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Coenzyme Q10

Introduction

Coenzyme Q10 (CoQ10) is an essential component of the mitochondria – the
energy producing unit of the cells of our body. CoQ10 is involved in the
manufacture of ATP, the energy currency of all body processes. A good
analogy for CoQ10’s role is similar to the role of a spark plug in a car
engine. Just as the car cannot function without that initial spark, the
human body cannot function without CoQ10.

Although CoQ10 can be synthesized within the body, there are a number
of circumstances where the body simply does not make sufficient amounts.
As the heart is one of the most metabolically active tissues in the
body, a CoQ10 deficiency affects the heart the most and can lead to
serious problems there. Deficiency could be a result of impaired CoQ10
synthesis due to nutritional deficiencies, a genetic or acquired defect
in CoQ10 synthesis, or increased tissue needs. Examples of diseases that
require increased tissue levels of CoQ10 are primarily heart and
vascular diseases including high cholesterol levels and high blood
pressure. In addition, people over the age of 50 may have increased
CoQ10 requirements as CoQ10 levels are known to decline with advancing
age.

Are there food sources of CoQ10?

Yes, but the level of CoQ10 in food is relatively low.1 For example, the
typical daily intake of CoQ10 from dietary sources is only about 3-5 mg
per day – nowhere near the level required to significantly raise blood
and tissue levels when CoQ10 supplementation is needed. Meat, poultry
and fish provide the majority of dietary CoQ10.

What are the principal uses of
CoQ10?


CoQ10 supplementation is used primarily in the treatment of
cardiovascular diseases such as elevated cholesterol levels, high blood
pressure, congestive heart failure, cardiomyopathy, mitral valve
prolapse, coronary artery bypass surgery, and angina. Considerable
scientific studies have validated these uses.2-4 CoQ10 has also been
shown to be helpful in diabetes; periodontal disease; immune deficiency;
cancer; as a weight-loss aid; and muscular dystrophy. Since the response
of CoQ10 can take time, a noticeable improvement might not occur until 8
or more weeks after therapy is begun.

How does CoQ10 improve heart
function?


By improving energy production in the heart muscle and by acting as an
antioxidant.5,6 The therapeutic use of CoQ10 in cardiovascular disease
has been clearly documented in both animal studies and human trials.
CoQ10 deficiency is common in patients with heart disease. Biopsy
results from heart tissue in patients with various cardiovascular
diseases showed a CoQ10 deficiency in 50-75% of cases.6 Correction of a
CoQ10 deficiency can often produce dramatic clinical results in patients
with any kind of heart disease.7-11

Can CoQ10 lower blood pressure?

Yes. CoQ10 deficiency has been shown to be present in 39% of patients
with high blood pressure. This finding alone suggests a need for CoQ10
supplementation. However, CoQ10 appears to provide benefits beyond
correction of a deficiency. In several studies CoQ10 has actually been
shown to lower blood pressure in patients with hypertension.12-14 The
effect of CoQ10 on blood pressure is usually not seen until after 4-12
weeks of therapy. Typical reductions in both systolic and diastolic
blood pressure with CoQ10 therapy in patients with high blood pressure
are in the 10% range.

How does CoQ10 help periodontal
disease?


Periodontal disease (gum disease) affects 60% of young adults and 90% of
individuals over age 65. Healing and repair of periodontal tissue
requires efficient energy production, a metabolic function dependent on
an adequate supply of CoQ10. CoQ10 deficiency has been reported in
gingival tissue of patients with periodontal disease.15-17 The frequency
of CoQ10 deficiency in several studies ranged from 60 to 96%. The
beneficial effect of CoQ10 in periodontal disease may be the result of
an improvement in the energy-dependent processes of healing and tissue
repair.14

How does CoQ10 boost the immune
system?


Tissues and cells involved with immune function are highly
energy-dependent and therefore require an adequate supply of CoQ10 for
optimal function. Several studies have documented an immune-enhancing
effect of CoQ and a benefit in cancer patients.18-20 Also, CoQ10 should
definitely be used by cancer patients taking any chemotherapy drug that
is associated with heart toxicity (e.g., adriamycin, athralines,
etc.).21

Since CoQ10 is needed for the
burning of fat, can it promote weight loss?


Yes. Since CoQ10 is an essential cofactor for energy production, it is
possible that CoQ10 deficiency is a contributing cause of some cases of
obesity. Serum coenzyme Q10 levels were found to be low in 52% of the
obese subjects tested.22 When the subjects with low CoQ10 levels were
given 100 mg/day of CoQ10 significant weight loss was achieved.

What is the best form of CoQ10?

Coenzyme Q10 is available primarily in tablet or capsules. Based on
bioavailability studies, the best preparations appear to be soft-gelatin
capsules that contain CoQ10 in an oil base or in a soluble form.23-25 In
order to further enhance absorption, CoQ10 should be taken with food.

