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 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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Coenzyme Q10 and Metabolic Syndrome

Metabolic syndrome, also known as syndrome X, is the name for a cluster of conditions – high blood pressure, high blood sugar, insulin resistance, increased risk of blood clots, abnormal cholesterol – that are dangerous themselves and can lead to heart disease and type 2 diabetes.  Coenzyme Q10 supplementation can improve the associated mitochondrial dysfunction and reduce oxidative stress.

Coenzyme Q10, the essential bio-nutrient, has properties that are germane to the treatment of several of the risk factors associated with the umbrella term “metabolic syndrome” [Casagrande].

These properties include the following:

  • a bio-energetics role in the cellular production of ATP energy [Casagrande]
  • a role as a fat-soluble antioxidant protecting against oxidative damage by harmful free radicals to cells and lipids [Casagrande]
  • an anti-inflammatory effect [Zhai]
  • a role in the protection and improvement of endothelial function [Gao]

What Factors Reduce Plasma Coenzyme Q10 Levels?

Typically, we expect to find plasma Coenzyme Q10 concentrations ranging from 0.6 to 1.0 micrograms per milliliter in unsupplemented healthy individuals.  With daily supplementation, it is possible to raise the plasma Coenzyme Q10 levels above the 2.5 micrograms per milliliter level needed for a therapeutic effect in heart disease and above the 3.5 micrograms per milliliter level needed for a therapeutic effect in neurodegenerative disease [Langsjoen].

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Coenzyme Q10 Supplements for Patients with Type 2 Diabetes

Diabetes is a major health problem world-wide. More than 90% of patients with diabetes have type 2 diabetes in which case the pancreas does not make enough insulin or the insulin that the pancreas makes is not effective. Patients with type 2 diabetes are at higher risk of developing heart disease, hypertension, and stroke. Oxidative stress is a known factor in the development and progression of type 2 diabetes. Coenzyme Q10 is an important fat-soluble antioxidant that can scavenge harmful free radicals and protect the cells from oxidative damage.

Individuals with type 2 diabetes are known to have considerably lower plasma/serum Coenzyme Q10 concentrations than do individuals who do not have diabetes [Zhang].

A 2018 meta-analysis and systematic review of the research literature indicates that Coenzyme Q10 supplementation improves glycemic control and increases HDL-cholesterol in individuals with type 2 diabetes [Zhang].

CoQ10 Supplementation and Glycemic Control

The results of the meta-analysis, drawn from an aggregated 13 clinical trials enrolling 795 patients with type 2 diabetes, show that the CoQ10 supplementation significantly decreased HbA1c (p=0.03) and fasting glucose (p=0.005).

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Coenzyme Q10 and mitochondrial function in diabetes

The level of oxidative stress is elevated in diabetes, and diabetes often induces mitochondrial dysfunction in the retina. Supplementation with Coenzyme Q10 provides antioxidant protection against the harmful effect of free radicals and improves bio-energetic function. Depicted here: a representation of a single mitochondrion.

The mitochondria – those little bean-shaped organelles inside the cells – are the primary source of cellular energy.  Coenzyme Q10, both the Coenzyme Q10 the body synthesizes and the Coenzyme Q10 we get in our food and in supplements, is fundamental to the cellular energy production process.  That means that Coenzyme Q10 is fundamental to the normal functioning of all tissues that are dependent on energy metabolism.  The retina is an example of such tissue.

Why is Coenzyme Q10 important for patients with diabetic retinopathy?

  • The number of diabetes patients diagnosed with diabetic retinopathy continues to grow.
  • We need new methods to prevent and treat diabetic retinopathy, which is a complication of diabetes that is caused by oxidative damage to the blood vessels in the retina.
  • Oxidative stress – the overproduction of harmful free radicals, also known as reactive oxygen species – is perhaps the primary cause of diabetic retinopathy [Calderon 2017].
  • Coenzyme Q10 supplements at higher than normal doses (400- 500 milligrams per day) can decrease oxidative stress and increase antioxidant enzyme activity in patients [Sanoobar 2013].
  • Coenzyme Q10 supplements in the form of ubiquinone improve mitochondrial homeostasis and diminish the breakdown of the energy production process [Rodriguez-Carrizalez 2016].

Antioxidant effect of CoQ10 on mitochondrial function in the retina

Researchers at the University of Guadalajara in Mexico investigated the antioxidant effect of adjunctive Coenzyme Q10 treatment on mitochondrial function in blood cells in patients with diabetic retinopathy [Rodriguez-Carrizalez 2016].

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Coenzyme Q10 adjunctive treatment for diabetic retinopathy

A randomized controlled study carried out at the University of Guadalajara, Mexico, showed that daily adjunctive treatment with 400 milligrams of Coenzyme Q10 for six months significantly reduced the extent of lipid peroxidation in patients diagnosed with non-proliferative diabetic retinopathy.

