Health & Fitness

Coenzyme Q10 (CoQ10) is the third-most consumed supplement,¹ yet many people don’t realize how clinically effective it really is.

Although it’s not approved by the U.S. Food and Drug Administration as a treatment or preventative drug, several new studies show that taking CoQ10 supplements may help address several chronic health conditions, including atrial fibrillation (a-fib), nonalcoholic fatty liver disease (NAFLD), insulin resistance, heart failure, cancer and migraines, to name a few.

Ubiquinol — the reduced, electron-rich form of CoQ10 that your body produces naturally — plays an important role in the electron transport chain of your mitochondria, where it facilitates the conversion of energy substrates and oxygen into the biological energy (adenosine triphosphate or ATP) needed by your cells for life, repair and regeneration.

It’s a fat-soluble antioxidant, meaning it works in the fat portions of your body, such as your cell membranes, where it mops up potentially harmful byproducts of metabolism known as reactive oxygen species (ROS). As such, ubiquinol and CoQ10 supplements help protect your mitochondrial membranes from oxidative damage, and this in turn has been shown to be helpful for a number of health conditions and chronic diseases.

Why CoQ10 Is so Important

Many conditions, including heart disease and migraines — for which CoQ10 has been found beneficial — appear to be rooted in mitochondrial dysfunction.² CoQ10 is used by every cell in your body, but especially your heart cells.

Cardiac muscle cells have about 5,000 mitochondria per cell, while liver cells have 1,000 to 2,000 mitochondria each.³ As another reference, mitochondria make up about 35% of the volume of cardiac tissue and only 3% to 8% of the volume of skeletal muscle tissue.⁴

About 90% or more of the ROS in your body are made by your mitochondria.⁵ Using the analogy of the mitochondria as an engine, the combustion (metabolism) that takes place in there creates exhaust fumes — damaging byproducts when produced in excessive amounts.

One of the functions of CoQ10, or ubiquinol, is to neutralize those byproducts.⁶ When ubiquinol is lacking, the byproducts remain and begin to damage the cell. Ubiquinol is particularly beneficial for your heart health. C-reactive protein (CRP) is a marker for inflammation, and when your CRP is elevated, it suggests you have a heightened risk for heart disease.⁷

Two other markers for inflammation are gamma-glutamyl transferase (GGT),⁸ which is an early marker of heart failure, and N-terminal pro b-type natriuretic peptide (NT-proBNP).⁹

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.

Low CoQ10 levels have also been detected in people with certain types of cancer,¹⁰ including lung, breast and pancreatic cancer, as well as melanoma metastasis, further strengthening the metabolic theory of cancer. The word “coenzyme” also provides a clue to its importance; it works synergistically with other enzymes to digest food, for example.

It also has the ability to increase your body’s absorption of important nutrients. More specifically, it helps recycle vitamins C and E,^11,12 thereby maximizing their beneficial effects.

CoQ10 Can Help Improve Atrial Fibrillation (AFib)

AFib is an abnormal, often rapid, heart rhythm that occurs when the atria, your heart’s upper chambers, beat out of sync with the ventricles, the heart’s lower chambers. It’s a common symptom in those with heart failure or heart disease but can also occur on its own.

Oxidative stress and increased ROS can play a role in the development of AFib. Conversely, scavenging of ROS and a reduction in oxidative stress have been shown to be an essential part of keeping the heart functioning normally.¹³

In one study, 102 patients with AFib were divided into two groups. One group was given a CoQ10 supplement while the other group was given a placebo. After 12 months of supplementation, 12 people in the placebo group had AFib episodes compared to only three people in the CoQ10 group.¹⁴

CoQ10 Can Stop the Progression of NAFLD

NAFLD is the most common cause of chronic liver disease around the world, with a prevalence of 25%.¹⁵ Obesity and insulin resistance increase your risk of NAFLD. Mitochondrial dysfunction and oxidative stress, two hallmarks of CoQ10 deficiency, have also been shown to play a role,¹⁶ as has choline deficiency, as detailed in “Fatty Liver Disease Is Caused by Choline Deficiency.”

