By Karen Lee Richards
No two fibromyalgia or ME/CFS patients are exactly alike. Each has a unique set of symptoms with varying degrees of severity. There is, however, one common denominator for the vast majority - a serious, sometimes even profound, lack of energy.
What could possibly cause that kind of fatigue?
Multiple studies have suggested that mitochondrial dysfunction may play a significant role in both fibromyalgia and ME/CFS, which would explain much of the energy deficit experienced by patients.
Mitochondria are the engines - or energy producers - that power every cell in the body. It is the job of the mitochondria to take in nutrients, break them down and use them to create energy for the cells. The more energy a cell needs, the more mitochondria it contains. Cells that require a lot of energy - like the heart, brain and other vital organs - may have thousands of mitochondria.
How do the mitochondria produce energy? This is where CoQ10 (coenzyme Q10) comes in. CoQ10 is the catalyst that makes it possible for the mitochondria to produce ATP (adenosine triphosphate), the molecule upon which all cellular functions in the body depend. In fact, 95% of all cellular energy production depends on CoQ10.
Given that statistic, it's not surprising to learn that, according to several different studies, people with FM and/or ME/CFS generally have very low levels of CoQ10. As we, therefore, might expect, many of the symptoms of a CoQ10 deficiency are remarkably similar to symptoms of FM and ME/CFS, such as:
Because CoQ10 is essential to every cell in the body, a severe CoQ10 deficiency can cause mitochondrial dysfunction, which in turn has a serious negative impact on multiple organs and body systems.
Fibromyalgia and CoQ10
Since 2009, a team of Spanish researchers has led the way in conducting studies that link CoQ10, mitochondrial dysfunction and fibromyalgia. They have consistently found that FM patients are deficient in CoQ10 - often with a 40-50% reduction in CoQ10 levels compared to healthy controls.
Following are some of their significant findings:
The distribution of CoQ10 in the blood was altered in FM patients.(1)
A CoQ10 deficiency alters mitochondrial function, leading to increased oxidative stress in FM.(2)
FM patients tested had low CoQ10 levels; after supplementation, both CoQ10 levels and symptoms improved.(3)
Results suggest a role for mitochondrial dysfunction and oxidative stress in the headache symptoms associated with FM; oral CoQ10 supplementation restored biochemical parameters and induced a significant improvement in clinical and headache symptoms.(4)
This study suggests that mitochondrial dysfunction may be driving an inflammatory process in FM; oral supplementation restored biochemical parameters and induced a significant improvement in clinical symptoms.(5)
FM patients had a CoQ10 deficiency, mitochondrial dysfunction and increased expression of a particular inflammasome (an immune system sensor that can induce inflammation); oral supplementation reduced the inflammasome activation.(6)
FM patients had low levels of both CoQ10 and serotonin; following CoQ10 supplementation, CoQ10 and serotonin levels were restored and symptoms of depression were measurably improved.(7)
Many well-known FM/ME/CFS physicians, like Dr. Mark Pellegrino, Dr. Charles Lapp and Dr. Jacob Teitelbaum, have been recommending CoQ10 for their patients for years. In fact, CoQ10 is one nutritional supplement that is almost universally endorsed by traditional and alternative FM/ME/CFS practitioners alike.
ME/CFS and CoQ10
As with fibromyalgia, ME/CFS patients have also been found to be deficient in CoQ10. In a 2009 study, plasma CoQ10 was analyzed in 58 ME/CFS patients and 22 normal controls. Researchers found that CoQ10 levels were significantly lower in the ME/CFS patients than in the normal controls. Additionally, they demonstrated a relationship between low CoQ10 levels and increased fatigue, autonomic and neurocognitive symptoms. The researchers went on to note that low CoQ10 levels are a predictor of chronic heart failure and may explain the early mortality rates of ME/CFS patients due to heart failure.(8)
A 2016 article in the journal BioFactors
reported on two studies using oral ubiquinol-10 (an advanced form of CoQ10) supplementation on ME/CFS patients. The first was an open label trial with 20 patients and the second a double-blinded, placebo controlled trial with 43 ME/CFS patients. Both trials found that ubiquinol-10 supplementation was effective in improving autonomic nervous function and cognitive function in ME/CFS.(9)
In her paper, "Chronic Fatigue Syndrome and Mitochondrial Dysfunction," Dr. Sarah Myhill, MD, a UK-based ME/CFS researcher and clinician, makes the case that ME/CFS is actually a symptom of mitochondrial failure.(10) Dr. Myhill recommends that ME/CFS patients have their CoQ10 levels checked and begin taking CoQ10 supplements if they are low. She also notes that CoQ10 will work best in conjunction with acetyl L-carnitine, magnesium, D-ribose and Vitamin B3 (niacinamide).(11)
Medications That Deplete CoQ10
There are numerous prescription and over-the-counter medications that can deplete the body of CoQ10. Unfortunately several of them are frequently prescribed for FM and ME/CFS, including many antidepressants, anticonvulsants and analgesic/anti-inflammatory medications.
