CoQ10 – forms, functions and latest research

Coenzyme Q10 (commonly referred to as CoQ10) is a member of the ubiquinone family of compounds and is an important vitamin-like substance that is found in virtually all cell membranes, including mitochondrial membranes. Although CoQ10 is naturally produced by the body, levels decline with age and while a certain amount can be found in food, the amount generally is not enough to significantly increase levels.

In this week’s blog we will take a look at it’s important functions and how these relate to our health, the latest research, and steps we can take to increase levels in the body.

Background

CoQ10 was first identified in 1957 and is naturally produced in the mitochondria (energy cells) and present in most human cells to varying degrees. It is the areas of the body with a high metabolic rate such as the heart and the liver which have the highest levels, as these organs require the most energy. In 1978, Dr Peter Mitchell won the Nobel Prize in chemistry for his explanation of biological energy transfer and the importance of CoQ10 to the process.^1,2  

Functions

Acting as a cofactor in the synthesis of adenosine triphosphate, or ATP (the body’s primary energy currency), is the principal role of CoQ10 within the body. Without adequate CoQ10, cellular activities are at risk as the tissues and organs within the body require ATP to function. In its reduced form, CoQ10 also works as an important antioxidant, protecting the body from free radicals and consequent cell damage. It also assists in the regeneration of other potent antioxidants, such as vitamin E. Its importance has been demonstrated in relation to many conditions and it is also a popular nutrient in anti-ageing strategies .

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Factors that can affect CoQ10 levels

Concentration levels decline with age, although other factors can be at play and include:

• Certain vitamin deficiencies, such as vitamin B6
• Mitochondrial disease
• Genetic defects – inherited genetic mutations affecting synthesis and utilisation³
• Oxidative stress (alcohol, smoking, sun, poor diet)
• Chronic disease – diabetes, heart disease and cancer have been linked to low levels^1,3
• Certain medications – the use of cholesterol-lowering medications called statins are known to inhibit the biosynthesis of Co-enzyme Q10. CoQ10 production is controlled by the same pathway that controls cholesterol synthesis.

What signs may indicate a deficiency?

Although each of us is different and symptoms may be a result of other causes, signs of a CoQ10 deficiency to be mindful of include:

• Physical fatigue
• Muscle weakness
• Mental fatigue
• Difficulty concentrating
• Conditions linked to oxidative stress (heart disease, cancer, stroke) 

What does the research say about the benefits of CoQ10?

Although many of the following areas are interrelated, CoQ10 has been associated with a range of health conditions: 

CoQ10 and oxidative stress

Oxidative stress is the result of an imbalance between harmful free radicals and the supply of antioxidants. Free radicals can be highly reactive species that can damage biological molecules such as DNA, proteins, carbohydrates, and lipids¹ and although they are a natural by-product of some cellular reactions, many modern exposures (pollution, medications, alcohol, processed foods, caffeine) can increase the load, and increase the body’s antioxidant requirements. CoQ10 plays a significant role in preventing the generation of free radicals and thus reducing oxidative stress.

• In a recent meta-analysis, researchers found that the activity of glutathione peroxidase, superoxide dismutase, and catalase increased following supplementation with CoQ10 and there was a significant increase in total antioxidant capacity.²
• It is of no surprise therefore that reduced concentrations of CoQ10 have been found in many diseases associated with increased oxidative stress, such as heart disease, stroke, cancer and ageing.^3-5 

CoQ10 and ageing

As mitochondria are producers of energy for the regeneration of cells and tissues, low tissue levels of CoQ10 have been strongly associated with ageing.¹ In fact, one of the hallmarks of ageing is a decline in energy metabolism.

Reduction in CoQ10 is therefore believed to contribute to the subsequent degeneration of energy demanding organs such as the liver, heart and skeletal muscles. In a meta-analysis carried out last year, it was found that CoQ10 supplementation decreased all-cause mortality events.²

The skin is the body’s largest organ and a reduction in CoQ10 leaves it more susceptible to damage from free radicals which can impact us aesthetically in the form of wrinkles, loss of radiance and skin tone. CoQ10 also provides skin cells with the energy needed for repair and regeneration. Benefits of CoQ10 in relation to skin ageing include:³

• Maintenance of the dermal matrix
• Protection against the degradation of collagen fibres by the enzyme collagenase
• Antioxidant protection against the oxidative effects of UVA
• Protection of keratinocytes

Studies show improved skin outcomes after supplementing with CoQ10.⁴ 

CoQ10 and heart health

CoQ10 may help to minimise the vascular damage induced by free radicals and the activation of inflammatory signalling pathways.¹ 

