As the heart is the most metabolically active organ in the body, a constant supply of energy is required to allow it to pump out blood to the rest of the body. If there is something we can do to improve the heart’s energy production, it is key that we learn about it. The good news is that the heart is highly responsive to supplementation. So far we have explained how good circulation is key because it allows nutrients to be transported where they are needed for heart cells to make energy. We have also explained that key nutrients for energy are L-Carnitine, D-Ribose, and magnesium. But there is another molecule that is essential in the energy cycle of the heart. This is the case of Co-enzyme Q10 (CoQ10).

Dr. Stephen Sinatra believes the discovery of CoQ10 was one of the greatest advancements of the 20^th century for the treatment of heart disease. He has seen the great improvement CoQ10 offers for many heart conditions like congestive heart failure, high blood pressure, angina, and arrhythmia, but also for non-cardiological issues like periodontal disease, cancer, diabetes, neurological disorders, male infertility, immune support in HIV/AIDS, even aging. In his practice he has used CoQ10 with his patients with a lot of success, even two of his patients were able to come off the transplant list. Despite all this, he still feels this nutrient is being ignored by many cardiologists. This is the reason he has dedicated much on his work to bringing awareness about it.

In today’s blog we will explain with detail what CoQ10 is, and how it can be used as part of a nutritional protocol that includes the ‘Heart and Body Extract’, L-carnitine, D-Ribose, and magnesium, together with a sensitive diet and moderate exercise. We will focus on the work of cardiologist Dr. Stephen Sinatra and his many years of experience in heart health.

Definition and biochemistry of CoQ10

CoQ10, also known as ubiquinone, is a fat soluble vitamin-like compound that is found and manufactured in virtually every cell and tissue of the human body. The highest concentrations are found in the liver, the kidneys and the lungs, but the heart requires the highest amounts.

Generally speaking, energy manufacture is a second by second process that depends on some necessary steps: oxygen, essential nutrients, vitamins and co-factors. A deficiency or imbalance in any of these may contribute over time to impaired functioning of the cells, tissues, organs and the entire body.

Specifically, manufacture of CoQ10 is a complex process that needs the aminoacid tyrosine and multiple vitamins: folic acid, vitamin C, B 12, B 6, B 5, co-factors, aminoacids, trace elements and a few essential nutrients. A deficiency in any of these will impair the cells’ ability to make CoQ10, and without CoQ10 our body cannot survive.

In terms of cellular energy production (ATP) ‘CoQ10 is a vital component of the mitochondrial respiratory chain supporting heart energy at the cellular level’ (1). In fact, cellular energy metabolism is CoQ10’s most important function. This is how it happens: Inside the mitochondria, electrons are transported in order to give up their energy to generate ATP, fueling every cellular function. CoQ10 is vital in the electron transport chain because it picks up electrons from one member of the chain and drops them at the feet of another. And the key aspect to understand here is that Co Q10 is constantly in motion: it picks up electron and delivers them along the chain over and over. Without CoQ10 doing this, the activity of the electron transport chain would slow or cease altogether. CoQ10 is like the spark in the mitochondria of each cell that initiates the energy process, making it vital to life. Deficiency in CoQ10 can translate into a failing heart or a declining immune system, both of which will put us at risk for disease and premature aging.

This step by step energy process dependent on oxygen and essential nutrients like CoQ10 is also why the ‘Heart and Body Extract’ is a key player in the energy production of the heart. Without proper circulation, oxygen and nutrients cannot reach the cell and this process then is hindered. Dr. Sinatra recommends a health protocol that includes key nutritional supplements like CoQ10 (around 360 mg/day), potassium, magnesium, garlic, 2-3 grams of fish oil, and 1-2 grams of L-carnitine. With this program, together with a sensible diet and exercise, he has been able to wean his patients off of anti-hypertensive drugs or at least reduce them.

CoQ10’s role as an antioxidant

CoQ10’s key role in energy production in every cell of the body also gives it a powerful antioxidant activity. Its properties as antioxidant are:

• It reduces oxidation of fats in the cell membrane
• It reduces oxidation of LDL
• It protects proteins and DNA from oxidation
• It assists the body in combating free radical stress: In this sense, CoQ10 is a powerful antioxidant molecule which can be used throughout the body but specifically for the prevention of atherosclerosis, and coronary heart disease. Coq10 accomplishes this by engulfing free radicals before they do damage. CoQ10 also recycles vitamin E, another key antioxidant nutrient.

How and when to supplement with CoQ10

As long as we are healthy and eat a diet high in vitamins, aminoacids, and minerals and as long as we are not exposed to many environmental toxins that lead to free radical formation, our bodies can make all the CoQ10 they need. But in the case of an ailing heart, supplementation is key. Just a 25% reduction of CoQ10 can cause our organs to become deficient and impaired. When levels decline by 75% serious tissue damage and even death may occur. Nutritional deficiencies, disease, stressors like high intensity exercise, cholesterol lowering drugs and aging can lead to deficiencies in CoQ10.