Statins, prescribed for lowering cholesterol, are particularly notorious for hindering the body's production of CoQ10. More and more doctors are strongly recommending CoQ10 for their patients who are taking statins.
All CoQ10 Is Not Created Equal
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. Therefore, it is particularly important for people with FM or ME/CFS to take the ubiquinol form of CoQ10 so they're not expending precious energy converting ubiquinone to its usable form.
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.(12)
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.(13)
How to Take Ubiquinol CoQ-10
The suggested dosage of Ubiquinol CoQ10 for FM and ME/CFS patients varies, but most experts start at around 150-200 mg./day. One FM/ME/CFS physician told me that many of his patients take 600 mg. or more each day. Check with your physician to determine the best starting dosage for you.
It's important to note that Ubiquinol CoQ10 is not a quick fix that will give you an immediate energy boost. Each individual is different, but it generally takes two to three weeks to restore optimal CoQ10 levels in blood plasma and tissues. You may, however, begin to notice a difference as your plasma levels start to increase around the fifth day. If you don't notice any difference after three weeks, you may want to discuss increasing the dosage with your doctor.
While standard CoQ-10 had to be taken with a fatty meal, Ubiquinol CoQ-10 bonds with water, making it easier to absorb and eliminating the need to take it with fatty foods.
1. Cordero MD, et al. Coenzyme Q10 distribution in blood is altered in patients with fibromyalgia
. Clin Biochem
. 2009 May;42(7-8):732-5.
2. Cordero MD, et al. Oxidative stress and mitochondrial dysfunction in fibromyalgia
. Neuro Endocrinol Lett
3. Cordero MD, et al. Coenzyme Q10 in salivary cells correlate with blood cells in Fibromyalgia: improvement in clinical and biochemical parameter after oral treatment. Clin Biochem
. 2012 Apr;45(6):509-11.
4. Cordero MD, et al. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q?? effect on clinical improvement
. PLoS One
5. Cordero MD, et al. Is inflammation a mitochondrial dysfunction-dependent event in fibromyalgia?
Antioxid Redox Signal. 2013 Mar 1;18(7):800-7.
6. Cordero MD, et al. NLRP3 inflammasome is activated in fibromyalgia: the effect of coenzyme Q10
. Antioxid Redox Signal. 2014 Mar 10;20(8):1169-80
7. Alcocer-Gómez E, et al. Coenzyme q10 regulates serotonin levels and depressive symptoms in fibromyalgia patients: results of a small clinical trial
. J Clin Psychopharmacol.
8. Maes M, et al. "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 cardi..." Neuroendocrinology Letters
9. Fukuda S, et al. Ubiquinol-10 supplementation improves autonomic nervous function and cognitive function in chronic fatigue syndrome
. 2016 Apr 29. doi: 10.1002/biof.1293.
10. Myhill S., Booth NE, McLaren-Howard J. "Chronic fatigue syndrome and mitochondrial dysfunction." Int J Clin Exp Med
. 2009; 2(1): 1-16.
11. Myhill S. (Oct. 2008) "Co-enzyme Q10 in Chronic Fatigue Syndrome."
12. Hosoe K, et al. "Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers."
Regul Toxicol Pharmacol. 2007 Feb;47(1):19-28. Epub 2006 Aug 21.
13. Kaneka Corporation study. "Treadmill test with the aged rat at age of 61-63 weeks." 2006.
Karen Lee Richards is ProHealth's Editor-in-Chief. A fibromyalgia patient herself, she co-founded the nonprofit organization now known as the National Fibromyalgia Association (NFA) and served as its vice-president for eight years. She was also the executive editor of Fibromyalgia AWARE
, the very first full-color, glossy magazine devoted to FM and other invisible illnesses. After leaving the NFA, Karen served as the Guide to Fibromyalgia and Chronic Fatigue Syndrome for the New York Times
website About.com, and then for eight years as the Chronic Pain Health Guide for The HealthCentral Network.