Cheap Coenzyme Q10 in some hospital pharmacies?

Some drug wholesalers may be providing Coenzyme Q10 supplements to the hospital pharmacy based on lowest price instead of based on documented absorption and health effects.  In that case, the chronic heart failure patients will not be getting the absorption and health benefits documented in the Q-Symbio trial.

Imagine my surprise, recently, when I heard from a reliable source that some hospital pharmacies are stocking cheap powder-based Coenzyme Q10 products for use with hospitalized heart failure patients.

I was shocked.

The most important thing about the Coenzyme Q10 supplement is its formulation.  Without a good formulation, there will very poor absorption.  Without good absorption, there can be no real benefit to heart failure patients.

Powder-based Coenzyme Q10 supplements are not going to do the job optimally.

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Factors affecting the absorption of Coenzyme Q10

The Andalusian Center for Developmental Biology at the Pablo de Olavide University in Sevilla, Spain,  has become an important center for Coenzyme Q10 research. Shown here:  a picture of the Plaza de España in Sevilla.

The absorption of Coenzyme Q10 is even more complicated than we realized.  Absorption of Coenzyme Q10 from supplements is difficult.  Okay, we know that.  Dr. William Judy, SIBR Research Institute, has explained why that is.  The formulation and composition of the Coenzyme Q10 capsule are the most important factors in the absorption of the Coenzyme Q10 molecules.

Recently, I watched a video of a presentation by Professor Guillermo López Lluch, University of Sevilla, Spain.  Dr. López Lluch was addressing the members of the International Coenzyme Q10 Association at a symposium in Bangkok, Thailand. He enumerated several factors that may affect the absorption of Coenzyme Q10.

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Coenzyme Q10: head-to-head comparison study of ubiquinone and ubiquinol absorption

What are we looking for in a Coenzyme Q10 nutritional supplement?  We want “full-range documentation” – documentation for good absorption, good response rate, and for health benefits. There is much variation in the formulation and absorption of Coenzyme Q10 supplements. It is best to select one with documented heart health benefits.

What we have been missing until now is a good study comparing the absorption of the more stable ubiquinone Coenzyme Q10 supplements with the absorption of the newer and less stable ubiquinol Coenzyme Q10 supplements head-to-head.  Now, the Coenzyme Q10 researchers at the University of Sevilla in Spain have carried out a direct comparison study in which the same study participants have been tested, with appropriate wash-out periods, on both ubiquinone and ubiquinol supplements.

The result:  One well-formulated ubiquinone Coenzyme Q10 preparation – the same preparation used in the Q-Symbio study, the KiSel-10 study, and the Gulf War Illness study –  has tested out significantly better than the ubiquinol preparation.  This particular ubiquinone Coenzyme Q10 supplement had nearly twice the absorption response as did the ubiquinol supplement in the study.

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Coenzyme Q10 Nutritional Supplements, 1981 to 2016

Gummy bears
Dr. Judy has watched the progression of Coenzyme Q10 supplements from dry powder tablets to dry powder in two-piece hard-gel capsules to dry powder in soybean oil in soft-gel capsules to Coenzyme Q10 dissolved in multiple lipids in soft-gel capsules. Today there are even Coenzyme Q10 gummy bears on the market. But what about the formulation? It is the supplement manufacturer’s formulation of the Coenzyme Q10 raw material that is most important for the absorption and health effects.

In line with other technologies, the production technology for Coenzyme Q10 nutritional supplements has advanced over the years.  For the past 35 years, Dr. William Judy of the SIBR Research Institute has followed the development of the Coenzyme Q10 nutritional supplements produced in the USA and around the world.

Dr. Judy has seen considerable improvement in the formulations of the Coenzyme Q10 nutritional supplements and in their effectiveness as an adjuvant treatment of chronic heart failure and other clinical conditions.  He has seen increasing awareness of the need for Coenzyme Q10 supplements in patients taking statin medications.  He has seen increasing awareness of the health benefits for healthy middle-aged and elderly people.

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Absorption of Coenzyme Q10, part III

Food
As we age beyond our 30s into middle age and old age, our bodies produce less and less Coenzyme Q10, but our need for Coenzyme Q10, especially for good heart health, does not decline. Healthy meals, even meals containing meat and fish, cannot make up the difference. We need a good daily supplement.

In this three-part series of articles, we have been discussing the absorption and bio-availability of the vital bio-nutrient Coenzyme Q10.  As we come into middle age and then into our senior years, we produce less and less Coenzyme Q10 ourselves.  Plus, certain medications — statin medications in particular — inhibit our bodies’ production of Coenzyme Q10 even more.  And, we know that adequate intakes of Coenzyme Q10 are necessary for good heart health and a decent quality of life.

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Absorption of Coenzyme Q10, part II

woman-strength
An adequate supply of Coenzyme Q10 to the heart muscle tissue cells is absolutely essential for good heart health. Coenzyme Q10 is necessary for the production of ATP energy in the cells. An energy starved heart is a failing heart.

Once we have swallowed a Coenzyme Q10 capsule, what happens next? Specifically, what happens as the Coenzyme Q10 flows from the stomach to the blood?  As it turns out, we know a fair amount about the transfer of the Coenzyme Q10.

The basics of Coenzyme Q10 absorption
Dr. William Judy’s study of Coenzyme Q10 absorption in large animals (large dogs that are conscious during the testing) and in humans have resulted in the following understanding:

Coenzyme Q10 is absorbed in the form of ubiquinone
Coenzyme Q10, regardless of whether it is taken in the form of ubiquinone supplements or in the form of ubiquinol supplements, will be absorbed in the small intestine in the form of ubiquinone.