• Lipid profiles: A meta-analysis last year showed that CoQ10 supplementation decreased total cholesterol, LDL-C, and triglyceride levels, and increased HDL-C levels in adults.²
• Heart failure: Heart failure occurs due to failure of the heart to pump adequately.³ CoQ10 increases the electron transfer in the mitochondrial respiratory chain and exerts anti-inflammatory and antioxidant effects. These effects improve the endothelial function and reduce afterload, which facilitates the heart pumping function. One systematic review and meta-analysis found that the decrease in the risk of heart failure associated with CoQ10 treatment was significant.⁴
• Statins: statin drugs inhibit one of the key steps in CoQ10 synthesis and as such, use of these drugs has been associated with a reduction in serum and muscle tissue CoQ10 levels. It has been shown that supplementing with CoQ10 could mitigate some of the negative side effects of this.⁵
• Cardiovascular disease (CVD), atherosclerosis and hypertension: By lowering lipid peroxidation of LDL particles that contributes to atherosclerosis, CoQ10 confers health benefits against cardiovascular diseases. In a 2022 systematic review of predominantly older adult males with CVD and hypertension, CoQ10 supplementation added to conventional therapy was shown to be safe and offered benefits clinically and at the cellular level.⁶

CoQ10 and energy

• Fatigue: A systematic review of interventional studies found significant beneficial effects of CoQ10 supplementation on fatigue status among fibromyalgia, statin-related fatigue, multiple sclerosis and end-stage heart failure subjects.¹
• Physical activity: Considering the role of CoQ10 in key parameters related to exercise performance such as energy production and antioxidant activity, it is no surprise that several studies have found an association between CoQ10 levels and physical performance.² Antioxidants are also important to hasten recovery from fatigue and to prevent exercise damage. 

CoQ10, metabolic syndrome and diabetes

Diabetes is a condition of increased oxidative stress and impaired energy metabolism and CoQ10 has been proposed in the management of diabetes and metabolic syndrome.

• A systematic review and meta-analysis assessed the antidiabetic effect of nutrients including CoQ10 as an add-on in type 2 diabetes patients. Administration of chromium, CoQ10, and vitamins C and E were shown to significantly improved glycaemic control.¹
• In further research, supplementation with CoQ10 showed an enhanced potential to lower cardiovascular risk in diabetic patients.²
• CoQ10 has shown improvements in lipid profile, glucose control, insulin homeostasis and hypertension control in Metabolic syndrome patients.³

CoQ10 and brain health

Several nutrients including CoQ10 may target neurobiological pathways perturbed in diseases affecting the brain such as inflammation, oxidative stress, and mitochondrial dysfunction.¹ Mitochondrial dysfunction, for example, has been associated with the onset and/or development of neurodegenerative diseases such as Parkinson’s disease, Alzheimer’s disease and Huntington’s disease.² 

How to increase CoQ10?

Supplementation

Both ubiquinone and ubiquinol are effective isomers of CoQ10 supplementation. Hundreds of scientific studies have shown that ubiquinone promotes energy production and neutralises free radicals and this form has been used in the vast majority of clinical trials.

Increase CoQ10 containing foods

Small amounts of CoQ10 are present in foods and as it is fat-soluble it is best absorbed with fat in a meal. Foods include:

• Meat (since CoQ10 is mainly found in high energy-demanding tissues, animal hearts and livers represent the richest sources)
• Oily fish
• Poultry
• Eggs
• Nuts and seeds
• Vegetables (spinach, broccoli, cabbage, cauliflower)
• Dairy

The average dietary intake of CoQ10 is estimated to be around 3-6mg/day.¹ While there is no specific recommended dietary intake for CoQ10, levels between 50-100mg are typically recommended to those who are older or have a condition which may benefit from CoQ10.

Antioxidants

Oxidative stress caused by lifestyle factors such as excessive alcohol, smoking, and processed food can negatively affect levels of CoQ10 so minimising these and upping your intake of antioxidant-rich foods can be of benefit. While our bodies naturally produce some antioxidants, certain foods are the best way to ensure you’re getting enough. Eating a rainbow diet is a good way to ensure an abundance of antioxidants. Aim to include plenty of red, green, yellow, orange and purple fruits and vegetables. 

Note: Although CoQ10 supplements are relatively safe, it is recommended to check any medications and contraindications before use.

