Medical Uses of Coenzyme Q10

about COENZYME Q10

Summary

Coenzyme Q10 is a naturally occurring substance found in all cells of the human body as well as in animals and many plants.  It has many vital roles in cells and without it human life would not be possible.  Coenzyme Q10 is a fat soluble antioxidant, combating the attack of oxygen free radicals which can damage many components of the cell.  Coenzyme Q10 is an integral part of the mitochondrial respiratory chain which produces energy in the cell.  Coenzyme Q10 has an important role in regulating genes which in turn control energy production and other important functions in the cell.  It is found in highest concentration in those organs and tissues with highest oxygen consumption such as the heart, brain and muscle.

As the body ages coenzyme Q10 content decreases.  Coenzyme Q10 is also depleted by diseases such as heart failure and kidney failure.  It is estimated that the body synthesises more than half its own coenzyme Q10 requirements, the rest being obtained from the diet.  Coenzyme Q10 is found in red meat, fish and green vegetables but these foods contain relatively small amounts of coenzyme Q10 compared to supplements.  Coenzyme Q10 supplements are virtually without side effects and are used for a variety of conditions including heart failure and brain disease.

Migraine headache

What is it?

A migraine headache is throbbing, moderate to severe pain, usually on one side of the head, that is made worse by physical activity, light, sounds or smells and is sometimes associated with nausea and vomiting.  Some people also experience changes in vision, balance and mood.  Migraine headaches tend to start between the ages of 10 and 40 years and in most people, they recur periodically until the age of 50-60 years.

Migraine treatment aims to prevent the frequency of attacks, blunt the severity of the attack and reduce the intensity of the pain associated with the headache.

Coenzyme Q10 and migraine headache

The exact cause of migraine headaches is unknown and there are several theories. One theory is that for some individuals, migraine is caused by a fault in the cell’s production of energy (mitochondrial impairment). Since CoQ10 is involved in cellular energy production, some studies have been performed to see whether CoQ10 supplements will be beneficial in migraine.

One study involving 32 migraine sufferers found that CoQ10 supplements (150mg daily) reduced the frequency of migraine headaches and reduced the number of days of each attack. In other words, people had less migraine headaches and if they did develop one, it was shorter than usual.

More specifically, the average number of days all sufferers experienced migraine was 7.34 days in the non-treatment period compared with 2.95 days by the end of the trial.

Nearly all people experienced some degree of benefit. Just over 9 out of ten people experienced at least a 25% reduction in the number of days with migraine compared to no treatment and nearly two-thirds of people experienced a 50% reduction in the number of days with migraine.  Additionally, CoQ10 significantly reduced the frequency of migraine attacks as the average number of attacks prior to treatment was 4.85 (in the previous 60 days) which decreased to 2.81 by the end of the trial.

According to this study, treatment with CoQ10 needs to be long term as at least 4 weeks of treatment was required before benefits were seen. With continued use, the beneficial effects grew stronger with maximal effects seen between 5-12 weeks. (Rozen et al., 2002).

In another study, CoQ10 was compared to an inactive capsule (placebo) to see whether the benefits were occurring by chance or not. The dose used was also larger, 300mg daily. Once again, after three months of treatment, CoQ10 began to reduce the frequency of migraine headaches, reduce the number of headache days and days with nausea (Sandor et al., 2005).

Based on these two studies, it seems that CoQ10 supplements decrease the frequency and of migraine headaches and the number of days of each attack however results are not immediate and at least 1-3 months of treatment is required.

Should I start taking it?

CoQ10 is not effective in all migraine sufferers and it is difficult to predict who will respond. If you are going to try this approach, it is suggested you take CoQ10 daily for 4-5 months. The daily dose should be between 150 mg – 300 mg.  If migraines start to become less frequent and last for less time, then you are responding well and should continue with the treatment.  However, if you experience no changes after this time then your body is not responding and this approach is not working for you.  It is also important to tell your doctor that you are taking CoQ10.

References

  • Rozen TD, Oshinsky ML, Gebeline CA, Bradley KC, Young WB, Shechter AL, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002 Mar; 22(2):137-41.
  • Sandor PS, Di Clemente L, Coppola G, Saenger U, Fumal A, Magis D, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2005 Feb 22; 64(4):713-5.

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Parkinson's disease

What is it?

