Heart Failure and Coenzyme Q10 as Adjuvant Therapy

Heart failure – it sounds scary. It is scary, but the medical term heart failure does not mean that your heart stops beating. No, instead, it means that your heart can’t pump enough blood and oxygen to your body.

Dr. William Judy
In the 30-year study of the management of congestive heart failure patients, Dr. Judy found that CoQ10 therapy in addition to conventional medication is more effective than conventional medication alone; however, the patients’ response to the CoQ10 adjunctive treatment is fairly slow, with peak improvements coming within 8 – 12 months. The conventional medication plus CoQ10 therapy is safe; it improves long-term survival compared to conventional medication alone.

Heart failure may develop because the heart muscle has weakened or has become thicker and stiffer. Your heart muscle can compensate for a period, but, eventually, you will need treatment.

The thing to remember is that the heart tissue is muscle tissue. As such, it needs a constant supply of ATP energy, and Coenzyme Q10 is essential to the process of ATP energy generation [Crane 2001]. Furthermore, the heart muscle tissue needs protection against the oxidative damage caused by harmful free radicals, and Coenzyme Q10 in its reduced form is an important antioxidant [Crane 2001].

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Coenzyme Q10 to Alleviate Fatigue

Fatigue. In many disorders, patients experience fatigue, even extreme fatigue, e.g., heart failure patients, chronic fatigue syndrome and fibromyalgia patients, multiple sclerosis patients, post-treatment Lyme disease syndrome patients, etc.

Dr. William V Judy
Today’s author is Dr. William Judy, founder and president of the SIBR Research Institute, where he has conducted studies of the effect of CoQ10 supplementation on fatigue in chronic heart failure and chronic fatigue syndrome patients.

The chronic fatigue may well be associated with cellular energy depletion and impaired mitochondrial function [Mantle 2022].

  • Research studies have implicated mitochondrial dysfunction in the development of chronic fatigue syndrome and fibromyalgia and in the resulting fatigue [Mantle 2022].
  • The outcomes of randomized controlled clinical trials have shown that CoQ10 supplementation significantly improves symptoms in chronic fatigue syndrome and fibromyalgia patients [Mantle 2022].
  • A 2019 systematic review of CoQ10 supplementation studies has shown significant benefits of CoQ10 supplementation on fatigue following exercise, statin intake, the development of multiple sclerosis, and the development of end-stage heart failure [Mehrabani 2019].
  • Supplemental CoQ10 has been shown to significantly improve plasma and skeletal muscle CoQ10 levels, exercise tolerance, and exercise recovery time in chronic fatigue patients. The response is not rapid. It takes months of supplementation to allow mitochondria regeneration and the improvement in exercise tolerance. If the supplementation of CoQ10 is stopped, then the chronic fatigue will slowly return [Judy 2018a, 2018b].

Coenzyme Q10, Inflammation, and Fatigue

Mantle et al [2022] make the point that that inflammation, which involves the release of pro-inflammatory cytokines, is not a wholly negative process in the body. Inflammation is the body’s normal response to infection or injury; it is essential for tissue healing.

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Coenzyme Q10 for People Over 65 Years of Age

Sufficient intakes of Coenzyme Q10 are increasingly important as we age. Our bodies synthesize less and less Coenzyme Q10 as we progress from middle age to our senior years. One estimate is that the CoQ10 status of an 80-year-old man’s heart muscle cells will be about half of what is normal in a 20-year-old man [Alehagen 2015].

Guillermo Lopez-Lluch
Prof. Guillermo Lopez-Lluch says that older people who have more symptoms of fragility also have lower concentrations of Coenzyme Q10 their blood plasma. The study data show that this relationship is more common in women than in men.

Sub-optimal levels of Coenzyme Q10 are associated with ageing, energy insufficiency, cardiovascular disease, stroke, and neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease [Why Humans 2022].

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Combined Coenzyme Q10 and Selenium Supplementation

There is a special biological interrelationship between Coenzyme Q10 and selenium. From a cardiologist’s perspective, there is a theoretical advantage in using both substances to prevent heart disease if the patients’ intakes are sub-optimal [Alehagen & Aaseth 2015a].

Heart chambers
Four years of daily supplementation of senior citizens with a combination of Coenzyme Q10 and selenium resulted in reduced risk of death from heart disease and in improved heart function.

This advantage has been demonstrated in the outcomes of the KiSel-10 Study, a randomized controlled trial that enrolled elderly community dwelling Swedish citizens, average age 78 years, with known low serum selenium status (mean: 67.1 mcg/L) [Alehagen 2013; Alehagen 2016a; Alehagen 2016b].

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The Instability of Ubiquinol – Misleading Marketing Claims?

On the Web, I see many incorrect and undocumented marketing claims for ubiquinol supplements. As a long-time Coenzyme Q10 researcher, I worry that consumers will be persuaded by these misleading marketing claims. In this article, I want to give some background information about how the Coenzyme Q10 in supplements is absorbed and transferred in the body.

Choice of Two Different Forms of Coenzyme Q10 in Supplements

Dr. William Judy in the lab
In 2021, I have published the results of the SIBR Research lab studies and large dog studies of the instability of the ubiquinol supplement. The studies show that the ubiquinol in supplements will be converted to ubiquinone in the small intestines prior to absorption, will then be absorbed in the ubiquinone form, and will be converted back to ubiquinol in the lymph.

