Coenzyme Q10: recent research results

Coenzyme Q10 (ubiquinone) is ubiquitous in human tissues; however, its concentration levels vary. Concentrations are highest in organs with high rates of metabolism, e.g. the heart, the kidneys, the liver. The bio-synthesis and thus the whole body content of Coenzyme Q10 decreases with increasing age in the adult years. Adequate concentrations of Coenzyme Q10 are essential for the health of nearly all human cells and tissues because Coenzyme Q10 is vital for the process of ATP energy generation and because it is an important lipid antioxidant.

Coenzyme Q10 adjunctive treatment of chronic heart failure patients significantly improves their symptoms and survival [Mortensen 2014].  A recent survey of the scientific literature shows that Coenzyme Q10 supplementation is safe, well-tolerated, and effective as an adjunctive treatment in various disease conditions that involve high cellular and tissue demands for energy and in diseases involving oxidative stress and inflammation [Garrido-Maraver 2014].

Coenzyme Q10 is a naturally occurring essential nutrient.  In human cells, it is a vital co-factor in the process of ATP energy generation and one of the most important lipid antioxidants.  In this article, I summarize briefly the results of some of the recent scientific research using Coenzyme Q10 as an active treatment compared to a placebo treatment.

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Coenzyme Q10 and the NQO1 gene and enzyme

Genes code for the making of enzymes, structural proteins, transport proteins, and defense proteins. The NQO1 gene codes for enzymes that reduce Coenzyme Q10 and Vitamin E to their antioxidant forms. Genetic variations called polymorphisms may lead to a failure to produce the standard form of a gene. There seem to be ethnic differences in the ability to produce the standard form of the NQO1 gene such that some ethnic groups have a higher percentage of individuals unable to produce the gene and thus make the enzymes that reduce Coenzyme Q10. However, these ethnic differences are on the order of 2 or 3 polymorphisms per 20 individuals, too few to warrant the marketing claim that individuals over the age of 40 have difficulty converting ubiquinone Coenzyme Q10 to its reduced form ubiquinol. 

NQO1 is the abbreviated form of the name for both the NAD(P)H dehydrogenase (quinone 1) gene and the NAD(P)H:quinone acceptor oxidoreductase enzymes that the gene codes for.
 
The NQO1 enzymes are of interest to us because they are responsible for the reduction of the ubiquinone form of Coenzyme Q10 to the ubiquinol form [Siegel 2017].  That conversion takes the Coenzyme Q10 molecules from their bio-energetics form to their antioxidant form.

NQO1 and the conversion of ubiquinone to ubiquinol

The ubiquinone form of Coenzyme Q10 is the essential form needed for the cellular process of ATP energy production.  The ubiquinol form of Coenzyme Q10 is the fat-soluble antioxidant form that provides protection against oxidative damage.

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Dr. Judy speaks on the formulation of Coenzyme Q10 supplements

Dr. William Judy, founder and president of the SIBR Research Institute, says the manufacturer of a Coenzyme Q10 supplement needs three things in the soft-gel capsule together with the 100 milligrams of dissolved Coenzyme Q10 crystals: A solvent in which the Coenzyme Q10 crystals are dissociated, a stable formulation that will prevent the re-crystallization of the Coenzyme Q10 inside the capsule, and one or more lipids that, ingested together with the Coenzyme Q10, will enhance the absorption of the Coenzyme Q10.

The formulation of the Coenzyme Q10 supplement is of utmost importance.  Formulation affects absorption.  Absorption affects efficacy.  Not all Coenzyme Q10 supplements give the same level of absorption.

Coenzyme Q10 molecules are fairly large, fat-soluble molecules.  Coenzyme Q10 has a six-carbon benzoquinone ring as its head and a ten-unit isoprenoid tail that is strongly hydrophobic.  For best absorption, Coenzyme Q10 needs to be ingested together with a meal containing some fat.  Despite some claims to the contrary, it is not possible to re-make Coenzyme Q10 into a water-soluble substance.  Such a product no longer has the properties of Coenzyme Q10 [Judy 2018].

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Coenzyme Q10 for ataxia patients

Friedreich’s ataxia is one of several different types of ataxia with different causes and prognoses. Friedreich’s ataxia is characterized by muscle weakness, loss of coordination, impairment of vision and hearing, slurred speech and curvature of the spine (scoliosis). Frequently, it results in the development of diabetes and/or heart failure. There is no cure; however, Coenzyme Q10 supplements can help to ameliorate the symptoms because of Coenzyme Q10’s role in cellular energy production and in antioxidant defense against oxidative damage to cells.

Considerably reduced concentrations of Coenzyme Q10 in the skeletal muscle – up to 75% reduced levels – are associated with a diagnosis of ataxia.  Coenzyme Q10 supplementation has proven beneficial in the treatment of both early and later stages of early-onset ataxia as well as in the treatment of adult-onset ataxia [Mantle & Hargreaves 2018].

Ataxia and Coenzyme Q10

Ataxia is the medical term for the loss of control of bodily movement, characterized by difficulty in walking and loss of balance.  Ataxia can also affect eye movement, speech, and ability to swallow.

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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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Coenzyme Q10 and statin medications

A set of pharmacological mechanisms suggests that the use of statin medications may be stimulating the development of atherosclerosis and chronic heart failure.  Japanese and American researchers have documented the mechanisms by which statin medications may be causing coronary artery calcification.  They propose that the guidelines regulating the use of statin medications be critically re-evaluated [Okuyama 2015].

