CoQ10 supplement benefit and side effects - Review of research information for heart disease, blood pressure, skin and antioxidant, use with statin drugs such as Lipitor and Zocor, by Ray Sahelian, M.D. Available in various dosages including 30 mg, 50, 60 and 100 mg. Use higher dosages, such as 200 mg and 300 mg carefully.

CoQ10 is a naturally occurring nutrient found in each cell of the body. This nutrient was first identified by University of Wisconsin researchers in 1957. It is found in foods, particularly in fish and meats. In addition to playing a significant role in the energy system of each of our cells, CoQ10 is also believed to have antioxidant properties and may play a role in heart health. Many who take this supplement notice that this nutrient enhances physical energy. For long term use I suggest no more than 30 mg or 50 mg a few days a week in those who are taking it for general health purposes.

Benefit and medical uses
Studies with CoQ10 have mostly focused on its benefit involving certain types of cardiovascular diseases, including congestive heart failure and hypertension. However, this nutrient has also been evaluated for high cholesterol and in diabetes. Patients with high cholesterol levels who are placed on statin drugs such as Lipitor and Zocor should take additional CoQ10 in the amount of 10 to 50 mg daily, or a few times a week, to counteract the muscle damage from statin drugs (consult with your doctor). Studies in relation to Parkinson's disease treatment have not yielded consistent results. We still have a long way to go to determine the proper clinical role and benefit of this nutrient.

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Food sources and daily intake
Meat, fish, nuts, and some oils are the richest nutritional sources, while much lower levels can be found in most dairy products, vegetables, fruits, and cereals. Large variations of CoQ10 content in some foods and food products of different geographical origin have been found. The average dietary intake is only 3-6 mg a day. Crit Rev Food Science Nutrition, April 2010.

Dosage for short term use and long term use
CoQ10 is available in a variety of dosages ranging from 10 mg to 300 mg per capsule. I personally believe that high doses are not needed, and may even be unhelpful or detrimental. Just as we recently discovered that high doses of vitamin E, generally over 200 or 400 units, are not beneficial, or even potentially harmful, we may eventually discover the same about CoQ10. I would not feel comfortable recommending to my patients to take more than 50 mg, or maximum 100 mg, a day, for long term use unless as a necessary treatment of a medical condition. For short term use one can take up to 300 mg a day for a few days.

Benefit and studies
What's your opinion on the use of CoQ10 for cancer treatment or prevention?
    I'm not convinced yet that it is an effective cancer treatment but I'm keeping an open mind for additional research to be published.

Cataract formation: One lab study found incubation of lenses with this nutrient reduced oxidative damage. Whether benefits could be achieved through oral supplementation remains to be seen.

Cholesterol level: Individuals on cholesterol medicines of the statin class such as Lipitor and others, may consider taking CoQ10 supplements since statins decrease blood CoQ10 levels.

Diabetes and high blood sugar: CoQ 10 may be of slight benefit in diabetics. It helps improve the function of endothelial cells lining blood vessels and may slightly help with blood sugar control.

Fatigue and energy levels: Use of this supplement can reduce fatigue and improve energy levels. However, if too much is taken, the opposite effect could occur.

Heart attacks and heart disease: In a small trial of patients with recent myocardial infarction, CoQ10 -- used in addition to aspirin and cholesterol-lowering drugs -- decreased the likelihood of further cardiac events for at least one year after the heart attack. The dosage used in the study was 60 mg twice daily.

Heart failure: One study in patients with heart failure showed significant improvement in functional status, clinical symptoms, and quality of life in end stage heart failure patients.

Hypertension: CoQ10 may help lower blood pressure by a small amount in some people.

Pre-eclampsia: Supplementation reduces the risk of developing pre-eclampsia in women at risk for the condition.

Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia.
Int J Gynaecol Obstet. 2009 Apr; Teran E, Hernandez I, Nieto B, Tavara R, Ocampo JE, Calle A. Experimental Pharmacology and Cellular Metabolism Unit, Biomedical Center, Central University of Ecuador, Quito, Ecuador.
Women at increased risk of pre-eclampsia were enrolled in a randomized, double-blind, placebo-controlled trial. Women were assigned to receive 200 mg of CoQ10 or placebo daily from 20 weeks of pregnancy until delivery. The primary outcome was rate of pre-eclampsia. Statistical analyses were by intention-to-treat. Of the 235 women enrolled in the trial, 118 were randomized to receive CoQ10 and 117 received a placebo. A total of 197 (83%) women were followed-up. The overall rate of pre-eclampsia was 20%. Thirty women (25%) in the placebo group developed pre-eclampsia compared with 17 women (14%) in the CoQ10 group, and this reduction was significant.

CoQ10 reverses muscle damage from statin cholesterol drugs
Those of you who have read my newsletters for the past few years are familiar with my warnings regarding side effects from statin drug use. I have mentioned before that statin drugs cause muscle pain and damage, and CoQ10 may be helpful. A small study published in the May 2007 issue of the American Journal of Cardiology supports my viewpoint. Statin drugs, such as Lipitor and Zocor, lower cholesterol levels, but at the same time they interfere with the making of coenzyme Q10 in the body. Scientists now suspect that CoQ10 deficiency may partly or fully contribute to the development of muscle damage in those on these cholesterol lowering drugs.. Dr. Giuseppe Caso and colleagues from Stony Brook University, Stony Brook, New York gave 100 mg of Coenzyme Q10 for one month to 32 patients using statins. Pain intensity decreased by 40% after a month of CoQ10 treatment whereas patients treated with vitamin E (as placebo) experienced no change in pain intensity. Sixteen of 18 coenzyme Q10-treated patients experienced a decrease in pain. Am J Cardiol 2007;99.