Let me start by saying that CoQ10 molecules are redox molecules that have an oxidized form called ubiquinone and a reduced form called ubiquinol. Regardless of whether the supplement manufacturer chooses to work with ubiquinone or ubiquinol, he or she must deal with the following problems [Judy 2018]:

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Coenzyme Q10 for Longevity

Interesting statistics regarding life expectancy and longevity in the United States:

  • Individuals with no chronic conditions by age 67 years can expect to live another 22.6 years on average.
  • Individuals aged 67 years with 5 chronic conditions can expect to live 7.7 fewer additional years, on average.
  • Individuals aged 67 years with 10 or more chronic conditions can expect to live 17.6 fewer additional years, on average.
Human cells
Our cells’ production of Coenzyme Q10 declines as we get older and older. We need adequate Coenzyme Q10 in our cells to produce ATP energy, to protect against harmful free radicals, and to modulate inflammation.

These are some of the outcomes of a retrospective cohort study done by researchers at the Johns Hopkins University Bloomberg School of Public Health using the data from 1,372,272 Medicare fee-for-service beneficiaries who were 67 and older [DuGoff 2014].

When the researchers talk about chronic conditions (also called co-morbidities), they are referring to such conditions as cancer, cardiovascular disease, diabetes, hypertension, kidney disease, liver disease, and neurodegenerative diseases, among others.

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Coenzyme Q10 Supplementation Increases ATP Levels

Fact: Adequate Coenzyme Q10 is essential for our cells’ generation of ATP energy.

Roger Federer
For cells and tissues with high energy needs, tissues such as heart muscle tissue and skeletal muscle tissue, there is a constant demand for CoQ10 molecules.

Adenosine triphosphate (ATP) molecules have been called the energy currency of the cells. ATP molecules have to be produced and stored for later use, similar to storing money in a bank. All of our cells contain ATP, and the ATP provides the energy for almost all cellular processes. ATP is, so to speak, what drives the cellular machinery.

CoQ10 molecules are vitamin-like substances that are an essential component of the oxidative phosphorylation process in the cells’ mitochondria; they are essential to the process that converts the energy from ingested carbohydrates and fatty acids into ATP [Schniertshauer 2016].

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Coenzyme Q10 Supplementation for Elderly Persons

Supplementation with Coenzyme Q10 has primarily made use of the oxidized form called ubiquinone. It is the stable form of Coenzyme Q10, the form with which all the important clinical studies have been done involving elderly persons, heart failure patients, and Gulf War Illness patients [Alehagen 2013; Golomb 2014; Mortensen 2014].

Walk in autumn weather
When we reach the September of our years, our cells synthesize less and less of Coenzyme Q10, the essential bio-nutrient that is needed for ATP energy generation, for antioxidant defense against harmful free radicals, and for anti-inflammatory effects.

In study participants with low baseline selenium status, the combination of Coenzyme Q10 together with the essential trace element selenium appears to reduce the level of oxidative stress and inflammation and to delay or ameliorate the development of some age-related disorders [Aaseth 2021].

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Coenzyme Q10 Supplementation for Fibromyalgia Patients

Fibromyalgia is a common chronic pain condition without a known cause and without a reliable, effective medical treatment. It has several signs and symptoms in common with chronic fatigue syndrome: fatigue, pain, weakness, a feeling of discomfort in the body, a sense of unease and/or anxiety and depression.

Woman suffering from fibromyalgia
Treatment of fibromyalgia generally involves physiotherapy, anti-convulsants, and antidepressant therapy. Adequate intake of Coenzyme Q10, magnesium, selenium, vitamin D, and vitamin B12 may be beneficial.

Mitochondrial dysfunction, oxidative stress, and inflammation have been associated with fibromyalgia.

CoQ10 supplementation may restore an underlying deficit in CoQ10 status, which has been associated with fibromyalgia, and may improve the fibromyalgia patient’s outlook by:

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The Instability of Ubiquinol Supplements – Lab Studies

At SIBR Research, we have long been concerned about misleading claims for ubiquinol supplements on the Web. It seems that there is a lack of understanding of the processes influencing the absorption and subsequent metabolism of ubiquinol. Moreover, this misunderstanding seems to have been exacerbated by some manufacturers’ incorrect claims regarding the bioavailability of their ubiquinol supplements [Mantle & Dybring 2020].

Dr William V Judy
SIBR Research studies show that the ubiquinol in supplements is very likely to be converted to ubiquinone in the small intestines, to be absorbed as ubiquinone, and then to be converted back to ubiquinol in the lymph.

Basic Information about Ubiquinone and Ubiquinol

  • Ubiquinol is the reduced form of Coenzyme Q10; it is the antioxidant form of Coenzyme Q10.
  • Ubiquinone is the oxidized form of Coenzyme Q10. It is essential for the process of ATP energy generation.

Note: Both forms of Coenzyme Q10 are bio-active forms.

Ubiquinone More Stable than Ubiquinol in Supplements

Ubiquinol molecules are electron donors. Thus, they are inherently unstable. They are constantly looking to give up two electrons. It is this property that first made us wonder whether the ubiquinol in supplements actually gets absorbed as ubiquinol or gets converted to ubiquinone before being absorbed.

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