Mitochondrial Primer 4: Role of CoQ10

October 15, 2018

ReferencesMitochondria and Future of MedicineMortenson JACC Heart FailureLangsjoen Biofactors

 You should know what CoQ10 is by now. It is in every mitochondrion, in every cell in your body. Ubiquitous. It sits between Complexes 1,2 and 3 and passes on electrons, thereby playing a critical role in the electron transport chain. About 2% of electrons escape the electron transport chain, and CoQ10 soaks those escaped little electrons up before they can cause damage. You make lots of it when you are young. You make much less when you are older. It was discovered in 1957 and in 1972 the level of its deficiency was linked to congestive heart failure. Many cardiologists got interested in it and it became a widely used supplement, particularly with statins and muscle pain. Initial studies of it were not exactly positive, perhaps because lab measurements were not as precise or available as they are today, thereby leading to inconsistent doses. 

But the Mortenson JACC study showed that 100 mg three times a day compared to conventional drug therapy alone reduced CV mortality by 42%, and all-cause mortality by 44%. That caught people's attention. Dr Sinatra has been one of its most prominent advocates and claims that the threshold of effectiveness is 2.5 ug/ml, and that one will not see much clinical benefit below that. He laughs off older studies that do not mention or measure blood levels. I personally see most folks with levels of .7 and 1.2 with very few above 1.5. Hmmm. As we age, we are all deficient. The other controversy about CoQ10 is whether one should take the common cheap form, ubiquinone, or the fancy expensive stuff, ubiquinol. They do switch back and forth in the body quite easily, but the -ol form is a more potent anti-oxidant. 

The manufacturer claims that the expensive form is worth it and backs it up with a very small study of 7 people who had failed with the -one. In that study, the average ejection fraction went from 22% to 39%, and their average New York Heart Association CHF class dropped from IV to II. Very impressive. A very small study, not blinded so open to lots of problems. The number two reason to visit a doctor is "fatigue". If your mitochondria are weakened by low protection secondary to low CoQ10, one will have decreased heart pumping which will mean decreased delivery of blood to muscles. In muscles, the same low CoQ10 level will result in reduced muscle ability. We call that fatigue. 

 www.What will work for me. What I think is going on is that most folks never get to the threshold of effective therapy. With random dosing of CoQ10 from variable sources, I suspect some folks just aren't getting enough, and some folks are getting knockoff CoQ10 that isn't even the real drug. With the ability to measure its level, we can now really check. A starting dose should be 100 mg 3 times a day. And then ask your doctor to check the level. You are looking for a level of 2.5. Nothing less will do. If less, double your dose. Check again. 

  Pop Quiz

  1. What is the role of CoQ10 in the mitochondria?                      Answer: two roles. 1) Passing on electrons between complexes in the electron transport chain, and 2) catching loose ones that get away from the electron transport chain.
  2. What happens to CoQ10 levels as we age?                               Answer: Drop precipitously.
  3. How much will a heart's ability to pump increase if you get a level above 2.5?            Answer: Mortenson's study showed over 40% reduction in mortality and a very small study of the reduced form showed a 22-39% increase in cardiac output.
  4. What blood level of CoQ10 do you want for yourself?             Answer: 2.5 and above
  5. And what is the dose you need to get that?                               Answer: Start with 100 mg 3 times a day. Then test and then double the dose.