How to Choose and Use CoQ10 for Maximum Effectiveness

• What Is CoQ10?|
• Best CoQ10 Supplement|
• Dosage|
• Uses|
• Does CoQ10 Fight Fatigue?|
• Nutrients That Complement CoQ10|
• Keep It Simple|

With so many formulations and dosages on the market, it can be a minefield trying to figure out which is the best CoQ10 supplement.

In this article, we’ll look at what science tells us about the most effective coenzyme Q10 formulations. We’ll also investigate the best ways to use this dietary supplement and some other nutrients that complement it.

What Is CoQ10?

CoQ10 and coenzyme Q10 are the more common names for a substance known as ubiquinone, meaning “everywhere” (i.e. ubiquitous).

Everywhere is a clue to where CoQ10 is found—it’s in the mitochondria (energy production powerhouses) of all of our body’s cells. 

Not surprisingly, it’s found most abundantly in the cells of very active organs like the [1]:

• Heart
• Lungs
• Liver 
• Kidneys
• Pancreas
• Adrenal glands 

CoQ10 is also found in foods like [2]:

• Meat
• Fish
• Nuts
• Seeds
• Oils (soybean, corn, olive, and canola)
• Dairy products
• Vegetables
• Fruits
• Cereals 

Despite being so ubiquitous, the whole body contains only about 500–1,500 mg of CoQ10 (less than the weight of a jumbo paperclip), and levels decrease as we get older [1].

What Does CoQ10 Do?

CoQ10 is involved in the chain of chemical reactions that generate adenosine triphosphate (ATP), the major currency of cellular energy in the body. 

CoQ10 is a powerful antioxidant that protects and supports the mitochondria as they go about producing ATP. Without CoQ10, the amount of ATP the mitochondria can produce drops—this means less energy is available to you.

Diseases and conditions that have been associated with reduced CoQ10 levels are [3]:

• Neurodegenerative diseases (like Alzheimer’s and Parkinson’s disease)
• Fibromyalgia 
• Migraine
• Diabetes
• Cancer
• Muscular diseases 
• Heart failure

Best CoQ10 Supplement

CoQ10 supplements are available in two main forms:

• Ubiquinol
• Ubiquinone

CoQ10 typically has low bioavailability, meaning it’s difficult for the body to absorb. More research is needed to determine the best high-absorption CoQ10 formulation [4].

Most of the original research on CoQ10 supplementation was done using ubiquinone, but more recent studies suggest using ubiquinol may be a better option:

• When healthy people were given the same dose of both ubiquinol and ubiquinone, ubiquinol was more effective at raising CoQ10 blood levels [5].  
• In healthy men, ubiquinol significantly raised CoQ10 levels, while ubiquinone didn’t raise them as much [6].

That said, not everyone who takes CoQ10 will always get greater benefits from ubiquinol. In the studies above, some people responded better to ubiquinone, and some didn’t absorb any form of CoQ10 very well.

Ubiquinol has a slightly different chemical structure from ubiquinone but is still a naturally occurring active form found in the body. In fact, CoQ10 shifts back and forth between ubiquinone and ubiquinol as part of its activity within the mitochondria in cells.

The difference in CoQ10 absorption between people may be related to things like age, general health, heart health, and gut microbiota composition [7].

CoQ10 is available in some multivitamins or as CoQ10 gummies, pills, and softgels. 

In the clinic, our go-to CoQ10 supplement is Moss Nutrition Coenzyme Q10 Select.

This is our top choice because it is formulated with Bioperine, a black pepper extract (also called piperine extract) that improves the bioavailability of nutrients like CoQ10 [8, 9]. 

As a bonus, this supplement is free of gluten, and because it is formulated with bioavailability in mind, it’s more likely to be better absorbed. 

Add Fat for Maximal Uptake 

CoQ10 is a fat-soluble compound that will be better absorbed in the presence of oil or fat [10]. 

Rather than focusing on the type, it may be better to focus on taking this supplement with a meal that contains some healthy fat, like nuts, coconut oil, or oily fish. 

One study found taking soft-gel capsules of CoQ10 combined with soy oil led to better absorption [7].

What’s the Best CoQ10 Dosage?

There’s not enough data to definitively recommend a minimum or maximum dose of CoQ10. The average therapeutic dose in studies is 400 mg (200 mg twice daily) [10].

Some studies have used high doses of up to 3,000 mg a day [10], but I tend to recommend starting much lower and increasing slowly until you reach the minimum effective dose for your needs.

Side Effects and Contraindications 

Since CoQ10 is produced naturally in the body, it’s usually well-tolerated. However, some rare, mild side effects could include [10]:

• Decreased appetite 
• Diarrhea 
• Dizziness
• Indigestion
• Nausea/vomiting

Some reports suggest that CoQ10 may decrease the effectiveness of the blood-thinning drug warfarin [11]. However, another study found no negative interaction between CoQ10 and this medication [10]. 

