Coenzyme Q10

by Michael B. Schachter M.D., F.A.C.A.M.

Coenzyme Q10 or CoQ10 is an extremely important nutrient that every cell in your body must have in order to produce energy. Although present in food, CoQ10 is not considered a vitamin because the body is able to make it from raw materials contained in food. Nevertheless, the body often cannot make enough for optimal functioning and therefore CoQ10 supplements may be very helpful. Because CoQ10 is involved in basic energy production by every cell in the body, optimal amounts can be beneficial for a wide variety of complaints, symptoms and diseases. To give you a brief idea about what types of complaints or disorders I am referring to, Co Q10 has been used successfully for periodontal disease, high blood pressure, congestive heart failure, angina pectoris of the heart, cardiomyopathy of the heart, protection of the heart from the damaging effects of the chemotherapeutic drug Adriamycin, immune disorders such as AIDS and most recently cancer.

How Does Coenzyme Q10 Work?
Biological chemical reactions require helper substances known as enzymes. These enzymes are catalysts or helpers for the biochemical reactions, but are not used up or changed during the chemical reaction. Enzymes are specialized protein molecules, which generally require a mineral, such as magnesium or zinc, and a non-protein organic chemical, called a coenzyme. Examples of coenzymes are vitamin B6, vitamin B12, folic acid, and coenzyme Q10.

As mentioned previously, coenzyme Q10 is specifically utilized in energy production in the cells. There are approximately 100 trillion cells in the human body and each must produce its own energy to carry out its functions. The cells produce energy by burning primarily fats and carbohydrates. This burning or oxidation process occurs as a result of oxygen combining with these foodstuffs to produce carbon dioxide and water. The energy produced by these chemical reactions is converted to chemical energy in the form ATP molecules. These ATP molecules are available to supply energy to the various chemical reactions necessary for life. More than 95 percent of the oxygen we breathe is used solely for the purpose of making energy through this process of burning the organic substances.

Where in the cell does this occur and what is the specific role of coenzyme Q10? Within each cell are small subcellular particles called mitochondria. Here is where the energy production process takes place. The mitochondria contain electron transport chains, which are the fundamental units for energy production in our cells. Through a series of chemical reactions along this electron transport chain, the ATP molecules are produced. Other familiar substances are involved in this electron transport chain. These include vitamin C, riboflavin (or vitamin B2), niacinamide (or vitamin B3), vitamin E and others.

Coenzyme Q10, which is fat-soluble and therefore mobile in cellular membranes, plays a unique role in the electron transport chain. It is a mobile messenger link between the various enzymes of the chain. Each pair of electrons processed by the chain must first interact with CoQ10. If you think of the cell as a little engine, which uses oxygen to burn the organic fuels that come from the organic foodstuffs, you may think of CoQ10 as the part of the engine that provides the spark for this process. No other substance will substitute for CoQ10. Without CoQ10 there is no spark and therefore no production of energy for the cell. And, without energy, there is no life. Optimal electron transport to generate ATP depends upon there being optimal levels of CoQ10 in the mitochondrial membrane.

Antioxidant Function of CoQ10
In addition to its vital role for the cell of an energy carrier, CoQ10 plays another vital role in cellular function as an antioxidant. An oxidant is a substance that tries to take electrons from nearby substances. An antioxidant is a substance that gives up electrons easily, and so can function to neutralize oxidants. The antioxidant nature of CoQ10 derives from its energy carrier function. As an energy carrier, the CoQ10 molecule is continuously going through an oxidation-reduction cycle. As it accepts electrons, it becomes reduced. As it gives up electrons, it becomes oxidized. In its reduced form, the CoQ10 molecule holds electrons rather loosely, so this CoQ molecule will quite easily give up one or both electrons and thus act as an antioxidant.

