Coenzyme Q10 supplementation

Coenzyme Q10 can be supplemented in oxidized form (ubiquinone) or reduced form (ubiquinol). Both forms are maintained in balance in plasma and pass from one state to the other as needed by the body.

In dietary supplements, depending on which nutrients are accompanying coenzyme Q10, either ubiquinol or ubiquinone can be used. Both nutrient forms increase blood plasma levels.

Foods with coenzyme Q10

CoQ10 is found in many foods, mainly the following: meats, chicken, sardines, soybeans, spinach, nuts, and sesame seeds. Foods that contain CoQ10 in smaller amounts: most vegetables, fruits, dairy products, and whole eggs.

CoQ10 is present in the typical diet, with red meats and poultry being the best sources (Pepe 2007). One study found that the highest concentrations of CoQ10 are found in meat (8–203 μg/g), poultry (17 μg/g), and fish (4–27 μg/g). However, intake and absorption of CoQ10 through foods has not been studied (Weber 1997).

With frying, a great deal of CoQ10 is lost, but this is not the case with grilling or boiling.

CoQ10 is found in many foods, but in scant amounts, mainly the following:

• Red meats, 8–203 μg/g.
• Poultry, 8–203 μg/g.
• Oily fish species, 4–27 μg/g.
• Soybeans, spinach, and nuts.

Intake and deficiencies

CoQ10 has antioxidant and anti-inflammatory action. CoQ10 inhibits lipoxidation and oxidation of proteins and DNA. Lipid peroxidation begins only when CoQ10 is depleted. CoQ10 acts in conjunction with lipoic acid, tocopherols, and vitamin C. (Bentinger 2007; Kaikkonen 2002; Lankin et al. 2007; Sakata et al. 2008; Fuller et al. 2006; Wang et al. 2004).

• Low CoQ10 levels are common in elderly people, mainly when they suffer from chronic diseases.
• In heart disease, CoQ10 helps to improve the following: cardiac function, symptoms, quality of life, and evolution.
• In hypertension, dyslipidemia, diabetes, asthma, fibromyalgia, and chronic fatigue syndrome, CoQ10 can help improve control and prevent complications.
• CoQ10 needs the “team” of basic nutrients to achieve its maximum therapeutic potential in chronic diseases.
• The usual doses of CoQ10 for long-term treatments are 100–600 mg.
• In supplements, it is best to use trans CoQ10 (from a natural source), either microencapsulated or formulated in an oil base.
• CoQ10 has an excellent safety profile, with few and mild side effects, in the recommended forms and doses. If CoQ10 is administered at doses above 100 mg with warfarin or acenocoumarol (Sintrom®), some patients’ doses of these drugs should be increased.

Low CoQ10 levels are common in elderly people, mainly when they suffer from chronic diseases.

Intake. One study found that people in Denmark ingest an average of 3–5 mg of CoQ10 a day in food.

With current diets, especially when low in meat or fish, it is difficult to obtain the necessary amounts, resulting in coenzyme Q10 intake that is considered suboptimal.

Endogenous synthesis. Endogenous synthesis is the main source, although this starts to decline after the age of 20, falling by up to 65% by the time a person reaches 80. The following are needed for synthesis: riboflavin, niacin, vitamin B6, folates, vitamin B12, pantothenic acid, and vitamin C, in addition to numerous minerals. Adequate vitamin B6 intake is essential for biosynthesis of coenzyme Q10. Coenzyme Q10 (ubiquinone) requires sufficient levels of NADH to change to the reduced form (ubiquinol) so that it can participate with the NADH in energy production. The participation of so many nutrients dependent on external inputs makes this process highly vulnerable.

In chronic diseases, when the overall antioxidant capacity of the tissues is exceeded, endogenous synthesis of CoQ10 is insufficient and it is necessary to increase external inputs. Plasma CoQ10 levels are lower under conditions of high oxidative stress, as in the case of diabetes and liver disorders.

Low levels in the blood are reportedly common in the elderly and in a wide range of pathologies, including chronic fatigue, heart disease, diabetes, and high blood pressure.

Medications

Statins. Administration of statins (lovastatin, simvastatin, pravastatin, etc.) to treat dyslipidemia lowers CoQ10 levels. Other drugs that affect CoQ10 include the following: beta blockers, oral antidiabetic drugs (sulfonylurea derivatives: glimepiride, gliclazide, glibenclamide, tolazamide, chlorpropamide, etc.), tricyclic antidepressants, phenothiazines, methyldopa, clonidine, and hydralazine.

Statins are drugs that lower cholesterol by inhibiting the HMG-CoA reductase enzyme that controls the synthesis pathway for cholesterol and coenzyme Q10, blocking the production of both substances equally.

