Big new Coenzyme Q10 in heart failure study proposed in the UK

The thickened heart muscle makes it more difficult for the heart to pump out adequate quantities of blood. Source: Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2).

Researchers in the United Kingdom are developed the methodology for a new randomized controlled trial of the efficacy of Coenzyme Q10 adjunctive treatment of heart failure patients.

Two earlier randomized controlled studies have produced results suggesting that daily supplementation with Coenzyme Q10 substantially reduces the morbidity and mortality in patients who are at risk for or have been diagnosed with heart failure.

Q-Symbio Study: Daily supplementation with 300 milligrams of Coenzyme Q10 for two years significantly improved the symptoms, quality of life, and survival of chronic heart failure patients [Mortensen 2014].

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Documented safety of Coenzyme Q10 supplementation

Yes, the raw material Coenzyme Q10 and the manufactured Coenzyme Q10 supplements are documented as safe and well-tolerated. However, the efficacy of the various CoQ10 supplements available on the US market varies considerably. It is wise to purchase a CoQ10 supplement that is supported by scientific documentation. For example, the CoQ10 supplement used in the Q-Symbio study, the KiSel-10 study, and the Gulf War Illness study has been evaluated in randomized controlled clinical trials. There is documented evidence that it is effective.

The nutritional supplement Coenzyme Q10 is non-toxic and without any noteworthy safety concerns [Hathcock; Ikematsu].

  • Coenzyme Q10 is very well-tolerated, and it does not cause any notable adverse effects at daily dosages as high as 1200 milligrams per day [Hathcock].
  • Studies of healthy individuals and studies of individuals with kidney impairment and liver impairment have not shown any potential for an adverse effect of CoQ10 supplementation on the kidneys or on the liver [Watson; Mabuchi; Farhangi].
  • A randomized, double-blind, placebo-controlled study enrolling healthy study participants showed no dose-related changes in hematology, blood biochemistry, and urinalysis [Ikematsu].
  • Moreover, plasma CoQ10 concentrations after an 8-month period of withdrawal from CoQ10 supplementation were nearly the same as before the supplementation [Ikematsu].

Importance of CoQ10 nutritional supplements

Note: Coenzyme Q10 is arguably the most important nutritional supplement for healthy individuals above the age of 40.  Cellular bio-synthesis of CoQ10 begins to slow down once we are past our 20s and lessens then with increasing age [Kalén].

  • CoQ10 in its oxidized form (ubiquinone form) is an essential co-factor in the process of cellular energy production.
  • CoQ10 in its reduced form (ubiquinol form) is an important fat-soluble antioxidant, protecting the cells against free radical damage.
  • CoQ10 is associated with significant improvement in endothelial function [Gao].
  • Coenzyme Q10 is a necessary supplement for patients taking statin medications as the use of statin medications inhibits the bio-synthesis of CoQ10 [Okuyama].

Daily supplemental dosages of CoQ10

  • A typical daily nutritional supplement dosage is 100 milligrams per day.
  • A typical therapeutic dosage for adjuvant treatment of chronic heart failure is 300 milligrams a day, taken as 3 times 100 milligrams with meals [Mortensen].
  • Coenzyme Q10 dosages of 300 milligrams per day have proven efficacy as an adjunctive treatment for chronic heart failure patients and patients with high blood pressure [Mortensen; Rosenfeldt].

No reports of potential overdose of CoQ10

There are no reports in the bio-medical literature of any potential for an acute intoxicating overdose in humans.

  • The estimated observed safe level of daily CoQ10 intake for adults is set at 1200 milligrams per day [Hathcock].
  • The few adverse effects reported in conjunction with Coenzyme Q10 supplementation – primarily nausea and other minor gastrointestinal effects – have been no more common at 1200 milligrams per day than at 60 milligrams per day [Hathcock].
  • 1200 milligrams per day is four times the daily amount of CoQ10 supplementation that resulted in the significantly improved symptoms and survival of chronic heart failure patients [Mortensen] and six times the amount that helped reduce the risk of death from heart disease in healthy senior citizens [Alehagen].
  • The highest daily dose of CoQ10 that has been investigated is 3600 milligrams per day for 12 weeks [Hyson].
Dr. William Judy, SIBR Research Institute, has seen a very low incidence of mild adverse effects of Coenzyme Q10 supplementation in his 30-year management of heart failure study.  Moreover, it is not clear that the few adverse effects that get reported are caused by the CoQ10 supplement. The same adverse effects occur in patients taking the placebo preparation.

Very low rate of mild adverse effects of CoQ10 supplementation

A 2003 survey of 13 randomized controlled studies of CoQ10 supplementation of heart failure patients as well as of open-label studies in heart failure showed that 200 milligrams of CoQ10 per day for 6–12 months and 100 milligrams per day for up to 6 years resulted in no major side effects.  The survey showed a rate of mild adverse effects at less than one-half of one percent [Mortensen].

