Here, below, is what I have learned about Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More over the years. CoQ10 is a naturally occurring redox compound that is essential for life in all humans. Dr. Karl Folkers called it “an essential bio-nutrient.”

• Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More in its ubiquinoneUbiquinone, the oxidized form of Coenzyme Q10, expressed as Q10 or CoQ10, is absolutely essential for the mitochondrial ATP energy production process. Ubiquinone is the form of Coenzyme Q10 that the body synthesizes, and ubiquinone is the form of Coenzyme Q10 that has been extensively tested for safety, absorption, and efficacy in clinical trials. More form, its oxidized state, plays an essential role in the production of ATPATP (adenosine triphosphate) molecules are the high-energy molecules with easily broken phosphate bonds that release energy to the energy-requiring processes in the cells. Coenzyme Q10 is essential to the process of ATP production. More energy. It is needed in optimal quantities for cellular bio-energeticsBio-energetics is both the process and the study of the flow and transformation of energy in living beings.  Coenzyme Q10 has both a bio-energetics function and an antioxidant function in the body. More in heart muscle and skeletal muscle tissue.
• In its ubiquinol form, its reduced state, Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More functions as a lipophilic antioxidantAntioxidants are substances that protect the cells and lipoproteins against the harmful effects of free radicals. They are substances that prevent the oxidation of other molecules and compounds. There are two broad categories of antioxidants: enzymatic and non-enzymatic. Non-enzymatic antioxidants are substances like Coenzyme Q10, vitamin C, vitamin E, glutathione, and various carotenoids. Prominent enzymatic antioxidants include catalase, glutathione peroxidase,... More, scavenging harmful free radicalsFree radicals are unstable and highly reactive molecules that are produced in the body during normal oxygen metabolism. Free radicals derived from oxygen are known as reactive oxygen species. Free radicals play both helpful and harmful roles in the body. Free radicals steal electrons from other substances in order to become stable. In so doing, the free radicals oxidize those... More and providing protection against oxidative damage.
• CoQ10 supplementation has been shown to improve endothelial function [Belardinelli 2008]. The endothelial cells line the inside of the heart and the blood vessels. They are the cells that release substances that regulate the contraction and relaxation of the blood vessels, and they release enzymes that regulate blood clotting and platelet adhesion. They are very important for good heart health.
• In clinical trials, CoQ10 supplementation has been associated with anti-inflammatory effects. A meta-analysis of 17 clinical trials has shown that CoQ10 status is associated significantly with reduced levels of the inflammatory mediators C-reactive protein, interleukin-6, and tumor necrosis factor-α [Fan 2017].

Blood and Tissue Deficiencies of Coenzyme Q10

• Blood and tissue CoQ10 deficiency can occur because of ageing and because of the effect of medications such as statinsStatins are a class of medications that effectively block the body’s synthesis of cholesterol. In so doing, statins also block the body’s synthesis of Coenzyme Q10. More.
• Blood and tissue CoQ10 deficiency have been associated with statin-associated muscle symptoms (muscle aches and pains, severe cramps, muscle weakness) and with some of the symptoms of patients with heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More and chronic fatigue syndromeChronic fatigue syndrome (CFS) is a complicated disorder with an unknown cause.  CFS is characterized by persistent fatigue that does not improve with rest and that cannot be explained by any identifiable medical condition. CFS is also known as myalgic encephalomyelitis (ME) and systemic exertion intolerance disease (SEID).  It is sometimes abbreviated ME/CFS. CFS patients typically have low levels of... More (tiredness, fatigue, lack of energy).
• Evidence from a 2016 meta-analysis supports the use of supplemental Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More in patients with statin-associated muscle symptoms [Qu 2016].
• The randomized controlled trial, the Q-Symbio StudyQ-Symbio is the abbreviated name for the two-year multi-center, randomized, double-blind, placebo-controlled study of Coenzyme Q10 supplements as an adjunct treatment of chronic heart failure patients. The name reflects the focus of the study on the SYMptoms, BIomarker status (BNP), and long-term Outcomes (hospitalizations and mortality) of the supplementation. The data from the Q-Symbio study show that long-term supplementation with... More, provides evidence for an adjunctive role for Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More in the treatment of patients with chronic heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More [Mortensen 2014].
• A 2013 meta-analysis has shown that supplementation with Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More resulted in significantly improved ejection fractionEjection fraction, sometimes called left ventricular ejection fraction, measures the percentage of blood that the heart pumps out of the left ventricle with each heart contraction. According to the Mayo Clinic guidelines, an ejection fraction above 55% is regarded as normal.  An ejection fraction under 50% is regarded as reduced. An ejection fraction below 40% is indicative of heart failure... More and improved NYHAThe New York Heart Association Functional Classification distinguishes four categories of heart failure according to how much the patients are limited in their physical activity. Category I: No limitation of physical activity. No undue fatigue, palpitation, or shortness of breath. Category II: Slight limitation of physical activity. Comfortable at rest. Fatigue, palpitation, or shortness of breath at ordinary physical activity.... More functional class [Fotino 2013].

CoQ10 Supplementation of Patients with Statin-Associated Muscle Symptoms

Writing in February, 2021, in a special issue of one of the leading cardiology journals: Journal of the American College of Cardiology, Texas cardiologists Albert E. Raizner and Miguel A. Quiñones, conclude that it seems “reasonable and justifiable” for cardiologists to use Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More supplements with patients diagnosed with statin-associated muscle symptoms [Raizner & Quiñones 2021].

