This blog is one of a continuing series of blogs that are attempting to peer into the future and see what treatments possibly await us. This blog provides an overview on CoQ10 – what forms work best and how to take it – and then takes a look at the next generation of more powerful CoQ10 supplements we may see.
- Are Intranasal Drugs the Future for ME/CFS and Fibromyalgia?
- Glial Cell Inhibitors: The Next Sleep Drugs for Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)?
- Cooling the Flames: Possible Approaches to Reducing Neuroinflammation in Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia
- Future Drugs for Fibromyalgia and Chronic Fatigue Syndrome (ME/CFS)? A Clinical Trials Survey
- Could Fibromyalgia Patients Linalool Their Pain Away (Someday)?
Coenzyme Q10 (CoQ10) is best known as an antioxidant – a scavenger of the free radicals that knock holes in the lipid membranes protecting our cells – sometimes setting off a free radical chain reaction. CoQ10 also mops up free radicals produced during energy production inside the cell and is an ATP production enhancer. If “dirty” energy production is occurring – as has been suggested in ME/CFS – CoQ10 might provide a way to clean up the mess and increase energy.
One of the most well-known and broadly used supplements, CoQ10 has been prescribed and/or studied in a surprising array of diseases including cardiovascular disease, diabetes, viral hepatitis, Parkinson’s disease, periodontal disease, and migraine, as well as fibromyalgia (FM) and chronic fatigue syndrome (ME/CFS).
Given that many of these factors have been implicated at one time or the other in both fibromyalgia and chronic fatigue syndrome (ME/CFS), CoQ10 looks like it might be a good deal for both diseases.
Spanish researchers have done the bulk of the investigations into CoQ10 and fibromyalgia. The most recent FM study – a small placebo-controlled crossover trial – found that adding CoQ10 to Lyrica (pregabalin) (300 mg/d (Mega Life Sciences – Thailand) further reduced pain, anxiety, mitochondrial induced oxidative stress and inflammation, while increasing the levels to two important antioxidants (reduced glutathione, superoxide dismutase).
A small (n=20) 2017 placebo-controlled study found that 300 mg/day (divided into 3 doses per day) of CoQ10 from Pharma Nord, Vejle, Denmark resulted in clinically significant improvement in depression, anxiety, and hostility, and was of moderate statistical significance in reducing somatization, and obsessive–compulsiveness. That finding, of course, suggested that those behavioral characteristics derive from high levels of oxidative stress and inflammation.
Apparently, the same trial (but another study) also found that CoQ10 produced significant reductions in fibromyalgia impact scores with reductions in pain, fatigue and morning tiredness most prominently occurring. Physiologically, reductions in inflammation, increases in antioxidant levels, mitochondrial biogenesis and AMPK gene expression were found.
Another small study from the same group found that CoQ10 increased serotonin levels and reduced depression in fibromyalgia. In 2012, Spanish researchers found that CoQ10 restored catalase and ATP levels in FM patients and significantly improved symptoms, including headache.
While the study results suggest CoQ10 may be helpful, a recent Spanish study did not find (probably to their surprise) that FM patients’ CoQ10 status was helpful in differentiating them from healthy controls. Thus, while CoQ10 supplementation was shown to be helpful in this small trial, problems with CoQ10 did not appear to be core to the disease.
It should be noted that CoQ10 assists ATP production in two of the five mitochondrial complexes (II. III.). Mitochondrial problems that do not affect those complexes probably won’t be helped by CoQ10. (The study did find mitochondrial issues with the FM patients appeared to have more mitochondrial degradation).
Chronic Fatigue Syndrome (ME/CFS)
In 2016, the Watanabe group’s small (n=43) placebo-controlled, double-blinded study from Japan found that 150 mg/day of ubiquinol-10 (the reduced form of CoQ10) for 12 weeks improved autonomic nervous system and cognitive functioning.
A larger (n=80) randomized, controlled, double-blinded Spanish trial found that a CoQ10/NADH mixture (50 mg CoQ10, 5 mg NADH, 40 mg Vit. C, 20 mg phosphatidylserine, 40 mg of vitamin C) taken 4 times/day found a trend (not statistically significant) towards a reduction in fatigue and no effect on pain levels or sleep. A similar CoQ10/NADH trial found a significant reduction in fatigue.
