What a difference 15 years make. They’re barely a crease on the face of time, but within their span we’ve seen movies go from DVD to the Cloud, telephones from utilities to virtual appendages, and coenzyme Q10 (CoQ10) from “niche” nutrient to veritable household name.
And Scott Steinford, executive director of the CoQ10 Association (Salt Lake City), has been around to witness it all. By the Association’s reckoning, CoQ10 is currently the fourth most consumed specialty supplement in North America, and the expectations, he says, are “for continued growth as education and awareness of its benefits are demonstrated.”
Indeed, CoQ10’s compound annual growth rate (CAGR) has held above 20% for more than the past decade and a half. And where the number of brands identified with the compound stood at 18 in 2001, the tally reached a full 123 by 2016. As for the size of the North American market, “skyrocketed” may be too dramatic a term, but there’s no denying that its ascent from an estimated 3.7 million consumers in 2001 to 16.5 million in 2016 is impressive.
As it happens, one factor that’s driven those consumers to CoQ10 is another inescapable force of change these past 15 years: the Internet. As Steinford says, “The Internet is affording consumers a lot of opportunity for education.” Recalling his own “discovery” of CoQ10 back in the era of hard-copy journals, he notes that the opportunities for diving into research then were limited to all but those with access to major libraries. But now, he says, the Internet unlocks “in a matter of moments literally thousands of studies that support CoQ10. And that’s driving demand because consumers are generating their own interest and knowledge.”
Knowledge Is Power
What knowledge are they generating? For starters, they’re becoming reacquainted with the electron transport chain they first encountered in high school biology, and with CoQ10’s role as a crucial electron carrier in it. In that capacity, CoQ10 helps cells generate ATP (adenosine triphosphate), which, as the body’s fundamental energy-transfer currency, is the stuff of life itself.
No wonder, then, that this ubiquitous compound—not coincidentally known as ubiquinone—resides in nearly every cell of the body, primarily in the mitochondria where electron transport occurs. But CoQ10 does more than carry electrons. As a natural antioxidant, it shields lipids and proteins from oxidation, and as one of the most investigated ingredients in the health space—with 3,000-plus studies referenced on PubMed, Steinford says—CoQ10 is emerging as a compound with the potential to improve everything from heart health and cognitive function to oral health, sports performance, and more.
Research has shown that long-term high doses may slow symptom progressions in early-stage Parkinson’s patients. In patients with heart failure, CoQ10 decreases hospitalizations, reduces labored breathing and edema, and increases overall quality of life, per other studies. Steinford even notes that the Q-SYMBIO Trial found that long-term CoQ10 treatment in patients with chronic heart failure safely attenuated symptoms and reduced major adverse cardiovascular events. “As more clinical studies are completed,” he says, “the ingredient will continue to be one of the most important options in the supplement market.”
The Cardiologist Connection
One sure sign of that importance is the buy-in CoQ10 gets from heart doctors. As Steinford notes, “Cardiologists are getting onboard with CoQ10 at a fairly significant rate. With more studies supporting its strength, these thought leaders are recommending it.”
A 2015 online study fielded by Research Now and commissioned by the CoQ10 Association found that 45% of cardiologists, without prompting, say they recommend CoQ10 to their patients, and that almost one in four—especially younger doctors—are eager to learn more about its efficacy and therapeutic use, Steinford says.
To no small extent, CoQ10’s future lies in these professionals’ hands—and in those of the scientific community tasked with researching it. Yet knowledge about its benefits “is still at its infancy,” Steinford maintains.
Perhaps not for long. “I recognized when I first encountered CoQ10,” he says, “that the more educated you become about it, the more it impresses you.”
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The Statin Story
Use of statins, those wildly popular cholesterol-lowering drugs, is on the rise, per the CDC. An online survey fielded by Research Now and commissioned by the CoQ10 Association (Salt Lake City) corroborates that claim with its finding that 100% of cardiologists queried prescribe statins to their patients.
But here’s the kicker: Fully 70% of those doctors also recommend that their statin patients take coenzyme Q 10 (CoQ10). Why? Because one side effect of statins is to dampen the body’s CoQ10 production, often within two weeks of statin-therapy onset. That dampening “is a known mechanism of action of statins,” says the CoQ10 Association’s Scott Steinford.
Another statin side effect—and the top reason patients often abandon therapy—is statin-associated myopathy, manifest largely as muscle cramps and pain. And this is where CoQ10 comes in: Because the enzyme is critical to energy production in energy-hungry muscles, some theorize that statin-associated myopathy may stem to some extent from statin-induced CoQ10 depletion.
While proof of a definitive link between the two remains elusive, Steinford notes that “it’s expected that a study supporting the positive benefits of CoQ10 on statin-induced cardiomyopathy will be released this year.”
