Coenzyme Q10 (CO-Q10)

Overview

Coenzyme Q10 (CoQ10) is an important nutrient in the human body. It is a fat-soluble vitamin-like compound that is also known as ubiquinone from the word ubiquitous, which means “everywhere.” Coenzyme Q or ubiquinone compounds are synthesized in the cells of all living organisms including plants, animals, and humans. There are 10 coenzyme Q compounds that occur throughout nature, but only coenzyme Q10 is synthesized in humans.

In 1958, Professor Karl Folkers elucidated the chemical structure of coenzyme Q10 while working at Merck, Inc. Working with minute quantities, Folkers was able to determine that CoQ10 had great promise in the treatment of cardiovascular disease. However, Professor Folkers was not able to convince his superiors to pursue the development of CoQ10 because Merck had recently launched their new drug in the cardiovascular arena called Diuril. Consequently, the formula and patent rights for coenzyme Q10 were sold to a Japanese company. The Japanese quickly developed new methods of synthesizing large quantities, and coenzyme Q10 has become a popular recommendation for the treatment for cardiovascular disease in Japan. Although coenzyme Q10 is widely used throughout Europe and Asia, its value is just beginning to be recognized in the United States.

Dosage Info

Dosage Range

30-300mg daily.

Most Common Dosage

30mg daily.

Dosage Forms

Softgel capsules containing CO-Q10 suspension in oil, powder-filled hardshell capsules, powder-based tablets, and liposomal sprays.

Adult RDI

None established

Adult ODA

30mg twice daily

RDA

• : None established

Interactions and Depletions

Interactions

• Anticoagulant medications
• orlistat

Depletions

• Beta-blockers
• Biguanides
• clonidine
• gemfibrozil
• haloperidol
• HMG-CoA reductase inhibitors
• hydralazine
• methyldopa
• Phenothiazines
• Sulfonylureas
• Thiazide diuretics
• Tricyclic antidepressants

Active Forms

Coenzyme Q10.

Absorption

Since coenzyme Q10 is a fat-soluble substance, absorption depends upon an individual’s fat digestion efficiency. Coenzyme Q10 is best absorbed if it is taken with a meal that contains some fat so that fat digestion is initiated. The absorption of coenzyme Q10 varies widely depending on the type of coenzyme Q10 product that is ingested.

Toxicities & Precautions

General

Coenzyme Q10 appears to be very safe. No studies have reported toxicity or adverse side effects.

Functions in the Body

Energy Production

Plays a role in the production of energy within the mitochondria. It is the coenzyme enzymes that are involved in the production of adenosine triphosphate (ATP), which is the high-energy fuel for all living cells. Coenzyme Q10 is a necessary component in Complex I, II, and III, which explains why CoQ10 plays such a critical role in energy production. (1)

Important Antioxidant

This fat-soluble antioxidant protects cellular membranes throughout the body from oxidative damage. It is uniquely able to reside in mitochondrial cell membranes where it provides protection against mitochondrial DNA free radical damage. (2) , (3)

Cardiovascular Disease

Coenzyme Q10 has proven to be a critical agent in the health of the cardiovascular system as well as an effective therapeutic agent in the treatment of a wide range of cardiovascular diseases. (4) , (5)

Periodontal Disease

It has been reported that adequate levels of coenzyme Q10 are required for the health of gingival tissues and that gingival deficiencies of CoQ10 may predispose individuals to periodontal disease. (6)

Protection

Helps to protect against the side effects of numerous classes of drugs, many of which actually cause drug-induced depletions of CoQ10. (7)

Clinical Applications

Mitral Valve Prolapse

Co-Q10 proved to be a very effective treatment in a dose dependent manner. A majority of patients receiving high doses returned to normal within one week. (8)

Muscular Dystrophy

Patients on Co-Q10 had increased cardiac function and exercise tolerance, reduced leg pain, less fatigue, and better limb control. (9)

