June 16th, 2011

Coenzyme Q10: Uses, Forms and Dosage Recommendations

Coenzyme Q10 (CoQ10) is an essential component of the mitochnodria that produce power for the body’s cells, and plays a critical role in the manufacture of ATP, the energy that drives all body processes. Think of CoQ10 as the spark plug of the body. Just as a car can’t function without an initial spark, the human body can’t function without CoQ10. CoQ10 is also a very important antioxidant that protects against cellular damage.

Although CoQ10 can be synthesized within the body, there are a number of circumstances in which our bodies simply don’t make sufficient amounts. Because the brain and heart are among the most metabolically active tissues in the body, CoQ10 deficiency affects them the most and can lead to serious problems. Deficiency could be due to a poor diet, a genetic or acquired defect, or increased tissue needs. Heart and vascular diseases, including high cholesterol and elevated blood pressure, require increased tissue levels of CoQ10. In addition, because CoQ10 levels decline with age, people over the age of 50 may have increased CoQ10 requirements. There are also a number of drugs (most notably lipid-lowering agents like statins) that adversely affect CoQ10.1-5

What are the Principal Clinical Uses of CoQ10?

Given the central role of CoQ10 in mitochondrial function and cellular antioxidant protection, its clinical applications are extensive. There are so many conditions in which CoQ10 may offer benefits that there is no question it should be considered an essential health nutrient. Specific clinical uses of CoQ10 include:

  • General antioxidant
  • Cardiovascular disease
    • High blood pressure
    • Congestive heart failure
    • Cardiomyopathy
    • Protection during cardiac surgery
    • High cholesterol that is treated by drugs, especially statins
  • Cancer (to boost immune function and/or offset chemotherapy side effects)
  • Diabetes mellitus
  • Male infertility
  • Alzheimer’s (prevention) and Parkinson’s disease (prevention and treatment)
  • Periodontal disease
  • Macular degeneration

Is There Science Supporting the Use of CoQ10?

The therapeutic use of CoQ10 has been clearly documented in both animal studies and human trials for all the conditions listed above—particularly for cardiovascular disease.6,7 Biopsy results from heart tissue in patients with various cardiovascular diseases showed a CoQ10 deficiency in 50 to 75 percent of all cases. Correction of a CoQ10 deficiency can often produce dramatic clinical results in patients with any kind of heart disease. For example, CoQ10 deficiency has been shown to be present in 39 percent 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 cardiovascular deficiency.

In several studies, CoQ10 has been shown to actually lower blood pressure in patients with hypertension.  The effect of CoQ10 on blood pressure is usually not seen until after four to 12 weeks of therapy, and the typical reductions in both systolic and diastolic blood pressure in patients with high blood pressure are modest, in the 10 percent range.8

Why Should I Take CoQ10 if I am on a Statin Drug?

Statin drugs like Crestor, Lipitor and Zocor work by inhibiting the enzyme HMG CoA reductase, which the liver requires to manufacture cholesterol. Unfortunately, these drugs also block the manufacture of other substances necessary for body functions, including CoQ10. Inhibition of CoQ10 synthesis by these drugs could explain their most commonly reported side effects, especially fatigue and muscle pain.4,5 One large study, the ENDOTACT study, demonstrated that statin therapy led to a significant decrease of CoQ10 plasma levels, but that decrease could be prevented entirely by supplementing with 150 mg of CoQ10. Additionally, supplementation with CoQ10 led to a significant improvement in the function of the blood vessel lining—one of the key goals in the treatment and prevention of atherosclerosis.9

Can CoQ10 Really Help With Parkinson’s Disease?

In double-blind studies, CoQ10 supplementation has been shown to be quite helpful to PD patients. All of the patients in these studies had the three primary features of PD—tremor, stiffness and slowed movements—and had been diagnosed with the disease within the last five years. After an initial screening and baseline blood tests, the patients were randomly divided into four groups. Three of the groups received CoQ10 at different doses (300 mg a day, 600 mg a day and 1,200 mg a day) for 16 months, while a fourth group received a placebo.

