Coenzyme Q10

Coenzyme Q10 (CoQ10) is a fat-soluble compound found in every cell of the body. While it is an essential compound, it can be produced in small amounts by humans, and thus is not a true vitamin.

CoQ10 is an electron acceptor in the respiratory (electron transport) chain, which is the ultimate pathway in carbohydrate, fat, and protein metabolism, whereas about 95% of the energy (ATP) for the body is produced. It also functions as a very powerful antioxidant, which protects the body from damage caused by harmful molecules.

Biosynthesis of CoQ10 requires at least 12 enzymes, and severe CoQ10 deficiency can result from mutations in any of the corresponding genes, whereas it presents as mitochondrial disease. Some chronic conditions, especially those involving mitochondrial function, can increase the demand for CoQ10 in the body, leading to deficiency. In addition, statin drugs used to lower blood cholesterol levels inhibit the biosynthesis of CoQ10 as well as cholesterol, from which CoQ10 is made. CoQ10 is naturally present in essentially all foods, but generally in small amounts, which leads many physicians to recommend supplementation for certain patients.

CoQ10 is sometimes recommended in individuals with heart disease and in those taking statin drugs. Some studies have shown a benefit in preventing migraine, and the Canadian Headache Society guideline recommends that 300 mg of CoQ10 be offered as a choice for prophylaxis (https://www.ncbi.nlm.nih.gov/pubmed/22683887). CoQ10 is also said to boost energy and speed recovery from exercise, and to slow down some effects of aging. Other studies have shown benefits in autism.

CoQ10 comes in two forms, ubiquinone, the oxidized form, and ubiquinol, the reduced antioxidant form. Both forms can easily be processed into the other by the body through either the loss or gain of electrons. Ubiquinone is the original and more clinically tested form, as well as the form that is in most dietary supplements. One study shows that ubiquinol has better gut absorption and that a five-fold lower dose is required to achieve the same blood level. Ubiquinol likely has better penetration into brain, which is a good argument for the use of this form in the nutritional supplementation of individuals with brain fog/mental fatigue and other brain conditions. In his practice, ubiquinol is recommended in patients with multiple conditions associated with mitochondrial dysfunction, including autism, cyclic vomiting, migraine, and other types of chronic pain such as muscle cramps.

CoQ10 in either form is generally very well tolerated without side effects. Some parents complain that their children are “over energized”, which is likely a result of improved energy metabolism allowing the child to get into more mischief than before. When this is an issue at bedtime, families have found that taking the second dose at dinner, instead of later, usually suffices.

CoQ10 may be measured in blood (serum), and this measurement reflects dietary intake and gut absorption rather than tissue status. It is thus useful to determine whether CoQ10 supplementation is adequate. When supplementing with CoQ10, note that the amount is usually quite low (100 mg) in most commercially-available supplements, and much higher dosages are generally required to arrive at a therapeutic level. Dosing should be discussed with your physician, who may benefit from Dr. Boles’ typical initial dosing of 10 mg/kg/dose or 200-300 mg/dose (whichever is smaller) of ubiquinol provided twice daily. Dosing is then increased until the blood level exceeds 3-4 mg/L. In addition, gel capsules provide better absorbance than powders. Many laboratories do not provide quantitative (number) results for high levels, and thus are generally not helpful in monitoring supplementation. In Dr. Boles’ experience, Quest Diagnostics has an excellent test (https://testdirectory.questdiagnostics.com/test/test-detail/19826/coenzyme-q10?cc=MASTER).

You may wish to speak to your physician regarding supplementing you child with ubiquinol from liquid or gel capsule formulations of ubiquinol in addition to taking ActivNeeds. NeuroNeeds has a highly-bioavailable ubiquinol product called QNeeds. See the above paragraph for Dr. Boles’ dosing and testing recommendations.