Obesity

Approximately 50 percent of obese patients were found to be Co-Q10 deficient and those taking Co-Q10 lost more than twice as much weight as controls. (10)

Cardiomyopathy

Co-Q10 strengthens the heart, substantially reduces mortality and is shown to be a safe and effective in long-term therapy for chronic cardiomyopathy. (11)

Congestive Heart Failure

Co-Q10 is a critical adjuvant complementary therapy for patients with congestive heart failure; it improves quality of life and increases survival. (12) In a review of studies, it was reported that Co-Q10 improves ejection fraction, exercise tolerance, cardiac output, and stroke volume in patients with CHF. (13)

Hypertension

At an average dose of Co-Q10 225mg/day resulted in a significant lowering of blood pressure and 56 of 109 patients (51%) were able to completely discontinue use of from 1 to 3 antihypertensive medications within six months. (14)

Atherosclerosis.

Coenzyme Q10 is transported throughout the body by being packaged into the LDL + VLDL fractions of cholesterol. Thus, this important antioxidant may be one of the most important agents to prevent and treat atherosclerosis due to its ability to prevent the oxidation of LDL-cholesterol. (15) , (16)

Parkinson’s Disease

Studies indicate that coenzyme Q10 may be beneficial in the prevention and treatment of patients with Parkinson’s disease (PD). For example in the MPTP model of PD, treatment with Co-Q10 is able to prevent much of the MPTP-induced loss of striatal dopaminergic neurons. (17) It has also been determined that PD patients have lower platelet mitochondrial Co-Q10 levels than controls, as well as reduced activity of Complex I in the electron transport chain in the brain. (18) Oral Co-Q10 was well absorbed by patients and improved Complex I activity, which suggests that Co-Q10 may help improve the cellular dysfunction and help prevent the neuronal deterioration that occurs in patients with Parkinson’s disease. (19) , (20)

A clinical trial has also been completed evaluating the use of Co-Q10 on patients with PD. Eighty patients with early PD were randomized to one of three Co-Q10 groups (300, 600 or 1,200 milligrams per day) or a placebo group in a multicenter, parallel-group, placebo-controlled, double-blind study. The patients were followed for up to 16 months and were evaluated using the Unified Parkinson Disease Rating Scale (UPDRS) at screening, baseline, and the 1-month, 4-month, 8-month, 12-month and 16-month visits. The researchers concluded that Co-Q10 was safe and well tolerated and that those receiving Co-Q10 developed less disability than those taking placebo. The greatest benefit was in those taking the highest dosage of Co-Q10 (1,200 mg/d). (21)

Infertility (male)

In infertile men, one study reported an inverse correlation between Co-Q10 content and sperm count in seminal plasma and the percentage of sperm with abnormal morphology. (22) In another study, treatment with CoQ10 resulted in improved sperm motility and improved rates of fertilization. (23)

Angina

Co-Q10 provided a 50 percent decrease in the frequency of angina episodes and the use of nitroglycerin along with significant increase in exercise capacity. (24)

Breast Cancer

Numerous cases of advanced metastasized breast cancer have gone into remission with high-dose coenzyme Q10 therapy. (25)

Chemotherapy Support

Co-Q10 provides significant protection against cardiac damage in patients receiving either of the anthracycline agents (doxorubicin or daunorubicin); the incidence of diarrhea and mouth ulcers is also reduced. (26)

Diabetes

Many diabetic individuals have a deficiency of, and low activity of Co-Q10 –synthesizing enzymes; Co-Q10 deficiency may hinder the ability of the pancreas to produce insulin. (27)

Periodontal Disease

Patients have been found to be coenzyme Q10 deficient locally (in gingival tissue), as well as systemically (in leucocytes); gingival deficiency could predispose this tissue to periodontal disease. (28)

Chronic Fatigue Syndrome

It has been suggested that coenzyme Q10 is one of the nutritional agents that could be beneficial in the treatment of patients with chronic fatigue syndrome. (29)

