Coenzyme Q10 - Supplement or Not?
In recent years, Coenzyme Q10 has become an increasingly popular focus of attention in the spheres of health and wellness. Supplements have been heavily advertised. Claims have been made that those over the age of 60 can gain more energy and slow down the aging process by ingesting CoQ10 supplements. The sale of CoQ10 supplements in the US has become a multi-million-dollar business, generating revenues of over USD 200 million in 2015 alone and according to recent estimates the sales are going to increase to over $ 1 billion by 2028! The purpose of this article is to explore this topic further and see if such attention is warranted.
There are some questions we must ask in order to get to the bottom of this puzzle.
What is Coenzyme Q10?
Coenzyme Q10 (CoQ10), also called ubiquinone, is a naturally occurring antioxidant that is found in every cell of the human body.
CoQ10 has three primary functions: it supports cardiovascular health, enables energy production and promotes healthy mitochondrial function.
Where does Coenzyme Q10 come from?
Most healthy people produce enough CoQ10 naturally, although its production decreases as we age.
We can obtain CoQ10 from dietary sources such as animal protein sources (pork, lamb, beef, chicken, oily cold-water fish), vegetable oils, nuts, vegetables (spinach, pea, broccoli, cauliflower), fruits (orange, strawberry, apple) and whole grains (rye, wheat). Daily intake between 3 and 5 mg is considered adequate.[1]
There is also some evidence that there is another way to boost our CoQ10 levels. A study showed that if we consume plant chlorophyll pigments and then gain exposure to sunlight, light-activated chlorophyll in our body may help regenerate Coenzyme Q10.[2] This would indicate that another method of increasing CoQ10 levels would be the combined consumption of leafy green vegetables and exposure to sunlight.
Another study brought similar results. Researches used two groups of healthy young subjects – “winter group,” when the mean outside temperature was 39.2°F, and “spring group,” when the mean outside temperature was 75.2°F. The scientists concluded that in the winter group, coenzyme Q10-TOTAL level in PLT was lower in comparison with the spring group by 29.24%, in whole blood by 10.10% and in plasma by 3.60%. I would argue that since people usually don’t spend much time outside in the winter and sunshine is scarce, perhaps the difference in the levels of CoQ10 in spring versus winter might have been due to sunlight exposure or the lack thereof, respectively, which would be consistent with the findings of the study above.[3]
How did we survive without it?
The results from the above-referenced two studies might help explain why humans as a species were able to survive to this day without supplementing CoQ10. Since ancient humans were mostly vegetarians consuming chlorophyll-rich plants and spent a lot of time outdoors, their bodies naturally produced enough CoQ10 for successful reproduction.
When to supplement with CoQ10?
It seems only logical that people should take any supplement only if they are deficient.
There are two kinds of CoQ10 deficiency; primary and secondary.
CoQ10 supplements are a useful tool in treatment of primary CoQ10 deficiencies. They can help with secondary deficiencies and drug-induced CoQ10 deficiency as well, however in these cases it may be unnecessary, since secondary deficiency can generally be prevented by adhering to a healthy diet and lifestyle.
What is primary coenzyme Q10 deficiency?
Primary coenzyme Q10 deficiency is caused by gene mutations and affects less than 1 in 100,000 people. It is interesting to note that the role of CoQ10 in human health was unknown until 1986, when a patient with Kearns–Sayre syndrome (a primary CoQ10 deficiency) was successfully treated with CoQ10.[4]
The mildest cases of primary coenzyme Q10 deficiency can affect people in their sixties and often cause problems with coordination and balance. In the most severe cases, primary CoQ10 deficiency can have an onset in infancy and cause severe brain dysfunction combined with muscle weakness (encephalomyopathy) and other body systems failure.
Other neurological abnormalities include seizures, intellectual disability, poor muscle tone, involuntary muscle contractions, progressive muscle stiffness, abnormal eye movements, vision loss, and sensorineural hearing loss. Another common feature of primary coenzyme Q10 deficiency is nephrotic syndrome (a form of kidney dysfunction) and hypertrophic cardiomyopathy (a type of heart disease that enlarges and weakens the heart muscle).[5]
What is secondary coenzyme Q10 deficiency?
As we age, our levels of CoQ10 decrease. It is a natural process that can lead to what is referred to as a secondary deficiency. There are also other, external, factors that may accelerate the decrease in normal levels of CoQ10. Among these factors are stress[6], poor nutritional habits and a variety of medical conditions and drug interactions.
