A few weeks ago, we covered the nine hallmarks of aging and gave a list of research-backed supplements that have shown promising links to slowing and even reversing aging. This week we thought we would take a deeper dive into one of the most requested supplements from this list—CoQ10.
CoQ10’s Role in the Body
CoQ10 is the short form ofcoenzyme Q10, a naturally occurring quinone found in animals and some bacteria. CoQ10 is the most abundant quinone in our bodies and functions as acoenzyme(helper molecule) assisting the mitochondria in making energy and functioning as an antioxidant. As an essential molecule, CoQ10 has 3 redox states which allow it to serve as an oxygen carrier in the mitochondria; this is crucial to its role in energy metabolism (i.e. electron transport) as well as its role as an antioxidant picking up free radicals.
Source: Wang, Y., & Hekimi, S. (2019). The Complexity of Making Ubiquinone. Trends in endocrinology and metabolism: TEM, 30(12), 929–943. https://doi.org/10.1016/j.tem.2019.08.009
We produce CoQ10 naturally and the highest concentrations of the molecule occur in organs that require a large amount of energy (and a lot of oxygen) to function: theheart, liver, kidneys, and pancreas. Deficiency is extremely rare (<1 in 100,000 people) and blood levels aren’t typically examined in healthy individuals. Most of the references about CoQ10 testing we’ve seen, have been in research settings or under specific circumstances (e.g., diagnosing a genetic or mitochondrial disorder). Blood values of CoQ10 vary based on the lab doing the testing, but we found that the “normal” reference range is considered to be 0.8–1.2 mg/L.
What Role Does CoQ10 Play in Longevity?
Unless you have a genetic or mitochondrial disorder or some other disease state that requires testing, it’s unlikely that you’ve ever measured your CoQ10 levels. And that’s okay. The most important thing to remember about this coenzyme when it comes to longevity is that itdeclines with age. Because of this, CoQ10 supplementation is a source of interest for mitigating the effects of age-related diseases and decline as well as a possible method to extend healthy life.
We were not surprised to find that research results on the use of CoQ10 is mixed. These are the highlights of what we found:
When it comes to heart disease the evidence on the benefits of CoQ10 supplementation is inconsistent. While some studies suggest a positive correlation with heart health, others suggest no effect. Among the strongest studies we found with evidence of positive effects, these three appeared to be the most robust:
- Q-SYMBIO study examined CoQ10 supplementation as an adjunctive treatment for heart failure in 420 patients with moderate to severe heart failure over a period of 2 years.Participants in the treatment group received100 mg 3 times daily (TID) in addition to standard therapy; the control group received a placebo TID plus standard therapy. At follow-up, participants in the treatment group had a 42% reduction in risk of a major adverse cardiovascular event, and a 40% reduction in risk 40% for both cardiac related deaths and all-cause mortality.
- KISEL-10 study examined mortality risk in 443 Swedishaged 70 to 88over a period of 5 years. Participants in the treatment group received a daily 1:1 supplementation of selenium and CoQ10 (200 mg each) over a period of 5 years; the control group received a daily placebo. At follow-up, participants in the treatment group had fewerhospitalizations, a slower deterioration in health-related quality of life, improved cardiac function (as evidenced by EKG) and a 53% reduction in cardiovascular mortality risk.
- A 2017 meta-analysis of14 clinical trials representing 2,149 patientswith heart failure suggests that supplementation of 30–100 mg of CoQ10 per day increased exercise capacity and lowered the risk of death by 31%.
Conversely, we found the following high-quality studies suggesting that there is no effect:
- This 2014 review of 7 clinical trials representing 914 patients with heart failure found that “pooled analysis suggests that the use of coenzyme Q10 has no clear effect on left ventricular ejection fraction or blood levels of coenzyme Q10” when compared to placebo.
- This 2014 review of 6 clinical trials representing 218 patients with heart failure found that supplementation had no effect on diastolic blood pressure (though systolic BP showed mixed results), no effect on blood lipids, and no effect on cholesterol when administered simultaneously with statin therapy.
One notable aspect of these (and most other) studies is their relatively small size.
