Covid-19 and Selenium and Coenzyme Q10

The individual’s status of selenium and Coenzyme Q10 may be a decisive factor in his or her immune system’s response to the SARS-CoV-2 virus that causes the acute respiratory distress of a Covid-19 infection.

Corona virus
A research review shows that selenium and CoQ10 supplementation has positive effects on the free radical-induced oxidative stress and the inflammation associated with patients with COVID-19 disease.

In particular, immune system cells require adequate selenium and Coenzyme Q10 to protect against oxidative stress and to modulate the inflammatory effect.

This is the conclusion of the authors of a 2021 review of the relevant research literature [Hargreaves & Mantle].

Iain R. Hargreaves, a biochemistry faculty member in the Pharmacy and Biomolecular Sciences Department of the Liverpool John Moores University, together with the medical doctor David Mantle, has written that adequate selenium status and adequate Coenzyme Q10 status may be important factors:

  • in the way the immune system initially responds to the Covid-19 virus
  • in the way that the resulting inflammation is subsequently resolved

In their 2021 review, Hargreaves and Mantle have emphasized the effect of sub-optimal status of selenium and Coenzyme Q10 on inflammation and oxidative stress [Hargreaves & Mantle 2021].

Hargreaves and Mantle reach the conclusion that optimal status of both selenium and Coenzyme Q10 is necessary for effective prevention and treatment of Covid-19 infections. Selenium and Coenzyme Q10 are decisive in two ways:

  • the maintaining of immune system balance against Covid-19 virus infections
  • the avoiding of a cytokine storm, which is the cause of lung damage and respiratory distress syndrome in patients with severe infections
What is Optimal Status for Selenium and Coenzyme Q10?

There is, as yet, no scientific consensus about the optimal levels of Selenium and Coenzyme Q10.

Optimal Selenium Status

Bomer et al. have concluded from the data of a large European cohort study that serum selenium concentrations below 100 mcg/L are associated in heart failure patients with worse heart failure symptoms, poorer exercise capacity, poorer quality of life, and poorer prognosis [Bomer]. That is a good place to start when considering optimal serum selenium levels.

Rayman has suggested in a seminal review article in The Lancet that the optimal serum/plasma concentrations of selenium for good health outcomes are in the range 120-150 mcg/L [see her figure 3 on page 4].

Optimal Coenzyme Q10 Status

Langsjoen [2014, p. 9] has suggested that it is important to raise plasma/serum CoQ10 concentrations above 2.5 mg/L in order to achieve a therapeutic effect with supplementation.

Selenium Status and the Immune System

Selenium is an essential trace element. Our cells cannot synthesize it. Accordingly, we must get the selenium that we need from the food that we eat and/or from selenium supplements. In many regions of the world, the soil and the food are poor in selenium content, making supplementation a necessity [Haug].

Selenium is needed in adequate quantities to permit the innate and adaptive immune systems to function optimally [Hargreaves & Mantle 2021].

Selenium is a component of the amino acid selenocysteine that is, in turn, an essential component of the antioxidant selenoproteins, e.g. the glutathione peroxidases and the thioredoxin reductases [Hargreaves & Mantle 2021].

Selenium is required for the formation of the thioredoxin reductases that play an important role in the reduction of CoQ10 molecules to the ubiquinol form. Without the presence of adequate thioredoxin reductase, Coenzyme Q10 will likely not have as much antioxidative effect as it could have [Xia; Nordman].

Selenium and Coenzyme Q10 in a Synergistic Relationship

Alehagen and Aaseth [2015] have studied the special inter-relationship between selenium and Coenzyme Q10 and have concluded:

  • that sub-optimal intakes of selenium restrict the ability of the cells to get sufficient quantities of the antioxidant form of Coenzyme Q10
  • that sub-optimal CoQ10 status will negatively affect selenium’s biological function in the cells

Thus, selenium and Coenzyme Q10, and selenium and Coenzyme Q10 in combination, are needed in sufficient quantities for the optimal functioning of the immune system [Alehagen & Aaseth].

Oxidative Stress

Low selenium status makes our cells vulnerable to oxidative stress, i.e. damage to cells, proteins, DNA, and lipids causes by an excess of harmful free radicals, in two ways:

  1. There is increased cell and tissue damage from oxidative stress in individuals with sub-optimal selenium status.
  2. There is increased likelihood that pathogenic viruses will development more virulent strains in the absence of sufficient selenium [Beck].

Note, for example, that Professor Urban Alehagen et al. in the KiSel-10 Study of combined selenium and Coenzyme Q10 supplementation of elderly Swedish citizens with an average age of 78 years and with low baseline selenium levels (67.1 mcg/L) found that the combined supplementation significantly improved blood bio-markers of oxidative stress and inflammation [Alehagen 2015a; Alehagen 2015b].


