Coenzyme Q 10 Part Deux

Sorry for delaying in this post. I’ve been busy and not been able to get to the internet. Today I want to spend some time reviewing what depletes it and what types of supplementation can be used.

In the last post I put up a chart of CoQ10 reduction as one ages past the early 20’s.

Unfortunately ageing is inevitable. As you get older, your levels of the substance go down. Malnourishment will also speed that process along. Dr. Langsjoen discusses in the video linked from the first post about the need for folate, b vitamins 2, 3 6 and 12, pantothenic acid, vitamin c, tyrosine, methionine, Mg, and Se among others. If there is a deficiency in one or more of these, then coQ10 production could be impaired.

Drugs are going to be a big factor in depletion. Statins seem to be the most indicted when it comes to coQ10 depletion, but they aren’t the only ones. Tricyclic antidepressants are also offenders including;

Amitriptyline                 Clomipramine                   Doxepin                 Nortriptyline

Diabetic medications that raise insulin levels are offenders, namely;

glipizide          glyburide       tolbutamide

Blood pressure meds also lower coQ10 including

clonidine             atenolol                bisoprolol               labetalol                 metoprolol                    nadolol                pindolol                propranolol            hydralazine            hydrochlorothiazide, chlorothiazide         indapamide          metolazone

Gemfibrozil and statins that are for cholesterol lower coQ10.

Some others include chlorpromazine, fluphenazine and prochlorperazine.

Many people take these medications listed above, especially the statins and blood pressure medications. Some are even started in their 20’s. I know because I was started on simvstatin when I was 26. I took it for 2 years. I know others in their 20’s who are on blood pressure medications and/or statins as well because the numbers “are just high”. I find this rather disconcerting. Some people are actually lowering their coQ10 stores at ages when they are naturally their highest. I believe some doctors are unaware of the specifics when it comes to drugs that deplete coQ10 and the importance of resupplying the body.

Disease states such as congestive heart failure are also problematic. Many people are placed on drugs such as metoprolol, a beta blocker, which does seem to reduce mortality. Congestive heart failure is characterized by the heart not being able to pump sufficiently thereby causing problems with breathing, edema and other sequelae. The heart is literally in an energy crisis and many of the drugs used for blood pressure, cholesterol and in some cases diabetes actually cause longer term harm energetically. The underlying problem of getting the myocytes (heart cells) to produce energy is not addressed by many family docs and cardiologists, and even when it is with supplementation the amount being used may not be sufficient.


CoQ10 can be seen in many stores and online. It comes in many fancy packages and with many different claims. Some come in powder forms and others come in oil. Some are liquid preps and others are wafers. Traditionally I recommend to my patients to get the gel caps containing oil. Many times this oil is soybean because it is so cheap. I don’t recomment soy in any form unless it is fermented, soybean oil included. Look at the label if you want to get some. I know the amount is small in a gelcap, but if this is something your going to be taking long term, that amount will add up over time. I don’t know that it would technically be clinically significant, but I would stay away if possible.

CoQ10 also comes in the reduced form ubiquinol. Ubiquinol has been shown to abosrb better into the bloodstream than regular coQ1o or ubiquinone.1-3 Dr. Langsjoen has seen the benefit in patients that use ubiquinol over coQ10 in his clinical practice. Refer to the video that I posted last time for that story. It is also recommended that if taking regular coQ10, that it be done with a meal containing some fat so as to help the molecule into the blood. The main goal of supplementation is to raise blood levels so as to get more of the supplement into the cells where they are needed most. Blood levels of 4mcg/ml appears to be an effective treatment for heart failure per Dr. Langsjoen.4-6

CoQ10 may also be useful in treating neurodegenerative disorders like alzheimers. In a review of oxidative damage’s role in neurodegeneration, Beal discusses the potential role of substance like coQ10 can have on preventing or maybe treating this problem.7