In 2005, Maes found very low plasma CoQ10 levels in ME/CFS.
On the plus side, most of the studies are placebo controlled and the results are mostly encouraging. On the downside, the studies tended to be quite small and many of them came from one research group.
Since the mitochondrial problems, if indeed they are present in FM and ME/CFS, are not clear – it’s not clear that taking CoQ10 will assist them. Fisher’s recent study, for instance, found problems in complex V of the mitochondria in ME/CFS, which is not one of the complexes affected by CoQ10.
There is another way that CoQ10 might be helpful, though – as an antioxidant. Increased levels of reactive oxygen species (free radicals) are one of the most consistent findings in ME/CFS and FM.
Better Blood Flows?
Kaneka Nutrients recently reported that healthy people with dyslipidemia – high rates of lipids in their blood – who took 100/200 mg/day of ubiquinone significantly increased their blood flows and reduced their levels of LDL oxidation.
(Lipid peroxidation/oxidation occurs when free radicals, in an attempt to achieve balance, rip electrons out of cellular membranes – often producing a free radical chain reaction.)
That’s an interesting finding, given the possibly reduced blood flows in ME/CFS, and the no less than five studies since 2001 which have found increased levels of lipid oxidation and/or free radicals in the blood of people with ME/CFS. Findings like those generally set people up for increased risk of cardiovascular illness. With virtually all ME/CFS patients, in particular, being unable to engage in strenuous exercise, anything to clean out the blood vessels may be a good idea.
The Two Forms of CoQ10
- Conventional CoQ10 or Ubiquinone – is the oxidized form of CoQ10, this form is more stable but has to be transformed into ubiquinol first. As we age, we become less able to convert CoQ10 to its usable form. Some people, particularly of Hispanic or Chinese descent, may also lack the enzyme to transform ubiquinone. Eating green, leafy vegetables may help.
- Ubiquinol – is more “hydrophilic” (i.e. it is absorbed better) and is the form of CoQ10 which scavenges free radicals in the mitochondria and cellular membranes, and it increases energy output. Our mitochondria naturally produce enormous amounts of free radicals which need to be mopped up.
Life Extension reported that one study showed that it took just 150 mg of ubiquinol to produce the same CoQ10 blood levels (3.96 mcg/ml) as 1,200 mg of CoQ10 (ubiquinone) over four weeks. Mice aging studies suggest that ubiquinol may be far superior for older patients. In low CoQ10 disorders – which both ME/CFS and FM may be – the goal is generally to get CoQ10 levels above 3.5 mcg/ml).
Life Extensions recommends 100-150 mg of ubiquinol daily for adults over the age of 30. It recommends 200-300 mgs of ubiquinol a day for those attempting to receive its “anti-aging” benefits. They noted that large doses (150-300 mg) result in an “exponential increase in blood CoQ10 levels”, which is sustained longer.
Dr. Mercola recommends starting with 200 to 300 mg per day, and then ramping down to 100 mg/day after three weeks when your CoQ10 plasma levels plateau. If you experience a lot of stress, though, 200-300 mg/day Is recommended. Other reports, though, suggest that it may take up to four weeks for the CoQ10 levels in your blood to reach their maximum levels.
The Future CoQ10
The CoQ10 of the future may be quite different from the formulations available today. A Spanish group recently produced a broad overview of the field “Coenzyme Q10: Novel Formulations and Medical Trends“- with a focus on CoQ10 future prospects.
CoQ10 has a lot of potential but there is a catch – low bioavailability. CoQ10 is a large molecule that doesn’t disperse well across gastrointestinal barriers; i.e. if you take CoQ10 orally, the intestinal absorption is poor. In fact, rat studies indicate that only about 3% of the orally ingested Coq10 is absorbed. The authors noted that CoQ10’s low bioavailability means it’s often not prescribed for conditions it could conceivably help.
