Coenzyme Q10 therapeutic applications

Evidence from randomized controlled trials like the Q-Symbio study show the efficacy of Coenzyme Q10 adjuvant treatment in improving the symptoms and survival of chronic heart failure patients. Illustration courtesy of Dr. William Judy, SIBR Research Institute.

For 30-plus years now, bio-medical researchers have investigated and documented the functions of Coenzyme Q10 in the human body:

  • An essential role in cellular production of ATP energy [Littarru 2007]
  • An important antioxidant role preventing the oxidation of proteins, lipids, and DNA [Littarru 2007]
  • A role in the enhancement of endothelial function [Littarru 2011]
  • A beneficial role in the expression of genes involved in human cell metabolism, signaling, and transport [Garrido-Maraver]

Moreover, the scientific documentation shows that Coenzyme Q10 supplements are safe, are well-tolerated, and are effective as adjunctive treatments in diseases involving high cellular and tissue demands for energy and in diseases involving oxidative stress and oxidative damage [Garrido-Maraver].

Absorption and Bio-Availability of Coenzyme Q10

As we get older, our bodies produce less Coenzyme Q10 [Kalén].  It is not realistic to make up the difference in the diet [Judy].  Supplementation is necessary.

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Coenzyme Q10 and crucial antioxidant enzymes

Oxygen is a strange element in our lives.  We cannot live without it.  We use it to burn nutrients to generate ATP energy in the cells.  So far, so good.

But, in the process of producing energy from nutrients – the process is called cellular respiration – some small portion of the oxygen produces a by-product: free radicals.  These radicals are atoms or molecules with one or more unpaired electrons in the outer orbit. There are many types of radicals; the radicals derived from oxygen – known as reactive oxygen species – are some of the most toxic radicals.

In moderate quantities, these free radicals have some useful inter-cellular and intra-cellular  signaling functions.  Moreover, the immune system’s phagocytic cells use radicals to kill pathogens.  However, in large quantities, the highly reactive radicals that escape the respiratory chain of the mitochondria can be toxic to the cells.  They can damage DNA, RNA, proteins and fatty acids in the blood and tissue.

In fact, the definition of oxidative stress is an imbalance between the quantities of potentially harmful free radicals and the quantities of antioxidants available to neutralize the free radicals before they can set off damaging chain reactions.  The process of lipid peroxidation is one of the most common examples of toxic activity by oxygen-derived radicals; the radicals target the fatty acids in the phospholipid cellular membranes, i.e. the plasma membranes of the cells and the mitochondrial membranes.  The antioxidant enzymes are important for the prevention of lipid peroxidation.

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Coenzyme Q10 and Red Yeast Rice against Heart Disease

Illustration showing how statin medications block the bio-synthesis of Coenzyme Q10 just as statin medications block the body’s synthesis of cholesterol.  Blocking the bio-synthesis of Coenzyme Q10 ultimately deprives the heart muscle cells of ATP energy and of antioxidant protection.  Illustration courtesy of Dr. William Judy, SIBR Research Institute.

Heart disease continues to be the number 1 cause of death in the developed world.  Much research has been done on efforts to modify some of the known risk factors for heart disease:

  • Diet
  • Exercise
  • Lifestyle

However, modifying these risk factors alone is not always sufficient to prevent heart disease.  Hence, the extensive prescription of statin medications in the United States because changing the lipid profiles of potential heart disease patients is do-able and effective. 

But the statin medications are not without adverse effects.  Even in generally healthy study participants given moderate statin doses, there can be unfavorable statin medication effects on energy and exertional fatigue.  Both simvastatin and pravastatin have been seen to contribute to a significant adverse effect of statins on energy and fatigue with exertion [Golomb 2012; Okuyama and Langsjoen 2015].

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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: Life-long therapy for heart failure patients

Dr. Karl Folkers (left) and Dr. Svend Aage Mortensen (right) together with Dr. William Judy and Dr. Per Langsjoen were pioneers in the adjunctive treatment of heart failure patients with Coenzyme Q10. Their studies showed that Coenzyme Q10 supplementation improves the symptoms and survival of heart failure patients.  Moreover, withdrawal of the Coenzyme Q10 adjunctive therapy leads to clinical relapse.

Coenzyme Q10 as an adjunctive therapy added to conventional medication improves the symptoms and the survival of heart failure patients. It reduces the number and length of hospitalizations of heart failure patients.

