Summary

Coenzyme Q10 (CoQ10) is an essential compound found in every cell of the body. CoQ10 is an electron carrier in the respiratory chain, which is the ultimate pathway in carbohydrate, fat, and protein metabolism, whereas about 95% of the energy for the body is produced. It also functions as an antioxidant, which protects the body from damage caused by harmful molecules. Although our bodies can manufacture CoQ10, deficiency can result from mutations in any of the 12 required genes, whereas it presents as mitochondrial disease. Statin drugs used to lower blood cholesterol levels inhibit the biosynthesis of CoQ10. Some chronic conditions, especially those involving mitochondrial function, can increase the demand for CoQ10 in the body, leading to deficiency. CoQ10 is generally present in only small amounts in foods, which leads many physicians to recommend supplementation. One study in children with ASD reported that significant improvements were noted using CoQ10, including in communication and social skills as well as sleeping. However, the role of CoQ10 in the treatment of autism is mostly driven by its antioxidant properties in ameliorating an underlying metabolic, redox, or mitochondrial condition. CoQ10 is also sometimes recommended for treating a wide range of other conditions, especially heart disease and migraine. Given the above and its tolerability (side effects are rare and mild), many expert physicians recommend CoQ10 in their patients with ASD, especially in those with signs of mitochondrial dysfunction and/or manifestations of migraine or chronic pain. The two forms of CoQ10, ubiquinone and ubiquinol, can easily be interchanged by the body. Ubiquinone is more clinically tested form and the form present in most dietary supplements. Ubiquinol may have better absorbance from the gut, and better penetration from blood to brain, while ubiquinone may be better for migraine/pain. In Dr. Boles’ experience, each form has advantages and disadvantages and both together are recommended in many of his patients.

Coenzyme Q10 in Spectrum Needs

CoQ10 is added in order to provide a wide basis of nutrition, especially given the important role of CoQ10 in energy metabolism and the preliminary data regarding its use as a food supplement in ASD. Ubiquinone is the form of CoQ10 provided in Spectrum Needs because ubiquinol is very-poorly absorbed from powders. Side effects are unexpected. You may wish to speak to your physician regarding supplementing you child with ubiquinol in addition to taking Spectrum Needs. Blood levels of CoQ10 can assist in determining the correct dose for your child.

The Details

What Is It? 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.

What Does It Do? 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 an antioxidant, which protects the body from damage caused by harmful molecules.

What Does Deficiency Appear as? 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.

What About Its Use in Autistic Spectrum Disorders (ASD)? The role of CoQ10 in the treatment of autism is not well studied. One open label study was conducted with 100 mg of the ubiquinol form of CoQ10 in 24 children with ASD ranging from age 3 to 6 years. Significant improvements were noted in communication skills, playing with friends, sleeping, and food acceptance with CoQ10 plasma levels above 2.2 mg/L
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953391/pdf/OMCL2014-798957.pdf). The use of CoQ10 in ASD is mostly driven by its electron transport properties in the respiratory chain, as well as in its antioxidant properties in ameliorating an underlying defect on reactive oxygen species (ROS or redox) metabolism or mitochondrial dysfunction. Several lines of evidence support the notion that some children with ASD have abnormal redox metabolism (this topic is reviewed in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910649/pdf/cmped-10-2016-043.pdf), including abnormal glutathione metabolism. Oxidative damage to proteins has been documented in the brain and other tissues in ASD. Redox abnormalities have been linked to mitochondrial dysfunction in children with ASD, and mitochondrial dysfunction is one of the most prevalent metabolic disorders in ASD. Biomarkers suggestive of mitochondrial dysfunction are identified in 30% or more of children with ASD, while about 5% meet strict criteria for a diagnosis of classical mitochondrial disease. In support of this high prevalence of mitochondrial dysfunction in ASD are two studies that found lower than normal electron transport chain function in immune cells from 80% of the children with ASD examined (https://www.ncbi.nlm.nih.gov/pubmed/?term=21119085; https://www.ncbi.nlm.nih.gov/pubmed/?term=24753527). Some of the signs that a given individual with ASD is more likely to have abnormal redox metabolism and/or mitochondrial dysfunction are the presence of chronic pain, increased fatigue on the day following unusual exertion, severe gastrointestinal disease, dysautonomia, or a history of regression (including any loss of abilities, whether transient or persistent). This list is incomplete, and you may want to consult with your physician; laboratory testing can also help. Based on the above considerations, and low side effect profile, many physicians recommend CoQ10 in their patients with ASD, especially in those with signs of mitochondrial dysfunction and/or manifestations of migraine or chronic pain.

What About Its Use in Other Conditions? 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.

What Form of CoQ10 is Best? CoQ10 comes in two forms, ubiquinone, the oxidized form, and ubiquinol, the reduced antioxidant form. Both forms can easily be processed into the other b y 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. Many people claim that ubiquinol has better gut absorption and that a much lower dose is required, but in Dr. Boles’ experience the monitoring of blood levels in his patients does not generally support this. 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 ASD. However, in Dr. Boles’ unpublished experience, ubiquinone is actually superior to ubiquinol in treating migraine headache, cyclic vomiting and other forms of migraine or chronic pain. In his practice, both ubiquinone and ubiquinol are recommended in patients with ASD and migraine, cyclic vomiting, and/or pain.

What Are the Common and/or Important Side Effects? 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.

Is There Any Laboratory Testing? CoQ10 may be measured in blood (plasma), 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 300 mg/dose (whichever is smaller) 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. Some specialized centers measure CoQ10 levels in cultured skin fibroblasts, muscle biopsies, and/or blood mononuclear cells, which are better indications of CoQ10 deficiency states, but not necessarily of substantial routine help in patient management.

How and Why is this Nutrient Used in Spectrum Needs

CoQ10 is added to Spectrum Needs in order to provide a wide basis of nutrition, especially given the important role of CoQ10 in energy metabolism. Ubiquinone is the form of CoQ10 provided in Spectrum Needs because ubiquinol is very-poorly absorbed from powders. Side effects are unexpected at the doses used in Spectrum Needs.

What About Additional Dosing Beyond Spectrum Needs?

You may wish to speak to your physician regarding supplementing you child with ubiquinol from liquid or gel capsule formulations in addition to taking Spectrum Needs.