CoQ10 – forms, functions and latest research

There are some supplements which may be helpful for a specific ailment or condition and others which could provide benefit to many – hello probiotics and omega-3! While often considered less frequently than these, CoQ10 stands firmly in the ‘universal benefit’ category.

Coenzyme Q10 (commonly referred to as CoQ10) is an antioxidant which although many have heard of, some may not fully understand all of its unique and important roles within the body.

CoQ10 is required by almost every single cell in the body to support growth and maintenance. As an antioxidant, it also works to protect cells from the effects of ageing – no surprise then that it has been a popular ingredient in anti-ageing cosmetics for several years.

Commonly understood for its role both as an antioxidant and a key player in energy production, CoQ10 is naturally produced by the body. With that said, this process can be inconsistent, with levels of CoQ10 declining with age.

A plethora of research has demonstrated the importance of CoQ10 in relation to several conditions, including heart health, brain function and even fertility. While a certain amount of CoQ10 can be found in food, the amount generally is not enough to significantly increase levels within the body.

Skip to Key Takeaways

What exactly is CoQ10?

CoQ10 was first discovered in 1940 and successfully extracted from the mitochondria of a beef heart in 1957. Since then, several terms have been used to refer to this compound; from coenzyme Q, CoQ and vitamin Q10, to the more frequently used CoQ10, ubiquinone and ubiquinol. There are actually several types of coenzyme Q in the body including coenzyme Q9 or Q3, distinguished by their structure. CoQ10 is the most common and is naturally produced in the mitochondria (energy cells) and present in most human cells to varying degrees. It is in 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.

Acting as a co-factor 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.

What is the difference between ubiquinone and ubiquinol?

There are two forms of CoQ10 commonly available in supplements: ubiquinone and ubiquinol. The term ubiquinone and CoQ10 can be used interchangeably as they both refer to the inactive form. Ubiquinone is the oxidised form of CoQ10 and must be reduced to ubiquinol in order to carry out a number of tasks in the body.

When CoQ10 or ubiquinone is ingested, it should be converted into ubiquinol in the mitochondria, however this process of conversion is not always 100% effective.

Why choose ubiquinol?

During early childhood the body can quite effectively convert ubiquinone into ubiquinol, reaching a peak at about age 20 and slowly beginning to decline thereafter.1 For this reason, while ubiquinone may suffice when you are younger, ubiquinol is the more bio-effective choice of supplement for most individuals.

Further to this, there are genetic factors to consider. NAD(P)H Quinone Dehydrogenase 1 (NQO1) is an enzyme which plays an important role in the conversion of ubiquinone into ubiquinol and is encoded for by the NQO1 gene.2 A particular SNP (single nucleotide polymorphism) or variation in the NQO1 gene can impact how well an individual can make this conversion. Therefore, those who do have this genetic tendency could benefit greatly from the ubiquinol form of CoQ10.

What does the research say about the benefits of CoQ10?

Antioxidant activity

As one of the few fat-soluble antioxidants in the body, CoQ10 plays a significant role in preventing the generation of free radicals (damage causing molecules produced in the body), thus reducing oxidative stress. It is no surprise then that the concentrations of CoQ10 in the body have been found to be reduced in many disease conditions connected with increased generation and action of reactive oxygen species, such as heart disease, stroke, cancer and even the ageing process.3,4

Free radicals are a natural by-product of some cellular reactions, however many modern exposures such as to pollution, medications, alcohol, processed foods and caffeine can increase free radical load in an individual, thus also increasing the body’s antioxidant requirements in order to neutralise their damage.

Energy production

Our body’s ability to process and use the energy from our food is just as, if not even more, important than the food itself. While consuming a diet of high nutrient density is important, if our system is not functioning correctly, then conversion of macronutrients into energy will not be effective. This is where CoQ10 comes in.

Energy production takes place in the mitochondria, organelles withincells where food and oxygen are converted into ATP (the primary energy molecule in the body). CoQ10 is critical for supporting these mitochondrial processes as it is required for the transport of the electrons which allow this complex network of enzymes to work and produce ATP – so without CoQ10, the body cannot make this vital source of energy.