Currently, there are no approved medical treatments for NAFLD. Lifestyle changes, such as elimination of processed vegetable oils and processed carbs, remain the gold standard for managing NAFLD and, hopefully, preventing its progression. Since CoQ10 levels tend to be depleted in those with NAFLD, supplementation has been shown to help reduce oxidative stress and inflammation.¹⁷

In one study,¹⁸ 44 patients were divided into two groups. One group was given 100 mg of CoQ10 each day, while the other was given a placebo. After four weeks of supplementation, the group taking CoQ10 dropped weight and had lower levels of serum AST, a blood marker that indicates liver disease and/or damage.

CoQ10 May Be the Answer for Several Other Conditions

In addition to helping with AFib and NAFLD, CoQ10 may be the answer to correcting several other chronic health conditions, including the following:

High blood pressure — CoQ10 acts directly on your endothelium, dilating your blood vessels and lowering blood pressure.19,20 CoQ10 also decreases aldosterone, a hormone that makes you retain salt and water.21,22 When aldosterone goes down, excess salt and water are excreted through your kidneys, often causing your blood pressure to go down.

Dyslipidemia — In one study,23 101 participants with dyslipidemia were given 120 mg of Coq10 or a placebo every day for 24 weeks. Without taking any lipid-lower drugs, participants taking the CoQ10 had decreases in harmful LDL and triglycerides and increases in total antioxidant capacity.

Heart failure — CoQ10 deficiency is linked to poorer prognosis for those with heart failure.24 Supplementing with CoQ10 can restore normal CoQ10 levels, helping to prevent heart cell damage and significantly improving heart failure.25

Chronic kidney disease — Increased oxidative stress is a major factor in chronic kidney disease and related cases of cardiovascular disease.26 Patients with chronic kidney disease tend to have decreased levels of CoQ10 in their blood. CoQ10 has been shown to improve mitochondrial function and decrease oxidative stress in chronic kidney disease patients, with and without dialysis.27

Systemic inflammation — Studies28,29 show that supplementing with 60 mg to 500 mg of CoQ10 for eight to 12 weeks can significantly reduce tumor necrosis factor alpha (TNF-α), IL-6 and CRP; three measures of widespread inflammation.

Stroke — Systemic inflammation, oxidative stress and nerve cell damage play a role in the development of stroke. Studies30 show that supplementing with CoQ10 can reduce ischemic lesions and improve outcomes in patients who have been treated with a statin after having a stroke (statins reduce CoQ10 levels in your body).

Migraine — CoQ10 deficiency is a common underlying factor of idiopathic migraines. Supplementing with CoQ10 can help reduce frequency and severity of migraines and alleviate associated symptoms such as nausea and sensitivity to light.31

Polycystic ovary syndrome (PCOS) — In one study,32 86 women with PCOS were given CoQ10 alone, CoQ10 with vitamin E, vitamin alone or a placebo. After eight weeks, the group taking CoQ10 alone had improved levels of sex hormones (lower levels of testosterone and luteinizing hormone) and improved insulin resistance.

Cancer — In one study,33 two women with breast cancer were given fatty acids, antioxidants and 300 mg to 390 mg of CoQ10. After two to three months, mammograms showed no tumors or residual tumor tissue, indicating cancer regression. A review34 in the Journal of Clinical Oncology that looked at how CoQ10 affected cancer treatment found it may help protect the heart and liver from toxicity during treatment.

Insulin resistance — CoQ10 levels are lower in mitochondria in insulin-resistant tissues.35 In one study,36 daily intake of 100 mg of CoQ10 improved insulin resistance and serum insulin levels in patients with markers of metabolic syndrome.

CoQ10 Versus Ubiquinol

As mentioned, ubiquinol is the reduced version of CoQ10 (aka ubiquinone). They’re actually the same molecule, but when CoQ10 is reduced it takes on two electrons, which turns it into ubiquinol. In your body, this conversion occurs thousands of times every second inside your mitochondria.

The flipping back and forth between these two molecular forms is part of the process that transforms food into energy. Ubiquinol production ramps up from early childhood until your mid- to late 20s. By the time you hit 30, it begins to decline.³⁷ Young people are able to use CoQ10 supplements quite well, but older people do better with ubiquinol, as it’s more readily absorbed.

How to Supplement With Ubiquinol

Your body can naturally make CoQ10, but genetic alterations in metabolism, poor diet, oxidative stress, chronic conditions and aging can all interfere with CoQ10 production and lead to CoQ10 deficiency. Statin drugs can also deplete CoQ10.

