Coenzyme Q10 is the raw material used by our cells for respiration and energy production. It has other functions such as supporting antioxidant defences, regulating cell death and temperature of the body, DNA repair etc.
Mitochondria are the energy-producing units of the cells. Cellular ATP or energy production requires multiple enzymes, micronutrients and other cofactors. Dysfunction of the mitochondria is observed in peripheral neuropathy.
Coenzyme Q10 supplementation helps to ameliorate mitochondrial dysfunction and boost antioxidant defences. It is available in the oxidised form as ubiquinone or reduced form as ubiquinol.
Deficiency in CoQ10 leads to reduced ATP and increases reactive oxygen species which contribute to oxidative stress. Oxidative stress is identified as one of the causes of peripheral neuropathy.
CoQ10 is proven to help in neuropathy by reducing oxidative stress, protecting from neurotoxicity and relieving neuropathic pain.
How does Coenzyme Q10 help in Neuropathy?
Here are a few evidence-based ways by which CoQ10 benefits in neuropathy treatment:
- Improves antioxidant defenses
- Manages blood sugar levels and prevents diabetic neuropathy
- Reduces nerve pain
- Reduces inflammation
- Prevents chemotherapy induced neurotoxicity and neuropathy
- Treats and prevents statin induced neuropathy
- Protects nerve health and prevents degeneration
Coenzyme Q10 For Neuropathy: Possible Evidence-Based Benefits
Let’s explore the research assessing the possible benefits of CoQ10 in peripheral neuropathy.
1.CoQ10 may help treat and prevent diabetic neuropathy
Coenzyme Q10 levels were lower in diabetic patients than healthy individuals. This indicated that diabetic patients had the low antioxidant capacity. Poor control over blood sugar levels was associated with an increase in oxidative stress.
Interestingly, a study published in Journal of Diabetes and Its Complications, 2015 reported that CoQ10 levels were high in type 2 diabetes patients compared to non-diabetic individuals. Increase in lipid levels, high glucose levels and inflammation led to increases in oxidative stress and high Coenzyme Q10 levels. High oxidative stress was associated with increased heart risk and peripheral neuropathy.
Coenzyme Q10 levels are disturbed in diabetes patients because of oxidative stress and reduced antioxidant defences.Therefore supplementing with it may benefit in diabetic neuropathy treatment.
In an animal model of diabetic neuropathy, Coenzyme Q10 supplementation was found to lower diabetic neuropathic pain by reducing oxidative stress. It served as antioxidant and anti-inflammatory agent.
Alpha Lipoic Acid, another excellent antioxidant, is an effective supplement for treating neuropathy. CoQ10 in combination with ALA improves nerve function and neuropathy symptoms by improving antioxidant defenses.
CoQ10 serves as an excellent antioxidant and preventive strategy for type 2 diabetes. (PNAS, 2013) It prevents degeneration and damage of peripheral nerve.
These pre-clinical findings have been investigated again in patients with diabetes.
Hernández-Ojeda and colleagues treated 49 diabetic polyneuropathy patients with ubiquinone (oxidised form of CoQ10) or placebo for 12 weeks. They received 400mg ubiquinone or placebo per day. Those treated with ubiquinone experienced significant improvement in neuropathy symptom score, neuropathy impairment as well as in nerve function. A decrease in oxidative damage markers was also observed.
Researchers concluded that 12-week therapy with ubiquinone improves nerve conduction and clinical outcomes as well as reduces oxidative stress in diabetic polyneuropathy.
However a few studies have shown contrasting results.
Akbari Fakhrabadi et al. investigated the effects of CoQ10 supplementation in diabetic neuropathy. 70 patients were enrolled in the study and treated with 200mg CoQ10 per day for 12 weeks. Improvement in total antioxidant capacity, inflammatory markers and insulin sensitivity was observed. But no significant improvement in neuropathy symptoms and nerve function was observed.
Recently a study published in Journal of Global Diabetes & Clinical Metabolism, 2017 highlighted the effect of CoQ10 supplementation on DNA damage in diabetic polyneuropathy. The patients were treated with 400mg CoQ10 every four weeks for 16 weeks. The therapy resulted in significant improvement in antioxidant capacity and CoQ10 levels, but no significant effect on DNA damage was observed.
Quick Gist: High levels of oxidative stress in diabetes can cause nerve damage and peripheral neuropathy.
CoQ10 helps lower oxidative stress, reduces glucose levels and improves insulin sensitivity. These improvements can help protect nerve health. One study reports that 400mg/day of ubiquinone for 12 weeks benefits in diabetic polyneuropathy.
