Alpha lipoic acid (ALA) and coenzyme Q10 (CoQ10) are naturally occurring compounds involved in cellular energy production and antioxidant defence. Both are synthesised by the body and available as food supplements in the UK. ALA is a unique antioxidant that works in both water- and fat-soluble environments, whilst CoQ10 plays a critical role in mitochondrial ATP production. They are often taken together for potential benefits in cardiovascular health, metabolic control, and neuroprotection, though robust evidence for synergistic effects remains limited. This article examines their mechanisms, dosing, safety, and suitability for different patient groups.

What Are Alpha Lipoic Acid and CoQ10?

Alpha lipoic acid (ALA) and coenzyme Q10 (CoQ10) are naturally occurring compounds that play essential roles in cellular energy production and antioxidant defence. Both substances are synthesised within the body but are also available as dietary supplements, classified as food supplements rather than licensed medicines in the UK.

Alpha lipoic acid is a sulphur-containing fatty acid found in mitochondria, the energy-producing structures within cells. It functions as a cofactor for several mitochondrial enzymes involved in converting glucose into usable energy. ALA is unique among antioxidants because it is both water- and fat-soluble, allowing it to work throughout the body. It also has the capacity to regenerate other antioxidants, including vitamins C and E, and glutathione. Small amounts of ALA are present in foods such as red meat, organ meats, and certain vegetables like spinach and broccoli, though supplemental doses are considerably higher than dietary intake.

Coenzyme Q10, also known as ubiquinone, is a vitamin-like substance present in virtually every cell of the body. It plays a critical role in the electron transport chain within mitochondria, facilitating adenosine triphosphate (ATP) production—the primary energy currency of cells. CoQ10 also acts as a potent antioxidant, protecting cell membranes and lipoproteins from oxidative damage. The body's natural production of CoQ10 appears to decline with age, and certain medications, particularly statins, can reduce endogenous levels. However, it's important to note that while these reductions can be measured, the clinical significance of supplementation remains uncertain. Dietary sources include oily fish, organ meats, and whole grains, though supplementation provides substantially higher concentrations.

Both compounds are researched for their potential roles in conditions associated with mitochondrial dysfunction, oxidative stress, and metabolic disturbance, including cardiovascular disease, diabetes, and neurodegenerative disorders.

Benefits of Taking Alpha Lipoic Acid and CoQ10 Together

The rationale for combining alpha lipoic acid and CoQ10 centres on their complementary mechanisms in supporting mitochondrial function and reducing oxidative stress. While each compound has individual benefits, it's important to note that there is no robust clinical evidence that combining these supplements provides synergistic effects beyond what might be achieved with either alone.

Cardiovascular health is one area where both supplements have been studied. CoQ10 has been investigated for supporting heart function, particularly in individuals with heart failure, though NICE guidance (NG106) does not recommend CoQ10 as standard treatment for heart failure or cardiomyopathies. ALA may potentially improve endothelial function and reduce inflammation, both of which are important in cardiovascular disease prevention. Some evidence suggests that ALA might improve lipid profiles and reduce markers of oxidative stress in individuals with metabolic syndrome, though more research is needed.

Metabolic and glycaemic control represents another potential benefit. Alpha lipoic acid has been investigated for its effects on insulin sensitivity and blood glucose regulation in type 2 diabetes. It may enhance glucose uptake in cells and reduce symptoms of diabetic peripheral neuropathy, though evidence is strongest for intravenous administration, with more modest and uncertain benefits from oral supplementation. CoQ10 has been studied for potential improvements in endothelial dysfunction and oxidative stress in diabetic patients. Neither supplement is recommended in NICE guidance for diabetes management.

Neuroprotection and cognitive function are areas of emerging interest. ALA can cross the blood-brain barrier and may protect neurons from oxidative damage. CoQ10's ability to cross the blood-brain barrier in humans is less established. Preliminary research suggests potential benefits in conditions such as Parkinson's disease, Alzheimer's disease, and age-related cognitive decline, though robust clinical trial evidence remains limited.

Energy and fatigue are commonly cited reasons for supplementation. Individuals with chronic fatigue syndrome, fibromyalgia, or mitochondrial disorders may report subjective improvements, although high-quality evidence is lacking. Patient responses vary considerably, and placebo effects cannot be excluded.

Recommended Dosage and How to Take Them

Dosage recommendations for alpha lipoic acid and CoQ10 vary depending on the condition being addressed, individual patient factors, and the formulation used. It is important to note that these supplements are not licensed medicines in the UK and are classified as food supplements, meaning they are not subject to the same regulatory scrutiny as prescription medications. Product quality can vary, so purchasing from reputable UK suppliers is advisable.

Alpha lipoic acid is typically taken in doses ranging from 300 mg to 600 mg daily. For diabetic neuropathy, clinical trials have most commonly used 600 mg once daily, usually administered in the morning on an empty stomach to enhance absorption. ALA is available in both R-lipoic acid and racemic (R/S) forms; the R-form is considered more bioavailable, though it is also more expensive and its clinical superiority over the racemic form used in most studies remains unestablished. Taking ALA with food may reduce absorption, so it is generally recommended to take it at least 30 minutes before meals.

Coenzyme Q10 is commonly supplemented at doses between 100 mg and 300 mg daily, though some individuals, particularly those with heart failure or taking statins, may use higher doses under medical supervision. CoQ10 is fat-soluble, so absorption is significantly improved when taken with a meal containing dietary fat. Ubiquinol, the reduced form of CoQ10, is often marketed as more bioavailable than ubiquinone, particularly in older adults or those with absorption issues, though both forms appear effective.