Early studies (e.g., here) on the effects of supplementation on diabetes showed no effect; however, subsequent and more recent studies tell a different story:
- This 2013 study of 64 diabetic patients suggests that 200 mg CoQ10 supplemented daily for 12 weeks reduces HbA1C by approximately 2% when compared to placebo. Note: This might not seem like much but a difference of 2% in HbA1C can move an abnormal blood glucose to the normal range.
- This 2014 study of 50 diabetic patients suggests that 150 mg of CoQ10 supplemented TID for 12 weeks significantly reduces fasting plasma glucose and HbA1C when compared to placebo.
- This 2018 randomized clinical trial of 80 adults with prediabetes suggests that 200 mg of CoQ10 per day for 8 weeks reduced insulin resistance when compared to the placebo.
- This 2018 meta-analysis and review of 13 trials representing 765 patients with diabetes suggests that CoQ10 supplementation significantly reduces HbA1C and fasting plasma glucose (average reduction 0.29% and approximately 11 points, respectively) when compared to placebo.
With respect to neurodegenerative diseases like Alzheimer’s and Parkinson’s, the research has not shown a clear effect of CoQ10 supplementation:
- This 2014 systematic review of 16 clinical trials representing 1,557 patients found no relevant data to support the use of CoQ10 for Parkinson’s and other movement disorders (e.g. Huntington’s, ALS).
- This phase 3 clinical trial in 600 patients found no clinical benefit to high dose CoQ10 supplementation (1200-2400mg/d) in patients with Parkinson’s disease.
- Furthermore, this 2016 meta-analysis and review of 5 clinical trials representing 981 patients found that “CoQ10 supplementation does not slow functional decline nor provide any symptomatic benefit for patients with Parkinson's disease”.
- Finally, we found this double-blind placebo-controlled trial in 78 patients with Alzheimer’s suggesting that CoQ10 supplementation (400 mg TID) for 16 weeks provided no decrease in levels of oxidative stress or neurodegeneration biomarkers and thus presents no clinical benefit to patients.
Research on the use of CoQ10 in cancer patients also presents mixed evidence.
- This decades old clinical trial in 20 pediatric cancer patients treated with anthracyclines chemotherapy drugs) found that when compared to placebo, patients treated with CoQ10 adjunctive therapy were protected against changes in heart function caused by the chemotherapy drugs.
- Conversely, this 2013 trial in 236 breast cancer patients found that when compared to placebo, 1:1 combination CoQ10/vitamin E supplementation (300 mg TID each) for 24 weeks, did not significantly affect self-reported fatigue, depression, and quality of life.
- We also found this 2016 exploratory trial in 59 breast cancer patients with cancer-related fatigue found that patients receiving a CoQ10-containing supplement (30 mg) plus branched-chain amino acids (2,500 mg) and L-carnitine (50 mg)had significantly better worst level of fatigue, global fatigue, and current feeling of fatigue scores when compared to placebo; however, the self-reported average feeling of fatigue did not differ between groups.
- Three older studies (study 1, study 2, study 3) conducted in humans have tested the efficacy of CoQ10 as adjuncts to traditional cancer treatment (e.g., chemotherapy) and suggest tumor regression following treatment with both low (90mg/d) and high-dose (390 mg/d) CoQ10 supplementation. While the results initially appear favorable, these studies present fundamental design flaws (e.g., lack of control groups, confounders, selection-bias) that compromise the integrity of the results. Because of this, newer, better-designed, and more robust studies are needed to verify results of these three preliminary trials.
- We also read older anecdotal reports and case studies of individual patients being supplemented with CoQ10 suggesting the coenzyme may prolong survival when used as an adjunct to traditional therapy; however, there we did not find larger scale studies to corroborate these findings. In fact, this recently updated fact sheet from the National Institutes of Health Center for Complementary and Integrative Health suggests that there is no evidence to suggest CoQ10 is beneficial for treating cancer.
