CoQ10 and Oxidative Stress: A 2020 Meta-analysis

Dr. Judy An Insider's Guide to Coenzyme Q10
Dr. William V. Judy, founder and president of SIBR Research, explains the differences between the ubiquinone form of Coenzyme Q10 and the ubiquinol form. The book is available from ISBN 978-87-7776-186-7.

First off, a few definitions:

Coenzyme Q10 is an essential bio-nutrient with vitamin-like properties. It is not considered a vitamin because our cells do synthesize Coenzyme Q10. However, once we reach adulthood, our bio-synthesis of Coenzyme Q10 begins to decline with increasing age [Kalén 1989]. Furthermore, statin medications are known to inhibit the bio-synthesis of Coenzyme Q10 [Okuyama 2015]. Supplementation is a must.

Oxidative stress is the result of an imbalance between the body’s production of harmful free radicals as a by-product of metabolic processes and the body’s supply of antioxidants to neutralize the free radicals. Oxidative stress, unchecked, results in damage to cell membranes, proteins, lipids, and DNA.

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Coenzyme Q10 and Metabolic Syndrome

Metabolic syndrome, also known as syndrome X, is the name for a cluster of conditions – high blood pressure, high blood sugar, insulin resistance, increased risk of blood clots, abnormal cholesterol – that are dangerous themselves and can lead to heart disease and type 2 diabetes.  Coenzyme Q10 supplementation can improve the associated mitochondrial dysfunction and reduce oxidative stress.

Coenzyme Q10, the essential bio-nutrient, has properties that are germane to the treatment of several of the risk factors associated with the umbrella term “metabolic syndrome” [Casagrande].

These properties include the following:

  • a bio-energetics role in the cellular production of ATP energy [Casagrande]
  • a role as a fat-soluble antioxidant protecting against oxidative damage by harmful free radicals to cells and lipids [Casagrande]
  • an anti-inflammatory effect [Zhai]
  • a role in the protection and improvement of endothelial function [Gao]

What Factors Reduce Plasma Coenzyme Q10 Levels?

Typically, we expect to find plasma Coenzyme Q10 concentrations ranging from 0.6 to 1.0 micrograms per milliliter in unsupplemented healthy individuals.  With daily supplementation, it is possible to raise the plasma Coenzyme Q10 levels above the 2.5 micrograms per milliliter level needed for a therapeutic effect in heart disease and above the 3.5 micrograms per milliliter level needed for a therapeutic effect in neurodegenerative disease [Langsjoen].

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How Coenzyme Q10 supplements protect us from the risk of heart disease

Dr. William V. Judy, Founder and President of SIBR Research, has done basic and clinical research into the safety, absorption, and health effects of Coenzyme Q10 supplementation for 40 years. His research has documented significant health benefits of CoQ10 supplements in patients with heart failure, chronic fatigue syndrome, and heart surgery.

As we get older, the risk of heart disease increases.  There are two basic explanations for this increasing risk:

  • Mitochondrial dysfunction
  • Oxidative stress

Mitochondrial dysfunction

The mitochondria are the tiny “powerhouses” in our cells.  They are organelles with their own DNA.  They produce almost all the energy that our cells need to live and work.

A slow degeneration of the quality of the mitochondria seems to be a cause of ageing and a cause of many of the degenerative diseases that come with ageing [Know 2018].

It is in the mitochondria that the food we eat is processed together with the oxygen we breath to make cellular energy, ATP energy.

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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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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 crucial antioxidant enzymes

Oxygen is a strange element in our lives.  We cannot live without it.  We use it to burn nutrients to generate ATP energy in the cells.  So far, so good.

But, in the process of producing energy from nutrients – the process is called cellular respiration – some small portion of the oxygen produces a by-product: free radicals.  These radicals are atoms or molecules with one or more unpaired electrons in the outer orbit. There are many types of radicals; the radicals derived from oxygen – known as reactive oxygen species – are some of the most toxic radicals.

In moderate quantities, these free radicals have some useful inter-cellular and intra-cellular  signaling functions.  Moreover, the immune system’s phagocytic cells use radicals to kill pathogens.  However, in large quantities, the highly reactive radicals that escape the respiratory chain of the mitochondria can be toxic to the cells.  They can damage DNA, RNA, proteins and fatty acids in the blood and tissue.

In fact, the definition of oxidative stress is an imbalance between the quantities of potentially harmful free radicals and the quantities of antioxidants available to neutralize the free radicals before they can set off damaging chain reactions.  The process of lipid peroxidation is one of the most common examples of toxic activity by oxygen-derived radicals; the radicals target the fatty acids in the phospholipid cellular membranes, i.e. the plasma membranes of the cells and the mitochondrial membranes.  The antioxidant enzymes are important for the prevention of lipid peroxidation.

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Coenzyme Q10 for diabetes patients

Some 21 million Americans have diabetes. Diabetes increases the inflammation that is associated with hardening of the arteries (called atherosclerosis). Atherosclerosis increases the risk of heart attack or stroke and the risk of chronic heart failure. Prolonged supplementation with Coenzyme Q10 may have beneficial health effects for diabetes patients.

Twelve weeks of supplementation with Coenzyme Q10 can significantly reduce the levels of oxidative stress associated with diabetes.

Recently, Swedish researchers reported the results of a study of the effects of daily Coenzyme Q10 supplementation on type-1 and type-2 diabetes patients.  Twice a day for a period of 12 weeks, the 22 diabetes patients in the study received 100 milligrams of oral Coenzyme Q10 in the form of ubiquinone.

The patients averaged 57 years of age (type-1 diabetes patients) and 63 years of age (type-2 diabetes patients). They were predominantly male patients [Montano].

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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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Coenzyme Q10, older athletes, and statins

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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