Co-enzyme Q10 in Chronic Fatigue Syndrome
Chronic fatigue syndrome is a symptom of mitochondrial failure, resulting in poor production of ATP which is the currency of energy in the body. To produce ATP, mitochondria need certain essential raw materials, namely Co-enzyme Q10, D-ribose, L-carnitine, magnesium and vitamin B3.
In a normal healthy person, Co-Q10 can be synthesised, but it requires the amino acid tyrosine, at least eight vitamins and several trace elements. Vitamins include folic acid, vitamin C, B12, B6 and B5. Synthesis of Co-Q10 is inhibited by environmental toxins and chronic disease. I am coming to the view that many of my CFS patients are metabolically dyslexic - that is to say even when all the raw materials are available, they cannot make their own Co-Q10 in sufficient amounts and therefore levels need to be measured and supplemented. Indeed a recent study showed a close correlation between levels of Co Q 10 and severity of CFS.
Blood levels of Co-enzyme Q10
Certainly when I check blood levels, it is very common to find very low levels of Co-Q10. Co-Q10 is the most important antioxidant in mitochondria and since it is the rate at which mitochondria fail which determines the normal ageing process, it may well be that Co-Q10 is a vital anti-ageing molecule! I also see co Q 10 as an aquired metabolic dyslexia - as we age we get less good at making certain key molecules and co Q 10 is one!
The normal range in blood given by Biolab Medical Unit is 0.55 - 2.0 mmol/L. This is equivalent to 0.637 - 2.3 μg/ml. However, Co-enzyme Q10 has been widely used in the treatment of heart failure, which we now know is what happens in patients with severe chronic fatigue syndrome. There have been a great many studies done looking at Co-enzyme Q10 levels in heart disease and although the optimal dose of Co-Q10 is not known for every pathological situation, most researchers now agree that blood levels of 2.5 μg/ml and preferably 3.5 μg/ml are required to have a positive impact on severely diseased hearts.
Clearly not all patients I see with chronic fatigue syndrome have severely diseased hearts, but my view is that we should be aiming for a level above 2.00 mmol/L - the Biolab units.
How much Co-Q10 to take
The question is how much Co-Q10 should be given to supplement levels? Again, the dose of Co-Q10 in order to achieve a response has been worked out for cardiac patients and this varies from 200 - 600 mg daily.
It is important that a hydro-soluble form of Co-enzyme Q10 is used in order to ensure good absorption. The absorption of Co-Q10 can be improved if it is taken with a fatty or oily meal. Or you could empty a capsule into a teaspoon of olive oil before swallowing the lot. It is possible for Co-Q10 to be prescribed on NHS Prescription! Co-Q10 is not in the British National Formulary, but it has not been blacklisted in capsule form, so is prescribable. If your GP is willing to help, then ask him to prescribe ubidecarenone 100mg capsules. The chemist can order any brand that is available to him and the Prescription Pricing Authority will honour the prescription.
So I am estimating that the following doses of Co-Q10 will be required:
|Co Q10 blood levels||Recommended daily dose||Comments|
|1.5 - 2.0 umol/l||100 mg||row 1, cell 3|
|1.0 - 1.5 umol/l||200mg||split the dose: 100 mg twice a day|
|0.5 - 1.0 umol/l||300mg||split the dose: 100 mg 3 times a day|
|less than 0.5 umol/l||400mg||split the dose: 200mg am, 100mg lunch, 100mg evening|
Once a therapeutic effect has been achieved, then it should be possible to reduce the dose to a lower maintenance dose, but a blood test may be required to re-check that levels are adequate.
Co-Q10 can be expected to work best in conjunction with magnesium (available in the Mineral Mix), D-ribose, acetyl L-carnitine (also available through eating red meat, especially mutton, lamb, beef and pork - but to get 2 grams you need to eat about a pound of meat a day!) and NAD (levels can be measured, but most people need 500mg of NAD daily - again, I can supply).
It may take up to 30 days to get blood levels up to a good level and therefore start to see clinical response. Most studies of use of Co-Q10 in heart disease assess patients at three months. I would also expect to see improvements in heart related symptoms such as chest pain, dysrhythmias, exercise tolerance, shortness of breath and mitral valve disease. There are virtually no side effects.
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