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.
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
What did the leading Coenzyme Q10 researchers have to say in New York?
Coenzyme Q10 has three primary fields of activity in the body: as a co-factor in the energy production process in the cells, as a fat-soluble antioxidant protecting cells against oxidative damage, and as a regulator of endothelial function. In addition, Coenzyme Q10 has anti-inflammatory properties and plays a role in proper cell signaling activity.
The most recently published data from the KiSel-10 study done in Sweden shows that the beneficial heart health effects of supplementation of elderly live-at-home individuals with a combination of Coenzyme Q10 and high-selenium yeast have persisted through year 12.
A bio-availability study done at a university in Spain shows that the formulation of the Coenzyme Q10 supplement is even more important than the form of the supplement. The absorption of a well-formulated ubiquinone Coenzyme Q10 supplement is better than the absorption of a ubiquinol supplement.
A sub-group analysis of the data from the Q-Symbio study of the effect of adjunctive Coenzyme Q10 treatment on European chronic heart failure patients shows even better results for Europeans than for all patients in the multi-center study.
Studies show that there may be interactions between Coenzyme Q10 and other nutritional supplements, meaning that we should be careful not to take these supplements at the same time we take our Coenzyme Q10.
The consensus at the conference was that the therapeutic level of Coenzyme Q10 in the plasma or serum is somewhere between 2.5 and 3.5 micrograms per milliliter. Above 4.0 micrograms per milliliter, the beneficial effect of Coenzyme Q10 supplementation is thought to flatten out.
Statin medications only deprive the body of Coenzyme Q10 by inhibiting the bio-synthesis of Coenzyme Q10 just as they inhibit the bio-synthesis of cholesterol. Now there is evidence that long-term use of statins has undesirable effects on cognitive function and on memory in particular. The statins easily cross the blood-brain barrier and adversely affect the protective myelin sheaths in which cholesterol is a key component.
More about these topics below.
The 9th conference of the International Coenzyme Q10 Conference at Columbia University in New York
Every three years, the International Coenzyme Q10 Association (ICQA) holds a conference at which researchers from around the world present their research findings related to Coenzyme Q10. This year, the conference was held at Columbia University in New York the 21st-24th of June. Many of the presentations and papers concerned the biochemistry of Coenzyme Q10’s effects.
In this article, I want to focus in on the presentations of results from human clinical studies. In the clinical area, the emphasis was demonstrating the importance of Coenzyme Q10 supplementation to heart health, healthy ageing, and better quality of life.
There is a significant reduction in the rate of Coenzyme Q10 bio-synthesis during the ageing process and in ageing-related diseases. Mice studies have given us reason to believe that there is a direct relationship between a longer and healthier life and Coenzyme Q10 function in the mitochondria of the cells [Hernandez-Camacho 2018].
Human studies of Coenzyme Q10 status and healthy ageing
Coenzyme Q10 adjunctive treatment of chronic heart failure patients significantly improves their symptoms and survival [Mortensen 2014]. A recent survey of the scientific literature shows that Coenzyme Q10 supplementation is safe, well-tolerated, and effective as an adjunctive treatment in various disease conditions that involve high cellular and tissue demands for energy and in diseases involving oxidative stress and inflammation [Garrido-Maraver 2014].
Coenzyme Q10 is a naturally occurring essential nutrient. In human cells, it is a vital co-factor in the process of ATP energy generation and one of the most important lipid antioxidants. In this article, I summarize briefly the results of some of the recent scientific research using Coenzyme Q10 as an active treatment compared to a placebo treatment.
NQO1 is the abbreviated form of the name for both the NAD(P)H dehydrogenase (quinone 1) gene and the NAD(P)H:quinone acceptor oxidoreductase enzymes that the gene codes for. The NQO1 enzymes are of interest to us because they are responsible for the reduction of the ubiquinone form of Coenzyme Q10 to the ubiquinol form [Siegel 2017]. That conversion takes the Coenzyme Q10 molecules from their bio-energetics form to their antioxidant form.
NQO1 and the conversion of ubiquinone to ubiquinol
The ubiquinone form of Coenzyme Q10 is the essential form needed for the cellular process of ATP energy production. The ubiquinol form of Coenzyme Q10 is the fat-soluble antioxidant form that provides protection against oxidative damage.
The formulation of the Coenzyme Q10 supplement is of utmost importance. Formulation affects absorption. Absorption affects efficacy. Not all Coenzyme Q10 supplements give the same level of absorption.
Coenzyme Q10 molecules are fairly large, fat-soluble molecules. Coenzyme Q10 has a six-carbon benzoquinone ring as its head and a ten-unit isoprenoid tail that is strongly hydrophobic. For best absorption, Coenzyme Q10 needs to be ingested together with a meal containing some fat. Despite some claims to the contrary, it is not possible to re-make Coenzyme Q10 into a water-soluble substance. Such a product no longer has the properties of Coenzyme Q10 [Judy 2018].
Considerably reduced concentrations of Coenzyme Q10 in the skeletal muscle – up to 75% reduced levels – are associated with a diagnosis of ataxia. Coenzyme Q10 supplementation has proven beneficial in the treatment of both early and later stages of early-onset ataxia as well as in the treatment of adult-onset ataxia [Mantle & Hargreaves 2018].
Ataxia and Coenzyme Q10
Ataxia is the medical term for the loss of control of bodily movement, characterized by difficulty in walking and loss of balance. Ataxia can also affect eye movement, speech, and ability to swallow.
Sometimes we see people and companies making incorrect and misleading claims without proper documentation to support their claims. In the years since its introduction in 2007, there have been some questionable claims for the ubiquinol version of Coenzyme Q10 supplements. The ubiquinol version is not nearly as well tested and documented as the traditional ubiquinone Coenzyme Q10 version is.
In the articles on this web-site, we prefer to report the positive results from randomized controlled trials involving the use of Coenzyme Q10 supplements. But, occasionally, we must react negatively to the misleading claims that we see in some of the advertisements for some of the Coenzyme Q10 products available for purchase in the US.
A set of pharmacological mechanisms suggests that the use of statin medications may be stimulating the development of atherosclerosis and chronic heart failure. Japanese and American researchers have documented the mechanisms by which statin medications may be causing coronary artery calcification. They propose that the guidelines regulating the use of statin medications be critically re-evaluated [Okuyama 2015].
If the researchers are correct, then, yes, statin medications do reduce total cholesterol and bad cholesterol levels. However, statin medications may not reduce the incidence of coronary heart disease. Furthermore, statin medications may be at least partially responsible for the increased incidence of chronic heart failure that has been observed in the period since statin medications were introduced in 1987.