Anecdotally I’ve talked to people at the pharmacy window who have told me it also seems to greatly improve muscle cramping. One lady said after a week of not taking it her cramps came back and she started it again. Within a week or so she said her cramps began to fade again. She is one of many who have reported this benefit. (I tell a lot of people to take CoQ10)


If coenzymeQ10 or ubiquinol is something you want to try then go for it. It does have a common side effect of nausea. Also it can interfere with warfarin binding to proteins in the blood, increasing the chance of bleeding for those patients. If you take warfarin, consult with a compentent doctor before supplementing. Ubiquinol appears to be the best absorbed so that is what I would recommend. For people using it as a preventative measure 50-100mg would probably be sufficient. For people with heart failure 200-300 mg divided twice daily or more may be required. It seems to depend more on the blood levels than the dose. For most of us, getting a coQ10 level measured may not be possible due to lack availability or money to pay. The supplement itself can be costly for some people, especially if you use ubiquinol rather than the less absorbable coQ10. If you have a doc or pharmacist who is knowledgable with this supplement, ask them for help. If they are unfamiliar, ask them to learn about it.

I think it important to note that it does take some time for coQ10 to begin working. It doesn’t start changing your life overnight so be patient.

There are other supplements that can be used to increase energy in the heart. I won’t be going over them in this post but would like to address them in future posts. A book that I would recommend is Reverse Heart Disease Now by James Roberts and Stephen Sinatra, two cardiologist who practice what they term integrative cariology. In the book they discuss the role of magnesium, l-carnitine, l-arginine and other supplements that can be used for the heart.

I want to express that I don’t receive any money from any company that makes any supplements or drugs. I believe CoQ10 and ubiquinol are great supplements and recommend them regularly.


The Brute

 1.  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.

2.  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 Oct;59(10):1541-50.

3. Shults CW, Flint BM, Song D, Fontaine D. Pilot trial of high dosages of coenzyme Q10 in patients with Parkinson’s disease. Exp Neurol. 2004 Aug;188(2):491-4.

4.  Langsjoen PH, Langsjoen AM. Overview of the use of CoQ10 in cardiovascular disease. Biofactors. 1999;9(2-4):273-84.

5.  Langsjoen PH, Littarru GP, Silver MA. Role of concomitant coenzyme Q10 with statins for patients with hyperlipidemia.
Curr Topics Nutr Res.2005;3(3):149–58.

6.  Langsjoen PH, Langsjoen AM. Coenzyme Q10 in cardiovascular disease with emphasis on heart failure and myocardial ischaemia.
Asia Pacific Heart J. 1998;7(3):160-8.

7. Beal MF. Mitochondrial dysfunction and oxidative damage in Alzheimer’s and Parkinson’s diseases and coenzyme Q10 as a potential treatment. J Bioenerg Biomembr. 2004 Aug;36(4):381-6.

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Coenzyme Q10

Coenzyme Q10 (CoQ10) is a substance that has been receiving some attention in the last few years. It is a vital component of electron transport in the mitochondria of ALL cells. I want to do a couple of post concerning this molecule, how it works and what makes it disappear. Now for a little background in cellular biology for those that need the refresher, or for those who aren’t familiar with it.

All cells in the human body have what are called mitochondria. Mitochondria can be thought of as the cell’s powerhouse. They make what is called ATP for the rest of the functions the cell needs to survive. CoQ10 is part of the “assembly line” so to speak of how this crucial ATP is formed. Without it, we don’t make ATP in the quantities that we now make it. Our cells have the ability to make ATP without mitochondria, however the yield is abysmal in comparison. CoQ10 is also found in the lipoproteins in our body which carry cholesterol in the blood vessels. The CoQ10 is responsible as an important antioxidant to keep the lipoprotein from becoming oxidized and initiating inflammation.

CoQ10 peaks at about 20 years of age and then begins to decline as shown below.


