Named for its prevalence in most living cells, ubiquinone or coenzyme Q10
(CoQ10) has become a popular natural health tool to combat a number of health
concerns, including oxidative stress and reduced energy. Despite its growing
popularity in the supplement marketplace, CoQ10 continues to makes progress in
both development of increasingly bioavailable forms and in proving itself as
beneficial to a wide-cross section of consumers with a wide range of health
targets.
Discovered in the 1950s as a part of beef heart mitochondria, CoQ10 has
become apparent as a vital part of the electron transport chain, a critical part
of the energy production process. In this capacity, CoQ10 helps move fats and
carbs across the mitochondrial membrane to help produce adenosine triphosphate
(ATP), which is used by body cells as energy. Due to this cellular role,
scientists have looked into various possible healthy effects attributable to
CoQ10.
While the electron transportation is fairly efficient, there are some leaks
of electrons during the process, which contribute to the formation of free
radicals such as super oxide. CoQ10 can serve as an antioxidant, protecting
against damage from these free radicals.
The body naturally produces CoQ10 from other, lower-numbered ubiquinones and
can further reduce CoQ10 to ubiquinol. However, this ability to reduce or
convert CoQ10 to ubiquinol diminishes with age. Up to the age of 20, most
healthy people have optimal ability to convert ubiquinone to ubiquinol; however,
production of ubiquinol begins to decline after the age of 20, resulting in
about a one-third loss of ubiquinol in vital organs, such as the heart, kidney
and liver.
Organs like the heart have high energy demands; thus, ubiquinol is important
for sustained output. This is why CoQ10 has been subjected to substantial
research in the area of heart health. In fact, CoQ10 has proven useful in
cardiovascular disease (CVD) based on two mechanisms, antioxidant and energy
production.
Oxidized cholesterol, especially low-density lipoprotein (LDL) cholesterol,
is a big factor in the development of atherosclerosis. In one trial,
administration of 3 mg/d of CoQ10 (Q-Gel®, from Tishcon) in rabbits with high
trans fat levels inhibited oxidative damage and atherosclerosis development.1
On the other hand, a combination of CoQ10 and vitamin E, as alpha-tocopherol,
was shown to increase plasma levels of vitamin E and beneficial high-density
lipoprotein (HDL) cholesterol in one trial,2 and reduce
atherosclerosis at the aortic root and descending thoracic aorta in another
trial.3
Targeting cholesterol control from another angle, CoQ10 has increasingly
shown itself a necessity in people taking statin drugs. These drugs affect
hydroxymethylglutaryl (HMG)-CoA reductase conversion which, in turn, affects
coQ10 synthesis.
Noting statin treatment generally results in lower plasma levels of CoQ10 due
possibly to lowered levels of LDL, scientists reported a decrease of CoQ10 seen
in the platelets and lymphocytes relative to statin use, suggesting CoQ10
synthesis itself may be inhibited.4
Intervention studies have all but confirmed this consequence. A Japanese open
study examining the impact of pitavastatin or atorvastatin on plasma levels of
CoQ10 in patients with hypercholesterolemia found the drugs not only reduced
total and LDL cholesterol and increased HDL cholesterol, but they also
significantly reduced plasma levels of CoQ10.5 Atorvastatin lowered
CoQ10 (-26.1 percent) more so than pitavastatin (-7.7 percent). In an Italian
study, three months of statin therapy dose dependently reduced total
cholesterol, as well as levels of both ubiquinol and ubiquinone in plasma.6
In fact, the researchers suggested CoQ10 be taken along with statin therapies to
mitigate the side effects of the drugs.
Statins are an adjunctive therapy for patients whose coronary heart disease
has led to heart failure (HF). However, a 2007 research report noted low
concentrations of cholesterol, possibly because of reduced CoQ10 levels, are
generally associated with a worse prognosis in HF patients.7 In fact,
plasma CoQ10 levels were determined to be independently predictive of mortality
in chronic heart failure (CHF), in a New Zealand trial on CHF patients.8
A randomized, placebo-controlled, double blind trial out of Australia confirmed
CoQ10 therapy can improve symptoms of heart failure and quality of life, as well
as reduce hospitalization of HF patients.9 Specifically, the
researchers said: "CoQ10 therapy improves cardiac functional status in patients
with moderately severe dilated cardiomyopathy receiving maximal non beta-blocker
therapy."
