Statin Users: To CoQ10 or not to CoQ10?

What is CoQ10? Before addressing the question just posed, let me first describe CoQ10. A lot of what I say in this section derives from a review by Mantle and Dybring (1). For starters, the name CoQ10 is an abbreviation for coenzyme Q10. As the name implies, this compound works with enzymes. The body has a whole lot of enzymes. These proteins facilitate many kinds of reactions. Pretty much anything that goes on in the body needs enzymes. Most enzymes do their job without a helper molecule. However, some require an assistant called a coenzyme. Most coenzymes contain a B vitamin, but CoQ10 is one of the exceptions.

One place CoQ10 functions is in cells’ mitochondria. If you ever learned any biochemistry, you probably heard about the mitochondria electron transport chain. This chain includes CoQ10. If you never had biochemistry, just know that this chain produces energy. This energy gets used for physical exertion, but also for the chemical energy required by various body processes.

Other functions have also been discovered for CoQ10 including antioxidant actions. Such actions protect body molecules from damage due to certain chemical reactions. One location where CoQ10 does this is in serum LDL, a complex of molecules including cholesterol (the so-called bad cholesterol). When this complex gets hit with oxidant damage, it leads to hardening of the arteries, which can lead to cardiovascular disease.

Most CoQ10 in the body is produced internally, but dietary intake makes some contribution. The amount of CoQ10 put in supplements usually greatly exceeds what’s found in a normal diet.

Does taking a statin drug lower body CoQ10 amounts? YES. Some recent research papers have even been giving information as to how this happens (ie 2,3).

So, should everyone on statins take COQ10 supplements? We don’t have data to say whether supplementation can normalize all body tissue CoQ10 contents. Still, at the very least, CoQ10 supplementation will substantially reverse statin-induced depletion. This leads to the question: Will taking the CoQ10 supplements produce any practical benefits? So far, that question has been considered mostly just in terms of muscle soreness (a common but not always occurring statin side effect). Study results are mixed. That’s not surprising considering variations in study design and the CoQ10 dose and source. And, for at least two of the studies, other researchers have criticized design aspects. Also, all these studies generally lack plasma or serum measures of CoQ10. This would give have given some idea of how well repletion went for the given protocols, the form of CoQ10 used, and study subject compliance.

When effects have been seen, the average degree of protection has varied. One factor could be that certain individuals may experience a stronger protection than others. An interesting genetic study (4) suggests that some people might be especially vulnerable to statin lowering of CoQ10 (and more prone to statin-induced muscle soreness).

Another consideration is that COQ10 supplementation in statin users may provide benefits other than reducing muscle soreness. This has not yet been given enough research attention.

In summary, we know statins lower body CoQ10 amounts, but we don’t have a full grasp on possible practical benefits of supplementation in statin users. Still, I recommend a conservative amount of CoQ10 like 100 mg/day. To me, this falls into the category of probably won’t hurt and may help. One caution here is that CoQ10 supplements can interact with some drugs.

D. Which CoQ10 should I take? I will cover that in a bit of detail in the book I am slowly writing (The Authoritative Guide to Nutritional Supplements). For now, here’s the short version (partly based on the review by Mantle and Dybring-1). CoQ10 that is not heavily crystalized absorbs the best. You don’t need to take the so called active or reduced ubiquinol form instead of ubiquinone (which what is put in most supplements unless otherwise noted). The body readily moves CoQ10 between the reduced and not reduced forms.

Despite what I just said, some research seems to indicate that ubiquinol (reduced CoQ10) absorbs better than ubiquinone. However, in this research, ubiquinol was not compared to a low-crystal ubiquinone. When low crystalized ubiquinone was used instead, it absorbed much better than ubiquinol.

Another version most people don’t need is Qunol “high absorption” CoQ10. This type of CoQ10 can disperse in water. Normally, CoQ10 doesn’t mix well with water. When you consume the usual CoQ10, it tends to absorb best when eaten with dietary fat. The Qunol CoQ10 might mix with water in the digestive system and absorb differently from conventional CoQ10. However, even if this does happen, it may not offer an advantage unless:
1. You take your CoQ10 on an empty stomach.
2. You take it with food having little or no fat.
3. You have a fat malabsorption problem.

Qunol’s TV ads claim “better” absorption, but the research isn’t published anywhere. I suspect that in this research, CoQ10 was given on an empty stomach. I also wonder if the comparison was made to crystalized CoQ10. The TV ads claim their brand is the #1 cardiologist recommended CoQ10. However, I don’t know how the company knows this. And, even if they did do some little survey, cardiologists are not necessarily experts on nutraceutical absorption.

I like Now Foods CoQ10 at 100 mg per capsule. I used this in an unpublished study and saw a big rise in serum CoQ10 readings at 11 days. However, I did not buy the retail Now Foods CoQ10 (such as what is found on Amazon). I got the product straight from the company. However, Now Foods is known for putting out quality products where the label amounts match well with the actual amounts.

E. Conclusion. Statins do reduce body CoQ10 contents. Practical benefits of CoQ10 supplementation to statin users remain a little uncertain, but may well exist. Some people may benefit more than others.