Coenzyme Q10 Before and After Heart Surgery

Dr. Willis Stogsdill
Dr. Willis Stogsdill, “Woody” to his friends and colleagues, was a co-author on my 2007 article “Coenzyme Q10 Facts or Fabrications.” He was a heart surgery anesthesiologist and chairman of the Department of Anesthesia at St. Vincent Hospital in Indianapolis for 25 years. He was instrumental in establishing the St. Vincent open heart surgery program. He was my highly esteemed colleague as well as my father-in-law. He passed away, aged 95, on November 12, 2019. He is missed.

In 1993, I wanted to see what protection Coenzyme Q10 supplementation could give the heart muscle during and after heart surgery. I discussed the idea with Dr. Karl Folkers and Dr. Willis Stogsdill.

We agreed that the idea had merit. Coenzyme Q10 is a natural and essential cofactor in heart muscle cells. It has bio-energetic, antioxidant, and anti-inflammatory effects. Typically, patients with heart failure have reduced blood and heart muscle tissue concentrations of Coenzyme Q10.

Heart surgery study in Indianapolis

We conducted a study with 10 high-risk heart surgery patients in a CoQ10 supplementation group and 10 high-risk heart surgery patients in a placebo group. The two groups were similar characteristics before the study began:

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Insufficient Evidence for the Claims for Ubiquinol Supplements

Dr. Karl Folkers
Dr. Karl Folkers was a biochemist who was instrumental in isolating vitamin B12 and in determining the structure of Coenzyme Q10. He was an important force behind the early clinical research into the effect of Coenzyme Q10 supplementation on heart failure patients. We collaborated on several clinical trials.

Looking back over my career, I can see that I have stood on the shoulders of giants. Here is a quick salute to the mentors who sparked my interest in the cardiovascular system, in biophysics and bio-engineering, in the electrical impedance technology, and in Coenzyme Q10 clinical research.

  • Dr. Loren D. Carlson, University of Kentucky, Lexington Medical School.
  • Dr. George Armstrong, NASA.
  • Dr. Lee Baker, Baylor University Medical School.
  • Dr. Michael Wilson, University of West Virginia Medical School.
  • Dr. Ishio Ninomiya, West Virginia Medical Center.
  • Dr. Karl A. Folkers, University of Texas Institute for Biomedical Research. Dr. Folkers was very instrumental in my getting started in clinical research on Coenzyme Q10 as an adjuvant therapy for heart failure. Dr. Folkers was also the person who encouraged me to establish the SIBR Research Institute.

Dr. Ishio Ninomiya on Doing Good Science

Dr. Ishio Ninomiya is the mentor who taught me to be skeptical about what I heard, read, and accepted. He insisted that I trust only the science that I could reproduce myself or that I could find being reproduced in the literature several times.

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When can we say: “now we have evidence”?

Urban Alehagen
The researcher and cardiologist, Professor Urban Alehagen, asks the question: how much more clinical evidence of the beneficial heart-related health effects of a combo Coenzyme Q10/Selenium supplementation within an elderly Swedish population do we need? He points to the results looking at 18 publications from the set of data based on the randomized controlled trial, the KiSel-10 Study.

As a professor and cardiologist at Linköping University and the Linköping University Hospital in Sweden, I was one of the researchers in the multi-center Q-Symbio Study of the effect of Coenzyme Q10 adjuvant therapy on morbidity and mortality in chronic heart failure. In that randomized controlled trial, we gave 420 patients 3 x 100 mg of Coenzyme Q10 in divided doses taken with meals or matching placebos daily for two years.

The trial outcomes showed that the CoQ10 treatment added on to the patients’ conventional heart failure medication was associated with a significant reduction in the symptoms and a significant improvement in the survival of the heart failure patients [Mortensen 2014].

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CoQ10 Reduces Frequency and Duration of Migraine

Dr. Ross Pelton
Hello, my name is Ross Pelton. I am a pharmacist, nutritionist, author, and a health educator. My specialty is natural medicine and nutrition. I am also the world’s leading authority on the topic of drug-induced nutrient depletions. My website, bio and blog are available at: https://naturalpharmacist.net/. Here is a link for a FREE copy of my Quick Reference Guide to Drug-Induced Nutrient Depletions: https://naturalpharmacist.net/dind

In April 2020, I published an article in Integrative Medicine: A Clinician’s Journal about the cardiovascular benefits of daily Coenzyme Q10 supplement [1]. As most of you know, Coenzyme Q10 is an important antioxidant, and it also plays critical roles in the mitochondrial production of energy in the form of ATP.

Endogenous production of Coenzyme Q10 peaks at about 20 years of age and then gradually declines throughout our adult years. One estimate is that the heart muscle cells of an 80-year-old will produce about half of the Coenzyme Q10 that the heart muscle cells of a 20-year-old will [2]. It is not practical to think about making up the difference by eating more or better. Consequently, daily CoQ10 supplementation is important [3].

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Dr. Judy: What Does the Evidence Show About Ubiquinone vs Ubiquinol?

