Nutraceuticals for Concussion Part 4: Coenzyme Q10 / Ubiquinol

Concussions are highly challenging to treat and there are very few evidence-based interventions that have been shown to consistently shorten recovery times. It is important for the sports medicine practitioner to have as many tools in their toolbox as possible and to have a solid understanding when these tools may be effective. I have seen many nutritional supplements proposed for concussions, and I believe that they have a potential role in concussion management. I decided to conduct a review of the current literature exploring the evidence and logic behind the more common supplements used. This article will be the fourth in this series, “Nutraceuticals for Concussion…”

This was written in 2016. I will try to update this post if new information comes out since this was written, but please be aware that this a information may become outdated before I am able to do so.

Again…the purposes of my blog posts are to facilitate thought and discussion or perhaps even motivate research to answer the remaining questions on this topic. That is all.  If you think that you have a concussion, please go see a concussion specialist.

Let’s get to know Coenzyme Q10…

Coenzyme Q10 is considered a pseudo vitamin because it can be synthesized endogenously (the body can make it). It exists in a reduced form (ubiquinol) and in an oxidized form (ubiquinone).  It is an essential enzyme cofactor in the electron transport chain, which is how mitochondria produce ATP via aerobic cellular respiration. In short, CoQ10 plays a vital role in sustaining mitochondrial energy production [1-4]. CoQ10 supplementation has been shown to be beneficial for some health problems related to defective cellular metabolism / mitochondrial dysfunction. Ultimately the proposed mechanism of action in these settings is through improved ATP production.

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(Image Credit: http://ispub.com/IJIM/9/2/14028#)

CoQ10 also appears to have antioxidant qualities, therefore likely being of benefit in the setting of highly oxidative states [5-8].

Dietary supplementation with CoQ10 increases brain levels in animal studies, however no human studies have been completed [9, 10]. With this in mind, we can understand theoretically how adding CoenzymeQ10 to our diet (via food or supplements) can enhance mitochondrial function in the brain and therefore ATP availability to the brain’s cells.

Studies looking at healthy humans have not been able to show improved cognition with CoQ10 supplementation [10, 11]. This may be much different in the concussed brain, however, because it is in the midst of an “energy crisis” (or an ATP crisis). Dysfunctional ATP production and altered glucose metabolism are central to concussion pathophysiology . This is why patients have symptoms (headaches, fatigue, dizziness etc.) when they are using their brain’s energy stores (via cognitive exertion) after a concussion. Oxidative damage also plays a key role in concussion pathophysiology, and CoQ10 is an antioxidant.  There is certainly some logic for a potential benefit here…CoQ10 can cross the blood brain barrier, it can support the production of ATP, it can mitigate oxidative damage, and a concussion represents an energy deficit + an oxidative state.

CoQ10 has been studied in regards to migraine headaches and shows some promise, but the evidence is not strong. It has been shown to be associated with a significant reduction in migraine frequency when taken regularly [12, 13]. In another study, it was demonstrated to be particularly effective for pediatric migraines (6-17 years old), whose plasma levels were found to be low [14]. Improvement in headache frequency and severity was observed in these subjects.

CoQ10 has also been studied in the setting of Huntington’s Disease and Parkinson’s Disease (Animal Models) with promising results. There was also a synergistic effect when combined with creatine [9, 15-17]. Here is my blog post on creatine for concussions.

I was unable to identify a single study directly examining CoQ10 supplementation and concussion recovery or post-traumatic headaches in humans. I think that there is enough theoretical logic here that it should be examined more closely.

Dosing of CoQ10 is still not strongly founded on research, but 1-3mg/kg per day has been recommended in the migraine literature [4]. It seems to be better absorbed when taken with meals. CoenzymeQ10 also appears to have a favorable side effect profile with less than 1% of subjects having side effects, which has consisted of dyspepsia, nausea, and diarrhea [12]. It has been shown to interact with certain medications, including Warfarin and theophylline, so I would not use it in patients on these medications.

