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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Coenzyme Q10 and Exercise and Training

People lifting weights in a fitness center.
Coenzyme Q10 is NOT on the Prohibited List of the World Anti-Doping Agency.

The substance Coenzyme Q10 has many properties that make it a logical nutritional supplement for athletes in training and for normal healthy people who exercise to stay fit.  Coenzyme Q10 supplements should help to improve exercise capacity and reduce the oxidative stress, muscle damage, and inflammation caused by strenuous exercise [Sarmiento].

  • The oxidized form of Coenzyme Q10 – ubiquinone – is essential for cellular production of ATP energy [Littarru].
  • The reduced form of Coenzyme Q10 – ubiquinol – is an important fat-soluble antioxidant protecting the cells and the mitochondria (and proteins and DNA) against the damage caused by harmful free radicals [Bentinger].
  • Coenzyme Q10 promotes good endothelial function in the blood vessels [Belardinelli].
  • Coenzyme Q10 supplementation is associated with reduced levels of bio-markers for inflammation [Fan; Zhai].
  • Starting in our 20s, the bio-synthesis of Coenzyme Q10 declines with increasing age; thus, the need for CoQ10 supplements [Kalén].

CoQ10 and Exercise Study Results Inconsistent

But nothing is ever as straightforward as it seems. Until now (February 2020), the results from intervention studies of Coenzyme Q10 supplementation of athletes and healthy people taking exercise have not been as solid as the results from CoQ10 adjuvant treatment in other conditions have been:

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Coenzyme Q10 Synergists

Professor Urban Alehagen
Professor Urban Alehagen, the lead researcher on the KiSel-10 Study, has emphasized the clinical significance of daily supplementation with both Coenzyme Q10 and high-selenium yeast.  Both supplements have a protective antioxidant role in the prevention of heart disease.

In the previous article on this site, we discussed substances that can counteract or inhibit the bio-synthesis or absorption or efficacy of Coenzyme Q10.  Today we want to look at substances that might actually boost the bio-synthesis or absorption or efficacy of Coenzyme Q10.

Among the substances we want to consider are the following nutritional supplements:

  • carnitine
  • NADH
  • PQQ
  • riboflavin
  • selenium

High-Selenium Yeast Supplements and Coenzyme Q10

Professor Urban Alehagen writes that a deficiency of selenium may restrict the cells’ ability to get optimal concentrations of Coenzyme Q10.  Moreover, the cells are dependent upon adequate concentrations of Coenzyme Q10 to achieve optimal function of selenium in the body. There seems to be a special interrelationship between Coenzyme Q10 and selenium that can be exploited clinically [Alehagen & Aaseth].

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Coenzyme Q10 Antagonists and Inhibitors

Dr. Judy's book: An Insider's Guide to Coenzyme Q10.
Dr. William Judy, founder and president of SIBR Research, advises against taking a vitamin C supplement within an hour of taking a CoQ10 capsule. In his book, Insider’s Guide to Coenzyme Q10, Dr. Judy summarizes the CoQ10 clinical research results. The book is available from amazon.com.

Human adults’ bio-synthesis of the essential bio-nutrient Coenzyme Q10 declines with increasing age [Kalén].  That is unfortunate.

We humans need sufficient quantities of Coenzyme Q10 for various biological functions:

  • cellular production of ATP energy
  • antioxidant protection of the cells against oxidative damage
  • maintenance of endothelial function in blood vessels
  • anti-inflammatory effects

Coenzyme Q10 Supplementation and Beyond

We can take a daily Coenzyme Q10 supplement, of course, and we should.  However, we should be very careful.

Commercially available CoQ10 supplements vary considerably in their formulation and in their absorption and bio-availability.  A cheap 30-cents-per day CoQ10 supplement at the supermarket or drugstore is most likely a poorly absorbed and ineffective supplement.

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Beware of Unfounded Claims for Coenzyme Q10 Absorption

Dr. William V. Judy in a white-coat standing
In 2008 and again in 2013, SIBR Research did small but legitimate comparison studies of ubiquinone and ubiquinol absorption. SIBR Research’s results indicated that the single-dose absorption of the ubiquinol product appeared to be no better than the absorption of the ubiquinone Coenzyme Q10 in a lipid-based soft-gel capsule. Pictured here: Dr. William V. Judy, president of SIBR Research.

As consumers of Coenzyme Q10 supplements, we must be ultra-careful in evaluating the marketing claims for CoQ10 absorption and efficacy.  The nutritional supplements market is a largely unregulated one.  It is up to us to do due diligence before buying a CoQ10 product.

All of the CoQ10 products on the market are not equally good.  There is very considerable variability in the formulation and solubilization of Coenzyme Q10 with the result that there is also great variability in the absorption and bio-availability of Coenzyme Q10.  It is important to remember that the less expensive CoQ10 product is not a good buy if we do not absorb any or much of the active ingredient.

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Coenzyme Q10’s Anti-Inflammatory Effects

Professor Urban Alehagen
A well-designed randomized controlled clinical trial, the KiSel-10 study, has shown that a combined daily supplementation of senior citizens with Coenzyme Q10 and high-selenium yeast can reduce cardiovascular mortality by over 50%. Professor Urban Alehagen thinks that a special interrelationship between the two supplements has resulted in less oxidative stress, less low-grade chronic inflammation, and less fibrosis in the senior citizens taking the active treatment as opposed to the placebo treatment.

Two independent meta-analyses of the available research literature have shown that Coenzyme Q10 supplementation is associated with healthy levels of bio-markers for chronic systemic inflammation [Zhai 2017; Fan 2017].

  • Chronic inflammation – a persistent low-grade inflammation – can have deleterious effects throughout the body. Over time, it can result in tissue damage.
  • Chronic inflammation is something different from acute inflammation, which is the immune system’s short-term response to an injury or an infection.
  • Chronic low-grade inflammation has been linked to increased risk of heart disease, stroke, diabetes, and metabolic disorders [Zhai 2017].
  • The extent of chronic low-grade inflammation can be measured by testing for the blood levels of known bio-markers for inflammation [Zhai 2017].

Coenzyme Q10 Effect on Tumor Necrosis Factor-Alpha

Zhai et al analyzed nine randomized controlled trials enrolling 428 study participants.  The results of their analysis showed that CoQ10 supplementation significantly improved the serum concentration of Coenzyme Q10 by 1.17 micrograms per milliliter on average compared to placebo treatment [Zhai].

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