CoQ10

Hello, and welcome to another episode of the Integrated Pharmacist Podcast. First, I'd like to apologize for the brief hiatus. Between studying for board exams and moving across the country for residency, I haven't had the resources to produce an episode. But I am happy to be back at it. My current position as a pharmacy resident in functional medicine has sparked a number of potential topics. On the top of the list is a controversial supplement called Co-emzyme Q10 or CoQ10.

CoQ10 is a special kind of molecule that assists in the processes of energy creation so that they happen more readily. If enzymes reduce the threshold of certain reactions, the coenzyme is like the key to unlock the enzyme door. We know this specific coenzyme is used heavily by mitochondria - that's the energy-producing factories inside all of our cells. In a process called the electron-transport-chain, CoQ10 helps our cells produce more energy from the food we eat. With the electron transport chain, we can produce more than 10 times the energy we could otherwise get out of a sugar molecule. When we have a good supply of CoQ10, each cell produces plenty of energy to function properly.
Our bodies create CoQ10 on its own. Like all the other coenzymes in our bodies, we have genes that regulate its creation. By the time we turn 35, however, our bodies grow more and more unable to produce it on its own. We can also deplete our supply of CoQ10 with poor nutrition, inadequate sleep, and taking certain medications.

Because of this reduction in CoQ10, it makes sense to try and supplement. But here's the controversy: our bodies don't absorb large molecules very well. We literally have systems in our gut for breaking down large molecules so we can absorb them. What's more is this molecule doesn't dissolve in water - it's hydrophobic. Scientists have struggled to formulate the supplement in ways that will increase absorption of the CoQ10 molecule. This is definitely one of those supplements you want to know what you're buying a little deeper than the average product. It's not just about whether or not the product has what it says it has or if it's contaminated with other things - the formulation has to be engineered for peak absorption. Although this concept is growing among health professionals, we're still in a time where many of them simply won't consider it because they don't think there's much use in taking something the body has a hard time absorbing.

Regardless of how most medical professionals feel, there are several studies that look at the effects of CoQ10 among a variety of patient populations. One I'd like to address focuses on patients with diabetes. It drew my attention because its focus is on CoQ10's ability to reduce blood pressure - which is not an effect we typically associate with it. This research was performed with 80 participants in Australia in 2002. Participants had clinical diabetes and high cholesterol, but they excluded patients who were very old, extremely obese, or who had blood pressure greater than 160/90. They also excluded anyone taking antioxidants, ACE-inhibitors, or calcium channel blockers. Participants in the experimental side took 2 capsules of 50mg of CoQ10 twice a day. By the end of the study, serum CoQ10 levels in these participants had increased 3 times compared to no increase in the placebo arm. They also experienced a reduction in blood pressure by an average of 6 systolic and 2 diastolic. There was an interesting effect on blood sugar as well. Although fasting serum glucose and insulin levels hadn't been altered significantly, hemoglobin A1c had been lowered by an average of 0.37. Surprisingly, this study did not demonstrate the antioxidant effect as measured by the biomarker F2-isoprostane. Compared to other similar studies, the patient population was generally better controlled in both diabetes and hypertension. CoQ10 performed better in smaller studies where patients had higher blood pressure or less controlled blood sugars.

It appears as though there is growing evidence in favor of using a CoQ10 supplement. However, we are still not in a position to see it being covered by insurance like some other supplements. I will reiterate that it is important to find a good quality supplement that is formulated for maximal absorption. Of the products I have been exposed to, the kinds that seem to reach this standard charge a little over $1 a pill. Roughly $30 for a month's supply seems reasonable, especially for the desirable outcomes in certain patient populations.

I have a story I'd like to share about this supplement. I know someone who asked me about taking
this supplement while I was in school. I had recently learned about its poor absorption in class and relayed that fact. He said he really felt a difference taking it. At the time, I wasn't sure if that was due to the placebo effect or not. Having read this study, I'm more inclined to believe there may have been something to it after all.

I want to thank you for joining me today. I am interested in hearing your story. Do you have experience with CoQ10? Has anyone recommended it to you? I would love to hear what your experience has been. Please write a review or send me an email at integratedpharmacist@gmail.com. You can also comment on my blog or find me on facebook and instagram. Thanks again for joining me today. I look forward to hearing from you. Please join me next week on the integrated pharmacist podcast.

References:

Hodgson, J., Watts, G., Playford, D. et al. Coenzyme Q₁₀ improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes. Eur J Clin Nutr 56, 1137–1142 (2002). https://doi.org/10.1038/sj.ejcn.1601464