Parkinson's disease is a slowly progressive disorder where there is degeneration of the nerve cells within a specific part of the brain. People with the disease have a muscle tremor, slower voluntary movements and increased muscle tone (rigidity). It tends to be an older person’s disease and most commonly begins between the ages of 50 and 79 years. The symptoms of Parkinson’s disease are caused by a loss of nerve cells and a decrease of the neurotransmitter dopamine in the basal ganglia in the brain.

Current pharmaceutical treatments provide effective control of symptoms in the early stages however there is a need to identify or develop substances which will protect nerves and either slow or stop further degeneration and ideally reverse pre-existing damage.

Coenzyme Q10 and Parkinson's disease

In 2002, new research was published which suggests CoQ10 may have benefits in this disease. Various doses of CoQ10 were compared to an inactive treatment (placebo) in a study involving 87 people with early stages of Parkinson’s disease. When the different doses were compared to placebo, it was found that people taking the highest dose (CoQ10 1200mg daily) developed significantly less disability than the people using inactive treatment. This was seen for mental and movement symptoms and activity of daily living (Shults CW et al., 2002).

These results suggest that high dose CoQ10 may slow the progression of the disease and/or improve symptoms. Future studies are required to clarify the exact benefits of CoQ10.

References

  • Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q 10 in early Parkinson disease. Evidence in slowing of the functional decline. Arch Neurol 2002;59:1541–1550.

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Freidrich's Ataxia

What is it?

Friedreich's ataxia (FRDA) is a rare hereditary disorder in which the sufferer progressively loses the ability to move their limbs, speak without slurring and may also suffer mental deterioration. The first symptoms may be seen between the ages of 5 – 15 years and by the late 20’s, often people are confined to a wheelchair. The disease is usually fatal by middle age due to abnormal heart rhythm or heart failure. There are no known treatments for the disease.

Currently, the exact cause remains unknown however it is suspected that impaired mitochondrial function (cellular energy production) and increased oxidative stress are likely to play a role and lead to loss of nerve cells. For some people with the disease, there may also be CoQ10 and vitamin E deficiencies and both have been implicated in ataxia.

Freidrich's Ataxia and Coenzyme Q10

In 2005, results of a 4-year study were published which showed a combination of vitamin E (2100 IU daily) and CoQ10 (400 mg daily) could potentially improve some symptoms of FRDA (Cooper and Schapira 2007).  Therapy had a significant and prolonged benefit on defective cellular energy production (mitochondrial function) in heart and skeletal muscles after 3 months.  Of the ten people treated, 6 people had a better level of physical functioning than expected after this time.  It is suspected that therapy may have improved the function of nerve cells, or slowed down further loss of nerve cells thereby slowing progression of the disease.  Whilst these are exciting results, large studies are required to clarify the exact benefits of CoQ10 and vitamin E in this group of people.

References

  • Cooper JM, Schapira AH. Friedreich's ataxia: coenzyme Q10 and vitamin E therapy.         Mitochondrion 2007 Jun; 7 Suppl:S127-35.

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Mitochondrial Myopathy

What is it?

Mitochondrial myopathies such as myocolonic epilepsy and Kearns-Sayre Syndrome are very rare in the community. They are a group of neuromuscular diseases caused by damage to the mitochondria within cells. These diseases are usually characterised by multi-organ abnormalities (especially muscle, heart and brain) and a high degree of free radical production.

According to a study of 44 people with various mitochondrial myopathies, treatment with CoQ10 (2mg/kg/day) orally over 6 months can partially decrease post-exercise lactate levels in some people. The 16 people experiencing this result were considered responders. It remains unclear why some people respond to this treatment and other do not and further tests failed to identify a reason.

References

  • Bresolin N, Doriguzzi C, Ponzetto C, Angelini C, Moroni I, Castelli E, et al. Ubidecarenone in the treatment of mitochondrial myopathies: a multi-center double-blind trial. J Neurol Sci 1990 Dec; 100(1-2):70-8.

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Diabetes mellitus

What is it?

Diabetes is a chronic condition which arises because there is a reduction or failure in the body’s ability to handle sugar. Type 2 diabetes is the most common form and is also known as ‘adult onset’ diabetes. Type 1 diabetes is the form more commonly seen in younger people and requires treatment with insulin.

Coenzyme Q10 and diabetes

Overall, human studies with CoQ10 suggest that supplementation lowers high blood pressure, and improves blood vessel function and blood flow in people with diabetes. It may also have a beneficial effect on blood sugar control. The dose used in most studies of people with diabetes is 200mg/day.

