Coenzyme Q-10 Reviewed

Neither classed as a vitamin or mineral, Coenzyme Q-10 (C0Q10 for short) is a naturally occurring biochemical which can be found in every cell of our bodies.  

It was first discovered in 1957 and during the early 70's interest was piqued when research suggested CoQ10 may help to treat a number of chronic ailments.  

Since then, and not surprisingly, it's been awarded a list of superlatives by the supplement companies that sell it.  But is supplemental CoQ10 really an elixir of youth and does it offer anything for those simply wanting to improve their overall health and fitness?


CoQ10 And Heart Disease

CoQ10 can be obtained from our diets or from supplements but it is also made endogenously (meaning it can be created inside the body without external sources).  It plays a crucial role in cellular energy production, normal cardiac function and stimulates the immune system.  Classed as an antioxidant, CoQ10 levels in our bodies reduces as we age, peaking at around age 20.

CoQ10 has been studied in a number of people with different chronic ailments.  Some of the results of these studies have found that individuals with diseases such as congestive heart failure, diabetes and Parkinson's disease, high blood pressure and breast cancer have low levels of CoQ10.  

Of course, the presence of low levels may not be causative of these illnesses (it could be the other way round) so what happened when researchers administered supplemental CoQ10 to these people?

A study of 424 patients suffering from a range of cardiovascular diseases found that were benefits from supplementing with CoQ10 [1].  When looking at specific types of cardiovascular disease results have been even more interesting... 

For people with congestive heart failure, taking 2mg per kilogram of bodyweight per day over the course of a year resulted in fewer cases of pulmonary oedema and cardiac asthma, as well as fewer hospital admissions [2].  

When a group of 8 studies was analysed by Soja and colleagues, they concluded that heart failure patients supplementing with CoQ10 had improved physiological markers such as stoke volume (the amount of blood pumped in one beat), ejection fraction (the proportion of blood pumped out of the heart compared to the amount left in) and cardiac output (the amount of blood pumped by the heart in one minute) [3].

Other positive findings include: reduced systolic blood pressure with 120mg per day of CoQ10 in those suffering with hypertension [4,5] and a reduction in angina pain, arrhythmias (irregular heart beat) and heart attacks in individuals with ischaemic heart disease [6].

It's important to note that some studies have found no benefit from taking CoQ10.  Despite CoQ10 levels in the blood increasing following supplementation of up to 200mg per day for 6 months, no improvements in ejection fraction, cardiac output, exercise duration and quality of life measures were found [7,8].  


CoQ10 And Other Diseases

As well as some encouraging results in people with heart disease, CoQ10 has also lead to improvements in patients with early Parkinson's disease.  

One study of 80 patients taking either 300mg, 600mg or 1200mg per day found that the 1200mg per day group showed significant improvements [9].  

CoQ10 may also have a positive on effect on the frequency and severity of migraines [10], breast cancer, type 2 diabetes [11] and Huntingdon's chorea [12]. 


CoQ10 and Exercise Performance

Because C0Q10 plays an important role in energy production, it led to speculation that it may improve athletic performance.  

This proposition was initially tested using a group of cyclists and triathletes over a four-week period [13]. Unfortunately, by the end, there was no evidence to support the theory.

In a follow up study using higher doses over a longer period of time, 100mg per day of CoQ10 was given to 10 cyclists over eight weeks [14]. There was also no effect found by this study on their performance, nor were there any notably improved fitness levels. Various other studies were performed using other vitamins, doses and time frames – also with no positive results [15,16].

Conversely, when CoQ10 was given to a group of healthy men with an average age of 45, the results did show an increase in energy levels, although their levels of performance were still unchanged [17]. Researchers think that the energy levels were affected perhaps because the CoQ10 created an anti-depressant effect, on account of its fat-soluble properties (which allow it to be absorbed into the nervous system). 

A Finnish study was one of a few which showed an improvement in the performance of professional cross-country skiers, who took CoQ10 supplements and placebos [18]. Those that used the coenzyme showed an improvement in overall aerobic fitness. 

From current research there seems to be very little evidence to support CoQ10 supplementation as an ergogenic aid - but what about its effect on recovery from muscle damage?

One study on marathon runners showed that CoQ10 combined with vitamin E had no effect on reducing the amount of muscle damage to the runners [19]. In fact, another study showed that taking CoQ10 during intense exercise can actually increase muscle damage [20]. Even the placebo group in this Swedish study outperformed the athletes taking the CoQ10 supplements!

Researchers have concluded that if your body is very low on oxygen, such as during a sprint, or other high intensity exercise, CoQ10 acts in reverse as a pro-oxidant, and promotes damage to the cells. 


Summary

To conclude, the evidence in favour of using CoQ10 to improve exercise performance is poor - and so at the moment it seems there really is no reason to shell out money for performance purposes.

It may however, turn out to be useful to middle aged men, if only for the purpose of relieving fatigue. Furthermore, it does show some promise in terms of other areas of health, such as improving conditions of heart disease, Parkinson's disease and diabetes.

CoQ10 has very low toxicity levels [21] for those who want to try it, but you should consult your doctor if you are currently taking medication as CoQ10 may interact with some of them.