If you’re considering taking CoQ10 and are currently on warfarin or other blood thinners, consult with your doctor first. 

What Is CoQ10 Good For?

Support for Statin Medication Users

Statin drugs (commonly prescribed to improve cardiovascular health) reduce cholesterol to support heart health at the expense of coenzyme-Q 10 levels [3, 11].

There are conflicting views as to whether low CoQ10 levels contribute to the muscle cramping and pain experienced by 10–15% of patients taking statins [3, 11, 12].

One study concluded that CoQ10 supplementation improved statin-associated muscle symptoms [13], while another didn’t [14].

Either way, CoQ10 supplementation is probably still a good idea for people on statins to replenish levels depleted by these drugs. In the clinic, we encourage it for clients on statins, particularly if they’re experiencing fatigue and muscle side effects. 

Help for Migraines

Migraine sufferers had shorter and less frequent migraines when taking CoQ10, according to one review [15].

Better Outcomes for Heart Failure Patients

Heart failure patients may live longer when supplementing with CoQ10, according to two separate studies [16, 17].

Additionally, CoQ10 appeared to be safe and improve the cost-effectiveness of heart failure treatment.

Heart disease patients were also able to exercise for longer when taking CoQ10 [18].

Fewer Depressive Symptoms

People with bipolar disorder had less depression when taking 200 mg/day of CoQ10 for eight weeks in one trial [19].

Improved PCOS Symptoms

For women with PCOS (polycystic ovary syndrome), one review found that CoQ10 supplementation was associated with significant improvements in [20]:

• Testosterone
• Fasting insulin levels
• Fasting glucose
• Insulin resistance
• Triglycerides
• Total cholesterol

CoQ10 combined with vitamin E appeared to be more effective than CoQ10 alone for improving testosterone and insulin resistance.

Better Blood Sugar Control

For people with Type 2 diabetes, CoQ10 significantly improved two markers of blood sugar control (hemoglobin A1c and fasting blood glucose), according to one review. HDL cholesterol also improved [21]. 

People with metabolic syndrome saw improved blood sugar control and less inflammation [22].

Improved Fibromyalgia Symptoms

Three trials that explored the effects of CoQ10 on fibromyalgia found [23]:

• 300 mg/day of CoQ10 for 40 days significantly improved depression scores. 
• The same dosage improved pain by 56%, the number of tender points by 44%, and overall fibromyalgia severity by 52%.
• 400 mg/day of CoQ10 for six months significantly improved physical pain scores.

Other Potential Benefits 

Developing evidence suggests a possible role of CoQ10 in:

• Reducing inflammation and oxidative stress in various diseases, including chronic kidney disease [24, 25, 26, 27]
• Improving systolic (but not diastolic) blood pressure [28]
• Improving levels of liver enzymes and inflammation in non-alcoholic fatty liver [29]
• Improving blood triglyceride levels [30]
• Improving blood flow to the thyroid [31] and reducing thyroid antibodies when taken along with other nutrients [32]
• Helping with fertility problems [33, 34, 35]

Does CoQ10 Fight Fatigue?

Since CoQ10 helps produce ATP within our mitochondria, you might assume it will improve energy levels. In practice though, the research regarding CoQ10 supplementation for fatigue is mixed. 

CoQ10 may be helpful for fatigue related to [36]:

• Fibromyalgia 
• Statin medications 
• Multiple sclerosis 
• End-stage heart failure

It’s unlikely that CoQ10 will turbo-boost your energy levels if you’re healthy. CoQ10 had no effect on energy levels in healthy adults in three out of four studies [36], and in the fourth, improvements were small and temporary [37].

Nutrients That Complement CoQ10

Taking CoQ10 with other compounds that have anti-inflammatory and antioxidant properties may yield better results than CoQ10 alone. 

Vitamin E, curcumin, fish oil, selenium, and nicotinamide adenine dinucleotide (NADH—a derivative of vitamin B3) are nutrients that may work synergistically with CoQ10. 

Here are some instances where CoQ10 works better with other nutrients.

Choosing CoQ10 Doesn’t Have to Be Complicated

Having a healthy amount of CoQ10 is important for how your cells make energy. People taking certain medications (like statins) or those who have medical conditions (like fibromyalgia and PCOS) may benefit from optimized CoQ10 levels. 

For most people who need it, the best CoQ10 supplement may be ubiquinol, 200–400 mg/day, taken with a meal that has healthy fats. Combining CoQ10 with piperine or black pepper extract may help improve absorption. 

If you’re struggling with symptoms like depression, low energy, and migraines, it’s best to look for and target root causes before reaching for CoQ10 supplements. Our team at the Ruscio Institute for Functional Health offers science-based, cost-effective care and we’re happy to help.

The Ruscio Institute has also developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.