To maintain good health, an adult body should contain 0.5 to 1.5 g of CoQ10³⁸ and sometimes it takes a supplement to keep you there. Dosing requirements will vary depending on your individual situation and needs.

As a general rule, the sicker you are, the more you need. The suggested dose is usually between 30 mg to 100 mg per day if you’re healthy, or 60 to 1,200 mg daily if you’re sick or have underlying health conditions.³⁹

If you have an active lifestyle, exercise a lot or are under a lot of stress, you may want to increase your dose to 200 to 300 mg per day. Importantly, if you're on a statin drug, you need at least 100 mg to 200 mg of ubiquinol or CoQ10 per day, or more. Ideally, you’ll want to work with your physician to determine your ideal dose.

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More than 1.13 billion people worldwide,¹ including up to 100 million Americans, have high blood pressure. Among certain populations, particularly older Americans, the prevalence of high blood pressure rises to more than 50%, making it a significant burden for public health, as high blood pressure is a major risk factor for coronary, cerebrovascular and peripheral vascular disease, along with heart attack and stroke.²

Medications are the first line of treatment for high blood pressure in conventional medicine, but such drugs carry “burdensome” side effects that often cause people to stop taking them, researchers noted in The Journal of Alternative and Complementary Medicine, adding — importantly — that lifestyle modification and mind-body interventions may be at least as effective as drug treatment and are generally free of side effects.³

Their study revealed, in fact, that mind-body practices that trigger your body’s relaxation response, such as meditation, play an important role in lowering blood pressure by favorably influencing a recently identified set of genes and biological pathways.⁴

The Power of Your Relaxation Response

One of the ways that meditation works to calm the body and mind is by triggering the relaxation response,⁵ which is the opposite of the fight-or-flight response that occurs due to stress.

By focusing on a word, phrase or repetitive prayer and disregarding everyday thoughts, the relaxation response is said to be activated,⁶ a process that’s similar to what occurs during mindfulness meditation, transcendental meditation and other meditative practices.

Once the relaxation response is elicited, biochemical changes are known to occur, including decreased oxygen consumption, blood pressure, heart and respiratory rate, and alterations in cortical and subcortical brain regions.⁷

In 2013, researchers revealed that relaxation response practice enhanced the expression of genes associated with energy metabolism, mitochondrial function and insulin secretion while reducing the expression of genes linked to inflammation and stress-related pathways,⁸ signaling its profound power within the body.

They also revealed, for the first time, that engaging in practices that evoke your body’s relaxation response, particularly when they’re done over the long term, “may evoke its downstream health benefits by improving mitochondrial energy production and utilization and thus promoting mitochondrial resiliency …”⁹

Meditation May Lower Blood Pressure by Altering Genetic Expression

As it relates to blood pressure, researchers with Beth Israel Deaconess Medical Center (BIDMC), Massachusetts General Hospital (MGH), and the Benson-Henry Institute for Mind Body Medicine at MGH revealed specific genes associated with the relaxation response that may reveal why it’s so beneficial for blood pressure.¹⁰

“In this study, we found that the relaxation response can successfully help reduce blood pressure in hypertensive patients who are not taking medication,” study author Dr. Randall Zusman, director of the division of hypertension at MGH, said in a news release.¹¹

The study involved 58 people with Stage 1 hypertension, which the study defined as having a systolic blood pressure between 140 and 159mm Hg and diastolic between 90 and 104mm Hg.

It should be noted that, in 2017, the American College of Cardiology and the American Heart Association published new guidelines that changed what was officially considered “high” blood pressure, and via these guidelines, blood pressure at or above 140/90 mm Hg is considered Stage 2 hypertension.¹²

None of the patients was taking medications to control their blood pressure at the start of the study, during which participants attended eight weekly sessions of mind-body interventions designed to elicit the relaxation response.

This included mindfulness meditation along with mantra repetition and diaphragmatic breathing. The participants also used a guided audio CD to help invoke the relaxation response once a day while at home.

Of the 24 participants who completed the eight-week intervention, 13 had a significant drop in blood pressure, such that they were no longer considered to have Stage 1 hypertension.

