Coenzyme Q10 (CoQ10) is a powerful antioxidant made naturally by the body but levels are known to decline as we age. Low levels are linked to chronic illnesses; it is a component of the electron transport chain inside the mitochondria and plays an important role in energy production and healthy metabolism. It is an important contributor to the immune system; it is anti-inflammatory and anti-aging.
Coenzyme Q10 and cancer - Getting to the heart of the matter
Coenzyme Q10 was discovered in 1957 by Dr. Fred Crane from the University of Wisconsin, who isolated it from beef hearts. Ubiquinone is converted in the body to the circulating form, ubiquinol. You can supplement with either version, although experts prefer uniquinol supplements, ubiquinone being the more common, cheaper version.
The name ubiquinone comes from the fact that the compound belongs to a group of substances called quinones, and it is ubiquitous.
Although it is found in the mitochondria of all human cells (1), the highest concentrations are found in the heart, liver, kidneys and pancreas, organs which have the most metabolically active cells. It is also found in large amounts in the cells of the immune system.
Sources of CoQ10
The best natural food sources are offal, nuts like peanuts and walnuts, oily fish like mackerel and sardines, extra virgin olive oil and seeds. However it is extremely hard to eat sufficient quantities to replace the shortfall in our bodies as we age - levels are known to drop dramatically in our bodies after the age of 50.
The importance of CoQ10
Coenzyme Q10 (CoQ10) is a component of the electron transport chain found on the inner membrane of mitochondria. It provides bioenergetic activity necessary for ATP synthesis. CoQ10 also protects against the reactive oxidative species generated during oxidative phosphorylation, having antioxidant activity in mitochondrial and lipid membranes. Coenzyme Q10 also has proven anti-inflammatory benefits.
Coenzyme Q10 is also essential for healthy immune function, where it plays a number of different roles, for example reducing inflammatory gene expression, playing a role in lysosomes, core to the immune response, and boosting macrophage activity. Supplementation has been shown to improve response (10).
CoQ10 also crosses the blood brain barrier.
The National Cancer Institute states that the body uses CoQ10 for cellular growth, to stay healthy and to protect cells from damage. There are no known side-effects, even where people have supplemented for 10 years.
Because it is known to improve metabolism, not surprisingly there is research (with selenium) on improving vitality, physical performance, quality of life and longevity (24). The longevity factors, even at low dose, include plasma glucose reduction (25).
Chronic illness and CoQ10 levels
People with chronic illnesses have lowered levels of CoQ10.
Low blood levels of CoQ10 have been found in patients with metabolic diseases such as dementia, cardiovascular issues, chronic fatigue syndrome and diabetes. And in patients with cancer. In fact, with breast cancer, prostate cancer, lung cancer, colorectal cancer, multiple myeloma, lymphoma, and cancers of the pancreas, kidney, and head and neck cancers. But is it cause or effect?
Certainly, it is causal. For example, in dementia - in 2014 Yamagishi et al, demonstrated that a lower serum CoQ10 level was associated with a greater risk of dementia in the Japanese (8).
With breast cancer, research concludes that lowered levels of CoQ10 are linked with advancement of the disease (see below).
There is also research that suggests that, while GLA from linoleic acid (omega 6) increased PSA levels in healthy men, both EPA from fish oils (Omega 3) and CoQ10 supplementation each reduced PSA levels significantly.
Co Q10 can also be corrective. Heart failure is largely an energy-deprived condition. Not surprisingly then, the Q-SYMBIO trial found that CoQ10 supplementation in patients with heart failure, not only improved functional capacity, but also significantly reduced cardiovascular events and mortality (9). In research, topical application using CoQ10 can even benefit aging skin (23), and the supplementation effects increase longevity as we reported above.
It is used as a food supplement in conditions such as chronic fatigue syndrome (CFS), congestive heart failure (where there are randomised clinical trials), hypertension, angina, diabetes mellitus, muscular dystrophy, and anti-aging.