Dietary sources of CoQ10 are vegetables (like broccoli and spinach), nuts, ocean fish and shellfish, and meats (pork, chicken and beef). However, we usually only get around 2-5 mg per day from food.

In cases of disease, supplementation is needed because dietary sources might not be enough. Something that needs to be understood about CoQ10 is that it is not uncommon to find it hard to absorb. Dr Sinatra explains that the relative large size of the CoQ10 molecule can impede its absorption. The powder forms of CoQ10 are almost totally unabsorbed by the intestine, while the fatty forms are more readily absorbed. This is because CoQ10 is a fatty substance and as such it needs a working digestive system.

Another important factor to consider is the kind of CoQ10 administered, as not all of them are the same. Some are more bioavailable than others. There are commercially available coQ10 capsules that contain either oil-based suspensions (soft gels) or dry power blends. Most have proven to be very poorly absorbed. CoQ10 may not be absorbed by the body for a number of reasons. The person may not be absorbing because of digestive problems, or the product may be of low quality, either because it doesn’t contain pure CoQ10 or because it may contain fillers.

Since CoQ10 is fat soluble it is poorly absorbed in water and is absorbed the same way as any regular fatty food is. It is therefore ingested better with fatty foods. And it requires a working liver and gallbladder. This also means that the fat soluble form is better than the powder. The largest producer of coenzyme Q10 in the world is the Japanese fermentation technology leader named Kaneka. The brand name is ‘Q-Gel’.

Deficiencies are more prominent in tissues that are more metabolically active, such as the heart, immune system, gingiva (soft tissue around the teeth) and an over active thyroid.

Dosage

The usual dosage is 100mg, but Dr. Sinatra has observed that higher doses might be needed. This is the when there is no evident improvement with the usual dose, in which case the dosage always needs to be increased until obvious improvement is seen. The sickest patients obviously will need more.

When it comes to the amount, it is important to consider how it is absorbed and how much is delivered to the tissues. Whether capsules, cap-tabs, or regular oil based Co-Q10 Dr. Sinatra’s recommendations are as follows:

• 90-150 mg daily as preventive in cardiovascular disease or periodontal disease
• 180-360 mg daily for the treatment of angina, cardiac arrhythmia, high blood pressure, and moderate gingival disease and for patients taking statin drugs
• 300-360 m daily for mild/moderate congestive heart failure
• 360-600 mg daily for severe congestive heart failure and dilated cardiomyopahy
• 600-1,200 mg daily for an improvement in quality of life in Parkinson’s disease

For severely impaired immune system as in cancer even higher doses of coQ10 may be required.

15 mg of Q-Gel softgel capsules, a water-soluble form of Co-Q10 is the equivalent of about 50 mg of standard coQ10. Once a therapeutic effect is obtained, that is, when there is improved well-being, lowered blood pressure, improved shortness of breath, better gum tissues, etc maintenance dose may be adjusted.

The most accurate way to assess how CoQ10 is being absorbed and delivered to tissues and organs is by blood test. When CoQ10 is delivered in sufficient dosages, it will support the tissues in need.

Ubiquinol, the other form of CoQ10

Ubiquinone is a stable form of CoQ10. Once ingested in the form of food or supplements, enzymes in the body called reductase reduce ubiquinone to ubiquinol, the antioxidant form that makes up practically all the circulating coQ10 in the body. More than 90% of the circulating CoQ10 in our body is present as ubiquinol. It is during the transport of electrons process in the mitochondrial membrane that this conversion from -none to -nol is done.

Ubiquinol has been developed as a commercial supplement only recently, and one small study has shown it has an excellent absorption rate when compared to the non-soluble form of CoQ10.

Is ubiquinol really better than ubiquinone?

Most ubiquinone has to be reduced to ubiquinol in order to be used by the body, so it would make sense that the best way is to supplement with its reduced or ubiquinol form. After years of research, Japan’s largest producer of CoQ10 in the world has recently developed a patented method to manufacture ubiquinol so that it can be used in supplements.

Dr. Sinatra recommends this form for patients with severely depleted energy such as patients with advanced end stage heart failure, liver failure, renal failure, or in patients with advanced, relentless chronic fatigue. In these cases there might be an advantage in using ubiquinol over ubiquinone since it does not need to be converted.

Also, those with a genetic mutation known as NQO1 lack the enzyme necessary to make the conversion. In these cases it might be more appropriate to use the ubiquinol form. Also for patients for which ubiquinone is not yielding results, Dr. Sinatra recommends ubiquinol.