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Ubiquinol - a form of CoQ10 - has been found to improve symptoms for some Parkinson's patients, and may well be a candidate for adjunctive treatment according to recent clinical research
The researchers conducted a study that lasted nearly two years. They tested a group of 58 Parkinson's patients. They divided the patients into two groups, depending upon their condition.
The first group of 26 patients was experiencing Parkinson's disease in a phase that is called the "wearing off" phase. This occurs when the levodopa drugs begin to reduce their effectiveness, and the Parkinson's symptoms begin to increase. It is typical for this 'wearing off' phase to occur after around two years on levodopa drugs.
This first 'wearing off' group - which continued to take levodopa during the study - was further divided into a CoQ10 group and a placebo group. The CoQ10 group of 14 patients was treated with 300 milligrams of ubiquinol-10 CoQ10 for 48 weeks - about 11 months. Meanwhile, 12 of the patients were treated with a placebo for the 48 weeks - again while continuing their levodopa drugs.
The second group was in the early phase of Parkinson's, and had not begun taking levodopa drugs. This group did not take the levodopa drugs during the trial.
This second group was also divided into a treatment and placebo group. The treatment group of 14 patients were treated with 300 milligrams of ubiquinol-10 CoQ10 for a total of 96 weeks - just shy of 22 months, nearly two years. The placebo group of eight early Parkinson's patients were given a placebo for the 96 week period.
Both groups were measured before and after the study period using the Unified Parkinson's Disease Rating Scale (UPDRS) index. This index is used to evaluate and measure the range of symptoms that occur with Parkinson's. Part one of the test includes cognition, behavior and mood. Part two includes a self-assessment of physical motion and control during daily tasks - such as speaking, eating, sleeping, walking and so on. Part three is the physician's assessment of these motor skills. Parts four and five of the test include gauging the severity of symptoms and the stage, along with the Activities of Daily Living evaluation.
Levodopa drug group responds to CoQ10
The researchers found that the CoQ10-treated patients in the first group - the group that continued the levodopa drugs but were experiencing a wearing off of their effectiveness - had significantly better scores on the UPDRS tests. The average difference in scores from the beginning to the end of treatment among the CoQ10 group decreased by 4.2 points, while the placebo groups UPDRS scores went up (meaning their condition worsened) by 2.9 points, despite the levodopa drugs.
This means the difference in score differences was actually 7.1.
To give you an idea of how significant this difference is, University of Maryland School of Medicine researchers tested 653 Parkinson's patients, and found the following "clinically important differences" (CID) between the following scores:
Minimal CID was 2.3 to 2.7 points on the UPDRS motor score and 4.1 to 4.5 on the UPDRS total score.
Moderate CID was 4.5 to 6.7 points on the UPDRS motor score and 8.5 to 10.3 on the UPDRS total score.
Large CID was 10.7 to 10.8 points on the UPDRS motor score and 16.4 to 17.8 on the UPDRS total score.
Thus we find that a 4.2 point reduction is significant, and a difference of 7.1 between the placebo group is significant in the scope of these CID levels.
CoQ10 reduces progression for early Parkinson's patients
Meanwhile, the early Parkinson's patients - who were treated for 96 months and were not taking levodopa drugs during that period - also scored lower on the UPDRS test compared with the placebo group. Their scores were an average of 1.2 points lower than the placebo group. This was considered by the researchers to be "statistically significant."
Note that during this period, both of the early Parkinson's groups experienced an increase in symptoms. But the CoQ10 group's progression of the disease was less than the placebo group.
Ubiquinone not so effective for Parkinson's
The above study comes on the heels of a study published last year that tested the oxidized form of CoQ10, ubiquinone. This study tested about 1,200 patients, of which about half took 1200 milligrams per day of CoQ10 or 2400 milligrams per day. The other half took a placebo. All the patients also received 1200 IU per day of vitamin E.
This study lasted for 16 months but did not show any significant benefit of this form and dose of CoQ10.
Yet other research has shown that the body's natural levels of CoQ10 are depleted among patients with Parkinson's along with other neurological conditions such as depression, chronic fatigue and others.