Heart Health

  •   Heart disease: there is research to suggest that those with congestive heart failure might have low levels of CoQ10. One study found that taking CoQ10 within three days of having a heart attack improved functional capacity of the heart and reduced the likelihood of a recurrence.5 As well as this, a strong association between CoQ10 intake and improved survival rate was discovered in a systematic review of CoQ10 in patients with heart failure. When taken in combination with other nutrients, CoQ10 also led to a reduction in recovery time following bypass or other heart surgeries.6
  • Blood Pressure: 60mg of CoQ10 taken across twelve weeks was able to effectively reduce the average blood pressure in individuals with hypertension.7
  •   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, particularly as it pertains to muscle weakness commonly experienced by patients using statins.8,9

Anti-ageing

It has been established that ATP, the body’s energy molecule, is critical for the maintenance of several functions; from sustaining muscle and bone strength to supporting metabolism and the health of skin cells. With the central role played by CoQ10 in the synthesis of ATP, it is no surprise then that low tissue levels of CoQ10 have been strongly associated with ageing. This reduction in CoQ10 leaves the body more susceptible to damage caused by free radicals which not only impacts us aesthetically, but it is also believed to contribute to declines in energy metabolism and degeneration of organs such as liver, heart and skeletal muscles.

Fertility

There is some evidence to suggest that CoQ10 may improve semen quality and sperm count in men with infertility.10,11 A meta-analysis investigating the effect of CoQ10 on male infertility concluded that supplementation resulted in a global improvement in sperm parameters including seminal and sperm concentration and sperm motility.12

CoQ10 may also have a positive effect on female fertility. A 2018 RCT study found that CoQ10 supplementation improved both the ovarian response and embryo quality in young women with decreased ovarian reserve undergoing IVF.13 Compared to the control, women in the CoQ10 group showed a significant increase in number of retrieved oocytes (immature eggs), higher fertilisation rate and increased number of high-quality embryos. Furthermore, fewer cancellations for embryo transfer due to poor embryo development were made by women in the CoQ10 group.

We know that fertility levels naturally decline with reproductive age, however the exact mechanisms behind this are not yet fully understood. In 2015, researchers investigated the role of mitochondrial dysfunction (associated with decreased capacity for CoQ10 production) as a factor in reproductive ageing. Diminished expression of Pdss2 and Coq6 (the enzymes responsible for CoQ10 production) were observed in the oocytes of older human and animal females.14 Researchers then went a step further and found that the administration of CoQ10 to these subjects reduced the mitochondrial factors contributing to premature ovarian failure.

Improved physical performance

Considering the role of CoQ10 in key parameters related to exercise performance such as energy production and antioxidant activity,15 it is no surprise that several studies have found an association between CoQ10 levels and physical performance. Two weeks of CoQ10 supplementation resulted in higher plasma and muscle levels of CoQ10 and improvements in maximal oxygen consumption and treadmill time to exhaustion versus control. Supplementation with 300mg of the ubiquinol form of CoQ10 across a six week period also demonstrated enhanced physical performance (measured as maximum power output) in young Olympic athletes.16

Metabolic syndrome and diabetes

As an antioxidant, CoQ10 has been proposed in the treatment of metabolic syndrome and type 2 diabetes. A trial investigating the effect of CoQ10 administration in type 2 diabetic patients (260mg/11 weeks) showed a mild, but significant reduction in fasting glucose levels, but without changing fasting insulin and glycated haemoglobin (HbA1c).17 When taken in combination with other nutrients such as astaxanthin and folic acid, CoQ10 also initiated reductions in total cholesterol, LDL-cholesterol, triglycerides, and blood glucose, while increasing HDL-cholesterol levels.17

Insulin resistance is a key feature in both diabetics and those with metabolic syndrome; it happens when the body does not respond to insulin efficiently leading to high blood levels of both insulin and glucose.18 Insulin levels declined in a group of 60 adults with metabolic syndrome (either overweight, obese or type 2 diabetes) following 100mg of CoQ10 daily over an eight week period. Interestingly, insulin levels increased in the placebo group. Furthermore, beta cell (responsible for producing insulin) function and antioxidant capacity improved, with fewer markers of inflammation present in CoQ10 group.