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Coenzyme Q10 supplements and ejection fraction

Dr. William V. Judy is the president of the SIBR Research Institute. His clinical research and the research of several other research teams shows that Coenzyme Q10 supplementation of heart failure patients significantly improves ejection fraction. Ejection fraction is the cardiologist’s measurement of how much blood the heart pumps out to the other body organs with each contraction.

Congestive heart failure.  Chronic heart failure.  The inability of the heart to pump adequate blood to the other body organs.  In chronic heart failure, the left ventricular ejection fraction – the percentage of blood leaving the heart each time it contracts – is too low.

The medical term heart failure sounds like a death sentence.  It does not mean sudden death, but the prognosis is usually not good.  Heart failure is a disease that gets progressively worse.

The results of the Q-Symbio study give us good reason to think that CoQ10 adjunctive treatment, i.e. CoQ10 supplementation in addition to conventional medical treatment, can slow down the progression of the disease and improve the symptoms and the survival of heart failure patients [Mortensen].

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Coenzyme Q10 and mitochondrial function in diabetes

The level of oxidative stress is elevated in diabetes, and diabetes often induces mitochondrial dysfunction in the retina. Supplementation with Coenzyme Q10 provides antioxidant protection against the harmful effect of free radicals and improves bio-energetic function. Depicted here: a representation of a single mitochondrion.

The mitochondria – those little bean-shaped organelles inside the cells – are the primary source of cellular energy.  Coenzyme Q10, both the Coenzyme Q10 the body synthesizes and the Coenzyme Q10 we get in our food and in supplements, is fundamental to the cellular energy production process.  That means that Coenzyme Q10 is fundamental to the normal functioning of all tissues that are dependent on energy metabolism.  The retina is an example of such tissue.

Why is Coenzyme Q10 important for patients with diabetic retinopathy?

  • The number of diabetes patients diagnosed with diabetic retinopathy continues to grow.
  • We need new methods to prevent and treat diabetic retinopathy, which is a complication of diabetes that is caused by oxidative damage to the blood vessels in the retina.
  • Oxidative stress – the overproduction of harmful free radicals, also known as reactive oxygen species – is perhaps the primary cause of diabetic retinopathy [Calderon 2017].
  • Coenzyme Q10 supplements at higher than normal doses (400- 500 milligrams per day) can decrease oxidative stress and increase antioxidant enzyme activity in patients [Sanoobar 2013].
  • Coenzyme Q10 supplements in the form of ubiquinone improve mitochondrial homeostasis and diminish the breakdown of the energy production process [Rodriguez-Carrizalez 2016].

Antioxidant effect of CoQ10 on mitochondrial function in the retina

Researchers at the University of Guadalajara in Mexico investigated the antioxidant effect of adjunctive Coenzyme Q10 treatment on mitochondrial function in blood cells in patients with diabetic retinopathy [Rodriguez-Carrizalez 2016].

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Coenzyme Q10 is a life-long essential supplement

Dr. William V. Judy, founder and president of SIBR Research Institute, has done studies of Coenzyme Q10 supplementation of patients with chronic heart failure and chronic fatigue syndrome. Generally, after 10 -12 weeks of supplementation, the patients’ symptoms and quality of life improve significantly. However, if the supplementation is stopped, the patients suffer a relapse to their previous condition. Coenzyme Q10 supplementation is a life-long adjuvant therapy.

Coenzyme Q10 is a life-time essential supplement for most people as they get on in years.  People who especially need a Coenzyme Q10 supplement – heart failure patients and chronic fatigue syndrome patients, for example – will suffer a relapse if they stop taking their daily CoQ10 supplements.

CoQ10 and the constant need for ATP energy

Dr. William Judy, founder and president of the SIBR Research Institute, tells me that the life-long need for Coenzyme Q10 supplementation is related to the cells’ constant need for ATP energy.

Excesses of ATP energy cannot be stored.  The cells must produce ATP energy when they need the energy.  CoQ10 is a vital co-factor in the production of ATP energy in the cells.

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Not all Coenzyme Q10 supplements are the same

Dr. William V. Judy, founder and president of SIBR Research Institute, has done studies showing that oral ubiquinol is converted to ubiquinone prior to its absorption in the small intestines. In the lymph, it is converted back to the ubiquinol form. It makes sense that the CoQ10 is primarily in the ubiquinol form in the lymph and blood because, there, the need for Coenzyme Q10’s antioxidant properties is greater than the need for the bio-energetics function of the ubiquinone form.

A well-formulated ubiquinone Coenzyme Q10 supplement was absorbed significantly better than a well-formulated ubiquinol supplement.  This is one of the take-home messages from a recent carefully designed Spanish university study [Lopez-Lluch 2018].

Remember: Ubiquinol supplements are notoriously difficult to work with.  As an antioxidant posed to give up its two extra electrons, ubiquinol is by its very nature unstable.  Often, the ubiquinol is oxidized (gives up its electrons) while still in the soft-gel capsule.

