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Previously, I wrote an article called“Coenzyme Q10 as Ubiquinone &Ubiquinol: For Cardiovascular

Health & More” for the February 2014issue of Vitamin Retailer. That articlereviewed some of the vital cellular func-tions and health/wellness applications forcoenzyme Q10 (CoQ10). This article willfocus strictly on new human research thathas been published in 2014 on CoQ10(ubiquinone) and ubiquinol. It will notreview studies on animals or in-vitrostudies (i.e. research done on cell lines ina laboratory, not on a live organism).

The Difference BetweenUbiquinone and UbiquinolBefore jumping into the research, let’s doa quick review on the difference betweenubiquinone and ubiquinol. Chemically,ubiquinol is the fully reduced form ofCoQ10 known as CoQ10H2. This meansthat it has two additional hydrogens thanstandard, oxidized ubiquinone, which isalso known as CoQ10. Most CoQ10products on the market today provideubiquinone, although it is ubiquinol thatprovides virtually all of benefits associat-ed with CoQ10. This does not necessari-ly mean that supplementation with

ubiquinol is necessary, however, sincethe human body can easily convertubiquinone into ubiquinol.1 The fact isthat supplementation with eitherubiquinone or ubiquinol has value.

CoQ10 and SemenPrevious research from 20042 showedthat infertile men with idiopathicasthenozoospermia (the medical term forreduced sperm motility) who take 200mg/day of CoQ10 had increased spermmotility after six months of treatment.Since low-seminal plasma concentrationsof CoQ10 have been associated withsome parameters of impaired sperm,researchers decided to further explorethe relationship between semen andCoQ10.

A recent randomized, placebo-con-trolled study3 examined the effect ofCoQ10 on catalase, superoxide dismu-tase (SOD) and F2–isoprostanes(prostaglandin-like compounds formed inthe body from the free radical-catalyzedperoxidation of essential fatty acids) inseminal plasma in infertile men. Forty-seven infertile men with idiopathicoligoasthenoteratozoospermia (the med-ical term for semen with a low concentra-

tion of sperm) received 200 mg/day ofCoQ10 or placebo for three months. Notsurprisingly, the results showed thatCoQ10 levels increased significantly fol-lowing supplementation in CoQ10 (P <0.001). In addition, the CoQ10 grouphad higher catalase and SOD activitythan the placebo group. There was alsoa significant positive correlation betweenCoQ10 concentration and normal spermform and structure (P = 0.037), catalase(P = 0.041) and SOD (P < 0.001).Furthermore, after supplementationthere was a significant reduction in semi-nal plasma 8-isoprostane in the CoQ10group compared to the placebo group(P = 0.003). The authors concluded thatthree-month supplementation withCoQ10 in oligoasthenoteratozoospermiainfertile men can reduce oxidative stressin seminal plasma and improve semenparameters and antioxidant enzymesactivity.

CoQ10 and FibromyalgiaIn 2002, an open, pilot study4 found thatsupplementation with 200 mg/day ofCoQ10 in conjunction with 200 mg/dayof Ginkgo biloba extract for 84 daysimproved quality of life parameters in

By Gene Bruno, MS, MHS, RH(AHG)

Dean of Academics, Huntington College of Health Sciences

Ubiquinone(CoQ10)

&Research Update

Ubiquinol

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fibromyalgia patients, including physicalfitness levels, emotional feelings, socialactivities, overall health and pain. The2002 study did not, however, investigatethe mechanism of action behind thesebeneficial effects. One possibility is thatthe mechanism had to do with the neu-rotransmitter, known as serotonin. Thereason is that the relationship betweenserotonin in the pathophysiology offibromyalgia has previously beenexplored, and medications that modu-late serotonin levels are currently used inthe treatment of fibromyalgia.5 Sinceserotonin is an important modulator ofpain perception, sleep, fatigue, cognitionand mood in normal subjects, this sup-ports the positions that disturbances inthese functions in fibromyalgia (e.g.fibromyalgia patients have higher levelsof depression) can result of abnormalitiesin the content, metabolism or transmis-sion serotonin. Recent research set outto determine if CoQ10 had an impact onserotonin in fibromyalgia patients.