The researchers then conducted a gene expression analyses to look for differences in gene expression among those who had responded to the mind-body intervention and those who had not. The expression of 1,771 genes differed among the two groups, and the study revealed that the reduction in blood pressure was related to genes involved in:¹³

• Immune regulatory pathways
• Metabolism and glucose metabolism
• Cardiovascular system development
• Circadian rhythm

The researchers noted that genes linked to the immune system appeared to be particularly critical for blood pressure reduction, and, according to study author Dr. John Denninger:¹⁴

“Our results suggest that the relaxation response reduced blood pressure — at least in part — by altering expression of genes in a select set of biological pathways.

Importantly, the changes in gene expression associated with this drop in blood pressure are consistent with the physical changes in blood pressure and inflammatory markers that one would anticipate and hope to observe in patients successfully treated for hypertension.”

Research Mounts That Meditation Works for High Blood Pressure

The calming effect of meditation has been shown in numerous studies to benefit blood pressure. In a 2019 study published in the Journal of Human Hypertension, mindfulness meditation was evaluated for its effects on not only blood pressure but also anxiety, stress and depression.

For an eight-week period, participants engaged in mindfulness training for two hours a week, or participated in a control group involving health education talks. The meditation group had lower blood pressure monitoring values after the intervention, and were also less judgmental, more accepting and less depressed than the control group.¹⁵

Practicing "mindfulness" means you're actively paying attention to the moment you're in right now. Rather than letting your mind wander, when you're mindful, you're living in the moment and letting distracting thoughts pass through your mind without getting caught up in their emotional implications.

Another group of researchers conducted a meta-analysis involving 13 studies on meditation and yoga for blood pressure health. Blood pressure decreased in response to both meditation and yoga, and meditation appeared to be particularly useful in decreasing the blood pressure of subjects older than 60 years.¹⁶

In another example, meditation exercises, particularly qigong, were useful for lowering diastolic blood pressure in people with elevated levels,¹⁷ while research shows meditation may also help lower blood pressure with just three months of practice, while at the same time decreasing psychological distress and increasing coping ability among young adults.¹⁸

More Reasons to Meditate

In addition to promoting your body’s relaxation response, meditation offers a host of additional benefits, including reducing stress via stress-reduction pathways in your body.¹⁹ As explained via a press release:²⁰

"When an individual experiences stress, activity in the prefrontal cortex — responsible for conscious thinking and planning — decreases, while activity in the amygdala, hypothalamus and anterior cingulate cortex — regions that quickly activate the body's stress response — increases.

Studies have suggested that mindfulness reverses these patterns during stress; it increases prefrontal activity, which can regulate and turn down the biological stress response. Excessive activation of the biological stress response increases the risk of diseases impacted by stress (like depression, HIV and heart disease).

By reducing individuals' experiences of stress, mindfulness may help regulate the physical stress response and ultimately reduce the risk and severity of stress-related diseases."

High blood pressure is just one such stress-related disease,²¹ and meditation offers a simple, inexpensive tool to help manage stress that can be practiced virtually anytime, anywhere.

Beyond stress, meditation can be a powerful pain reliever,²² and research from the National Center for Complementary and Alternative Medicine (NCCAM) supports the notion that meditation acts as a form of "mental exercise" that can help regulate your attention and emotions while improving well-being.

It's been found previously that meditation prompts changes in the amygdala, a region of your brain associated with processing emotion. The research suggests these beneficial brain changes persist even after the meditation session is over, resulting in enduring changes in mental function.²³

Two Common Forms of Meditation

If you’re new to meditation, you may want to get started with one of two common forms, mindfulness meditation and self-induced transcendence. For mindfulness meditation, simply sit quietly, perhaps with some soothing music, breathe rhythmically, and focus on something such as your breathing, a flower, an image, a candle, a mantra, or even just being there, fully aware, in the moment.

At the same time, let distracting thoughts pass by without taking your focus. Transcendence-style meditation is another form, which strengthens your corpus callosum, the bridge between your two brain hemispheres, according to Emily Fletcher of @zivameditation, my friend and meditation teacher.

By strengthening the connection between your right and left hemispheres, you gain access to more creative problem solving, and increase your productivity without adding stress.

Fletcher’s book, "Stress Less, Accomplish More: Meditation for Extraordinary Performance," is an excellent guide for people with busy minds and busy lives, and may help you stick with meditation for the long run, which is particularly important if you’re using it to help control your blood pressure. This is also key to triggering your body’s relaxation response. In an interview, Fletcher stated:²⁴

“The point of meditation is not to stop your mind from thinking. The point of meditation is to be a stress relieving tool, and the way that we do that in this style is that we de-excite the nervous system which creates order and we give the body very deep rest. The body wants to thank us for that, and it thanks us by dissolving our stress."