My personal belief is that the best form of CoQ10 on the market is
Clear Q™ by Natural Factors. In order to enhance the absorption and
utilization of CoQ10, some manufacturers have looked to synthetic
compounds to enhance the solubility of CoQ10. Instead of following this
approach, Natural Factors has chosen to utilize nature instead. Using a
patent pending process known as Lipcom® (short for lipid compression),
they dissolved CoQ10 in the purest form of natural vitamin E (Clear Base™
Vitamin E; pure, 100% natural d-alpha tocopheryl acetate). The result is
that the CoQ10 is biologically enhanced due to increased absorption,
utilization, and function. In a preliminary study, blood levels of CoQ10
at six hours after taking Clear Q produced an increase that was 235%
greater than the increase achieved with standard CoQ10. Equally
impressive is the fact that blood levels of CoQ10 after six hours from
taking a loading dosage of Clear Q can reach above 2.5 mcg/ml –
considered the blood level required in order to achieve consistent
results with CoQ10.

By providing the CoQ10 dissolved in the vitamin E, absorption is not
only enhanced, but also the likelihood that the CoQ10 will remain in its
active form. CoQ10 is present in the blood in both oxidized (inactive)
and reduced (active) form. During times of increased oxidative stress or
low vitamin E levels, more CoQ10 will be converted to its oxidized
(inactive form). Thus, by providing high levels of pure vitamin E the
biological activity and function of CoQ10 is enhanced. In addition, the
CoQ10 actually enhances vitamin E activity as well.26-28

How much CoQ10 should I take?

While the usual dosage recommendation for CoQ10 is 50 to 150 mg/day,
there are a lot of variables to consider when trying determining whether
this amount is really ideal. First of all, as mentioned above it appears
that the ultimate judge of whether CoQ10 is going to be effective is
whether or not CoQ10 blood levels rise above 2.5 mcg/ml and are
maintained at this level for a prolonged period. Since the normal blood
level for CoQ10 is roughly 1 mcg/ml, it is often difficult to achieve
this therapeutic blood level especially if using poorly absorbed forms
of CoQ10. Here are my recommendations for getting the most out of CoQ10.

Use Clear Q™ – take a loading dosage of four capsules with a meal.
This loading dosage will provide 200 mg CoQ10 and 1600 IU vitamin E. If
you use another CoQ10 product, I would recommend that it be in a soft
gelatin capsule and that you take 300 mg of CoQ10 as a loading dosage
and be sure that the meal includes at least one tablespoon of oil (salad
dressing, olive oil, flaxseed oil, peanut butter, etc.). After the
loading dosage, I would recommend taking two capsules of Clear Q™ for
one week followed by a maintenance dosage of one capsule of Clear Q™
daily thereafter for people weighing up to 250 pounds; and two capsules
per day for people over 250 pounds.

Is CoQ10 safe?

Coenzyme Q10 is very safe and there have been no serious adverse effects
ever reported even with long-term use. Because safety during pregnancy
and lactation has not been proven, CoQ10 should not be used during these
times unless the potential clinical benefit (as determined by a
physician) outweighs the risks.

Does CoQ10 interact with any drugs?

There are no known adverse interactions between CoQ10 and any drug or
nutrient. While there are no adverse drug interactions many drugs
adversely affect CoQ10 levels or CoQ10 is able to reduce the side
effects of the drug. In addition to adriamycin (discussed above), CoQ10
supplementation has been shown to counteract some of the adverse effects
of certain cholesterol-lowering, beta-blocker, and psychotrophic drugs.

The drugs lovastatin (Mevacor), pravastin (Pravachol), atorvastatin (Lipitor)
and simvastatine (Zocor) are widely used to lower blood cholesterol
levels. They work by inhibiting the enzyme (HMG CoA reductase) that is
required in the manufacture of cholesterol in the liver. Unfortunately,
in doing so these drugs also block the manufacture of other substances
necessary for body functions including CoQ10. Supplementing CoQ10 (50 mg
per day) is necessary to prevent the depletion of CoQ10 in body tissues
while on these drugs.29

References:

  1. Weber C. Bysted A, and Holmer G: The coenzyme Q10 content of the
    average Danish diet. Int J Vit Nutr Res 1997;67:123-9.

  2. Gaby AR. The role of coenzyme Q10 in clinical medicine: part II.
    Cardiovascular disease, hypertension, diabetes mellitus and
    infertility. Alt Med Rev 1996;1:168-75

  3. Thomas SR, Witting PK, Stocker R: A role for reduced coenzyme Q in
    atherosclerosis? Biofactors. 1999;9:207-24.

  4. Overvad K, et al.: Coenzyme Q10 in health and disease. Eur J Clin
    Nutr. 1999;53:764-70.

  5. Weber C, et al.: Effect of dietary coenzyme Q10 as an antioxidant
    in human plasma. Mol Aspects Med 1994;15 (Suppl.):s97-102.