A randomized, double-blind, placebo-controlled study6 examined the effects of300 mg/day of CoQ10 (divided intothree daily doses) on serotonin anddepression in 20 fibromyalgia patients

for 40 days. Ten patients receivedCoQ10 and 10 patients received amatching placebo. CoQ10 and serotoninlevels were assessed using blood andblood platelet samples, and depressionwas evaluated the Beck DepressionInventory (BDI) scale. Results showedthat CoQ10 and serotonin levels inplatelets from fibromyalgia patients wererestored in the CoQ10-treated groupcompared to placebo group. A signifi-cant improvement in depressive symp-toms was also observed in the CoQ10-treated group compared to the placebogroup (P < 0.001). In fact, the authors ofthe study stated, “Our findings also sup-port the hypothesis that CoQ10 supple-mentation can be used as an alternativetherapy for controlling depression.”

CoQ10, the Mediterranean Dietand AgingPast research has shown that CoQ10plays a role as a powerful antioxidant incells, inhibiting lipid peroxidation in cellmembranes and DNA,7 and is involved inhelping to protect against different typesof oxidative damage.8,9,10 A study11 in2012 found that CoQ10 supplementa-tion in combination with the

Mediterranean dietin an elderly popu-lation reduces theinflammatoryresponse and stressto those parts of thecell responsible formanufacturing pro-teins—which isimportant to helpprevent aging-relat-ed disease such asdiabetes, inflamma-tion and neurode-generative disor-ders, includingAlzheimer's dis-ease.12 The questionis, would CoQ10and theMediterranean diethelp also helpreduce DNA dam-age, which wouldbe a boon to theaging population?This was explored inrecent research.

In July of 2014, anew study13 waspublished in which20 participants wererandomly assignedto one of threegroups for four

weeks: 1) a Mediterranean diet supple-mented with coenzyme Q10, 2) aMediterranean diet alone, and 3) a satu-rated fatty acid-rich diet. Volunteers werethen tested to determine if certain genesexpressed themselves (the process bywhich information from a gene is used inthe synthesis of a protein or RNA), whichin this case would be an indicator ofDNA damage. The results showed thatthose in the Mediterranean diet group,and especially those in Mediterraneandiet supplemented with coenzyme Q10group, experienced a reduction in theexpression of the genes associated withincreased DNA damage. The researchedconcluded that these results indicated atriggering of DNA repair machinery.

Ubiquinol and AutismSince autistic spectrum disorders can beassociated with mitochondrial dysfunc-tion and oxidative stress,14 and sinceCoQ10 is beneficial for treating both ofthese issues,15 this raised the question asto whether supplementation with CoQ10would be helpful with autism. A casestudy16 published in 2006 did report avariety of improvements in an autistic girltreated with a program of vitamin sup-plements, L-carnitine and CoQ10, butthis was insufficient for drawing conclu-sions for a larger population of autisticpatients. However, a recent study17 tookanother look at this question.

Twenty-four children, aged 3-6 years,with autism were given 50 mg ofubiquinol twice daily for a total dailydose of 100 mg. Data on behavior of thechildren were collected from parents.The results were that supplementationwith ubiquinol improved symptoms inchildren with autism, including:

• communication with parents (in 12percent)

• verbal communication (in 21 percent)• playing games of children (in 42 per-

cent)• sleeping (in 34 percent)• food rejection (in 17 percent)This is the first study in which benefi-

cial effects of ubiquinol in children withautism has been demonstrated.