Secondary coenzyme Q10 deficiency has been associated with many different disorders including mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes (MELAS), cardiovascular disease, mitochondrial disorders and neurodegenerative disorders.[7]
The problem is that many of the symptoms described above might have other causes, so a comprehensive look at the individual’s health should be employed. If other cases are eliminated, a blood test for CoQ10 serum level is warranted.
Are Supplements Needed?
Below is a list of several medical conditions that have been helped by supplementing:
Parkinson’s disease
The neuroprotective effects of CoQ10 have been investigated for a potential role in treatment of Parkinson’s. Even though some trials found no significant benefit of high-dosage CoQ10 in early Parkinson’s disease, a controlled trial in which the active, reduced form of CoQ10 was used showed significant improvement in PD symptoms without side effects.[8]
Hypertension
There is evidence that CoQ10 supplements can significantly lower systolic blood pressure. However, the decrease in diastolic blood pressure was not statistically significant.[9]
Heart failure and other heart conditions
A randomized, controlled multicenter trial concluded that long-term CoQ10 treatment of patients with chronic heart failure is safe, improves symptoms, and reduces major adverse cardiovascular events.[10]
Migraines
A meta-analysis CoQ10 of five studies with 346 patients concluded that CoQ10 can be a potent therapeutic agent with respect to migraine duration and migraine days/month.[11]
Autism
Several studies have demonstrated beneficial effects of ubiquinol in children with autism. In a small study, 24 autistic children aged 3–6 years were given ubiquinol as a supportive therapy and improved their symptoms such as communication with parents (in 12%), verbal communication (in 21%), playing games of children (in 42%), sleeping (in 34%), and food rejection (in 17%).[12]
A separate trial showed that high doses of CoQ10 can improve gastrointestinal problems and sleep disorders in children with ASDs with an increase in the CoQ10 of the serum.[13]
Statin-induced myopathy (muscular weakness)
Our body makes the antioxidant CoQ10 using the same enzyme that is used to make cholesterol. Unfortunately, this enzyme is blocked by cholesterol-lowering statin drugs and myopathy is the most common side effect of statin use. A review of multiple studies showed a benefit in symptoms of myalgia or improvement of serum levels of CoQ10 with supplementation. Supplementation of CoQ10 at a dose of between 30 and 200 mg daily has shown to have beneficial effects on statin myopathy with no noted side effects.[14],[15]
That brings us to another question. Should you get tested?
You should get tested if you suffer from symptoms of coenzyme Q10 deficiency and other possible causes and diagnoses have been ruled out.
If you have primary coenzyme Q10 deficiency, your symptoms would likely force you to seek medical attention -- your doctor should order a test and determine a diagnosis and appropriate treatment.
What are normal serum levels of CoQ10?
There is not a complete consensus on the “normal” level of CoQ10. Different laboratories use different ranges for serum CoQ10 levels which vary widely. For example, LabCorp gives a reference range of 0.37 − 2.20 µg/mL, the Cleveland Heart Lab® 0.36 to 1.59 µg/mL A more restrictive view might place the normal range at 0.8-1.2 µg/mL.
How much supplemental CoQ10 and what form should we take?
Here too, no optimal dose of CoQ10 has been established. In research, doses of CoQ10 ranged from 30 mg to 2,400 mg per day. A typical daily dose is 100 milligrams to 200 milligrams.
As a supplement, CoQ10 is available as capsules, tablets and by IV. In trials, ubiquinol, the active form of CoQ10, appeared to be more effective and preferred form used in enhancing the CoQ10 status.[16]
Are there any risks of taking CoQ10 supplements?
Side effects from using supplemental CoQ10 are rare and mild and manifest as diarrhea, nausea, and heartburn. However, in some cases, taking supplemental CoQ10 could be dangerous as CoQ10 may interact with some drugs such as the anticoagulant (blood thinner) warfarin, anisindione and dicumarol.[17] Also, given the lack of evidence about their safety, CoQ10 supplements are not recommended for children or for women who are pregnant or breastfeeding.[18]
Conclusion
In recent years, it has become accepted wisdom that as we age, we need to supplement with CoQ10. The truth is that unless you suffer from a CoQ10 deficiency or take cholesterol-lowering statins and are experiencing myalgia symptoms, you do not need to supplement. Although research has been scarce and its results mixed, it is also possible that CoQ10 supplementation might be useful for people suffering from Parkinson’s disease, certain heart conditions, migraines and other conditions.