Dr Judy's book
Dr. William V. Judy, president of SIBR Research and author of Coenzyme Q10: An Insider’s Guide, addresses the question of whether to buy a ubiquinone Coenzyme Q10 supplement or a ubiquinol supplement.

Here Dr. Judy writes about the question of Coenzyme Q10 supplements in the form of ubiquinone vs ubiquinol.

For some time now, I have been thinking about the data comparing the absorption and bioavailability of the two commercially available forms of Coenzyme Q10: ubiquinone and ubiquinol.

  • Ubiquinone is the oxidized form of Coenzyme Q10, the form that is essential for ATP energy production in the cells. It is the most tested form. When it accepts two electrons, it is reduced and becomes ubiquinol.
  • Ubiquinol is the reduced form of Coenzyme Q10. In its reduced form, Coenzyme Q10 is an important lipid-soluble antioxidant. The Coenzyme Q10 in the lymph and blood is predominantly in the ubiquinol form. This makes sense, as there is more need for antioxidant protection in the blood than there is for bio-energetics.

Some of the numbers that have been presented in marketing claims for this newer and less tested form, ubiquinol, have seemed surprisingly high.

Analysis of the Steady-State Bioavailability of Ubiquinone and Ubiquinol

I have done an analysis of the steady-state bioavailability of ubiquinol compared to 1) dry powder ubiquinone, 2) dry-powder-in-oil-base ubiquinone, and 3) crystal-free oil-based ubiquinone formulations. Note that I am not talking about studies of single-dose absorption here.

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Dr. Judy Writes About Coenzyme Q10

Dr. William V. Judy
Dr. William V. Judy, founder and president of SIBR Research, writes as a guest columnist for Q10facts.com. Dr. Judy has done clinical research in the Coenzyme Q10 adjuvant treatment of patients with heart failure, chronic fatigue syndrome, and prostate cancer. He has supported Prader-Willi children with Coenzyme Q10 therapy. He is the author of the 2018 book Coenzyme Q10: An Insider’s Guide, which is available on amazon.com. ISBN 978-87-7776-186-7.

The question that I get asked about the most is whether there is any benefit from supplementing with Coenzyme Q10 if a person does not have a diagnosed CoQ10 deficiency?

Yes, I think there is a benefit. We should not be waiting until an obvious CoQ10 deficiency manifests itself. Instead, we should be giving people in their 40s and above the following advice:

  1. Your cells’ bio-synthesis of Coenzyme Q10 will decline with increasing age. Taking various medications, statin medications in particular, will also inhibit your body’s own production of Coenzyme Q10.
  2. The heart muscle cells need sufficient Coenzyme Q10 to produce enough ATP energy. To prevent the development and worsening of heart disease, you need to take daily CoQ10 supplements to get your plasma CoQ10 levels above 2.0 mcg/mL. If you already have symptoms of heart disease, you probably need to get your plasma CoQ10 levels above 2.5 mcg/mL [Langsjoen 2014].
  3. Taking 2 or 3 times 100 mg of Coenzyme Q10 daily, together with a meal, for 12 to 24 weeks, should get your plasma CoQ10 levels up to the target level. Firstly, taking more than 100 mg at a time will not bring much extra benefit. Secondly, taking the Coenzyme Q10 together with some fat in a meal will improve the absorption of the Coenzyme Q10.
  4. You must continue to take CoQ10 supplements even after you reach a plasma concentration of 2.0 mcg/mL. If you stop taking the CoQ10 supplement, your blood levels will decline. Moreover, the Coenzyme Q10 will not go from the blood into the tissue cells unless you have a higher concentration of CoQ10 in the blood.

What is a CoQ10 Deficiency?

In the USA, the normal level of plasma CoQ10 is quoted to be 0.45 to 1.50 mcg/mL. I feel that the 0.45 – 0.60 mcg/mL plasma levels are found in individuals with clinical conditions.

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CoQ10 Supplementation for MS Patients

Wheelchair in the park
MS patients may consider using a wheelchair to conserve strength and reduce fatigue or to prevent falls. Clinical trial evidence shows that high doses of CoQ10 daily can reduce the feeling of fatigue.

Daily supplementation of 60 multiple sclerosis patients with 200 milligrams of Coenzyme Q10 for three months showed beneficial clinical outcomes for the multiple sclerosis patients [Moccia 2019]:

The open-label crossover design study also had the following biological benefits [Moccia 2019]:

  • decreased the intracellular production of harmful free radicals
  • reduced the extent of oxidative damage in the peripheral blood
  • improved the anti-inflammatory environment in the peripheral blood
  • attenuated the extent of pro-inflammatory cytokines in the peripheral blood

CoQ10 and MS and Depression and Fatigue

In a randomized, double-blinded, placebo-controlled trial, daily CoQ10 supplementation of multiple sclerosis patients with 500 mg/day for 12 weeks was associated the following health benefits [Sanoobar 2016]:

  • a significant decrease in fatigue symptoms quantified using the fatigue severity scale
  • a significant improvement of depression symptoms as shown in Beck Depression Inventory scores

CoQ10 and MS and Inflammation and Oxidative Stress

In the same study, supplementation with 500 milligrams per day for 12 weeks significantly reduced the blood levels of known bio-markers for systemic inflammation compared to the placebo group [Sanoobar 2015]:

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Daily CoQ10 Supplementation for Senior Citizens

Dr. William Judy
Dr. William Judy, founder and president of SIBR Research, says that individuals vary in the extent to which their cells synthesize less CoQ10 with increasing age in the adult years. Generally, though, he is concerned if an individual has a blood CoQ10 concentration below 0.60 micrograms per milliliter.

