Coenzyme Q10 therapeutic applications

Evidence from randomized controlled trials like the Q-Symbio study show the efficacy of Coenzyme Q10 adjuvant treatment in improving the symptoms and survival of chronic heart failure patients. Illustration courtesy of Dr. William Judy, SIBR Research Institute.

For 30-plus years now, bio-medical researchers have investigated and documented the functions of Coenzyme Q10 in the human body:

  • An essential role in cellular production of ATP energy [Littarru 2007]
  • An important antioxidant role preventing the oxidation of proteins, lipids, and DNA [Littarru 2007]
  • A role in the enhancement of endothelial function [Littarru 2011]
  • A beneficial role in the expression of genes involved in human cell metabolism, signaling, and transport [Garrido-Maraver]

Moreover, the scientific documentation shows that Coenzyme Q10 supplements are safe, are well-tolerated, and are effective as adjunctive treatments in diseases involving high cellular and tissue demands for energy and in diseases involving oxidative stress and oxidative damage [Garrido-Maraver].

Absorption and Bio-Availability of Coenzyme Q10

As we get older, our bodies produce less Coenzyme Q10 [Kalén].  It is not realistic to make up the difference in the diet [Judy].  Supplementation is necessary.

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Coenzyme Q10 and Red Yeast Rice against Heart Disease

Illustration showing how statin medications block the bio-synthesis of Coenzyme Q10 just as statin medications block the body’s synthesis of cholesterol.  Blocking the bio-synthesis of Coenzyme Q10 ultimately deprives the heart muscle cells of ATP energy and of antioxidant protection.  Illustration courtesy of Dr. William Judy, SIBR Research Institute.

Heart disease continues to be the number 1 cause of death in the developed world.  Much research has been done on efforts to modify some of the known risk factors for heart disease:

  • Diet
  • Exercise
  • Lifestyle

However, modifying these risk factors alone is not always sufficient to prevent heart disease.  Hence, the extensive prescription of statin medications in the United States because changing the lipid profiles of potential heart disease patients is do-able and effective. 

But the statin medications are not without adverse effects.  Even in generally healthy study participants given moderate statin doses, there can be unfavorable statin medication effects on energy and exertional fatigue.  Both simvastatin and pravastatin have been seen to contribute to a significant adverse effect of statins on energy and fatigue with exertion [Golomb 2012; Okuyama and Langsjoen 2015].

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Coenzyme Q10: Life-long therapy for heart failure patients

Dr. Karl Folkers (left) and Dr. Svend Aage Mortensen (right) together with Dr. William Judy and Dr. Per Langsjoen were pioneers in the adjunctive treatment of heart failure patients with Coenzyme Q10. Their studies showed that Coenzyme Q10 supplementation improves the symptoms and survival of heart failure patients.  Moreover, withdrawal of the Coenzyme Q10 adjunctive therapy leads to clinical relapse.

Coenzyme Q10 as an adjunctive therapy added to conventional medication improves the symptoms and the survival of heart failure patients. It reduces the number and length of hospitalizations of heart failure patients.

We know this from the documented results of randomized, double-blind, placebo-controlled studies [Morisco; Munkholm; Mortensen].

Coenzyme Q10 adjunctive therapy for heart failure

Recently, Dr. William Judy, founder and president of SIBR Research Institute, told me about an interesting outcome of the early Coenzyme Q10 studies with heart failure patients.

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End-of-the-year Coenzyme Q10 report card

Coenzyme Q10 as a nutritional supplement – if properly formulated – gets an A grade for performance.  Coenzyme Q10 goes right to the head of the class on our list of daily nutritional supplements, right up there with vitamin D capsules, organic high-selenium yeast tablets, and fish oil capsules (if we don’t eat as much fish as we should).

As the fall semester 2017 drew to a close, I reviewed the published bio-medical documentation and assigned some performance grades to the nutritional supplement Coenzyme Q10. As might be expected of an “essential bio-nutrient,” Coenzyme Q10 maintained an exemplary grade point average.

Properly formulated Coenzyme Q10 supplements

Right.  We want to get a supplement made with pharmaceutical-grade Coenzyme Q10 and manufactured under conditions of pharmaceutical control. We want a Coenzyme Q10 supplement that meets the following criteria:

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Interview with Dr. Judy: the need for Coenzyme Q10

Q.  Good morning, Dr. Judy.  You have talked with us about the safety of Coenzyme Q10 supplements, and you have told us that the formulation of the supplement is decisive for the absorption of Coenzyme Q10.  Shouldn’t we talk today about why we adults need daily Coenzyme Q10 supplements?

Coenzyme Q10 molecules are redox molecules.  Ubiquinone can accept electrons, and ubiquinol can donate electrons.   Oxireductase enzymes catalyze ubiquinone’s accepting electrons.  Free radicals take electrons from ubiquinol and become stable.

A.  Yes, indeed.  Coenzyme Q10 is very much needed and, at the same time, very little known by most people.  Our bodies produce Coenzyme Q10 –called ubiquinone –, and Coenzyme Q10 is found in all of our cells except the red blood cells.  That should tell us something.

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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 and exercise and ageing

Coenzyme Q10 supplementation and exercise confer significant heart health benefits and anti-ageing benefits.  The exercise can be aerobic exercise or strength training or both.  The Coenzyme Q10 supplement you choose should be a supplement with well-documented absorption and efficacy.

The biggest difference in elderly (70+) men and women still living at home and still relatively healthy is the extent to which they exercise.  Among elderly adults of the same socioeconomic status, nutrition and lifestyle do not vary much.  Exercise levels do vary considerably.

With the variations in exercise level come variations in ageing.  The question is, what is the role of Coenzyme Q10 status in the elderly and the rate at which they age?

The differences in ageing – manifested in differences in functional capacity, exercise status, and body weight — are connected to Coenzyme Q10 plasma levels and to Coenzyme Q10/cholesterol ratios in plasma.

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The safety of Coenzyme Q10 supplements

Healthy eating
To stay as young as we can as late in life as possible, we need to eat right, exercise, and get a good night’s sleep. Then, a well-tested and well-documented Coenzyme Q10 supplement should be right at the top of the list of nutritional supplements that we take. As we get older, our bodies produce less and less Coenzyme Q10, and we cannot make up the difference through food alone.

Coenzyme Q10 supplements are so safe that I have not spent much time writing about their safety.  It would not be much of an exaggeration to say that Coenzyme Q10 supplements are as safe as water.  In fact, in study after study, there is no difference in side effects between the Coenzyme Q10 active treatment group and the placebo control group. 

We need a good Coenzyme Q10 status.  There are two primary reasons why Coenzyme Q10 supplementation provides heart health benefits:

  • Coenzyme Q10 is essential to the process of cellular energy production.
  • Coenzyme Q10 works as an antioxidant to protect the cells against the damage caused by harmful free radicals.

Let’s look at some of the studies.

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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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