Essential Nutrients for Mitochondrial Function - CoQ10

Synthesis and Function

    Coenzyme Q10 (CoQ10) is an endogenous, fat-soluble antioxidant and is found in nearly every cell in the body. It is a member of the ubiquinone family, which refers to their ubiquitous presence in living organisms and their chemical structure, which contains the functional group benzoquinone. CoQ10 participates in many metabolic pathways and assists in providing the cell with the energy it needs to function. CoQ10 exists in three oxidation states: ubiquinol, ubisemiquinone, and ubiquinone. The ability of the benzoquinone head group of CoQ10 to accept and donate electrons is critical to its function. As part of the mitochondrial electron transport chain (ETC), CoQ10 transports high-energy electrons generated during fatty acid and glucose metabolism from the mitochondrial matrix to the intermembrane space. The energy released from this process is used to produce ATP. Additionally, its presence in the cell membrane allows it to neutralize free radicals, protecting the cell membrane and lipoproteins from oxidation [1].

    CoQ10 is produced via the melavonate pathway, which is the same pathway that controls cholesterol synthesis. A critical step in this pathway is catalyzed by an enzyme named 3-hydroxy-3-methylglutaryl coenzyme A reductase, or simply HMG-CoA reductase. Drugs that inhibit this enzyme -- HMG-CoA reductase inhibitors, AKA "statins" -- are used to lower cholesterol levels. Because they inhibit HMG-CoA reductase, they can also inhibit synthesis of CoQ10.

The Melavonate Pathway [2]

Deficiency

    There is no Recommended Dietary Allowance (RDA) because the body produces CoQ10 endogenously. Dietary sources of CoQ10 are minimal. It is assumed that most healthy people are able to synthesize an adequate supply of CoQ10 without dietary modifications or supplementation; however, there are a few factors that may contribute to CoQ10 deficiency [4]:

• Genetics - Mutations in genes involved in the melavonate pathway cause primary CoQ10 deficiency. Other mutations in genes NOT involved in the melavonate pathway can cause secondary CoQ10 deficiency and could represent an adaptive mechanism to bioenergetic requirements.
• Aging - Naturally occurring levels of CoQ10 decrease with age. Production peaks between ages 20-30 and then declines.
• Medications - As discussed above, cholesterol-lowering statin medications (e.g. atorvastatin, lovastatin, pravastatin, simvastatin) also inhibit production of CoQ10.
• Nutritional deficiencies - Deficiencies of nutrients essential for synthesis of CoQ10 (e.g. vitamin B6).
• Increased tissue needs related to chronic health conditions - Decreased levels have been observed in individuals with diabetes mellitus, cancer, congestive heart failure, neurodegenerative disorders, fibromyalgia, and muscular diseases.

    There are no documented deficiency symptoms in the general population, but deficiency has been associated with [4]:

• Physical fatigue
• Muscle weakness
• Mental fatigue
• Difficulty concentrating
• Memory lapses
• Migraine headaches

Supplementation

    Artificially synthesized CoQ10 supplements are available and are generally well-tolerated. Dosages of 100-200mg daily are usually recommended. High doses (> 1,200mg daily) may cause gastrointestinal discomfort, such as gastritis, reduced appetite, nausea, and diarrhea. CoQ10 absorbs slowly in the small intestine. Absorption is increased when taken with fatty foods. Oil-based forms of CoQ10 may result in greater absorption and higher doses may be necessary for uptake in peripheral tissues [3]. There are no absolute contraindications for CoQ10 supplementation, although there is a possibility for interaction with warfarin (Coumadin) due to CoQ10's structural similarity to vitamin K.

Uses and Efficacy

    Supplementation with CoQ10 does improve mitochondrial function and antioxidant activity. However, insufficient evidence exists to recommend CoQ10 supplementation in most people.

Evidence for positive effects of supplementation has been demonstrated for the following [4]:

• Mitochondrial dysfunction syndrome caused by genetic mutations
• Inflammation
• Aging health protection
• Cardiovascular conditions
• Congestive heart failure - moderate-quality evidence for the reduction of mortality and hospitalization for heart failure [5].

Positive effects of supplementation has been found for the following, but more research is needed to determine validity [4]:

• Neurodegenerative diseases
• Parkinson's disease - insufficient, but promising evidence for slowing functional decline in patients with Parkinson's disease [6].
• Kidney disease
• Metabolic syndrome and diabetes
• Human fertility

    With regards to reducing adverse side effects of statin drugs (muscle pain, weakness, cramps, fatigue), studies have shown mixed results; however, some patients have seen relief of these symptoms [7].  

Bottom Line: CoQ10 supplementation may be beneficial for some people. Since there are few side effects, I would say it's worth a try if you're suffering from any of the above chronic health conditions or symptoms associated with CoQ10 deficiency, especially if you are also taking statin medications. However, if you don't notice an improvement after trying it for a month or two, it might not be worth the money for you. 

I don't make this stuff up:

1. Coenzyme Q10. (2021, January 1). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/dietary-factors/coenzyme-Q10

2. Turunen, M., Olsson, J., & Dallner, G. (2004). Metabolism and function of coenzyme Q. Biochimica et Biophysica Acta (BBA) - Biomembranes, 1660(1–2), 171–199. https://doi.org/10.1016/j.bbamem.2003.11.012

3. Garrido-Maraver, J., Cordero, M. D., Oropesa-Ávila, M., Fernández Vega, A., de la Mata, M., Delgado Pavón, A., de Miguel, M., Pérez Calero, C., Villanueva Paz, M., Cotán, D., & Sánchez-Alcázar, J. A. (2014). Coenzyme q10 therapy. Molecular syndromology, 5(3-4), 187–197. https://doi.org/10.1159/000360101

4. Hernández-Camacho, J. D., Bernier, M., López-Lluch, G., & Navas, P. (2018). Coenzyme Q10 Supplementation in Aging and Disease. Frontiers in physiology, 9, 44. https://doi.org/10.3389/fphys.2018.00044

5. Al Saadi T, Assaf Y, Farwati M, Turkmani K, Al-Mouakeh A, Shebli B, Khoja M, Essali A, Madmani ME. Coenzyme Q10 for heart failure. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD008684. DOI: 10.1002/14651858.CD008684.pub3.

6. Shults CW, Oakes D, Kieburtz K, Beal MF, Haas R, Plumb S, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Arch Neurol. 2002;59:1541–50.

7. Qu, H., Guo, M., Chai, H., Wang, W., Gao, Z., & Shi, D. (2018). Effects of Coenzyme Q10 on Statin‐Induced Myopathy: An Updated Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association, 7(19), 1. https://doi.org/10.1161/jaha.118.009835