I've reached the point of exhaustion on research. I feel I have a good a reasonable good grasp on everything, except CoQ10. And interestingly out of all the drugs and supplements discussed in this forum it is one discussed relatively much less than virtually all the other supplements and drugs. It's arguably one of the most popular supplements on the market. Some of this information overlaps with a separate thread on supplements started by @smurtlaw but I feel it's a significant supplement to warrant it's own thread.
On its face, being a powerful antioxidant and moderate anti-inflammatory, one would think it is most likely anti-cancer and therefore anti-PCa and especially a "no-brainer" if you are on statins. But a more recent deep-dive has left me scratching my head moreso than any other substance (more than Metformin, LOL.)
Let me first dispel what I consider in my opinion after exhaustive research to be some general myths regarding CoQ10 as it regards to statin usage.
Fact: Statins reduce the bodies ability to produce CoQ10.
Myth: CoQ10 reliably eliminates Myalgia caused by statins. In fact it has not been shown to be a reliable way to prevent myalgia (muscle pain side effect) in statin users. There have been studies that go both ways but I found the more recent the study, the more the trend was toward CoQ10 not having a reliable significant benefit.
sciencedirect.com/science/a...
"This systematic review and meta-analysis did not demonstrate that CoQ10 supplementation was beneficial for patients with statin-associated muscle pain or improved adherence to statin therapy."
So I think it's safe to say we can disregard the necessity for CoQ10 supplementation to offset statin-induced myalgia. Not to say 100% of people taking it won't benefit from it but the SOC practice these days is to switch to a different statin and/or adjust the dose. Not tell patients to take CoQ10 supplements.
Furthermore, for those worried about CoQ10 deficiency causing other issues...
Fact: The average amount of CoQ10 coming from a person's diet is 5-10 mg a day.
The Mayo Clinic's stance is the following:
"If you are worried that your coenzyme Q10 level is low, you can have it checked with a blood test at your doctor’s office. If it is lower than normal, then you may first want to consider making changes to your diet. For most people, eating at least five fruits and vegetables a day, fish two to three times a week, and nuts two to three times a week keeps their coenzyme Q10 level normal, even if they are taking a statin."
newsnetwork.mayoclinic.org/...
This does not mean though, despite a good diet, if you have significantly deficient CoQ10 serum levels and/or serious cardiovascular health issues, a supplement is not possibly beneficial. If it is, very small doses in the 25-50 mg range may be all that is needed to mimic healthy levels normally achieved by a healthy diet. Not these doses in the 100-300 mg that are commonly marketed to save people from their statin-induced myalgia.
Now on to the main topic: What about CoQ10 supplements regarding their ability to slow the progression of PCa or reduce risk of recurrence?
For me the jury is still out. I tend to lean toward a philosophy of "when in doubt, leave it out." A search for studies on CoQ10 and cancer, especially Prostate Cancer, shows conflicting evidence. I found very little evidence (so far) showing a clear benefit to CoQ10 supplementation and slowing PCa progression/recurrence such as this:
" CoQ10 therapy also significantly reduced serum PSA level by 33·0 (95 % CI 27, 40) % (P= 0·002)."
pubmed.ncbi.nlm.nih.gov/231...
But as you search further, it's very hard to find clear evidence of benefit. To me, this study's conclusion best sums up the current state of clinical evidence regarding CoQ10 and Prostate Cancer.
"The results suggest the possibility that moderate levels of circulating CoQ10 may be optimal for the reduction of prostate cancer risk; however, the findings were weak and not statistically significant."
ncbi.nlm.nih.gov/pmc/articl...
"However, a subsequent study in prostate cancer found no association between circulatory CoQ10 status and the risk of developing the disease."
mdpi.com/2076-3921/10/5/759...
In a separate thread about CoQ10, Hidden presented a hypothesis that the beneficial effect of statins on hampering PCa was indeed it's ability to lower CoQ10 levels! Unfortunately there are no human cohort trials to back this up but it is a very interesting hypothesis that casts doubt on the potential benefit of taking CoQ10 as part of an anti-PCa supplement regimen.
aacrjournals.org/cancerres/...
"Tumor cells often rewire specific metabolic pathways to negotiate stresses associated with their mutational burden/genetics or microenvironment. The mevalonate (or isoprenoid) pathway is one such example, as enzymes within the pathway are overexpressed in tumors to support production of cholesterol, coenzyme Q (CoQ), and other biomolecules. ..,
In vivo metabolic tracing to demonstrate that pancreatic ductal adenocarcinoma (PDAC) tumors rely on the mevalonate pathway to synthesize CoQ de novo. Targeting this pathway with statins induces redox stress in cells, and cotreatment of mice with simvastatin and a mitogen-activated protein kinase (MEK) inhibitor strongly enhanced apoptosis in pancreatic tumors. The authors first observed that statin treatment inhibited the growth of PDAC cells in vitro, regardless of serum availability. However, minimal cholesterol is synthesized by cancer cells under serum replete conditions, so this growth phenotype suggested that statin treatment compromised PDAC cell growth through an alternate mechanism than cholesterol depletion. The mevalonate pathway fuels production of several biomolecules important for cell function beyond cholesterol, including isoprenyl units for posttranslational modifications, dolichols that are involved in N-glycosylation, and the isoprenoid side-chain of CoQ. Upon looking deeper into their labeling studies and mass spectrometry data, the authors observed that CoQ was highly synthesized, in contrast to dolichols (at least in vitro). Statins potently reduced CoQ abundance and biosynthesis, suggesting that inhibition of CoQ synthesis was compromising cell growth."
A study regarding CoQ10 and Breast Cancer and anti-oxidants (in conjunction with chemotherapy) seems to (loosly) back the above up.
pubmed.ncbi.nlm.nih.gov/318...
"There were indications that use of any antioxidant supplement (vitamins A, C, and E; carotenoids; coenzyme Q10) both before and during treatment was associated with an increased hazard of recurrence."
It's unfortunate there is no "silver bullet" out there. With that in mind, my focus tends to be more on eliminating anything that has the potential to have a harmful effect regarding PCa (or no significant evidence of being beneficial.)
Initially I was pro-CoQ10. But as of now, my own opinion is that CoQ10 supplementation should be considered more for people with cardiovascular health risks (and proven extreme low CoQ10 serum levels) and that maintaining moderate healthy blood levels through low doses probably does not risk promoting PCa. While high dosages may carry with it more potential risk than reward, the degree of which is basically unknown. Maybe essentially as far as PCa CoQ10 supplementation "doesn't significantly matter one way or the other?" What do others think?
Is Simvastatin more effective than the other statins, against PCa?
For those on statins: adding dipyridamole might be a good idea
Statins and prostate cancer