References

1. Langsjoen H, Langsjoen P, Langsjoen P, Willis R, Folkers K (1994). Usefulness of coenzyme Q10 in clinical cardiology: a long-term study. Mol Aspects Med. 15 Suppl:s165-75

2. Morisco, C., Trimarco, B., & Condorelli, M. (1993). Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. The Clinical Investigator, 71, S134-S136College of Nutrition, 20, 591-598

3. Soja AM, Mortensen SA (1997). Treatment of congestive heart failure with coenzyme Q10 illuminated by meta-analyses of clinical trials. Mol Aspects Med. 18 Suppl:S159-68

4. Burke BE, Neuenschwander R, Olson RD (2001). Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension. South Med J. Nov;94(11):1112-7

5. Singh RB, Niaz MA, Rastogi SS, Shukla PK, Thakur AS (1999). Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hypertens. Mar;13(3):203-8

6. Singh RB, Wander GS, Rastogi A, Shukla PK, Mittal A, Sharma JP, Mehrotra SK, Kapoor R, Chopra RK (1998). Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction. Cardiovasc Drugs Ther.  Sep;12(4):347-53

7. Watson PS, Scalia GM, Galbraith A, Burstow DJ, Bett N, Aroney CN (1999). Lack of effect of coenzyme Q on left ventricular function in patients with congestive heart failure. J Am Coll Cardiol. May;33(6):1549-52

8. Khatta, M., Alexander, B.S., Krichten, C.M., Fisher, M.L., Freudenberger, R., Robinson, S.W., & Gottlieb, S.S. (2000). The effect of coenzyme Q10 in patients with congestive heart failure. Annals of Internal Medicine, 132, 636-640

9. Shults, C.W., Oakes, D., Kieburtz, K., Beal, M.F., Haas, R., Plumb, S., Juncos, J.L., Nutt, J., Shoulson, I., Carter, J., Kompoliti, K., Perlmutter, J.S., Reich, S., Stern, M., Watts, R.L., Kurlan, R., Molho, E., Harrison, M., & Lew, M. (2002). Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Archives of Neurology, 59, 1541-1550

10. Rozen TD, Oshinsky ML, Gebeline CA, Bradley KC, Young WB, Shechter AL, Silberstein SD (2002). Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia. Mar;22(2):137-41

11. Hodgson, J.M., Watts, G.F., Playford, D.A., Burke, V., & Croft, K.D. (2002). Coenzyme Q10 improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes. European Journal of Clinical Nutrition, 56, 1137-1142

12. Huntington Study Group (2001). A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington's disease. Neurology. Aug 14;57(3):397-404

13. Weston, S.B., Zhou, S., Weatherby, R.P., & Robson, S.J. (1997). Does exogenous coenzyme Q10 affect aerobic capacity in endurance athletes? International Journal of Sport Nutrition, 7, 197-206

14. Braun, B., Clarkson, P.M., Freedson, P.S., & Kohl, R.L. (1991). Effects of coenzyme Q10 supplementation on exercise performance, VO2max, and lipid peroxidation in trained cyclists. International Journal of Sport Nutrition, 1, 353-365

15. Bonetti, A., Solito, F., Carmosino, G., Bargossi, A.M., & Fiorella, P.L. (2000). Effect of ubidecarenone oral treatment on aerobic power in middle-aged trained subjects. Journal of Sports Medicine and Physical Fitness, 40, 51-57

16. Nielsen, A.N., Mizuno, M., Ratkevicius, A., Mohr, T., Rohde, M., Mortensen, S.A., & Quistorff, B. (1999). No effect of antioxidant supplementation in triathletes on maximal oxygen uptake, 31P-NMRS detected muscle energy metabolism and muscle fatigue. International Journal of Sports Medicine, 20, 154-158

17. Porter, D.A., Costill, D.L., Zachwieja, J.J., Krzeminski, K., Fink, W.J., Wagner, E., & Folkers, K. (1995). The effect of oral coenzyme Q10 on the exercise tolerance of middle-aged, untrained men. International Journal of Sports Medicine, 16, 421-427

18. Ylikoski, T., Piirainen, J., Hanninen, O., & Penttinen, J. (1997). The effect of coenzyme Q10 on the exercise performance of cross-country skiers. Molecular Aspects of Medicine, 18, S283-S290

19. Kaikkonen, J., Nyyssonen, K., Tomasi, A., Iannone, A., Tuomainen, T.P., Porkkala-Sarataho, E., & Salonen, J.T. (2000). Antioxidative efficacy of parallel and combined supplementation with coenzyme Q10 and d-alpha-tocopherol in mildly hypercholesterolemic subjects: a randomized placebo-controlled clinical study. Free Radical Research, 33, 329-340

20. Malm, C., Svensson, M., Ekblom, B., & Sjodin, B. (1997). Effects of ubiquinone-10 supplementation and high intensity training on physical performance in humans. Acta Physiologica Scandinavica, 161, 379-384

21. Munkholm, H., Hansen, H.H., & Rasmussen, K. (1999). Coenzyme Q10 treatment in serious heart failure. Biofactors, 9, 285-289