The value of Liquid Q-Gel (Liq-Nol)

By Evan L. Lipkis MD

Q. What is Coenzyme Q-10?

A. This is a fat soluble vitamin that is found in every living cell. In 1957 Frederic Crane discovered coenzyme Q-10 in beef heart. A Nobel prize was won in 1978 by Peter Mitchell for the discovery of the role of coenzyme Q-10 in cellular energy production. Coenzyme resides in the mitochondria or the “powerhouse” of the cell. It is here that energy in the form of ATP is developed for cellular function and defense. High concentrations of coenzyme are found in the heart and the brain.

Q. Tell me a little information on congestive heart failure?

A. This is the number one cause of hospitalization in the elderly in the USA. The main cause of congestive heart failure is coronary artery disease but other causes include hypertension, heart valve disorders and cardiomyopathy (muscle problem within the heart). Obesity may also contribute to heart failure.

Major symptoms include: needing to rest on a few pillows at night, waking up at night feeling short of breath, crackles in the lungs on exam, an extra heart sound on exam, distended neck veins on exam, and a large heart on chest x-ray. Minor symptoms include: leg swelling, nocturnal cough, a large liver and a pleural effusion (fluid in the lung). The diagnosis is made with two major criteria or one major and two minor criteria. Generally if there is shortness of breath, fatigue, cough and leg swelling, then consider heart failure as a cause.

A simple and inexpensive blood test that measures a hormone called BNP (B Natriuretic Peptide) is 95 % accurate in both diagnosing heart failure and excluding it.

ACE inhibitor medicines (Altace, Zestril, Accupril for example) can decrease mortality by 50–73%. Spironolactone, a diuretic can reduce death rate by 30% in severe heart failure. Beta blockers (Coreg, Toprol XL) can also reduce heart-failure mortality by one-third. Exercise training, diuretics and a low-cholesterol, low-salt diet can be beneficial. Q-gel, an antioxidant, may also be helpful. Digoxin, Inocor Natrecor and Dobutamine help the heart pump stronger but don’t decrease mortality. These agents may reduce hospitalizations. Spironolactone, a special diuretic, helps to reduce mortality in severe heart failure patients. Cardiac Resynchronization Therapy (CRT) is a special pacemaker that allows both ventricles (the pumping chambers of the heart) to pump at the same time. In other words in selected patients this device helps the heart pump more efficiently. Sometimes automatic implantable defibrillators devices (AICD) are placed in the heart to avoid fatal heart rhythm disturbances. This device is especially helpful in heart failure patients who have had a recent heart attack. It is also helpful if the heart failure has caused a rhythm disturbance called sustained ventricular tachycardia. This heart rhythm problem can be fatal and the AICD saves lives by shocking the heart out of this bad rhythm.

If a test such as echocardiogram (looks at the heart-pumping ability) or a BNP is abnormal, an ACE inhibitor and a beta blocker should be considered. These medicines should be added even if there are no symptoms and the above tests are abnormal. Sometimes patients will cough on an ACE inhibitor and the medication needs to be discontinued. In this case “an ARB” may be tried. This class of drugs is also effective in heart failure and includes Cozaar, Diovan, Atacand, Avapro, etc. Finally, your weight should be monitored meticulously. If there is an abrupt change in your weight, then your nurse practitioner, physician assistant or physician should be contacted immediately. For example, if you gain 3 pounds quickly, then the dose on your diuretic may need to be increased.

Also consider a sleep study. Obstructing your airway during sleep may be a sign of sleep apnea. This condition may aggravate heart failure and is treatable with CPAP or continuous, positive airway pressure. In other words “you wear a mask” which allows pressurized air to keep the airway open.

Q. Can Coenzyme help heart failure?
A. Several studies have shown that high dosages of coenzyme Q-10 can reduce shortness of breath, fluid in the lungs heart palpitations, leg swelling, quality of life and much more!