Dr. Sahelian’s experience
The effect from 30 mg is mild, mostly consisting of a slightly higher energy level. The effects become more noticeable with 50 mg. I have taken up to 100 mg in the morning. On this dose, I notice an increase in energy as the day goes on, with an urge to take a long walk or be physically active. There is enhanced focus, motivation, and productivity, along with the desire to talk to people. The 100-mg dose of CoQ10, though, is too much since I feel too energetic and alert even in late evening when I want to slow down and get ready for sleep. I usually do not recommend more than 10 to 50 mg of CoQ10 on a long term basis without medical supervision.

Fatigue reduction
Antifatigue effect of coenzyme Q10 in mice.
J Med Food. 2010 Feb;13(1):211-5. Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden.
The aim of this study was to investigate whether coenzyme Q10 has an antifatigue effect in mice. ICR male mice were orally given CoQ10 in the form of Bio-Quinone (Pharma Nord, Vejle, Denmark) at doses of 0, 1.5, 15, or 45 mg/kg/day for 4 weeks. Mice were made to perform swimming exercise with loads attached to their tails, corresponding to approximately 5% of their body weights, and the total swimming time until exhaustion was measured. Furthermore, the post-exercise concentration of serum urea nitrogen (SUN), pre-/post-exercise and post-rest concentration of lactic acid, and pre-exercise hepatic glycogen were determined. Mice treated with CoQ10 showed a significantly prolonged exhaustive swim time, increased liver glycogen contents, and decreased SUN levels compared to control animals. The lactice acid level was not significantly changed. These results suggest that supplementation improves swimming endurance and has an antifatigue effect.

Heart failure benefit
CoQ10 may be helpful in heart failure, but more research is needed to find the ideal dosage range. For the time being I would suggest those with heart failure not to exceed 30 mg or 50 mg a day.

Coenzyme Q10 and exercise training in chronic heart failure.
Eur Heart J. 2006 Nov;27(22):2675-81. Belardinelli R, et al. Lancisi Heart Institute, Via Conca, 71 Torrette di Ancona, Italy.
There is evidence that plasma CoQ10 levels decrease in patients with advanced chronic heart failure (CHF). However, it is not known whether oral CoQ10 supplementation may improve cardiocirculatory efficiency and endothelial function in patients with CHF. We studied 23 patients in NYHA class II and III (20 men, three women, mean age 59 years) with stable CHF secondary to ischemic heart disease [ejection fraction 37%], using a double-blind, placebo-controlled cross-over design. Patients were assigned to each of the following treatments: oral CoQ10 100 mg tid, CoQ10 plus supervised exercise training (ET) (60% of peak VO(2), five times a week), placebo, and placebo plus ET. Each phase lasted 4 weeks. Both peak VO(2) and endothelium-dependent dilation of the brachial artery improved significantly after CoQ10 and after ET as compared with placebo. CoQ10 main effect was: peak VO(2)+9%, brachial artery dilation +38%, systolic wall thickening score index (SWTI) -12%; ET produced comparable effects. Supplementation resulted in a four-fold increase in plasma CoQ10 level, whereas the combination with ET further increased it. No side effects were reported. Oral CoQ10 improves functional capacity, endothelial function, and LV contractility in CHF without any side effects. The combination of CoQ10 and ET resulted in higher plasma CoQ10 levels and more pronounced effects on all the abovementioned parameters.

Migraine headache
I have read coq10 could possibly be beneficial for migraines in it's different forms, I read an article that migraines don't necessarily mean pain. They come in different forms and with different symptoms such as nausea and dizziness. Is it possible that this nutrient actually works for this? I know many popular medicines are given for migraines but their side effects are far worse than beneficial. Is there really hope for these people by taking this nutritional supplement? I regularly look at your website and love the information on all the herbs and alternatives. I love educating myself more and I have 100% trust and respect for your website.
    It is possible that a few individuals may benefit from taking these pills, but there are many factors that influence migraine headaches and taking this supplement pill alone is not likely to have a major effect.

Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial.
Neurology. 2005 Feb 22;64(4):713-5.
Riboflavin, which improves energy metabolism similarly to coenzyme Q10, is effective in migraine prophylaxis. We compared CoQ10 (3 x 100 mg/day) and placebo in 42 migraine patients in a double-blind, randomized, placebo-controlled trial. CoQ10 was superior to placebo for attack-frequency, headache-days and days-with-nausea in the third treatment month and well tolerated; 50%-responder-rate for attack frequency was 14% for placebo and 47% for CoQ10.

How does it work?
Each cell in the body needs a source of energy to survive, so cells break down sugars, fats, and amino acids to make energy. Small enclosures within cells that make this energy are called mitochondria. CoQ10 exists naturally in our mitochondria and carries electrons involved in energy metabolism. CoQ10 is essential in the production of adenosine triphosphate (ATP), the basic energy molecule of each cell.
   In the bloodstream, CoQ10 is mainly transported by lipoproteins such as LDL (low-density lipoprotein) and HDL (high-density lipoprotein). It is thought that CoQ10 is one of the first antioxidants to be depleted when LDL is subjected to oxidation. Hence, it is an important nutrient that prevents the oxidation of lipoproteins, thus potentially reducing the risk of arteries from forming plaques and getting damaged.
   In healthy individuals, CoQ10 is found in high concentrations in the heart, kidneys, and liver.

Prescription drug interactions

Warfarin - Coumadin blood thinner
The administration of CoQ10 and warfarin does not significantly affect the anticoagulant effect of warfarin in rats. A Human trial shows Co Q10 and Ginkgo biloba do not influence the clinical effect of warfarin. Those who take statin drugs may consider taking additional CoQ10.