Patients with diabetic retinopathy who took 400 milligrams of Coenzyme Q10 (ubiquinone form) daily had significantly reduced levels of lipid peroxidation products in their blood at the end of a six-month study, compared to baseline levels [Rodriguez-Carrizalez 2016].

Diabetic retinopathy is an eye disease caused by high blood sugar levels resulting in damage to the blood vessels in the retina. The blood vessels can swell and leak, or they can close off and stop the blood from flowing.

Why is Coenzyme Q10 important?

Firstly, hyperglycemia – high blood sugar – induces the excess production of harmful free radicals and impairs the endogenous antioxidant defense system.

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The latest on Coenzyme Q10 and diabetes

My New Year’s Resolution: take care of myself and avoid type-2 diabetes.   Studies show that daily Coenzyme Q10 supplements are safe for patients with diabetes to take. That is good news because people with diabetes need the heart muscle cell protection that Coenzyme Q10 uniquely provides. Supplementation with Coenzyme Q10 slightly but significantly reduced fasting blood sugar levels and did not affect fasting insulin levels or Hb1Ac levels.

What do we hear about diabetes?  It is a silent disease.  Its symptoms are often silent until it is too late.  None of us wants to get type-2 diabetes. 

However, if it should happen, the main thing to know about Coenzyme Q10 supplementation and diabetes is that Coenzyme Q10 supplements are safe for diabetics to take.  Of course, diabetics should inform their physicians that they are planning to take a daily Coenzyme Q10 supplement of 100 or 200 milligrams, but there are research results to document that doing so is safe.

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Coenzyme Q10 and metabolic syndrome

Recent scientific studies show that daily Coenzyme Q10 supplements confer beneficial health outcomes in patients diagnosed with metabolic syndrome. Among the improvements associated with the Coenzyme Q10 supplementation are improved serum insulin levels, glucose homeostasis levels, and plasma total antioxidant capacity concentrations.

Until recently, we have not seen much research done concerning the effects of Coenzyme Q10 supplementation on metabolic syndrome.  Now, a start has been made.  The preliminary results show that Coenzyme Q10 supplementation has beneficial effects on serum insulin concentrations, glucose homeostasis parameters, and bio-markers of oxidative stress in patients diagnosed with metabolic syndrome [Raygan].

Dr. Raygan and colleagues have reported in the European Journal of Nutrition that daily supplementation with 100 milligrams of Coenzyme Q10 for eight weeks resulted in the following significantly improved health outcomes for overweight or obese patients aged 45-80 years who had been diagnosed with diabetes and coronary heart disease:

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Coenzyme Q10 for diabetes patients

diabetes-picture
Some 21 million Americans have diabetes. Diabetes increases the inflammation that is associated with hardening of the arteries (called atherosclerosis). Atherosclerosis increases the risk of heart attack or stroke and the risk of chronic heart failure. Prolonged supplementation with Coenzyme Q10 may have beneficial health effects for diabetes patients.

Twelve weeks of supplementation with Coenzyme Q10 can significantly reduce the levels of oxidative stress associated with diabetes.

Recently, Swedish researchers reported the results of a study of the effects of daily Coenzyme Q10 supplementation on type-1 and type-2 diabetes patients.  Twice a day for a period of 12 weeks, the 22 diabetes patients in the study received 100 milligrams of oral Coenzyme Q10 in the form of ubiquinone.

The patients averaged 57 years of age (type-1 diabetes patients) and 63 years of age (type-2 diabetes patients). They were predominantly male patients [Montano].

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Coenzyme Q10 and diabetes: a systematic review

Cyclist
A woman cycles to raise money for a diabetes awareness event. A recent systematic review of the research literature shows that diabetics can safely take Coenzyme Q10 supplements to achieve documented heart health benefits.

A 2016 systematic review and meta-analysis of the evidence from randomized controlled trials has shown that daily supplementation with Coenzyme Q10 slightly but significantly reduced fasting blood sugar levels.  Another good thing: Coenzyme Q10 supplementation did not significantly affect fasting insulin levels or Hb1Ac levels.

In other words, pre-diabetics and diabetics can safely take Coenzyme Q10 supplements to gain these known heart health benefits:

  • Improvement of the ATP energy production in the heart muscle cells [Mortensen]
  • Protection of the heart muscle cells against oxidative damage [Alehagen]
  • Improvement of endothelial function in the heart and blood vessels [Littarru]
  • Reduction of high blood pressure [Rosenfeldt]

Good Coenzyme Q10 news for pre-diabetics and diabetics
Yes, pre-diabetics and diabetics will want to talk with their physicians about the meta-analysis conducted by Dr. Moradi and his colleagues.  Pre-diabetics and diabetics can benefit from taking daily Coenzyme Q10 supplements in the same way that participants receiving the active Coenzyme Q10 treatment in the following studies have benefited as compared to participants in the placebo control groups:

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