Coenzyme Q10 for Adjunctive Treatment of Heart Failure

Blood circulation
Heart failure does not mean that the heart has stopped working. It means that the heart is not pumping as much blood out to the rest of the body as it should. The consequence is that the body organs and tissues do not get as much oxygen and as many nutrients as they need. Clinical trials show that treatment with Coenzyme Q10 in addition to conventional heart failure medication is beneficial.

Adjunctive treatment of chronic heart failure patients with 3 times 100 milligrams of Coenzyme Q10 daily for two years gave the following significant results compared with placebo treatment [Mortensen 2014]:

  • reduced number of deaths from heart disease
  • reduced number of deaths from all causes
  • reduced number of heart failure related hospitalizations
  • improved NYHA class

Absorption and Bioavailability of the CoQ10 Supplement

CoQ10 supplements are very different from one another. The CoQ10 supplement that gave the beneficial heart health outcomes listed above is a specially formulated CoQ10 preparation, specially formulated with respect to the carrier oils in which the Coenzyme Q10 raw material is dispersed and with respect to the heating and cooling process used in the manufacture of the supplement. It has documented absorption and bioavailability.

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Coenzyme Q10: Clinical Applications

Picture of Dr. WilliamV. Judy
In the February and March 2019 issues of WholeFoods magazine, the long-time Coenzyme Q10 clinical researcher, Dr. William V. Judy, warns: Buyer beware. CoQ10 supplements do not give equal absorption. It is important to buy a CoQ10 supplement that has documented absorption and bioavailability and that has documented beneficial heart health effects.

Coenzyme Q10 is an essential bio-nutrient that has vitamin-like properties.

  • It is a vital co-factor in the cellular process of ATP energy generation.
  • It is an important lipid-soluble antioxidant. It has anti-inflammatory effects.
  • Substantial reduction of bio-markers for oxidative stress and inflammation has been seen in several randomized controlled trials [Martelli 2020].

Coenzyme Q10 is a redox molecule, having both an oxidized form (ubiquinone) and a reduced form (ubiquinol).

CoQ10 Supplementation and Heart Disease Risk Factors

Coenzyme Q10 and Heart Failure

In the Q-Symbio Study, researchers gave chronic heart failure patients 300 mg/day (3 x 100 mg in divided dosages) or matching placebos for two years.

Coenzyme Q10 and High Blood Pressure

Older meta-analyses of the effect of Coenzyme Q10 on hypertension showed significant reductions in both systolic and diastolic blood pressure [Rosenfeldt 2007; Ho 2009]. A more recent meta-analysis has shown that CoQ10 supplementation is associated with a significant reduction in systolic blood pressure but not in diastolic blood pressure in patients with metabolic syndrome [Tabrizi 2018].

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Testing the Potency of Coenzyme Q10 Supplements

CoQ10 capsules in blister pack
Yes, of course, the capsule must contain 100 mg of Coenzyme Q10 if that is what the label says. However, the absorption of Coenzyme Q10 is complex. The CoQ10 potency test results do not take important factors into consideration:  Dissolving the CoQ10 Crystals – Dividing the CoQ10 Daily Dosage – Deciding on the Form (ubiquinone or ubiquinol) and Formulation 

A US supplements manufacturer reports that its testing shows some of the CoQ10 supplements sold on amazon.com do not contain the quantity of Coenzyme Q10 indicated on the product label [Schultz, 2020, May 14].

The testing shows that seven of the ten tested products had less than 80% potency. These seven named products are not products from major sellers of CoQ10 supplements in the USA.

The other three tested products tested are labeled “X Brand” in the test report. These three products are said to contain 93%, 96.5%, and 86% of the declared active ingredient [NOW® Testing].

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Enzyme Systems Convert Ubiquinone to Ubiquinol

Dr. Judy COQ10 Insider's Guide book
Dr. William Judy in his 2018 book, Coenzyme Q10: An Insider’s Guide, discusses the absorption and bioavailability of the ubiquinone and ubiquinol forms of Coenzyme Q10. The book is available from amazon.com. ISBN: 978-87-7776-186-7

There are numerous enzyme systems at work in the body to convert ubiquinone, the oxidized form of Coenzyme Q10, to ubiquinol, the reduced form of Coenzyme Q10.  Despite marketing claims to the contrary, it is not necessary to take a ubiquinol supplement to get sufficient ubiquinol in the body [Mantle & Dybring 2020].  No worries there.

This is the take-home message in a peer-reviewed journal article published on May 5, 2020, in the Antioxidants journal [Mantle & Dybring 2020].