These findings need to be corroborated with thorough research in human studies. If taken at early stages, CoQ10 may help prevent diabetic neuropathy.
2.It can protect from neurotoxicity of chemotherapeutic agents
Coenzyme Q10 levels are low in cancer patients. It can benefit as an antioxidant supplement in addition to cancer therapy. (Molecular Syndromology, 2014)
Neurotoxicity associated with chemotherapy is one of the factors that lead to high dropout rate in cancer therapy. Coenzyme Q10 protects from such neurotoxicity.
In an experimental study, water-soluble CoQ10 reduced cisplatin neurotoxicity. Cisplatin prevented the development of new neurons, and CoQ10 was found to reverse this inhibitory activity. CoQ10 stimulated nerve growth, prevented DNA damage and offered neuroprotection.
Celebi et al. demonstrated the protective effect of CoQ10 in paclitaxel-induced peripheral neuropathy. Paclitaxel treatment increased pain sensitivity while administration of CoQ10 with paclitaxel prevented such rise in nerve pain sensations and improved pain bearing threshold.
Quick Gist: CoQ10’s neuroprotective effect protects from chemotherapy-induced neurotoxicity and prevents neuropathic pain. These findings need to be confirmed in human studies.
3.It protects from alcoholic neuropathy
Oxidative stress is one of the toxic effects of excess or chronic alcohol consumption.
Chronic alcohol consumption depletes CoQ10 levels in the liver cells and triggers inflammation in the liver. This contributes to alcohol-induced liver steatosis. (Toxicology, 2012)
Mitochondria are energy-producing units of the cell. Chronic alcohol consumption may trigger mitochondrial dysfunction and cause damage to other organs in the body.
It even disturbs mitochondrial function in the brain and causes alcohol-induced neurological disorders like neuropathy. (PLoS One, 2013)
CoQ10 supplementation may help in reducing oxidative damage in alcoholism and also protect nerve health.
Khandhare et al. demonstrated that CoQ10 relieves neuropathic pain and improves nerve function in alcoholic neuropathy. The researchers identified that there were multiple mechanisms behind this protective action of CoQ10 such as reduction of oxidative damage and pro-inflammatory agents and neuroprotective action.
Combination therapy with CoQ10 and Vitamin E resulted in better protective action against neurotoxicity caused by alcohol than CoQ10 alone.
Quick Gist: Coenzyme Q10 can strengthen antioxidant defences to combat adverse effects of alcoholism. Findings of the pre-clinical study reveal that combination of Coenzyme Q10 and vitamin E can protect from alcohol-induced neuropathy.
4.Coenzyme Q10 can help in drug-induced neuropathy
Drug-induced neuropathy accounts for 2-4% of the patient population with peripheral neuropathy; chemotherapy-associated neuropathy is a part of this group.
HIV patients who are on anti-retroviral therapy present with symptomatic neuropathy. Patients treated with stavudine (an anti-HIV medicine) are likely to develop severe neuropathy.
Amiodarone is an anti-arrhythmic medication which is known to cause demyelinating neuropathy.
Statins are medicines prescribed for high cholesterol levels and heart diseases; these are known to cause muscle weakness and neuropathy.
Water soluble formulation of Coenzyme Q10 is proven to prevent neurotoxicity (in vivo) caused by the HIV treatment-induced neuropathy (Current HIV Research, 2010).
Langsjoen and his colleagues conducted a study wherein they treated patients with heart diseases and on statin therapy with supplemental CoQ10. The patients were asked to replace statins with Coenzyme Q10 and within 12 months a significant reduction (approx. 80%) in neuropathy symptoms was observed.
The patients were on statin therapy for 28 months and were experiencing side effects such as fatigue, memory loss, dyspnea, myalgia and peripheral neuropathy. They were asked to discontinue statin therapy and were treated with 240mg CoQ10 per day initially.
The patients were followed up for more than 12 months. The prevalence of symptoms dropped significantly with therapy: fatigue reduced from 84% to 16%, memory loss reduced from 8% to 4% and peripheral neuropathy from 10% to 2%.
No adverse events were observed with statin discontinuation. These positive findings of CoQ10’s protective action on drug-induced neuropathy need to be corroborated with further human studies.
Quick Gist: HIV medications and statin drugs for long-term cause neurotoxicity and peripheral neuropathy. CoQ10 supplementation can protect from such neurotoxicity and prevent drug-induced peripheral neuropathy.
5. CoQ10 may help reduce nerve pain
Neuropathic pain or ‘burning pain’ is the most debilitating symptom of peripheral neuropathy. Chronic neuropathic pain can cause sleep disturbances and impairs quality of life.