There is also research suggesting CoQ10 might be helpful as part of a complementary and integrative cancer programme. For example, research with Tamoxifen in rats with mammary tumours suggests that while CoQ10 supplementation does little on its own, when used with Tamoxifen it performed much better, and when niacin and riboflavin were added, it performed better still.
What is a coenzyme?
A coenzyme is a compound that helps enzymes do their job; and enzymes affect all the biochemical processes in the body making them happen and even regulating their rate. Coenzymes are crucial to healthy metabolism.
Immune system
As a powerful antioxidant, CoQ10 neutralises free radicals and helps protect your DNA from damage. The National Cancer Institute in America quotes studies that show it helps the body better resist cancer. It also works with vitamin E to protect cell membranes (and particularly immune cell membranes) from free radical attack, thus boosting the immune system. It also seems to activate macrophages, the seek-and-destroy cells of the immune system. In research by Dr. Annelie Brauner of the Karolinska Institure in Sweden, 2 x 100 mg of CoQ10 supplementation per day for 12 weeks resulted in greater NK activity in the immune system, increasing the ability to deal with viruses, plus a reduction in inflammatory hBD2 peptides.
CoQ10 and age
A deficiency of CoQ10 has been linked in research with fatigue, muscle aches, DNA damage and premature aging
There are several studies in mice showing that daily supplementation with CoQ10 reduces senescence (3). CoQ10 seems to help because of its activation of mitochondria and through increasing failing gene expression (4). There is a placebo-controlled 4-year clinical study on humans where the researchers used both selenium and CoQ10 and found that the group taking the two supplements spent less days in hospital and had an improved, health-related quality of life (5). The follow up study after 12 years showed the group taking both supplements had a far lower cardiovascular mortality.
There is research showing that CoQ10 seems to enhance the many benefits of resveratrol and this includes both protection against the early stages of dementia and aging.
Finally, there is a 2019 meta-analysis of randomised and clinical studies showing that even low daily doses of CoQ10 improve blood glucose and HbA1c levels (6); again there is synergy with resveratrol in other studies..
Low levels of Coenzyme Q10 and cancer
As with most chronic illness, cancer patients on diagnosis seem to have low levels of CoQ10 in their blood (Lockwood 1994). Early research on the benefits with cancer was carried out by Dr. Karl Folkers, who became interested when his next-door neighbour, who had terminal metastatic lung cancer, started taking CoQ10 and had a complete remission.
At the National Cancer Research Institute in Tokyo a research study using rats showed that one group who were supplemented with Co Q10 had significantly less cancer develop than the group not supplementing, when both were infected with cancer.
It would seem that low levels can increase cancer risk; and that maintained low levels can increase advancement. Is it a direct effect, or an indirect effect via, for example, the immune system? It seems it is both.
For example:
1. "The action of CoQ10 on the immune system is profound. It promotes bioenergetic processes in human immune cells" (Bliznakov).
2. "Supplementation with CoQ10 can cause completed regression of tumours in advanced breast cancer, including one patient with metastases to her liver". (Diamond).
There is little doubt that CoQ10 is effective. There is even a warning caused by its effectiveness. Lund concluded that it should not be used during radiotherapy; and O'Brien concluded that, as an antioxidant, it could hinder the full action of radiotherapy!
So, CoQ10 can work in the mitochondria, and/or with the immune system, and/or as an antioxidant and/or as an inti-inflammatory. Research suggests it may also help minimise some negative effects of chemotherapy especially on the heart. The National Cancer Institute web page quotes research showing that 'CoQ10 helps the heart resist the damaging side-effects of the cancer drug Doxorubicin'.
Studies with CoQ10 and cancer started in the Sixties when it was shown that patients with cancer were deficient in CoQ10. There are numerous small clinical studies on CoQ10 and its benefits for patients with cancer and, in America, the NCI promised a large scale clinical trial, but, nothing happened. No one funds large studies on natural supplements! The result is that there are not many recent studies or large scale studies, even though early studies were full of potential.
