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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Coenzyme Q10 Adjunctive Treatment for Heart Failure

Dr. William Judy
Dr. William Judy has been doing clinical research with CoQ10 treatment of heart failure patients for 40 years. The heart muscle tissue of heart failure patients is known to be deficient in Coenzyme Q10. Three times 100 milligrams of Coenzyme Q10 per day added to conventional heart failure medicine improves the patients’ quality of life and chances of survival as compared to placebo together with conventional treatment.

Heart failure is what happens when the heart is no longer able to pump out blood as strongly as it should.  It occurs when the heart is too weak or too stiff to fill up with blood and pump out blood efficiently. It is characterized by reduced functional capacity and reduced quality of life:

  • Reduced ability to exercise and do work
  • Shortness of breath
  • Swelling in the lower extremities
  • Weakness and fatigue from exertion

Heart failure is one of the most costly medical conditions in terms of complications and hospitalizations.  The costs of medical care for heart failure patients is expected to rise from $30 billion per year in 2018 to nearly $70 million by 2030 [Bhatt & Butler 2018].

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Top Ten Coenzyme Q10 and Heart Disease Studies

The best thing about Coenzyme Q10 adjuvant treatment of heart disease is that the CoQ10 treatment is a positive treatment. It does not block or reduce any neurohormonal activities in the body; instead, it enhances mitochondrial function in the process of cellular ATP energy production. And it provided antioxidant defense of the heart muscle cells.  Pictured here: Dr. Svend Aage Mortensen, lead researcher on the Q-Symbio Study.

We have over 30 years of evidence from published clinical trials showing that the ubiquinone form of Coenzyme Q10 supplementation is safe, well-tolerated, and effective as an adjuvant treatment for heart disease patients. The ubiquinone form of Coenzyme Q10 is also stable and affordable.  

It is important to remember that Coenzyme Q10 supplements vary considerably in their absorption and bio-availability.  A recent comparison study has shown that the formulation of the supplement – the composition of the carrier oils and the heating/cooling process – is more important for absorption and bio-availability than the form of the supplement (ubiquinone or ubiquinol) is [Lopez-Lluch 2019].

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Coenzyme Q10 Meta-analyses Summarized

Dr. William V. Judy, founder and president of the SIBR Research Institute, has written about the clinical aspects of CoQ10 supplementation in his 2018 book entitled Coenzyme Q10: An Insider’s Guide. The book is highly recommended.  It is available from amazon.com.

Coenzyme Q10 is a bio-nutrient essential to the process of ATP energy generation in the cells.  It is also an important fat-soluble antioxidant.  It helps to maintain proper endothelial function  regulating vascular contraction and relaxation and regulating the enzymes that control blood clotting, immune function, and platelet adhesion.  It has anti-inflammatory properties [Littarru 2010].  Our primary source of Coenzyme Q10 is our bodies’ bio-synthesis of the substance.  Our food contributes considerably less Coenzyme Q10.

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Coenzyme Q10 and Fibrosis and Ageing

Dr. Urban Alehagen, professor emeritus, Linköping University in Sweden, is the lead researcher on the KiSel-10 study of the effects of combined Coenzyme Q10 and selenium supplementation on the heart health of senior citizens. Senior citizens who took CoQ10 and high-selenium yeast supplements for four years had significantly better heart function and significantly reduced heart mortality compared to senior citizens who took matching placebos. One possible explanation is that there was significantly less fibrogenic activity in the treatment group than in the placebo group and that the reduced levels of fibrosis are related to the improved heart function and reduced cardiovascular mortality in the treatment group.

Daily supplementation with the ubiquinone form of Coenzyme Q10 and selenium-enriched yeast has significant health benefits for senior citizens:

  • The combination of the two supplements reduces the levels of bio-markers for fibrosis in senior citizens [Alehagen 2018].
  • The combination of the two supplements improves cardiovascular function and reduces the risk of cardiovascular mortality [Alehagen 2013].
  • The combination of the two supplements provides a means of correcting a dietary shortage to which senior citizens may be subject [Hargreaves & Mantle].