Pre-clinical studies have proven that CoQ10 reduces neuropathic pain. Zhang et al. demonstrated that CoQ10 reduces oxidative stress and inflammatory agents to relieve neuropathic pain in type 1 diabetes. (Anesthesiology, 2013)
It can help in the prevention of diabetic neuropathy or neuropathic pain and is safe for long-term use.
Managing blood sugar levels helps reduce neuropathic pain in diabetes. But strict control of blood sugar may cause episodes of hypoglycemia (low blood sugar) and this in turn gives rise to nerve pain.
Zhang and colleagues have found that Coenzyme Q10 prevents hypoglycemia induced neuropathic pain in diabetes by normalising blood sugar levels and inhibiting nerve cell damage.
Combination of Coenzyme Q10 and low-level laser therapy may have better therapeutic outcomes in neuropathic pain than either therapy alone. (Medical Journal of the Islamic Republic of Iran, 2014)
Levetiracetam is an anticonvulsant that also has pain relieving property and is prescribed for treating painful diabetic neuropathy.
Levetiracetam has a synergistic action with Coenzyme Q10, and this combination also helps treat painful diabetic neuropathy. The combination helps reduce the effective dose of both agents by 30 folds.
Quick Gist: Coenzyme Q10 alleviates neuropathic pain by reducing oxidative stress and inflammation. Researchers suggest that early treatment with CoQ10 can help in the prevention of neuropathic pain, but this needs to be validated by human studies.
6.It is a neuroprotective agent
Mitochondrial Complex I is a respiratory complex and changes in this complex may contribute to the development of neurological diseases. Coenzyme Q10 is involved in the activity of this complex.
CoQ10 supplement works as an antioxidant and prevents disturbances in the activity of this mitochondrial complex. This activity of CoQ10 contributes to its neuroprotective activity.
Matthews and colleagues demonstrated that Coenzyme Q10 increases brain mitochondrial concentrations to protect brain health.
Though not studied in peripheral neuropathy model, CoQ10 has proven nerve-regenerating potential. When administered at early stages of inflammation, it can improve nerve regeneration and support re-myelination of nerve fibres.
Quick Gist: Coenzyme Q10 protects the brain and nervous system as an antioxidant and anti-inflammatory agent. It can help in nerve regeneration and restore nerve function in case of damage.
Bioavailability of CoQ10: Should you take Ubiquinone or Ubiquinol for Neuropathy?
All the cells in the body are capable of synthesising Coenzyme Q10 except for red blood cells. It is also available in dietary sources such as meat, fish and some veggies and these provide 3-5mg per day.
CoQ10 has a variety of names, but we will focus on two of them.
Ubiquinone is the oxidised form of CoQ10 while ubiquinol is the reduced form. When ubiquinone reaches the intestine, it is reduced to ubiquinol.
There is quite a bit of debate about the bioavailability of ubiquinone and ubiquinol. Various sources state that ubiquinol has better bioavailability than ubiquinone but a group of experts have refuted this claim.
In an animal study, ubiquinol is found to better than ubiquinone in mitigating brain-related disorders associated with CoQ10 deficiency.
A study published in Clinical Pharmacology in Drug Development, 2014 demonstrated that rise in plasma Coenzyme Q10 levels was higher with ubiquinol than with ubiquinone at the same dose. This study was supported by Kaneka Nutrients.
This comparison was between soft gel ubiquinol capsules and soft gel ubiquinone capsules. No side effects were observed.
In contrast to these studies, there have been both animal studies and human studies which have found both ubiquinone and ubiquinol equally effective in different disorders such as dry mouth syndrome, diabetes.
Also, in the studies conducted on physical activity levels in healthy individuals, ubiquinol was found to be effective in improving secondary outcomes of the study but did not have a significant effect on primary outcomes such as improvement in exercise performance and reduction in exercise-induced muscle damage etc.
There are about 500 clinical trials in the Pubmed database investigating the effects of ubiquinone. That is quite a bit of research in comparison to the number of clinical trials on ubiquinol.
The bioavailability of commercial CoQ10 (ubiquinone) formulation is poor. Since it is oil-soluble, the absorption of CoQ10 supplements can be improved by taking them after a meal containing dietary fat.
Also, gel and oil-based capsules of ubiquinone are preferred to tablets regarding absorption. (Nutrition Research, 2002) In fact, the Coenzyme Q10 or ubiquinone used in the famous Ki-Sel10 study, Gulf War Illness and Q-Symbio study is an oil based formulation with the trade name Bio-Quinone.