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Coenzyme Q10 supplements: cheaper is not a good investment

In a double-blind, cross-over study, Professor Guillermo Lopez-Lluch and a team of researchers at the Pablo de Olavide University in Sevilla, Spain, have demonstrated that the composition and the formulation of the supplement is very important to the absorption and bio-availability of the Coenzyme Q10.

On this website, we review the results of clinical trials of the effects of oral Coenzyme Q10 supplementation.  We high-light human studies that show the following significant health benefits of taking a well-formulated CoQ10 supplement:

  • Improved symptoms and survival of heart failure patients
  • Reduced risk of death from heart disease and better maintained heart function among senior citizens
  • Improved quality of life for chronic fatigue syndrome patients
  • Faster recovery with fewer complications following heart surgery
  • Lowered systolic and diastolic blood pressure
  • Reduced frequency and intensity of migraine headaches

Why the need for CoQ10 supplementation?

Bio-synthesis of CoQ10 falling with increasing age.

Yes, our bodies do synthesize Coenzyme Q10 in almost all cells; however, the bio-synthesis of Coenzyme Q10 is a complicated multi-step process, and the extent of Coenzyme Q10 bio-synthesis decreases with increasing age once we pass our 20s.

Insufficient uptake of CoQ10 from the diet.

Moreover, it is difficult to get enough Coenzyme Q10 from our food alone to make up the difference in the declining endogenous production of CoQ10.  Remember, too, that it becomes more difficult to extract nutrients from our food as we get older.

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Coenzyme Q10: Misleading claims for ubiquinol products

Dr. William V. Judy (Ph.D. in physiology and bio-physics) founded the SIBR Research Institute to do absorption and bio-availability studies of Coenzyme Q10 and other natural products. Dr. Judy’s clinical research studies have focused on the effects of Coenzyme Q10 supplementation on Prader-Willi syndrome, congestive heart failure, chronic fatigue syndrome, diabetes, and certain cancers.Dr. Judy wants to see scientific documentation for claims of better absorption. There is so much variation in CoQ10 products that consumers must be cautious.

Marketers continue to make many unsubstantiated and misleading claims for the ubiquinol version of Coenzyme Q10 supplements.  As long ago as 2007, Dr. William Judy, the founder and president of the SIBR Research Institute, wrote a seminal article revealing the facts and fabrications that existed in marketing texts for ubiquinol products.  So far, no one has refuted the points that Dr. Judy made [Judy 2007].

CoQ10 formulation more important than CoQ10 form

Now, in 2018, we have the results of the double-blind, cross-over study done in Sevilla, Spain.  That study showed that a well-formulated ubiquinone Coenzyme Q10 supplement gave a significantly better bio-availability than did a well-formulated ubiquinol supplement.  That the ubiquinol supplement itself was well formulated is evidenced by the fact that the ubiquinol product out-performed other less well formulated ubiquinone products [Lopez-Lluch 2018].

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Coenzyme Q10: the European Q-Symbio study analysis

Biochemist Anne-Louise Mortensen shows that serum Coenzyme Q10 levels above 3.0 micrograms per milliliter can be achieved through daily supplementation with 300 milligrams of a patented ubiquinone Coenzyme Q10 supplement. The outcomes of the long-term supplementation of chronic heart failure patients were reduced risk of death from heart disease, reduced risk of death from all causes, reduced incidence of hospitalization, and reduced incidence of other major adverse cardiovascular events.

The Q-Symbio randomized, double-blind, placebo-controlled study of the effect of Coenzyme Q10 adjunctive treatment on the symptoms, adverse cardiovascular events, and survival of chronic heart failure patients is the single best Coenzyme Q10 clinical study that we have.

The Q-Symbio study was a two-year multi-center study enrolling 420 patients with moderate to severe heart failure.  The patients were randomly assigned to an active treatment group receiving 100 milligrams of Coenzyme Q10 three times a day or to a group taking matching placebos three times a day [Mortensen 2014].  The Coenzyme Q10 or placebo treatment was given in addition to the conventional heart failure medication.  The patients were recruited for the study in several European, Asian, and Australian countries.

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Coenzyme Q10: a new comparative bio-availability study

Professor Guillermo López-Lluch listens to a comment from professor emeritus Gian Paolo Littarru at the 9th conference of the International Coenzyme Q10 Association in New York, June 24, 2018.

Arguably, the most exciting Coenzyme Q10 research results of 2018 are the results of a comparative bio-availability study done at the Pablo de Olavide University in Sevilla, Spain.  The researchers’ carefully designed study demonstrates that the uptake of Coenzyme Q10 from oral supplements depends primarily on two factors [López-Lluch 2018]:

***The composition and formulation of the supplement, especially the types of substances used to dissolve the Coenzyme Q10 raw material in the supplement capsules

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