Coenzyme Q10

Coenzyme Q10 (ubiquinone) is a substance similar to vitamin E in the body. Its tasks are in two main areas: electron transfer in the mitochondrial respiratory chain and participation as a redox partner in antioxidative processes. Coenzyme Q10 is therefore involved in ATP synthesis is fundamental for the generation of energy in the cells. Suboptimal processes in the citrate cycle of the mitochondria lead to an insufficient supply of biochemical forms of energy, which manifest themselves symptomatically in the tissues and at the organ level. The skeletal muscles and the heart muscle are primarily affected (1). Coenzyme Q10 contributes to strengthening the immune defense, promotes the integrity and stabilization of cell membranes and prevents induced ageing processes of the cell organs through the central tasks of antioxidative protection of biological membranes. 
 

Coenzyme Q10 is an endogenous substance that can be synthesized by the human body itself and is also supplied by the diet. Coenzyme Q10 is not considered as an essential nutrient in healthy people. However, in altered physiological states, where the synthesis rate is limited or the need is increased, an exogenous supply may be necessary. Coenzyme Q10 is therefore classified as a conditionally essential nutrient (2), the supplementation of which is necessary in the case of certain diseases and increased demand. These include heart disease, diabetes mellitus, neurodegenerative diseases, cancer, ageing processes, competitive sports and increased oxidative stress (3). 
 

Coenzyme Q10 exists in two biochemical forms, ubiquinone and reduced ubiquinol. Both compounds are ingested with food and both exist in the body. The reduced (non-oxidized) ubiquinol is the more active form of coenzyme Q10 than ubiquinone, which has to be converted into the active form of ubiquinol in the body via several enzymatic steps. This process is influenced by selenium and zinc status and can be restricted with increasing age or in the case of disease. 
 

Ubiquinol has two additional hydrogen groups compared to ubiquinone, which increases the polarity of the benzoquinone ring. This fact could be responsible for the observed superior bioavailability of ubiquinol. In a study with Biogena coenzyme Q10 active Gold Ubiquinol, the active reduced form showed a greatly improved uptake rate. After just one month, the Q10 plasma levels of participants supplemented with 50 mg/d ubiquinol were almost twice as high as those of participants receiving 120 mg/d ubiquinone (4). The results of the performance tests showed that the higher plasma values also lead to a better mitochondrial performance and an increased energy supply. Here, too, the ubiquinol group was far superior to the ubiquinone group in all parameters (5). Further studies show that in cardiac patients who do not respond sufficiently to ubiquinone supplementation and show unsatisfactory clinical improvements, supplementation with active ubiquinol can achieve both a significant increase in plasma levels as well as an increase in heart function and a favorable clinical result (5). 
 

Coenzyme Q10 is particularly important in the treatment of statin-induced side effects. The cholesterol-lowering statins inhibit the biosynthesis of mevalonic acid from 3-hydroxy-3-methylglutaryl-coenzyme-A and therefore interrupt the biosynthesis of cholesterol produced from mevalonic acid. Since mevalonic acid is also essential for endogenous coenzyme Q10 synthesis, this process also leads to a reduced endogenous supply of coenzyme Q10 (6). In clinical studies and therapeutic practice, many patients taking statins or HMG-CoA reductase inhibitors (e.g. Simvastin, Lovastin, Pravastin) experience a significant decrease in coenzyme Q10 plasma levels (<12 µg/ml) (7). Treatment with atorvastatin, for example, reduced coenzyme Q10 levels in patients from 0.81 (+/- 0.21) to 0.46 (+/- 0.10) µg/ml (8). The importance of coenzyme Q10 for mitochondrial energy metabolism suggests that the impairment of coenzyme Q10 status probably plays a decisive role in the development of statin-induced side effects. These include myalgia and myopathies such as muscle pain, muscle fatigue or reduced muscle performance as well as increased occurrence of ligament injuries and the tendency to cramps and inflammation of the tendons. Since coenzyme Q10 is essential for the formation of ATP in the mitochondrial respiratory chain, Q10 depletion may lead to performance disorders of skeletal and cardiac muscles (9). In a clinical study, a 40 % reduction in muscle pain was achieved after 30 days of daily supplementation with100 mg coenzyme Q10 (10).
 

Coenzyme Q10 is essential for the energy metabolism of the heart muscle. In cardiological diseases such as heart failure and ischemic heart diseases, Q10 levels in the heart muscle are significantly lower. This energetic depletion of tissue can be counteracted by regular daily supplementof 60 – 500 mg Q10 (11). Coenzyme Q10 is generally recommended as an adjuvant in chronic heart disease. Clinical studies show that 60 – 75 % of patients treated with coenzyme Q10 experienced a significant improvement in performance. A significant increase in life expectancy was observed in patients with heart failure (12). Supplementation with coenzyme Q10 in this indication framework is now a clinical standard in many countries and is recommended as a safe and well-tolerated adjuvant measure (13). A meta-analysis confirms the potential of coenzyme Q10 as an effective treatment for hypertension without side effects. Both systolic and diastolic blood pressure have been significantly reduced by Q10 supplementation (14). 
 

Due to its strong antioxidant properties, coenzyme Q10 is an important substance in the prevention and treatment of arteriosclerosis. After a myocardial infarction, Q10 supplementations demonstrates a significant reduction in reactive free radicals and thus a reduction in the risk of further atherothrombosis (15)(7)(16)(17).
 

