By Dr. Mercola
Coenzyme Q10 and ubiquinol are two vitally important supplements that many are still unaware of. Risa Schulman, Ph.D., is a biologist and functional food expert who has spent the last two decades researching these and other supplements.
"I kind of pulled together my love of human physiology, plant physiology and the environment into a lifelong career, looking at how compounds in plants and various natural products can help us to keep our bodies working optimally," she says.
"My mission is to dig into the science and separate the wheat from the chaff ... and then to get the word out to the public as to what the health benefits are, how they can be used, and what things are useful."
Coenzyme Q10 Versus Ubiquinol
Ubiquinol is the reduced version of coenzyme Q10 (CoQ10, aka ubiquinone). They're actually the same molecule, but when CoQ10 is reduced it takes on two electrons, which turns it into what we call ubiquinol.
In your body, this conversion occurs thousands of times every second inside your mitochondria — the "engine" of each cell in which energy is produced
"The reason it does this flipping back and forth between these two forms of the molecule is that this is part of the process that helps us to change our food into energy," Schulman explains.
"This is very important to healthy functioning, and obviously important for all muscles, in particular your heart muscle, which works hardest of all the muscles."
In addition to converting food into energy, ubiquinol also has a number of additional functions. For starters, ubiquinol is a lipid-soluble (fat-soluble) antioxidant, meaning it works in the lipid portions of your body, such as your cell membranes. It's one of the very few antioxidants that are fat-soluble.
Ubiquinol is also the only fat-soluble antioxidant that's actually generated within your body and doesn't have to be ingested from your food.
Why Ubiquinol Is a Better Choice for Many
Ubiquinol production ramps up from early childhood up until your mid- to late 20s. By the time you hit the age of 30, it begins to decline. Young people are able to use CoQ10 supplements quite well, but older people do better with ubiquinol as it's more readily absorbed.
According to Schulman, some people cannot convert CoQ10 to ubiquinol at all in their bodies, and they definitely need to use ubiquinol or they won't get any of the benefits.
"If someone takes a CoQ10 supplement, the body very quickly will convert it to ubiquinol, because that's the preferred form. It will transport that CoQ10 through the blood, as ubiquinol, into the tissues and eventually into the mitochondria," she explains.
“But there are some people who lack the enzyme that helps to convert the CoQ10 to ubiquinol. That could be partly due to aging, but it’s also genetic. There’s something called a single nucleotide polymorphism SNP).
There's a particular SNP that's called NQO1. When a person has either one or two copies of this SNP, their ability to convert CoQ10 is either slightly or severely compromised.
What that means, practically, is that if this person takes a CoQ10 supplement ... their body can't convert it in a way that makes it usable. Those people in particular can benefit very much from taking ubiquinol, instead of ubiquinone."
Research has shown that Hispanic and Chinese populations are especially prone to having this single nucleotide polymorphism. There are also genetic tests you can get that can identify whether you have it.
How to Regenerate CoQ10 Naturally
Interestingly, recent research shows you can improve your body's conversion of CoQ10 to ubiquinol by eating lots of green leafy vegetables, which are loaded with chlorophyll, in combination with sun exposure.
Once chlorophyll is consumed it gets transported into your blood. Then when you expose significant amounts of skin to sunshine, that chlorophyll absorbs the solar radiation and facilitates the conversion of CoQ10 to ubiquinol.
You can also improve absorption of CoQ10 by taking it with a small amount of healthy fat, such as some olive oil, coconut oil, or avocado.
Ubiquinol Combats Free Radicals in Your Mitochondria
About 90 percent or more of the reactive oxygen species (ROS) in your body are produced in your mitochondria. Using the analogy of the mitochondria as an engine, the combustion (metabolism) that takes place in there creates exhaust fumes — damaging byproducts.
One of the functions of ubiquinol is to mop up those byproducts. When ubiquinol is lacking, the byproducts remain and begin damaging the cell. Ubiquinol is particularly beneficial for your heart health, a marker for which is C-reactive protein. When C-reactive protein is elevated it suggests you have a heightened risk for heart disease, as it's a marker for inflammation.