Most recently, scientists have looked at why some CHF patients benefit from
CoQ10 supplementation, while others do not.10 The research team from
East Texas Medical Center and Trinity Mother Francis Hospital, Tyler, Texas,
noted some class IV CHF patients taking ubiquinone still test low for plasma
CoQ10 levels and show little improvement normally associated with such
supplementation.11 Seven end-stage CHF patients were switched from
ubiquinone administration to ubiquinol (as KanekaQH®, from Kaneka Corp.), the
reduced form of CoQ10. There was a dramatic increase in plasma CoQ10 levels in
all seven patients after the switch, and EKG tests improved in four of the
patients.
While none of the seven were taking supplemental vitamin E, plasma vitamin E
levels rose along with CoQ10 levels, suggesting a sparing effect. The patients,
who were also not taking statins, experienced no increased in oxidized CoQ10
levels, and there was no interaction between CoQ10 and coumadin in the four
patients taking that medication. The researchers noted given a normally alarming
mortality rate for class IV CHF patients—74 percent at six months, 94 percent at
12 months—six of the patients in the study have survived longer than expected,
still alive at the 12-to-20 month stage. The seventh patient stopped ubiquinol
after three months and died three months later.
Tom Schrier, U.S. sales manager for Kaneka, summed up the take-home message:
"Your body makes ubiquinol from ubiquinone; however, the ability to perform this
conversion decreases as you age. For younger, healthier individuals who can
aptly produce ubiquinol from ubiquinone, it is fine to supplement with
ubiquinone. However, in those with diminished ability to convert ubiquinone, it
is essential to supplement with ubiquinol, as the health benefits from CoQ10 are
tied to this reduced form."
Heart health certainly is a main focal point of CoQ10 supplementation, but
the antioxidant and protective effects of this nutrient benefit other areas of
health. At first glance, CoQ10 levels have been linked to various problems
associated with various body organs and systems.
The results of an Institute of Neurology, London, study highlighted evidence
of a deficit in brain CoQ10 status linked to the pathophysiology of Parkinson's
disease.12 Such a deficiency may accelerate precursors of beta-amyloid
plaque deposits, a causative factor in Alzheimer's disease (AD); research has
found CoQ10 supplementation in such cases may help prevent AD, PD and other
neurodegenerative problems.
CoQ10 therapy might be the solution to counter amyloid beta peptide toxicity
in brain mitochondria, according to animal research.13 Hong Kong
researchers found a group of 48 mice (four genotypes) treated with CoQ10 (1,200
mg/d) for 28 days after ischemic injury for 28 days experienced protection of
the brain from infarction and atrophy induced by the ischemia.14 And
a study out of Weill Medical College of Cornell University, New York, found
dietary administration of CoQ10 can protect against dopamine loss, offering
neuroprotective effects in PD.15 Researchers have also found a link
between cerebrospinal fluid levels of oxidized CoQ10 levels and duration of
illness in patients with amyotrophic lateral sclerosis (ALS), suggesting
mitochondrial oxidative damage may play a role in pathogenesis of ALS.16
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Where the brain thinks, the eyes see, and ocular health is not safe from the
CoQ10-related metabolic problems that plague the brain and the heart. Peking
University, China, researchers reported a familiar finding: CoQ10 levels in the
retina can decline by about 40 percent with age.17 This decline can
result in decreased antioxidant ability and a decreased rate of ATP synthesis in
the retina, which may lead to the progression of macular degeneration.
Fortunately, as in the other organs, CoQ10 therapy can help protect the retina.