ConclusionSupplementation with ubiquinone andubiquinol has been shown in research tocontinue offering a range of benefits.Based upon research published in 2014,this includes reduction oxidative stresssemen, a reduction of depression infibromyalgia patients, reduction in theexpression of the genes associated with

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Tinnitus is not the only conditionlinked to low vitamin B12 levels associ-ated with aging. Several studies havefound the level of vitamin B12 declineswith age and that vitamin B12 deficien-cy is found in as high as 40 percent ofpersons aged 65 and over. The defi-ciency may be the result of reduceddietary intake, but a more likely expla-nation is as we age there is reducedsecretion of a compound known asintrinsic factor that facilitates B12absorption. Low vitamin B12 levels canbe devastating at any age, but in theelderly it can lead to significant impair-ment in nerve function and mentalcapacity. Tinnitus for many elderly folksmay be the tip of the iceberg if it isrelated to low vitamin B12 levels.

One study looked at blood levels ofvitamin B12 in 100 consecutive geriatricoutpatients who were seen for variousacute and chronic medical illnesses.They found that 11 patients had serumB12 levels at 148 pmol/L or below—thecut off for vitamin B12 deficiency; 30patients had levels between 148 to 295pmol/L; and 59 patients had levelsabove 296 pmol/L. After the initialdetermination, the patients were fol-lowed for up to three years. Thepatients with B12 levels below 148pmol/L were treated and were notincluded in the analysis of declining

cobalamin levels. The average annualdecline was 18 pmol/L for patients whohad higher initial B12 levels, but forpatients with lower initial B12 levels,the average annual serum decline wasmuch higher at 28 pmol/L.

These results indicate that measuringthe level of vitamin B12 in the blood(serum cobalamin) or measuring the uri-nary excretion of methylmalonic acid asscreening tests for vitamin B12 defi-ciency appears to be indicated in theelderly. Alternatively, I would recom-mend anyone over the age of 65, or avegetarian at any age, to take theactive form of vitamin B12, methyl-cobalamin, at a dosage of 1,000 to3,000 mcg daily. Note: this highdosage bypasses the need for intrinsicfactor to aid absorption.

Vitamin B12 is available in severalforms. The most common forms arecyanocobalamin and hydroxocobal-amin, however, these two forms mustbe converted to methylcobalamin bythe body and may not be the best forolder people as many may have areduced ability to convert cyanocobal-amin and hydroxocobalamin to methyl-cobalamin. In animal models of aging,while methylcobalamin led to signifi-cant increases in lifespan, cyanocobal-amin had no effect. Methylcobalaminhas also produced better results in clin-

ical trials than cyanocobalamin andshould, therefore, be considered thebest available form whenever specificbenefits of vitamin B12 are desired.

Final CommentsThere is little research on dietary fac-tors in tinnitus—there just isn’t anymoney in it. That said, a new studyexamining data from the UK Biobankresource, a very large cross-sectionalstudy of adults aged 40-69 living in theUK provides some interesting clues.After controlling for lifestyle, noiseexposure, hearing, personality andother factors; a relationship betweenpersistent tinnitus, defined as presentat least a lot of the time, was reducedwith fish consumption indicating anoth-er possible benefit from fish oil supple-mentation. VR

Michael T. Murray, ND, iswidely regarded as one ofthe world's leading authori-ties on natural medicine. Heis a graduate, former facul-ty member and serves onthe Board of Regents ofBastyr University in Seattle,WA. The author of morethan 30 books on health

nutrition, Murray is also director of productdevelopment and education for NaturalFactors Nutritional Products. For more infor-mation, visit www.doctormurray.com.

NATURALMEDICINE with Dr. Michael Murray

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increased DNA damage and improvedsymptoms in children with autism. VR

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Am Coll Nutr. 2001;20(6):591-598.2 Balercia G, Mosca F, Mantero F, et al. Coenzyme Q10

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3 Nadjarzadeh A, Shidfar F, Amirjannati N, et al. Effectof Coenzyme Q10 supplementation on antioxidantenzymes activity and oxidative stress of seminal plasma: adouble-blind randomised clinical trial. Andrologia. 2014Mar;46(2):177-83.

