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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Coenzyme Q10 and the energy starved heart

The number of bean-shaped mitochondria in our cells varies according to the energy needs of the various organs. The cells in organs with high energy needs, e.g. the heart, the liver, the skeletal muscle, will have greater numbers of mitochondria than will the cells of less active organs, e.g. the skin.  Adequate supply of Coenzyme Q10 is necessary to keep the mitochondria actively producing ATP molecules.

Cellular respiration is the name for the process by which the ATP molecules are produced inside the mitochondria in our cells.  Coenzyme Q10 in its oxidized form is an essential component in this process of energy production.

Fewer Coenzyme Q10 molecules in the mitochondria inevitably mean less ATP energy production.  Fewer ATP molecules mean less energy for our cells. 

Heart muscle cells with low Coenzyme Q10 concentrations and with fewer ATP molecules produced make for an energy starved heart.

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Coenzyme Q10 and chronic low-grade inflammation

Researcher
Long-term adjunctive treatment of chronic heart failure patients with Coenzyme Q10 supplements is safe and has improved the patients’ symptoms and has reduced the patients’ risk of major adverse cardiovascular events.  Now, researchers have begun to investigate whether adjunctive treatment with Coenzyme Q10 reduces chronic low-grade inflammation.

Chronic, low-grade, systemic inflammation is common in many diseases: cardiovascular disease, metabolic syndrome, non-alcoholic fatty liver disease, obesity, type-2 diabetes [Zhai 2017].  Anti-inflammatory drugs give modest improvement at best and are associated with long-term adverse effects [Esser 2015].  Some researchers have begun to investigate whether Coenzyme Q10 as an adjunctive treatment has anti-inflammatory health benefits.

The results of the KiSel-10 study have shown that daily supplementation with 200 milligrams of Coenzyme Q10 and 200 micrograms of SelenoPrecise® selenium significantly reduced the levels of sP-selectin and hs-CRP, both markers for inflammation, as compared to placebo supplementation.

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Coenzyme Q10 and healthy ageing

Elderly couple on the beach
Given the importance of Coenzyme Q10 in the process of cellular energy production and in the process of neutralizing harmful free radicals, it is very important to take a daily Coenzyme Q10 supplement as we grow older.

Coenzyme Q10 is an essential bio-nutrient that is made naturally in the human body.  It is a necessary co-factor in the process of cellular energy production.  It also functions as a lipid-soluble antioxidant protecting our cells against oxidative damage (oxidative damage = damage caused by free radicals that harm cell membranes and cell DNA and proteins and fats in the blood).

Unfortunately, as we pass through our 20s and move into our 30s and 40s and head towards senior citizen status, our cells produce less of this essential substance with increasing age [Kalén]. We know this.

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The proper manufacture of Coenzyme Q10 supplements

Nurse picture
Health professionals know that it is the formulation of the Coenzyme Q10 nutritional supplement that is decisive in the absorption and the heart health effects. It is important to choose a daily Coenzyme Q10 supplement that has documented results in randomized controlled trials.

Coenzyme Q10 supplements are clearly one of the products in today’s America that come in many different formulations.  And, with respect to Coenzyme Q10’s absorption and effectiveness, the important difference is the difference in the formulation.  Dr. William Judy, the director of the SIBR Research Institute, has tested Coenzyme Q10 supplements with absorption rates ranging from below 1% to as high as 8% of a 100-milligram capsule.

Coenzyme Q10 absorption necessary for heart health benefits
That is as good as saying that some Coenzyme Q10 supplements give no absorption of consequence at all.  At the other end of the spectrum, we know that some formulations give an absorption that is associated with statistically significant health benefits.  I am referring, of course, to the results that we have seen in these randomized controlled trials:

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