Oxygen free radicals are oxidants that are produced normally in the body during metabolism and also under various stress conditions. They are called free radicals because they can combine easily with other substances to damage cell membranes and lead to significant pathology and diseases. Antioxidants like the well known vitamins C and E, as well as beta carotene are able to neutralize these free radicals. Coenzyme Q10 also functions as an antioxidant. As an antioxidant, it appears to help correct dietary deficiency of vitamin E in animal models, protects against the toxic effects of adriamycin, protects against low oxygen states which results in large amounts of free radical formation and reduce oxidative distress that often results from surgery.

What about the chemical structure of CoQ10? It is one member of a family of substances known as quinones. Quinones are widely distributed in nature, as they are essential for generating energy in living things that use oxygen. This ubiquitous nature of these quinones has led some scientists to refer to them as ubiquinones. All of the CoQ molecules have a head to which is attached a tail. This tail can have from one to 12 repeated units. Humans have only one type of CoQ, which has 10 repeated units and is therefore called Coenzyme Q10.

History of CoQ10
Coenzyme Q10 was discovered in the United States in 1957 by Prof. FL. Crane at the University of Wisconsin. A year later in 1958, the chemical structure was reported by Dr. D. E. Wolf, under Dr. Karl Folkers at Merck Laboratories. Dr. Folkers has continued to research CoQ10 over the years and in 1986, he was awarded the prestigious Priestly Medal of the American Chemical Society for his research into CoQ and other nutrients. I heard Dr. Folkers lecture in the mid 80's at an ACAM conference on the role of CoQ10 in treating congestive heart failure and other heart conditions. In the spring of this year, I again heard Dr. Folkers, now 83 years old, talk about CoQ10 at an ACAM meeting in Minneapolis. This time he amazed the ACAM physicians by describing some cases of breast cancer that completely regressed on doses of CoQ10 of 300 to 400 mg daily. He also was critical of most of the available CoQ10 products, which are in the form of powdered CoQ10 capsules. Since CoQ10 is fat or lipid soluble and not water soluble, he said that this form of CoQ10 was not very bio available and would not be absorbed from the intestine. He recommended supplements that contained CoQ10 dissolved in oil. Since that time, a number of new CoQ10 products have hit the market. An oil liquid form is now available and chewable wafers of CoQ10 combined with fatty acids has also been released by several companies.

Although CoQ was discovered in the United States almost forty years ago, it is still not widely prescribed in western countries. In contrast, in Japan. where most of the research has been done in people, it is one of the most widely used drugs. Human testing began in Japan in 1963 on a case by case basis, but it was not until 1974 when sufficient supplies of pure CoQ10 became available, that clinical trials could be carried out. The reasons for CoQ10 not being used more frequently in the U.S. and other western countries is probably the same old story of money. Being a natural substance, CoQ10 is not patentable as a new drug and therefore profits are severely limited. Not only are potential profits from CoQ10 limited, but also profits from competitive patentable drugs with similar actions are threatened by the potential safety and efficacy of CoQ10 for a wide variety of disorders. In recent years, the FDA has attempted to remove CoQ10 from the shelves of health food stores, but has so far been unsuccessful.

Beneficial Uses for Heart Conditions
Japanese scientists, as early as 1976, showed that CoQ10 was helpful in heart conditions. In one study, seventeen patients with mild congestive heart failure were given 30 mg/day of CoQ10. Every patient improved in 4 weeks and 53% became symptom free. In another, more recent and much larger, randomized placebo controlled, double-blind study, 641 patients with more severe congestive heart failure were given either a placebo or approximately 150 mg/day of CoQ10 for one year. The number of patients requiring hospitalization because of worsening failure was 38% lower in the CoQ10 group. Episodes of life threatening pulmonary edema (a buildup of fluid in the lungs was 60% less in the treatment group. Patients with life threatening cardiomyopathy have reduced levels of CoQ10 in their heart muscles. When CoQ10 was given to a group of these patients, the strength of their heart muscle increased significantly, and their survival time increased three-fold.

