Mitochondrial Support for Athletes: Beyond the Energy Drink Hype

Look, I've seen the stats. A 2023 review in Sports Medicine (doi: 10.1007/s40279-023-01875-4) analyzed 41 studies and found that over 60% of endurance athletes show some level of mitochondrial dysfunction under heavy training loads. But here's what those numbers miss: your body doesn't read studies. I've had Division I sprinters with "perfect" bloodwork who couldn't finish a workout without hitting a wall. The problem wasn't their training—it was their cellular engines.

I bought into the protein timing myth for years. Everyone did. But mitochondria? That's where the real performance gains hide. Your muscles are only as good as the energy they can produce. And that happens in these tiny organelles most people haven't thought about since high school biology.

What the Research Actually Shows (Not Just the Hype)

Let's start with NAD+. You've seen the ads. "Reverse aging! Boost energy!" The biochemistry is fascinating—NAD+ is crucial for mitochondrial function and declines with age. A 2021 randomized controlled trial (PMID: 34083488) with n=123 older adults found that NR (nicotinamide riboside, an NAD+ precursor) supplementation increased NAD+ levels by about 40% over 8 weeks. But—and this is critical—the performance improvements were modest. Some participants felt better; others noticed nothing.

Here's my clinical take: NAD+ boosters like NR or NMN might help if you're over 40 or in extreme training stress. For a 22-year-old college athlete? Probably overkill. Your body makes plenty if you're getting enough tryptophan and niacin from food.

Now PQQ (pyrroloquinoline quinone). This one's interesting. A 2020 study published in the Journal of the International Society of Sports Nutrition (17:31, doi: 10.1186/s12970-020-00364-7) had n=14 trained cyclists take 20mg PQQ daily for 3 weeks. They saw improved time trial performance and lower inflammatory markers (IL-6 decreased by 17%, p<0.05). Small study, but the mechanism makes sense—PQQ helps generate new mitochondria (mitochondrial biogenesis).

I had a marathoner last year—42, hitting the wall at mile 18 every race—who added PQQ and CoQ10. His next marathon? Negative split, personal best. Was it just the supplements? No. But they were the missing piece.

Coenzyme Q10. The evidence here is actually pretty solid, especially for the reduced form (ubiquinol). A 2018 meta-analysis in Pharmacological Research (doi: 10.1016/j.phrs.2018.02.012) looked at 17 RCTs with n=1,684 total participants. CoQ10 supplementation significantly reduced fatigue scores (standardized mean difference -0.50, 95% CI: -0.82 to -0.18). That's not huge, but it's real. And for athletes, a 5% reduction in perceived exertion can mean the difference between podium and pack.

Dosing & Recommendations: Stop Underdosing

This drives me crazy. People buy a "mitochondrial support" blend with 10 ingredients at 5mg each. That's throwing pennies in a wishing well. Here's what actually works:

I usually recommend Thorne Research's Basic Nutrients III as a foundation—it has the B-vitamins in active forms. Then add specific mitochondrial supports. For CoQ10, I like Jarrow Formulas' QH-Absorb (the ubiquinol form).

Point being: start with 2-3, not 10. Give it 8-12 weeks. Your mitochondria turnover every 2-4 weeks, so you need time.

Who Should Avoid or Be Cautious

Honestly, most healthy athletes tolerate these well. But:

• People on blood thinners (warfarin): CoQ10 can potentially interact. Check with your doctor.
• Anyone with thyroid issues: ALCAR might affect thyroid hormone conversion in high doses. I'd keep it under 1,000mg daily if you're hypothyroid.
• During chemotherapy: Some oncologists recommend against antioxidants during certain treatments. This isn't my specialty—always defer to your oncologist.
• If you have low blood pressure: CoQ10 can lower it further. Not usually a problem for athletes, but worth monitoring.

I had a client—a 38-year-old cyclist with borderline low BP—who felt lightheaded when he started CoQ10. We halved his dose, problem solved. Your body gives feedback. Listen to it.

FAQs: Quick Answers

Can I get these from food instead?
Some. Organ meats have CoQ10 (heart, liver). Spinach has PQQ (tiny amounts—about 0.1mg per cup). But to get therapeutic doses for athletic performance, you'd need unrealistic amounts. Supplements make sense here.

When will I notice effects?
Most people feel something within 2-4 weeks—better recovery, less afternoon slump. Full mitochondrial adaptation takes 8-12 weeks. Don't expect magic overnight.

Should I cycle these supplements?
Not really. Your mitochondria need consistent support. The one exception: if you're using high-dose ALCAR (over 2g daily), some people report tolerance. A 4-weeks-on, 1-week-off pattern can help.

Are NAD+ injections worth it?
I'm skeptical. The oral precursors (NR, NMN) work fine for most people at 1/10th the cost. Save your money for quality food and sleep tracking.

Bottom Line: What Actually Matters

• Foundation first: No supplement fixes poor sleep, dehydration, or nutrient deficiencies. Get your B-vitamins, magnesium, and protein intake dialed in.
• Pick 2-3, dose adequately: CoQ10 (100-300mg ubiquinol) + PQQ (10-20mg) + magnesium glycinate (400mg) is a solid starting stack.
• Timing matters less than consistency: Take them daily, not just workout days. Mitochondrial support isn't a pre-workout—it's infrastructure.
• Individual response varies wildly: I've seen powerlifters respond better to ALCAR, endurance athletes to PQQ. Experiment (methodically).

Disclaimer: This is general information, not medical advice. Talk to your healthcare provider before starting any new supplement regimen, especially if you have health conditions or take medications.