Ubiquinone (Oxidized Form) and Ubiquinol (Reduced Form)

Coenzyme Q10 molecules are redox molecules. In the body, they convert back and forward between their oxidized form, ubiquinone, and their reduced form, ubiquinol.  What does that mean, oxidized and reduced?

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Facts About Coenzyme Q10 Absorption and Bio-Availability

Dr. Judy in lab coat
Dr. William V. Judy, SIBR Research Institute, explains: Absorption is the movement of the ingested Coenzyme Q10 through the stomach and small intestines into the lymph and then into the blood circulation. Bioavailability is the accumulation of the ingested Coenzyme Q10 in the blood over time in response to daily doses. It is the amount of Coenzyme Q10 that is available for transport into the tissue cells.

Fact: Without decent absorption and bio-availability of our CoQ10 supplement, we cannot hope to get good heart health effects.

Fact: There is much variability from one CoQ10 supplement to another. It is important to choose a CoQ10 supplement for which there is documented evidence of absorption and bio-availability as well as published evidence of improvement of heart health signs and symptoms.

Sadly, the claims for the absorption of many CoQ10 supplements have been greatly exaggerated in many cases.

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Coenzyme Q10 and Type-2 Diabetes

Blood sugar test
According to a 2017 report by the Centers for Disease Control and Prevention (CDC), more than 100 million US adults have diabetes or pre-diabetes. More than 30 million Americans – nearly 10% of the adult population – have diabetes, of whom more than 90% have type-2 diabetes. Moreover, more than 84 million Americans have pre-diabetes and will have full-blown diabetes within five years if they are not treated.

Diabetes is a serious disease. It is the seventh leading cause of death in the United States. It can be managed with exercise, diet, insulin, and other drugs to control blood sugar levels.

Coenzyme Q10 for Prevention and Adjunct Treatment of Type-2 Diabetes

In a 2017 article in the British Journal of Diabetes, Dr. David Mantle, a Fellow of the Royal Society of Chemistry and of the Royal College of Pathologists, makes the following points about the use of Coenzyme Q10 supplements to prevent and treat type-2 diabetes:

  • CoQ10 depletion has been implicated in the pathogenesis of diabetes.
  • Coenzyme Q10 plays important roles in both mitochondrial bio-energetics and in antioxidant protection against oxidative stress.
  • Supplementation with Coenzyme Q10 can significantly improve glycemic control.
  • Supplementation with Coenzyme Q10 can improve vascular dysfunction.
  • Supplementation with Coenzyme Q10 may be of particular importance in type-2 diabetics who have been prescribed statins.
  • Supplementation with Coenzyme Q10 may be of particular importance for patients with fatty liver disease.
  • Supplementation with Coenzyme Q10 is well tolerated, with no significant adverse effects reported in long-term use.
  • The importance of the formulation of the Coenzyme Q10 supplement with respect to product quality and bio-availability cannot be over-emphasized.
Back cover of Dr Judy's book
In his 2018 book, The Insider’s Guide to Coenzyme Q10, Dr. William Judy discusses the clinical research conducted with Coenzyme Q10 supplements.

Three Different Forms of Coenzyme Q10 Supplements

Coenzyme Q10 occurs in the body in three closely related chemical forms:

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Coenzyme Q10 and Heart Disease

Yellow-orange Coenzyme Q10 crystals
In its raw material form, Coenzyme Q10 consists of crystalline compounds. These crystals must be dissolved to single CoQ10 molecules to permit absorption. Only single CoQ10 molecules can be absorbed. CoQ10 crystals have poor dissolution within the chyme of the intestines because melting point of CoQ10 crystals is 10 degrees centigrade above body temperature. Thus, the absorption of the Coq10 supplement depends upon the manufacturer’s formulation, upon the solubility of the Coenzyme Q10 in the oil matrix.

Coenzyme Q10 is a naturally occurring vitamin-like bio-nutrient that is essential to the cellular process of ATP energy production. It is especially important for the optimal functioning of tissues with high energy requirements such as heart muscle tissues [Mantle 2015].

Beyond its role in cellular energy production, Coenzyme Q10 has the following important biological functions:

Bio-Synthesis of Coenzyme Q10 Declines with Age

The human body’s ability to synthesize Coenzyme Q10 peaks at some time in a person’s 20s and gradually declines thereafter [Kalén 1989]. Consequently, supplementation is necessary. It is not possible to make up the age-related loss of Coenzyme Q10 by eating more carefully.

