Coenzyme Q10: Implications for Health & Performance (And 20 Top Food Sources)

Coenzyme Q10 is a member of the ubiquinone family of compounds, named for the ubiquitous nature of these compounds in humans and all living organisms.  

Coenzyme Q10 is made naturally in the human body, therefore it’s not considered a vitamin, however it has many fundamental roles in human physiology and health.(1) 

In this article, I’ll review the roles of CoQ10 in the body, highlight its potential role in athletic performance, review CoQ10 rich food sources, and discuss considerations for special populations and supplementation. 

What Is It?

Coenzyme Q10 is a fat-soluble compound made in your body and acquired from your diet. The highest levels are found in the heart, liver, kidneys, and pancreas.

At the cellular level, the greatest concentration of CoQ10 is found in the mitochondria – the tiny powerhouses of your cells – and thus it plays a fundamental role in aerobic energy production.

To convert the carbohydrates and fats you eat into adenosine triphosphate (ATP), the primary energy currency used by your cells, it’s necessary to have CoQ10 present in the inner mitochondrial membrane.

Coenzyme Q10 also plays a key role as a fat-soluble antioxidant in your cellular membranes and lipoproteins, the latter responsible for ferrying lipids around the body. For example, oxidized low-density lipoprotein (LDL) is a biomarker associated with increased risk of heart disease, and when LDL is oxidized, the CoQ10 antioxidant is the first called into action.(2)

Coenzyme Q10 also plays an important role in recycling other antioxidants in the body, in particular, alpha-tocopherols (vitamin E) and ascorbate (vitamins C).(3)

High concentrations of CoQ10 are also found in lysosomes, the garbage collectors of your cells which clean up all the cellular debris. 

CoQ10 & Athletic Performance

If you’re an athlete, can CoQ10 help your athletic performance?

Only a few small studies have looked into whether supplementation with 100-150mg/day of CoQ10 could impact physical performance in recreational and trained athletes. To date, CoQ10 supplementation has failed to produce benefits for maximal oxygen consumption (VO2 max), time to exhaustion, aerobic power or anaerobic markers.(4,5,6,7,8)

There may be some potential benefit for muscular recovery from intense exercise, specifically with respect to oxidative stress and low-grade inflammation, however the research is limited.(9,10,11) 

CoQ10 & Human Health 

Coenzyme Q10 plays a key role in supporting cardiovascular health.

Atherosclerosis is a condition where arterial walls become inflamed and accumulate fatty substances called plaques, narrowing and stiffening arteries and increasing your risk of heart attack and stroke. 

An early sign of the development of atherosclerosis is the oxidation of in your arterial walls. A reduced form of coenzyme Q10 - the first antioxidant called into action - works together with vitamin E to quench the pro-inflammatory oxidative fires in the artery wall.  

Supplementation has been shown in multiple studies to increase the concentration of CoQ10 in LDL in humans.(12, 13) Ensuring sufficient levels of coenzyme Q10 may be a promising strategy to reduce LDL oxidation and therefore the early progression of atherosclerosis.

Some studies have shown mild benefit for blood pressure, endothelial function, and blood flow however the effect size does not appear to be large.

Fibromyalgia is another condition where coenzyme Q10 may play a supportive role in symptom management. Several small, double-blinded studies found a dose of 300mg per day reduced fatigue and tiredness, as well as pain and soreness in fibromyalgia sufferers.(13,14)

COQ10 Food Sources

What foods are richest in coenzyme Q10? 

Currently, the US National Academy of Medicine does not have a specific dietary intake recommendation for CoQ10.(15)  The estimated daily intake of CoQ10 in the general population is approximately 3-6mg per day.(16)

The dietary sources with the highest concentration of CoQ10 are animal-based foods, such as organ meats, venison, beef, chicken and fish.(16) The next best sources include nuts and oils. (See 20 Top Food Sources infographic below)

Symptoms of CoQ10 Deficiency 

Lower plasma levels of CoQ10 are found in people with diabetes (type-1 and type-2), regularly taking cholesterol lowering medications called statins, congestive heart failure (CHF), and cancer.