I'm an 83 year old retired RPh, I have a pace maker, use Lipitor 80 mg, Coumadin 6 mg daily and 1.000 units of co Q 10 daily. I am maintaining my INR in proper range. Using name brand is warfarin is essential because of the variations in strength in generic brands (changing with every refill). On lower dosages of Co Q 10 I tore a bicep and experienced varying amounts of muscle pain. Although I am on a multi-drug regime for blood pressure control, the Co-Q 10 seems key to my health stability.

Side effects, safety, caution, danger, risk
High dosages of CoQ10, such as more than 100 or 200 mg, can induce restlessness, insomnia and fatigue. Long term side effects of high dose CoQ10 use are not clear at this time. I usually do not recommend more than 20 to 60 mg daily on a long term basis without medical supervision or a good reason to take it.

I have found your web site very helpful. It seems to provide a very realistic approach to vitamins and supplements. I must be very sensitive because I had terrible insomnia on daily 30 mg doses of coq10. It was only through your web site that I finally figured out that correlation.
    Most of the time it takes 60 to 100 mg or more to cause the insomnia side effect, but some people are much more sensitive than others.

I am male, 52 year old from India with mild CHF and hypertension. This was primarily caused by work related stress (more of the physical nature, I am an editor and need to type a lot and hear lots of noisy audio). After several trials of medications, I started feeling better with a combination of lisinopril and atenolol and an addition of an Ayurvedic compound the ingredients of which I am not very sure. Soon I started feeling better and even started exercising on my Bullworker. It so happened that I read about COQ10 in a pharmacy ad here, went through all its articles on the internet and started taking COQ10 initially 30 mg and then went up to 100 mg. For the first couple of days I felt better, soon I felt quite sick, by BP seemed to increase, my heart seemed to pound and my heart rate seemed to increase. Since none of such side-effects of COQ10 is documented on the internet I continued to take them and continued to feel sick. Soon I reduced the dosage to only 30 mg. Yesterday night, since I had already bought the COQ10 100 mg bottle, I took one 100 mg capsule and again right from today morning I have started feeling sick with increased hypertension, a feeling of heart pounding etc. Now, I have decided to stop it. With your wide knowledge on supplements can you please enlighten me as to why I am going through this paradoxical reaction from COQ10? I am sure my case will interest you and this could also throw light on a supplement which seems to be talked about widely as beneficial for heart disease but yet not approved by US FDA, I presume. I wish to inform you about another anomalous side reaction i had with this supplement ( I read your article on your site that COQ10 had a very energising effect on you). On the contrary, any dose of COQ10 above 30 mg makes me extremely drowsy. I wish to add that i am taking this supplement manufactured by a reputed company here to which very small amounts of vitamin E, magnesium and l-carnitine are added. Ideally all these supplements are supposed to be wonderful for the heart.
    Different people have different reactions to medications and supplements, and much depends on dosage and interaction with other medications. Perhaps 100 mg is too high a dose for you or it is interacting with the lisinopril and/or atenolol. Some people may do better with a dosage of 10 mg to 30 mg daily or every other day.

Prolonged intake of coenzyme Q10 impairs cognitive functions in mice.
J Nutr. 2009 Oct; Sumien N, Heinrich KR, Shetty RA, Sohal RS, Forster MJ. Department of Pharmacology and Neuroscience, Institute for Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
Coenzyme Q10 is widely consumed as a dietary supplement to enhance bioenergetic capacity and to ameliorate the debilitative effects of the aging process or certain pathological conditions. Our main purpose in this study was to determine whether CoQ10 intake does indeed attenuate the age-associated losses in motor, sensory, and cognitive functions or decrease the rate of mortality in mice. Mice were fed a control nonpurified diet or that diet containing 0.68 mg/g (low dosage) or 2.6 mg/g (high dosage) CoQ10, starting at 4 months of age. Amounts of the ubiquinols CoQ(9)H(2) and CoQ(10)H(2) measured in a parallel study were augmented in the cerebral cortex but not in any other region of the brain. Intake of the low-CoQ10 diet did not affect age-associated decrements in muscle strength, balance, coordinated running, or learning / memory, whereas intake at the higher amount increased spontaneous activity, worsened the age-related losses in acuity to auditory and shock stimuli, and impaired the spatial learning / memory of old mice. The Co Q10 diets did not affect survivorship of mice through 25 mo of age. Our results suggest that prolonged intake of Co Q10 in low amounts has no discernable impact on cognitive and motor functions whereas intake at higher amounts exacerbates cognitive and sensory impairments encountered in old mice.

Has anyone heard of someone taking cqo10 and getting like a indigestion feeling? I had taken 400 mg one day and 200 the next, and then 100mg the next and then felt like gassey in my abdomen.

Recommendations for supplementation, review, guidelines
CoQ10 is probably beneficial in cardiovascular conditions and this nutrient will likely be found to play some positive role in cognitive or neurodegenerative disorders, but more studies are needed. In the meantime, it would seem appropriate to supplement with this nutrient as part of a long-term health regimen, particularly for those with cardiovascular conditions. Long-term therapy with 10 to 60 mg a few days a week seems a reasonable option for many individuals.

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CoQ10 liquid, any benefit over the oral pills?
Is CoQ10 available in liquid form? Does it offer any additional benefit in liquid as opposed to capsules or softgels?
    Yes, some companies do sell CoQ10 in liquid form. I don't see any reason to take CoQ10 liquid unless a person has difficulty swallowing pills. Plus, the liquid form is more expensive and could be less stable in terms of storage.