Q. In Parkinson’s Disease, what happens to the levels of Coenzyme Q-10?

A. As we age levels of coenzyme begin to diminish. This process can start in the 30s. Research has demonstrated that coenzyme levels in the mitochondria are lower than in age-matched healthy individuals. We know that when Parkinson’s disease becomes evident, 80% of the cells in the Basal Ganglia have degenerated. Cell death in this movement center of the brain leads to symptoms of Parkinson’s which include tremor, rigidity, shuffling of gait and a generalized slowness in motion. While the lack of coenzyme Q-10 is unlikely to be the sole cause of Parkinson’s Disease, it may indeed be a contributing factor.

Q. Can Coenzyme Q-10 slow the course of Parkinson’s?

A. There are a few studies that may shed some light on this important question. In one trial 200 mg. of coenzyme Q-10 was used to treat Parkinson’s patients over a three month period of time. There was no effect. It was postulated that the trial was too short and the dose of coenzyme was too low. In 1994 animal experimentation revealed that coenzyme Q-10 and nicotinamide could offer cell protection against a toxin that can induce Parkinson’s Disease called MPTP. In 2002 a new study published in the Annals of Neurology by Dr. Clifford Shults and colleagues demonstrated that high dosages of coenzyme Q-10 can slow the progression of Parkinson’s Disease.

Q. Can you give me more details about this important study?

A. 80 people with Parkinson’s who were never treated were given varying doses of coenzyme Q-10. Half of the patients received a placebo and the other half received 300, 600 or 1200 milligrams of coenzyme Q-10. During this 16 month trial, patients taking 1200 mg. per day had 44% less mental and physical disability. According to Dr. Shults, “the greatest benefit was seen in activities of daily living: dressing bathing eating and walking.” In other words, these patients had greater independence. All of the dosages of coenzyme Q-10 were safe and well tolerated.

Q. What is the downside of this exciting study?

A. These results are preliminary and only involved 80 patients. More studies will be needed. Another confirmatory trial involving 400 Parkinson’s patients will be underway soon but will take years to complete.

Q. Do you think that 1200 milligrams of coenzyme Q-10 will be well tolerated?

A. Coenzyme Q-10 has not been used at these dosages in prior studies but was very well tolerated during this trial. Coenzyme is a natural substance that our own bodies generate. 300-600 mg have been used for heart failure and other neurologic diseases without significant side effects.

Q. Are there any other ways to slow the progression of Parkinson’s Disease?

A. Deep Brain Stimulation may be helpful in reducing medication for this disease and improving quality of life. A probe is inserted on both sides of the brain where Parkinson’s disease occurs. These electrodes are connected to a pulse generator under the skin. This is like a pacemaker for the brain. The patient can control the amount of current that this pacemaker generates. This concept is a definite breakthrough for Parkinson’s disease. Gene therapy may also prove useful and experiments are ongoing. A bio-engineered protein (GDNF) can be infused into the brain to help protect nerve cells and regenerate damaged ones. After a few months of treatment there has been improvement in patients. This trial only involves 10 patients and not enough data has been collected. Cox 2 inhibitors may be helpful in preventing nerve cell death and subsequent Parkinson’s Disease in mice. These drugs are normally used for arthritis but may be useful in degenerative diseases of the brain. Human studies are needed.

Q. Is it reasonable to begin treatment with Coenzyme Q-10?

A. Given that Parkinson’s is a progressive disease and other trials may take years to complete, it is reasonable to start this supplement. No significant toxicity has been seen to date. Coenzyme Q-10 has been used extensively around the world for over 40 years.

Q. What is the best preparation of coenzyme Q-10?

A. Q-Gel is an exceptional brand because the absorption is superior compared to conventional brands. The actual blood levels are important and most vitamin manufacturers do not perform absorption studies.

Q. What is the cost?

A. Coenzyme Q-10 at 1200 mg daily costs $200-$300 per month when obtained through discount stores. This price is prohibitive for most people. Additionally several tablets daily must be taken to reach the 1200 mg dosage.