  6. Folkers K, Vadhanavikit S and Mortensen SA: Biochemical rationale
    and myocardial tissue data on the effective therapy of
    cardiomyopathy with coenzyme Q10. Proc Natl Acad Sci 1985;82:901.

  7. Langsjoen H, et al.: Usefulness of coenzyme Q10 in clinical
    cardiology: a long-term study. Mol Aspects Med
    1994;15(Suppl.):s165-75.

  8. Hofman-Bang C, Rehnquist N, and Swedberg K: Coenzyme Q10 as an
    adjunctive treatment of congestive heart failure. J Am Coll Cardiol
    1992;19:216A.

  9. Morisco C, Trimarco B and Condorelli M: Effect of coenzyme Q10
    therapy in patients with congestive heart failure: a long-term
    multicenter randomized study. Clin Investig 1993;71(Suppl.8):S134-6.

  10. Baggio E, et al.: Italian multicenter study on the safety and
    efficacy of coenzyme Q10 as adjunctive therapy in heart failure.
    CoQ10 Drug Surveillance Investigators. Mol Aspects Med
    1994;15(Suppl.):s287-94.

  11. Kamikawa T, et al.: Effects of coenzyme Q10 on exercise tolerance
    in chronic stable angina pectoris. Am J Cardiol 1985;56:247.

  12. Digiesi V, et al.: Mechanism of action of coenzyme Q10 in
    essential hypertension. Curr Ther Res 1992;51:668-72.

  13. Langsjoen P, et al.: Treatment of essential hypertension with
    coenzyme Q10. Mol Aspects Med 1994;15(Suppl.):S265-72.

  14. Digiesi V, et al.: Coenzyme Q10 in essential hypertension. Mol
    Aspects Med 1994;15(Suppl.):s257-63.

  15. Nakamura R, Littarru GP, Folkers K. Deficiency of coenzyme Q in
    gingiva of patients with periodontal disease. Int J Vitam Nutr Res
    1973;43:84-92.

  16. Wilkinson EG, et al.: Bioenergetics in clinical medicine. VI.
    Adjunctive treatment of periodontal disease with coenzyme Q10. Res
    Commun Chem Pathol Pharmacol 1976;14:715-9.

  17. Hanioka T, et al.: Effect of topical application of coenzyme Q10
    on adult periodontitis. Mol Aspects Med 1994;15(Suppl):S241-8.

  18. Folkers K, et al.: Increase in levels of IgG in serum of patients
    treated with coenzyme Q10. Res Comm Pathol Pharmacol 1982;38:335-8.

  19. Lockwood K, Moesgaard S, Folkers K. Partial and complete
    regression of breast cancer in patients in relation to dosage of
    coenzyme Q10. Biochem Biophys Res Comm 1994;199:1504-8.

  20. Lockwood K, Moesgaard S, Yamamoto T, Folkers K. Progress on
    therapy of breast cancer with vitamin Q10 and the regression of
    metastases. Biochem Biophys Res Comm 1995;212:172-7.

  21. Iarussi D, et al.: Protective effect of coenzyme Q10 on
    anthracyclines cardiotoxicity: control study in children with acute
    lymphoblastic leukemia and non-Hodgkin lymphoma. Mol Aspects Med
    1994;15(Suppl.):s207-12.

  22. van Gaal L, de Leeuw ID, Vadhanavikit S, and Folkers K:
    Exploratory study of coenzyme Q10 in obesity. In: Folkers K,
    Yamamura Y, eds: Biomedical and Clinical Aspects of Coenzyme Q, Vol
    4. Elsevier Science Publ, Amsterdam, 1984. pp369-73.

  23. Weiss M, et al.: Bioavailability of four oral coenzyme Q10
    formulations in healthy volunteers. Molec Aspects Med
    1994;15:273-80.

  24. Chopra RK, et al.: Relative bioavailability of coenzyme Q10
    formulations in human subjects. Internat J Vit Nutr Res
    1998;68:109-13.

  25. Malqvist ML, et al.: Bioavailability of two different formulations
    of coenzyme Q10 in healthy subjects. Asia Pacific J Clin Nutr
    1998;7:37-40.

  26. Zhang Y, Turunen M, and Appelkvist EL: Restricted uptake of
    dietary coenzyme Q is in contrast to the unrestricted uptake of
    alpha-tocopherol into rat organs and cells. J Nutr 1996;126:2089-97.

  27. Ibrahim WH, et al.: Dietary coenzyme Q10 and vitamin E alter the
    status of these compounds in rat tissues and mitochondria. J Nutr
    2000;130:2343-8.

  28. Kaikkonen J, et al.: Antioxidative efficacy of parallel and
    combined supplementation with coenzyme Q10 and d-alpha-tocopherol in
    mildly hypercholesterolemic subjects: a randomized
    placebo-controlled clinical study Free Radic Res 2000;33:329-40.

  29. Bargossi AM, et al.: Exogenous CoQ10 supplementation prevents
    plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors.
    Mol Aspects Med 1994;15(Suppl.):s187-93.