Dr. Judy: Coenzyme Q10 Supplements Against Heart Failure

Here, below, is what I have learned about Coenzyme Q10 over the years. CoQ10 is a naturally occurring redox compound that is essential for life in all humans. Dr. Karl Folkers called it “an essential bio-nutrient.”

  • Coenzyme Q10 in its ubiquinone form, its oxidized state, plays an essential role in the production of ATP energy. It is needed in optimal quantities for cellular bio-energetics in heart muscle and skeletal muscle tissue.
  • In its ubiquinol form, its reduced state, Coenzyme Q10 functions as a lipophilic antioxidant, scavenging harmful free radicals and providing protection against oxidative damage.
  • CoQ10 supplementation has been shown to improve endothelial function [Belardinelli 2008]. The endothelial cells line the inside of the heart and the blood vessels. They are the cells that release substances that regulate the contraction and relaxation of the blood vessels, and they release enzymes that regulate blood clotting and platelet adhesion. They are very important for good heart health.
  • In clinical trials, CoQ10 supplementation has been associated with anti-inflammatory effects. A meta-analysis of 17 clinical trials has shown that CoQ10 status is associated significantly with reduced levels of the inflammatory mediators C-reactive protein, interleukin-6, and tumor necrosis factor-α [Fan 2017].
Dr. William Judy lecturing
In addition to doing clinical research into the efficacy of Coenzyme Q10 supplementation for some 40 years, early on in my career, I developed and refined a method of bio-electrical impedance measurement. I was able to use this non-invasive method to evaluate heart function in Black Lung Disease patients, in participants in the NASA Apollo program, and in open heart surgery patients in recovery. My message: use Coenzyme Q10 to ward off heart problems.

Blood and Tissue Deficiencies of Coenzyme Q10

  • Blood and tissue CoQ10 deficiency can occur because of ageing and because of the effect of medications such as statins.
  • Blood and tissue CoQ10 deficiency have been associated with statin-associated muscle symptoms (muscle aches and pains, severe cramps, muscle weakness) and with some of the symptoms of patients with heart failure and chronic fatigue syndrome (tiredness, fatigue, lack of energy).
  • Evidence from a 2016 meta-analysis supports the use of supplemental Coenzyme Q10 in patients with statin-associated muscle symptoms [Qu 2016].
  • The randomized controlled trial, the Q-Symbio Study, provides evidence for an adjunctive role for Coenzyme Q10 in the treatment of patients with chronic heart failure [Mortensen 2014].
  • A 2013 meta-analysis has shown that supplementation with Coenzyme Q10 resulted in significantly improved ejection fraction and improved NYHA functional class [Fotino 2013].

CoQ10 Supplementation of Patients with Statin-Associated Muscle Symptoms

Writing in February, 2021, in a special issue of one of the leading cardiology journals: Journal of the American College of Cardiology, Texas cardiologists Albert E. Raizner and Miguel A. Quiñones, conclude that it seems “reasonable and justifiable” for cardiologists to use Coenzyme Q10 supplements with patients diagnosed with statin-associated muscle symptoms [Raizner & Quiñones 2021].

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Coenzyme Q10 Supplementation in Ageing and Disease

In the Mechanisms of Ageing and Development journal, Professor Jan Aaseth, Professor Urban Alehagen, and I have published a review of the research literature relating to Coenzyme Q10 and aging. Here, I want to summarize the main points briefly.

Professor Jan Alexander
Dr. Jan Alexander is MD, PhD, ERT, and Professor at the Norwegian Institute of Public Health in Oslo. He is the co-author, together with Professor Urban Alehagen and Professor Jan Aaseth, of many articles about Coenzyme Q10 and selenium. (ERT stands for Eurotox Registered Toxicologist.)

What is Coenzyme Q10 and Why is it Important?

Coenzyme Q10 is a substance with vitamin-like effects on our health; however, our cells can synthesize Coenzyme Q10, so, by definition, it is not a vitamin. Among its important health-promoting effects are the following:

  • an essential component in the process of ATP energy generation
  • an important fat-soluble antioxidant in cellular membranes and lipoproteins
  • an anti-inflammatory agent

What Causes Sub-Optimal Coenzyme Q10 Levels?

Once we have passed our 20s, our cells’ ability to synthesize Coenzyme Q10 declines and decreases steadily with increasing age [Kalén 1989]. It is reasonable to think that most individuals in middle age and in their senior years might benefit from a CoQ10 supplement.