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Absorption of Coenzyme Q10, part I

steak
Once we pass the age of 20, our bodies begin to produce less Coenzyme Q10 with increasing age. Various medications, including statin medications, interfere with our production of Coenzyme Q10. Most of us cannot hope to make up the difference in our meals. For good heart health, we need a daily Coenzyme Q10 supplement. The ubiquinone form of supplement is the most stable form and the most carefully researched form.

Coenzyme Q10 is a vitamin-like substance that is an essential bio-nutrient.  It is vital for the cellular process of ATP energy production. It is an important antioxidant protecting the cells against harmful free radicals. It is thought to improve epithelial cell function in the blood vessels and to protect against the development of atherosclerosis and high blood pressure. In this essay, we review some of  the basic facts of Coenzyme Q10 absorption and bio-availability.

Importance of Coenzyme Q10 absorption
Coenzyme Q10 bio-synthesis declines with age
Our bodies produce Coenzyme Q10 in much the same way that they produce cholesterol.  However, once we reach our 20’s, our bio-synthesis of Coenzyme Q10 begins to decline with increasing age [Kalén].  One estimate is that the plasma Coenzyme Q10 concentration of an average 65-year-old will be only about half the plasma concentration of an average 25-year-old: approximately 0.65 micrograms per milliliter versus 1.35 micrograms per milliliter.

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Coenzyme Q10 in muscle tissue cells

Bill Judy Picture
How much of the concentration of Coenzyme Q10 in muscle tissue is endogenous Coenzyme Q10 produced in the muscle tissue cells themselves, and how much is exogenous Coenzyme Q10 entering the tissue from the blood? Dr. Judy remembers that Japanese researchers were the first to determine these cellular levels in muscle tissue. They tagged the plasma Coenzyme Q10 – the Coenzyme Q10 from supplements –with an isotope. Then, afterwards, they measured the Coenzyme Q10 in muscle tissue cells. In their measurements, the tagged exogenous Coenzyme Q10 was about 48% of the total, and the endogenous Coenzyme Q10 was about 52%. Of course, in the case of older people and in cases of cellular Coenzyme Q10 deficiencies (heart failure and chronic fatigue, for example), the levels of exogenous CoQ10 can be expected to exceed the levels of endogenous Coenzyme Q10.

Okay, from solid research results, we know several things about the essential bio-nutrient Coenzyme Q10.

  • our bodies produce Coenzyme Q10, which is an essential substance for our cells’ energy production and for the antioxidant protection of our cells
  • once we reach our 20’s, our body’s own production of Coenzyme Q10 decreases with increasing age
  • statin medications inhibit our bodies’ production of Coenzyme Q10
  • we are very unlikely to get all the Coenzyme Q10 that we need from our food
  • the risk of heart disease and other diseases increases with the lesser availability of Coenzyme Q10
  • we need a daily Coenzyme Q10 supplement.

Coenzyme Q10 levels in tissue cell and in plasma
Basic fact: Plasma Coenzyme Q10 levels will always exceed tissue cell Coenzyme Q10 levels except, possibly, in some very well-conditioned athletes, e.g. soccer players and cross-country skiers and cyclists. In some superior athletes, the tissue cell Coenzyme Q10 levels and the plasma Coenzyme Q10 levels may come close to being equal.

How does Coenzyme Q10 get from the blood to the cells?
Coenzyme Q10 molecules move from the blood into the tissue cells by the process of diffusion.  If plasma Coenzyme Q10 concentrations were lower than the tissue cell Coenzyme Q10 concentrations, then the diffusion of Coenzyme Q10 from the blood into the tissue cells could not take place.  There would need to be some sort of active transport of Coenzyme Q10 into the tissue cells, and we know of no active transport of Coenzyme Q10 into the tissue cells [Judy 2016].

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Dr. Judy speaks about Coenzyme Q10

dr-judy-in-bologna-2015
Dr. William V. Judy delivering remarks about Coenzyme Q10 absorption at the International Coenzyme Q10 Association conference in Bologna, Italy, in October, 2015.

Dr. William V. Judy earned his doctorate degree in physiology and bio-physics in 1971.  He has worked as an aerospace scientist in NASA’s manned spacecraft center and has taught in the Indiana University School of Medicine as a Professor of Physiology.  Dr. Judy has worked in basic and clinical research for 56 years now; the major focus of his research has been on the absorption, efficacy, and safety of Coenzyme Q10.  He was an early colleague of Dr. Karl Folkers, with whom he carried out joint research studies for 21 years.
 
Absorption of Coenzyme Q10 from supplements
Dr. Judy makes the following points about the absorption of Coenzyme Q10:

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Coenzyme Q10: The best of q10facts.com

Karl Folkers
Dr. Karl Folkers, the researcher who established the chemical structure of the Coenzyme Q10 molecule and who developed the biochemical rationale for the use of Coenzyme Q10 as an adjuvant treatment of chronic heart disease, called Coenzyme Q10 the “essential bio-nutrient.”

In this article, I look back over the past 80 q10facts.com articles and pick out my favorites.  Together, these articles give a good picture of what I have tried to present on this website: documented results from scientific studies of the absorption, safety, and efficacy of Coenzyme Q10 supplements in the form of ubiquinone.  At the present time, there simply is not the same quality or quantity of research results related to the use of Coenzyme Q10 supplements in the ubiquinol form.

Coenzyme Q10’s therapeutic value
This article summarized the clinical research evidence for the use of Coenzyme Q10 as an adjunctive therapy for the following patients:

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