The group that took the 1,200 mg dose had less decline in mental function; motor function; and ability to carry out activities of daily living, such as feeding or dressing themselves. The greatest effect was on activities of daily living. The groups that received 300 mg a day and 600 mg a day developed slightly less disability than the placebo group, but the effects were less than those in the group that received the highest dosage of CoQ10. These results indicate that the beneficial effects of CoQ10 for PD are achieved at higher dosages. No significant side effects were seen in any of the patients.10

What is the Best Form of CoQ10?

Most CoQ10 that is sold commercially is produced primarily via a yeast fermentation process. CoQ10 is available in two interchangeable chemical forms—ubiquinone and ubiquinol. About 95 percent of the CoQ10 in the body is ubiquinol. However, ubiquinone is easily converted to ubiquinol after ingestion.

CoQ10 dietary supplements have traditionally only been available in the ubiquinone form. Ubiquinone is a crystalline powder that is insoluble in water and is difficult to absorb when taken on an empty stomach. However, when ubiquinone is taken with food (especially oils), it’s absorbed at least twice as fast as when it’s taken on an empty stomach.11

Recently, ubiquinol CoQ10 entered the supplement market. Ubiquinol has greater solubility and, as a result, greater bioavailability than ubiquinone,12,13 but exactly how much better it’s absorbed remains to be answered. In the only published study at this point that looked at ubiquinol absorption, subjects took a total of 10 capsules a day that included the emulsification agents diglycerol monooleate, canola oil, soy lecithin and beeswax.13 It’s possible that ubiquinone may have been absorbed almost as well as ubiquinol given the significant amount of oil and emulsifiers consumed along with it. Curiously, the study did not directly compare ubiquinol and ubiquinone absorption.

While many have jumped on the ubiquinol bandwagon, it’s important to point out that ubiquinone has an extensive history of successful use, particularly in oil-based soft gel capsules. Furthermore, several technologies are now used to enhance the bioavailability of ubiquinone, including particle size reduction (nanonization) and solubility enhancement via the use of emulsifying agents, carriers and self-emulsifying systems.14

For example, combining ubiquinone with a soy peptide (BioQ10 SA) results in exceptional bioavailability because the soy peptide emulsifies the CoQ10 and helps usher it into the bloodstream.15 Given the excellent absorption of this form of ubiquinone, the advantage of ubiquinol over regular ubiquinone appears to have more to do with its improved solubility than because it is in the ubiquinol form.

Based upon existing data from published clinical studies, it’s possible to calculate the approximate plasma levels of CoQ10 for different commercial forms. This data allows for the comparative dosage schedule provided below.

100 mg                                                                        Estimated plasma levels in mcg/ml

Ubiquinone suspended in rice bran oil in a soft gel capsule               1.8

BioQ10 SA (in either a soft or hard gel capsule)                                                   2.50

Ubiquinol in a soft gel capsule                                                                                             2.50

 

300 mg                                                                        Estimated plasma levels in mcg/ml

Ubiquinone suspended in rice bran oil in a soft gel capsule               3.5

BioQ10 SA (in either a soft or hard gel capsule)                                                   7.0

Ubiquinol in a soft gel capsule                                                                                             7.0

 

Is it True that Ubiquinol is 8 Times Better Absorbed Than Ubiquinone?

No, this marketing statement is taking data out of context. It involves comparing the absorption of 300 mg of ubiquinol in the aforementioned absorption study with blood levels achieved in studies of Parkinson’s disease in which dosages of 2,400 mg of ubiquinone were given along with 1,200 IU of vitamin E. The problem with this comparison is that high-dosage vitamin E interferes with CoQ10 absorption, and when dosages of ubiquinone exceed 300 mg, the percentage of CoQ10 absorbed declines significantly. Plasma CoQ10 levels at a dosage of 2,400 mg per day are not significantly greater than those at a 600 mg per day dosage. So a more accurate approximation is that ubiquinol is only slightly better absorbed than CoQ10 in soft gel capsules emulsified with rice bran oil at dosages of 100 mg per day, and about two times better absorbed at 300 mg per day (as shown in the tables above).

So Which Form and How Much CoQ10 Should I Take?