Studies on peripheral neuropathy in humans have utilised ubiquinone (oxidised) form. Ubiquinone and ubiquinol are interchangeable forms, and both are equally effective.
Taking oil-based ubiquinone supplements or taking ubiquinone after meals containing dietary fat helps improve its absorption.
Dosage of Coenzyme Q10 For Peripheral Neuropathy
There are very few studies in humans that have investigated the effect of CoQ10 in peripheral neuropathy. These have utilised a dose of 200mg-400mg/ day CoQ10 for 12-16 weeks.
It is fat soluble, and thus you should take it after a meal for better absorption. CoQ10 has a half-life of 36 hours.
Start with small doses and increase gradually. High doses (200mg or more) may not suit some individuals. It is advisable to work with a health practitioner to identify a dose that suits you.
Coenzyme Q10 is available in two forms: ubiquinone or the oxidised form and ubiquinol or the reduced form. The body rapidly converts ubiquinone to ubiquinol in the intestine.
Note: The symptoms and severity of peripheral neuropathy differs with every individual. This may influence the use or efficacy of dietary supplements, herbs or alternative treatments for the disorder. Please consult a health practitioner before taking CoQ10 supplements.
Side Effects & Precautions with Coenzyme Q10 Use
CoQ10 does not cause any significant side effects within recommended doses. Very mild gastric side effects have been reported with CoQ10 supplementation. (American Family Physician, 2005)
High dose (200mg or more) may not suit some individuals; please consult a health practitioner about the dose.
Safety of CoQ10 is not ascertained in pregnancy and lactation.
It is recommended to take CoQ10 if taking stain therapy but please consult a doctor about the same.
Some reports suggest that CoQ10 may interact with warfarin, but there is no conclusive evidence about the same. Please take with caution if you are taking antiplatelet medications or have a bleeding disorder.
It may have interactions with the following medications: daunorubicin, doxorubicin, blood pressure medications, timolol, blood-thinning medicines, antidepressants and cholesterol-lowering drugs.
Please consult a doctor before taking CoQ10 supplements.
Suggested Coenzyme Q10 Supplements For Peripheral Neuropathy
Please consult a health practitioner before taking any health supplement.
Ubiquinone supplements in the form of gel/softgel capsules help in increasing absorption of CoQ10. If taking tablets,powder form or other capsules that do not contain oil, it is best to consume them after a meal rich in healthy fats.
Bio-Quinon Q10 is developed by Pharma Nord Inc., US. This is the formulation that has been used in KiSel-10 and Q-Symbio study. It is an expensive supplement but can be trusted for its quality.
Buy from Amazon (US, UK, Canada)
Image Credit: Pharma Nord, Inc.
Here are a few other relatively inexpensive dietary supplements that provide ubiquinone in an absorbable form and are reported to help with peripheral neuropathy and pain by users.
|Qunol Ultra CoQ10||Doctor’s Best High Absorption CoQ10 with Bioperine|
Image Credit:Quten Research Institute
Image Credit: Doctor’s Best
|100mg ubiquinone with vitamin E in softgel capsule
Caution: Contains soy. Please read full ingredient list.
|100mg ubiquinone with black pepper extract (bioperine) and extra virgin olive oil in softgel capsules
Caution: Contains beeswax. Please read full ingredient list.
Ubiquinol is the reduced form of ubiquinone. Though it is said to be a more absorbable form, ubiquinol is likely to help very few individuals (according to CoQ10 research experts).
Ubiquinone benefits most of the population. Also ubiquinol is more expensive than ubiquinone.
|Jarrow Formulas Ubiquinol QH-Absorb||BlueBonnet CellularActive CoQ10 Ubiquinol|
Image Credit: Jarrow Formulas
Image Credit: Bluebonnet Nutrition Corporation
|100mg ubiquinol (Kaneka-QH) per softgel capsule||100mg ubiquinol (Kaneka-QH) per vegetarian softgel capsule|
Coenzyme Q10 serves as an antioxidant and protects nerve health from oxidative stress. It can help mitigate causes of peripheral neuropathy in addition to providing symptomatic relief.
In diabetic neuropathy, Coenzyme Q10 improves insulin sensitivity and blood sugar control. This lowers oxidative stress and relieves nerve dysfunction.
Three human studies have examined Coenzyme Q10’s action in diabetic neuropathy, and only one study has confirmed positive effects. And these studies have used ubiquinone, the oxidised form of CoQ10.
The antioxidant also protects from neurotoxicity and can relieve neuropathic pain. These potential benefits need to be further evaluated in human studies that examine its effect in nondiabetic peripheral neuropathy.
Have you used CoQ10 for peripheral neuropathy? Do leave your comments below.