Notice that the heart seems to lose the most. CoQ10 is extremely important in the heart because, well, your heart requires a lot of energy to pump 24/7. Kidneys also seem to get hit hard with the decrease as we age. By the time we hit our 70’s and 80’s the numbers are as low as those of newborns or lower.¹

This poses a problem as we age because we still need energy to live and function, but that energy is in lower supply. It also becomes an issue when looking at antioxidant status of cells and lipoproteins. Lets discuss some of these in order of the following:

1. Antioxidant use

2. Energy for the heart

3. Depletion

4. Supplementation

Antioxidants are well-known to us. Many think of vitamin C or E as antioxidants as well as the many that exist in foods such as blueberries or other plant foods. One way in which CoQ10 benefits humans is the ability to prevent the LDL from becoming oxidized. This is important as oxidized LDL is thought to be an initiator in the inflammation process which causes atherosclerosis in arteries. CoQ10 can also rejuvenate vitamin E by taking radicals from the α-tocopherol molecule. Thus the molecule reverts back to being essentially a brand new antioxidant, even though it had already been used up. Radicals are those pesky particles that cause damage to tissue and even DNA, which can cause mutation and other health problems. They are also thought to play a part in aging.

Energy for the heart as stated above is very important. It is the one muscle that is constantly working as long as one is alive. We need CoQ10 to make that energy for pumping blood. People that suffer from congestive heart failure (CHF) are unable to pump blood as efficiently as a person who has no dysfunction. Part of the problem is the heart doesn’t have enough energy to pump the blood. CHF becomes complicated when fluid builds up in the lungs and breathing becomes difficult. CoQ10 has been shown to increase the ability of the heart to pump blood and decrease symptoms of CHF. Peter Langsjoen, a cardiologist in Texas, has done much research into the usefulness of CoQ10 and has published several studies concerning the molecule. A video of him talking about it to dental students can be found here. He also co-authored a paper that explains many of the studies done on the heart with CoQ10 here. I want to go over just a couple of those studies.

In one study, 424 patients with different types of heart failure were treated with on average 240mg/day of CoQ10. They followed up for 8 years with an average follow-up of 18 months. Improvements were seen in NYHA functional status and 50% reduction on average of concomitant cardiovascular medication used. Effects were apparent at 1 month with maximal effects at 6 months. Withdrawal of the supplement resulted in patients declining to pre-treatment levels within 3-6 months.²

Another in-vitro study shows that supplementation with CoQ10 can increase the amount of the substance in LDL particles, increasing their defense against oxidation³. While I don’t know of any hard study endpoints like mortality or MI reduction, this could be important in the fight against primary and secondary heart disease.

Some studies have also shown a reduction in blood pressure on CoQ10 supplementation with as little as 100mg/day.

In the next post we’ll look at depletion and supplementation. I think this is a very important supplement for many people. I routinely recommend it at the counseling window at the pharmacy. For those of you who have time I recommend the two links. The video is 40 min in length so you may not be able to watch it all at once, but take a look. The latter parts deal more with periodontal disease rather than heart but there are pearls that Dr. Langsjoen reviews that I believe are beneficial. Until next time.


1. Kalen A, Appelkvist E-L, Dallner G: Age related changes in the lipid composition of rat and human tissues. Lipids 24: 579–584, 1989.

2. H.A. Langsjoen, P.H. Langsjoen, P.H. Langsjoen, R. Willis and K. Folkers, Usefulness of coenzyme Q10 in clinical cardiology: a long-term study, Molecular Aspects of Medicine 15(Suppl.) (1994), s165–s175.

3. R. Aejmelaeus, T. Metsä-Ketelä, P. Laippala, H. Alho and T. Solakvi, Ubiquinol-10 and total peroxyl radical trappingcapacity of LDL lipoproteins during aging: the effects of Q-10 supplementation, Molecular Aspects ofMedicine 18(Suppl.) (1997), s113–s120.


Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.