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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Concerns about claims for ubiquinol products

Woman at computer
People deciding on a nutritional supplement need more than undocumented marketing claims. They need evidence from randomized controlled studies. They need evidence that shows whether the difference in the outcome, e.g. heart function, between the active Coenzyme Q10 treatment study group and the placebo treatment study group is statistically significant.

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.

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Dr. Judy’s Coenzyme Q10 research history

When the ubiquinol supplement enters the stomach and when the capsule opens, the ubiquinol begins to oxidize. In the small intestine, the ubiquinol is converted to almost all ubiquinone. In the absorption cells and in the abdominal lymph ducts, the Coenzyme Q10 is initially almost all in the ubiquinone form. The Coenzyme Q10 enters the blood from the lymph. Thus, it appears that ubiquinol is absorbed as ubiquinone and not as ubiquinol. It is then converted back to ubiquinol before entering the blood. From: Dr. Judy’s presentation at the International Coenzyme Q10 Association symposium in Bologna, Italy, October, 2015.

Q. Good morning, Dr. Judy.  Let’s talk about the Coenzyme Q10 research you have done in your career.  But, first, do you remember when you first met Dr. Karl Folkers, the grand old man of Coenzyme Q10 research?

A. Good morning.  Yes, I met Dr. Folkers in 1968.  He had just started the Institute for Bio-Medical Research at UT in Austin.  He came to talk to Dr. Les Geddes and Dr. Lee Baker in the Physiology and Biophysics Department at Baylor University Medical School in Houston, Texas.  He talked to them about the bio-electrical impedance method for non-invasively measuring cardiac function in heart failure patients.

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Coenzyme Q10 Absorption Q & A with Dr. Judy

Long-time Coenzyme Q10 researchers and colleagues of Dr. Judy: Dr. Karl Folkers (left) and Dr. Svend Aage Mortensen, the lead researcher on the Q-Symbio study.

Q.  Good morning, Dr. Judy.  Thank you for taking some time for q10facts.com.  Last time we talked about the safety of Coenzyme Q10.  What about the absorption and bioavailability of Coenzyme Q10?  That has been a special area of research for you at the SIBR Research Institute, I think.

A.  Good morning.  Yes, you are correct.  I have been involved in several clinical studies of the efficacy of Coenzyme Q10 supplementation, but my big interest for the past 20 years has been in testing the absorption and bioavailability of the various Coenzyme Q10 supplements.  Maybe I should start by distinguishing between absorption studies and bioavailability studies.

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Coenzyme Q10 Question & Answer session with Dr. William Judy

Dr. William Judy, Founder and President of the SIBR Research Institute, is one of the leading Coenzyme Q10 experts in the United States and one of the oldest.  His 2007 paper on the absorption and transfer of Coenzyme Q10 is still the seminal paper on the subject.  His research efforts have focused on Coenzyme Q10 and heart failure, cancer, chronic fatigue syndrome, and Prader-Willi syndrome as well as studies of Coenzyme Q10 absorption and bioavailability.

Good morning, Dr. Judy.  Thank you for taking the time to answer some questions about Coenzyme Q10, the substance that your friend and colleague Dr. Karl Folkers liked to call “the essential bio-nutrient.”

Q. Why did Dr. Folkers call Coenzyme Q10 “the essential bio-nutrient,” Dr. Judy?  Let’s start there.

A. Yes, and you know, I think, that Dr. Emile Bliznakov called Coenzyme Q10 the “Miracle Nutrient” and Dr. Peter Mitchell, the Nobel Prize winner, called it the “Wonder Nutrient.”

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Drugs that deplete Coenzyme Q10

Many different prescription drugs, the statin medications prominent among them, inhibit the bio-synthesis and/or absorption of Coenzyme Q10. And Coenzyme Q10 is vital to life.  We must be mindful of the need for a well-formulated Coenzyme Q10 supplement whenever we are taking a Coenzyme Q10 depleting medication.

There are surprisingly many prescription drugs that inhibit the body’s bio-synthesis of Coenzyme Q10 or inhibit the body’s absorption of Coenzyme Q10 from supplements or both.  Of course, there are many drugs that inhibit the uptake of other nutrients as well, but it is difficult to think of any one supplement that is more important to us as we age.

Coenzyme Q10 is “the essential bio-nutrient” (in the words of the chemist Dr. Karl Folkers), and our bodies produce less and less of it as we get older.  It is practically impossible to make up for the decreased bio-synthesis from food alone.  We, all of us, need a well-formulated Coenzyme Q10 supplement.

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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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