CoQ10 and Ubiquinol Supplements Review
Initial Posting: 12/16/16 Last Update:11/6/18
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- What does it do? People often take CoQ10 to offset a decline in natural levels which occurs with the use of statin (cholesterol-lowering) medication. Some take it to feel more energized or for a variety of other purposes. It may also modestly help with elevated cholesterol levels, migraine, and other conditions. The evidence supporting these uses remains preliminary, although it does benefit people with congestive heart failure (See What It Does). After being absorbed into the body, more than 90% of CoQ10 is converted to its active form, known as ubiquinol (CoQH2-10), which is also available as a supplement and appears to have greater bioavailability (i.e., it raises blood levels more). (See What It Is).
- How much to take? CoQ10 and ubiquinol are typically taken at a dose of 50 to 200 mg per day, although higher doses have been used (See Dosage). Certain formulations have improved absorption (See Absorption and Bioavailability Enhancers)
- Best choice? Among 44 CL Approved products, CL selected several as its Top Picks. One product was Not Approved, as it contained less than its listed amount of CoQ10 (See What CL Found).
- How to take it? Gastrointestinal side-effects may occur but can be minimized by breaking up the dose over the day, although it may interfere with sleep if taken before bed. Most forms are best absorbed with fats, so take CoQ10 and ubiquinol with meals.
- Cautions: At typical doses, CoQ10 and ubiquinol appear to be generally safe, but there are possible interactions with blood thinners and diabetes medications (see Concerns and Cautions).
What It Is:
Coenzyme Q10 (CoQ10), also known as ubiquinone, is a naturally occurring anti-oxidant compound and is used for energy production within cells. It's manufactured in the heart, liver, kidney and pancreas. The body normally produces sufficient CoQ10, although some medications such as statins may interfere with this process and CoQ10 levels in the body may decline with age and heart disease. Only small amounts of CoQ10 are available from food, mainly beef and chicken. Consequently, dietary supplements are the most common way to increase the body's CoQ10 levels.
After being absorbed into the body (See Absorption, Formulation and Dose), more than 90% of CoQ10 is converted to its active form, known as (CoQH2-10) or ubiquinol. Ubiquinol has strong antioxidant properties. Conditions that cause oxidative stress on the body, like liver disease, decrease the ratio of ubiquinol to CoQ10. In the body, blood levels of CoQ10 steadily rise from young adulthood through middle-age, peaking at around age 60, when levels then decrease — although they do not fall below levels of early adulthood. However, levels of CoQ10 in tissue of the brain, heart and pancreas do decrease with age. Perhaps of greater significance though, is that, after age 60, the body seems to convert less CoQ10 into its active form (ubiquinol), resulting in a decreased ratio of ubiquinol to CoQ10 and indicating a higher level of oxidative stress (Niklowitz, J Clin Biochem Nutr 2016; Claessens, Ann Clin Biochem 2016).
Like CoQ10, ubiquinol is available as a dietary supplement. (For more information about forms sold, see What to Consider When Buying and Using.)
What It Does:
Taken orally, coenzyme Q10 may help treat congestive heart failure, a disease in which the heart doesn't adequately maintain circulation. CoQ10's role in cell energy production may be the mechanism by which it assists the heart. An analysis of 13 clinical studies found that taking coenzyme Q10 (usually 100 mg daily) significantly improves how well the heart pumps blood (i.e., ejection fraction) by about 3.7% compared to placebo in people with mild-to-moderate heart failure (Fotino, Am J Clin Nutr 2013). The largest and longest clinical study to date found that taking 100 mg three times daily of coenzyme Q10 for 2 years significantly reduced the chance of an adverse cardiovascular event (e.g., hospitalization, worsening heart failure, or death) by almost 50% compared to placebo in people with moderate-to-severe heart failure and significantly improved measures of quality of life such as activity levels, fatigue, and shortness of breath. It's important to note that these benefits from CoQ10 may require long-term supplementation (2 years); when researchers checked after just 3 months of supplementation, no significant improvements were found (Mortensen, Eur J Heart Failure 2013; Mortensen, JACC Heart Failure 2014). In all of these studies, coenzyme Q10 was used in addition to prescription heart failure treatment, not in place of it.
CoQ10 might help reverse side effects caused by "statins," drugs used to lower high cholesterol, although this has not been well established due to conflicting results. Some of the side effects reportedly reversed with CoQ10 include myalgia (muscle pain), fatigue, dyspnea, memory loss and peripheral neuropathy. In a study among people reporting muscle pain associated with taking statins, a dose of 50 mg of CoQ10 twice daily (100 mg per day) for 30 days reduced the intensity of mild to moderate muscle pain by 33.1% and the interference with daily activities by 40.3%, while no improvement occurred among people treated with placebo. Symptoms improved among seventy-five percent of those treated with CoQ10 (Skarlovnik, Medical Science Monitor 2014). Some studies using somewhat higher daily doses of CoQ10 (120 mg to 200 mg) have not shown benefit for muscle pain (Bookstaver, Am J Cardiol 2012; Young, Am J Cardiol 2007). Nevertheless, a review of twelve randomized placebo-controlled studies involving CoQ10 (including those cited above) concluded that, overall, CoQ10 improved statin-associated muscle symptoms, i.e., pain, weakness, cramps, and tiredness (Qu, J Am Heart Assoc 2018).
