Coenzyme Q10, older athletes, and statins

woman-exercising
The more intensely and strenuously we exercise, the more quickly we reach the anaerobic threshold. A 2012 study has shown that 200 milligrams of Coenzyme Q10 daily can significantly delay the time to the anaerobic threshold. The Coenzyme Q10 supplementation was also associated with significant improvement in muscle strength in the study.

Older active adults who are taking a statin medication?  Shouldn’t they go right to the top of the list of people who need a good Coenzyme Q10 supplement?

That is the question that Dr. Richard Deichmann and his colleagues in the Department of Internal Medicine at the Ochsner Clinical School in New Orleans asked themselves. They tested whether daily supplementation with 200 milligrams of Coenzyme Q10 daily for six weeks would improve measures of cellular energy production, muscle function, and well-being in older active adults taking statin medications.

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Coenzyme Q10 and exercise in younger and older adults

sevilla-cathedral
Sevilla is famous for its cathedral, Santa Maria de la Sede, the largest Gothic cathedral in the world, built during the 15th century. Sevilla is also famous for its university. Within the university, the Developmental Biology Institute has been doing much research into the nutritional and medical importance of Coenzyme Q10.

Spanish researchers at the Pablo de Olavide University in Sevilla hypothesized that the effect of physical activity on plasma Coenzyme Q10 levels and on plasma Coenzyme Q10/cholesterol ratios might vary according to the age of the individuals engaging in the physical activity. Their results show, for the first time, an apparently different effect of exercise on young people and on older people.

  • Lower levels of plasma Coenzyme Q10 and lower Coenzyme Q10/cholesterol ratios were associated with high levels of physical activity in the young people more so than in older people who were also exercising. That result was surprising.
  • Moreover, lower levels of plasma Coenzyme Q10 and lower Coenzyme Q10/cholesterol ratios were associated with high levels of physical activity in the younger people more so than with moderate levels of physical activity in younger people. That result was not surprising.
  • What was most surprising was the data that showed that older people who exercised more often and more intensely had higher levels of Coenzyme Q10 in plasma and higher ratios of Coenzyme Q10 to cholesterol in plasma than did older adults who exercised moderately or who were mostly sedentary. In this respect, the effect of exercise on the older people differed from the effect of exercise on the younger participants [Del Pozo-Cruz 2014].

Coenzyme Q10 and physical activity in young people
In the Spanish study, the young participants had an average age of 20 years plus or minus 2 years.  Two possible explanations come to mind for the lower plasma Coenzyme Q10 levels in highly active younger people:

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Coenzyme Q10 improves endothelial function

woman-boxer
Good health and good fitness depend on good blood circulation.  Good blood circulation depends on good endothelial function.  Research shows that taking a daily Coenzyme Q10 supplement is associated with improved endothelial function.  Supplementation with a combination of Coenzyme Q10 and high selenium yeast has significantly reduced the risk of dying from heart disease in elderly KiSel-10 study participants.

How does Coenzyme Q10 supplementation keep the heart young and healthy? The primary explanation is that Coenzyme Q10 is absolutely vital to the cellular process of producing energy, and the heart muscle needs energy constantly.  An energy-starved heart is a failing heart.

A second and also important explanation is that oxidative damage causes the heart muscle cells to age and deteriorate. Coenzyme Q10 has antioxidant and anti-inflammatory effects that can help to prevent the development of atherosclerosis.

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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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Coenzyme Q10 and exercise: what do we know?

exercise-and-coq10
Coenzyme Q10 supplementation performs many roles in the body that benefit athletes and people who exercise. It is an essential co-factor in cellular energy production, it is the most important fat-soluble antioxidant preventing oxidative damage and muscle damage,, and it improves endothelial function.

Does Coenzyme Q10 supplementation improve exercise capacity?  Do we know?  In 2016, Professor Julio J. Ochoa and his colleagues at the University of Granada in Spain conducted an exhaustive review of the published literature about the Coenzyme Q10 supplementation and exercise.  The researchers did database searches and found 372 journal articles about Coenzyme Q10 and exercise.  An amazing number.

Variation in the Coenzyme Q10 and exercise studies
Of course, the results of the studies reported in the 372 journal articles varied quite a bit for a variety of reasons:

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Coenzyme Q10: the best of q10facts.com — part II

emergency-room
Daily supplementation with 200 milligrams of Coenzyme Q10 has been shown to reduce the number of hospitalizations and re-hospitalizations of chronic heart failure patients. The use of Coenzyme Q10 as an adjuvant treatment improves the quality of life for patients and reduces the expenses of health care systems.