In normal cases of inflammatory response to injury and illness, the immune system shuts down the process of inflammation following the repair of the damaged tissue.

In some Covid-19 patients, the inflammation gets out of control, and that leads to cytokine storms that are so destructive not only to the lungs but also to the heart and liver and kidneys.

Hargreaves and Mantle hypothesize that vulnerability to cytokine storms will be greater in patients who are have sub-optimal selenium and Coenzyme Q10 status.

Bottom line: Supplementation with Selenium

Optimal selenium status is necessary for effective antioxidant protection and for modulation of the inflammatory response. Hargreaves and Mantle point to a demonstrated link between low regional selenium status and poor recovery outcomes in Covid-19 patients in China [Zhang].

Bottom Line: Combined CoQ10 and Selenium Supplementation

The KiSel-10 Study, a four-year randomized controlled trial, has shown the effectiveness of combined selenium and Coenzyme Q10 supplementation in reducing the extent of oxidative stress and inflammation in elderly individuals with low initial selenium status [Alehagen 2015a; Alehagen 2015b].

Last Word: Pharmaceutical Grade Supplements

Commercially available supplements do not all have the same absorption and efficacy. Hargreaves and Mantle recommend finding and buying pharmaceutical-grade selenium and Coenzyme Q10 supplements with documented absorption.


Alehagen U, Johansson P, Björnstedt M, Rosén A. Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: A 5-year prospective randomized double-blind placebo-controlled trial. Int J Cardiol. 2013;167:1860-1866.

Alehagen U, Aaseth J, Johansson P. Less increase of copeptin and MR-proADM due to intervention with selenium and coenzyme Q10 combined: Results from a 4-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. Biofactors. 2015a;41:443-52.

Alehagen U, Lindahl TL, Aaseth J, Svensson E. Levels of sP-selectin and hs-CRP decrease with dietary intervention with selenium and coenzyme Q10 combined: a secondary analysis of a randomized clinical trial. PLoS One. 2015b;10:e0137680.

Alehagen U, Alexander J, Aaseth J, Larsson A. Decrease in inflammatory biomarker concentration by intervention with selenium and coenzyme Q10: a subanalysis of osteopontin, osteoprotergerin, TNFr1, TNFr2 and TWEAK. J Inflamm (Lond). 2019;16:5.

Beck MA, Levander OA, Handy J. Selenium deficiency and viral infection. J Nutr. 2003 May;133(5 Suppl 1):1463S-7S.

Hargreaves IR / Mantle D. COVID-19, Coenzyme Q10, and Selenium. Chapter 13 in: Guest PC, ed. Identification of Biomarkers, New Treatments, and Vaccines for COVID-19. Advances in Experimental Medicine and Biology. 2021;1327:163-168.

Haug A, Graham RD, Christophersen OA, Lyons GH. How to use the world’s scarce selenium resources efficiently to increase the selenium concentration in food. Microbial Ecology in Health and Disease. 2007 Dec;19(4):209-228.

Langsjoen PH, Langsjoen AM. Comparison study of plasma coenzyme Q10 levels in healthy subjects supplemented with ubiquinol versus ubiquinone. Clin Pharmacol Drug Dev. 2014 Jan;3(1):13-7.

Nordman T, Xia L, Björkhem-Bergman L, Damdimopoulos A, Nalvarte I, Arnér ES, Spyrou G, Eriksson LC, Björnstedt M, Olsson JM. Regeneration of the antioxidant ubiquinol by lipoamide dehydrogenase, thioredoxin reductase and glutathione reductase. Biofactors. 2003;18(1-4):45-50.

Okuyama H, Langsjoen PH, Hamazaki T, Ogushi Y, Hama R, Kobayashi T, Uchino H. Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. Expert Rev Clin Pharmacol. 2015 Mar;8(2):189-99.

Xia L, Nordman T, Olsson JM, Damdimopoulos A, Björkhem-Bergman L, Nalvarte I, Eriksson LC, Arnér ES, Spyrou G, Björnstedt M. The mammalian cytosolic selenoenzyme thioredoxin reductase reduces ubiquinone. A novel mechanism for defense against oxidative stress. J Biol Chem. 2003 Jan 24;278(4):2141-6.

Zhang J, Taylor EW, Bennett K, Saad R, Rayman MP. Association between regional selenium status and reported outcome of COVID-19 cases in China. Am J Clin Nutr. 2020 Jun 1;111(6):1297-1299.

The information presented in this review article is not intended as medical advice and should not be used as such.

30 August 2021

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