We know this from the documented results of randomized, double-blind, placebo-controlled studies [Morisco; Munkholm; Mortensen].

Coenzyme Q10 adjunctive therapy for heart failure

Recently, Dr. William Judy, founder and president of SIBR Research Institute, told me about an interesting outcome of the early Coenzyme Q10 studies with heart failure patients.

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End-of-the-year Coenzyme Q10 report card

Coenzyme Q10 as a nutritional supplement – if properly formulated – gets an A grade for performance.  Coenzyme Q10 goes right to the head of the class on our list of daily nutritional supplements, right up there with vitamin D capsules, organic high-selenium yeast tablets, and fish oil capsules (if we don’t eat as much fish as we should).

As the fall semester 2017 drew to a close, I reviewed the published bio-medical documentation and assigned some performance grades to the nutritional supplement Coenzyme Q10. As might be expected of an “essential bio-nutrient,” Coenzyme Q10 maintained an exemplary grade point average.

Properly formulated Coenzyme Q10 supplements

Right.  We want to get a supplement made with pharmaceutical-grade Coenzyme Q10 and manufactured under conditions of pharmaceutical control. We want a Coenzyme Q10 supplement that meets the following criteria:

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Coenzyme Q10: Good news for dialysis patients

Did you know? Kidney disease kills more Americans every year than either breast cancer or prostate cancer. High blood pressure and diabetes are the main causes of chronic kidney disease. Some 468,000 Americans depend on dialysis. Coenzyme Q10 supplements can reduce the risk of oxidative damage to the cells and can reduce the risk of damage to the heart muscle for dialysis patients.

Supplementation of patients undergoing maintenance dialysis with 1200 milligrams of Coenzyme Q10 for four months has been shown to be safe and effective at reducing a bio-marker of oxidative stress [Rivara].

Super, I thought, when I read this report, which appeared in the medical journal The American Journal of Kidney Diseases.  The journal is the official journal of the National Kidney Foundation.

1200 milligrams a day.  That is four times the daily dosage used in Dr. Mortensen’s Q-Symbio study of chronic heart failure patients.  Six times the daily dosage used in Dr. Alehagen’s KiSel-10 study of elderly Swedish citizens.  And 1200 milligrams per day were safe and well tolerated.  Good news.  Not surprising news but good to see confirmed.

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Interview with Dr. Judy: the need for Coenzyme Q10

Q.  Good morning, Dr. Judy.  You have talked with us about the safety of Coenzyme Q10 supplements, and you have told us that the formulation of the supplement is decisive for the absorption of Coenzyme Q10.  Shouldn’t we talk today about why we adults need daily Coenzyme Q10 supplements?

Coenzyme Q10 molecules are redox molecules.  Ubiquinone can accept electrons, and ubiquinol can donate electrons.   Oxireductase enzymes catalyze ubiquinone’s accepting electrons.  Free radicals take electrons from ubiquinol and become stable.

A.  Yes, indeed.  Coenzyme Q10 is very much needed and, at the same time, very little known by most people.  Our bodies produce Coenzyme Q10 –called ubiquinone –, and Coenzyme Q10 is found in all of our cells except the red blood cells.  That should tell us something.

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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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Dr. Judy’s Coenzyme Q10 research history

When the ubiquinol supplement enters the stomach and when the capsule opens, the ubiquinol begins to oxidize. In the small intestine, the ubiquinol is converted to almost all ubiquinone. In the absorption cells and in the abdominal lymph ducts, the Coenzyme Q10 is initially almost all in the ubiquinone form. The Coenzyme Q10 enters the blood from the lymph. Thus, it appears that ubiquinol is absorbed as ubiquinone and not as ubiquinol. It is then converted back to ubiquinol before entering the blood. From: Dr. Judy’s presentation at the International Coenzyme Q10 Association symposium in Bologna, Italy, October, 2015.

Q. Good morning, Dr. Judy.  Let’s talk about the Coenzyme Q10 research you have done in your career.  But, first, do you remember when you first met Dr. Karl Folkers, the grand old man of Coenzyme Q10 research?

A. Good morning.  Yes, I met Dr. Folkers in 1968.  He had just started the Institute for Bio-Medical Research at UT in Austin.  He came to talk to Dr. Les Geddes and Dr. Lee Baker in the Physiology and Biophysics Department at Baylor University Medical School in Houston, Texas.  He talked to them about the bio-electrical impedance method for non-invasively measuring cardiac function in heart failure patients.

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