Coenzyme Q10 and breast cancer care: a new review

Individuals with breast cancer are much more likely to have low plasma Coenzyme Q10 concentrations than healthy individuals. Cell line studies, animal studies, and a few human studies suggest that Coenzyme Q10 supplementation may be beneficial as an adjunctive treatment together with conventional therapy for breast cancer.The published bio-medical journal literature about the efficacy of Coenzyme Q10 adjunct treatment in breast cancer care is sparse but promising.  

The published bio-medical journal literature about the efficacy of Coenzyme Q10 adjunct treatment in breast cancer care is sparse but promising. So concludes the author of a 2017 systematic review of the journal articles indexed in PubMed. PubMed is the free public index to the National Library of Medicine’s Medline database [Tafazoli].

More well-designed clinical studies are needed to provide answers to questions about the adjuvant use of Coenzyme Q10 in breast cancer treatment and care:

  • Is Coenzyme Q10 effective as a single intervention agent?
  • Is Coenzyme Q10 more effective in combination with other nutritional supplements such as essential fatty acids and selenium?
  • What formulations and what daily dosages of Coenzyme Q10 are most effective?

Documentation about Coenzyme Q10 and breast cancer care

Coenzyme Q10 concentrations and breast cancer

  • Evidence from human breast tissue samples shows that Coenzyme Q10 concentrations are much lower in cancerous tissue than in normal tissue [Tafazoli].
  • Data from a case-control study has shown an inverse relationship between plasma Coenzyme Q10 concentrations and the incidence of breast cancer, independent of menopausal status [Tafazoli].
  • Cell line studies have shown that the addition of Coenzyme Q10 does not inhibit the apoptotic, anti-growth, and anti-colonization effects of the chemotherapy drug doxorubicin – trade name Adriamycin while it does protect the heart muscle [Tafazoli].
  • Coenzyme Q10 supplementation added to chemotherapy with doxorubicin (Adriamycin) prevents the mitochondrial damage and subsequent cardio-toxicity caused by reactive oxygen species produced during the treatment with doxorubicin [Tafazoli].

Coenzyme Q10 and mammary carcinomas

An animal study has shown that oral administration of Coenzyme Q10 had the following effects on rats with induced mammary carcinomas [Tafazoli]:

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Coenzyme Q10 as heart failure medicine

Chronic heart failure is characterized by an energy starved heart.  The Q-Symbio study’s lead researcher, Dr. Svend Aage Mortensen, treated chronic heart failure patients with 300 milligrams of Coenzyme Q10 daily as an adjunctive treatment to the conventional heart failure medications. His thinking was that the conventional treatments block rather enhance cellular processes and do not address the heart muscle cells’ need for the cofactor Coenzyme Q10 in the ATP energy production process. He used Coenzyme Q10 supplements to address the dysfunction of cellular bio-energetics that is associated with heart failure.

The Q-Symbio randomized, double-blind, controlled study of the effect of Coenzyme Q10 supplementation on morbidity and mortality in heart failure shows that adjuvant supplementation of heart failure patients with 300 milligrams of Coenzyme Q10 daily reduces the all-cause risk of death by half [Mortensen 2014].  The 300-milligram dosage was administered in 100-milligram increments three times a day, always with meals.  Dr. Svend Aage Mortensen, the lead researcher on the Q-Symbio study, recommended that daily administration of Coenzyme Q10 should become a component of the standard treatment of heart failure [Mortensen 2015].

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Coenzyme Q10 and heart health

Coenzyme Q10, also known as ubiquinone, is a fat-soluble substance that is similar to a vitamin but is synthesized in our bodies. In adulthood, the body’s synthesis of Coenzyme Q10 declines with increasing age.  Furthermore, statin medications inhibit the body’s production of Coenzyme Q10. Supplementation is nearly always necessary; it is not possible to make up deficits of Coenzyme Q10 by careful eating. Optimal concentrations of Coenzyme Q10 in the blood and in the heart muscle tissues is especially important for good heart health.

Coenzyme Q10 has become the third most purchased specialty nutritional supplement according to a recent survey.  The number of daily users of Coenzyme Q10 in the United States has risen from some 3 million people in the year 2000 to over 16 million people at present [Sinatra 2018].