References

  • Andersen CB, Henriksen JE, Hother-Nielsen O, Vaag A, Mortensen SA, Beck-Nielsen H. The effect of coenzyme Q10 on blood glucose and insulin requirement in patients with insulin dependent diabetes mellitus. Mol Aspects Med 1997; 18 Suppl:S307-9.

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Chronic Obstructive Pulmonary Disease (COPD)

What is it?

Chronic obstructive pulmonary disease (COPD) is characterised by chronic inflammation and irreversible limitatio of the airways. It causes long-term morbidity and disability. COPD is caused by an inflammatory response to inhaled toxins, most often cigarette smoke. Due to the increasing incidence of smoking in developing countries, COPD is predicted to be the fifth most frequent cause of death in the world by 2020.

The first sign of COPD is usually a productive cough which eventually leads to breathlessness and wheezing which becomes more severe over time. People who continue to smoke with COPD experience a quicker deterioration of health.

COPD and Coenzyme Q10

At least two clinical studies have investigated the use of CoQ10 supplements in people with COPD. Although the studies were small, they indicate a possible role for CoQ10 which needs to be further clarified in larger studies.

In one study, people were assigned CoQ10 (50 mg/day) or placebo as part of their pulmonary rehabilitation program. Treatment with CoQ10 resulted in a 13% increase in maximal oxygen consumption and a 10% increase in maximum expired volume which were both significant (Satta et al., 1991).

In a smaller trial, CoQ10 (90 mg/day) taken over 8 weeks found treatment improved hypoxaemia at rest but did not change overall pulmonary function (Fujimoto et al., 1993).

References

  • Satta A, Grandi M, Landoni CV, Migliori GB, Spanevello A, Vocaturo G, Neri M. Effects of ubidecarenone in an exercise training program for patients with chronic obstructive pulmonary diseases. Clin Ther. 1991 Nov-Dec; 13(6):754-7.
  • Fujimoto et al. Clin Invest 71.8 suppl 1993; s126-s166.

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Periodontal Disease

What is it?

Periodonal disease is also known as gum disease. It is a condition characterised by chronic inflammation and infecti of the gums and surrounding tissue and is the major cause of adult tooth loss. Gum disease tends to develop when plaque is allowed to build up along the gum line.

Periodontal Disease and Coenzyme Q10

There has been relatively little research conducted with coenzyme Q10 in periodontal disease however a small study exists which produced promising results

A study of 10 people with peridontitis found that topical application of coenzyme Q10 to the affected areas for 3 weeks resulted in significant improvements in gum health and healing (Hanioka et al., 1994).

References

  • Hanioka T, Tanaka M, Ojima M, Shizukuishi S, Folkers K. Effect of topical application of coenzyme Q10 on adult periodontitis. Mol Aspects Med. 1994; 15 Suppl:s241-8.

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Sports Supplement

Because coenzyme Q10 is essential for energy production within the cell, researchers have suspected it may be of benefit in enhancing physical performance amongst athletes.

At least eight clinical studies have investigated coenzyme Q10 supplements in various sports people. Overall, the results have been mixed with the majority showing no clear benefits in physical capacity (Braun and Cohen 2007). The doses used in the studies varied from 60 mg to 150 mg daily and lasted from 1 to 2 months.

References

  • Braun L, Cohen M. Herbs and Natural Supplements - an evidence based guide. 2nd Ed. 2007. Elsevier, Australia.

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Coenzyme Q10 and Cancer

There have been three small studies using coenzyme Q10 in women with breast cancer after they have received standard treatment. The results suggest some may be helped by the treatment however because the studies were small and the results were poorly reported, further studies are required to clarify the effect of CoQ10.

Reducing side effects caused by chemotherapy (anthracyclines)

There is some research suggesting that coenzyme Q10 may help to reduce heart and liver toxicity caused by the anthracycline group of anticancer drugs.

Animal Models

Several studies conducted with animal models have shown that coenzyme Q10 might prevent the heart damage side effects caused by the cancer drug adriamycin (Kishi et al., 1976; Kishi et al., 1984; Usui et al., 1982).

Human Studies

In 2004, a review was published which analysed the results of 6 human studies which used coenzyme Q10 supplements together with cancer drugs. Overall the results indicated that coenzyme Q10 may provide some protection against heart and liver toxicity associated with some cancer treatments. Three of the six studies were randomised clinical trials and three were non-randomised clinical trials. Patients in five out of six studies received anthracyclines. The coenzyme Q10 dosage used in the studies ranged from 90 mg/day to 240 mg/day and the duration of treatment varied according to an individual's cancer treatment. No side effects were reported. Unfortunately, poor reporting of details in the studies mean the results cannot be seen as conclusive and further investigation is required to confirm the results.