The actual dosage of CoQ10 is based on which form is being used and what blood levels are being targeted. For example, in people who are taking a statin drug or are seeking general antioxidant support, the goal is to achieve a blood level of CoQ10 slightly above the normal level (0.7 to 1.0 mcg per ml). For people with cardiovascular disease, periodontal disease or other conditions not involving the brain, the target is 2.5 mcg per ml. And for brain-related conditions like Parkinson’s disease, the target is 3.5 mcg per ml. The following chart provides the dosage recommendations for the various forms of CoQ10. Keep in mind that divided dosages (taking CoQ10 two to three times daily) with meals will result in higher blood levels compared to a single dosage, especially at higher dosage levels.

Estimated Daily Dosage Requirements for Different Forms of CoQ10:

Target CoQ10 soft gels BioQ10 SA Ubiquinol
Normal Blood Levels 

(0.7-1.0 mcg/ml)

50-100 mg 25-50 mg 25-50 mg
Non-Brain Support 

(2.5 mcg/ml)

150-200 mg 100-150 mg 100-150 mg
Brain Support 

(3.5 mcg/ml)

300-400 mg 150-200 mg 150-200 mg
Price per 100 mg* $0.20 $0.40 $0.80

*Approximate price

From a cost perspective, it makes sense to use ubiquinone in soft gel capsules for lower dosage recommendations and either BioQ10 SA or ubiquinol when higher dosages are necessary. In addition, there is a small subset of people who may not respond to conventional ubiquinone in a soft gel and would benefit significantly more from ubiquinol or BioQ10 SA.16 Blood measurements of CoQ10 can help determine if you’re one of those people.

References:

1.         Quinzii CM, DiMauro S, Hirano M. Human coenzyme Q10 deficiency. Neurochem Res 2007;32:723-7.

2.         Quinzii CM, Hirano M. Coenzyme Q and mitochondrial disease. Dev Disabil Res Rev. 2010 Jun;16(2):183-8.

3.         Miles MV, Horn PS, Tang PH, et al: Age-related changes in plasma coenzyme Q10 concentrations and redox state in apparently healthy children and adults. Clin Chim Acta 2004;34:139-144

4.         Rundek T, Naini A, Sacco R, Coates K, DiMauro S. Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. Arch Neurol. 2004;61(6):889-92.

5.         S.A. Mortensen, A. Leth, E. Agner and M. Rohde, Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol. Aspects Med. 1997;18:S137–S144.

6.         Bonakdar RA, Guarneri E. Coenzyme Q10. Am Fam Physician 2005;72:1065-70.

7.         Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Mol Biotechnol 2007;37:31-7.

8.         Kumar A, Kaur H, Devi P, Mohan V. Role of coenzyme Q10 (CoQ10) in cardiac disease, hypertension and Meniere-like syndrome. Pharmacol Ther 2009;124:259-68.

9.         Kuettner A, Pieper A, Koch J, Enzmann F, Schroeder S.Influence of coenzyme Q(10) and cerivastatin on the flow-mediated vasodilation of the brachial artery: results of the ENDOTACT study. Int J Cardiol. 2005 Feb 28;98(3):413-9.

10.       Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol 2002;59:1541-50.

11.       Ochiai A, Itagaki S, Kurokawa T, et al. Improvement in intestinal coenzyme q10 absorption by food intake. Yakugaku Zasshi. 2007 Aug;127(8):1251-4.

12.       Bhagavan HN, Chopra RK. Plasma coenzyme Q10 response to oral ingestion of coenzyme Q10 formulations. Mitochondrion 2007;7 Suppl:S78-88.

13.       Hosoe K, Kitano M, Kishida H, et al. Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers. Regul Toxicol Pharmacol. 2007 Feb;47(1):19-28.

14.       Beg S, Javed S, Kohli K. Bioavailability enhancement of coenzyme Q10: an extensive review of patents. Recent Pat Drug Deliv Formul. 2010 Nov;4(3):245-55.

15.       Takeda R, Sawabe A, Nakano R, et al. Effect of various food additives and soy constituents on high CoQ10 absorption. Japanese Journal Medicine Pharmaceutical Science 2011;64(4):614-20.

16.       Langsjoen PH, Langsjoen AM. Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors. 2008;32(1-4):119-28.