Statins can cause myopathy. These adverse effects can be prevented by CoQ10 supplementation (Bhagavan 2006). Treatment with statins leads to CoQ10 depletion; supplementation with CoQ10 prevents this depletion in platelets and blood (Littarru 2007). CoQ10 supplementation may prevent statin-induced coQ10 deficiency without altering its capacity to lower cholesterol or its anti-inflammatory properties, likewise reducing the oxidizability of LDL-cholesterol (Littarru 2007).

A study by Mabuchi et al. evaluated plasma levels of CoQ10 and LDL in 14 hypercholesterolemic patients being treated with atorvastatin 10 mg/day. After eight weeks of treatment, a drop in plasma cholesterol and CoQ10 levels was observed. The authors recommend CoQ10 supplementation of patients under treatment with atorvastatin to avoid the risks associated with CoQ10 depletion (Mabuchi 2005).

Beta blockers. Beta blockers cause serum CoQ10 content to fall by inhibiting CoQ10-dependent enzymes (Bhagavan 2006).

Oral hypoglycemic agents. It has been observed that some oral hypoglycemics (glyburide, phenformin, and tolazamide) reduce endogenous CoQ10 levels, therefore CoQ10 supplementation improves glycemic control in diabetics.

In April 2014, Professor Emeritus Ginter, of the Slovakia Medical University (Institute of Preventive and Clinical Medicine), published a letter to the editor of the Bratislava Medical Journal (BLL) summarizing the relationship between statins, coenzyme Q10, and type II diabetes.

Between 1958 and 1996, the type II diabetes rate in the U.S. gradually rose. However, since 1997, with increased statin consumption, the percentage of the United States population with type II diabetes has increased dramatically. In type II diabetes, CoQ10 deficiency may be related to alterations in the function of pancreatic beta cells and the development of insulin resistance. Low plasma CoQ10 concentrations have been negatively correlated with inadequate glycemic control and diabetes complications. Recent studies have demonstrated that statins increase the risk of type II diabetes, and a large-scale meta analysis even showed its diabetogenic effect (Ginter, 2014).

CoQ10 deficiency is linked to a higher incidence of cardiovascular diseases and heart failure, which should be taken into account in the decision to administer these drugs; if administered, they should be combined with a CoQ10 supplement.

Nutrients. Supplementation with alpha-tocopherol (vitamin E) at high doses lowers plasma CoQ10 levels.

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Dosage and precautions

CoQ10 has an excellent safety profile, with mild and infrequent side effects (digestive upset and mild itching), at doses of 100–600 mg, the usual dose in clinical trials and treatments.

Dosage. The amounts administered in chronic diseases range from 150–600 mg, divided into two or three doses, depending on the type, severity, and associated pathologies. The usual dose is 200–300 mg.

Safety. In the Nukui et al. study with 46 healthy subjects, it was observed that administration of P40 (2250 mg/day of PureSorbQ-40TM = equivalent to 900 mg/day of CoQ10) is safe and allows absorption of sufficient amounts of coenzyme Q10. In this study, treatment was administered for four consecutive weeks. After two weeks, plasma CoQ10 concentrations 11 times higher than at the start of treatment were observed (Nukui 2007).

CoQ10 has an excellent safety profile (Bhagavan 2006 and Bonakdar 2005) and shows no toxicity (Hathcock 2006). The safety of CoQ10 in oral administration at high doses over long periods has been confirmed. CoQ10 has a good safety profile and tolerability in adults at doses of up to 1200 mg/day and in children up to 10 mg/kg/day (Miles 2007). There is no data on its use by women during pregnancy or breastfeeding (Bonakdar 2005).

Side effects. In human studies, few side effects have been observed in relation to treatment with CoQ10: epigastric pain (0.39%), loss of appetite (0.23%), nausea (0.16%), diarrhea (0.12%), and elevated HDL/SGOT (rare) (Mortensen 2003). A six-year monitoring study with 126 patients taking 100 mg/day of CoQ10 found no signs or symptoms of intolerance, except in two patients who experienced mild itching (Mortensen 2003).

A multi-center study with 2,500 patients treated with CoQ10 found ten adverse reactions, five of which were linked to the treatment: four cases of nausea/gastrointestinal disturbances and one case of hives (Mortensen 2003). No side effects were observed in two clinical trials involving patients with Huntington’s chorea and Parkinson’s disease treated with doses of 600 and 1200 mg, respectively (Beal, 2002). Another study established the safety and tolerability of CoQ10 at a dose of 3,000/mg day in patients with Parkinson’s disease and amyotrophic lateral sclerosis (Bhagavan, 2006).

Some studies have found mild side effects (gastrointestinal) after administration of CoQ10, although these are apparently unrelated to the dose and appear in the same proportion as in patients given a placebo, suggesting that these gastrointestinal effects could be related to the capsule or the oily excipient (Hathcock 2006 and Hosoe 2007).