Current studies suggest that CoQ10 may be useful for reducing inflammation throughout the body. Two of the most robust studies include:
- This 2017 meta-analysis and review of 17 clinical trials examining the effects of CoQ10 supplementation on C-reactive protein (CRP), IL-6, and TNF-α—inflammatory cytokines that can contribute and/or exacerbate chronic age-related disease like heart disease and diabetes. The results of this analysis suggest that 60-500 mg/day of CoQ10 (or its reduced form ubiquinol) for a period of 1-4 weeks significantly reduces blood levels of CRP, IL-6 and TNF-αby 0.35mg/L, 1.61pg/mL, and 0.49pg/mL, respectively.
- This 2018 systematic review and meta-analysis of 7 prospective intervention studies examining the effect of CoQ10 supplementation on CRP and IL-6. The results of the analysis suggest that 60-300 mg/day of CoQ10 significantly reduces IL-6 by 0.72pg/dL. CoQ10 was not associated with a significant reduction in CRP.
In our opinion, the case in favor of CoQ10 supplementation starts with the fact that there is not much debate about the role that CoQ10 plays at a cellular level. On this plane, anything that supports mitochondrial health and function we would consider a plus. It’s role as an antioxidant, helping to counter the natural increase in cellular oxidative stress that comes with aging, is another. It also implies a connection to countering chronic inflammation. There is also not much debate around the fact that cellular CoQ10 levels decline with age (although, exactly why --as in the case of NAD-- is not entirely clear). Lastly, CoQ10 is considered safe and will cause no harm.
These seem to be the strongest arguments in favor of including this supplement in a longevity protocol. The underlying assumption is that taking a CoQ10 supplement will result in increases of CoQ10 availability at the cellular level. For the n=1 experimenters out there, this is something you could validate by taking before/after CoQ10 blood plasma measurements.
Having said all that, the evidence to date on CoQ10s benefits in prevention or treatment of specific health conditions has been mixed and needs to be considered on a case by case basis. If you are considering CoQ10 in this context, make sure you consult with your primary care provider before taking this or any other type of supplement.
Should I Supplement CoQ10?
When it comes to getting more CoQ10, you have a choice between dietary sources and synthetic supplements.
Dietary sources of CoQ10 include oily fish (e.g., salmon, tuna), organ meats (e.g., liver), and whole grains. Most of us obtain sufficient amounts of CoQ10 from our diet, but as we age or develop chronic diseases, it may be worth supplementing as an “in-case” strategy..
if you’re looking for a more exhaustive list and want to dig into the research, check out this article we found on CoQ10 content in foods and fortification strategies.
Choosing A Supplement
It’s important to always consider absorption and bioavailability when picking a supplement. CoQ10 is a fat-soluble molecule and is best absorbed with meals that have fats and oils. It also comes in its oxidized (CoQ10) and reduced form (ubiquinol) which can affect the bioavailability of the compound. Check out this video from Consumer Labs on what else to consider when choosing a CoQ10 supplement.
If you’re ready to pick a supplement, one company that has piqued our interest is MitoQ and their line of CoQ10 boosting supplements. The company has focused on innovating on the deliverability of CoQ10 into the mitochondria by making the particles smaller and bonding them with a positively-charged ion that attracts it to the mitochondria. Click here to learn more about the science behind the MitoQ formula. If you’d rather skip right to the supplement, check out their tips on choosing the right variation for you, (note: Nowgevity has no affiliation with this company).
For other ideas on potentially good CoQ10 brands check out Labdoor’s rankings here. Labdoor tests supplements and gives them a quality rating based on a set of attributes such as label accuracy, product purity, efficacy, etc.
Drug Interactions and Side Effects
While CoQ10 is generally considered safe, consult your doctor before beginning to supplement especially if you have heart failure, diabetes, liver or kidney problems or the are taking any of the following medications:
- Statins for cholesterol
- Oral diabetes drugs or insulin
- Warfarin/Coumadin or other blood thinners
- Thyroid medications
- Chemotherapy agents
Supplementing CoQ10 may cause the following adverse effects:
Avoid use of CoQ10 in children or women who are breastfeeding or pregnant.
Share your experiences with CoQ10 with us or anything we may have left out: email@example.com
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