Part 2: The Clinical Benefits of CoQ10
Posted by Scott V Watkins, MD
As explained in Part 1 of this two-part series, Coenzyme Q10 (CoQ10) accomplishes an electron exchange to help produce ATP — adenosine triphosphate, or the energy molecule of the body.
While this electron transfer is beyond the scope of this article, it is important to understand that to complete this exchange, CoQ10 exists in three forms. One of these three is ubiquinol: which is the ACTIVE form of CoQ10. For CoQ10 to function in the body, it must be in a reduced form. Some people aren’t able to convert CoQ10 to ubiquinol, and there are also rare genetic deficiencies that don’t allow the body to produce CoQ10. Both these deficiencies can have significant consequences. The good news is supplementation is available in various doses of CoQ10 or ubiquinol through the Functional Medicine website shop (https://functionalmed411.com/?s=ubiquinol&post_type=product&product_cat=0).
CoQ10 is normally produced by the cells and is widely distributed throughout the body. But CoQ10 production begins to decrease after the age of only 20! For most of our lives, therefore, we have too little natural CoQ10 for optimal performance. By the age of 80, the cardiac muscle concentration of CoQ10 is reduced to only about 50% of the levels that are found in younger patients. That’s important to note because cardiovascular disease remains the No. 1 killer of people in the United States and in many other developed nations. As well, persistent heart failure is associated with increased reactive oxygen species (ROS), but that can be mitigated by CoQ10, as discussed above in this article. To that end, various studies, notably in the U.S. and Japan, have been conducted on cardiac patients to examine the importance of CoQ10 and its role in preventing cardiac death. There are indications that CoQ10 therapy or replacement is associated with decreased risk of arrhythmias (irregular heart rates) after cardiac surgery, and also with decreased mortality. CoQ10 supplementation has also been used clinically to treat heart failure.
CoQ10 became more widely known with the growth in prescription numbers of statins: medications commonly used to lower cholesterol. Statins affect the production of cholesterol by acting on a substrate called mevalonate, which is integrally involved in the production of CoQ10. Statins stop the enzymatic conversion of mevalonate, thereby decreasing cholesterol, but also lowering CoQ10. This decrease of CoQ10 is what leads to the muscle damage and pain that can occur in some patients taking statins: While this isn’t a universal phenomenon, many physicians who prescribe statins will also recommend starting CoQ10 supplementation, as any muscle pain that does occur can be quite severe. I speak from experience: I felt this pain from low-dose statins that were prescribed to me about 10 years ago. The pain in my legs was severe enough to limit my walking and exercise. However, I overcame the issue by stopping statins and taking high doses of CoQ10. To this day, I have never tried another statin and I take ubiquinol daily.
Due to how statins block the enzymatic reaction and reduce CoQ10, supplementation does not affect the function or action of the statin. In other words, taking CoQ10 supplements does not block the benefits of a statin. They can and do work in synergy. For patients who cannot tolerate statins (such as myself), Functional Medicine offers a variety of methods other than statins to lower cholesterol.
Chronic inflammation is felt to be the basis of so many diseases, including diabetes, cardiovascular disease, chronic kidney disease, neurodegenerative diseases, and arthritis. The list is quite extensive. CoQ10, in addition to its importance in ATP production, plays a significant role in helping to combat chronic inflammation due to its antioxidant role and widespread presence throughout the body in the cell membrane, according to published research. For example, a meta-analysis of nine trials involving 428 subjects that were published in PLoS One in 2017 concluded that “CoQ10 supplementation may partly improve the process of an inflammatory state.” The meta-analysis by Chinese researchers noted that “chronic inflammation contributes to the onset and development of metabolic diseases,” and found CoQ10 supplementation decreased CRP (C – reactive protein), IL-6 (interleukin – six), and TNF alpha (tumor necrosis factor-alpha), all markers of inflammation in the body.
CoQ10 also suppresses oxidative damage of the lipoproteins that carry fats through our blood. Most people know these as triglycerides, and the “good” and “bad” cholesterol levels. An easy way to visualize the end result of oxidation of the lipoproteins is to consider the idea of rancid fat. This is obviously not something one wants circulating through our blood. Again, CoQ10 to the rescue!
Still, other studies have examined the clinical applications of CoQ10 for conditions other than cardiovascular disease, as detailed in several published studies that can be found on the U.S. National Library of Medicine’s website. Reduced levels of CoQ10 have been found in patients with fibromyalgia and Parkinson’s disease, and some research indicates supplementation has shown a delayed progression of symptoms for both of these conditions. For people with autism and Down syndrome, research indicates some benefits of CoQ10 supplementation. Conversely, however, CoQ10 supplementation doesn’t appear to aid in some neurodegenerative diseases, including Alzheimer’s and Huntington’s, despite the discovery of lower levels of CoQ10 in some patients, and it’s believed that may be due to the poor transport of CoQ10 across the blood-brain barrier. As well, people with Type 2 diabetes have lower levels of CoQ10. Supplementing with CoQ10 has been shown to reduce the amount of damage that high blood sugars can do, for example, decreasing blood vessel dysfunction in diabetics.
In summary, in detailing the clinical and biochemical aspects of CoQ10, it’s easy to see why this enzyme is of utmost importance because while produced naturally by our bodies, CoQ10 levels begin to decline at just age 20 and decrease as we age — when we need it the most.
So, who needs CoQ10?
You do.
Be well.
