Dr. Judy Writes About Coenzyme Q10

Dr. William V. Judy
Dr. William V. Judy, founder and president of SIBR Research, writes as a guest columnist for Q10facts.com. Dr. Judy has done clinical research in the Coenzyme Q10 adjuvant treatment of patients with heart failure, chronic fatigue syndrome, and prostate cancer. He has supported Prader-Willi children with Coenzyme Q10 therapy. He is the author of the 2018 book Coenzyme Q10: An Insider’s Guide, which is available on amazon.com. ISBN 978-87-7776-186-7.

The question that I get asked about the most is whether there is any benefit from supplementing with Coenzyme Q10 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 Q10 will decline with increasing age. Taking various medications, statin medications in particular, will also inhibit your body’s own production of Coenzyme Q10.
  2. The heart muscle cells need sufficient Coenzyme Q10 to produce enough ATP 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 Q10 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 Q10 together with some fat in a meal will improve the absorption of the Coenzyme Q10.
  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 Q10 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.

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Low Coenzyme Q10 Status and Increased Heart Disease Risk

Dr. William Judy
Long-time Coenzyme Q10 researcher Dr. William Judy says that there is considerable individual variation in blood CoQ10 concentrations. Generally, though, he regards a plasma or serum CoQ10 level below 0.60 micrograms per milliliter as a warning sign.

Japanese cardiologists have reported a significant connection between low Coenzyme Q10 status and the risk of death from heart disease and other causes [Shimizu 2020].

  • The researchers collected and examined blood samples from 242 men and women admitted to Juntendo University Hospital’s coronary care unit in Tokyo.
  • They followed the heart disease patients for a three-year period.
  • 58 of the 242 patients (24%) died during the follow-up period from heart disease, cancer, infection, and other causes.
  • The patients who died had an average blood CoQ10 concentration of 0.48 micrograms per milliliter. The patients who survived had a higher average blood CoQ10 concentration of 0.58 micrograms per milliliter.
  • Overall, the researchers found that patients with a “higher” blood CoQ10 concentration of 0.46 or greater micrograms per milliliter had a 52% lesser likelihood of dying from all causes than did the patients with blood CoQ10 concentrations below 0.46 micrograms per milliliter.
  • Nota bene: The patients with the low CoQ10 blood levels were the patients with the higher dosages of statin medications.

Why Low CoQ10 Levels are Associated with Heart Disease Mortality

Book Insider's Guide to Coenzyme Q10
In his book Insider’s Guide to Coenzyme Q10, Dr. Judy discusses the effects of increasing age, malnutrition, and statin medications on blood Coenzyme Q10 levels and the consequent effect on heart function. Available from amazon.com. ISBN: 978-87-7776-186-7.

This research shows that heart disease patients with lower blood CoQ10 levels are at greater risk of dying sooner than heart disease patients with higher blood CoQ10 levels [Shimizu 2020].

  • Statin medications are known to inhibit the body’s endogenous production of Coenzyme Q10; logically, every heart patient taking a statin medication will need adjunctive Coenzyme Q10 treatment. Okuyama et al [2015] have explained the mechanisms by which statin medication may increase the risk of developing atherosclerosis and heart failure.
  • Lower blood CoQ10 levels are also associated with greater age [Shimizu 2017]. Malnutrition among senior citizens may be contributing to low CoQ10 status; this is another argument for supplementation.
  • Adequate levels of Coenzyme Q10 are associated with reduced levels of blood bio-markers for inflammation, in particular interleukin 6, C-reactive protein, and tumor necrosis factor alpha [Fan 2017].

Evidence from CoQ10 Supplementation and Heart Disease Studies

Bottom Line: CoQ10 Status and Cardiovascular Disease risk

Adequate levels of Coenzyme Q10 are essential to the cells’ production of ATP energy; moreover, Coenzyme Q10 is an important lipid-soluble antioxidant that scavenges harmful free radicals [Shimizu 2017].

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CoQ10 for Dogs and Cats

King Charles Spaniel
Myxomatous mitral valve disease is the most common heart disease in dogs. It often leads to congestive heart failure. The Cavalier King Charles Spaniel is especially at risk of developing mitral valve disease at an early age. From the onset of congestive heart failure in dogs with mitral valve disease, the median survival time is less than a year even with medical therapy [Christiansen 2020]. Applied early enough, Coenzyme Q10 supplements may increase the life expectancy and quality of life for dogs at risk of heart disease.
Increasingly, people are feeding their dogs CoQ10 supplements. The CoQ10 supplementation is used provide dogs and cats the following health benefits [Gollakner 2020; Puotinen CJ 2019]:

  • improved cellular energy production
  • enhanced antioxidant protection against lipid peroxidation
  • anti-inflammatory effects
  • reduced endothelial dysfunction

Typically, the CoQ10 supplement is given by mouth as a capsule or as a liquid. It is possible, of course, to squeeze the CoQ10 filling out of a capsule onto the dog food.

Pharmacokinetics Study of Repeated Oral CoQ10 Dosing of Spaniels

Now, a research team in Denmark has investigated the pharmacokinetics of oral dosing of Cavalier King Charles Spaniels over a three-week period [Christiansen 2020].

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A Pharmacist Looks at CoQ10 Supplements

Dr. Ross Pelton
Dr. Ross Pelton brands himself as The Natural Pharmacist; he is also a certified clinical nutritionist. He is currently the Scientific Director for Essential Formulas. Dr. Pelton is the author of The Drug-Induced Nutrient Depletion Handbook. For a FREE copy of Dr. Pelton’s Quick Reference Guide to Drug-Induced Nutrient Depletions, go to naturalpharmacist.net/dind.

In the April/May 2020 issue of the journal IMCJ: Integrative Medicine: A Clinician’s Journal, pharmacist Dr. Ross Pelton reviews the most important developments in Coenzyme Q10 clinical research:

• The Q-Symbio Study in which researchers gave chronic heart failure patients 3 x 100 mg of Coenzyme Q10 or placebo daily as an adjuvant treatment together with conventional heart failure medications for two years. The outcome was significantly improved symptoms, quality of life, and survival in the CoQ10 treatment group compared to the placebo group [Mortensen 2014].

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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.

  • The CoQ10 adjuvant treatment significantly improved the symptoms, quality of life, and survival of the heart failure patients [Mortensen 2014].
  • A sub-analysis of the European segment of the international multi-center Q-Symbio Study showed that the CoQ10 intervention also significantly improved the patients’ ejection fraction [Mortensen 2019].

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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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:

  • In its reduced form, Coenzyme Q10 is a lipid soluble antioxidant that protects cell membranes from oxidative damage caused by harmful free radicals [Mantle 2015].
  • Coenzyme Q10 improves endothelium-dependent vaso-dilation in patients with diabetes and in patients with coronary artery disease [Tiano 2007].
  • In a meta-analysis of 17 RCTs, CoQ10 supplementation significantly reduces the blood levels of known bio-markers for systemic inflammation: C-RP, IL-6, and TNF-α [Fan 2017].

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’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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