Another use for CoQ10 in heart patients is in those with angina pectoris. In one double-blind study, treatment with 150 mg/day of CoQ10 for only 4 weeks, the episodes of chest pain was reduced in the treatment group by 53%. Also, exercise tolerance was increased. One of the chemotherapeutic drugs used most by oncologists is Adriamycin. Although Adriamycin is believed to be effective for many different cancers, such as breast cancer, it carries a serious risk of cardiac toxicity and a significant number of patients treated with this drug die from the complications of cardiomyopathy associated with Adriamycin rather than the cancer, itself.

In one small study of 14 cancer patients receiving Adriamycin, half were given 100 mg/day of CoQ10. All 7 of the patients given Adriamycin alone developed cardiac toxicity, whereas none of those given CoQ10 developed this complication. Furthermore, the CoQ10 did not interfere with the therapeutic effects of Adriamycin. Some studies have also shown that CoQ10 can help to lower blood pressure. In one study, 16 people were given 60 mg/day of CoQ10 for 5 to 16 weeks. In all cases there was a drop in either systolic BP, diastolic BP or both, but these effects did not occur until the patients had been on the CoQ10 for 4 to 12 weeks. Similarly, in a more recent double-blind placebo controlled group, subjects either received a placebo or 100 mg/day of CoQ10 for 10 weeks. No change occurred in the placebo group, but the CoQ10 group had reduced systolic and diastolic values.

A most ironic situation occurs with the cholesterol lowering drug Mevacor or lovastatin. This drug is given to lower LDL cholesterol levels in order to reduce risks of a heart attack. However, this drug clearly lowers CoQ10 levels in the tissues, thus increasing risk for heart disease. Certainly, anyone taking Mevacor or similar type drugs should be on a significant dosage of CoQ10. Similarly, the beta blockers, drugs that are used extensively to treat heart disease, high blood pressure and other conditions, also deplete the heart and other tissues of CoQ10. Unfortunately, most cardiologists and other conventional physicians in the United States are unaware of this fact and do not give patients on these drugs supplements of CoQ10.

Benefits in Periodontal Disease, Immune Disorders, Cancer and Other Conditions
Toxicity studies in animals has not shown any adverse side effects, even at dosages many times greater than those used in clinical studies. Also, there is no evidence for fetal abnormalities, distress to the mother during pregnancy or soon after birth. There is no evidence of any significant risks to humans taking CoQ10. As long as it has been carefully and rigorously purified, it appears to be safe as a nutritional supplement. As a daily supplement to the diet, CoQ10 requires about four to eight weeks to build up to peak concentration in the body and it often takes several weeks of daily administration to accomplish effects that are noticeable.

Periodontal or gum disease is very common in the United States and other Western countries. Plaque-forming bacteria that live in the mouth appear to be an important trigger for the disease, which manifests as inflamed gum tissue that may eventually result in the loss of teeth, as the teeth become loose in their bony sockets. Healing and repair of periodontal tissues requires efficient energy production, which as we have seen, required sufficient amounts of CoQ10. As early as 1971, Dr. Folkers reported that gum tissue taken from patients with periodontal disease was often deficient in CoQ10. In 1973, Dr. Folkers and Dr. Matsumura completed a double-blind study using CoQ10 for periodontal disease. They reported that it was superior to the then treatment of choice for periodontal disease. Dr. Wilkinson reported in the late 70's that at dosages of 50 to 75 mg per day often halted the deterioration of the gums with healing sometimes occurring within days. As of 1988, a total of 9 clinical studies involving 304 patients have confirmed many experimental studies with animals. CoQ10 can effectively reverse gum disease. 

Other conditions for which experimental evidence exists on the helpful role of CoQ10 are: diabetes mellitus, obesity, athletic performance, hearing disorders and muscular wasting diseases. In short, coenzyme Q10 is an amazing natural substance with far reaching therapeutic potential and an extremely low toxicity. It should be used much more extensively in the treatment of patients.