Symptoms and Causes of Deficiency

There is only a limited amount of coenzyme Q10 in dietary sources. The majority of CoQ10 in humans is manufactured by the body’s cells. The biosynthesis of coenzyme Q10 is a 17-step process that requires the following nutrients: riboflavin (B₂), niacinamide (B₃), pantothenic acid (B₅), pyridoxine (B₆), cobalamin (B₁₂), folic acid, vitamin C, and numerous other trace elements. (30) Consequently, there are many ways the complex synthesis of coenzyme Q10 can be interrupted. It is probable that many people with health problems are suffering from a coenzyme Q10 deficiency due to inadequate dietary intake of the necessary nutrients and/or ingestion of one or more drugs that interrupt the synthesis of coenzyme Q10. (31)

The symptoms of coenzyme Q10 deficiency include: congestive heart failure, high blood pressure, angina, mitral valve prolapse, stroke, cardiac arrhythmias, cardiomyopathies, lack of energy, gingivitis, and a generalized weakening of the immune system.

Since coenzyme Q10 is intimately involved in the production of energy, a deficiency of CoQ10 first affects the heart and cardiovascular system because the heart is the most energy demanding muscle in the human body. The results of some studies are suggesting that congestive heart failure is primarily a coenzyme Q10 deficiency disease.

Dietary Sources

Although coenzyme Q10 occurs in the cells of all plants and animals, dietary sources do not provide adequate levels of this nutrient.