Oxidized verses reduced CoQ10
The two most common types of supplemented CoQ10 are ubiquinone and ubiquinol. There is also semiquinone or ubisemiquinone but these are not common in supplements.
Ubiquinone is the oxidized state of the coenzyme, while ubiquinol is the fully reduced form.
The importance of oxidized or reduced relates to CoQ10's contribution to the electron transport chain - part of the ATP cycle that our cells use to create energy. During the electron transport chain, the oxidized form of CoQ10 (ubiquinone) gathers electrons in the process and the reduced form of CoQ10 (ubiquinol) provides electrons.
Outside of the back and forth exchange of electrons, the advantage of ubiquinol over ubiquinone is that it will also neutralize free radicals, including those of lipid peroxides that can damage cells and tissues. This occurs because it provides electrons that free radicals are missing - neutralizing those molecules before they damage the body's cells and tissues.
Then of course, once the ubiquinol has reduced free radicals by donating electrons, it is now in the position of being able to gather electrons as part of the ATP process.
This is still only the thesis of many scientists on precisely why ubiquinone doesn't work as well as ubiquinol for Parkinson's disease. Its precise mechanism has yet to be fully determined, just as the precise cause for Parkinson's has yet to be fully determined. And this doesn't meant that ubiquinol is better than ubiquinone in all cases. It simply depends upon the situation.
CoQ10 with creatine
Another study with Parkinson's found that CoQ10 plus creatine was able to significantly reduce Parkinson's symptoms. In this study - from China's Weihai Municipal Hospital and Medical College - 75 Parkinson's disease patients were tested for 12 and 18 months.
The patients were randomized and given either a placebo or a combination of 10 grams of creatine monohydrate and 300 milligrams of CoQ10 per day.
The combination of creatine and CoQ10 resulted in reduced Parkinson's cognitive symptoms as assessed by the Montreal Cognitive Assessment (MoCA). This occurred at both 12 months and 18 months. The researchers also found that the combination therapy also resulted in significantly reduced plasma phospholipid levels within the bloodstream of the Parkinson's disease patients.
Unfortunately, I could not determine whether the CoQ10 used was ubiquinol or ubiquinone from the paper. But I have contacted the lead researcher and will update this article when I find out. However, it is my guess that the reduced form of CoQ10 was used, as the lower phospholipids has been linked with lower levels of lipid peroxidation, and from the study above, ubiquinol has been shown to be effective in Parkinson's.
Where does CoQ10 come from?
Besides the chemical constructs and the difference between ubiquinol and ubiquinone, CoQ10 is essentially produced within the cells (endogenous), but can also be obtained from a variety of foods (exogenous). Plant-based food sources include nuts, parsley and broccoli, sesame seeds, soybeans, vegetable oils and many other foods in smaller amounts.
The production of bile acids by the liver apparently increases our levels of endogenous CoQ10.
In terms of supplementation, there is a great variety of CoQ10 supplements, and a 2004 ConsumerLabs study found that some CoQ10 supplements actually contained very little of the nutrient. This combined with the question of whether ubiquinol or ubiquinone was supplemented is likely why so many of the studies on CoQ10 have resulted in varying success.
Then there is the question of whether the supplement source is bioidentical with our digestive tracts and will thus be absorbed well. While there are synthesized forms of CoQ10, some brands offer ubiquinol produced by yeast. This form - produced by living organisms - would likely offer the greatest absorption in my opinion.
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Shulman LM, Gruber-Baldini AL, Anderson KE, Fishman PS, Reich SG, Weiner WJ. The clinically important difference on the unified Parkinson's disease rating scale. Arch Neurol. 2010 Jan;67(1):64-70. doi: 10.1001/archneurol.2009.295.
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Li Z, Wang P, Yu Z, Cong Y, Sun H, Zhang J, Zhang J, Sun C, Zhang Y, Ju X. The effect of creatine and coenzyme q10 combination therapy on mild cognitive impairment in Parkinson's disease. Eur Neurol. 2015;73(3-4):205-11. doi: 10.1159/000377676.
CONSUMERLAB.COM FINDS DISCREPANCIES IN STRENGTH OF COQ10 SUPPLEMENTS: Increasingly Popular Supplement, But Health Professionals and Consumers Cautioned To Check Brands -- 2004.