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Coenzyme Q10 and Non-Alcoholic Fatty Liver Disease

Older man
Mitochondrial dysfunction, oxidative stress, and inflammation have been implicated in the development of non-alcoholic fatty liver disease (NAFLD). Treatment with the essential bio-nutrient Coenzyme Q10 may improve the prognosis for NAFLD patients. CoQ10 has a key role in mitochondrial function as well as having antioxidant and anti-inflammatory action. CoQ10 levels are depleted in NAFLD.

The results of two randomized controlled studies indicate that CoQ10 supplement at a dosage of 100 mg/day can be effective in reducing systemic inflammation and in improving biochemical variables associated with Non-Alcoholic Fatty Liver Disease (NAFLD) [Farsi 2016; Farhangi 2014].

NAFLD is a chronic liver disorder related to systemic inflammation.

  • The NAFLD condition exists whenever the accumulation of fat in the liver cells, primarily in the form of triglycerides, exceeds 5–10% of liver weight.
  • NAFLD is the most common liver disorder worldwide; its prevalence in the general population is estimated at 20–30%.
  • NAFLD’s prevalence increases to 60–70% in obese individuals and to 70–90% in individuals with diabetes [Mantle & Hargreaves 2020].

Coenzyme Q10 is an essential bio-nutrient that has been shown to reduce the blood levels of bio-markers of systemic inflammation [Fan 2017; Zhai 2017]. Moreover, number of pre-clinical studies have demonstrated the capacity of supplemental Coenzyme Q10 to prevent or reduce the extent of liver tissue damage by a variety of toxic agents [Mantle & Hargreaves 2020].

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Coenzyme Q10 and NADH and Chronic Fatigue Syndrome

DNA strand
Basically, our efforts to avoid or delay the onset of the various pathologies associated with increasing age involve managing the effects of cellular bio-energetic disturbances, oxidative stress, and mitochondrial dysfunction. Combined supplementation with Coenzyme Q10 and NADH may be a beneficial anti-ageing treatment.

Most recently, nicotinamide adenine dinucleotide (NAD+ in its oxidized form and NADH in its reduced form) has been getting much attention as a possible anti-ageing substance.

  • Like Coenzyme Q10, NAD+/NADH is a coenzyme that is present in nearly all human cells.
  • Like Coenzyme Q10, NAD+/NADH exists in both an oxidized form and a reduced form.
  • Like Coenzyme Q10, NAD+/NADH is needed for the cellular process of producing ATP energy from the food that we eat.
  • Like Coenzyme Q10, NAD+/NADH has an antioxidant function in the cells protecting against the damage caused by oxidative stress.
  • Like Coenzyme Q10, NAD+/NADH is essential for life.  Without NAD+/NADH, the cells will not produce energy and will die.
  • Like Coenzyme Q10, NAD+/NADH levels decrease as we get older.

Coenzyme Q10 and NAD+/NADH and Chronic Fatigue Syndrome

The results of a 2015 Spanish study indicate that Coenzyme Q10 and NADH supplementation could be a beneficial treatment of chronic fatigue syndrome and other chronic fatiguing illnesses for three reasons [Castro-Marrero]:

  • Coenzyme Q10 and NADH are essential co-factors in the process of cellular bio-energetics; they can boost mitochondrial function.
  • Coenzyme Q10 and NADH are powerful free radical scavengers that mitigate lipid peroxidation and DNA damage caused by oxidative stress.
  • Coenzyme Q10 and NADH supplementation can reduce the extent of oxidative damage and mitochondrial dysfunction associated with chronic fatigue syndrome.

In sum, oral CoQ10 plus NADH supplementation seems to be a safe and effective therapy to reduce fatigue, restore mitochondrial function and bio-energetic metabolism, and ameliorate oxidative damage in chronic fatigue syndrome [Castro-Marrero].

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Undocumented Claims for Coenzyme Q10 Absorption and Efficacy in the US Market

Back cover of Dr. Judy's book An Insider's Guide to Coenzyme Q10
In his 2018 book, An Insider’s Guide to Coenzyme Q10, Dr. William Judy of SIBR Research summarizes the results of clinical studies using ubiquinone CoQ10 supplements. He also includes anecdotes about the use of CoQ10 supplements. The book is available from amazon.com.

Even if they are made from the same raw material, the CoQ10 products on the US retail market are very diverse in terms of their absorption and in terms of their health effects. 

We, as consumers, need to see documentation, preferably in peer-reviewed scientific journals, for the absorption and efficacy of the CoQ10 product we buy.

The form of the retail Coenzyme Q10 product can be different (either the ubiquinone form or the ubiquinol form), and the formulation can be different (different carrier oils and different heating and cooling processes).

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