Cancer patients do seem to have low levels of CoQ1O in their blood 
One study showed that there is a correlation between low levels of CoQ10 in patients and advancement of Breast cancer (16). Another showed a topical cream of CoQ10 'cured' two thirds of mice given melanoma (17). But despite early promise, there is a little evidence that CoQ1O may help in the treatment of brain cancer.
With melanoma patients in a post-surgical, 2007 clinical trial using alpha-interferon and CoQ10, the group taking the CoQ10 had a 10-fold lower risk of metastases than the placebo group, with a 13-fold lower risk in advanced cases of melanoma (7).
The original NCI research proposal confirmed that animal studies have shown that CoQ10 can fight certain forms of cancer, and that laboratory and animal studies have shown CoQ10 can stop cancer cells growing.
A series of studies by the Lennard M Miller School of Medicine in Miami showed that, while cancer cells in normal patients don't die, loading the plasma with CoQ10 seems to restore apoptic potential by suppressing the bcl-2 gene. This has no effect on healthy cells.
More recent studies have shown multiple ways CoQ10 might work in cancer treatment -
* by strengthening the immune system to prevent or fight cancer.
* by restoring the damaged metabolic activity of the mitochondria, due to lowered CoQ10 levels
* by shutting down basic fibroblast growth factors needed to support tumours, by blocking ERK. This inhibits angiogenesis (18).
* by reducing inflammation in the tissues and thus reducing initial causation, and longer-term metastases
The evidence for the anti-inflammatory benefits? A double blind, placebo controlled clinical trial showed that supplementing with 100 mg of CoQ10 caused a significant decrease in cytokines and IL6 and IL8, significantly reducing inflammation (19).
There is also limited research that moderate plasma levels of CoQ10 may reduce risk of prostate cancer and another showing supplementation for patients may increase survival. One study (Folkers) showed it significantly increased IgG. All three studies hoewever were on low numbers of subjects.
With brain tumours, a 2019 study looked at the potential of CoQ10 to scavenge free-radicals in GBM patients and found that CoQ10 supplementation and Temozolomide acted synergistically in restricting proliferation. CoQ10 made TMZ more cytotoxic (20).
CoQ10 and the mitochondria
CoQ10 is essential for the effective working of healthy mitochondria, or power stations, inside the cell and as such it is found in all human, animal and plant cells. The more energetic the tissue (heart, muscle, brain) the more mitochondria are present.
There are a number of studies showing that CoQ10 supplementation can correct poor mitochondrial function - for example, this one in reproductive aging (21).
There is also research that the Mediterranean diet supplemented with CoQ10 can improve the DNA 'repair' system particularly correcting p53.
CoQ10 is involved in the synthesis of ATP, the powering fuel of the mitochondria. However, in cancer, as with many illnesses, the mitochondria go "wrong" and can even shut down, leaving energy production to the cytoplasm. Cancer tumours are notoriously hypoxic. They run out of oxygen supplies easily. CoQ10 protects (even corrects) the failing mitochondria. The involvement with the body's energy systems has shown in research that supplementation has a positive effect with metabolic syndrome, for example in chronic fatigue syndrome. As with cancer, low plasma levels of CoQ10 are linked to increased levels of Chronic Fatigue Syndrome, and supplementation improves symptoms significantly (22).
The National Cancer Institute also report that it seems to offer benefits as an adjuvant therapy (i.e. a therapy after the primary therapy). It seems it may help as part of a total Integrative Programme but seems to work less well on its own. For example, in a study in Denmark with 22 breast cancer patients, high CoQ1O supplementation did play a significant factor but only with and after surgery.
We know this from other studies. CoQ10 is the great 'helper'. For example, in research CoQ10 makes resveratrol work better.
Is CoQ10 a cancer cure?