4 Lister RE. An open, pilot study to evaluate the poten-tial benefits of coenzyme Q10 combined with Ginkgobiloba extract in fibromyalgia syndrome. J Int Med Res2002;30:195-9.

5 Häuser W, Wolfe F, Tölle T, et al. The role of antide-pressants in the management of fibromyalgia syndrome:a systematic review and meta-analysis. CNS Drugs.2012;26:297-307.

6 Alcocer-Gómez E, Sánchez-Alcázar JA, Cordero MD.Coenzyme q10 regulates serotonin levels and depressivesymptoms in fibromyalgia patients: results of a small clin-ical trial. J Clin Psychopharmacol. 2014 Apr;34(2):277-8.

7 Ernster L, Dallner G. Biochemical, physiological and

medical aspects of ubiquinone function. Biochim BiophysActa. 1995;1271(1):195-204.

8 Bertelli A, Ronca G. Carnitine and coenzyme Q10:biochemical properties and functions, synergism andcomplementary action. Int J Tissue React 1990;12:183-6.

9 Gül I, Gökbel H, Belviranli M, Okudan N, BüyükbaşS, Başarali K. Oxidative stress and antioxidant defense inplasma after repeated bouts of supramaximal exercise:the effect of coenzyme Q10. J Sports Med Phys Fitness.2011 Jun;51(2):305-12.

10 Sakata T, Furuya R, Shimazu T, Odamaki M, OhkawaS, Kumagai H. Coenzyme Q10 administration suppressesboth oxidative and antioxidative markers in hemodialysispatients. Blood Purif. 2008;26(4):371-8.

11 Yubero-Serrano EM, Gonzalez-Guardia L, Rangel-Zuñiga O, et al. Mediterranean diet supplemented withcoenzyme Q10 modifies the expression of proinflammato-ry and endoplasmic reticulum stress-related genes in eld-erly men and women. J Gerontol A Biol Sci Med Sci. 2012Jan;67(1):3-10.

12 Yoshida H. ER stress and diseases. FEBS J. 2007Feb;274(3):630-58.

13 Gutierrez-Mariscal FM, Yubero-Serrano EM, Rangel-Zúñiga OA, et al. Postprandial activation of p53-depend-ent DNA repair is modified by Mediterranean diet supple-mented with coenzyme Q10 in elderly subjects. JGerontol A Biol Sci Med Sci. 2014 Jul;69(7):886-93.

14 Fillano JJ, Goldenthal MJ, Rhodes CH, et al.Mitochondrial dysfunction in patients with hypotonia,epilepsy, autism, and developmental delay: HEADD syn-drome. J Child Neurol. 2002;17:435–439

15 Chan A, Reichmann H, Kogel A, et al. Metabolicchanges in patients with mitochondrial myopathies andeffects of coenzyme Q10 therapy. J Neurol1998;245:681-5.

16 Poling JS, Frye RE, Shoffner J, Zimmerman AW.Developmental Regression and MitochondrialDysfunction in a Child With Autism. J Child Neurol. Feb2006; 21(2): 170–172.

17 Gvozdjáková A, Kucharská J, Ostatníková D,Babinská K, Nakládal D, Crane FL. Ubiquinol improvessymptoms in children with autism. Oxid Med Cell Longev.2014;2014:798957.

Gene Bruno, MS, MHS, the dean ofacademics for Huntington Collegeof Health Sciences, is a nutritionist,herbalist, writer and educator. Formore than 30 years he has educat-ed and trained natural productretailers and health care profession-als, has researched and formulatednatural products for dozens ofdietary supplement companies, andhas written articles on nutrition,herbal medicine, nutraceuticals andintegrative health issues for trade,consumer magazines and peer-reviewed publications.

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