Coenzyme Q10

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Latest Edit: Hector 2014-3-17 (EDT)

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Coenzyme Q10 is also known as ubiquinone because it can be found ubiquitously in nature and is chemically made up of a quinone structure. CoQ10 is an important coenzyme in the electron-transport chain in the mitochondria which is a series of reduction-oxidation (redox) reactions which are crucial for the manufacturing of ATP (an important energy source for many biochemical reactions in the body). ATP is very important for the functioning of many organs and tissues and therefore CoQ10 is essential for proper bodily functioning. CoQ10 also acts as an antioxidant.[1].

The body can synthesize CoQ10 from phenylalanine and tyrosine, however, there are times when the body is not capable of making enough CoQ10. The tissues in the body which are most at risk for deficiency of CoQ10 are the tissues which are most metabolically active such as the heart, brain, immune system, gingiva, and gastric mucosa. Low levels have been associated with cardiovascular disease, hypertension, periodontal disease, asthma, Parkinson's disease, and AIDS. [1]

Contents

Food Sources

As the other name for CoQ10, ubiquinone, suggests, sources of CoQ10 can be found almost anywhere in every plant and animal cell. The high doses of CoQ10 required to achieve clinical effects probably can't be acquired through food. Vegetarians have much higher plasma levels of CoQ10 which suggests that a diet high in plant foods may help to preserve CoQ10 levels [2]

Uses

The following is a list of the primary uses for Coenzyme Q10. [1]

