Coenzyme Q10 Ameliorates Statin-Associated Muscle Symptoms

In his 2018 book entitled Coenzyme Q10: An Insider’s Guide, Dr. William V. Judy describes the complicated relationship between Coenzyme Q10 and statin medications. Please see pages 80-85. The book is available from

A 2018 meta-analysis and systematic review has shown that Coenzyme Q10 supplementation significantly ameliorates statin-induced muscle symptoms [Qu]:

  • reduces muscle pain
  • reduces muscle weakness
  • reduces muscle cramping
  • reduces muscle fatigue

The positive results of the meta-analysis suggest that Coenzyme Q10 supplementation may be a complementary approach to the management of statin-induced myopathy [Qu].

Why Do You Need Coenzyme Q10 Supplements with Statin Medication?

Statin medications are drugs widely prescribed in order to lower patients’ levels of total cholesterol and the so-called “bad” ldl-cholesterol.  Statins are used to protect against heart attack and stroke; however, they do have adverse effects.

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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 (], 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, 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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Coenzyme Q10 and energy and fitness

swimmers triathlon
Competing in a triathlon or in long distance races requires lots of energy over extended periods. Coenzyme Q10 is instrumental in the body’s production of ATP, the body’s basic unit for the storage of energy in its chemical form.

What about Coenzyme Q10 and energy and physical fitness, I have been wondering.  I know that Coenzyme Q10 in its ubiquinone form plays a vital role in the production of adenosine triphosphate (ATP) molecules in the mitochondria in the cells.

The ATP molecules are the basic units of energy in the body.  The ATP molecules are what provide the energy for the contraction and extension of muscles.

Q10 and ATP and muscle aches and fatigue
Even when we are rested up, we do not have enough ATP molecules to allow us to exert ourselves intensely for more than a few minutes.  When we exercise very intensively (run sprints, for example) or exercise strenuously for longer periods, our muscle tissues are forced to go from aerobic energy production, i.e. from burning oxygen, to the anaerobic (non-oxygen-burning fermentation) mode of energy production.

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Coenzyme Q10 and selenium: partners against heart disease

Surgeons and hospitalized patient
Swedish seniors, both men and women, who took Q10 and selenium supplements for a 4-year period spent 13% fewer days in the hospital and had significantly better quality of life than did Swedish seniors who took placebos.

There is a tantalizingly interesting relationship between the essential bio-nutrient Coenzyme Q10 and the trace element selenium and heart disease.  One of the first clinical researchers to tease out the effects of supplementation with Q10 and selenium in heart attack patients was Dr. Bodo Kuklinski.  

Coenzyme Q10 and selenium for heart attack patients
Dr. Kuklinski tested 61 patients who had been admitted to the hospital in Rostock, Germany, with an acute myocardial infarction and with symptoms of less than six hours’ duration.  He assigned 32 of the patients to the adjuvant treatment group and 29 of the patients to the control group.

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Ubiquinone? Ubiquinol? What does Dr. Judy say?

Dr. William V. Judy, himself a 16-year survivor of a heart attack, takes 200 mg a day of a ubiquinone Q10 supplement. The normal life span for Class IV Chronic Heart Failure patients is 7 years when taking conventional therapy only.

Coenzyme Q10 in its ubiquinone form?  Or in its ubiquinol form?  Which form is best?  And why is one form the better choice?  It is the question that doesn’t go away.

Difference between Q10 searches in Medline and Google
When I look at Medline for reports of randomized controlled trials (RCTs) showing the effects of Q10 supplementation, I find mostly studies using the ubiquinone form.  It is the well-documented form.

When I use Google to look for new information about Q10 supplements, I find more claims than I find reports of research results.  In Google, the ratio of ubiquinol claims to ubiquinone claims is much higher than the ratio of ubiquinol-to-ubiquinone research results is in Medline.  That is strange.

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Fewer hospital visits with Q10

Hospital beds in paint
Being re-admitted to the hospital is hard on the patient and the family and the hospital system. Judicious use of Coenzyme Q10 supplements can reduce the number of re-hospitalizations.

The energy-starved heart.   More than anyone, the Danish cardiologist Dr. Svend Aage Mortensen was the person who wanted to do clinical research into the phenomenon of the failing heart that was starved for energy.  He thought that there was an issue in heart failure patients with heart cell mitochondria colonizing and atrophying adjacent to the cell membranes.

Less Q10 with age and with statin medications
Dr. Mortensen thought that the issue was closely related to an inadequate supply of Coenzyme Q10. As people got older, their bodies produce less Q10.  They also absorb less Q10 if they begin to eat smaller meals and less meat and fish.  Moreover, he knew that patients taking statin medications were having their own bio-synthesis of Coenzyme Q10 blocked by the statin medications.

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Following Q10 from the stomach to the cells

Q10 C59 H90 O4
The Q10 molecules are large fat-soluble molecules. They have somewhat hydrophilic heads and strongly hydrophobic tails. As such, they need to form into micelles to move into the watery phase near the absorption cells in the small intestine.

Earlier, I asked Dr. William Judy about drug delivery systems using nanoparticles.
Could the use of nanoparticles be a good way to increase the absorption of Q10 molecules?

Dr. Judy looked at the published research literature and decided that, given the present state of research and development, nanoparticles are still not as effective as the body’s own micelles for the delivery of Q10 to the absorption cells in the small intestine.

Q10 difficult to absorb
To recapitulate: Coenzyme Q10 is difficult to formulate in a way that ensures that it will be absorbed in the small intestine.  There are several reasons for this difficulty:

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Weak arguments for the ubiquinol form of Q10

Red flag
The use of logical fallacies in advertisements for Coenzyme Q10 products should raise a red flag in your mind. Fallacies are false and misleading arguments based on faulty evidence or on faulty reasoning or both.

Often, people who have only weak evidence or weak reason and logic to support their arguments resort to the use of logical fallacies.  Far too often, for example, we see fallacies used in commercial advertisements and in political campaigns.  Some of the most recognizable fallacies used (unfairly) in arguments and in discussions are the appeal to emotion, the appeal to tradition, the ad hominem attack, the straw man, the red herring, the slippery slope, and so on. We have to be on guard against the use of these fallacies.

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Meta-analyses of Q10 in heart failure

Illustration for metaanalysis
Three solid meta-analyses provided the background data and information that led to the design and funding of the Q-Symbio study of the effects of Q10 supplementation on chronic heart failure.

Why do a meta-analysis of Q10 studies?  And, what is a meta-analysis anyway?
A meta-analysis is a statistical method for the combining of the results from two or more independent studies of the effects of the same treatment variable on the same or similar outcomes. In our case, the supplementation with Q10 is the independent variable, the treatment variable, and the various aspects of heart disease are the dependent variables.  The meta-analysis method is used in the hope of gaining greater knowledge of the efficacy of bio-medical treatments through the combining and comparing and contrasting of the data from the studies selected for analysis.

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