The use of coenzyme Q10 in migraine represents a new therapeutic field. Clinical studies suggest that coenzyme Q10 status in pediatric and adult migraine patients is below normal levels. Supplementation with 1 - 3 mg coenzyme Q10/kg body weight leads to a significant reduction in migraine frequency and intensity (19). This is confirmed by earlier studies, which have observed a reduction in migraine attacks of over 50% with coenzyme Q10 substitution of 150 mg/day over 3 months (19). There is also initial evidence of a possible therapeutic use of coenzyme Q10 in tinnitus aurium. A subgroup of subjects who had previously been found to have a reduced coenzyme Q10 status had significant improvements in tinnitus symptoms after Q10 supplementation (20). 
 

With increasing age, the Q10 concentration in various tissues decreases significantly due to limited self-synthesis. The heart is primarily affected, but also the musculature. Since reduced ATP synthesis and the resulting reduced energy production seem to be responsible for the generally declining performance of the human body, it is assumed that the maintenance of coenzyme Q10 concentrations can counteract an age-related drop in performance and aging processes in general. In addition to improvements in ATP synthesis and antioxidant action, this is achieved by regulation of gene expression, which is responsible for the age-related change in the number and length of muscle fibers (21). In addition, coenzyme Q10 can slow the diminishing adaptation of aging tissue to stress and maintain an adequate response to stressors. This has been demonstrated in clinical studies for the heart tissue and other organs (22).
 

A number of studies have shown that supplementation with ubiquinol significantly increases sperm count and mobility. In a double-blind, placebo-controlled study, 228 men with idiopathic infertility, i.e. infertility without known cause, were given 200 mg ubiquinol per day or one placebo for 26 weeks. The subsequent examination showed that the quality of semen fluid in the intervention group had improved significantly, both in terms of increasing sperm density and improving sperm motility and sperm morphology (23). Another study investigated the effect of coenzyme Q10 administration on the partner's pregnancy rate. 287 men with idiopathic infertility were given 300 mg coenzyme Q10 twice daily for 12 months. The results were promising: both sperm concentration and sperm mobility improved significantly. After completion of supplementation, and a further 12 months of follow-up a significant increase (34.1%) in the partner's pregnancy rate was observed. Q10 administration improved semen quality with a positive effect on the pregnancy rate in this study (24).
 

Various clinical studies in patients with periodontitis and gingivitis confirm a reduction in the coenzyme Q10 content and thus an energy impoverishment of the affected tooth tissue (25). Oral supplementation and topical application with a Q10 oral spray show significant improvements in inflammatory processes, bleeding, periodontal pocket depth and tooth mobility after 6 weeks of treatment. 
 

Lower coenzyme Q10 levels can often be observed in cancer patients. Studies show that tumor patients can benefit from Q10 supplements. In a case study, 84 patients with breast cancer and elevated tumor markers received tamoxifen and coenzyme Q10, niacin and riboflavin, with a significant decrease in tumor markers (23). In a 9-year pilot study of 41 end-stage cancer patients, oral treatment with Q10 and an antioxidant mix improved their chances of survival, 76% of patients lived longer than predicted (26).
 

Due to the symptomatic parallels of long covid syndrome to chronic fatigue syndrome (CFS), both coenzyme Q10/ubiquinol and NADH (nicotinamide adenine dinucleotide) play an essential component as part of the electron transport chain responsible for mitochondrial ATP production. CFS has been shown to show disturbances in CoQ10 and NADH levels, as well as redox status. In a study of 207 patients by Castro-Marrero et al, administration of 200 mg CoQ10 and 20 mg NADH over a 12-week period resulted in a reduction in cognitive fatigue ("brainfog") and general fatigue perception, as well as an improvement in quality of life and sleep (27).
 

Coenzyme Q10 is available on the market in different qualities, which is why reputable suppliers look for a high-quality and safe sources. The Japanese company Kaneka® has been one of the world's leading coenzyme Q10 producers for 25 years and has further consolidated its position as an innovative and reliable Q10 supplier with a new, hitherto unique manufacturing process. Kaneka® coenzyme Q10 is biosynthesised by special yeast cells from which a bioidentical coenzyme Q10 can be extracted. The Kaneka® coenzyme Q10 is thus completely similar to the natural all-trans-coenzyme Q10 found in foods and is free of synthetic cis isomers. All steps of the manufacturing process meet pharmaceutical GMP standards, ensure reliable and consistent substrate quality and are certified as kosher. Kaneka® coenzyme Q10 was also tested for toxicological safety and was classified as a safe and well-tolerated substance in doses of up to 900 mg/day in healthy volunteers (28).
 

NutriGellets® are specially produced pearls made from fish gelatine, in which the active substances are evenly stored and distributed. Even sensitive active substances such as ubiquinol are protected by the gelatine matrix and can be introduced into a transparent uncoloured capsule shell. This means that the capsules only contain ubiquinol as an active substance; auxiliary substances, colorings and preservatives can be dispensed with altogether. In addition, NutriGellets® technology optimizes the bioavailability of active substances. The natural polymer structure of gelatine ensures an even distribution of the active ingredients and an increase in surface area. The matrix dissolves in the aqueous environment and warmth of the small intestine, the active substances are then dispersed very finely and evenly. The oily substances form a stable emulsion and can be easily absorbed by the body. 

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