Brain health

Mitochondrial dysfunction has been associated with the onset and/or development of neurodegenerative diseases.19 Preclinical research has shown that CoQ10 can preserve mitochondrial function and reduce the loss of dopaminergic neurons in the case of Parkinson’s disease.20 Furthermore, low levels and even deficiency of CoQ10 was observed at a higher frequency in patients with Parkinson’s disease.21,22

Although the exact mechanisms behind its effect on the reversal of functional mitochondrial decline are still not fully understood,20,23 clinical trials in patients suffering from Parkinson’s, Huntington’s, and Friedreich’s ataxia do suggest a clear role for CoQ10 in the delay of functional cognitive decline.24,25

The role of CoQ10 in autism has also been investigated26 as patients with autistic spectrum disorders exhibit higher proportions of mitochondrial dysfunctions in comparison with the general population.27 A combination of carnitine, CoQ10 and B-vitamins resulted in improvements in ASD patients.27,28

Dental health

CoQ10 levels may be low in people with gum disease and some research suggests that boosting levels through supplementation may help to speed up gum healing. Biopsies of patients with gingivitis have previously shown deficiencies of CoQ10 in the periodontal tissues,29 while supplementation with CoQ10 has been shown to reduce gingival inflammation when compared to scaling and root-planing alone.30 Furthermore, the topical application of CoQ10 resulted in a reduction in gingival bleeding and plaque scores among patients experiencing plaque induced gingivitis.31

Migraine support

Migraine ranks among the most frequent neurological disorders globally. A meta-analysis of five studies which included a total of 346 patients found that CoQ10 supplementation was effective at reducing the number, severity and duration of migraines across a one month period versus control.32 These findings were confirmed by several other studies,33–35 with one study finding an associated reduction in TNF-α and calcitonin gene-related peptide (both markers for inflammation), however further studies are required to understand the mechanisms.33

CoQ10 in food

Certain foods which contain CoQ10* include:36

  • Ubiquinone: meat, fish, legumes, vegetables
  • Ubiquinol: broccoli, cabbage, oysters, liver, avocado

*Small amounts of CoQ10 are present in the foods above, with the average dietary intake estimated to be around 3-5mg/day.37 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.

Key Takeaways

  • CoQ10 is an antioxidant that is required to support the growth and maintenance of almost every single cell in the body.
  • It was first discovered in 1940 and is referred to by several names including: Coenzyme Q, CoQ, vitamin Q10, CoQ10, ubiquinone and ubiquinol.
  • It is naturally produced in the mitochondria (energy cells) and plays a central role in the generation of ATP (the body’s primary energy currency).
  • There are two commonly available supplement forms of CoQ10: ubiquinone and ubiquinol. When CoQ10 (ubiquinone) is ingested, it should be converted into ubiquinol by the mitochondria for use in the body, however this process of conversion is not always effective. Furthermore, our ability to convert ubiquinone into ubiquinol declines with age and can be influenced by certain genetic factors. For these reasons, ubiquinol is the most bio-effective choice for most.
  • Supplementing with CoQ10 has been found to mitigate many of the side-effects of taking statin drugs – particularly muscle weakness. It also elicited positive outcomes on blood pressure and reduced the likelihood of recurrence in patients who suffered from a heart attack.
  • As a critical component of energy generation in the body, CoQ10 supports vital body functions such as metabolism; sustaining muscle and bone strength, as well as maintaining the health of skin cells. This is particularly pertinent when cellular ageing is considered.
  • CoQ10 may improve sperm quality and mobility in men struggling with infertility, while it improved fertilisation outcomes in women undergoing IVF treatments. Furthermore, signs of mitochondrial dysfunction as a factor in reproductive ageing were diminished.
  • Physical performance was improved, measured as maximum oxygen consumption, power output and treadmill time, in athletes following CoQ10 supplementation over a six-week period.
  • A role for CoQ10 in metabolic syndrome and those with type 2 diabetes has been observed, with supplementation resulting in a reduction in total and LDL cholesterol, triglycerides and fasting glucose levels.
  • Mitochondrial dysfunction has been identified as a central feature in the development of neurodegenerative diseases, with CoQ10 administration showing positive outcomes in patients with Parkinson’s disease, Huntington’s disease, Friedreich’s ataxia and those with autism spectrum disorders.
  • CoQ10 levels can be low in those experiencing gum disease, with oral and topical CoQ10 both initiating reductions in gingival, bleeding and plaque scores among patients with gingivitis.
  • Migraines, too, have been found to benefit from CoQ10 supplementation, with patients noting reductions in number, severity and duration of their migraines.
  • While some CoQ10 can be found in foods such as organ meats, soybeans, spinach and broccoli, the levels are rarely high enough to significantly raise levels within the body.