Influence on skin health and absorption
The advantages of a novel CoQ10 delivery system in skin photo-protection.
Int J Pharm. 2010 March. Yue Y, Zhou H, Liu G, Li Y, Yan Z, Duan M. State Key Lab Biomembrane & Membrane Biotechnology, School of Life Sciences, Tsinghua University, Beijing 100084, China.
Coenzyme Q10 has been reported as a powerful antioxidant in plasma. However, CoQ10 was barely satisfactory in topical drug delivery because of its lipid solubility. To improve the anti-oxidative efficiency of CoQ10 in skin photo-ageing, the present research prepared a novel CoQ10 nano-structured lipid carrier (CoQ10-NLC) and characterised it by size and freeze-fracture transmission electron microscopy (FF-TEM). In UVA-irradiated fibroblasts, the protection of CoQ10-NLC was more effective than the CoQ10-emulsion as demonstrated by cell viability and morphological changes of the cell body and nucleus. In addition, malondialdehyde (MDA, the product of lipid peroxidation) concentration decreased by 61% in the group treated with CoQ10-NLC compared to the group subjected to general CoQ10-emulsion. In the presence of CoQ10-NLC, the activities of the anti-oxidative enzymes superoxide dismutase (SOD) and glutathione peroxidase (GSH-px) were reinstated to 81% and 75%, respectively, of the control group. In vivo, the CoQ10-NLC displayed a stronger capability to penetrate the stratum corneum and permeate the dermis after a topical skin application. These results reveal that CoQ10-NLC has greater antioxidant properties and topical skin penetration than the CoQ10-emulsion.

Research studies and published clinical trials
Co-supplementation with vitamin E and coenzyme Q10 reduces circulating markers of inflammation in baboons.
Am J Clin Nutr. 2004 September5.
Inflammation and oxidative stress are processes that mark early metabolic abnormalities in vascular diseases. We explored the effects of a high-fat, high-cholesterol (HFHC) diet on vascular responses in baboons and the potential response-attenuating effects of vitamin E and coenzyme Q(10) (CoQ10) supplementation. We used a longitudinal design by subjecting 21 baboons to sequential dietary challenges. After being maintained for 3 mo on a baseline diet (low in fat and cholesterol), 21 baboons were challenged with an HFHC diet for 7 wk. The serum C-reactive protein (CRP) concentrations did not change. Subsequent supplementation of the HFHC diet with the antioxidant vitamin E (250, 500, or 1000 IU/kg diet) for 2 wk reduced serum CRP concentrations. Additional supplementation with CoQ10 (2 g/kg diet) further reduced serum CRP to approximately 30% of baseline. Introduction of the HFHC diet itself significantly decreased serum P-selectin and von Willebrand factor concentrations. However, neither vitamin E alone nor vitamin E plus CoQ10 significantly altered the serum concentrations of P-selectin or von Willebrand factor. Dietary supplementation with vitamin E alone reduces the baseline inflammatory status that is indicated by the CRP concentration in healthy adult baboons. Cosupplementation with CoQ10, however, significantly enhances this antiinflammatory effect of vitamin E.

Pilot trial of high dosages of CoQ10 in patients with Parkinson's disease.
Exp Neurol. 2004 Aug;188(2):491-4.
The safety and tolerability of high dosages of coenzyme Q10 were studied in 17 patients with Parkinson's disease (PD) in an open label study. The subjects received an escalating dosage of coQ10 -- 1200, 1800, 2400, and 3000 mg per day with a stable dosage of vitamin E (alpha-tocopherol) 1200 IU/day. The plasma level of coQ10 was measured at each dosage. Thirteen of the subjects achieved the maximal dosage, and adverse events were typically considered to be unrelated to coQ10. The plasma level reached a plateau at the 2400 mg/day dosage and did not increase further at the 3000 mg/day dosage. Our data suggest that in future studies of CoQ10 in Parkinson's disease, a dosage of 2400 mg/day (with vitamin E/alpha-tocopherol 1200 IU per day) is an appropriate highest dosage to be studied.

Co-supplementation with vitamin E and CoQ10 reduces circulating markers of inflammation in baboons
American Journal of Clinical Nutrition, Vol. 80, No. 3, 649-655, September 2004
Background: Inflammation and oxidative stress are processes that mark early metabolic abnormalities in vascular diseases. Objectives: We explored the effects of a high-fat, high-cholesterol (HFHC) diet on vascular responses in baboons and the potential response-attenuating effects of vitamin E and coenzyme Q10 (CoQ10) supplementation. Design: We used a longitudinal design by subjecting 21 baboons (Papio hamadryas) to sequential dietary challenges. Results: After being maintained for 3 mo on a baseline diet (low in fat and cholesterol), 21 baboons were challenged with an HFHC diet for 7 wk. The serum C-reactive protein (CRP) concentrations did not change. Subsequent supplementation of the HFHC diet with the antioxidant vitamin E (250, 500, or 1000 IU/kg diet) for 2 wk reduced serum CRP concentrations from 0.9 to 0.4 mg/dL. Additional supplementation with CoQ10 (2 gram /kg diet) further reduced serum CRP to 30% of baseline (0.28 ± 0.03 mg/dL; compared with the HFHC diet). Introduction of the HFHC diet itself significantly decr eased serum P-selectin and von Willebrand factor (from 187 to 161%) concentrations. However, neither vitamin E alone nor vitamin E plus CoQ10 significantly altered the serum concentrations of P-selectin or von Willebrand factor. Conclusions: Dietary supplementation with vitamin E alone reduces the baseline inflammatory status that is indicated by the CRP concentration in healthy adult baboons. Cosupplementation with CoQ10, however, significantly enhances this antiinflammatory effect of vitamin E.

