CoQ-10 Genetics, Statins and Pain
- Thomas McKnight, MD, MPH, MDIV
- Aug 3, 2020
- 1 min read
Years ago, while working at an Air Force (AF) base, four active duty members came to see me with diffuse muscle pain in their legs, thighs, arms, and back. They were not having cardiac or allergic reactions. Unable to complete the required annual 1.5-mile fitness run due to the pain, each was medically boarded out of the military. In an attempt to find a cause, two of the patients had muscle biopsies...unremarkable results. The only common variable among the four was that all were taking a statin for high cholesterol.
Statins replace HMG-CoA in the liver, thus disturbing the pathway for making low density lipoproteins (LDL), the 'bad' cholesterol. Unfortunately, HMG-CoA is also critical for the Mevalonate Pathway which makes ubiquinone (CoQ-10) that becomes ubiquionol and is vital for producing mitochondrial energy in each cell, especially muscle cells. If a person is genetically compromised at the gene that converts the inactive to the active CoQ-10 then they will have 'just enough' CoQ-10 for daily living. Medication that upstream blocks HMG-CoA lowers ubiquinol levels that may have been sub-optimal from the beginning.
The four AF individuals were having a genetic reaction, not an allergic one. Treatment is simple - prophylactically take the active form of CoQ-10, especially if started on a statin and having muscle discomfort, primarily of the legs.
Image Credit: "Generic marathon photo" by Danielle Walquist Lynch is licensed under CC BY 2.0
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