CoQ10, itself, may modestly lower elevated cholesterol levels. A study among middle aged people in China with high cholesterol levels who were not taking statins or other cholesterol-lowering drugs found that 60 mg of CoQ10 taken twice daily after meals (120 mg per day) for 5 ½ months decreased LDL cholesterol and triglyceride levels, although not total cholesterol levels, compared to placebo. Among those who took CoQ10, average LDL cholesterol decreased by 6.5% and average triglyceride levels decreased by nearly 20%. In addition, average fasting blood sugar and insulin levels decreased by 6% and 21%, respectively, and average systolic and diastolic blood pressure decreased by 4% and 5%, respectively, compared to placebo (Zhang, J Clin Lipidol 2017). (However, as noted in Concerns and Cautions, a review clinical studies concluded that CoQ10 does not have a clinically significant effect on lowering blood pressure).
Although the above study suggested an effect of CoQ10 on blood sugar levels, a study in China that focused on men and women (average age 61) with type 2 diabetes found 100 mg of liquid ubiquinol daily (taken as four drops before breakfast, lunch and dinner) for three months did not significantly decrease fasting blood sugar levels, HbA1c (a measure of blood sugar over several months) or improve insulin resistance, compared to placebo. Nevertheless, at the end of the study, those who took the ubiquinol used less anti-glycemic medication than those who took the placebo (Yen, Br J Nutr 2018). CoQ10 does not, however, appear to further lower cholesterol levels in people taking a statin drug. This was shown in a study in Denmark among 55 men and women who were already taking the statin drug simvastatin (40 mg/day); adding 400 mg of ubiquinol (the active form of CoQ10) daily for two months did not lower LDL, total cholesterol or triglyceride levels compared to simvastatin with placebo (Hansen, Cytokine 2018).
A study in Switzerland among 42 men and women with migraine (with or without aura) found that 100 mg of CoQ10 taken as liquid drops three times daily (total daily dose of 300 mg CoQ10) for three months modestly decreased the frequency of attacks by about one migraine per month and slightly decreased the number of days with nausea but did not decrease the duration of episodes, compared to placebo. The improvements were noticeable only after the first month of supplementation (Sandor, Neurology 2005). A study in Iran among 45 men and women (average age 32) with migraine found that those who took 200 mg of ubiquinol (Ubiquinol Active CoQ10, Natural Factors Inc. Canada) as capsules twice daily with meals (total daily dose of 400 mg) for three months had greater reductions in the frequency (- 6 vs. - 3 migraines per month), duration (- 7 vs. - 4 hours), and severity of episodes (-3.4 vs. -2.4 points on a scale of 1 to 10) compared to placebo. CoQ10 supplementation also reduced blood levels of lactate and nitric oxide, both of which may be elevated in people with migraine (Nattagh-Eshtivania, Eur J Integr Med 2018).
CoQ10 may reduce symptoms of mitochondrial encephalomyopathies. It may also help prevent pre-eclampsia (a complication of pregnancy) and reduce the likelihood of more heart problems in some people who've had a first heart attack. CoQ10 may also be useful in treating diseases including muscular dystrophy, AIDS, and hypertension. There is also evidence that it may increase sperm motility. Although CoQ10 is sometimes touted for enhancing athletic performance this use hasn't been well demonstrated.
CoQ10, both topical and oral, is sometimes promoted to help treat gum disease, although the evidence is limited. One small study reported a benefit with the application of CoQ10 gel (PerioQ) in addition to non-surgical cleaning treatment, compared to treatment alone (Sale, J Indian Soc Periodontol 2014). Another small study in India, among 30 men and women with periodontitis who recieved traditional treatment (deep cleaning with scaling and root planing), found that those who took 120 mg of CoQ10 daily for three months after treatment had a modest decrease in gum inflammation compared to those who took a placebo after treatment, but there were no improvements in other measures of disease, such as plaque or pocket depth (gaps between teeth and gums which can deepen and allow for bacteria that cause gum disease to grow) (Manthena, J Clin Diagn Res 2015).
In children with trisomy 21 (Down syndrome), ubiquinol supplementation has been shown to increase the ratio of ubiquinol to CoQ10 to normal levels -- although it is unknown if this provides medical benefit.
A very small study of ubiquinol (100 mg per day) in elderly people suggested an improvement in self-assessed "vitality." More recently, a small, placebo-controlled study in veterans in their forties and early fifties with Gulf War illness found that taking 100 mg of CoQ10 (in oil from a softgel) daily for 3 to 4 months appeared to improve physical function and symptoms of the illness (such as recalling words and names, impatience, irritability, headache, fatigue with exertion, low energy to do things, and muscle pain). There was no improvement with sleep problems — possibly due to an "activation" effect of CoQ10. Self-rated health status also improved among men, although not among women. These effects, however, were not found with a larger, 300 mg dose (Golomb, Neural Computation 2014).