There are good reasons for this increase, which the American cardiologist Dr. Stephen Sinatra has explained in a recent electronic book published by the WholeFoods Magazine [Sinatra 2018].  I want to summarize Dr. Sinatra’s reasoning for my readers.

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Coenzyme Q10 and heart failure: a new meta-analysis

Symptoms of heart failure include shortness of breath, a tired feeling all the time, a build-up of fluid in the tissues, and heart palpitations. This chest x-ray shows an enlarged heart, the build-up of fluid between the lungs and the chest, the infiltration of fluid into  the lungs, and dilated pulmonary blood vessels. Still to come for this heart failure patient is the collecting of more fluid in the lungs, making breathing even more difficult.

Heart failure patients treated with daily Coenzyme Q10 supplements in addition to their conventional heart failure medications have significantly lower death rates and significantly improved exercise capacity compared with heart failure patients treated with conventional medications alone [Lei].

This is the conclusion of the 2017 meta-analysis of relevant randomized controlled trials reported by Li Lei and Yan Liu in the BMC Cardiovascular Disorders journal.  The two cardiologists analyzed the results from 14 randomized controlled studies enrolling a total of 2149 patients.

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Coenzyme Q10 and systemic inflammation: a review

A 2017 meta-analysis of aggregated data from 17 clinical studies shows that Coenzyme Q10 supplementation is associated with reduced levels of bio-markers for systemic inflammation.  Attribution: Austin, V., Crack, P. J., Bozinovski, S., Miller, A. A., & Vlahos, R. (2016). COPD and stroke: are systemic inflammation and oxidative stress the missing links?  Clinical Science (London, England: 1979), 130(13), 1039-1050.

Coenzyme Q10 supplementation has a significant lowering-effect on bio-markers of low-grade systemic inflammation. This is the conclusion of a 2017 meta-analysis of 17 randomized controlled studies enrolling 811 study participants [Fan].

Inflammation is an immune system response to harmful stimuli. However, whenever the inflammation persists and becomes a chronic condition, and whenever the circulating levels of cytokines (= substances secreted by immune system cells) are elevated by a factor of two or more, then the inflammation itself can be harmful to the body in the long term.

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Coenzyme Q10 and migraine headaches

The migraine headache is characterized by severe throbbing pain, which is usually experienced on just one side of the head. Other symptoms include nausea, vomiting, and sensitivity to light and sound. Migraine attacks can last for many hours and even for days, and the pain can be so severe that it is disabling. Clinical studies have shown that daily Coenzyme Q10 supplements can help to reduce the frequency, the duration, and the intensity of migraine headaches.

Migraine headaches are more than just really bad tension-type headaches.  Migraine is a disabling neurological disease that keeps its victims from living and working normally.

Migraine is the third most prevalent disease in the world and the sixth most disabling disease in the world. Nearly one in four American households has a family member who suffers from migraine headaches [Migraine Research Foundation].

  • Migraine affects three times as many women as men. 
  • Migraine is most common between the ages of 25 and 55 years.
  • Migraine is a very expensive disease, both in terms of the expenditures for treatment and in terms of the lost production [Migraine Research Foundation]

Prophylactic treatment of migraine

Despite the prevalence and economic expense of migraine headaches, there are few medications approved to prevent its occurrence, and even fewer medications that do not have potentially serious adverse effects [Shoeibi].

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Coenzyme Q10 and fatty acids and statin medications

Statin medications, also known as HMG-CoA reductase inhibitors, have a good record at reducing high cholesterol levels. However, statin medications inhibit not only the body’s synthesis of cholesterol but also the body’s synthesis of Coenzyme Q10, which the heart muscle cells need for energy production and antioxidant protection. Statin drugs lower the plasma and tissue levels Coenzyme Q10. We need greater awareness of this relationship between statin drugs and the essential bio-nutrient Coenzyme Q10.

Statin medications?  What are we to think?  Statins undoubtedly lower cholesterol levels and reduce the number of heart attacks.