For instance, University of Rome Tor Vergata, Italy, scientists discovered
intraocular administration of CoQ10 can limit glutamate increase and offer
neuroprotection, "suggesting that oxidative stress and energy failure might be
implicated in the mechanisms of retinal ganglion cell death."18
A pair of studies published in 2008 show CoQ10 plays a role in protecting
another vital organ, the kidneys, from renal disease. University of
Pennsylvania, Philadelphia, researchers detailed how CoQ10 deficiency correlates
to autoimmune kidney disease, at least in mice, where CoQ10 levels were
significantly lower in the disease group than in controls.19
Meanwhile, across the country, University of California, Los Angeles, scientists
found CoQ10 supplementation can rescue mice carrying a kidney disease mutation
gene from certain end-stage kidney disease and death.20
Interestingly, their results showed CoQ10 may benefit such kidney cases by
acting as a fat-soluble antioxidant, rather than by boosting kidney
mitochondrial respiration.
Many organs and body systems are involved in cystic fibrosis (CF), a
hereditary disease marked by thick mucus production that clogs up function of
the lungs, liver, pancreas, lungs and many other organs. This is a disease
affecting mostly children, as CF progresses from birth and often results in
childhood mortality. Plasma CoQ10 levels are lower in children with CF, probably
due to malabsorption of fat, according to Dutch researchers.21
Follow-up work performed by University of Colorado, Denver, scientists featured
CoQ10 levels measured annually in 381 CF patients.22 About half of
the patients were deficient in CoQ10, with deficiency correlated to pancreatic
insufficiency (PI). Low CoQ10 levels were significantly associated with
Pseudomonas aeruginosa colonization in patients with PI and CF (under age 24
months), but not with subsequent lung function or hospitalization rates.
Decreased CoQ10 levels were also linked to other markers of nutritional status,
including total lipids, beta-carotene and alpha-tocopherol. Researchers
suggested a prospective study could elucidate the potential benefits of CoQ10
supplementation in children with CF.
While disease states can lower CoQ10 and increase the need for increased
CoQ10 supplementation or intake for cell protection and antioxidant benefits,
other areas of health and fitness rely on CoQ10 for its role in replenishing
energy. Japanese researchers reported oral administration of CoQ10 (100 or 300
mg/d) in healthy adults for one week prior to a workload trial can improve
subjective fatigue and physical performance.23 CoQ10 supplementation
(300 mg/d) has also been shown to reduce exercise-induced muscular injury,
possibly due to its antioxidant effects.24 In fact, in another study,
14 days of supplementation with fast-melt CoQ10 in both aerobically trained and
untrained male and female adults resulted in increased muscle CoQ10
concentration and lowered serum superoxide dismutase (SOD) oxidative stress,
while plasma CoQ10 concentrations and time to exercise exhaustion also
increased.25
Positive research results on CoQ10 supplementation continue to pour in. One
current FDA- and NIH-funded clinical trial involves mito-patients taking liquid
ubiquinol, as LiQNOL® from Tishcon, which holds an orphan drug designation for
CoQ10 in the treatment of mitochondrial cytopathies, which are characterized by
defects in the mitochondria often related to DNA mutations.
CoQ10 is also making headway against inflammation, as a recent research
report explained CoQ10 has moderate anti-inflammatory in human monocytic cell
lines, possibly due to the nutrient's antioxidant activities.26
In addition to these new research directions, about a dozen federally funded
trials are underway researching the effects of CoQ10 on health issues such as
muscular dystrophy, mitochondrial disease and preeclampsia.
Navigating the CoQ10 Inventory
When it comes to CoQ10 products in retail stores, the primary question on
retailers' minds is: who needs what type of CoQ10?
In general terms, everyone needs CoQ10. "CoQ10 is required in every cell in
the body, so everyone needs it," said Ken Halvorsrude, Doctor's Best. "In terms
of supplementing with CoQ10, I suggest everyone older than 45 consider
supplementation."
Carl Germano, senior vice president of product development and research for
Millennium Biotechnologies, explained the biosynthesis of CoQ10 is a 17-step
process that is highly vulnerable to aging or to certain stress or disease
conditions. Aging people must rely on supplemental sources of CoQ10 to maintain
adequate levels.
