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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Highlights of the 9th International Coenzyme Q10 Association Conference

The 9th Conference of the International Coenzyme Q10 Association was held June 21 – 24 in the Faculty House at Columbia University in New York. Researchers from many different countries and continents attended.

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.

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Coenzyme Q10 and healthy ageing

Physical exercise combined with a Mediterranean diet and Coenzyme Q10 supplementation should improve our chances for healthy ageing and for the prevention of chronic oxidative stress leading to neurodegenerative disease and heart disease.

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

Professor Alehagen’s KiSel-10 study:

Four years of daily supplementation with 200 milligrams of Coenzyme Q10 and 200 micrograms of high-selenium yeast resulted in significant health benefits for elderly community-living study participants as compared to placebo supplementation [Johansson 2015]:

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Coenzyme Q10: recent research results

Coenzyme Q10 (ubiquinone) is ubiquitous in human tissues; however, its concentration levels vary. Concentrations are highest in organs with high rates of metabolism, e.g. the heart, the kidneys, the liver. The bio-synthesis and thus the whole body content of Coenzyme Q10 decreases with increasing age in the adult years. Adequate concentrations of Coenzyme Q10 are essential for the health of nearly all human cells and tissues because Coenzyme Q10 is vital for the process of ATP energy generation and because it is an important lipid antioxidant.

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.

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Coenzyme Q10 and the NQO1 gene and enzyme

Genes code for the making of enzymes, structural proteins, transport proteins, and defense proteins. The NQO1 gene codes for enzymes that reduce Coenzyme Q10 and Vitamin E to their antioxidant forms. Genetic variations called polymorphisms may lead to a failure to produce the standard form of a gene. There seem to be ethnic differences in the ability to produce the standard form of the NQO1 gene such that some ethnic groups have a higher percentage of individuals unable to produce the gene and thus make the enzymes that reduce Coenzyme Q10. However, these ethnic differences are on the order of 2 or 3 polymorphisms per 20 individuals, too few to warrant the marketing claim that individuals over the age of 40 have difficulty converting ubiquinone Coenzyme Q10 to its reduced form ubiquinol. 

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.

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Dr. Judy speaks on the formulation of Coenzyme Q10 supplements

Dr. William Judy, founder and president of the SIBR Research Institute, says the manufacturer of a Coenzyme Q10 supplement needs three things in the soft-gel capsule together with the 100 milligrams of dissolved Coenzyme Q10 crystals: A solvent in which the Coenzyme Q10 crystals are dissociated, a stable formulation that will prevent the re-crystallization of the Coenzyme Q10 inside the capsule, and one or more lipids that, ingested together with the Coenzyme Q10, will enhance the absorption of the Coenzyme Q10.

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].

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Coenzyme Q10 for ataxia patients

Friedreich’s ataxia is one of several different types of ataxia with different causes and prognoses. Friedreich’s ataxia is characterized by muscle weakness, loss of coordination, impairment of vision and hearing, slurred speech and curvature of the spine (scoliosis). Frequently, it results in the development of diabetes and/or heart failure. There is no cure; however, Coenzyme Q10 supplements can help to ameliorate the symptoms because of Coenzyme Q10’s role in cellular energy production and in antioxidant defense against oxidative damage to cells.

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.

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