Co-enzyme Q10 in Chronic Fatigue Syndrome

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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. Please see "Coenzyme Q10 deficiency in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is related to fatigue, autonomic and neurocognitive symptoms and is another risk factor explaining the early mortality in ME/CFS due to cardiovascular disorder." for details of this study and its conclusions.

Blood levels of Co-enzyme Q10

Tt is very common to find very low levels of Co-Q 10. Co-Q 10 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-Q 10 is a vital anti-ageing molecule! I also see Co Q-10 as an acquired metabolic dyslexia - as we age we get less good at making certain key molecules and Co Q-10 is one of these molecules!

The normal range in blood is 0.55 - 2.0 mmol/L. This is equivalent to 0.637 - 2.3 μg/ml. However, Co-enzyme Q 10 has been widely used in the treatment of heart failure, which we now know is what happens in patients with severe chronic fatigue syndrome ( please see CFS - The Central Cause: Mitochondrial Failure section 7). 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.

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. However for most, 100mgs daily is sufficient. My guess is there is better absorption in people on a PK diet who have sorted their upper fermenting gut.

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, and 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.

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 - to get 500mgs you need to eat about a 250grams of meat a day) and NAD (levels can be measured, but most people need at least 500mg of NAD daily often 1500mgs).

It may take up to 30 days to get blood levels up to a good level and therefore to start to see clinical response. Most studies of the 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 no side effects.

Please see also "My book Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis" for more detail on dosing.

Ubiquinone versus Ubiquinol

For the biochemists among us, in the human body, CoQ10 exists either in its oxidized form, ubiquinone, or in its reduced form, ubiquinol. When oxidized CoQ10 (ubiquinone) is used by the body, it transforms and becomes ubiquinol.

Ubiquinol may be better absorbed, but it is much more expensive that ubiquinone. My view is that if ubiquinone is taken with a fatty meal to improve its absorption AND there is good antioxidant status so it may be easily converted to ubiquinol then this gets the best of both worlds- - a cheaper supplement that is as effective.

You can see the science below.......

The form of CoQ10 found in most supplements is called ubiquinone. In order to produce cellular energy, the body must convert the ubiquinone to ubiquinol. It is the ubiquinol that carries electrons through the mitochondria and produces energy.Young healthy people (under 25) can easily convert CoQ10 to ubiquinol. But as we age or when we have a chronic illnesses, our ability to convert CoQ10 to ubiquinol diminishes. A 2007 study compared how well humans absorbed ubiquinone and ubiquinol. The results showed that it takes eight times as much ubiquinone to equal the blood plasma concentrations of ubiquinol. More specifically, 150 mg. of ubiquinol was equal to 1200 mg. of standard CoQ10. Additionally, in an unpublished study with aged rats, blood concentrations were sustained longer with ubiquinol. After eight hours, the concentration of ubiquinol CoQ10 was 3.75 times greater than standard CoQ10.

Source - Prohealth article on "The Crucial Role CoQ10 Plays in Fibromyalgia and ME/CFS"
Linked Published Study - "Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers."
Linked Unpublished Study - Kaneka Corporation study. "Treadmill test with the aged rat at age of 61-63 weeks." 2006.

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