If you have questions regarding the topics that have been raised, or any other health matters, please do contact me (Tracey) by phone or email at any time.

tracey@cytoplan.co.uk, 01684 310099

Tracey Hanley and the Cytoplan Editorial Team


Relevant Cytoplan Products

  • CoQ10 Multicomprehensive multivitamin and mineral, additionally containing 80mg of CoQ10 (ubiquinol) per two capsule dose.
  • Krill, CoQ10 and K2comprises krill oil, vitamin K, vitamin D3, resveratrol, lycopene and 60mg of CoQ10 (ubiquinol).
  • Antioxidant plus CoQ10contains 50mg of CoQ10 (ubiquinol), 4.5mg of beta-carotene, 100mg of vitamin C and 16mg of vitamin E.
  • Cyto-Renewcontains acetyl-L-carnitine, alpha lipoic acid, Ginkgo iloba, N-acetyl-L-cysteine, rosemary extract and 25mg of CoQ10 (ubiquinol).

References

  1. Kalén A, et al (1989) ‘Age-related changes in the lipid compositions of rat and human tissues.’ Lipids, 24(7), pp. 579-584.
  2. Jaiswal AK, et al (1988) ‘Human dioxin-inducible cytosolic NAD(P)H:menadione oxidoreductase. cDNA sequence and localization of gene to chromosome 16.’ J Biol Chem, 263(27), pp. 13572-13578.
  3. Battino M, et al (2001) ‘Elevated Hydroperoxide Levels and Antioxidant Patterns in Papillon-Lefèvre Syndrome.’ J Periodontol, 72(12), pp. 1760-1766.
  4. Battino M, et al (1999) ‘Oxidative injury and inflammatory periodontal diseases: the challenge of anti-oxidants to free radicals and reactive oxygen species.’ Crit Rev Oral Biol Med, 10(4), pp. 458-476.
  5. Ayers J, et al (2018) ‘Recent Developments in the Role of Coenzyme Q10 for Coronary Heart Disease: a Systematic Review.’ Curr Atheroscler Rep, 20(6), pp. 29.
  6. Jafari M, et al (2018) ‘Coenzyme Q10 in the treatment of heart failure: A systematic review of systematic reviews.’ Indian Heart J, 70, pp. 111-117.
  7. Burke BE, et al (2001) ‘Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension.’ South Med J, 94(11), pp. 1112-1117.
  8. 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.
  9. Tóth Š, et al (2017) ‘Addition of omega-3 fatty acid and coenzyme Q10 to statin therapy in patients with combined dyslipidemia.’ J Basic Clin Physiol Pharmacol, 28(4), pp. 327-336.
  10. Mancini A, et al (2005) ‘An update of Coenzyme Q10 implications in male infertility: biochemical and therapeutic aspects.’ Biofactors, 25(1-4), pp. 165-174.
  11. Safarinejad MR (2009) ‘Efficacy of Coenzyme Q10 on Semen Parameters, Sperm Function and Reproductive Hormones in Infertile Men.’ J Urol, 182(1), pp. 237-248.
  12. Lafuente R, et al (2013) ‘Coenzyme Q10 and male infertility: a meta-analysis.’ J Assist Reprod Genet, 30(9), pp. 1147-1156.
  13. Xu Y, et al (2018) ‘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, 16(1), pp. 29.
  14. Ben-Meir A, et al (2015) ‘Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging.’ Aging Cell, 14(5), pp. 887-895.
  15. Sarmiento A, et al (2016) ‘Coenzyme Q10 Supplementation and Exercise in Healthy Humans: A Systematic Review.’ Curr Drug Metab, 17(4), pp. 345-358.
  16. Alf D, et al (2013) ‘Ubiquinol supplementation enhances peak power production in trained athletes: a double-blind, placebo controlled study.’ J Int Soc Sports Nutr, 10, pp. 24.