But statin medications can and do have adverse effects [Okuyama].  One of the undesirable unintended consequences of taking a statin medication is that the patient’s bio-synthesis of Coenzyme Q10 is also inhibited.  The body produces cholesterol and Coenzyme Q10 in the same biological pathway.  Cut off one, and you cut off the other as well.

The heart muscle cells need Coenzyme Q10

Low plasma and tissue concentrations of Coenzyme Q10 are clearly associated with increased risk of heart failure [Folkers].

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Coenzyme Q10 therapeutic applications

Evidence from randomized controlled trials like the Q-Symbio study show the efficacy of Coenzyme Q10 adjuvant treatment in improving the symptoms and survival of chronic heart failure patients. Illustration courtesy of Dr. William Judy, SIBR Research Institute.

For 30-plus years now, bio-medical researchers have investigated and documented the functions of Coenzyme Q10 in the human body:

  • An essential role in cellular production of ATP energy [Littarru 2007]
  • An important antioxidant role preventing the oxidation of proteins, lipids, and DNA [Littarru 2007]
  • A role in the enhancement of endothelial function [Littarru 2011]
  • A beneficial role in the expression of genes involved in human cell metabolism, signaling, and transport [Garrido-Maraver]

Moreover, the scientific documentation shows that Coenzyme Q10 supplements are safe, are well-tolerated, and are effective as adjunctive treatments in diseases involving high cellular and tissue demands for energy and in diseases involving oxidative stress and oxidative damage [Garrido-Maraver].

Absorption and Bio-Availability of Coenzyme Q10

As we get older, our bodies produce less Coenzyme Q10 [Kalén].  It is not realistic to make up the difference in the diet [Judy].  Supplementation is necessary.

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Coenzyme Q10 and crucial antioxidant enzymes

Oxygen is a strange element in our lives.  We cannot live without it.  We use it to burn nutrients to generate ATP energy in the cells.  So far, so good.

But, in the process of producing energy from nutrients – the process is called cellular respiration – some small portion of the oxygen produces a by-product: free radicals.  These radicals are atoms or molecules with one or more unpaired electrons in the outer orbit. There are many types of radicals; the radicals derived from oxygen – known as reactive oxygen species – are some of the most toxic radicals.

In moderate quantities, these free radicals have some useful inter-cellular and intra-cellular  signaling functions.  Moreover, the immune system’s phagocytic cells use radicals to kill pathogens.  However, in large quantities, the highly reactive radicals that escape the respiratory chain of the mitochondria can be toxic to the cells.  They can damage DNA, RNA, proteins and fatty acids in the blood and tissue.

In fact, the definition of oxidative stress is an imbalance between the quantities of potentially harmful free radicals and the quantities of antioxidants available to neutralize the free radicals before they can set off damaging chain reactions.  The process of lipid peroxidation is one of the most common examples of toxic activity by oxygen-derived radicals; the radicals target the fatty acids in the phospholipid cellular membranes, i.e. the plasma membranes of the cells and the mitochondrial membranes.  The antioxidant enzymes are important for the prevention of lipid peroxidation.

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Coenzyme Q10 and Red Yeast Rice against Heart Disease

Illustration showing how statin medications block the bio-synthesis of Coenzyme Q10 just as statin medications block the body’s synthesis of cholesterol.  Blocking the bio-synthesis of Coenzyme Q10 ultimately deprives the heart muscle cells of ATP energy and of antioxidant protection.  Illustration courtesy of Dr. William Judy, SIBR Research Institute.

Heart disease continues to be the number 1 cause of death in the developed world.  Much research has been done on efforts to modify some of the known risk factors for heart disease:

  • Diet
  • Exercise
  • Lifestyle

However, modifying these risk factors alone is not always sufficient to prevent heart disease.  Hence, the extensive prescription of statin medications in the United States because changing the lipid profiles of potential heart disease patients is do-able and effective. 

But the statin medications are not without adverse effects.  Even in generally healthy study participants given moderate statin doses, there can be unfavorable statin medication effects on energy and exertional fatigue.  Both simvastatin and pravastatin have been seen to contribute to a significant adverse effect of statins on energy and fatigue with exertion [Golomb 2012; Okuyama and Langsjoen 2015].

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