Coenzyme Q10 and Tamoxifen

Tamoxifen is a drug which is used in breast cancer. It has been shown to be effective not just as an adjuvant therapy after surgery, chemotherapy or radiation therapy in early and advanced breast cancer cases, but also in chemoprevention in high risk pre- and post-menopausal women.

As a side benefit, tamoxifen also reduces cholesterol levels however this does not translate into heart protective effects because the drug increases triglyceride levels which are a risk factor for heart disease.

A study using coenzyme Q10, riboflavin (vitamon B2) and niacin (vitamin B3) supplements together with tamoxifen found that the vitamins prevented the increase in triglyceride levels but did not hamper the beneficial effects on cholesterol levels (Yuvaraj et al., 2007).

References

  • Lockwood K, Moesgaard S, Yamamoto T, Folkers K. Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases. Biochem Biophys Res Commun. 1995 Jul 6;212(1):172-7.
  • Lockwood K, Moesgaard S, Folkers K. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochem Biophys Res Commun. 1994 Mar 30;199(3):1504-8.
  • Usui T, Ishikura H, Izumi Y, Konishi H, Dohmae N, Sawada H, Uchino H, Matsuda H, Konishi T. Possible prevention from the progression of cardiotoxicity in adriamycin-treated rabbits by coenzyme Q10. Toxicol Lett. 1982 Jun;12(1):75-82.
  • Kishi T, Watanabe T, Folkers K. Bioenergetics in clinical medicine: prevention by forms of coenzyme Q of the inhibition by adriamycin of coenzyme Q10-enzymes in mitochondria of the myocardium. Proc Natl Acad Sci U S A. 1976 Dec;73(12):4653-6.
  • Kishi T, Takahasi K, Mayumi T, Hama T. Protective effect of coenzyme Q10 on adriamycin toxicity in beating heart cells. In: K. Folkers and Y. Yamamura, Eds. Biomedical and Clinical Aspects of Coenzyme Q10. 1984; Elsevier, Amsterdam. pp 181-188.
  • Roffe L, Schmidt K, Ernst E. Efficacy of coenzyme Q10 for improved tolerability of cancer treatments: a systematic review. J Clin Oncol. 2004 Nov 1;22(21):4418-24. Review.
  • Yuvaraj S, Premkumar VG, Vijayasarathy K, Gangadaran SG, Sachdanandam P. Ameliorating effect of coenzyme Q10, riboflavin and niacin in tamoxifen-treated postmenopausal breast cancer patients with special reference to lipids and lipoproteins. Clin Biochem. 2007 Jun;40(9-10):623-8. Epub 2007 Mar 19.

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Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a progressive neurodegenerative disease of the retina and it represents the leading cause of blindness in industrialised countries. Some research suggests that oxidative stress and mitochodrial dysfunction play a central role in the development of the disease. As a result, antioxidants such as coenzyme Q10 have been considered as potentially useful in preventing or slowing the disease.

To date, one study of 100 people with AMD has been conducted which used coenzyme Q10, L-carnitine and n-3 fatty acids. 106 volunteers with AMD were randomly assigned coenzyme Q10 or placebo and asked to take their treatment for 12 months (Feher et al., 2005). Treatment with the nutritional supplement improved visual function in the most affected eyes for people with early AMD. This result was observed after 6 months. The group receiving placebo experienced a worsening of visual function over the same time period which suggests that the nutritional combination slowed further disease progression.

References

  • Feher J, Kovacs B, Kovacs I, Schveoller M, Papale A, Balacco Gabrieli C. Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. Ophthalmologica 2005 May-Jun;219(3):154-66.

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Kidney Failure

People with renal (kidney) failure tend to have higher oxidative stress and decreased function of the antioxidant network compared with health individuals. Increased oxidative stress appears to develop in the early phase of kidney disease (Gazdikova et al., 2001).

A study of 48 patients on long-term haemodialysis and 15 uraemic patients found that both groups had significantly lower coenzyme Q10 levels when compared with the normal group (Lippa et al., 1994).

References

  • Gazdikova K, Gvozdjakova A, Kucharska J, Spustova V, Braunova Z, Dzurik R. Oxidative stress and plasma concentrations of coenzyme Q10, alpha-tocopherol, and beta-carotene in patients with a mild to moderate decrease of kidney function. Nephron 2001 Jul; 88(3):285.
  • Lippa S, Colacicco L, Calla C, Sagliaschi G, Angelitti AG. Coenzyme Q10 levels, plasma lipids and peroxidation extent in renal failure and in hemodialytic patients. Mol Aspects Med 1994; 15 Suppl:s213-9.