Schrier provided a simple way to differentiate the two main types of CoQ10
supplementation: "For those between the ages of 20 and 45 who are healthy and
can efficiently convert ubiquinone to ubiquinol, it is fine to simply take
KanekaQ10 ubiquinone, which is the cheaper supplement. However, for those 45 and
older or who have deficiencies in producing ubiquinol, the only way to get the
cell protective, antioxidative and energizing effects attributed to CoQ10 is to
take KanekaQH, the reduced or preconverted form, ubiquinol, which is responsible
for all those benefits."
While it could seem ubiquinol, being the pre-converted form, would be more
highly touted as a supplement than ubiquinone, the price of ubiquinol is double,
sometimes triple, the cost of ubiquinone at retail. Schrier noted ubiquinol,
while pre-converted, is not intended to squash ubiquinone sales, but provide a
means for increasing CoQ10 levels in people who can't make it from ubiquinone.
Thus, retailers should be guiding Baby Boomers and older customers more
toward ubiquinol, explaining the increased cost of developing the advanced form
is the reason for the increased retail cost. Younger and healthier customers
will find the cheaper ubiquinone products sufficient for energy and preventive
maintenance needs.
As for why consumers are or should be gravitating towards the CoQ10 products,
experts highlight the four main benefits of CoQ10 supplementation. Rodger Jonas,
PL Thomas, which represents Kaneka in the Eastern United States, pointed to
sustained energy, antioxidant protection, heart health benefits and gum disease
prevention are the top drivers in this category. This reflects growing research
showing periodontal patients frequently have deficient CoQ10 levels in their
gums.27
Steve Holtby, president and CEO, Soft Gel Technologies, Inc., said CoQ10 has
been finding a broader consumer base for years. "Although the majority of
consumers using CoQ10 are still mostly heart patients, CoQ10 is now being touted
for many other applications, such as Parkinson’s disease, diabetes, and energy,"
he said, adding evidence is accumulating for CoQ10’s role of in the treatment of
mitochondrial disorders and neurodegenerative diseases. "With more and more
research showing that there is a decrease in plasma and tissue concentrations
CoQ10 associated with aging, it is being touted as a critically important
nutrient that should be considered for optimum health."
Kazie Uyama, N.D., president, C’est Si Bon Co., added although CoQ10 is used
for a wide variety of diseases, it mostly garners attention for cardiovascular
related diseases such as coronary artery disease (CAD), cardiomyopathy, CHF,
hypertension, stroke and arrhythmia. "CoQ10 is definitely for your heart," she
said.
Even once a retailer has figured out whether the customer needs ubiquinol or
ubiquinone, and for what health goals, there are still many products available
to choose. There are products that contain only CoQ10, and there are others that
feature CoQ10 in formulation with other ingredients, often targeting specific
health conditions, such as heart health.
"I don’t know if consumers like CoQ10 alone or with some combination, but I
personally feel it does not need to be combined," Uyama said, reasoning a
stand-alone product gives consumers the choice to use it however they want in
their health regimens. "By adding something to CoQ10, it may or may not satisfy
their particular needs. Making it a stand-alone product, it rather gives them
choices."
Halvorsrude mostly agreed, saying, "If a strong case can be made for
combining it with other ingredients, such as red yeast rice, then I think
consumers don’t need any persuasion to buy it as a combo product. However,
Doctor’s Best finds that a stand-alone product meets the preference and
expectations of most consumers."
Up until recently, CoQ10 was available only as a dietary supplement, most
effectively in a soft-gel form. Schrier explained as a lipid-soluble nutrient,
the soft-gel makes for an ideal carrier. If for some reason the customer finds
and chooses an alternate supplement form, it is imperative to take it with some
fat, as CoQ10 is more bioavailable when accompanied by some fat.
Catching the functional product wave, CoQ10 is finding its way into foods and
beverages thanks to newer technologies. "Food and beverage area are launching
new products rather quickly," Jonas assured. He explained CoQ10 was in short
supply prior to the end of last year, but a new facility was built in Texas by
Japan-based Kaneka, one of the largest suppliers of raw ubiquinone, and the
primary supplier of ubiquinol. "The short supply made prices high, and the
product was difficult to bring into the food and beverage area."
