Olive oil, 4–160 mg/kg
Beef, 26-40 mg/kg
Pork, 14-45 mg/kg
Sunflower oil, 4–15 mg/kg
Peanuts, 27 mg/kg
Walnuts, 19 mg/kg
Sesame seeds, 18–23 mg/kg
Pistachio nuts, 20 mg/kg
Hazelnuts, 17 mg/kg
Avocados, 10 mg/kg
Parsley, 8–26 mg/kg
Broccoli, 6–9 mg/kg
Spinach, as high as 10 mg/kg
Grapes, 6–7 mg/kg
Sardines, wide range about 5 to 60 mg/kg
Fish with white filet, 11–16 mg/kg
Salmon, 4–8 mg/kg
Tuna, 5 mg/kg
Currants, 3 mg/kg
Oranges, 1–2 mg/kg
Assessment and Plan: Coenzyme Q10
- CoQ10 as a supplement is either in the form of ubiquinone, or a reduced oxidized form, ubiquinol. Ubiqinone is oxidized to ubiquinol in the body. There is theory that the preferred form of CoQ10 is ubiquinol because it may be absorbed better than ubiquinone resulting in a lower dose requirement.
- Since CoQ10 is fat soluable, it is absorbed better with oil either in the supplement itself, or taken with food containing oil. Cardiologist, Dr. Sinatra performed his own research in which he tested 12 patients for the absorption rates of ubiquinone vs. ubiquinol. He found that ubiquinol resulted in only slightly higher levels in most of the patients tested, concluded that ubiquinol is not worth the higher cost. (39)
- Coenzyme Q10 Adverse Reactions and Interactions: Coenzyme Q10 is generally taken in much higher doses than that which is available in food sources. The concentration of Coenzyme Q10 in foods is quite low as noted above. Coenzyme Q10 side-effects were minimal when used by many age groups and may safely be used in children (1) and in women who may become pregnant (1,2). Less nausea occurred in the coenzyme Q10 group than placebo, but allergic skin rash after taking coenzyme Q10 has been reported (1). According to Liu, J et al, a dose of 1200 mg of coenzyme Q10 daily was well tolerated and only diarrhea and pharyngitis occurred slightly more than in the placebo group (37). For patients taking warfarin, this agent was cleared more rapidly by coenzyme Q10 which reduced the effect of anticoagulation (32), therefore if coenzyme Q10 is taken with warfarin, PT INR (prothrombin time international normalized ratio) will need to be monitored more closely and warfarin may need to be increased.
- Dosing: After review of the research, preferred dose of CoQ10 is 50 mg -100 mg daily for general health maintenance under 65 tears of age. Those with hypertension or headaches, 100 mg daily. Those taking statins or over 65 take 100-200 mg daily. Those with heart disease or failure, 200-300 mg daily. Dividing the dose to twice daily increases absorption rates.
- Coenzyme Q10 and headaches:
- 100 mg of a liquid, water-soluble form of coenzyme Q10 (Q-Gel) taken 3 times daily (300 mg coenzyme Q10 total per day) for 3 months resulted in 50% reduction in migraine attacks (14% in placebo group), less migraine attacks per month, and more headache free days than placebo. (1)
- Coenzyme Q10 and hypertension:
- Within multiple studies including coenzyme Q10 at variable doses between 60 mg daily and 360 mg daily with different designs including randomized controlled trials, systematic reviews, and open label studies, systolic blood pressure decreased by 11-17 mmHg on average, and diastolic blood pressure decreased by 8-10.3 mmHg on average more than placebo (5,6,10,11).
- Coenzyme Q10 60 mg daily was given to patients on anti-hypertensive medications, which further improved bp control after 8 weeks of therapy (7).
- Coenzyme Q10 at 50 mg twice daily for 10 weeks decreased systolic blood pressure from an average of 164.5 mmHg to 146.7 mmHg, and diastolic blood pressure decreased from an average of 98.1 mmHg to 86.1 mmHg (8).
- One small study on healthy patients showed that Coenzyme Q10 at 50 mg daily slightly increased systolic blood pressure (SBP) by 2 mmHg (9).
- Coenzyme Q10 levels should be monitored to achieve desired therapeutic level while monitoring for response. Rosenfeldt FL et al expressed that co-enzyme Q10 levels are patient dependent based on variable absorption, use of other medications, and patient response. The authors performed a meta-analysis which noted that Co-Q10 was used to control blood pressure gradually over months by using doses of 75–360 mg daily to attain a therapeutic level of CoQ10 over >2.0 mcg/ml. (10)
- Coenzyme Q10 and hyperlipidemia: Although there is no standard for co-enzyme Q10 replacement, and monitoring, we recommend a co-enzyme Q10 supplement with statin medications to keep the level over 0.70 micromol/L, closer to healthy controls. As a guidance for dosing, the trial mentioned above used co-enzyme Q10 to control blood pressure gradually over months by using doses of 75–360 mg daily to attain a therapeutic level of CoQ10 over 2.0 mcg/ml (10).
- Coenzyme Q10 at 50 mg twice daily for 10 weeks decreased average total cholesterol from 222 mg/dL to 213 mg/dL, but HDL did not change (8).
- Researchers tested co-enzyme Q10 levels in patients taking statins and all different statin agents reduced cholesterol but also decreased production of coQ10 (13,14).
- 80 mg oral atorvastatin (a statin drug to reduce cholesterol levels) reduced the average concentration of coenzyme Q10 in the blood by about 50% after 30 days, reduced levels from 1.26 micrograms per milliliter to 0.62 micrograms per milliliter, and may also contribute to muscle pain, exercise intolerance and myoglobinuria (14).
- Coenzyme Q10 may also enhance the effect of lipid-lowering medications used by patients with high cholesterol. (15)
- Coenzyme Q10 and heart failure:
- Patients with NYHA Classes III and IV taking 100 mg of CoQ10 over 6 years established average levels of 2.89 mcg per ml, improved ejection fraction from 44% to 60%, improved 1-2 NYHA classes in 85% of patients, and showed no evidence of toxicity or intolerance (17).
- Langsjoen PH, et al found that coenzyme Q10 appeared to have the greatest effect in patients with a level of at least 2.5 mcg per ml and increased ejection fraction (EF) as follows (40-48% of patients had very low control levels of co-enzyme Q10) (18):
- Starting EF of 10%-30%: Improved EF 115%-210% during activity.
- Starting EF of 50%-80%: Improved EF 10%-25% during activity.