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Coenzyme Q10 and Female Infertility: Two Meta-Analyses

Compared with placebo or no-treatment, oral supplementation with Coenzyme Q10 can increase clinical pregnancy rates in women undergoing Assisted Reproductive Technology procedures [Florou 2020].

Pregnant woman
A good definition of female infertility is the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. This failure to achieve pregnancy after 12 months of trying affects one out of six couples worldwide.

Compared to control study participants, women diagnosed with poor ovarian response undergoing controlled ovarian stimulation have better clinical outcomes in terms of pregnancy achievement and in terms of a lower dosage of gonadotrophin required for ovulation induction when Coenzyme Q10 is used as an adjuvant therapy [Zhang 2020].

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Misinformation About Coenzyme Q10 Supplements

My name is Ross Pelton, and I “brand” myself as The Natural Pharmacist. I am deeply interested in and passionate about Coenzyme Q10, which is a critically important biochemical compound and a critically important nutritional supplement.

Dr Ross Pelton
Because I am a natural pharmacist and nutritionist, I recognize that most people in their middle and senior years are going to need a daily Coenzyme Q10 supplement. The simple fact is that from our 20s on, most of us synthesize less and less Coenzyme Q10 as we get older. The absorption rate of many CoQ10 products is very low. The situation is further complicated by many misleading marketing claims for some of the CoQ10 supplements.

The internet has rapidly become a vast source of information – and misinformation.

Unfortunately, misinformation and untruths about Coenzyme Q10 makes selecting a quality CoQ10 nutritional supplement a difficult and confusing problem for the general public.

In the journal Antioxidants, authors Mantle & Dybring [1] have reviewed the available literature about the absorption, transport, and bioavailability of the bio-nutrient Coenzyme Q10.

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Coenzyme Q10 and Selenium Lower Cardiovascular Mortality in an Elderly Swedish Population

In the KiSel-10 project, our research group has reported that daily supplementation of elderly community living Swedish citizens with a combination of 200 micrograms of organic selenium and 200 milligrams of Coenzyme Q10 for four years is associated with the following statistically significant heart health outcomes [Alehagen 2013: Johansson 2015]:

  • reduced risk of death from heart disease
  • reduced blood levels of a protein bio-marker for heart failure
  • improved heart function shown on echocardiograms
  • improved health-related quality of life
Professor Urban Alehagen
Low intakes of selenium are associated with the increased risk of death from heart disease. Supplementation with selenium and Coenzyme Q10 reduce the risk by reducing oxidative stress, systemic inflammation, fibrosis, and endothelial dysfunction [Alehagen 2018].

Possible Mechanisms for the Positive Clinical Outcomes

Thus far, our research group has published sub-analyses from the KiSel-10 Study that illuminate possible mechanisms to explain the positive clinical effects of the combined supplementation:

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Dr. Judy Shares Some Coenzyme Q10 Case Reports

Over the years, many physicians have worked with SIBR Research by entering their patients into clinical trials conducted by SIBR Research. Many of these physicians, after seeing the benefits that Coenzyme Q10 gave to their patients, requested Coenzyme Q10 for their families or for themselves. In this article, I will relate some of their successes and failures.

Dr. William Judy in the lab
I have had two pacemakers over a 20-year interval. My mother has had four pacemakers in 40 years. We have taken CoQ10 for 30 and 49 years respectively. At SIBR Research, we have seen no problems in pacemaker patients taking CoQ10. In fact, CoQ10 seems to stabilize the heart cell membranes and to prevent cells other than the A-V and V pacemaker nodes from initiating ventricular systoles.

A physician requested CoQ10 for his mother

In 2002, a heart surgeon called our office and asked about our experiences in supplementing heart failure patients with Coenzyme Q10. I had previously met this physician in 1966 when he was a surgical fellow at Methodist Hospital in Houston, and I was a fellow in the department of Physiology at Baylor School of Medicine. We met at a lecture given by Dr. Karl Folkers on the biochemistry of CoQ10 in heart failure.

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Coenzyme Q10 and Selenium Protect Against Heart Disease

In 2013, Professor Urban Alehagen and a team of researchers reported on the beneficial effects of daily supplementation of elderly Swedish citizens with a combination of 200 mg of Coenzyme Q10 and 200 mcg of selenium, in divided doses with meals, over a four-year period.

Professor Jan Aaseth
I am Jan Aaseth, a Norwegian medical doctor and university professor and researcher. In my career, I have specialized in medical biochemistry and in internal and occupational medicine. Much of my research focuses on the importance of micronutrient status throughout all stages of life. In recent years, I have investigated the role of selenium and coenzyme Q10 deficiency in the development of cardiovascular disease, with particular emphasis on oxidative stress and low-grade systemic inflammation.

