physician as interactions between foods, supplements and other
medications are all possible. Be careful about supplementing without
first testing to make sure there is actually a deficit. Dr. David Bell
has also written about mitochondrial dysfunction in ME and CFS
Dr. Sarah Myhill on Coenzyme Q10 in Chronic Fatigue Syndrome (ME/CFS)
by Sarah Myhill, MD
Dr. Sarah Myhill is a UK-based physician and clinical nutritionist
with a special interest in the treatment of fatigue and ME/CFS.
Pioneering research led by Dr. Myhill suggests that the cells' energy
generating mitochondria are dysfunctional in ME/CFS patients. The
phenomenon was measured directly by Acumen Lab in the UK, and the
report ("Chronic Fatigue Syndrome and Mitochondrial Dysfunction,"
http://www.ijcem.com/files/IJCEM812001.pdf) by Dr. Myhill, Dr. John
McLaren-Howard, and Dr. Norman Booth, was published in January 2009 by
the International Journal of Clinical and Experimental Medicine
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
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
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
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
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:
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
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.