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Kidney Transplant

An animal model of kidney transplantation was used to determine whether coenzyme Q10 had any favourable effects after surgery (Tatsukawa et al., 1979). The study found that administration of coenzyme Q10 enhanced the rate and extent of ATP resynthesis by the mitochondrion and increased survival rate in test animals. Research is now required to determine whether coenzyme Q10 can produce similar beneficial effects in humans.

References

  • Tatsukawa Y, Dohi Y, Yamada K, Kawasaki T. The role of coenzyme Q10 for preservation of the rat kidney: a model experiment for kidney transplantation. Life Sci 1979 Apr 2; 24(14):1309-14.

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Amyotrophic Lateral Sclerosis (ALS)

This is a rare, progressive neurodegenerative disease which results in a loss of muscle function leading to paralysis and eventually death. Whilst the exact cause remains unknown, increased oxidative stress has been found in people with ALS.

A study using an animal model has found that coenzyme Q10 supplements modestly increase life expectancy (Matthews et al., 1998). Research is now required to investigate its effect in humans.

References

  • Matthews RT, Yang L, Browne S, Baik M, Beal MF. Coenzyme Q10 administration increases brain mitochondrial concentrations and exerts neuroprotective effects. Proc Natl Acad Sci U S A 1998 Jul 21; 95(15):8892-7.

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Reduced Sperm Counts

An excess of free radicals is known to impair sperm cell function and play a negative role in male factor fertility. Since coenzyme Q10 has an antioxidant function, it has been tested in infertile males to see whether treatment can improve semen quality and sperm function.

Twenty-two males with low sperm motility were treated with coenzyme Q10 (200 mg daily) for 6 months (Balercia et al., 2004). Although treatment did not improve sperm count, it did improve forward sperm motility and the wives of three patients achieved spontaneous pregnancy (13.6%) within 3 months of the discontinuation of therapy (a 2.4% pregnancy rate per cycle). Six months after discontinuing coenzyme Q10 use, sperm motility reverted back to original levels. Currently, there is a larger study underway to test these effects again.

References

  • Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, et al. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Fertil Steril 2004 Jan; 81(1):93-8.
  • Balercia G, Buldreghini E, Vignini A, Tiano L, Paggi F, Amoroso S, et al. Coenzyme Q10 treatment in infertile men with idiopathic asthenozoospermia: a placebo-controlled, double-blind randomized trial. Fertil Steril 2009 May; 91(5):1785-92.

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Statin Drugs and Coenzyme Q10

Statin drugs are widely prescribed by medical doctors to reduce the body's production of cholesterol. Some examples are: simvastatin, lovastatin and pravastatin.

During this process, statins also reduce the body's production of coenzyme Q10. Studies have indicated that statins can reduce blood levels of coenzyme Q10 by 16-54%. Tests with experimental models show that levels of coenzyme Q10 in the heart muscle and liver can also be reduced.

The most frequent and serious side effects associated with the use of statin drugs are muscle disorders which range in severity from mild muscle aches and pains to fatal muscle destruction. One of the theories proposed to explain these side effects relates to a reduction in muscle coenzyme Q10.

Currently, it is unclear whether taking coenzyme Q10 supplements together with statins will prevent people developing muscle side effects as the evidence available is confusing and contradictory.

There have been two human studies looking at coenzyme Q10 as a treatment once the side effects have developed. One study treated 41 people with statin-induced muscle side effects with either vitamin E (400 IU/day) or coenzyme Q10 (100 mg/day) for 30 days. Of the 21 people receiving coenzyme Q10, 18 experienced significant improvements in muscle pain whereas only 3 out of 20 people taking vitamin E experienced a reduction in symptoms. Another study of 22 people with elevated cholesterol levels and statin-induced muscle side effects found treatment with coenzyme Q10 (200 mg/day) was no better than placebo at reducing symptoms.

Overall, coenzyme Q10 is a safe and well tolerated supplement which could possibly reduce the risk of statin-induced muscle side effects and treat side effects once established however further research is required to confirm these effects.

References

  • Marcoff L, Thompson PD. The role of coenzyme Q10 in statin-associated myopathy: a systematic review. J Am Coll Cardiol 2007 Jun 12; 49(23):2231-7.

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