Coenzyme Q10 or CoQ10 is an absolutely critical factor for cellular energy generation. Owing to its being required for proper functioning of the mitochondrial electron transport chain an insufficiency in this nutrient may play a role in any condition related to fatigue and chronic pain such as fibromyalgia. Moreover the necessity for CoQ10 and cholesterol for proper myelin synthesis and neuronal communication suggests that disruptions in the endogenous synthesis and/or exogenous supply of these nutrients may underlie pathological processes that ultimately lead to multiple sclerosis Parkinson’s disease Alzheimer’s disease amyotrophic lateral sclerosis (ALS or “Lou Gehrig’s disease”) and other neuromuscular and neurodegenerative disorders.

CoQ10 is produced endogenously but there are several common factors that may interfere with its synthesis potentially resulting in the need for supplementation. The most obvious and insidious of these is statin drug use. Statin drugs—HMG CoA reductase inhibitors to use their more descriptive scientific name—exert their effects early on in the mevalonate pathway. They are designed to reduce the endogenous synthesis of cholesterol but along the way they also interfere with the synthesis of everything else that is generated via the same initial mechanism. One of these end products is CoQ10; others include prenylated proteins that are required for proper glucose-induced insulin signaling. It is not surprising therefore that common side-effects of statin drugs include fatigue and muscle pain and weakness. (Statin use has even resulted in severe cases of rhabdomyolysis and acute renal failure which were reversed upon supplementation with CoQ10.) 

The role of CoQ10 in healthy mitochondrial function cannot be overstated. Not only is it a part of the physical structures required to generate ATP but it is also a cellular and mitochondrial antioxidant. The running of the electron transport chain is the largest source of oxygen free radicals in the entire body and CoQ10 in its reduced form (ubiquinol) is a primary mitochondrial antioxidant. It also inhibits the oxidation of proteins lipids DNA and lipoproteins. As CoQ10 may be especially important for brain mitochondrial function reduction in the supply of both cholesterol and CoQ10 may be an underappreciated factor in the pathogenesis or exacerbation of Alzheimer’s disease. (In fact higher serum levels of cholesterol later in life are associated with decreased risk for dementia. Lower serum cholesterol levels have been linked to increased all-cause mortality among the elderly.) 

Statin drug use is a double-whammy for CoQ10 synthesis and transport in the body. Not only do these drugs interfere with the generation of this compound but CoQ10 does not typically travel unbound through the blood. It is primarily bound to lipoproteins during the transport of LDL cholesterol and with less cholesterol and fewer LDL particles circulating there may be less than optimal delivery of CoQ10 to its target tissues.

Apart from medication that interferes with CoQ10 synthesis and transport normal aging may be another factor in reduced CoQ10 availability. Evidence suggests the body becomes less effective at producing CoQ10 in advanced age. It is not surprising then that some of the illnesses linked to low levels of this nutrient are more common among older people. 

As a fat-soluble compound CoQ10 supplements are best absorbed when taken with a meal that contains fat. It may be beneficial to take CoQ10 in divided doses as increasing doses can lead to reduced absorption. To get CoQ10 from dietary sources the foods highest in this nutrient are animal proteins—specifically hard-working tissues such as beef and pork heart and liver followed by muscle meats. Fish is also a good source with red-fleshed fish being higher than white fish and salmon. Nuts and seeds contain small amounts and vegetables and fruit contain the least although they do provide some CoQ10.

Owing to the fundamental role of CoQ10 in energy generation neuromuscular coordination and healthy cognitive function consider evaluating the suitability of supplementation for patients with conditions related to chronic fatigue muscle weakness and general malaise.