No RDI levels have been established but there has been some speculation as to possible deficiency signs and symptoms. These include fatigue, muscle aches and pains and chronic gum disease. Coenzyme Q10 297
Based on biopsy and/or serum samples, it has been observed that relative CoQ10 deficiency is associated with:
• congestive heart failure (Sole &Jeejeebhoy 2002, Spigset 1994a)
• cardiomyopathy (Mortensen et al 1990)
• hypertension (Karlsson et al 1991)
• ischaemic heart disease (Karlsson et al 1991)
• hyperthyroidism (Bianchi et al 1999)
• breast cancer (Folkers et al 1997). At this stage it is still unclear whether an observation of relative deficiency in a particular disease state can be interpreted as part of the aetiology of that disease or whether lowered levels are a consequence of disease. In heart failure the situation is somewhat clearer, as patients with more advanced heart failure have significantly lower CoQ10 levels than those with less advanced conditions (Mortensen 1993). A deficiency state may result from:
• impaired or reduced synthesis due to nutritional deficiencies, advancing age or medication use
• interactions with drugs — there is clinical evidence that lovastatin, pravastatin and simvastatin reduce CoQ10 status in humans, which may in part explain the incidence of side-effects, particularly myopathy, associated with their use (Bargossi et al 1994a, b, Folkers et al 1990, Mortensen et al 1997). Clinical evidence also suggests that use of gemfibrozil and other fibric acid derivatives reduce CoQ10 levels (Aberg et al 1998). In vitro evidence suggests that other drugs, such as clonidine, hydralazine, hydrochlorothiazide, methyldopa, metoprolol and propranolol, may also decrease endogenous production of CoQ10 (Kishi et al 1975). Other sources cite tricyclic antidepressants as further medicines that can reduce CoQ10 status (Pelton et al 1999)
• genetic or acquired defects in synthesis or utilisation
• inadequate intake or biosynthesis to meet increased requirements resulting from illness or excess physical exertion.
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