The traditional way to improve CoQ10 bioavailability has simply been to pack it in oils. People taking CoQ10 should note that it’s practically insoluble in water and should be taken with high fat meals. The oil formulations increase drug solubility in the gut and enhance drug transport via the lymphatic system. Negative factors, though, such as the poor dispersion rate of the supplement in the gut, its not so stellar mixing ability, and the large particles that are still present, inhibit its bioavailability.
The desire to get more CoQ10 to the tissues has resulted in a surprisingly fertile field of experimentation with many approaches being tried. Several attempts (oil solution and suspension, lipid and surfactant-based emulsion, solid dispersion system) have been made to increase CoQ10’s bioavailability, but the authors reported that the bioavailability remained low.
Researchers have not given up, though, and recent efforts have been more successful.
- Nano-liposomes – Freeze-dried nano-liposomes with “long circulating elements” that improve the stability, and prolong circulation times, appear to increase bioavailability.
- SEDDS – Lipid-free self-emulsifying drug delivery systems (SEDDS) which feature surfactants that reduce the surface tension of CoQ10 – allowing it to be more easily absorbed through the gut wall – appear to be effective.
- SNEDDS “Self-nanoemulsifying” CoQ drug delivery systems or SNEDDS have been developed to increase CoQ10’s delivery across the gastrointestinal membranes. These delivery systems use oils, surfactants and a drug to produce a product which, when subject to the kind of agitation found in the intestinal tract, produces droplets small enough to ooze through the gut wall into the blood. Early results suggest this approach may work with much lower levels of CoQ10 able to be used.
- Lipid Free Nanoparticles – the goal – to take the fat and its problems with dispersion, emulsification, etc. out of the equation. In this approach, nanoparticles of CoQ10 are modified with surfactants using a hot, high pressure system. The surfactants allow CoQ10 to ooze through the cell membrane and slip between the tight junctions present. Animal studies suggest the process works and bioavailability is significantly enhanced.
- Oleogels – solubilized CoQ10 – “emulsions where CoQ10 is dissolved in an oil-dispersed phase” – have increased bioavailability. Solubilized formulations of CoQ10 do appear to be available.
- Water-based CoQ10 solutions – The authors reported that a water soluble version (Q10Vital) has been produced which is as effective – if not more effective- than oil-based preparations. Qunol has a liquid from of CoQ10 which they say is both water and oil soluble.
Creating forms of higher bioavailable CoQ10 is clearly a growth field. Just in the last two months, two new formulations were published in the scientific literature.
This is not to suggest that ubiquinol in its present form cannot be successful. Studies show that taking it in sufficient amounts for 4 weeks or so results in increased levels in the bloodstream. Better, more effective forms in the future are likely, however.
Note that if you’re buying through Amazon, be sure to purchase supplements from a reputable retailer based in the U.S. (Even then, counterfeit pages identical to the retailers’ pages can be made.) A 2017 Forbes article indicated that the Chinese have flooded Amazon with counterfeit products, and Amazon has done little to combat that. It stated that 25% of Amazon’s vendors are Chinese. Jill Carnahan recommends avoiding Amazon and buying direct from the manufacturer, if possible.
CoQ10 is a mighty antioxidant and plays a key role in ATP production as well. Fibromyalgia and ME/CFS studies, while small, do suggest that CoQ10 might be helpful with pain, cognition, mood and other symptoms.
It’s not clear that CoQ10 will help mitochondrial functioning in FM or ME/CFS, but it should help clean up the free radicals that studies indicate are present.
CoQ10 is best used in its ubiquinol form, which is better absorbed and has more potent antioxidant properties. Older people, in particular, are advised to use ubiquinol.
Suggested doses for healthy people appear to be around 100 mg/day. For those under stress and those wishing to receive CoQ10’s possible anti-aging properties, the suggested dose is 200-300 mg/day. The study parameters suggest that four weeks should be allowed for CoQ10 (ubiquinol) to reach its maximum levels in the bloodstream.
Because ubiquinol is fat soluble, it should always be taken with high-fat meals.
CoQ10 has been prescribed for many diseases but the authors of a recent overview suggest that its uses have been limited by the difficulty it has making its way through the gut wall into the blood.
A surprising number of different formulations have been created, with several showing promise. One form – solubilized CoQ10 – does appear to be available. Expect more effective forms of CoQ10 to show up in the future.