients like proteins and fats.

Your body generates ATP itself as well as recycles it through a process called oxidative phosphorylation. A much faster process than synthesizing ATP from scratch, recycling is the preferred method of energy production. Eighty to ninety percent of ATP is recycled in the mitochondria (the ‘battery’ of each cell), then released into the fluid portion of cells to be used for energy.

Back to the car analogy, your body is the car, the mitochondria is the battery of the car and ATP is the energy produced by that battery.

So these mitochondria require a good amount of the “awesome foursome” to generate ATP.

Coenzyme Q10 and L-Carnitine are fundamental to the ATP recycling process and D-ribose is necessary for generating ATP from scratch.

Back to our car - D-ribose helps fill the body’s petrol tank while L-carnitine and CoQ10 help the body convert that fuel into usable energy.

Literally, D-ribose is a structural component of the ATP molecule, and L-carnitine and CoQ10 help recycle ATP by transporting fatty acids across mitochondrial membranes and shuttling electrons back and forth between enzymes, respectively.

Co-Q10 then acts as an antioxidant to protect mitochondrial membranes from free-radical damage. Like a spark plug central to both processes, magnesium “turns on” the enzymes that drive the entire metabolic reaction.

So, what’s the big deal? Our car seems to be running… So we must be getting enough of these nutrients by ourselves, right?

Well yes, sort of. Your car still works. The engine still turns on and you can get to the shops and back without it blowing up.

However it’s not exactly functioning like a brand new Ferrari, is it? Feeling tired, getting exhausted and not getting any ‘better’ are some of the symptoms that your car is running on empty – you’re literally scraping the bottom of the fuel tank and running on fumes.

So What Is Causing These Nutrients To Be Running So Low?

Photo by: Tim De Pauw

Firstly, you’re more than likely using up a lot of them! If you have a heart condition, any damage to the heart, an arrhythmia, or heart failure then your body needs MORE of these nutrients to perform the heart’s function. Basically, your old, worn out car is chewing through energy at a rate of knots.

Age is also against us. After the age of 40, our own body’s production of CoQ10 and L-carnitine starts to decrease, explaining why people commonly associate lack of energy the older they get.

People suffering from coronary artery disease often can’t keep up with the heart’s energy demands. With heart disease, the heart continually overworks to pump blood through inflamed and congested blood vessels and ultimately expends energy much faster than the mitochondria can produce it.

If you take medications, you may also be deficient in these nutrients. Beta blockers, for example, which prove effective in stabilizing people during emergency situations and improving symptoms, inhibit the production of enzymes necessary for CoQ10 synthesis. Statins, which reduce the production of cholesterol in the liver, also reduce the production of CoQ10 by the body as it is formed from the same enzyme.

Already produced by your body, any or all of the “awesome foursome” can usually safely and effectively be ingested in tandem with medications like beta blockers, blood thinner, statins, calcium channel blockers, nitrates and ACE inhibitors. Not only will taking energy-enhancing supplements help reduce negative side effects associated with medication, but it might eventually reduce, or even eliminate, your need for such medication.

Please note: Always consult with your doctor and/or pharmacist before taking any supplements to ensure safety.

Important information: Always start with one supplement at a time. Always start with a low dose and gradually increase so you can gauge any potential side effects or allergies.

How Much Do I Need per Day of Each Nutrient?

Photo by: Diana Polekhina

For otherwise healthy individuals

Coenzyme Q10: 90-150 mg: good brands include Cytoplan (Use HA10 for a 10% discount), Healthspan 

L-Carnitine: 250-750 mg.

D-Ribose: 5 grams

Magnesium: 400 mg.

Optional: Multivitamin and 1-2g fish oil

For individuals suffering from high blood pressure

Coenzyme Q10: 180-360 mg.

L-Carnitine: 500-1000 mg.

D-Ribose: 5-10 grams

Magnesium: 400-800 mg. 

Optional: Multivitamin and 1-2g fish oil

For individuals suffering from chronic fatigue or fibromyalgia

Coenzyme Q10: 300-360 mg daily.

L-Carnitine: 2000-3000 mg daily.

D-Ribose: 15 grams daily.

Magnesium: 400-800 mg daily. 

Optional: Multivitamin and 1-2g fish oil

For individuals diagnosed with coronary artery disease

Coenzyme Q10: 180-360 mg.

L-Carnitine: 1000-2000 mg.

D-Ribose: 10-15 grams

Magnesium: 400-800 mg 

Optional: Multivitamin and 1-2g fish oil

For individuals with abnormal heart rhythms, such as atrial fibrillation or PVCs

Coenzyme Q10: 180-360 mg.

L-Carnitine: 1000-2000 mg.

D-Ribose: 7-10 grams

Magnesium: 400-800 mg 

Optional: Multivitamin and 1-2g fish oil

For individuals with congestive heart failure

Coenzyme Q10: 300-360 mg

L-Carnitine: 2000-2500 mg

D-Ribose: 10-15 grams

Magnesium: 400-800 mg

Optional: Multivitamin and 1-2g fish oil

Get in touch if you’d like more information or to book a personalised cardiac exercise and nutrition program with me.