  • Mitochondrial Diseases: In some cases of mitochondrial diseases, CoQ10 deficiencies have also been detected, some of which are congenital deficiencies. A study was done on six patients with deficient muscle CoQ10 which showed improvements such as increased strength, improved ataxia, and less frequent seizures with supplementation. Congenital deficiency of CoQ10 should be considered when treating a patient with familial ataxia.
Article Coenzyme Q10 and Parkinson Disease, J Orthomolecular Med 2012;Vol27(3)
  • Parkinson's Disease (PD): CoQ10 is therapeutically beneficially in the treatment of (PD) due to the oxidative damage associated with (PD) and the reduced activity of part of the electron transport chain which relies on CoQ10. Clinical effect may only be observed once normal plasma levels are reached. Treatment is more effective if started earlier in the course of the disease in order to delay progression.
  • Friedreich Ataxia: Friedreich Ataxia is a demyelination disease of the central nervous system. There is a cardiomyocyte hypertrophy associated with this disease and it is believed that it is due to mitochondrial oxidative stress. CoQ10 supplementation has shown positive results.
  • Immune Function: CoQ10 has shown immune enhancing effects at the mitochondrial level. Several studies have shown positive results in terms of immune enhancement in those with immune suppression due to aging and chronic illness with CoQ10 supplementation.
  • Acquired Immunodeficiency Syndrome (AIDS): AIDS is associated with many nutritional deficiency and although supplementation does not provide a cure, it does prevent weight loss and boosts immunity. CoQ10 provides antioxidant activity that is beneficial for individuals with AIDS and can also decrease the occurrence of opportunistic infections.
  • Aging: Peak levels of CoQ10 in most organs occurs by 20 years and after 35 or 40 years, the body begins to lose its ability to make CoQ10. This results in a decrease in the body's antioxidant capabilities and also decreased energy production and can lead to age-associated disease. Topical CoQ10 has also shown some benefit for skin health related to aging.
  • Cancer: The antioxidant capabilities of CoQ10 also makes it a possible treatment for cancer. One study showed benefit of CoQ10 supplementation for the treatment of breast cancer in terms of decreased cancer size, decreased mortality, decreased metastases, decrease need for pain killers, and partial remission. Although the studies have not been well-controlled, it appears that CoQ10 supplementation may be a warranted component of a comprehensive breast cancer treatment regimen and other cancers such as Thyroid Cancer.
  • Periodontal Disease: Healing of gingival tissues relies on adequate CoQ10 for efficient energy production. Many tissue biopsies of gingival tissue from those with periodontal disease indicate that there is a deficiency in CoQ10 within the tissue. CoQ10 supplementation can improve the integrity of the tissue and speed up the rate of healing in those with periodontal disease.
  • Gastric Ulcers: It is the antioxidant activity of CoQ10 which could possibly have an effect in preventing ulcerations due to oxidative damage. In addition, adequate CoQ10 is needed to produce protective mucous and new gastric mucosal cells. In animal studies, CoQ10 supplementation has shown promise in healing gastric ulcers which can decrease the effects of hypoxia on ulcers. CoQ10 may be a warranted treatment option for elderly individuals with intractable gastric ulcers particularly in those with illnesses which produce hypoxic states.
  • Physical Performance: Theoretically, CoQ10 could also be a viable treatment to increase physical performance due to its involvement in energy production and its concentration in muscle tissue. Supplementation could increases aerobic capacity and muscle performance. Larger studies are needed to consider its effects proven.
  • Muscular Dystrophy: Many studies have shown that there is a CoQ10 deficiency in the muscle mitochondria of those with muscular dystrophy. Supplementation with CoQ10 indefinitely for those with muscular dystrophy is encouraged by some. For those with conditions which affect cardiac function, supplementation also improved heart functioning in a couple studies. In another study, patients reported increased exercise tolerance, reduced leg pain, better control of leg function, and less fatigue with CoQ10 supplementation.
  • Asthma: Oxygen free radicals are attributed to the pathogenesis of asthma. Adequate antioxidants are essential for asthmatics, however, they are often decreased. Supplementation with antioxidants including CoQ10 can decrease oxidative stress and asthma symptoms. In addition, CoQ10 supplementation may also reduce adverse effects of glucocorticosteriod treatment.
Article CoQ10 and Heart Failure, IHP ; September 2012
Article Coenzyme Q10: Cardiovascular applications, IHP, [1], Feb/Mar 2011
  • Cardiovascular Disease (CVD): CoQ10 is essential for proper energy production in many body tissues including the heart and is therefore critical for heart contraction. CoQ10 deficiency has been detected in many individuals with various cardiovascular diseases, however, it is not clear if this deficiency leads to disease or is the result of the disease. CoQ10 may also help prevent atherosclerosis due to it's antioxidant action. CoQ10 levels decrease inversely related to the severity of heart disease. Low plasma levels have been found in those with ischemic heart disease and dilated cardiomyopathy. Myocardial deficiencies have been found in those with aortic stenosis or insufficiency, mitral stenosis or insufficiency, diabetic cardiomyopathy, tetralogy of Fallot, atrial septal defects, ventricular septal defects, and in those undergoing cardiac surgery. Supplementation can increase tissue levels and be beneficial for this population. CoQ10 supplementation may be warranted in a variety of cardiovascular conditions including: cardiomyopathy, congestive heart failure, angina, arrhythmias, prevention of adriamycin toxicity, protection during cardiac surgery, mitral valve prolapse, and hypertension.
  • Diabetes: Low levels of CoQ10 in tissues is also found in individuals with diabetes. CoQ10 supplementation may help with decreasing blood pressure and improving glycemic control in this population. Furthermore, supplementation may also help prevent arteriosclerosis. Finally, there is growing research that suggests that type II diabetes may be associated with a mitochondrial dysfunction for which CoQ10 provides support.
  • Infertility: Oxidation in sperm cells may be a contributing factor in male infertility. Low levels of CoQ10 have been found in sperm with low motility and abnormal morphology and research suggests that it could be due to oxidation as a result of low CoQ10.
  • Toxic Exposure: Toxic exposure can lead to disruptions in the mitochondrial respiratory chain. CoQ10 has shown cytoprotective capabilities by protecting cellular membranes from damage from toxic chemical exposure.

Prescribing Considerations

The recommended dosages have not yet been established. To determine what your specific requirements are talk to your naturopathic doctor or other trained medical professional.