Timing and combination: There is no established protocol for taking ALA and CoQ10 together. A practical approach is to take ALA in the morning on an empty stomach and CoQ10 with breakfast or lunch to optimise absorption. Some individuals prefer to take both supplements together with a fatty meal, accepting a potential reduction in ALA absorption for the sake of convenience.

Duration: Benefits, if they occur, may take several weeks to months to become apparent. It is advisable to trial supplementation for at least 8–12 weeks before assessing efficacy. Patients should consult their GP or a registered dietitian before starting supplementation, particularly if they have underlying health conditions or are taking other medications.

These supplements are not recommended for children unless under specialist supervision. Keep all supplements out of reach of children, as overdose cases have been reported.

Potential Side Effects and Safety Considerations

Both alpha lipoic acid and CoQ10 are generally well-tolerated, with a favourable safety profile in most individuals. However, as with any supplement, side effects can occur, and certain precautions should be observed.

Alpha lipoic acid side effects are typically mild and may include:

• Gastrointestinal symptoms: Nausea, vomiting, abdominal discomfort, or diarrhoea, particularly at higher doses

• Hypoglycaemia: ALA may lower blood glucose levels, which is beneficial for diabetics but poses a risk if combined with antidiabetic medications. Blood glucose should be monitored, and medication doses may require adjustment

• Skin reactions: Rash or itching has been reported in some individuals

• Thiamine deficiency: Chronic high-dose ALA may theoretically interfere with thiamine (vitamin B1) metabolism, particularly in individuals with alcohol use disorder

• Insulin autoimmune syndrome: Rarely, ALA has been associated with this condition causing unexpected hypoglycaemia; seek urgent medical advice if experiencing unexplained low blood sugar

Coenzyme Q10 is considered very safe, with few reported adverse effects. Possible side effects include:

• Gastrointestinal upset: Mild nausea, diarrhoea, or loss of appetite

• Insomnia or restlessness: Some individuals report difficulty sleeping if CoQ10 is taken late in the day

• Skin reactions: Rarely, rash may occur

Drug interactions are an important consideration. CoQ10 may reduce the effectiveness of warfarin, potentially lowering INR values and requiring closer monitoring. ALA may potentiate the effects of insulin and oral hypoglycaemic agents, increasing the risk of hypoglycaemia. Patients taking antioxidant supplements during chemotherapy should discuss this with their oncology team, as theoretical concerns exist about potential interference with treatment efficacy.

Contraindications and cautions: Pregnant or breastfeeding women should avoid these supplements due to insufficient safety data. Individuals with thyroid disorders should use ALA cautiously, as there is limited evidence suggesting it might theoretically interfere with thyroid hormone metabolism. Patients on levothyroxine should consult their GP before starting ALA. Patients undergoing surgery should inform their surgical/anaesthetic team and consider discontinuing supplementation at least two weeks beforehand, following local hospital policy for non-essential supplements.

When to seek medical advice: Patients should contact their GP if they experience severe gastrointestinal symptoms, signs of hypoglycaemia (sweating, tremor, confusion), allergic reactions, or any unexpected symptoms after starting supplementation. Suspected adverse reactions can be reported to the MHRA Yellow Card Scheme.

Who Should Consider Alpha Lipoic Acid and CoQ10 Supplements?

While alpha lipoic acid and CoQ10 are widely available over the counter, supplementation is not appropriate for everyone, and the evidence base varies considerably across different conditions. Certain groups may derive more benefit than others, though individualised assessment is essential.

Individuals taking statin medications represent a group who may consider CoQ10 supplementation. Statins inhibit HMG-CoA reductase, an enzyme involved in both cholesterol and CoQ10 synthesis, potentially leading to reduced CoQ10 levels. While evidence is mixed and inconsistent regarding whether CoQ10 supplementation improves statin-associated muscle symptoms, some patients report subjective improvement in muscle pain and fatigue. There is no official NHS recommendation for routine CoQ10 use in statin users, but it may be considered on an individual basis.

People with type 2 diabetes or non-diabetic hyperglycaemia (pre-diabetes) may consider alpha lipoic acid, particularly if they have symptoms of peripheral neuropathy (tingling, burning, or numbness in the extremities). Some evidence supports ALA's role in improving nerve conduction and reducing neuropathic pain, though it is not a first-line treatment. NHS and NICE guidance recommend duloxetine as first-line pharmacological treatment for painful diabetic neuropathy. Blood glucose monitoring is essential if using ALA, and supplementation should be discussed with a diabetes specialist.

Individuals with cardiovascular disease, particularly heart failure, may consider CoQ10. Some studies suggest improvements in exercise capacity and quality of life, though it should complement, not replace, evidence-based medical therapy. NICE guidance (NG106) does not recommend CoQ10 as standard treatment for heart failure.

Older adults experiencing age-related decline in energy, cognitive function, or mitochondrial efficiency might consider these supplements, though expectations should be realistic. The evidence for anti-ageing benefits is largely theoretical.

People with chronic fatigue or fibromyalgia sometimes report subjective improvements, though placebo effects cannot be excluded, and evidence from controlled trials is limited.

Who should avoid supplementation: Individuals with well-controlled conditions on stable medication regimens may not require supplementation. Those with multiple comorbidities, polypharmacy, or complex medical needs should seek specialist advice before starting. Patients on warfarin, insulin/sulfonylureas, or levothyroxine should consult their healthcare provider before use. Supplementation should never replace a balanced diet, regular physical activity, or evidence-based medical treatment. Patients should discuss supplementation with their GP or pharmacist to ensure it is safe and appropriate for their individual circumstances.

Frequently Asked Questions