"CoQ10 moved beyond traditional supplements many years ago," Halvorsrude
said. "Coca-Cola put CoQ10 into Coca-Cola in Japan, which was a big part of the
reason that bulk CoQ10 made in Japan suddenly became unavailable in the United
States." He said he sees more and more instances of CoQ10 appearing in
functional foods and beverages, but he hopes the integrity of the CoQ10 remains
intact, and meaningful amounts are used per serving—recommended dosing falls
between 200 mg and 300 mg per day for the first two to three weeks, and 100 mg
per day as a maintenance dosage, according to Kaneka guidelines.
Functional products have long been scrutinized and criticized for
insufficient dosing, but Schrier argued, while the proper therapeutic dose, as
it relates to existing research on CoQ10, is ideal, CoQ10 intake can be a build
up, whereby even a little bit helps and contributes to the diet and endogenous
production.
Interesting CoQ10-containing functional products on the market include soup,
cookies, gum, beverage, cheese, yogurt, bars, smoothies and other beverages.
One of the technologies aiding inclusion of CoQ10 in beverages is
nanotechnology. "When CoQ10 is nano-encapsulated it is made water-soluble, the
particle size is reduced, and it become more bioavailable," Jonas explained,
noting CoQ10 is normally a lipid-soluble ingredient with an orange color. "The
end consumer knows they can now get a beverage or water-soluble CoQ10 with
greater availability. The greater bioavailability makes sense if it positively
impacts cost, effectiveness and/or use level. However, the consumer is not
always aware that one is more bioavailable than another."
This is part of the retailer's struggle in guiding customers through the
range of CoQ10 products. One of the biggest points of differentiation among
CoQ10 ingredients and finished products is bioavailability. Explaining the
science of bioavailability can get very cumbersome to customers who might not
have long periods of time to spend choosing the best CoQ10 product for them and
their family.
"In general, consumer understanding of CoQ10 is about where consumer
understanding of antioxidants was in the mid-‘80s," Halvorsrude said, adding
consumers do know that CoQ10 is a necessary and valuable substance for their
body. "Some have heard of ubiquinol and are concerned as to whether the product
contains ubiquinol or ubiquinone, but it doesn’t do much good to try to help
them understand the interconnected nature of the two forms."
Holtby further differentiated between mass market and health food consumers
on the subject of product knowledge. "With mass market consumers, most of these
people would know just the basics about most supplements—[they would be] more
concerned with price than quality, and since they don’t have as strong a grasp
of nutrition as others, they won’t be doing research to find the most
efficacious products," he argued. "In health food stores and retail supplement
stores, the consumer is already of a mindset that they want to improve their
health, and these stores offer a wider variety of supplements than other places.
The consumer generally wants to educate themselves to a deeper extent, and will
often do their own research." He noted many of these consumers will rely on the
store’s employees to recommend the best supplements.
Uyama believes science helps and is never a bad thing for consumers. "People
always want to know more about CoQ10, but prefer fair third-party
research/studies over a biased perspective."
Among the methods retailers can use to educate their customers on CoQ10 and
the full offering of products, a list of talking points for staff can be very
effective. Many manufacturers are more than willing to provide talking point
sheets or help retailers create their own sheets.
As for where to stock CoQ10 products in the store, this has become a tricky
problem for retailers. Uyama reported some retailers stock targeted products in
their respective sections, such as heart health, anti-aging or antioxidants.
However, she suggested retailers could also consider creating a special section
for general CoQ10 products under a category banner of cell rejuvenation,
perhaps.
There will always be challenges in merchandising and promoting CoQ10 products
to customers, due to the broad reach of the nutrient's main health benefits.
Understanding the actions, supplemental forms and new technologies for
functional applications will help retailers capture this growing market. IRI
data showed 2007 retail sales of CoQ10 grew 19 percent in volume and 9 percent
in unit sales. As the third largest non-letter-vitamin category, the CoQ10
market will be a force to reckon with, especially in terms of functional
products, and retailers need to keep up on the segment's product developments
and health research results.
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