We have added a new form of Coenzyme Q-10 to those we alreadystock at the office. It is priced slightly cheaper per milligram than our current ‘top of the line’ product and if the current ‘word in the journals’ is to be believed, will do a better job of increasing blood levels of coenzyme Q-10 than other products.
Below is an article I wrote recently with the goal of making some sense out of the various Coenzyme Q-10 products currently being sold:
July 1, 2008
Jacob Schor ND, FABNO
A patient came in recently with a long list of symptoms that had miraculously disappeared when he started taking Ubiquinol, a new form of Coenzyme Q-10 being sold.
I cursed him silently, knowing that his good fortune would force me to sort out what I’ve been calling my Co--Q-fusion. There are so many competing Co enzyme Q-10 products that I’ve been at a loss what to tell patients about which product to take.
Co Q-10 was first isolated in 1957, its structure determined in 1958, and the first consideration that it could be useful for treating cancer suggested in 1961. The 1978 Nobel Prize in chemistry was awarded for work involving the energy producing mechanisms that utilize Co Q-10.
Yet a decade later when I attended NCNM there was still little mention of using Co Q-10 therapeutically. This goes to show how these days, with research readily available online, new knowledge moves faster into clinical practice then it did in the past. Whatever the case, the good Dr. MacIntosh, our biochemistry professor and others hardly mentioned Co Q-10 during the late 1980’s when I had the pleasure of their instruction. For all of you who are in a similar situation and can’t figure out which advertisement to believe, here is what I’ve been able to figure out.
First Co Q-10 is good for lots of things, there is loads of research.
There is little question that coenzyme Q-10 has remarkable and useful properties as a supplement. It serves a pivotal role in energy metabolism because it is a cofactor in the production of ATP through the mitochondrial electron transport chain. Second, it is a fat soluble antioxidant, protecting cells, cell membranes and especially the mitochondria from oxidative damage.
This chemical has clear benefit in a number of therapeutic situations, including heart disease, mitochondrial damage and protection during chemotherapy. A phase II study is underway using it to treat Parkinson’s Disease.
There is no need to explain all that stuff. The NIH website and others have nice reviews. The question I want to address is the differences between these many products on the market.
We can divide all these various forms of Co Q-10 into three basic groups.
First there is the basic yellow powder called ubiquinone. This is the crystallized stuff that’s been on the market for decades. It is the oxidized form of Co Q-10, relatively difficult to absorb but it is the form that the majority of researchers have used in almost all of the published papers.
Second, there are versions of that yellow ubiquinone powder mixed and emulsified with various oils and fats for the purpose of increasing absorption. We’ve known for years that Co-Q is absorbed better if presented to the digestive tract along with fat. That’s why our common suggestion is to take one’s Q-10 with meals or along with fish oil capsules, or even mixed in with avocado or peanut butter. I confess that over the years I have been frustrated with company representatives who have tried to sell me on these ‘improved’ forms of Co Q-10 by showing off studies that have compared their new product’s absorption to plain old Q10 taken while fasting. The studies rarely answered the real question; is the emulsified version better absorbed than Co Q-10 taken with food?
Third, there is ubiquinol, the new kid on the block that is generating a great deal of marketing excitement. Ubiquinol is the reduced form of ubiquinone.
There are several good arguments in favor of this new product. First is that ubiquinol, the reduced form, is the active form in the body. It doesn’t have to be reduced once it is absorbed. Second, it is better absorbed than the oxidized form, ubiquinone.
Is one form more effective?
Just so you remember:
Ubiquinone =oxidized form
Ubiquinol = reduced form
Inside the body 80% of the Co Q-10 exists in the reduced ubiquinol form. Ubiquinone, the oxidized form, when taken as a supplement, is quickly reduced into ubiquinol as it is absorbed. The fraction of reduced to oxidized Co Q-10 found in food varies considerably but in most, the majority is ubiquinone and ubiquinol makes up only about 17 to 35% of the total Co Q -10 content.
But here is the catch, Ubiquinol is better absorbed than ubiquinone. In rat experiments the ubiquinol is absorbed twice as well as ubiquinone.
My first bottom line was to figure out which products increase blood levels of Co Q-10 the most. Of course no published study cleanly compares all the various products side by side. One has to patch together information from various studies, hoping the methodologies are similar enough to yield results that are comparable. Let’s assume they are. (which is a weak assumption but it’s the best we can do at the moment)
There has been a steady progression of improvement over the years. Blood baseline levels of Co Q-10 are typically around .65 mcg/ml. The crystalline powders we first used at a dose of 100 mg/day taken for four weeks, double blood levels to about 1.35 mcg/ml. (Stogsdill 2006)
Absorption is clearly improved by mixing the crystalline ubiquinone with various fat delivery systems. The ‘softgel’ capsules from the late 1990s are advertised to increase levels to 2.56ucg/ml (at 60 mg/day for four weeks).
