CoQ10 Under the Spotlight
There is a plethora of research on Coenzyme Q10, the form and the dose, the time frame in which optimal serum levels are reached and how those levels are tested. How do practitioners navigate this to determine the best dose and form for their patients?
Recently, researchers tested seven formulations and found that the two most absorbable forms were soft-gel capsules containing Ubiquinone and Ubiquinol.1 You might think that this was a given, since these are the two most widely available forms. What is interesting is that the paper concluded that it is not the form but the carrier (lipid carriers are best) and individual characteristics (such as age, BMI and pathology) of the patient that have the most impact on bioavailability.1
Understanding the Pharmacokinetics
In healthy enterocytes, Ubiquinone is converted to Ubiquinol, then is primarily bound to VLDL and LDL cholesterol for transport into systemic circulation via the lymphatic system.2,3 Therefore serum levels of CoQ10 largely depend on the amount of CoQ10-containing lipoproteins in circulation.3 After incorporation into lipoproteins in the liver, CoQ10 is subsequently concentrated in various tissues (adrenal glands, spleen, kidneys, lungs and the myocardium).3 In the Electron Transport Chain, CoQ10 converts between the reduced form (Ubiquinol) to the oxidised form (Ubiquinone) and back again as it receives and transfers electrons.4 Also, serum CoQ10 levels peak 5-10 hours after ingestion5 and research measuring overall CoQ10 levels outside this time frame may be missing statistically relevant information.
Other factors such as physical activity markedly reduce muscle tissue levels which do not correlate to serum levels, suggesting that tissue levels and serum levels are independently regulated.3
Ubidecarenone Effectively Increases Serum CoQ10
It is worth noting that while serum levels provide a useful guide, caution still needs to be applied to their interpretation. Serum levels should only be regarded as a surrogate for tissue, with mitochondrial levels, in particular, being the most important measure of CoQ10 status.6 The adult reference range for plasma CoQ10 is approximately 0.5 – 1.7 μmol/L or 0.8 to 1 mg/mL, however, optimal levels may vary for addressing specific conditions (e.g. 2.78 μmol/L for congestive heart failure).7
Study results show:
- 90mg of CoQ10 in powder form raised baseline plasma levels from 1.080 μmol/L to 2.890 μmol/L after 2 months of supplementation.6
- 100mg of CoQ10 in an oil suspension increased serum CoQ10 levels to 2.930 μmol/L after 2 months of supplementation.6
- When the dose of the oil suspension was raised to 300mg, the plasma levels increased to 3.764 μmol/L after 4 weeks.6
These results suggest that just 100mg of Ubiquinone, a dose found in many common, and more affordable, CoQ10 supplements, can raise serum CoQ10 levels to a concentration that research suggests is sufficient for a beneficial effect in a variety of conditions including cardiovascular disease, statin induced myopathy, and infertility.7,8,9,10
Clinical Outcomes vs Cost
The price of CoQ10 can vary dramatically, with some products still costing up to two and a half times more than others. Finding a balance between therapeutic effectiveness of a given nutrient and price is often a key influencing factor affecting many clinicians’ choice of supplements.
The research on Ubiquinol is interesting, however, Ubiquinone has been validated for more than 30 years in both research and clinical practice. The Q-SYMBIO study, the largest CoQ10 study to date, demonstrated a 50% reduction in mortality rates from congestive heart failure using the affordable and humble oil-based Ubidecarenone (Ubiquinone) form.7
Take Home Message
The answer to the question we raised at the start is to assess each patients’ individual needs.
- Will a product raise serum CoQ10 levels sufficiently enough to be of therapeutic value but not be a waste of money on unsubstantiated high doses?
- Is the speed at which serum CoQ10 levels raise clinically significant for specific clinical presentations?
- Is CoQ10 just one part of a bigger clinical picture that requires several nutrients and synergistic action to achieve positive treatment outcomes?
- For example, the combination of Alpha Lipoic Acid and CoQ10 may have a significantly stronger synergistic effect on increasing Peroxisome proliferator-activated receptor gamma coactivator-1 (PGC1α), improving stress response and increasing cellular glutathione levels.11
- López-Lluch G, del Pozo-Cruz J, Sánchez-Cuesta A, Cortés-Rodríguez AB, Navas P. Bioavailability of coenzyme Q10 supplements depends on carrier lipids and solubilization. Nutrition. 2019;57:133-140. doi:10.1016/j.nut.2018.05.020
- Juan Garrido-Maraver, Mario D. Cordero MO-A et al. Coenzyme Q10 Therapy. Mol Syndromol. 2014;5(3-4):187-197. doi:10.1159/000360101
- Cohen LB and M. Herbs and Natural Supplements: An Evidence-Based Guide. 4th ed. (Arthur R, Fox G, McEwen B, Oates L, Tiralongo E, Zylan L, eds.). Chatswood, NSW: Churchill Livingstone/Elsevier Australia; 2015.
- Casagrande D, Waib PH, Jordão Júnior AA. Mechanisms of action and effects of the administration of Coenzyme Q10 on metabolic syndrome. J Nutr Intermed Metab. 2018;13(August):26-32. doi:10.1016/j.jnim.2018.08.002
- Natural Medicines Database. Coenzyme Q10 Monograph. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=938. Published 2019. Accessed April 10, 2019.
- Bhagavan HN, Chopra RK. Plasma coenzyme Q10 response to oral ingestion of coenzyme Q10 formulations. Mitochondrion. 2007;7(SUPPL.):s78-s88. doi:10.1016/j.mito.2007.03.003
- Mortensen SA, Rosenfeldt F, Kumar A, et al. The effect of coenzyme Q10on morbidity and mortality in chronic heart failure: Results from Q-SYMBIO: A randomized double-blind trial. JACC Hear Fail. 2014;2(6):641-649. doi:10.1016/j.jchf.2014.06.008
- Qu H, Guo M, Chai H, Wang WT, Ga ZY, Shi DZ. Effects of coenzyme Q10 on statin-induced myopathy: An updated meta-analysis of randomized controlled trials. J Am Heart Assoc. 2018;7(19):1-11. doi:10.1161/JAHA.118.009835
- Majzoub A, Agarwal A. Systematic review of antioxidant types and doses in male infertility : Benefits on semen parameters , advanced sperm function , assisted reproduction and live-birth rate. Arab J Urol. 2018;16(1):113-124. doi:10.1016/j.aju.2017.11.013
- Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: A randomized controlled trial. Reprod Biol Endocrinol. 2018;16(1):1-11. doi:10.1186/s12958-018-0343-0
- Wagner AE, Ernst IMA, Birringer M, Sancak Ö, Barella L, Rimbach G. A combination of lipoic acid plus coenzyme Q10 induces PGC1α, a master switch of energy metabolism, improves stress response, and increases cellular glutathione levels in cultured C2C12 skeletal muscle cells. Oxid Med Cell Longev. 2012;2012. doi:10.1155/2012/835970