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CoQ10 References: 

Background, Functions and Factors

1. Saini R. (2011). Coenzyme Q10: The essential nutrient. Journal of pharmacy & bioallied sciences, 3(3), 466–467.
2. Q10facts Home. Available at: https://www.q10facts.com/ (Accessed: 6 January 2023)
3. Coenzyme Q10, Linus Pauling Institute. [online] Available at: https://lpi.oregonstate.edu/mic/dietary-factors/coenzyme-Q10 

Oxidative Stress

1. Lobo, V., Patil, A., Phatak, A., & Chandra, N. (2010). Free radicals, antioxidants and functional foods: Impact on human health. Pharmacognosy reviews, 4(8), 118–126.
2. Sangsefidi, Z. S. (2020). The effect of coenzyme Q10 supplementation on oxidative stress: A systematic review and meta-analysis of randomized controlled clinical trials. Food science & nutrition, 8(4), 1766–1776.
3. Simani, L. (2018). Serum Coenzyme Q10 Is Associated with Clinical Neurological Outcomes in Acute Stroke Patients. Journal of molecular neuroscience : MN, 66(1), 53–58.
4. Sharma, A. et al. (2016) ‘Coenzyme Q10 and Heart Failure’, Circulation: Heart Failure, 9(4).
5. Shidal, C. et al. (2021) ‘Prospective study of plasma levels of coenzyme Q10 and lung cancer risk in a low-income population in the Southeastern United States’, Cancer medicine, 10(4), pp. 1439–1447.

Ageing

1. Ayunin, Q., (2022). Improving the anti-ageing activity of coenzyme Q10 through protransfersome-loaded emulgel. Scientific reports, 12(1), 906.
2. An, P., Wan, S. (2022). Micronutrient Supplementation to Reduce Cardiovascular Risk. Journal of the American College of Cardiology, 80(24), 2269–2285.
3. Hoppe, U., (1999). Coenzyme Q10, a cutaneous antioxidant and energizer. BioFactors (Oxford, England), 9(2-4), 371–378.
4. Žmitek, K. (2020). Effects of a Combination of Water-Soluble CoenzymeQ10 and Collagen on Skin Parameters and Condition: Results of a Randomised, Placebo-Controlled,Double-Blind Study. Nutrients, 12(3), 618. 

Heart Health

1. Cicero, A. F. G., (2022). Noninvasive instrumental evaluation of coenzyme Q₁₀ phytosome on endothelial reactivity in healthy nonsmoking young volunteers: A double-blind, randomized, placebo-controlled crossover clinical trial. BioFactors (Oxford, England), 48(5), 1160–1165.
2. Liu, Z. (2022). Effects of Coenzyme Q10 Supplementation on Lipid Profiles in Adults: A Meta-analysis of Randomized Controlled Trials. The Journal of clinical endocrinology and metabolism, 108(1), 232–249.
3. DiNicolantonio, J.J. et al. (2015) ‘Coenzyme Q10 for the treatment of heart failure: a review of the literature’, Open Heart, 2(1), p. e000326.
4. Mareev, V. Y., (2022). Kardiologiia, 62(6), 3–14.
5. Skarlovnik A, et al (2014) ‘Coenzyme Q10 supplementation decreases statin-related mild-to-moderate muscle symptoms: a randomized clinical study.’ Med Sci Monit, 20, pp. 2183-2188.
6. Sue-Ling. (2022). Coenzyme Q10 as Adjunctive Therapy for Cardiovascular Disease and Hypertension: A Systematic Review. The Journal of nutrition, 152(7), 1666–1674. 

Energy

1. Mehrabani, S. et al. (2019) ‘Effect of coenzyme Q10 supplementation on fatigue: A systematic review of interventional studies’, Complementary therapies in medicine, 43, pp. 181–187.
2. Drobnic, F. (2022). Coenzyme Q₁₀Supplementation and Its Impact on Exercise and Sport Performance in Humans: A Recovery or a Performance-Enhancing Molecule?. Nutrients, 14(9), 1811.

Metabolic syndrome

1. Kim, Y., (2022). Could nutrient supplements provide additional glycemic control in diabetes management? A systematic review and meta-analysis of randomized controlled trials of as an add-on nutritional supplementation therapy. Archives of pharmacal research, 45(3), 185–204.
2. Dludla, P. V (2020). The impact of coenzyme Q₁₀on metabolic and cardiovascular disease profiles in diabetic patients: A systematic review and meta-analysis of randomized controlled trials. Endocrinology, diabetes & metabolism, 3(2), e00118.
3. Abdul-Ghani MA, DeFronzo RA (2008) Mitochondrial dysfunction, insulin resistance, and type 2 diabetes mellitus. Curr Diab Rep 8(3):173–178. 

Brain health

1. Ashton, M. (2021). A Systematic Review of Nutraceuticals for the Treatment of Bipolar Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 66(3), 262–273.
2. Arun S, et al (2016) ‘Mitochondrial Biology and Neurological Diseases.’ Curr Neuropharmacol, 14(2), pp. 143-154. 

CoQ10 and food

1. Pravst, I., Zmitek, K., & Zmitek, J. (2010). Coenzyme Q10 contents in foods and fortification strategies. Critical reviews in food science and nutrition, 50(4), 269–280.

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If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.

nutrition@cytoplan.co.uk
01684 310099

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Last updated on 8th February 2023 by cytoffice