Statin medications reduce total and bad cholesterol levels but may not reduce the extent of atherosclerosis or the risk of chronic heart failure.                         Attribution: By BruceBlaus [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons.
If the researchers are correct, then, yes, statin medications do reduce total cholesterol and bad cholesterol levels.  However, statin medications may not reduce the incidence of coronary heart disease.  Furthermore, statin medications may be at least partially responsible for the increased incidence of chronic heart failure that has been observed in the period since statin medications were introduced in 1987.

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Coenzyme Q10 adjunctive treatment for diabetic retinopathy

A randomized controlled study carried out at the University of Guadalajara, Mexico, showed that daily adjunctive treatment with 400 milligrams of Coenzyme Q10 for six months significantly reduced the extent of lipid peroxidation in patients diagnosed with non-proliferative diabetic retinopathy.

Patients with diabetic retinopathy who took 400 milligrams of Coenzyme Q10 (ubiquinone form) daily had significantly reduced levels of lipid peroxidation products in their blood at the end of a six-month study, compared to baseline levels [Rodriguez-Carrizalez 2016].

Diabetic retinopathy is an eye disease caused by high blood sugar levels resulting in damage to the blood vessels in the retina. The blood vessels can swell and leak, or they can close off and stop the blood from flowing.

Why is Coenzyme Q10 important?

Firstly, hyperglycemia – high blood sugar – induces the excess production of harmful free radicals and impairs the endogenous antioxidant defense system.

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Coenzyme Q10 and breast cancer care: a new review

Individuals with breast cancer are much more likely to have low plasma Coenzyme Q10 concentrations than healthy individuals. Cell line studies, animal studies, and a few human studies suggest that Coenzyme Q10 supplementation may be beneficial as an adjunctive treatment together with conventional therapy for breast cancer.The published bio-medical journal literature about the efficacy of Coenzyme Q10 adjunct treatment in breast cancer care is sparse but promising.  

The published bio-medical journal literature about the efficacy of Coenzyme Q10 adjunct treatment in breast cancer care is sparse but promising. So concludes the author of a 2017 systematic review of the journal articles indexed in PubMed. PubMed is the free public index to the National Library of Medicine’s Medline database [Tafazoli].

More well-designed clinical studies are needed to provide answers to questions about the adjuvant use of Coenzyme Q10 in breast cancer treatment and care:

  • Is Coenzyme Q10 effective as a single intervention agent?
  • Is Coenzyme Q10 more effective in combination with other nutritional supplements such as essential fatty acids and selenium?
  • What formulations and what daily dosages of Coenzyme Q10 are most effective?

Documentation about Coenzyme Q10 and breast cancer care

Coenzyme Q10 concentrations and breast cancer

  • Evidence from human breast tissue samples shows that Coenzyme Q10 concentrations are much lower in cancerous tissue than in normal tissue [Tafazoli].
  • Data from a case-control study has shown an inverse relationship between plasma Coenzyme Q10 concentrations and the incidence of breast cancer, independent of menopausal status [Tafazoli].
  • Cell line studies have shown that the addition of Coenzyme Q10 does not inhibit the apoptotic, anti-growth, and anti-colonization effects of the chemotherapy drug doxorubicin – trade name Adriamycin while it does protect the heart muscle [Tafazoli].
  • Coenzyme Q10 supplementation added to chemotherapy with doxorubicin (Adriamycin) prevents the mitochondrial damage and subsequent cardio-toxicity caused by reactive oxygen species produced during the treatment with doxorubicin [Tafazoli].

Coenzyme Q10 and mammary carcinomas

An animal study has shown that oral administration of Coenzyme Q10 had the following effects on rats with induced mammary carcinomas [Tafazoli]:

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Coenzyme Q10 as heart failure medicine

Chronic heart failure is characterized by an energy starved heart.  The Q-Symbio study’s lead researcher, Dr. Svend Aage Mortensen, treated chronic heart failure patients with 300 milligrams of Coenzyme Q10 daily as an adjunctive treatment to the conventional heart failure medications. His thinking was that the conventional treatments block rather enhance cellular processes and do not address the heart muscle cells’ need for the cofactor Coenzyme Q10 in the ATP energy production process. He used Coenzyme Q10 supplements to address the dysfunction of cellular bio-energetics that is associated with heart failure.

The Q-Symbio randomized, double-blind, controlled study of the effect of Coenzyme Q10 supplementation on morbidity and mortality in heart failure shows that adjuvant supplementation of heart failure patients with 300 milligrams of Coenzyme Q10 daily reduces the all-cause risk of death by half [Mortensen 2014].  The 300-milligram dosage was administered in 100-milligram increments three times a day, always with meals.  Dr. Svend Aage Mortensen, the lead researcher on the Q-Symbio study, recommended that daily administration of Coenzyme Q10 should become a component of the standard treatment of heart failure [Mortensen 2015].

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Coenzyme Q10 and heart health

Coenzyme Q10, also known as ubiquinone, is a fat-soluble substance that is similar to a vitamin but is synthesized in our bodies. In adulthood, the body’s synthesis of Coenzyme Q10 declines with increasing age.  Furthermore, statin medications inhibit the body’s production of Coenzyme Q10. Supplementation is nearly always necessary; it is not possible to make up deficits of Coenzyme Q10 by careful eating. Optimal concentrations of Coenzyme Q10 in the blood and in the heart muscle tissues is especially important for good heart health.

Coenzyme Q10 has become the third most purchased specialty nutritional supplement according to a recent survey.  The number of daily users of Coenzyme Q10 in the United States has risen from some 3 million people in the year 2000 to over 16 million people at present [Sinatra 2018].

There are good reasons for this increase, which the American cardiologist Dr. Stephen Sinatra has explained in a recent electronic book published by the WholeFoods Magazine [Sinatra 2018].  I want to summarize Dr. Sinatra’s reasoning for my readers.

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