To quote one of the researchers in the breast cancer advancement study: "I don't think this is the cure-all, end-all, anti-cancer compound, but it certainly is a good one". Lowered levels increase cancer risk; lowered levels when you have cancer already seem to prompt more blood supplies and more metastasis. CoQ10 seems to enhance other supplements and even drugs like Tamoxifen. It can reduce cytotoxicity and cellular damage. If used in your overall Integrative and Complementary treatment programme, it seems to have real benefits, although the benefits of supplementation seem to build up and may take three months to kick-in according to research.
Warning: Statins lower CoQ10 levels
It has been clearly established that statins reduce Coenzyme Q10 levels in the body. 'Hydroxyl-methylglutaryl coenzyme A reductase inhibitors or statins are proven to interfere with the production of mevalonic acid, which is a precursor in the synthesis of coenzyme Q10' (11). A meta-analysis of placebo controlled clinical trials was very clear on this issue showing 'a significant reduction in plasma CoQ10 levels following treatment with statins' (12).
UCLA researchers have found that older adults with mild cognitive impairment are more than twice as likely to develop Dementia over the following 8 years if taking a Lipophilic statin, when compared to those not taking a statin, or taking a Hydrophilic statin (13).
Doctors can and do watch for signs of muscle and heart problems. However, they rarely check for the danger of developing dementia. Statins are the enemy of CoQ10.
As we showed above, Japanese researchers showed that lowered CoQ10 levels increased risk of dementia. Lowered CoQ10 levels were linked with advancement in breast cancer.
The Mayo Clinic even suggests trying CoQ10 supplementation if taking a statin (2).
Supplementation can help: Research in the American Journal of Cardiology showed that using CoQ10 as a supplement could reduce muscle pain (Myopathy) associated with taking statins (15).
Lipophilic statins such as Lipitor (Atorvastatin) have been shown to be the bigger problem (13). Statin use can also double the risk of diabetes and obesity according to the University of Texas Southwestern and the University of Eastern Finland (14). We also have a blog on why people should not self-medicate with statins. Statins are a double edged sword.
Supplementing? Ubiquinone or Ubiquinol?
Coenzyme Q10 is one of the body's natural chemicals that is in plentiful supply at puberty, but declines with age. Studies in America showed that 60-year old adults taking levels of CoQ10 around 30-50 mg for a period of 3 months or more could restore serum levels similar to those of people in their Twenties. In other words, supplementation seems to deliver, but slowly.
Research levels with breast cancer patients are often at much higher levels around 250mg - 300mg per day.
One in five Americans supplement with CoQ10, and it seems frequently advised if you take statins.
Ubiquinol is the reduced form of ubiquinone (the oxidised form of CoQ10) and in limited research studies it seems to be more bioavailable. It gives up an electron more readily to neutralise a free-radical. Several studies with mice have shown greater uptake in the liver and greater anti-aging benefits. (Green Med Info) The ubiquinone form is converted in the body to the ubiquinol form and 90 per cent of the circulating blood plasma CoQ10 is in this ubiquinol form - that's the one that protects you!
No serious side-effects are reported in healthy people using the supplement. It does not need drug approval as it is classified as a food supplement. It is fat soluble so, if supplementing, take with a meal.
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References
1. https://pubmed.ncbi.nlm.nih.gov/25126052/
2. May Clinic patient page; try CoQ10 with statin; https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
3. Fischer, Schmelzer; 2012 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3542089/
4. Tian, Nishio, Oct 2013 - CoQ10 supplementation activates mitochondrial functions to decelerate senescence - https://www.researchgate.net/publication/2578126305.
