Coenzyme Q10 and NADH and Chronic Fatigue Syndrome

DNA strand
Basically, our efforts to avoid or delay the onset of the various pathologies associated with increasing age involve managing the effects of cellular bio-energetic disturbances, oxidative stress, and mitochondrial dysfunction. Combined supplementation with Coenzyme Q10 and NADH may be a beneficial anti-ageing treatment.

Most recently, nicotinamide adenine dinucleotide (NAD+ in its oxidized form and NADH in its reduced form) has been getting much attention as a possible anti-ageing substance.

  • Like Coenzyme Q10, NAD+/NADH is a coenzyme that is present in nearly all human cells.
  • Like Coenzyme Q10, NAD+/NADH exists in both an oxidized form and a reduced form.
  • Like Coenzyme Q10, NAD+/NADH is needed for the cellular process of producing ATP energy from the food that we eat.
  • Like Coenzyme Q10, NAD+/NADH has an antioxidant function in the cells protecting against the damage caused by oxidative stress.
  • Like Coenzyme Q10, NAD+/NADH is essential for life.  Without NAD+/NADH, the cells will not produce energy and will die.
  • Like Coenzyme Q10, NAD+/NADH levels decrease as we get older.

Coenzyme Q10 and NAD+/NADH and Chronic Fatigue Syndrome

The results of a 2015 Spanish study indicate that Coenzyme Q10 and NADH supplementation could be a beneficial treatment of chronic fatigue syndrome and other chronic fatiguing illnesses for three reasons [Castro-Marrero]:

  • Coenzyme Q10 and NADH are essential co-factors in the process of cellular bio-energetics; they can boost mitochondrial function.
  • Coenzyme Q10 and NADH are powerful free radical scavengers that mitigate lipid peroxidation and DNA damage caused by oxidative stress.
  • Coenzyme Q10 and NADH supplementation can reduce the extent of oxidative damage and mitochondrial dysfunction associated with chronic fatigue syndrome.

In sum, oral CoQ10 plus NADH supplementation seems to be a safe and effective therapy to reduce fatigue, restore mitochondrial function and bio-energetic metabolism, and ameliorate oxidative damage in chronic fatigue syndrome [Castro-Marrero].

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Undocumented Claims for Coenzyme Q10 Absorption and Efficacy in the US Market

Back cover of Dr. Judy's book An Insider's Guide to Coenzyme Q10
In his 2018 book, An Insider’s Guide to Coenzyme Q10, Dr. William Judy of SIBR Research summarizes the results of clinical studies using ubiquinone CoQ10 supplements. He also includes anecdotes about the use of CoQ10 supplements. The book is available from amazon.com.

Even if they are made from the same raw material, the CoQ10 products on the US retail market are very diverse in terms of their absorption and in terms of their health effects. 

We, as consumers, need to see documentation, preferably in peer-reviewed scientific journals, for the absorption and efficacy of the CoQ10 product we buy.

The form of the retail Coenzyme Q10 product can be different (either the ubiquinone form or the ubiquinol form), and the formulation can be different (different carrier oils and different heating and cooling processes).

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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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