References

1. View Abstract: Ebadi M, Govitrapong P, Sharma S, at al. Ubiquinone (coenzyme q10) and mitochondria in oxidative stress of parkinson’s disease. Biol Signals Recept. May2001;10(3-4):224-53.
2. View Abstract: Pobezhimova TP, Voinikov VK. Biochemical and physiological aspects of ubiquinone function. Membr Cell Biol. 2000;13(5):595-602.
3. View Abstract: Sarkela TM. The modulation of oxygen radical production by nitric oxide in mitochondria. J Biol Chem. Mar2001;276(10):6945-9.
4. View Abstract: Langsjoen H, Langsjoen P, Langsjoen P, et al. Usefulness of coenzyme Q10 in clinical cardiology: a long-term study. Mol Aspects Med. 1994;15(Suppl):s165-75.
5. View Abstract: Langsjoen PH, Langsjoen Am. Overview of the use of CoQ10 in cardiovascular disease. Biofactors. 1999;9(2-4):273-84.
6. View Abstract: Hansen IL, et al. Bioenergetics in Clinical Medicine. IX. Gingival and Leucocytic Deficiencies of Coenzyme Q10 in Patients with Periodontal Disease. Res Commun Chem Pathol Pharmacol. Aug1976;14(4):729-38.
7. Pelton R, et al. The Drug-Induced Nutrient Depletion Handbook 2nd Edition. Hudson, OH: Lexi-Comp, Inc; 2001.
8. View Abstract: Oda T. Effect of Coenzyme Q10 on Stress-induced Cardiac Dysfunction in Paediatric Patients with Mitral Valve Prolapse: A Study by Stress Echocardiography. Drugs Exp Clin Res. 1985;11(8):557-76.
9. View Abstract: Folkers K, et al. Two Successful Double-blind Trials with Coenzyme Q10 (Vitamin Q10) on Muscular Dystrophies and Neurogenic Atrophies. Biochem Biophys Acta. May1995;1271(1):281-86.
10. van Gaal L, et al. Explatory Study of Coenzyme Q10 in Obesity. In: Folkers K, Yamamura Y, eds: Biomedical and Clinical Aspects of Coenzyme Q10. Vol 4. Amsterdam: Elsevier Science Publications; 1984:369-73.
11. View Abstract: Langsjoen PH, et al. A Six-year Clinical Study of Therapy of Cardiomyopathy with Coenzyme Q10. Int J Tissue React. 1990;12(3):169-71.
12. View Abstract: Sinatra ST. Coenzyme Q10: A Vital Therapeutic Nutrient for the Heart with Special Application in Congestive Heart Failure. Conn Med. Nov1997;61(11):707-11.
13. View Abstract: Tran MT, Mitchell TM, Kennedy DT, Giles JT. Role of coenzyme Q10 in chronic heart failure, angina, and hypertension. Pharmacotherapy. Jul2001;21(7):797-806.
14. View Abstract: Langsjoen P, et al. Treatment of Essential Hypertension with Coenzyme Q10. Mol Aspects Med. 1994;15(Suppl):S265-72.
15. View Abstract: Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med. 1997;18 Suppl:S137-44.
16. View Abstract: Singh RB, Neki NS, Kartikey K, et al. Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction. Mol Cell Biochem. Apr2003;246(1-2):75-82.
17. View Abstract: Ebadi M, Govitrapong P, Sharma S, at al. Ubiquinone (coenzyme q10) and mitochondria in oxidative stress of parkinson’s disease. Biol Signals Recept. May2001;10(3-4):224-53.
18. View Abstract: Muller T, Buttner T, Gholipour AF, Kuhn W. Coenzyme Q10 supplementation provides mild symptomatic benefit in patients with Parkinson’s disease. Neurosci Lett. May2003;341(3) 201-4.
19. View Abstract: Shults CW, Haas RH, Beal MF. A possible role of coenzyme Q10 in the etiology and treatment of Parkinson’s disease. Biofactors. 1999;9(2-4):267-72.
20. View Abstract: Winkler-Stuck K, Wiedemann FR, Wallesch CW, Kunz WS. Effect of coenzyme Q10 on the mitochondrial function of skin fibroblasts from Parkinson patients. J Neurol Sci. May2004;220(1-2):41-8.
21. View Abstract: Shults CW, Oakes D, Kieburtz K, Beal MF, Haas R, Plumb S, et al. Effects of coenzyme q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. Oct2002;59(10):1541-50.
22. View Abstract: Alleva R, Scararmucci A, Mantero F, et al. The protective role of ubiquinol-10 against formation of lipid hydroperoxides in human seminal fluid. Mol Aspects Med. 1997;18(Suppl):S221-8.
23. View Abstract: Lewin A, Lavon H. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med. 1997;18(Suppl):S213-9.
24. View Abstract: Kamikawa T, et al. Effects of Coenzyme Q10 on Exercise Tolerance in Chronic Stable Angina Pectoris. Am J Cardiol. Aug1985;56(4):247-51.
25. View Abstract: Lockwood K, et al. Progress on therapy of Breast Cancer with Vitamin Q10 and the Regression of Metastases. Biochem Biophys Res Commun. Jul1995;212(1):172-77.
26. View Abstract: Tsubaki K, et al. Investigation of the Preventive Effect of CoQ10 against the Side-effects of Anthracycline Antineoplastic Agents. Gan To Kagaku Ryoho. Jul1984;11(7):1420-27.
27. View Abstract: Kishi T, et al. Bioenergetics in Clinical Medicine XV. Inhibition of Coenzyme Q10-enzymes by Clincically used Adrenergic Blockers of Beta-receptors. Res Commun Chem Pathol Pharmacol. May1977;17(1):157-64.
28. View Abstract: Hansen IL, et al. Bioenergetics in Clinical Medicine. IX. Gingival and Leucocytic Deficiencies of Coenzyme Q10 in Patients with Periodontal Disease. Res Commun Chem Pathol Pharmacol. Aug1976;14(4):729-38.
29. View Abstract: Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. Apr2000;5(2):93-108.
30. View Abstract: Folkers K. Relevance of the Biosynthesis of Coenzyme Q10 and of the Four Bases of DNA as a Rationale for the Molecular Causes of Cancer and a Therapy. Biochem Biophys Res Commun. Jul1996;224(2):358-61.
31. View Abstract: Rundek T, Naini A, Sacco R, Coates K, DiMauro S. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol. Jun2004;61(6):889-92.