A small, preliminary study in Spain among middle- aged adults with fibromyalgia (chronic, wide-spread muscular pain and fatigue) found that 100 mg of CoQ10 taken three times daily for 40 days significantly improved measures of interpersonal sensitivity, depression, anxiety, hostility, and symptoms of somatization and obsessive-compulsion compared to placebo (Alcocer-Gomez, CNS Neurosci Ther 2017). A reduction in inflammation and clinical symptoms, including sleep quality and tender points, was also noted by the researchers, but, unfortunately, data was not provided for these findings.
CoQ10 may help people with trigeminal neuralgia (nerve pain in the face and jaw). A small study in Thailand among men and women being treated with standard medication (carbamazepine e.g. Tegretol, Carbatrol) for trigeminal neuralgia found that 100 mg of CoQ10 taken three times daily for two months significantly reduced self-reported nerve pain and certain measures of oxidative stress compared to placebo (Khuankaew, Free Radic Res 2018).
Although preliminary research had suggested CoQ10 might delay the progression of Parkinson disease, a large, placebo-controlled clinical study found no benefit from high-doses of CoQ10 (1,200 mg or 2,400 mg daily) in people with early Parkinson Disease (Parkinson Study Group, JAMA Neurol 2014). In fact, over the course of the 16+ month study, symptoms worsened more among those given CoQ10, particularly at the higher dose, than in the placebo group, although these differences were not statistically significant. All patients in the study also received high-dose (1,200 mg daily) vitamin E. An earlier, smaller study had suggested benefit with a daily dose of 1,200 mg of CoQ10 (also with 1,200 mg of vitamin E), although not at lower doses (300 mg and 600 mg) (Shults, Arch Neurol 2002).
Although some studies have found CoQ10 to lower elevated blood pressure, a critical review of these studies concluded that CoQ10 does not have a clinically significant effect in lowering blood pressure (Ho, Cochrane Database Syst Rev 2016). Interestingly, one physician found that CoQ10 helped maintain blood pressure in seven older people with orthostatic hypotension (low blood pressure upon standing) who were also using traditional treatments (clonidine, salt tablets, compression stockings etc.). The patients were given 257 mg of CoQ10 daily for approximately eight months. This apparently reduced the drop in systolic blood pressure upon standing from 30 mmHg to just 7 mmHg, although the study lacked controls and can only be considered preliminary. Three of the individuals had signs of multiple system atrophy, an neurogenerative disease that can affect the autonomic nervous system (and therefore, blood pressure) and is associated with mutations in an enzyme involved in CoQ10 synthesis (Rembold, Am J Med 2017).
A clinical study in India suggested that taking 100 mg of CoQ10 daily for two months could significantly lower elevated homocysteine levels. However, the study had no placebo control, so the results area inconclusive (Ritu, J Clin Trials Cardiol 2014). In a placebo-controlled study in China, neither a low (60 mg) nor higher (150 mg) dose of CoQ10 taken daily for three months had a significant effect on homocysteine levels (Lee, Nutrition 2012). Furthermore, a study among healthy older men and women in Japan (average age 59) whose homocysteine levels were not elevated found that supplementation with 100 mg to 120 mg of ubiquinol for six to twelve months had no effect on homocysteine levels in men and slightly increased levels in women — although this study did not include a control group, making the results inconclusive (Kinoshita, Funct Foods Health Dis 2016). In short, there is no solid evidence that CoQ10 or ubiquinol lowers homocysteine levels. Also, keep in mind that although elevated homocysteine is associated with a higher risk of heart disease, lowering homocysteine levels have not been shown to be beneficial.
A preliminary study among 33 healthy, middle-aged women found that 150 mg of water-soluble CoQ10 (Q10Vital® from Valens Intl.) taken daily for three months significantly reduced visible wrinkles around the eyes, nose and lips compared to placebo. However, there were no improvements in wrinkles on the forehead or frown lines between eyebrows, nor were there improvements in skin thickness or hydration, and there was no evidence of increased protection from UV damage. A lower dose (50 mg) had more limited effectiveness (Zmitek, Biofactors 2016).
More information about CoQ10's uses and clinical studies is found in the review article in the Encyclopedia on the ConsumerLab.com website.
Quality Concerns and What CL Tested For:
No U.S. government agency is responsible for routinely testing CoQ10 or ubiquinol supplements for their contents or quality. Research by ConsumerLab.com in 2000, 2004 and 2009 found that not all CoQ10 supplements contained their claimed amounts of active ingredient, although all products tested in 2006 and 2011 met their claims. In 2013, all but one of the CoQ10 and ubiquinol products selected for testing contained their listed amounts of these ingredients, and in 2015, all but two products contained their listed amounts. Because products on the market are constantly changing, ConsumerLab.com again recently evaluated CoQ10 products, as well as ubiquinol products, to determine whether they contained the amounts of CoQ10 or ubiquinol stated on their labels, and, if regular tablets, disintegrated properly. (See How Products Were Evaluated for information on testing methods and passing score.) [Note; In past reviews, ConsumerLab.com has checked CoQ10 and ubiquinol products for idebenone, a potential manufacturing by-product, but none has been found. Consequently, products were not tested for idebenone.]