Compared to the study participants in the placebo group, the KiSel-10 study participants who received the active treatment had significant heart health benefits [Alehagen 2013]:

  • reduced risk of death from heart disease
  • better heart function as shown on echocardiograms
  • lower blood levels of the NT-proBNP protein, a bio-marker for the risk of heart failure

In 2015, Professor Alehagen and I analyzed what we knew, as clinicians, about selenium and Coenzyme Q10 and heart disease [Alehagen & Aaseth 2015]. We asked ourselves why that combination had protected against heart disease in elderly people.

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Coenzyme Q10 Absorption and Bio-Availability

As a pharmacist and a clinical nutritionist, I can see the possibilities of food and dietary supplements as a form of medicine. For example, I am very interested in the health benefits of probiotics. I am intrigued by the manufacturing process that produces probiotic supplements that mimic the activity of our gastrointestinal tract processing food. By that, I mean our GI tract’s use of bacteria to ferment fibers in foods to produce post-biotic metabolites.

Dr. Ross Pelton
As a “natural pharmacist,” I am a passionate advocate of Coenzyme Q10 supplementation. I suspect that many people get little or no benefit from the daily CoQ10 supplement they take because the absorption rates of many of the commercial products are very low, often only 1-2% of a 100-mg tablet or capsule. It is important to choose a CoQ10 supplement with good documentation of absorption and bio-availability.

Low Absorption of Many CoQ10 Supplements

I am also an advocate of the nutritional supplement Coenzyme Q10, which is produced from pure natural yeast in a fermentation process.

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Coenzyme Q10 Before and After Heart Surgery

In 1993, I wanted to see what protection Coenzyme Q10 supplementation could give the heart muscle during and after heart surgery. I discussed the idea with Dr. Karl Folkers and Dr. Willis Stogsdill.

Dr. Willis Stogsdill
Dr. Willis Stogsdill, “Woody” to his friends and colleagues, was a co-author on my 2007 article “Coenzyme Q10 Facts or Fabrications.” He was a heart surgery anesthesiologist and chairman of the Department of Anesthesia at St. Vincent Hospital in Indianapolis for 25 years. He was instrumental in establishing the St. Vincent open heart surgery program. He was my highly esteemed colleague as well as my father-in-law. He passed away, aged 95, on November 12, 2019. He is missed.

We agreed that the idea had merit. Coenzyme Q10 is a natural and essential cofactor in heart muscle cells. It has bio-energetic, antioxidant, and anti-inflammatory effects. Typically, patients with heart failure have reduced blood and heart muscle tissue concentrations of Coenzyme Q10.

Heart surgery study in Indianapolis

We conducted a study with 10 high-risk heart surgery patients in a CoQ10 supplementation group and 10 high-risk heart surgery patients in a placebo group. The two groups were similar characteristics before the study began:

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Insufficient Evidence for the Claims for Ubiquinol Supplements

Dr. Karl Folkers
Dr. Karl Folkers was a biochemist who was instrumental in isolating vitamin B12 and in determining the structure of Coenzyme Q10. He was an important force behind the early clinical research into the effect of Coenzyme Q10 supplementation on heart failure patients. We collaborated on several clinical trials.

Looking back over my career, I can see that I have stood on the shoulders of giants. Here is a quick salute to the mentors who sparked my interest in the cardiovascular system, in biophysics and bio-engineering, in the electrical impedance technology, and in Coenzyme Q10 clinical research.

  • Dr. Loren D. Carlson, University of Kentucky, Lexington Medical School.
  • Dr. George Armstrong, NASA.
  • Dr. Lee Baker, Baylor University Medical School.
  • Dr. Michael Wilson, University of West Virginia Medical School.
  • Dr. Ishio Ninomiya, West Virginia Medical Center.
  • Dr. Karl A. Folkers, University of Texas Institute for Biomedical Research. Dr. Folkers was very instrumental in my getting started in clinical research on Coenzyme Q10 as an adjuvant therapy for heart failure. Dr. Folkers was also the person who encouraged me to establish the SIBR Research Institute.

Dr. Ishio Ninomiya on Doing Good Science

Dr. Ishio Ninomiya is the mentor who taught me to be skeptical about what I heard, read, and accepted. He insisted that I trust only the science that I could reproduce myself or that I could find being reproduced in the literature several times.

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