Fibrosis and the Ageing Process

Fibrosis is the bio-medical term for the formation of fibrous connective tissue, much of which is collagen.

  • Fibrosis is a normal process for wound healing and tissue repair.
  • In senior citizens, there is a greater risk of uncontrolled continuation of the formation of fibrous connective tissue, resulting in tissue scarring and loss of function in organs such as the heart, lungs, liver, and kidneys [Hargreaves & Mantle].
  • Progressive fibrosis and loss of function in vital organs is a known symptom of ageing [Hargreaves & Mantle].
  • Organ fibrosis has been estimated to be a factor in up to 50% of all-cause human deaths [Hargreaves & Mantle].
  • Effective treatments for fibrosis in senior citizens are not available at present [Hargreaves & Mantle].

Coenzyme Q10 and Senior Citizens

Coenzyme Q10 has important biological roles in humans:

  • Coenzyme Q10 is an essential co-factor in the cellular process of ATP energy generation [Belardinelli].
  • Coenzyme Q10 is an important fat-soluble antioxidant, neutralizing the harmful effects of free radicals in lipid environments and reducing the extent of oxidative stress [Belardinelli].
  • Coenzyme Q10 has a beneficial effect on the endothelial cells that regulate the contraction and relaxation of the blood vessels and regulate such processes as blood clotting, immune function, and platelet adhesion [Belardinelli].
  • Coenzyme Q10 reduces the blood levels of bio-markers for inflammation, indicating that Coenzyme Q10 may have anti-inflammatory properties [Hargreaves & Mantle].

Decreasing CoQ10 Bio-Synthesis with Increasing Age

The major source of Coenzyme Q10 in humans is the endogenous bio-synthesis of the substance.

  • Once we humans reach our 20s, most of us begin to synthesize less Coenzyme Q10 as we get older [Hargreaves & Mantle].
  • It is impossible to make up the ageing-related loss of bio-synthesized Coenzyme Q10 by eating more food or by eating more wisely [Hargreaves & Mantle].
  • Daily supplementation is necessary [Hargreaves & Mantle].
  • Not all CoQ10 supplements are equally well formulated.  The formulation of the CoQ10 supplement plays a vital role in CoQ10 absorption and bio-availability [Lopez-Lluch].

Cardiovascular Fibrosis and Senior Citizens

Post-mortem analysis has revealed that, in the normal ageing process, the collagen content providing structural support for heart muscle’s contractile cells increases approximately 50% from the third decade to the seventh decade of life [Hargreaves & Mantle].

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Coenzyme Q10 Crystals and Coenzyme Q10 Absorption

The Coenzyme Q10 raw material is a yellow or orange crystalline powder produced by a yeast fermentation extraction process. The CoQ10 crystals are fat-soluble. They are practically insoluble in water, and any attempt to make them water-soluble will rob them of their CoQ10 characteristics. Coenzyme Q10 is soluble in lipids, but keeping the Coenzyme Q10 molecules from re-crystallizing inside the supplement capsules is difficult.  And humans cannot absorb CoQ10 crystals, only single CoQ10 molecules.

Absorption of the Coenzyme Q10 in commercial nutritional supplements varies considerably.  The dissolution of the CoQ10 crystals and the absorption of the Coenzyme Q10 molecules depend upon the composition of the oil matrix and the formulation of the CoQ10 nutritional supplement.  The manufacturer of a CoQ10 supplement must deal with raw material that is very difficult to work with.

Coenzyme Q10 Soluble in Lipids at Higher Temperatures

Coenzyme Q10 is practically insoluble in water but is soluble in lipids; however, no individual lipids have been found in which 100 milligrams of Coenzyme Q10 can be dissolved so that the dissolved Coenzyme Q10 molecules inside the nutritional supplement capsules will not re-crystallize at normal storage temperatures: typically, between 60 and 75 degrees Fahrenheit.

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