  • Dietary: no level has been established for optimal dietary intake
  • Supplemental: ranges from 50-150mg (300mg may be needed in severe cases) -OR- 2mg CoQ10 for each kg (2.2 pounds) body weight [2]

Deficiency Symptoms

Deficiency in coenzyme Q10 can have a number of causes namely: impaired synthesis due to nutritional deficiency; a genetic or acquired defect in CoQ10 synthesis; illness leading to increased demand in a specific tissue; drug depletion; and is seen commonly in the elderly. [1], [3]

Conditions where low levels of CoQ10 are typically found:

  • CoQ10 is available in different formulations: oil-based capsules, powder-filled capsules, and tablets, and solubilized soft-gels. The solubilized soft-gels are claimed to give higher absorption [4].
  • Best taken with food. About 3 weeks of daily dosing is necessary to reach maximal serum concentrations.
  • CoQ10 is also available topically in some toothpastes and skin creams.

Safety

Coenzyme Q10 is generally regarded as safe.

  • Rare side-effects may include: mild nausea, gastrointestinal discomfort, anorexia, skin eruptions, fatigue, insomnia, headache, dizziness, irritability, photosensitivity, dyspepsia, vomiting, diarrhea, dermatitis, flu-like symptoms. Dividing doses may help to reduces side effects.
  • Children: Adverse effects are not generally seen. Unless indication is essential, CoQ10 is not usually prescribed to children.
  • Adults: CoQ10 supplementation is considered generally safe in adults.
  • Pregnancy and Breastfeeding
  • Oral intake should be avoided as there is a lack of controlled studies outlining its safety for this population.
  • Precautions
  • Drug Interactions:[3]
Supportive or Beneficial:
  • Beta-1-Adrenoceptor Antagonists and Related Antihypertensive Medications - Drug can inhibit CoQ10-related mitochondrial enzymes in cardiac tissues and can lead to adverse effects. Concomitant use with CoQ10 can be beneficial.
  • Chlorpromazine, Thioridazine, and Related Phenothiazines - Drugs appear to inhibit important CoQ10-related enzymes and can lead to adverse myocardial depressant effectes. CoQ10 mitigates these effects.
  • Doxorubicin and Related Anthracycline Chemotherapy - CoQ10 supplementation can reduce free-radical damage and prevent drug-induced cardiotoxicity. Monitor closely within the context of integrative oncology care.
  • Sulfonylureas and Related Oral Hypoglycemic Agents - Diabetic individuals are more likely to be predisposed to compromised CoQ10 status and elevated oxidative stress. CoQ10 support can mitigate drug-induced adverse effects and may enhance insulin function and cardiovascular health.
Addresses Drug-Induced Deficiency:
  • HMG-CoA Reductase Inhibitors (Statins) - Drug lowers CoQ10 levels by directly inhibiting its synthesis. Co-administration can prevent drug adverse effects. Monitor closely within the context of integrative cardiovascular care.
  • Tricyclic Antidepressants - Drug can interfere with CoQ10 enzymes and may induced deficiency which can lead to cardiac adverse effects. Concomitant CoQ10 can mitigate these adverse effects.
Other:
  • Warfarin - Administration of CoQ10 may be therapeutically appropriate for many individuals receiving coumarin therapy. Gradual changes in dosage levels of CoQ10 are critical to maintain INR within therapeutic range. Monitor INR closely.
  • Nutrient Interactions: [3]
  • L-Carnitine - Concomitant use may have an additive effect. This could be beneficial but close monitoring is necessary particularly with those with serious heart disease or other cardiovascular conditions.
  • Vitamin B6 - B6 is required for the synthesis of CoQ10 from tyrosine. There may be a synergistic benefit to co-administration but more research is warranted.
  • Vitamin E - Both nutrients act within a larger antioxidant network.

Resources

  1. 1.0 1.1 1.2 1.3 Pizzorno Joseph E, Murray Michael T (1999) Textbook of Natural Medicine, Elsevier
  2. 2.0 2.1 Murray Michael T (1996) Encyclopedia of Nutritional Supplements: The Essential Guide for Improving Your Health Naturally, Prima Publishing.
  3. 3.0 3.1 3.2 Stargrove Mitchell Bebell, Treasure Jonathan, McKee Dwight L (2008) Herb, Nutrient, and Drug Interactions; Clinical Implications and Therapeutic Strategies, Mosby
  4. Hendler Sheldon S, Rorvik David (Editors) (2001) PDR for Nutritional Supplements, Medical Economics Company Inc.
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