As we get older – and more susceptible to aging-related diseases – the mitochondria and the endoplasmic reticula in our cells synthesize significantly less Coenzyme Q10. This seems to be especially true of CoQ10 bio-synthesis in the heart muscle cells, kidney cells, leg muscle cells, and abdominal wall muscle cells [Díaz-Casado 2019].

In some human tissues, the highest levels of CoQ10 are found in 20-year-olds. After the 20’s comes the ageing-related decline in CoQ10 levels in various human tissues [Kalén 1989].

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Low Coenzyme Q10 Status and Increased Heart Disease Risk

Dr. William Judy
Long-time Coenzyme Q10 researcher Dr. William Judy says that there is considerable individual variation in blood CoQ10 concentrations. Generally, though, he regards a plasma or serum CoQ10 level below 0.60 micrograms per milliliter as a warning sign.

Japanese cardiologists have reported a significant connection between low Coenzyme Q10 status and the risk of death from heart disease and other causes [Shimizu 2020].

  • The researchers collected and examined blood samples from 242 men and women admitted to Juntendo University Hospital’s coronary care unit in Tokyo.
  • They followed the heart disease patients for a three-year period.
  • 58 of the 242 patients (24%) died during the follow-up period from heart disease, cancer, infection, and other causes.
  • The patients who died had an average blood CoQ10 concentration of 0.48 micrograms per milliliter. The patients who survived had a higher average blood CoQ10 concentration of 0.58 micrograms per milliliter.
  • Overall, the researchers found that patients with a “higher” blood CoQ10 concentration of 0.46 or greater micrograms per milliliter had a 52% lesser likelihood of dying from all causes than did the patients with blood CoQ10 concentrations below 0.46 micrograms per milliliter.
  • Nota bene: The patients with the low CoQ10 blood levels were the patients with the higher dosages of statin medications.

Why Low CoQ10 Levels are Associated with Heart Disease Mortality

Book Insider's Guide to Coenzyme Q10
In his book Insider’s Guide to Coenzyme Q10, Dr. Judy discusses the effects of increasing age, malnutrition, and statin medications on blood Coenzyme Q10 levels and the consequent effect on heart function. Available from amazon.com. ISBN: 978-87-7776-186-7.

This research shows that heart disease patients with lower blood CoQ10 levels are at greater risk of dying sooner than heart disease patients with higher blood CoQ10 levels [Shimizu 2020].

  • Statin medications are known to inhibit the body’s endogenous production of Coenzyme Q10; logically, every heart patient taking a statin medication will need adjunctive Coenzyme Q10 treatment. Okuyama et al [2015] have explained the mechanisms by which statin medication may increase the risk of developing atherosclerosis and heart failure.
  • Lower blood CoQ10 levels are also associated with greater age [Shimizu 2017]. Malnutrition among senior citizens may be contributing to low CoQ10 status; this is another argument for supplementation.
  • Adequate levels of Coenzyme Q10 are associated with reduced levels of blood bio-markers for inflammation, in particular interleukin 6, C-reactive protein, and tumor necrosis factor alpha [Fan 2017].

Evidence from CoQ10 Supplementation and Heart Disease Studies

Bottom Line: CoQ10 Status and Cardiovascular Disease risk

Adequate levels of Coenzyme Q10 are essential to the cells’ production of ATP energy; moreover, Coenzyme Q10 is an important lipid-soluble antioxidant that scavenges harmful free radicals [Shimizu 2017].

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CoQ10 for Dogs and Cats

King Charles Spaniel
Myxomatous mitral valve disease is the most common heart disease in dogs. It often leads to congestive heart failure. The Cavalier King Charles Spaniel is especially at risk of developing mitral valve disease at an early age. From the onset of congestive heart failure in dogs with mitral valve disease, the median survival time is less than a year even with medical therapy [Christiansen 2020]. Applied early enough, Coenzyme Q10 supplements may increase the life expectancy and quality of life for dogs at risk of heart disease.
Increasingly, people are feeding their dogs CoQ10 supplements. The CoQ10 supplementation is used provide dogs and cats the following health benefits [Gollakner 2020; Puotinen CJ 2019]:

  • improved cellular energy production
  • enhanced antioxidant protection against lipid peroxidation
  • anti-inflammatory effects
  • reduced endothelial dysfunction

Typically, the CoQ10 supplement is given by mouth as a capsule or as a liquid. It is possible, of course, to squeeze the CoQ10 filling out of a capsule onto the dog food.

Pharmacokinetics Study of Repeated Oral CoQ10 Dosing of Spaniels

Now, a research team in Denmark has investigated the pharmacokinetics of oral dosing of Cavalier King Charles Spaniels over a three-week period [Christiansen 2020].

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