On the other hand, you should not take a CoQ10 supplement if you are taking blood thinners and you should also be aware that just like with all other supplements, CoQ10 is not approved by the U.S. Food and Drug Administration for the treatment of any medical condition, and it has not been tested by the FDA for safety and effectiveness.[19]
The important takeaway here is that most cases of low levels of CoQ10 can be easily prevented by adhering to a healthy diet rich especially in green vegetables and by a healthy, active lifestyle.
[1] Gutierrez-Mariscal FM, Yubero-Serrano EM. Villalba JM et al. “Coenzyme Q10: From bench to clinic in aging diseases, a translational review.” Food Sci. Nutr. 2018. [2] Xu C, Zhang J, Mihai D M et al. “Light-harvesting chlorophyll pigments enable mammalian mitochondria to capture photonic energy and produce ATP.” Cell Sci. 2014 Jan 15;127(Pt 2):388-99. [3] Gvozdjáková A, Kucharská J, Sumbalová Z et al. “Platelets mitochondrial function depends on CoQ10 concentration in winter, not in spring season.” Gen Physiol Biophys. 2019 Jul;38(4):325-334. [4] Ogasahara S, Nishikawa Y, Yorifuji S et al. “Treatment of Kearns-Sayre syndrome with coenzyme Q10.” Neurology. 1986 Jan;36(1):45-53. [5] https://ghr.nlm.nih.gov/condition/primary-coenzyme-q10-deficiency, Accessed October 30, 2023. [6] Navas P, Villalba J M, de Cabo R. “The importance of plasma membrane coenzyme Q in aging and stress responses.” Mitochondrion. 2007, 7S, S34-S40. [7] Cornelius N, Byron C, Hargreaves I et al. “Secondary coenzyme Q10 deficiency and oxidative stress in cultured fibroblasts from patients with riboflavin responsive multiple Acyl-CoA dehydrogenation deficiency.” Human Molecular Genetics, Volume 22, Issue 19, 1 October 2013, Pages 3819–3827 [8] Yoritaka A, Kawajiri S, Yamamoto Y et al. “Randomized, double-blind, placebo-controlled pilot trial of reduced coenzyme Q10 for Parkinson's disease.” Parkinsonism Relat Disord. 2015 Aug;21(8):911-6. [9] Tabrizi R, Akbari M, Sharifi N. “The Effects of Coenzyme Q10 Supplementation on Blood Pressures Among Patients with Metabolic Diseases: A Systematic Review and Meta-analysis of Randomized Controlled Trials.” High Blood Press Cardiovasc Prev. 2018 Mar;25(1):41-50. [10] Mortensen SA, Rosenfeldt F, Kumar A et al. “The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial.” JACC Heart Fail. 2014 Dec;2(6):641-9. [11] Zeng Z, Li Y, Lu S, Huang W et al. “Efficacy of CoQ10 as supplementation for migraine: A meta-analysis.”Acta Neurol Scand. 2019 Mar;139(3):284-293. [12] Gvozdjáková A, Kucharská J, Ostatníková D et al. “Ubiquinol Improves Symptoms in Children with Autism” Oxid Med Cell Longev. 2014; 2014: 798957. [13] Mousavinejad E, Ghaffari MA, Riahi F et al. “Coenzyme Q10 supplementation reduces oxidative stress and decreases antioxidant enzyme activity in children with autism spectrum disorders.” Psychiatry Res. 2018 Jul;265:62-69. [14] Zhang X, Shi Z, Liu Q, Quan H, Cheng X. “Effects of coenzyme Q10 intervention on diabetic kidney disease: A systematic review and meta-analysis.” Medicine (Baltimore). 2019 Jun;98(24):e15850. [15] Littlefield N, Beckstrand R L, Luthy K E. “Statins' effect on plasma levels of Coenzyme Q10 and improvement in myopathy with supplementation.” J Am Assoc Nurse Pract. 2014 Feb;26(2):85-90. [16] Zhang Y , Liu J , Chen XQ , Oliver Chen CY . “Ubiquinol is superior to ubiquinone to enhance Coenzyme Q10 status in older men.” Food Funct. 2018 Nov 14;9(11):5653-5659. [17] https://www.drugs.com/drug-interactions/ubiquinone,coq10.html#list, Accessed October 30, 2023. [18] Coenzyme Q10 Information | Mount Sinai - New York, Accessed October 30, 2023. [19] Facts about Dietary Supplements | FDA, Accessed October 30, 2023.