Atorvastatin decreases the CoQ10 level in the blood of patients at risk for cardiovascular disease and stroke.
Rundek T. olumbia University College of Physicians & Surgeons, New York, NY 10032, USA.
Arch Neurol. 2004 Jun;61(6):889-92.
Statins are widely used for the treatment of hypercholesterolemia and coronary heart disease and for the prevention of stroke. There have been various adverse effects, most commonly affecting muscle and ranging from myalgia to rhabdomyolysis. These adverse effects may be due to a coenzyme Q(10) (CoQ10) deficiency because inhibition of cholesterol biosynthesis also inhibits the synthesis of CoQ10. To measure CoQ10 levels in blood from hypercholesterolemic subjects before and after exposure to atorvastatin calcium, 80 mg/d, for 14 and 30 days. Prospective blinded study of the effects of short-term exposure to atorvastatin on blood levels of CoQ10. Stroke center at an academic tertiary care hospital. We examined a cohort of 34 subjects eligible for statin treatment according to National Cholesterol Education Program: Adult Treatment Panel III criteria. The mean blood concentration of CoQ10 was 1.26 micro g/mL at baseline, and decreased to 0.62  micro g/mL after 30 days of atorvastatin therapy. A significant decrease was already detectable after 14 days of treatment. Even brief exposure to atorvastatin causes a marked decrease in blood CoQ10 concentration. Widespread inhibition of CoQ10 synthesis could explain the most commonly reported adverse effects of statins, especially exercise intolerance, myalgia, and myoglobinuria.

Parkinson's Disease: A small but promising study found that coenzyme CoQ10 may help stop the nerve cell death that characterizes Parkinson's. disease. The study involved just 80 people. Half ate maple-nut flavored wafers containing various CoQ10 doses, half took a placebo for up to 16 months. By the study's end, the 23 patients on the highest daily doses had 44 percent less decline in mental function, movement and ability to perform daily living tasks than the placebo group. Research has suggested that energy-supplying structures inside cells called mitochondria may be impaired in Parkinson's disease. Patients studied had early-stage Parkinson's and took a placebo or CoQ10 in doses of 300 milligrams, 600 mgs or 1,200 mgs daily. Their symptoms were evaluated for up to 16 months. By the eighth month, the 23 patients on the highest dose showed significantly less impairment than the others. Side effects, including back pain, headaches and dizziness, were mostly mild.
        Dr. Sahelian comments: I'm surprised these patients could tolerate these very high doses of CoQ10. I have had feedback from those using high doses of CoQ10 that, in some people, there is excessive stimulant-like effect and high levels of alertness that may cause insomnia.

CoQ10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study.
Clin Cardiol. 2004 May;27(5):295-9.
The number of patients awaiting heart transplantation is increasing in proportion to the waiting period for a donor. Studies have shown that coenzyme Q10 (CoQ10) has a beneficial effect on patients with heart failure. The purpose of the present double-blind, placebo-controlled, randomized study was to assess the effect of CoQ10 on patients with end-stage heart failure and to determine if CoQ10 can improve the pharmacological bridge to heart transplantation. METHODS: A prospective double-blind design was used. Thirty-two patients with end-stage heart failure awaiting heart transplantation were randomly allocated to receive either 60 mg U/day of Ultrasome--CoQ10 (special preparation to increase intestinal absorption) or placebo for 3 months. All patients continued their regular medication regimen. Assessments included anamnesis with an extended questionnaire based partially on the Minnesota Living with Heart Failure Questionnaire, 6-min walk test, blood tests for atrial natriuretic factor (ANF) and tumor necrosis factor (TNF), and echocardiography. Twenty-seven patients completed the study. The study group showed significant improvement in the 6-min walk test and a decrease in dyspnea, New York Heart Association classification, nocturia, and fatigue. No significant changes were noted after 3 months of treatment in echocardiography parameters (dimensions and contractility of cardiac chambers) or ANF and TNF blood levels. The administration of CoQ10 to heart transplant candidates led to a significant improvement in functional status, clinical symptoms, and quality of life. However, there were no objective changes in echo measurements or ANF and TNF blood levels. Coenzyme Q10 may serve as an optional addition to the pharmacologic armamentarium of patients with end-stage heart failure. The apparent discrepancy between significant clinical improvement and unchanged cardiac status requires further investigation.

Serum coenzyme Q10 concentrations in healthy men supplemented with 30 mg or 100 mg coQ10 for two months in a randomized controlled study.
Biofactors. 2003;18(1-4):185-93.
Serum CoQ10 concentrations were evaluated in healthy male volunteers supplemented with 30 mg or 100 mg CoQ10 or placebo as a single daily dose for two months in a randomized, double-blind, placebo-controlled study. Median baseline serum CoQ10 concentration in 99 men was 1.2 mg/l. Baseline serum CoQ10 concentration did not depend on age, while borderline significant positive associations were found for body weight and smoking 1-10 cigarettes / day. Supplementation with 30 mg or 100 mg CoQ10 resulted in median increases in serum CoQ10 concentration of 0.55 mg/l and 1.3 mg/l, respectively, compared with a median decrease of 0.2 mg/l with placebo. The changes in the CoQ10 groups were significantly different from that in the placebo group, and the increase in the 100 mg CoQ10 group was significantly greater than that in the 30 mg CoQ10 group. The change in serum CoQ10 concentration in the CoQ10 groups did not depend on baseline serum CoQ10 concentration, age, or body weight.

Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction.
Singh RB. Mol Cell Biochem. 2003 Apr;246(1-2):75-82.
In a randomized, double-blind, controlled trial, the effects of oral treatment with CoQ10, 120 mg/day, a bioenergetic and antioxidant cytoprotective agent, were compared for 1 year, on the risk factors of atherosclerosis, in 73 (CoQ10, group A) and 71 (B vitamin group B) patients after acute myocardial infarction (AMI). After 1 year, total cardiac events (24 vs. 45%) including non-fatal infarction and cardiac deaths were significantly lower in the intervention group compared to control group. The extent of cardiac disease, elevation in cardiac enzymes, left ventricular enlargement, previous coronary artery disease and elapsed time from symptom onset to infarction at entry to study showed no significant differences between the two groups. Plasma level of vitamin E and high density lipoprotein cholesterol showed significant increase whereas thiobarbituric acid reactive substances, malondialdehyde and diene conjugates showed significant reduction respectively in the CoQ10 group compared to control group. Approximately half of the patients in each group were receiving lovastatin (10 mg/day) and both groups had a significant reduction in total and low density lipoprotein cholesterol compared to baseline levels. It is possible that treatment in patients with recent MI may be beneficial in patients with high risk of atherothrombosis, despite optimal lipid lowering therapy during a follow-up of 1 year. Adverse effect of treatments showed that fatigue was more common in the control group than CoQ10 group.

Open label trial of coenzyme Q10 as a migraine preventive.
Cephalalgia. 2002 Mar;22(2):137-41.
The objective was to assess the efficacy of CoQ10 as a preventive treatment for migraine headaches. Thirty-two patients (26 women, 6 men) with a history of episodic migraine with or without aura were treated with coenzyme Q10 at a dose of 150 mg per day. Thirty-one of 32 patients completed the study; 61% of patients had a greater than 50% reduction in number of days with migraine headache. The average number of days with migraine during the baseline period was 7.3 and this decreased to 2.9 after 3 months of therapy, which was a statistically significant response. Mean reduction in migraine frequency after 1 month of treatment was 13% and this increased to 55% by the end of 3 months. Mean migraine attack frequency was 4.8 during the baseline period and this decreased to 2.8 attacks by the end of the study period, which was a statistically significant response. There were no side-effects noted with CoQ10. From this open label investigation CoQ10 appears to be a good migraine preventive. Placebo-controlled trials are now necessary to determine the true efficacy of CoQ10 in migraine prevention.

Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension.
South Med J. 2001 Nov;94(11):1112-7.
Increasing numbers of the adult population are using alternative or complementary health resources in the treatment of chronic medical conditions. Systemic hypertension affects more than 50 million adults and is one of the most common risk factors for cardiovascular morbidity and mortality. This study evaluates the antihypertensive effectiveness of oral coenzyme Q10, an over-the-counter nutritional supplement, in a cohort of 46 men and 37 women with isolated systolic hypertension. We conducted a 3 month randomized, double-blind, placebo-controlled trial with twice daily administration of 60 mg of oral CoQ10 and determination of plasma CoQ10 levels before and after the treatment. The mean reduction in systolic blood pressure of the CoQ10-treated group was 17 mm Hg. None of the patients exhibited orthostatic blood pressure changes. Our results suggest supplementation may be safely offered to hypertensive patients as an alternative treatment option.

CoQ10 supplement emails
Q. I read your site because I was doing some research on coq10, and it struck me as ironic. My doctor told me to take 100mg of it every day, and I am feeling worse than ever: tired, no get up and go, difficulty concentrating, waking up more tied than when I got to bed, falling asleep during the day, you name it. I feel as if I had aged 10 years in a month. Ever seen a case like that?
   A. Everyone responds differently to supplements. The dose of a supplement can make a huge difference. As to CoQ10, too high a dose can cause insomnia or shallow sleep resulting in tiredness the next day. I personally do not take more than 30 or 60 mg.

Q. My son William was born on July 31, 2001 with Prader-Willi Syndrome. At the age of 3 months William was still sleeping 20 plus hours a day had no normal wake / sleep pattern when I found information regarding Prader-Willi Syndrome and the benefits of coq10. I immediately ordered coq10 and began giving William 90 mg daily he almost immediately responded with a normal wake / sleep pattern. Have you done any research with coq10 and Prader-Willi Syndrome? I'm very interested in any research information you may have.
     A. We have not evaluated this condition in relation to coq10, however we will mention it on our website and maybe others with this condition may try it and give us feedback.

Q. I've read of a study done that was published in the journal Cephalgia regarding the use of Coq10 in reducing the frequency of migraines. I'm not sure if this news is available on your site yet. On your page you mention that higher doses of 100-300 mg are poorly absorbed. In light of the study that used such doses, do you still feel higher doses not to be as beneficial? Seeing that CoQ10 is synthesized in most human tissue, do you feel a similarly equal response would be gained from making certain that protein intake, especially that from a good source of tyrosine & phenylalanine, & of vitamin B6 is maintained?
   A. We've added the study you mention (see above). At this point I would like to see one or two more studies with CoQ10 and headache before recommending this nutrient for the purpose of headache prevention. I don't see where on this page mentioning that CoQ10 is poorly absorbed in high doses. I'm not yet convinced that people need to take more than 60 mg on a long term basis. Based on my knowledge of biochemistry, I don't think the amino acids and Viamint B6 would have much of an influence on CoQ10 levels.

Q. Dr. Sahelian, do you take CoQ10 yourself? And if so, how much?
   A. I take 30 mg a couple of days a week. I have so many other herbs and supplements on my kitchen counter that I don't want to over do it and take too much of this nutrient along with other supplements that I experiment with.

Q. I just wanted to mention that I recently began taking COQ10 and noticed that there was a significant change in my health. I've felt so much better physically and mentally. My ability to focus had been lacking in the past year or so but after taking CoQ10 I've been able to think clearer. My energy levels are higher, and although I've given up eating beef, I'm noticing a difference in my physical self.