Insufficient coenzyme Q10 status may also occur as you get older, research showing  plasma concentrations declining with age.(17) Therefore, some experts believe it may play a role in supporting longevity. However, it’s not clear whether this reduction over a lifespan is indeed a sign of deficiency or a natural phenomenon.

If your intake of coenzyme Q10 is deficient or insufficient, you may experience some of the following symptoms; physical fatigue, poor memory and difficulty concentrating, poor immunity, muscle pain, and increased risk of heart disease.

It is possible to perform a blood test to assess CoQ10 status, the general population reference range is 0.36-1.59 ug/mL.

Drugs Interactions & Supplementation

If you’re taking CoQ10 supplements, be sure to check with your doctor for potential interactions with medications. 

For example, if you’re taking a blood-thinning medication like warfarin (coumadin), as well as a CoQ10 supplement, you may experience a potentially dangerous reduced anti-coagulant effect of your medication.(18)

A common side-effect of statin medications is lowered plasma levels of CoQ10.

If you’re taking a statin medication – drugs classified as HMG-CoA reductase inhibitors – you will experience a drop in your CoQ10 levels because the enzyme HMG-CoA reductaseis responsible for both cholesterol and coenzyme Q10 production. 

It’s been well-established that lipid-lowering statins like Crestor, Lipitor, etc. consistently reduce CoQ10 levels in patients.(19,20,21,22) That said, experts believe CoQ10 levels are reduced when patients take statins because overall circulating lipid levels are reduced on statins, rather than a direct inhibition of CoQ10 synthesis.  

(Talk to your doctor about supplementation if you’re currently taking a stating drug).

The best evidence for the benefit of supplementation of CoQ10 is with respect to genetic mitochondrial disorders caused by mutations in CoQ10 genes (at very high doses). CoQ10 may be somewhat effective as an adjunct therapy for congestive heart failure and coronary artery bypass surgery. And currently, there is no evidence it improves diabetes, neurodegenerative conditions or breast cancer. 

If you’re supplementing with CoQ10, be sure to consume with meals that contains some dietary fat to improve absorption. Supplement doses can range from 30-100mg per capsule.

This well above the estimated average daily intake, therefore it’s probably best to consume smaller doses more frequently throughout the day. Finally, CoQ10 production may be impacted by inadequate intake of pantothenic acid (vitamin B6).

The Bottom Line

Coenzyme Q10 is made naturally in the body and an important compound for human health, playing key roles in aerobic energy metabolism and as a fat-soluble antioxidant. 

While it has not shown the ability to directly improve athletic performance, it may be able to support recovery from intense exercise via its role in buffering oxidative stress and low-grade inflammation. 

A “Food First” approach is ideal for athletes and upgrading health, with organ meats and animal proteins the richest natural sources of CoQ10. Incorporate more foods high in coenzyme Q10 to support your best mental and physical performance.

Dr. Marc Bubbs ND, MSc, CISSN, CSCS

References

1)   Acosta MJ, Vazquez Fonseca L, Desbats MA, et al. Coenzyme Q biosynthesis in health and disease. Biochim Biophys Acta. 2016;1857(8):1079-1085. 

2)   Ernster L, Dallner G. Biochemical, physiological and medical aspects of ubiquinone function. Biochim Biophys Acta. 1995;1271(1):195-204.

3)   Navas P, Villalba JM, de Cabo R. The importance of plasma membrane coenzyme Q in aging and stress responses. Mitochondrion. 2007;7 Suppl:S34-40. 

4)   Laaksonen R, Fogelholm M, Himberg JJ, Laakso J, Salorinne Y. Ubiquinone supplementation and exercise capacity in trained young and older men. Eur J Appl Physiol Occup Physiol. 1995;72(1-2):95-100.  