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I generally prefer foods over supplements. Foods that are high in CoQ10 include terrestrial meats such as beef, pork, and chicken.  Heart seems to have the highest amount, followed by liver, then by muscle tissue. Fish has moderate amounts, though considerably less than land animals. Plant based foods have relatively less CoQ10 content.

It appears that increasing CoenzymeQ10 intake has a lot of potential as an effective tool to have in the concussion practitioner’s toolbox…Whether it is through supplementation or through one’s diet.

To go further down the rabbit hole …  http://examine.com/supplements/Coenzyme+Q10/

Thanks for reading!

 

 

  1. Tepper, S.J., Nutraceutical and Other Modalities for the Treatment of Headache. CONTINUUM: Lifelong Learning in Neurology, 2015. 21(4, Headache): p. 1018-1031.
  2. Sun-Edelstein, C. and A. Mauskop, Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments. Headache: The Journal of Head and Face Pain, 2011. 51(3): p. 469-483.
  3. Rajapakse, T. and T. Pringsheim, Nutraceuticals in Migraine: A Summary of Existing Guidelines for Use. Headache: The Journal of Head and Face Pain, 2016. 56(4): p. 808-816.
  4. Daniel, O. and A. Mauskop, Nutraceuticals in Acute and Prophylactic Treatment of Migraine. Current treatment options in neurology, 2016. 18(4): p. 1-8.
  5. Bentinger, M., K. Brismar, and G. Dallner, The antioxidant role of coenzyme Q. Mitochondrion, 2007. 7: p. S41-S50.
  6. Forsmark-Andrée, P., et al., Lipid peroxidation and changes in the ubiquinone content and the respiratory chain enzymes of submitochondrial particles. Free Radical Biology and Medicine, 1997. 22(3): p. 391-400.
  7. Mukai, K., S. Kikuchi, and S. Urano, Stopped-flow kinetic study of the regeneration reaction of tocopheroxyl radical by reduced ubiquinone-10 in solution. Biochimica et Biophysica Acta (BBA)-General Subjects, 1990. 1035(1): p. 77-82.
  8. Tomasetti, M., et al., Coenzyme Q 10 enrichment decreases oxidative DNA damage in human lymphocytes. Free Radical Biology and Medicine, 1999. 27(9): p. 1027-1032.
  9. Matthews, R.T., et al., Coenzyme Q10 administration increases brain mitochondrial concentrations and exerts neuroprotective effects. Proceedings of the National Academy of Sciences, 1998. 95(15): p. 8892-8897.
  10. Sumien, N., et al., Prolonged intake of coenzyme Q10 impairs cognitive functions in mice. The Journal of nutrition, 2009. 139(10): p. 1926-1932.
  11. Food and D. Administration, Guidance for industry: estimating the maximum safe starting dose in initial clinical trials for therapeutics in adult healthy volunteers. Center for Drug Evaluation and Research (CDER), 2005.
  12. Rozen, T., et al., Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia, 2002. 22(2): p. 137-141.
  13. Sandor, P., et al., Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology, 2005. 64(4): p. 713-715.
  14. Slater, S.K., et al., A randomized, double-blinded, placebo-controlled, crossover, add-on study of CoEnzyme Q10 in the prevention of pediatric and adolescent migraine. Cephalalgia, 2011. 31(8): p. 897-905.
  15. Fornai, F., et al., Parkinson-like syndrome induced by continuous MPTP infusion: convergent roles of the ubiquitin-proteasome system and α-synuclein. Proceedings of the National Academy of Sciences of the United States of America, 2005. 102(9): p. 3413-3418.
  16. Yang, L., et al., Combination therapy with coenzyme Q10 and creatine produces additive neuroprotective effects in models of Parkinson’s and Huntington’s diseases. Journal of neurochemistry, 2009. 109(5): p. 1427-1439.
  17. Beal, M.F., Neuroprotective effects of creatine. Amino Acids, 2011. 40(5): p. 1305-1313.

 

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