Q. Is CoQ10 helpful in maintaining healthy gums particularly for those who are lax in daily flossing. If so, what dosage is recommended.
   A. Although a couple of studies have indicated that it may be helpful in gum disease, the most important way to keep healthy gums is to remove the food particles that are stuck between teeth. This is best accomplished by flossing. You may wish to keep your floss by your bed at night or near your favorite sofa while watching TV before bed and thus have a reminder to floss at night. I personally prefer flossing before brushing.

Q. Does the effectiveness of Co Q10 matter if it is taken in capsule form or if emulsified in an oil like alpha tocopherol.  I read an advertising leaflet that said not to waste money on CoQ10 tablets or capsules, because they cannot be absorbed into blood stream.
   A. There are probably differences in absorption between different CoQ10 products, and perhaps oil emulsified products are better absorbed, however, most CoQ10 supplements contain 30, 60 or 100 mg which are dosages far greater than normally needed by the body. Hence, even if 100 percent of the CoQ10 is not absorbed, practically speaking it should not make too much difference.

Q. I’ve read conflicting articles regarding the amount of CoQ10 absorbed from the intestines depending on its form. Can you tell me if there’s a difference between different product?
   A. Studies of the effectiveness of coenzyme Q10 (CoQ10) have been confusing due to the variable bioavailability of numerous CoQ10 preparations. Researchers at the Alfred Hospital and Baker Medical Research Institute, in Melbourne, Australia evaluated two different preparations of CoQ10: a soybean oil-based preparation and a complex micelle emulsion. Twelve healthy individuals received 300 mg CoQ10 daily of either preparation for 7 days in a double-blind cross-over design. Blood samples to determine serum levels of CoQ10 and lipids were taken at baseline, after 24 h and after 7 days. Both preparations induced significant increases in serum CoQ10 levels at 24 h and 7 days and there was were no differences between CoQ10 levels for the two preparations at either time point.
        Since most people take a large dose of coQ10, such as 60 or 100 mg, even if one preparation were not absorbed as well, there should still be plenty of CoQ10 to be helpful.

Q. I am 32 years old with a 10 month old daughter.  My menstrual period returned about a month after her birth and has remained on a regular 28 day cycle.  I started to take CoQ10 about a month ago ( CoQ10 120 mg a day) after reading articles about its role in possibly preventing migraine headaches. (Tests have given migraine sufferers CoQ10 between 125mg to 250mg per day). I haven’t had a migraine since taking the CoQ10, however I have missed my period this month.  I am currently 15 days late and have had a negative pregnancy test today. I am wondering if the CoQ10 could have affected my cycle in anyway or is it just a coincidence that I am late after taking the tablets for just a month?  I’ve been looking for a list of CoQ10 side effects but haven’t really come across anything.  Are you aware of anything like this happening?
     A. We have not had such reports regarding CoQ10 and menstrual changes but we still know very little about high dose nutrient interactions within the body.

Article Submitted to a Health and Wellness magazine

Many of my patients who take CoQ10 notice an increase in energy. But some are under the misconception that the more CoQ10 they take, the healthier they will be. Perhaps you have already heard of it being touted for heart health, vitality, and other benefits. But before you take this interesting nutrient as a supplement, learning some simple facts could help you make a more informed decision.

What is it?
CoQ10 – short for Coenzyme Q10 -- is a naturally occurring nutrient and antioxidant found in each cell of the body. CoQ10 was first identified by University of Wisconsin researchers in 1957. CoQ10 has been gradually becoming more popular in the past decade.

How does it work?

Each cell in the body needs a source of energy to survive, so cells break down sugars, fats, and amino acids to make energy. Small enclosures within cells that produce this energy are called mitochondria. CoQ10 exists naturally in our mitochondria and carries electrons involved in energy metabolism. CoQ10 is essential in the production of adenosine triphosphate (ATP), the basic energy molecule of each cell. Other mechanisms of action may include stabilization of calcium dependent slow channels and alteration of prostaglandin metabolism.

What Foods Contain this natural substance?
CoQ10 is found in foods, particularly in fish and meats, and small amounts are found in nuts. There is little or no CoQ10 in grains, vegetables or fruits. Hence, some vegetarians may not get adequate amounts of this nutrient, although, fortunately, the body is able to synthesize CoQ10 when dietary sources are not adequate. Dietary intake of CoQ10 is about 2 to 5 mg per day.

Benefit

Studies with CoQ10 have mostly focused on its benefit involving certain types of cardiovascular diseases, including congestive heart failure and hypertension and to a certain extent for high cholesterol and in diabetes. Not all the results have been positive and much more research is needed before we determine the full benefits, side effects, and appropriate dosage.

Dosage

CoQ10 is available in a variety of dosages ranging from 10 mg to 300 mg per capsule, but most commonly in 30, 50, and 60 mg. I personally believe that high doses are not needed, and may even be unhelpful or detrimental. I’ve had patients who have reported fatigue when taking dosages above 100 mg. Just as we recently discovered that high doses of vitamin E, generally over 400 units, are not beneficial, or even potentially harmful, we may eventually discover the same about CoQ10. I would not feel comfortable recommending to my patients to take more than 50 mg or maximum 100 mg of CoQ10 a day, unless for the temporary treatment of a medical condition.
     CoQ10 is best taken in the morning, before or with breakfast. 

Questions on research, side effects, benefit and the right dosage
Q. Is Coq10 a vitamin ?
   A. Coq10 is not a vitamin but a nutrient. CoQ10 is naturally made in the body. Technically, a vitamin is a substance that the body cannot synthesize or cannot synthesize enough to maintain health and physiological functioning.

Q. Is better libido a CoQ10 benefit ?
   A. I don't think this supplement has a benefit of sexual enhancement, at least the effects, if any, are not easily noticed.

