Pioneering research led by UK-based physician/clinical nutritionist Sarah Myhill, MD, demonstrates that the cells’ energy generating mitochondria are dysfunctional in ME/CFS patients. The phenomenon was measured directly at Acumen Lab by Dr. Myhill, Dr. John McLaren-Howard, and Dr. Norman Booth in 2009 (see “Chronic Fatigue Syndrome and Mitochondrial Dysfunction” ). The trio then linked ME/CFS severity to level of mitochondrial ATP production  in July 2012; and in Nov 2012 reported on improvements in ATP production and symptoms for severely ill patients  on a two-pronged regimen of nutritional support and energy expenditure management.
Chronic Fatigue Syndrome is a Symptom of Mitochondrial Failure…
Resulting in poor production of ATP (adenosine triphosphate), which is the currency of energy in the body.
To produce ATP, mitochondria need certain essential raw materials, namely Coenzyme Q10 (CoQ10), D-ribose, L-carnitine, magnesium and vitamin B-3.
In a normal healthy person, CoQ10 can be synthesized, but it requires the amino acid tyrosine, at least eight vitamins, and several trace elements. The vitamins include folic acid, vitamin C, B-12, B-6 and B-5.
Synthesis of CoQ10 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 CoQ10 in sufficient amounts, and therefore levels need to be measured and supplemented.
Indeed a recent study showed a close correlation between levels of CoQ10 and severity of CFS. (“Coenzyme Q10 Deficiency in ME/CFS”  by Michael Maes, et al.)
Blood Levels of Coenzyme Q10
Certainly when I check blood levels, it is very common to find very low levels of CoQ10. CoQ10 is the most important antioxidant in the mitochondria, and since it is the rate at which mitochondria fail that determines the normal ageing process, it may well be that CoQ10 is a vital anti-ageing molecule!
I also see CoQ10 as an acquired metabolic dyslexia with age – as we age we get less good at making certain key molecules, and CoQ10 is one.
The normal range in blood given by Biolab Medical Unit (www.biolab.co.uk ) is 0.55 – 2.0 mmol/L (millimoles per liter). This is equivalent to 0.637 – 2.3 ug/ml (micrograms per milliliter). However, Coenzyme 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 Coenzyme Q10 levels in heart disease, and although the optimal dose of CoQ10 is not known for every pathological situation, most researchers now agree that blood levels of 2.5 ug/ml and preferably 3.5 ug/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 the Biolab Unit’s 2.00 mmol/L.
How Much CoQ10 to Take
The question is, how much CoQ10 should be given to supplement levels? Again, the dose of CoQ10 in order to achieve a response has been worked out for cardiac patients and this varies from 200 mg to 600 mg daily.
It is important that a hydro [water]-soluble form of Coenzyme Q10 be used in order to ensure good absorption.
The absorption of CoQ10 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.
(In the UK, it is possible for CoQ10 to be prescribed on National Health Service Prescription. CoQ10 is not in the British National Formulary, but it has not been blacklisted in capsule form, so can be prescribed if your GP is willing to help.)
I am estimating that the following doses of CoQ10 will be required:
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CoQ10 Blood levels 1.5 – 2.0 umol/l
100 mg CoQ10
CoQ10 Blood levels 1.0 – 1.5 umol/l
200 mg CoQ10 (split the dose: 100 mg twice a day)
CoQ10 Blood levels 0.5 – 1.0 umol/l
300 mg CoQ10 (split the dose: 100 mg 3 times a day)
CoQ10 Blood levels less than 0.5 umol/l
400 mg CoQ10 (split the dose: 200 mg am, 100 mg lunch, 100 mg 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.
CoQ10 can be expected to work best in conjunction with:
• 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 (the conenzyme nicotinamide adenine dinucleotide). Levels can be measured, but most people need 500 mg of NAD daily.
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 CoQ10 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.
– Sarah Myhill, MD
[For more information on CoQ10 see “Coenzyme Q10 – The Energy Maker,”  by Karen Lee Richards.]
* This article is reproduced with kind permission from Dr. Sarah Myhill’s educational website (DrMyhill.co.uk )® Sarah Myhill Limited, Registered in England and Wales: Reg. No. 4545198.
Note: This information has not been reviewed by the FDA. It is for general information purposes only; is not meant to replace the personal attention of a medical doctor; and is not intended to prevent, diagnose, treat or cure any condition, illness or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.