Q. How can I obtain Coenzyme Q-10 at a reasonable cost with less dosing intervals?

A. Advanced Vitamins offers coenzyme Q-10 in liquid form. It is called Liquid Q-Gel or LIQ-NOL and it is a special form of Q-Gel. One teaspoon twice daily provides about 1200 mg of coenzyme per day. It is best to take the teaspoon of LIQ-NOL in juice. You may also take one teaspoon twice daily and wash it down with water since it has a honey like consistency. One bottle lasts nearly 2 months and costs $139. Therefore the average cost per month is approximately $69.50. The easy administration and lower cost makes this product useful for patients with Parkinson’s Disease and heart failure. For heart failure take 1 teaspoon daily. At this dosage, one bottle will last nearly 4 months! While the data is preliminary, coenzyme Q-10 provides the promise of safely slowing the progression of Parkinson’s disease and helping heart failure patients. Call 866-775-7628 to obtain this product. Alternatively order at our website www.DrLipkis.com.

COENZYME Q 10 Patient handout (taken from Natural Medicines/Comprehensive Database)

Q. What other names is the product known by?

A. CoQ, CoQ 10, Mitoquinone, Ubidecarenone, Ubiquinone, Q10.


Q. What is it?

A. Coenzyme Q10 (CoQ 10) is a vitamin like substance found throughout the body, but especially in the heart, liver, kidney, and pancreas. It is eaten in small amounts in meats and seafood. Coenzyme Q10 can also be made in a laboratory and is used as medicine.

Q. Is it Effective?

A. Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for COENZYME Q 10 are as follows: Effective for...
Mitochondrial disorders, inherited or acquired disorders that limit energy production in the cells of the body.

Possibly Effective for...
Congestive heart failure (CHF), in combination with other medications.
Chest pain (angina).
High blood pressure (hypertension).
Parkinson's disease.
Improving the immune system of people with HIV/AIDS.
Reducing damage to the heart from doxorubicin (Adriamycin), a chemotherapy medication.
Muscular dystrophy, an inherited disorder involving muscle wasting.
Coenzyme Q 10 deficiency (very rare).

Possibly Ineffective for...
Huntington's disease.
Improving blood sugar control in people with diabetes.

Likely Ineffective for...
Improving exercise performance.
Dental (periodontal) disease, when applied directly to the teeth and gums.

Insufficient Evidence to Rate Effectiveness for...
Breast cancer, fatigue, hair loss, male infertility, a muscle condition called "statin induced myopathy," and many other conditions.


Q. How does it work?

A. Coenzyme Q 10 is an important vitamin like substance required for the proper function of many organs and chemical reactions in the body. It helps provide energy to cells. Coenzyme Q 10 also seems to have antioxidant activity. People with certain diseases, such as congestive heart failure, high blood pressure, periodontal disease, Parkinson's disease, certain muscular diseases, and AIDS, might have lower levels of coenzyme Q 10.

Q. Are there safety concerns?

A. Coenzyme Q 10 is safe for most adults. While most people tolerate coenzyme Q 10 well, it can cause some mild side effects including stomach upset, loss of appetite, nausea, and diarrhea. It also might lower blood pressure, so check your blood pressure carefully if you have very low blood pressure. Dividing the total daily dose by taking smaller amounts two or three times a day instead of a large amount all at once can help reduce side effects.

Do not use coenzyme Q 10 if:You are pregnant or breast feeding.

Q. Are there any interactions with medications?

A. CoQ 10 might lower blood pressure. If you have high blood pressure, the dose of your blood pressure medications might need to be changed to prevent your blood pressure from going too low. Some high blood pressure medications include diltiazem (Cardizem), ramipril (Altace), hydrochlorothiazide (HCTZ), and many others. Talk to your healthcare provider about the dose of your high blood pressure medications.

CoQ 10 might DECREASE THE EFFECTIVENSS of a group of medicines called beta blockers that are used to slow the heartbeat. Some of these are atenolol (Tenormin), metoprolol (Toprol XL), propranolol (Inderal), and others.

CoQ 10 can DECREASE THE EFFECTIVENESS of the blood thinning medication warfarin (Coumadin). The dose of warfarin (Coumadin) might need to be changed. Talk to your healthcare professional about the need for blood tests and warfarin dose adjustments.

CoQ 10 might DECREASE THE EFFECTIVENESS of some cancer treatments, including radiation therapy and certain chemotherapy drugs such as cyclophosphamide (Cytoxan) and others. If you have cancer, talk to your oncologist (cancer doctor) before using CoQ 10.

Before taking CoQ 10, talk with your healthcare professional if you take these or any other medications.