  17. Moradi M, et al (2016) ‘Effect of Coenzyme Q10 Supplementation on Diabetes Biomarkers: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials.’ Arch Iran Med, 19(8), pp. 588-596.
  18. Raygan F, (2016) ‘The effects of coenzyme Q10 administration on glucose homeostasis parameters, lipid profiles, biomarkers of inflammation and oxidative stress in patients with metabolic syndrome.’ Eur J Nutr, 55(8), pp. 2357-2364.
  19. Arun S, et al (2016) ‘Mitochondrial Biology and Neurological Diseases.’ Curr Neuropharmacol, 14(2), pp. 143-154.
  20. Schulz JB and Beal MF (1995) ‘Neuroprotective effects of free radical scavengers and energy repletion in animal models of neurodegenerative disease.’ Ann N Y Acad Sci, 765, pp. 100-10.
  21. Mischley LK, et al (2012) ‘Coenzyme Q10 deficiency in patients with Parkinson’s disease.’ J Neurol Sci, 318(1-2), pp. 72-75.
  22. Buhmann C, et al (2004) ‘Plasma and CSF markers of oxidative stress are increased in Parkinson’s disease and influenced by antiparkinsonian medication.’ Neurobiol Dis, 15(1), pp. 160-170.
  23. McGarry A, et al (2017) ‘A randomized, double-blind, placebo-controlled trial of coenzyme Q10 in Huntington disease.’ Neurology, 88(2), pp. 152-159.
  24. Shults CW (2003) ‘Coenzyme Q10 in neurodegenerative diseases.’ Curr Med Chem, 10(19), pp. 1917-1921.
  25. Beal M (2002) ‘Coenzyme Q10 as a possible treatment for neurodegenerative diseases.’ Free Radic Res, 36(4), pp. 455-460.
  26. Gvozdjáková A, et al (2014) ‘Plasma membrane coenzyme Q: evidence for a role in autism.’ Biol Targets Ther, 8, pp. 199.
  27. Rossignol DA and Frye RE (2012) ‘Mitochondrial dysfunction in autism spectrum disorders: a systematic review and meta-analysis.’ Mol Psychiatry, 17(3), pp. 290-314.
  28. Gvozdjáková A, (2014) ‘Ubiquinol Improves Symptoms in Children with Autism.’ Oxid Med Cell Longev, 2014, pp. 1-6.
  29. Littarru GP, et al (1971) ‘Deficiency of Coenzyme Q10 in Gingival Tissue from Patients with Periodontal Disease.’ Proc Natl Acad Sci, 68(10), pp. 2332.
  30. Manthena S, et al (2015) ‘Effectiveness of CoQ10 Oral Supplements as an Adjunct to Scaling and Root Planing in Improving Periodontal Health.’ J Clin DIAGNOSTIC Res, 9(8), pp. ZC26-8.
  31. Chatterjee A,et al (2012) ‘Evaluation of Co-Q10 anti-gingivitis effect on plaque induced gingivitis: A randomized controlled clinical trial.’ J Indian Soc Periodontol, 16(4), pp. 539-542.
  32. Zeng Z, et al (2019) ‘Efficacy of CoQ10 as supplementation for migraine: A meta-analysis.’ Acta Neurol Scand, 139(3), pp. 284-293.
  33. Dahri M, et al (2018)’ Oral coenzyme Q10 supplementation in patients with migraine: Effects on clinical features and inflammatory markers.’ Nutr Neurosci., pp. 1-9.
  34. Shoeibi A, et al (2017) ‘Effectiveness of coenzyme Q10 in prophylactic treatment of migraine headache: an open-label, add-on, controlled trial.’ Acta Neurol Belg, 117(1), pp. 103-109.
  35. Sandor PS, et al (2005) ‘Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial.’ Neurology, 64(4), pp. 713-715.
  36. Kubo H, et al (2008) ‘Food content of ubiquinol-10 and ubiquinone-10 in the Japanese diet.’ J Food Compos Anal, 21(3), pp. 199-210.
  37. Weber C, et al (1997) ‘The coenzyme Q10 content of the average Danish diet.’ Int J Vitam Nutr Res, 67(2), pp. 123-129.

