Dr. Judy remembers Dr. Svend Aage Mortensen

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Long-time friends and Coenzyme Q10 researchers Dr. William Judy (left) and Dr. Svend Aage Mortensen (right)

It was a very sad and unexpected loss in the field of bio-medical research when Dr. Svend Aage Mortensen died on April 22, 2015, of infection and complications following heart valve replacement surgery in Copenhagen.

Dr. William Judy and Dr. Svend Aage Mortensen were long-time friends and contemporaries in the field of Q10 research.  Both men knew and admired and worked with Dr. Karl Folkers.  Dr. Folkers had, already in the early 1970s, reported on research showing a positive correlation between a deficiency of Coenzyme Q10 and the incidence of heart disease.

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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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Dr. William Judy talks about Q10 and Congestive Heart Failure

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Dr. William Judy has worked in basic and clinical research for over forty years, focusing primarily on Coenzyme Q10, Hyaluronic Acid, and other natural products that promote health maintenance and disease relief.

Recently I talked with Dr. William Judy, one of the pioneers in coenzyme Q10 research in the United States.  Dr. Judy did a Ph.D. in physiology and biophysics at West Virginia University, where he wrote his doctoral dissertation on the topic of Sympathetic Nervous Control of Renal Hemodynamics.

Early on in his career, Dr. Judy worked with Dr. Karl Folkers in the Institute for Biomedical Research at the University of Texas in Austin.  Dr. Folkers, who was and is widely regarded as the father of CoQ10 clinical and biomedical research, and Dr. Judy collaborated on studies of Q10 absorption and bioavailability, studies of Q10 as adjunctive treatment in congestive heart failure patients, and studies of Q10 in the treatment of cancer patients, prostate cancer patients in particular.

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Coenzyme Q10 supplementation and coronary artery disease

Elevated total cholesterol levels and/or elevated low-density lipoprotein (LDL) cholesterol levels are associated with increased risk of coronary artery disease, which is the most common form of heart disease. Now, a meta-analysis shows that CoQ10 supplementation significantly improves total cholesterol and HDL-cholesterol in coronary artery disease patients.

Coenzyme Q10 adjuvant treatment of heart failure patients significantly improves the symptoms and survival of chronic heart failure patients [Mortensen; Morisco; Munkholm].

How does it look with Coenzyme Q10 supplementation and coronary artery disease?

Coronary artery disease is caused by hardening and narrowing of the coronary arteries that bring blood to the heart muscle? Coronary artery disease is also known as ischemic heart disease, which is heart disease characterized by reduced flow of blood containing oxygen to the heart muscle.

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Coenzyme Q10 adjuvant therapy for chronic heart failure

Dr. Svend Aage Mortensen (right), pictured here with Dr. Karl Folkers, was the lead researcher on the Q-Symbio study of the effects of Coenzyme Q10 adjuvant therapy for chronic heart failure patients. Now, Dr. Anne Louise Mortensen has focused in on the European patients in the international Q-Symbio study.

There are positive outcomes from an analysis of the European sub-group of chronic heart failure patients (n = 231 out of a total of 420 patients) in the international multi-center Q-Symbio study.  Two years of adjuvant treatment with 3 times 100 milligrams of ubiquinone Coenzyme Q10 daily in addition to conventional heart failure treatment reveals [Mortensen 2019]:

  • significantly fewer patients suffering major adverse cardiovascular events (= death due to heart attack or heart failure or hospitalization due to acute heart failure or pulmonary embolism) compared to placebo
  • significantly fewer heart disease deaths and all-cause deaths compared to placebo
  • significantly more improvements of the patients’ NYHA classifications compared to placebo
  • significantly improved ejection fraction compared to placebo

What was the Q-Symbio study of CoQ10 and heart failure?

The Q-Symbio study was an international multi-center randomized, double-blind, placebo-controlled study that demonstrated that daily treatment with 3 times 100 milligrams of a pharmaceutical-grade ubiquinone Coenzyme Q10 preparation for two years in addition to conventional treatment significantly improved the symptoms and survival of chronic heart failure patients [Mortensen 2014].

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Coenzyme Q10 is a life-long essential supplement

Dr. William V. Judy, founder and president of SIBR Research Institute, has done studies of Coenzyme Q10 supplementation of patients with chronic heart failure and chronic fatigue syndrome. Generally, after 10 -12 weeks of supplementation, the patients’ symptoms and quality of life improve significantly. However, if the supplementation is stopped, the patients suffer a relapse to their previous condition. Coenzyme Q10 supplementation is a life-long adjuvant therapy.

Coenzyme Q10 is a life-time essential supplement for most people as they get on in years.  People who especially need a Coenzyme Q10 supplement – heart failure patients and chronic fatigue syndrome patients, for example – will suffer a relapse if they stop taking their daily CoQ10 supplements.

CoQ10 and the constant need for ATP energy

Dr. William Judy, founder and president of the SIBR Research Institute, tells me that the life-long need for Coenzyme Q10 supplementation is related to the cells’ constant need for ATP energy.

Excesses of ATP energy cannot be stored.  The cells must produce ATP energy when they need the energy.  CoQ10 is a vital co-factor in the production of ATP energy in the cells.

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Not all Coenzyme Q10 supplements are the same

Dr. William V. Judy, founder and president of SIBR Research Institute, has done studies showing that oral ubiquinol is converted to ubiquinone prior to its absorption in the small intestines. In the lymph, it is converted back to the ubiquinol form. It makes sense that the CoQ10 is primarily in the ubiquinol form in the lymph and blood because, there, the need for Coenzyme Q10’s antioxidant properties is greater than the need for the bio-energetics function of the ubiquinone form.

A well-formulated ubiquinone Coenzyme Q10 supplement was absorbed significantly better than a well-formulated ubiquinol supplement.  This is one of the take-home messages from a recent carefully designed Spanish university study [Lopez-Lluch 2018].

Remember: Ubiquinol supplements are notoriously difficult to work with.  As an antioxidant posed to give up its two extra electrons, ubiquinol is by its very nature unstable.  Often, the ubiquinol is oxidized (gives up its electrons) while still in the soft-gel capsule.

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Coenzyme Q10: Misleading claims for ubiquinol products

Dr. William V. Judy (Ph.D. in physiology and bio-physics) founded the SIBR Research Institute to do absorption and bio-availability studies of Coenzyme Q10 and other natural products. Dr. Judy’s clinical research studies have focused on the effects of Coenzyme Q10 supplementation on Prader-Willi syndrome, congestive heart failure, chronic fatigue syndrome, diabetes, and certain cancers.Dr. Judy wants to see scientific documentation for claims of better absorption. There is so much variation in CoQ10 products that consumers must be cautious.

Marketers continue to make many unsubstantiated and misleading claims for the ubiquinol version of Coenzyme Q10 supplements.  As long ago as 2007, Dr. William Judy, the founder and president of the SIBR Research Institute, wrote a seminal article revealing the facts and fabrications that existed in marketing texts for ubiquinol products.  So far, no one has refuted the points that Dr. Judy made [Judy 2007].

CoQ10 formulation more important than CoQ10 form

Now, in 2018, we have the results of the double-blind, cross-over study done in Sevilla, Spain.  That study showed that a well-formulated ubiquinone Coenzyme Q10 supplement gave a significantly better bio-availability than did a well-formulated ubiquinol supplement.  That the ubiquinol supplement itself was well formulated is evidenced by the fact that the ubiquinol product out-performed other less well formulated ubiquinone products [Lopez-Lluch 2018].

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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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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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