Last month, I wrote brief summaries of some of the best articles that have been published on this website.  This month, I want to present summaries of several more good q10facts.com articles about the health benefits of Coenzyme Q10 supplementation.  The information in all of these articles is based on clinical study results published in peer-reviewed bio-medical journals.  In each summary, there is a link to the original article.

Fewer hospitalizations with Coenzyme Q10
In the Q-Symbio study, 420 chronic heart failure patients on conventional heart failure medications were randomly assigned to an adjuvant Coenzyme Q10 treatment group (n=202) or to a placebo control group (n=218).  In the study, Dr. Svend Aage Mortensen and his fellow researchers wanted to test the hypothesis that the condition of the energy-starved heart could be improved by the use of Coenzyme Q10 supplementation.

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Coenzyme Q10: ubiquinone or ubiquinol?

Q10 crystals
Formulation of the Coenzyme Q10 supplements is very important. How do we know which producers of Coenzyme Q10 supplements can take the raw material, pictured here, and dissolve it in lipids and seal it in capsules so that it gives good health effects?

Recently, some readers have written in asking what my problem with the ubiquinol version of Coenzyme Q10 supplements is.  Let me try to answer that question.  I don’t think that I have a problem with ubiquinol itself.  I have great respect for ubiquinol’s utility as a lipid-soluble antioxidant.  The problem that I have tried to address on q10facts.com is the misleading nature of the marketing claims and the stretching of scientific facts in many of the marketing claims for the ubiquinol products.

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Coenzyme Q10 on prescription?

Mother and daughter
We know that the body’s production of Coenzyme Q10 begins to decrease with age once we reach our 20’s, and we know that Coenzyme Q10 plays an important role in both cellular bio-energetics and antioxidant protection. It just makes sense to supplement our diets with Coenzyme Q10 in an attempt to avoid heart failure later on in life.

For as long as I have been writing this blog, I have been wondering why cardiologists are not prescribing Coenzyme Q10 for certain classes of heart disease patients.  Two classes of patients come to mind immediately: chronic heart failure patients and patients taking statin medications.  Let’s look at the evidence for heart failure patients. (We can talk about patients on statin medications next week.)

Coenzyme Q10 and chronic heart failure
Chronic heart failure.  Heart failure.  It sounds scary.  It is scary.  The words “heart failure” do not mean that the heart has stopped working.  What heart failure means is some combination of the following conditions:

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Talking to the cardiologist about taking Coenzyme Q10

hospital hallway
Two big randomized controlled trials (Morisco 1993 and Mortensen 2014) have shown significantly fewer hospital visits for heart failure patients with Coenzyme Q10 supplementation as compared to placebo supplementation. In addition, a big randomized controlled trial (Alehagen 2013) enrolling healthy elderly people showed significantly fewer admissions to hospital in the Coenzyme Q10 and selenium group.

Doctors are people with a scientific slant of mind.  They tend to be skeptical.  They want proof.  And, when it comes to clinical research, they want results from randomized, double-blind, placebo-controlled studies with very large sample sizes.  Then, if there is a statistically significant result, they want to see the study replicated.

Access to information about Coenzyme Q10
So, one big reason that I write articles about Coenzyme Q10 is that I want heart disease patients (and people wanting to avoid heart disease) to have a chance to inform themselves about the heart health effects of a good Coenzyme Q10 supplement.  After all, I am a librarian by training and by trade.

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Coenzyme Q10 and energy and fitness

swimmers triathlon
Competing in a triathlon or in long distance races requires lots of energy over extended periods. Coenzyme Q10 is instrumental in the body’s production of ATP, the body’s basic unit for the storage of energy in its chemical form.

What about Coenzyme Q10 and energy and physical fitness, I have been wondering.  I know that Coenzyme Q10 in its ubiquinone form plays a vital role in the production of adenosine triphosphate (ATP) molecules in the mitochondria in the cells.

The ATP molecules are the basic units of energy in the body.  The ATP molecules are what provide the energy for the contraction and extension of muscles.

Q10 and ATP and muscle aches and fatigue
Even when we are rested up, we do not have enough ATP molecules to allow us to exert ourselves intensely for more than a few minutes.  When we exercise very intensively (run sprints, for example) or exercise strenuously for longer periods, our muscle tissues are forced to go from aerobic energy production, i.e. from burning oxygen, to the anaerobic (non-oxygen-burning fermentation) mode of energy production.

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