How Coenzyme Q10 supplements protect us

Dr. William V. Judy, Founder and President of SIBR Research, has done basic and clinical research into the safety, absorption, and health effects of Coenzyme Q10 supplementation for 40 years. His research has documented significant health benefits of CoQ10 supplements in patients with heart failure, chronic fatigue syndrome, and heart surgery.

As we get older, the risk of heart disease increases.  There are two basic explanations for this increasing risk:

  • Mitochondrial dysfunction
  • Oxidative stress

Mitochondrial dysfunction

The mitochondria are the tiny “powerhouses” in our cells.  They are organelles with their own DNA.  They produce almost all the energy that our cells need to live and work.

A slow degeneration of the quality of the mitochondria seems to be a cause of ageing and a cause of many of the degenerative diseases that come with ageing [Know 2018].

It is in the mitochondria that the food we eat is processed together with the oxygen we breath to make cellular energy, ATP energy.

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Absorption and Transport of Coenzyme Q10

Oxidation. We know it from rusting cars and rancid butter. It is the loss of electrons in chemical reactions. The opposite process is called reduction. Reduction is the gain of electrons. Coenzyme Q10 molecules are redox molecules. That means, we can take CoQ10 supplements in their oxidized form, ubiquinone, and be confident that it will be converted to the reduced form, ubiquinol, which is the form that acts as an antioxidant and protects against the oxidation of cells and fats and proteins and DNA.

Coenzyme Q10 supplements are not all the same.  Some give a much better absorption than others. To get real value for the money we spend on CoQ10 supplements, we need to seek out and buy a product with documented good absorption.

A randomized controlled study done in 2018 has shown that a patented ubiquinone Coenzyme Q10 supplement gives significantly better absorption than a patented ubiquinol supplement [Lopez-Lluch 2018].

Dissolving Coenzyme Q10 crystals to single molecules

The Coenzyme Q10 raw material is a crystalline powder.  These crystals cannot diffuse into the intestinal absorption cells.  The crystals will pass right through the intestinal tract and will be eliminated in the feces.

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Choosing a ubiquinone Coenzyme Q10 supplement

Professor Guillermo Lopez-Lluch and a research team tested seven different CoQ10 supplement formulations containing 100 mg of CoQ10 in 14 young, healthy individuals. The researchers measured CoQ10 bio-availability as area under the curve of plasma CoQ10 levels over 48 hours after the ingestion of a single dose. They repeated the measurements in the same group of 14 volunteers in a double-blind crossover design with a minimum of 4-week washout between intakes. The research results showed that there were statistically significant variations in the bio-availability of the CoQ10 formulations. The best absorbed CoQ10 formulation was a formulation containing ubiquinone (oxidized CoQ10) dissolved in a soy oil matrix.

The first-ever head-to-head comparative bio-availability study has shown that a patented ubiquinone Coenzyme Q10 preparation gives a significantly better absorption and bio-availability than a patented ubiquinol product.

That is what happened in the double-blind, cross-over study conducted by researchers at the Pablo de Olavide University in Sevilla, Spain, in 2018 [Lopez-Lluch 2019].  

This is important for several reasons:

Until this study in 2018, there had never been a head-to-head comparison study of the bio-availability of a ubiquinone CoQ10 supplement and a ubiquinol supplement [Judy 2018].

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Coenzyme Q10 and pregnancy

Normally, in this blog we focus on clinical research into the effects of Coenzyme Q10 supplementation of heart failure patients, senior citizens, patients with high blood pressure, patients with diabetes, and so on. Today, we have summarized a randomized controlled trial of Coenzyme Q10 supplementation of pregnant women.

What about Coenzyme Q10 supplements for pregnant women and breastfeeding mothers, you ask.  Well, yes, that seems to be a logical question.  

Coenzyme Q10 is an essential factor in the cellular process of energy production.  It plays an important role in antioxidant protection of the cells. It helps to maintain good endothelial cell function [Littarru 2010].

And, pregnancy is certainly a time when women need extra energy.  Ditto when they are breastfeeding.  

Similarly, pregnancy and breastfeeding are times of increased oxidative stress and thus increased need for antioxidant protection.  Pre-term mothers and infants, in particular, need extra antioxidant defense [Abuhandan 2015].

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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: 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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