5)   Malm C, Svensson M, Ekblom B, Sjodin B. Effects of ubiquinone-10 supplementation and high intensity training on physical performance in humans. Acta Physiol Scand. 1997;161(3):379-384.  

6)   Weston SB, Zhou S, Weatherby RP, Robson SJ. Does exogenous coenzyme Q10 affect aerobic capacity in endurance athletes? Int J Sport Nutr. 1997;7(3):197-206.  

7)   Porter DA, Costill DL, Zachwieja JJ, et al. The effect of oral coenzyme Q10 on the exercise tolerance of middle-aged, untrained men. Int J Sports Med. 1995;16(7):421-427.  

8)   Braun B, Clarkson PM, Freedson PS, Kohl RL. Effects of coenzyme Q10 supplementation on exercise performance, VO2max, and lipid peroxidation in trained cyclists. Int J Sport Nutr. 1991;1(4):353-365. 

9)   Abdizadeh L, Jafari A, Armanfar  M. Effects of short-term coenzyme Q10 supplementation on markers of oxidative stress and inflammation after downhill running in male mountaineers. Science & Sports. 2015;30(6):328-334. 

10)Díaz-Castro J, Guisado R, Kajarabille N, et al. Coenzyme Q(10) supplementation ameliorates inflammatory signaling and oxidative stress associated with strenuous exercise. Eur J Nutr. 2012;51(7):791-799.  

11)Leelarungrayub D, Rawattikanon A, Klaphajone J, Pothong-sunan P, Bloomer RJ. Coenzyme Q10 supplementation decreases oxidative stress and improves physical performance in young swimmers Open Sports Med J 2010

12)Mohr D, Bowry VW, Stocker R. Dietary supplementation with coenzyme Q10 results in increased levels of ubiquinol-10 within circulating lipoproteins and increased resistance of human low-density lipoprotein to the initiation of lipid peroxidation. Biochim Biophys Acta. 1992;1126(3):247-254.

13)Cordero, M et al. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q₁₀effect on clinical improvement. PLoS One. 2012;7(4):e35677.

14)Cordero, M et al. Can coenzyme q10 improve clinical and molecular parameters in fibromyalgia? Antioxid Redox Signal. 2013 Oct 20;19(12):1356-61.

15)Weber C. Dietary intake and absorption of coenzyme Q. In: Kagan VE, Quinn PJ, eds. Coenzyme Q: Molecular Mechanisms in Health and Disease. Boca Raton: CRC Press; 2001:209-215. 

16)Pravst I, Zmitek K, Zmitek J. Coenzyme Q10 contents in foods and fortification strategies. Crit Rev Food Sci Nutr. 2010;50(4):269-280. 

17)Hernandez-Camacho JD, Bernier M, Lopez-Lluch G, Navas P. Coenzyme Q10 Supplementation in Aging and Disease. Front Physiol. 2018;9:44. 

18)Natural Medicines. Coenzyme Q10. Professional handout/Drug Interactions. Available at: https://naturalmedicines-therapeuticresearch-com. Accessed 1/21/19.

19)Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci U S A. 1990;87(22):8931-8934.  

20)Colquhoun DM, Jackson R, Walters M, et al. Effects of simvastatin on blood lipids, vitamin E, coenzyme Q10 levels and left ventricular function in humans. Eur J Clin Invest. 2005;35(4):251-258.  

21)Mabuchi H, Higashikata T, Kawashiri M, et al. Reduction of serum ubiquinol-10 and ubiquinone-10 levels by atorvastatin in hypercholesterolemic patients. J Atheroscler Thromb. 2005;12(2):111-119.  

22)Bargossi AM, Battino M, Gaddi A, et al. Exogenous CoQ10 preserves plasma ubiquinone levels in patients treated with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Int J Clin Lab Res. 1994;24(3):171-176.