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A Little Help from the Supplement Shelf
Dietary supplements, as the name suggests, supplement the diet to provide the full quantity of nutrients we need. But that description fails to capture why we supplement with CoQ10, as our bodies actually produce more of the compound than we obtain from the foods we eat.
Why do we supplement with CoQ10, then? Because our capacity to produce the enzyme endogenously isn’t invulnerable—nor does it always supply us with sufficient quantities. Stress, physical exercise, illness, and prescription drugs, like statins, all affect our ability to synthesize CoQ10 de novo; smoking depletes existing levels. Even the unstoppable passage of time takes its toll: CoQ10 production “begins to decrease by age 20,” Steinford notes. “By age 40, you’re producing typically half what you did at 20—and it goes down from there.”
Sounds grim, right? Not with the help of supplements. According to LabDoor.com, anywhere from 30 to 100 mg of our CoQ10 requirements come courtesy of sources other than our bodies. And while the top supplemental dosage offered 15 years ago was about 30 mg, Steinford says, “now the commonly recommended CoQ10 dosage for the average adult is 100 mg to 200 mg daily, with some brands offering a 600-mg capsule product.”
And if you were thinking of closing the CoQ10 gap via food, you may want to think again depending on your taste for organ meat: You’d need to eat about a kilogram of beef liver—perhaps CoQ10’s premier food source—to attain even 50 mg. And, says Steinford, “Food companies rarely fortify their products due to the high value of an effective therapeutic dose.”
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Supply and Demand
Two of the key factors driving CoQ10 demand, Steinford says, are 1) improving margins at retail, and 2) lower ingredient costs. But this wasn’t always the case.
As recently as 2001, the entirety of the CoQ10 raw-material supply was controlled by a consortium of Japanese businesses—a degree of consolidation that never bodes well for pricing. Further, a little over a decade ago, the CoQ10 market underwent a serious supply shortage. The combined effect was that top per-kilogram prices for bulk CoQ10 in 2000 and 2005, respectively, were $2,000 and $5,000 (although typical pricing hovered closer to half those amounts).
Since then, not only has the supply chain opened up—with China now supplying about 90% of the raw material and the United States shoring up the remaining 10%—but current manufacturing capacity has caught up and pumped the CoQ10 pipelines with sufficient product to support consistently strong category growth at reasonable ingredient prices. How reasonable? “Per-kilo CoQ10 prices are one-tenth what they were at the beginning of the century,” Steinford says, “and production is up almost twentyfold.”
The flipside of this scenario is that low, low prices don’t encourage suppliers to invest in the scientific research that supports and expands the market for their CoQ10 products. Current low pricing threatens further to pinch quality [ed: ital] and supply. The upshot: “The CoQ10 Association encourages manufacturers to maintain their focus on quality, science and education, and not strictly on pricing,” Steinford cautions.
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What You Buy Is What You Get
When Steinford first ventured into the CoQ10 space, most of the world regarded the compound as a pharmaceutical ingredient. Only within the past decade, he says, has it assumed its new identity as a dietary supplement.
Yet, given the differential regulatory regimes governing pharmaceuticals and supplements—and given the lingering specter of adulteration and misidentification that haunts the latter—one can forgive consumers and nutrition brands that raise safety, identity, and purity concerns vis-à-vis CoQ10.
For several reasons, however, CoQ10 confounds those concerns. First, says Steinford, CoQ10 is a single molecule that’s bioidentical to what the body produces itself; as such, a kilogram as-purchased typically assays as 98%–99% active CoQ10. “There’s no room for adulteration,” as Steinford puts it. The same can’t be said for nutritional ingredients that are blends of multiple inputs, each at risk for tampering.
And CoQ10 has its own recognized USP monograph test for assay, which Steinford describes as “very understandable, solid—and strict. It’s easy to tell what you’re getting when you’re testing for CoQ10.”
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Steinford is a CoQ10 evangelist: He truly believes that this compound has the power to better people’s health and quality of life. But he knows that spreading the good news takes work, and that industry will need to expend energy if it wants to see CoQ10 reach its potential.
“The key to the continued success of CoQ10 rests with ingredient manufacturers working together to promote science and education that support the ingredient,” he insists. Suppliers have done yeoman’s work maintaining product quality even as they reduce production costs, but “the level of benefit that this attention to production cost provides will have diminishing returns if the efforts aren’t synergized with more sustainable benefits related to research and consumer education,” he says.
And the thirst for education is out there. The CoQ10 Association’s Research Now survey found that cardiologists, in particular, “are very open to CoQ10 usage,” Steinford says. “But they need to see more proof of efficacy and quality, along with better usage education and guidelines.”
His prescription: Brand owners should “encourage their ingredient suppliers to reinvest in education and science,” he says. The ubiquity of this enzyme means that “there’s a lot yet to learn about how CoQ10 can help the body. We’ve only touched the surface.”
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