A Pharmacist Looks at Coenzyme Q10

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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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 and Longevity

Metaphorically speaking, CoQ10 supplementation is our umbrella protecting against the risk of chronic degenerative diseases. Studies indicate that 100-300 milligrams of daily Coenzyme Q10 supplementation can reduce the risk of cardiovascular disease, type-2 diabetes, kidney disease, and liver disease.

We all want to live longer, with good health and good energy in our senior years.  One factor that enhances our chances of living longer and better is our ability to avoid chronic degenerative diseases such as cardiovascular disease, diabetes, kidney disease, and liver disease.  Coenzyme Q10 supplements can help.

The rationale for using CoQ10 supplements to enhance our chances for a long and healthy life is based on the role of Coenzyme Q10 in the production of cellular energy.  In addition, Coenzyme Q10 has known antioxidant and anti-inflammatory effects [Mantle & Hargreaves].

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