Healthy Blood Pressure Strategies

Meditation is only one component of maintaining a healthy blood pressure. Insulin resistance is another, because as your insulin and leptin levels rise, it causes your blood pressure to increase. Eventually, you may become insulin and/or leptin resistant.

With regard to insulin resistance, research shows intermittent fasting promotes insulin sensitivity and improves blood sugar management by increasing insulin-mediated glucose uptake rates,²⁵ which is important for resolving high blood pressure.

Toward that end, KetoFasting, which combines a cyclical ketogenic diet and intermittent fasting with cyclical partial fasting, is an important strategy to optimize your blood pressure and can be combined with meditation and other relaxation-response triggering activities to help you achieve optimal health.

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A common refrain during the COVID-19 pandemic is, “I’m so tired.” After months of adjusted living and anxiety, people are understandably weary. Parents who haven’t had a break from their kids are worn out. Those trying to juggle working from home with homeschooling are stretched thin. Between concerns about health, finances, and isolation, everyone is feeling some level of additional stress during this unusual time, and that’s tiring. We all could use a good, long nap — or better yet, a vacation.

But while a break would be nice, most people — except those who are actually sick with COVID-19 or other illnesses — are able to push through their fatigue, precisely because they aren’t sick. “Tired” is a nebulous word that covers a broad spectrum of levels of fatigue. A crucial distinction, however, is between regular fatigue and illness-related fatigue.

Regular fatigue

Everyday fatigue that is not illness-related starts with a baseline of health. You may feel sleepy, you may in fact be sleep-deprived, or your body and mind may be worn out from long hours, exertion, or unrelenting stress — but you don’t feel sick. Your muscles and joints don’t ache like when you have the flu. You are capable of getting out of bed and powering through the day, even if you don’t want to. A cup of coffee or a nap might perk you up.

This type of fatigue is usually related to external factors: lack of sleep, stress, an extra-hard workout. But internally, your body is working well: your glands and organs are operating properly; infection is not depleting your body of energy; your nervous system may be overtaxed, but it’s not frayed from actual impairment.

Illness-related fatigue

When I was acutely ill with persistent Lyme, babesiosis, and ehrlichiosis (all tick-borne illnesses), as well as chronic Epstein-Barr virus, a good night’s sleep did nothing. Naps were staples of my day that helped me survive but didn’t improve my energy. Drinking a cup of coffee was akin to treating an ear infection with candy. No matter how much I rested, my exhaustion persisted.

I felt like I had the flu, except it lasted for years. My whole body ached. I suffered migraine headaches. I had hallucinogenic nightmares. Exercise was out of the question; at times, I was literally too tired to walk up a flight of stairs or sit at the dinner table. I couldn’t concentrate, unable to read or watch TV. Sometimes I was too tired to talk.

There was no pushing through this level of fatigue, because it was caused by internal factors: illnesses that were ravaging my body. Only when they were adequately treated did I start to get my energy back.

For me, the root causes were bacterial infections (Lyme, ehrlichiosis), a parasite (babesiosis), and a virus (Epstein-Barr). Profound fatigue may also result from a host of other diseases and conditions, including chronic fatigue syndrome, fibromyalgia, and multiple sclerosis.

Is it everyday fatigue or illness-related fatigue?

When determining whether your tiredness is everyday fatigue or illness-related, consider the following questions:

• Do you feel worn out, or do you feel sick?
• Have you experienced this before, or does it feel more extreme or unrelenting?
• When you lessen the load of external factors (work, stress, long days) does the fatigue improve, or does it persist?
• Do you feel refreshed after a good night’s sleep or a nap?
• Can you go about your day, or is it impossible to get out of bed?
• Has the fatigue persisted longer than you would expect?
• Are you experiencing other symptoms that might point to illness?

The bottom line

No one knows your body better than you do. You know what feels normal, and you know what you feel like when you’re sick. If you are not responding to regular fatigue remedies, your fatigue has persisted over time, you have other symptoms, or you just don’t feel right, it’s probably time to call your doctor.

The post Illness-related fatigue: More than just feeling tired appeared first on Harvard Health Blog.

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