5. Johansson, Alehagen et al 2015, J Nutr Health Aging;
6. Meta-analysis - Therapeutic Potential of CoQ10 - 2019.
7. http://www.ncbi.nlm.nih.gov/pubmed/17505263
8. Serum coenzyme Q10 and risk of disabling dementia: the Circulatory Risk in Communities Study (CIRCS); Atherosclerosis; 2014 Dec;237(2); https://pubmed.ncbi.nlm.nih.gov/25463064/#affiliation-1
9. Recent Developments in the Role of Coenzyme Q10 for Coronary Heart Disease: a Systematic Review; Curr Artherosclero Rep; 2018 May 16;20(6):29; Jessica Ayers et al - https://pubmed.ncbi.nlm.nih.gov/29766349/#affiliation-1
10. Coenzyme Q10 and Immune Function: An Overview; Antioxidants (Basel); 2021; May 11, 10(5); David Mantle et al. https://pubmed.ncbi.nlm.nih.gov/34064686/
11. Ochsner journal; 2010 Spring 10(1); Richard Deichmann et al - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096178/
12. Statin therapy and plasma coenzyme Q10 concentrations--A systematic review and meta-analysis of placebo-controlled trials; Pharmacol Res; 2015 Sep;99:329-36 - https://pubmed.ncbi.nlm.nih.gov/26192349/#affiliation-1
13. Prasanna Padmanabham, student research program, molecular and medical pharmacology, University of California, Los Angeles. Research presented online at the conference of the Society of Nuclear Medicine and Molecular Imaging annual meeting, June 11 to 15, 2021
14. Statin use can double risk of Diabetes - https://chriswoollamshealthwatch.com/your-illness/diabetes/statins-can-double-risk-of-diabetes/
15. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins; Am Journal Cardiology; 2007, May 15, (99) 10 - https://pubmed.ncbi.nlm.nih.gov/17493470/
16. Joliet P et al., Plasma Coenzyme Q10 Concentrations in Breast Cancer;
Prognosis and Therapeutic Consequences, Int J Clin Pharmacol 1998.
17. CoQ10, a Gentle Cancer Killer - https://www6.miami.edu/ummedicine-magazine/fall2005/fstory4.html
18. Coenzyme Q10 decreases basic fibroblast growth factor (bFGF)-induced angiogenesis by blocking ERK activation; Oncol Res, 2011;19(10-11):455-61; Jae Sun Choi et al - https://pubmed.ncbi.nlm.nih.gov/22715588/
19. The Effect of Coenzyme Q10 Supplementation on Vascular Endothelial Growth Factor and Serum Levels of Interleukin 6 and 8 in Women with Breast Cancer: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial; Ther Clin Risk Manag. 2019; 15: 1403–1410 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900311/
20. Modulation of Antioxidant Potential with Coenzyme Q10 Suppressed Invasion of Temozolomide-Resistant Rat Glioma In Vitro and In Vivo; Oxid Med Cell Longev. 2019; 2019: 3061607. Published online 2019 Mar 12. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432727/
21. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging; Aging Cell 2015 Oct; 14(5): 887–895. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568976/
22. Coenzyme Q10 Depletion in Medical and Neuropsychiatric Disorders: Potential Repercussions and Therapeutic Implications; Mol Neurobiol 48, 883–903 (2013). https://doi.org/10.1007/s12035-013-8477-8
23. Aging skin is functionally anaerobic: importance of coenzyme Q10 for anti aging skin care;
Biofactors; 2008;32(1-4):245-55 - https://pubmed.ncbi.nlm.nih.gov/19096122/#affiliation-1
24. Alehagen U, Aaseth J, Alexander J, Johansson P. Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: 12-years on. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193120
25. A meta-analysis of randomized and placebo-controlled clinical trials suggests that coenzyme Q10 at low dose improves glucose and HbA1c levels; Nutr Res, 2017 Feb;38:1-12. doi: 10.1016/j.nutres.2016.12.001. Epub 2016 Dec 8.
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N.B.
Please be clear: At CANCERactive we do not consider the above compound to be a cure for cancer, despite what the research says or experts doing the research may claim. The above, is an article on the compound from published research and expert opinion in the public domain. At CANCERactive we do not believe that any single compound (drug, vitamin, whatever) is a cure for cancer. We believe that people can significantly increase their personal odds of survival by building a Complementary and Integrated Programme of treatments. Equally, cancer prevention is best practiced through a width of measures.