In the KiSel-10 project, our research group has reported that daily supplementation of elderly community living Swedish citizens with a combination of 200 micrograms of organic seleniumSelenium (symbol Se, atomic number 34) is a trace element that is an essential nutrient and an essential component of some of the most important antioxidants in the body, in particular the selenoproteins glutathione peroxidase, thioredoxin reductase, and selenoprotein P. Selenium is involved in the optimal functioning of the immune system. Professor Alehagen has pointed out that there exists a... More and 200 milligrams of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More for four years is associated with the following statistically significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant. More heart health outcomes [Alehagen 2013: Johansson 2015]:

• reduced risk of death from heart disease
• reduced blood levels of a protein bio-marker for heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More
• improved heart function shown on echocardiograms
• improved health-related quality of life

Possible Mechanisms for the Positive Clinical Outcomes

Thus far, our research group has published sub-analyses from the KiSel-10 StudyIn the KiSel-10 study, 443 Swedish citizens aged 70 to 88 received either a combined daily supplementation of high-selenium yeast and Coenzyme Q10 or matching placebos. The elderly Swedish citizens who received the active treatment of selenium and Coenzyme Q10 had significantly reduced risk of death from heart disease, significantly better heart function as recorded on echocardiograms, and significantly lower... More that illuminate possible mechanisms to explain the positive clinical effects of the combined supplementation:

Over the years, many physicians have worked with SIBR Research by entering their patients into clinical trials conducted by SIBR Research. Many of these physicians, after seeing the benefits that Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More gave to their patients, requested Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More for their families or for themselves. In this article, I will relate some of their successes and failures.

A physician requested CoQ10 for his mother

In 2002, a heart surgeon called our office and asked about our experiences in supplementing heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More patients with Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More. I had previously met this physician in 1966 when he was a surgical fellow at Methodist Hospital in Houston, and I was a fellow in the department of Physiology at Baylor School of Medicine. We met at a lecture given by Dr. Karl Folkers on the biochemistry of CoQ10 in heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More.

In 2013, Professor Urban Alehagen and a team of researchers reported on the beneficial effects of daily supplementation of elderly Swedish citizens with a combination of 200 mg of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More and 200 mcg of seleniumSelenium (symbol Se, atomic number 34) is a trace element that is an essential nutrient and an essential component of some of the most important antioxidants in the body, in particular the selenoproteins glutathione peroxidase, thioredoxin reductase, and selenoprotein P. Selenium is involved in the optimal functioning of the immune system. Professor Alehagen has pointed out that there exists a... More, in divided doses with meals, over a four-year period.

Compared to the study participants in the placebo group, the KiSel-10 studyIn the KiSel-10 study, 443 Swedish citizens aged 70 to 88 received either a combined daily supplementation of high-selenium yeast and Coenzyme Q10 or matching placebos. The elderly Swedish citizens who received the active treatment of selenium and Coenzyme Q10 had significantly reduced risk of death from heart disease, significantly better heart function as recorded on echocardiograms, and significantly lower... More participants who received the active treatment had significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant.   More heart health benefits [Alehagen 2013]:

• reduced risk of death from heart disease
• better heart function as shown on echocardiograms
• lower blood levels of the NT-proBNP protein, a bio-marker for the risk of heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More

In 2015, Professor Alehagen and I analyzed what we knew, as clinicians, about seleniumSelenium (symbol Se, atomic number 34) is a trace element that is an essential nutrient and an essential component of some of the most important antioxidants in the body, in particular the selenoproteins glutathione peroxidase, thioredoxin reductase, and selenoprotein P. Selenium is involved in the optimal functioning of the immune system. Professor Alehagen has pointed out that there exists a... More and Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More and heart disease [Alehagen & Aaseth 2015]. We asked ourselves why that combination had protected against heart disease in elderly people.

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 StudyQ-Symbio is the abbreviated name for the two-year multi-center, randomized, double-blind, placebo-controlled study of Coenzyme Q10 supplements as an adjunct treatment of chronic heart failure patients. The name reflects the focus of the study on the SYMptoms, BIomarker status (BNP), and long-term Outcomes (hospitalizations and mortality) of the supplementation. The data from the Q-Symbio study show that long-term supplementation with... More of the effect of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More adjuvant therapy on morbidity and mortality in chronic heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More. In that randomized controlled trial, we gave 420 patients 3 x 100 mg of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More 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 failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More medication was associated with a significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant.   More reduction in the symptoms and a significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant.   More improvement in the survival of the heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More patients [Mortensen 2014].

The question that I get asked about the most is whether there is any benefit from supplementing with Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More 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 Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More will decline with increasing age. Taking various medications, statin medications in particular, will also inhibit your body’s own production of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More.
2. The heart muscle cells need sufficient Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More to produce enough ATPATP (adenosine triphosphate) molecules are the high-energy molecules with easily broken phosphate bonds that release energy to the energy-requiring processes in the cells. Coenzyme Q10 is essential to the process of ATP production. More 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 Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More 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 Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More together with some fat in a meal will improve the absorption of the Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More.
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 Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More 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.