CO-ENZYME Q - A Patient's Guide
Abstract
What is coenzyme Q10?
Coenzyme Q10 (CoQ10) is a lipid-soluble vitamin-like compound. It is synthesized by the body and obtained from dietary fat. Other names for CoQ10 are Vitamin Q10, Ubiquinone, Idebenone and Mitoquinone.
Coenzyme Q10 is present in almost all cells of the human body, where it is used by cells to produce energy and is also used by the body as an antioxidant.
Why is this supplement used?
Coenzyme Q10 is widely used in many countries. It is claimed to be of benefit in a variety of cardiovascular diseases, musculoskeletal disorders and neurodegenerative diseases.
It is taken in the belief that the lipid-soluble antioxidant properties provide protection against free-radical damage within mitochondria.
Another popular reason why some people take CoQ10 is to avert the negative effects of medications such as statins (cholesterol lowering medication) such as statin myopathy.
The mechanism of statin myopathy is unclear; however, it is known that statins reduce the synthesis not only of cholesterol but also of CoQ10. One theory suggests that statin myopathy results from mitochondrial dysfunction in muscle caused by CoQ10 deficiency. For this reason, supplemental CoQ10 has become a popular treatment for statin myopathy.
What are some other examples of when it is used?
Some conditions where CoQ10 is sometimes used and the corresponding doses (ref 1):
AIDS 200mg/day
Alzhiemers disease 120mg three times daily
Angina 60mg/day
Cardiomyopathy 100-600mg/day
Congestive heart failure 1mg/kg/day or 100-600mg/day
Hypertension 75-360mg/day; average dose 225mg/day
Migraine 100mg three times daily
Parkinson’s disease 300-1200mg/day
Periodontal disease 5ml/day of 200mg/ml CoQ10
Is there proof that CoQ10 actually works?
In a small randomized controlled trial of 32 patients with hypercholesterolemia and statin-associated myopathy, 18 patients were treated with CoQ10, 100 mg daily, and 14 patients with vitamin E, 400 IU (chosen to control for the antioxidant effects of CoQ10) daily for 30 days. Compared with the vitamin E group, the CoQ10 group showed a 40% decrease in pain severity and a 38% reduction in pain interference with daily activities (ref 2)
Several other studies, while showing that serum CoQ10 levels do decrease with statins, have failed to show benefit in muscle aches from supplementation.
Another very small study involving only 20 patients with fibromyalgia found reduced levels of CoQ10 when compared with 10 healthy controls – so small a study that not a good one to draw any conclusions from.
An overview of different trials of CoQ10 use in congestive heart failure have showed only small improvements in ejection fraction and cardiac output (i.e. the effectiveness of the heart as a pump)
To further assess the effectiveness of CoQ10 in certain diseases, there are currently ongoing trials looking at whether CoQ10 supplementation improves survival in congestive heart failure patients and whether it improves symptoms of Parkinson’s disease.
Is it worth getting serum CoQ10 levels checked?
Serum levels of CoQ10 do not seem to correlate well with tissue deficiency or with symptoms so it is not generally recommended.
Any potential side effects or harm in taking supplements?
No serious side effects have been reported from the use of CoQ10. However there have been some reports of mild insomnia, elevated liver enzyme levels, rashes, nausea, abdominal pain, dizziness, visual sensitivity, headache and fatigue.
It is not recommended for use during pregnancy or while breast-feeding.
CoQ10 can change the body’s response to warfarin or insulin so caution is advised in these circumstances.
What is the bottom line?
In summary, more research is needed to determine whether CoQ10 is useful for treatment of statin myopathy or the wide range of conditions for which it is sometimes commonly used.
At present no current cardiology guidelines recommend the routine use of CoQ10 in people taking statins, they might be worth a try (with careful monitoring) in patients with mild statin-induced myopathy.
As far as its uses in other conditions such as Parkinson’s disease and congestive heart failure - it is a matter of waiting for the current trials to be completed and analyzed to fully determine if there are any benefits.
A sensible approach may be to increase dietary sources of CoQ10 before deciding to try supplements.
Good dietary sources of CoQ10 include oily fish (e.g. fresh sardines, mackerel), offal (e.g. liver, kidney), eggs, nuts, soy, sesame and some vegetables (e.g. spinach, broccoli).
References:
- Uptodate : coenzyme Q10:natural drug information
- medscape: does coenzyme Q10 relieve statin-induced myopathy?
http://www.medscape.com/viewarticle/709107