Two other markers for inflammation are gamma-glutamyl transferase (GGT), which is an early marker of heart failure, and NT-proBNP. There's an association between the levels of these two markers and ubiquinol as well. When ubiquinol is supplemented, both these markers go down and genes associated with them are downregulated.
The Case for a Healthy High-Fat Diet
Over the past 15 years, scientists have begun to recognize that ROS are not 100 percent bad. They're also important signaling molecules. If you indiscriminately suppress them you can actually run into complications with the Law of Unintended Consequences. In my view, a wise strategy is to simply feed your body a cleaner fuel to suppress excess ROS generation.
To continue the analogy of your mitochondria being an engine, to prevent pollution you want to use a cleaner-burning fuel. Glucose is an inherently "dirty" fuel that generates lots of ROS, whereas healthy dietary fats, including saturated fats, burn much cleaner and more efficiently.
In fact, burning carbohydrates is associated with a 30 to 40 percent increased production of ROS compared to burning fat. It makes a lot of sense that if you produce fewer ROS to begin with, then you don't have to be as careful about supplying your body with antioxidants. (Personally, I have some concern over indiscriminate use of antioxidants, but not necessarily ubiquinol.)
“Counter to how we’ve all been trained to think in the last years, regarding the free radical theory of aging, you don’t want to suppress it all the time,” Schulman says. “In fact, free radicals actually play a very critical positive role in the body because they turn on various very important functions.
Nitric oxide, for example, has free radical properties. It's a critical signaling molecule and is also critical for the health of your arteries. I haven't read anything in the literature regarding whether there's a discriminating or non-discriminating suppression of reactive oxygen species by ubiquinol in the mitochondria.
But my understanding of the biochemistry and the bioenergetics that are happening there leads me to believe that it's more of a random process."
Another strategy you could use to reduce the production of excess ROS involves the timing of your last meal of the day. Many make the mistake of eating a large meal before they go to bed.
By supplying your body fuel at a time when very little is needed leads to the generation of excess ROS that then must be countered with antioxidants. Avoiding food for at least three hours or more before bedtime can take the load off your body by preventing excess ROS production in the first place.
Finally, making sure you are not overloaded with iron is another powerful strategy. Believe me, iron overload is every bit as dangerous as vitamin D deficiency. If you are an adult male or non-menstruating woman then you are at high risk.
Please make sure you get your ferritin level checked and confirm that the level is below 80 nanograms (ng)/milliliters (ml), preferably between 40 and 60 ng/ml. If it is higher than that then it is imperative that you regularly donate your blood or have therapeutic phlebotomies to get it in that range.
Statin Users Are in Dire Need of CoQ10
At least 1 in 4 American adults over the age of 40 are currently taking a statin drug to lower their cholesterol. Soon that number is expected to reach 1 in 3. Statins work by inhibiting the enzyme HMG-CoA reductase, which is one of the facilitators of your body's production of cholesterol. But statins also impair production of CoQ10, and the resulting depletion can have very severe consequences.
"This is a very important topic," Schulman says. "Many who take statins have the side effects of muscle pain, fatigue and memory loss — to such a point that compliance becomes an issue; people don't want to be on statins anymore. It's been documented and recognized medically that these are real effects and that they're due to the statins. What's actually happening? The way a statin works is that it blocks your body's production of cholesterol.
We're always thinking about cholesterol from the diet ... Most people don't realize that cholesterol in the body comes from two places: from the diet and from your internal production of cholesterol. Cholesterol is quite important to your body, because cholesterol is one of the major components of cell membranes. It's also the precursor for all the sex hormones. It's not all bad. It's just bad when there's too much and that depends on what kind as well."
Besides shutting down your body's ability to produce ubiquinol, statin drugs also shut down the conversion of vitamin K1 to vitamin K2, which is critically important in many body functions, including heart health.
Impairing these three pathways — the production of cholesterol and CoQ10, and the vitamin K1 to K2 conversion — has adverse effects on the production of energy and on cardiovascular health, and here's why: when you reduce your ubiquinol levels, the conversion of your food to energy becomes less efficient, which leads to lower energy, fatigue and muscle pains.
And the longer you're on a statin drug, the more ubiquinol-starved your body becomes and the more severe the side effects become. Recently published papers have also detailed the cardiovascular repercussions of statins. As it turns out, they actually end up causing many of the disease endpoints the drugs promised to prevent. But that's not all!