With time the way the Co Q-10 crystals are blended into the oil got fancier. For example Q-absorb™ that uses a “proliposome lipid-soluble delivery system” is advertised to increase Co-Q10 levels [100 mg tid] to 3.64 ucg/ml, that’s about 3 times over baseline. (It’s also triple the daily dose as in the earlier mentioned papers) (see what I mean by this being a weak assumption)
Now there is a ‘crystal free’ COQMAX CF ™ that claims to have emulsified the Co A-10 moleules into the oil without crystal formation. This version raises blood levels to 3.43 ucg/ml after 28 days. (Xymogen) We’ve been using this at our office for a number of years.
Now along comes ubiquinol.
We have one study on absorption of ubiquinol that was sponsored by Kanek, a the company that manufactures it. (Hosoe 2006) The study looked at both safety and absorption and found no safety concerns. They report blood levels increased more with higher doses. After 28 days taking 300 mg doses per day after breakfast, ubiquinol levels increased from a baseline of 0.66 to 8.28 mcg/ml. This is something like an 11 fold increase.
This got my immediate attention.
Lower doses of ubiquinol yielded less impressive results. At 90 mg per day, ubiquinol levels increased from a baseline of 0.57 to 2.84 mcg/ml. At 150 mg per day, ubiquinol levels increased from a baseline of 0.65 to 3.84 mcg/ml. These results were only slightly higher than prior results achieved though older supplements.
Certainly if you compare this with plain old co Q-10 powder that increase levels to only 1.35 mcg/ml, these numbers look really good.
That’s the good news.
The bad news is that this is about all we know about using ubiquinol in people. Over the last 30 years there have been numerous clinical trials giving people ubiquinone. To date we have only two studies using ubiquinol in humans. The first (Hosoe et al. 2007) from which we pull this data looked at toxicity and absorption. A second in August 2007 used ubiquinol in heart failure patients. A third from that December looked at ubiquinol use in children with trisomy-21 gene.
While there are a multitude of studies using older forms of Co-q, there are almost none published using Ubiquinol.
Quest Labs will measure Co Q-10 levels for you. This won’t do much good as they only quantify results up to 4 ucg/ml. Higher results are simply reported as “>4” and trust me patients are not thrilled to pay the cost of the lab test (which isn’t cheap) to learn that. They like to see numbers.
Ubiquinol does increase serum C0 Q-10 above 4. I can’t confirm how much higher I’ve gotten patients.
If ubiquinol raises blood Co Q-10 levels higher than other forms of Co Q-10 do, can we assume it will have the same therapeutic action as earlier less absorbable forms, only more so?
If doubling serum Co Q-10 levels is helpful, does tripling, quadrupling or increasing it by a factor of eleven provide more and more benefit? Do the benefits of increasing blood ubiquinol levels continue to increase with dose or is there simply a threshold that needs to be crossed to get maximum benefit and above which further increases do not accrue further benefit? These are the questions.
More is not always better. Yet, sometimes it is.
At this point we don’t have the answers.
There may be subsets of the population in which ubiquinol is superior. Some people may have trouble converting ubiquinone to ubiquinol. Or perhaps, digestive problems may limit absorption of the plain or fat ubiquinone products. There may be certain conditions where we want all the Co-10 in the blood we can get and other conditions that simply doubling baseline levels will do the trick.
As much as I had hoped to arrive at a definitive answer at about this point, I’m not there and may be force to resort to the cop out of the educated and say more research is required. While we wait for that to happen, here’s what I’m doing in practice. As serum levels of ubiquinol appear dose dependent, I’m going to try patients on different doses and see if they can feel the difference symptomatically as we increase to high doses. If they don’t report further symptom improvement, I’ll keep them at the lower doses and presumably the ‘lower’ serum levels.
[This approach reminds me of a discount grocery store chain in the midwest called Hy-Vee. Their motto is, “If you can’t taste the difference, why pay the difference?” ]
Ubiquinol is new, it’s exciting, it offers the chance to increase serum C0 Q-10 levels higher than ever before. We should be seeing plenty of research coming out on this in the near future. At present, I just don’t know that it matters how much Co Q-10 you get into someone, more is not always better.
Steady state bioavailability
Date Product CMax peak absorption Steady state
1970s crystalline 1% 1.35 mcg/ml
1979 oilbase capsule 2.5% 2.48-2.56 mcg/ml (100 mg/day)
1995 Tishcon softgel hydrosoluble 2.78% 2.8-3.4 (120 mg/day)
1996 Softgel technologies 5.9% 2.56 (60 mg/day)
Jarrow Q-absorb 3.64 (300 mg/day)
2006 DS1215 7.5% 3.43
DS 1217 8.1% 3.19
2008 Taneka ubiquinol 8.28 mcg/ml (300 mg/day)