Q. I think I got a side effect from ClQ10. I took 300 mg CoQ10 for a week and I think I was having trouble sleeping at night.
     A. My impression is that high dosage CoQ10 side effect is shallow sleep but I am not 100 percent sure.

Q. What is the right CoQ10 dosage. I read on some web sites that 300 mg is the right CoQ10 dosage but you seem to be more cautious and you recommend a lower C0Q10 dosage.
   A. I think people often take too high a dosage of CoQ10 and other supplements. I don't see why most people require more than 50 mg a few times a week. We just don't know what kind of CoQ10 side effects may occur by taking several hundred mgs for months and years. More is not necessarily better when it comes to supplements. Plus, many people who take CoQ10 also take other supplements and we don't know what kind of interactions would occur with other herbs, nutrients, and medicines.

Q. I am a medical doctor and have been taking 100mg of CoQ10 for several years--originally for GI dysmotility ("Hollow Visceral Neuropathy"), now more for what is hopefully resolving diabetes (iatrogenic). A knowledgeable supplement representative informed me recently that CoQ10 toxicity has been noted, but could not provide more information.
     A. I have not come across human trials for any length of time with CoQ10 that have shown any significant toxicity, however, I am quite cautious when it comes to taking high doses of supplements for prolonged periods. My personal limit is 50 mg of CoQ10 two or three times a week.

Q. Do you think those taking statins should take CoQ10 ?
     A. To be on the safe side, 50 mg CoQ10 can be taken a few times a week by those on statin drugs.

I buy CoQ10 100 mg and last 2 days took 100 mg in morning with water, I'm so tired i cannot do anything, complete tired whole body, i don't know if i should try 50mg instead or just quit using? I'm skipping today and see what happens.
    Some people are quite sensitive to nutrients, in your case you may only need 30 mg every other day. Too high a dose of CoQ10 could perhaps lead to fatigue in some people.

I just wanted to share my story with CoQ10. I am a nurse and well acquainted with traditional medicine, but I have been interested and increasingly convinced that alternative "natural" treatment is highly advantageous and overlooked as the better choice. I was diagnosed with breast cancer in February 2008. My younger sister was diagnosed several years ago. Our cancers were IDC and strongly ER and PR positive. Her cancer involved lymph nodes, mine non nodal. She went through chemo and radiation treatments, tried anti-hormonal (but too many adverse side effects). I have just finished radiation and will be encouraged to take Tamoxifen in July 2008. I started using "natural" progesterone cream when my sister was diagnosed after reading Dr John R. Lee's book on progesterone and his comment on his breast cancer patients maintaining remission while using the cream, my sister started at this time as well, I used the cream in hopes of deterring breast cancer and estrogen dominance...she used it to deter a breast cancer recurrence. My sister used many other supplements as well, has taken 100mg CoQ10 and other supplements. When my excisional biopsy Lumpectomy came back positive with unclear margins, I asked my sister about her supplements and she mentioned the CoQ10, so I googled it and found about Dr. Folkers study in Denmark, using CoQ10 390 mg and other supplements. So after OK'ing it with my surgeon that I could take the CoQ10 supplement, I increased daily until I reached a 400 mg dose. MRI with CAD determined no other noticeable breast cancer, so partial mastectomy was schedule for 3 weeks later to get clear margins and sentinel node biopsy. Well I took CoQ10 400mg all the way until the night before surgery. The fairly large resected area came back with only a single 2.5mm cribiform cancer and at least a 5mm clear margin from there, I asked the surgeon for a copy of the path report, because I wanted to know how clear the margins actually were, I was shocked, initially the surgeon told me the first path report the cancer went to the edge of the margins, so to only find a single area on the whole resection made me think the supplement may have helped clear things up, Just as the women in the Denmark study experienced. I was taking the CoQ10 through the first week of radiation, but my sister saw me Mother's day and commented I looked a little "Jaundice", just on my tanned face, the rest of my body was my usual pale creamy white, but I decide to take a break on the CoQ10 400mg and also the turmeric I was trying (it caused indigestion), But I can't prove the CoQ10 supplement had anything to do with it, but you have to wonder.

Hello and thank you for putting up what I consider THE best supplement site on the web -- I saw a question about lower dose Q10 in your April 2009 research update and was wondering what you may think doing this my liquid-form Q10: Opening it up and pouring the 100mg liquid-filled capsule into a small 1-2 oz. jar of high quality oil, then taking it by sipping the oil as needed? Will it even absorb properly taking it this way?
   It will absorb well, but there is a concern of getting too many calories from the oil. Another option is to take the 100 mg with breakfast 2 or 3 times a week till the bottle is finished and then purchasing a lower dosage.

Do you consider CoQ10 to be a super antioxidant that can slow down the aging process?
    I have not seen human studies regarding the long term use of this supplement and its effect on the aging process.

We commenced supplementing by Coq10 when simvastatin has been prescribed. For better absorption I switched, recently, to use the SUPER UBIQUINOL (from Life extension) variety. In order to optimize the use I searched the Internet and came across your fine publication: CoQ10 supplement benefit and side effects. In the above referenced site, scale of dosages is provided for the various conditions I understand the recommended dosage is - amongst others - determined by the ABSORPTION EFFICIENCY. For which variety of CoQ10 is the range of dosages - in your above mentioned paper - intended?
    Too much is being made about absorption of this nutrient and many companies are selling different varieties of this supplement and making unjustified promises when simple and cheaper forms are just as good and the differences in absorption and efficiency are not that different between various brands. Even if they are slightly different, for practical purposes this makes hardly any clinical difference. There is no clear evidence that taking a more expensive CoQ10 version will improve health any more than a standard product.
 

See a YouTube information video on CoQ10 health benefit