Statins Severely Compromise Your Metabolism
As mentioned, one of the most rational strategies to reduce ROS production is to burn clean fuel. Ultimately, that results from eating a diet high in healthy high-quality fats. When fat is metabolized, ketones are created — a fat-soluble molecule that is readily burned in the mitochondria without causing the production of excess ROS.
Ketones are produced in the liver, and the enzyme that produces ketones is the same that produces cholesterol, namely HMG-CoA reductase. So when you're taking a statin drug, you also severely diminish your liver's ability to make ketones, thereby compromising your ability to benefit from a clean fuel (fat). In short, your metabolism becomes severely compromised.
Even if you're taking vitamin K2 and ubiquinol, you still have to address the fact that you cannot make ketones, because you cannot take a ketone supplement. Ultimately, this has cardiovascular consequences as well, because your heart is the most mitochondrial-dense tissue in your body. If you deprive your cardiac tissue of fuel, by definition you impair your cardiovascular health.
Ubiquinol Benefits Heart Failure Patients
Heart failure is nearly at epidemic levels. There's a specific physiological condition called diastolic dysfunction where your ventricle hardens. As a result, your heart cannot properly refill with blood during diastole. This can eventually progress to heart failure. Unfortunately, many who have this condition don't even know it. There are markers that can be used to screen for it though, including NT-proBNP and GGT.
"There are a couple of papers out there now that talk about actual physician experience with patients with heart failure. They had some of these patients on CoQ10, and then they ended up switching to ubiquinol because of the better absorption. But the bottom line is that they saw a reversal in the New York Heart Association class.
That's the New York Heart Association's way of rating the severity of the disease. They see reductions in the severity of the disease. They see improvement in the ejection fraction, which is a measure of how well the heart is working in patients ... This is one of the other fantastic benefits of ubiquinol and something that both doctors and patients should know about," Schulman says.
I personally think all heart failure patients should be on ubiquinol. To me, failure to do so is medical negligence. When it comes to heart health, a more general benefit is that ubiquinol also acts as an antioxidant in your blood, where it prevents the oxidation of LDL cholesterol, thereby helping prevent atherosclerosis. This is another important heart health function of ubiquinol.
Suggested Dosing Recommendations
Dosing requirements will vary depending on your individual situation and needs, but some general guidelines can still be made. As a general rule, the sicker you are, the more you need. According to Schulman, the highest amount she's seen used in a research setting was 600 milligrams (mg) per day, and that was for severely ill people.
If you're just starting out with ubiquinol, start with 200 to 300 mg per day. Within three weeks, your plasma levels will typically plateau to its optimum level. After that, you can go down to a 100 mg/day maintenance dose. This dose is typically sufficient for healthy people. If you have an active lifestyle, exercise a lot, or are under a lot of stress due to your job or "life" in general, you may want to increase your dose to 200 to 300 mg/day.
Remember, if you're on a statin drug you MUST take at least 100 to 200 mg of ubiquinol or CoQ10 per day, or more. To address heart failure and/or other significant heart problems you may need around 350 mg per day or more. Ideally, you'll want to work with your physician to ascertain your ideal dose. Your doctor can do a blood test to measure your CoQ10 levels, which would tell you whether your dose is high enough to keep you within a healthy range.
CoQ10 (or ubiquinol) is also appropriate for those with other chronic diseases besides heart problems, such as diabetes, amyotrophic lateral sclerosis (ALS), chronic fatigue and autism for example. Ideally, you'll want to split the dose up to two or three times a day, rather than taking it all at once, as this will result in higher blood levels.
Other dosing guidelines, as presented by Dr. Stephen Sinatra (a board-certified cardiologist, and a prominent expert in the field of natural cardiology) include:
✓ Hypertension, 200 mg/day
✓ World class athletes who need extra ATP turnover, 300 to 600 mg/day
✓ Heart transplant or severe congestive heart failure (CHF), 300 to 600 mg/day in divided doses
✓ Arrhythmia, 200 mg/day
✓ Typical athletes, 100 to 300 mg/day
✓ Mitral valve prolapse, a combination of 400 mg magnesium and 100 to 200 mg of ubiquinol