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10 thoughts on “CoQ10 – forms, functions and latest research

  1. I wish I had read this before the exam at CNM on Friday at 13pm There was an essay question on CoQ10 that I fluffed!

    Very well written article.

  2. My sister suffered a mini-stroke 2 years ago and was prescribed statins and blood thinners. I told her about coenzyme Q10 and she consulted her GP who advised her not to take it as they are not sure about the effects with her medication. Being worried about a further stroke, my sister didn’t take the supplements. Any thoughts?

    1. Hi Janette,
      Thanks for your question. In fact Coenzyme Q10 levels in the body are depleted by statins. On the other hand, at very high levels CoQ10 might not be recommended with blood thinners. However, the CoQ10 in all our products is at a level that can be taken alongside blood thinning medication. We recommend that any supplements are taken 2 hours away from medication.
      Best wishes, Clare

    1. Hi Mark,
      Thank you for your question. Food sources of coenzyme Q10 include liver, kidney, heart, beef, sardines and mackerel. In terms of vegetable sources, it can be found in broccoli and cauliflower. However coenzyme Q10 levels in food are quite small, mostly it is synthesised in the body.
      I hope this helps.
      Best wishes, Clare

  3. Hello Clare,
    First thank you for sharing this information about CoQ10.
    I did take it for one year, after a pancreatitis (hormonal related, not alcohol related), then I stooped. Combined with other supplements made a big difference to my recovery. This was in 2017 and I am well since then.
    Also my sister had breast cancer, and after chemotherapy and post treatment of 5 years, she is very tired, her hair and nails are very damaged. I have recommended CoQ10 to her, and her doctor has not opposed, but has not giving much importance. anyway, my sister would like to take it.
    Can we take CoQ10 for long time? 1 year, 2 years…how long? I also would like to start taking it again.

    1. Hi Rose,
      Thank you for your comment.
      Yes you can take CoQ10 long-term. We have it in a number of products, but a good one for you and your sister might be our all-round multivitamin and mineral with CoQ10; CoQ10 Multi. This has good levels of B vitamins which are important for energy production, as well as excellent levels of vitamins C, D and trace minerals. Your sister could take this in conjunction with our Hair, Skin and Nails product. Also we do offer a free health questionnaire service if this is of interest to either of you. If you complete and return a health questionnaire we will send some written diet and supplement recommendations. You can download the health questionnaire here.
      Best wishes,
      Clare

  4. Thankyou for this blog, so much wonderful information-
    Do you have a booklet with all the benefits of your supplements- I’m a kinesiologist and whatever my clients test for I would like to read out the benefits to them . Also
    What supplements would you recommend for dementia?

    1. Hi Joanne,

      Thank you for your positive comments on our blog. We do have a catalogue for practitioners which includes research on various nutrients included in our products. The catalogue is only intended for practitioners’ use in choosing appropriate supplements for clients. If you let me have your address I will send you one.

      As a practitioner you may be interested in our 121 training. This is available to book here.
      and you will spend an hour (via Zoom) with one of our nutritional therapists learning more about our products and we can focus on areas of health of particular interest to you.

      Regarding dementia, it would be useful to have some more information on the person – age, symptoms, specific diagnosis, any supplements/medications currently being taken. If you email me directly I will make some suggestions – clare@cytoplan.co.uk. Also, we do offer a free health questionnaire service which may be of interest. If the person (perhaps with your support) completes and returns the questionnaire we will send some written diet and lifestyle recommendations.

      Thanks,
      Clare

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