Post-viral fatigue syndrome (PVFS) is an umbrella term for several neuroimmune disorders of unknown cause. Disabling fatigue, muscle and joint pain, cognitive impairment, poor-quality sleep, autonomic nervous system dysfunction, and neuropsychiatric symptoms are characteristic of PVFS. The best known manifestations of PVFS include chronic fatigue syndrome, fibromyalgia, and long COVID disorders [Mantle 2024].

Tired old man

Worldwide, some 65 million suffer from chronic disabling disorders who are diagnosed without any clear understanding of the underlying physiological mechanisms. These disorders are characterized by non-restorative sleep and muscle and joint pains.

To date, the published bio-medical literature does not point to any effective treatments for these disorders. However, it is known that the mitochondria play a crucial role in the cellular metabolism that is responsible for tissue ATP energy production. Accordingly, it seems likely that there is an inter-relationship between mitochondrial dysfunction and sub-optimal cellular bioenergetic metabolism in individuals with PVFS disorders. Given the documented beneficial effects of CoQ10 supplementation on mitochondrial function, on oxidative stress, and on chronic systemic inflammation, Mantle et al have proposed Coenzyme Q10 as a therapeutic strategy for the treatment of PVFS [Mantle 2024].

Role of Coenzyme Q10 in Post-Viral Fatigue Syndrome Disorders

In a 2024 overview article, Mantle et al have amassed considerable evidence indicating the involvement of mitochondrial dysfunction in the development of fibromyalgia, chronic fatigue syndrome, and long COVID. Coenzyme Q10 plays an essential role in the process of ATP energy generation in the mitochondria. Coenzyme Q10 also serves as an important lipid-soluble antioxidant that protects the mitochondria from oxidative damage caused by harmful free radicals. Therefore, it is reasonable to suppose that CoQ10 supplementation can improve mitochondrial function and reduce the fatigue associated with PVFS [Mantle 2024].

Decreased endogenous CoQ10 levels are associated with increased vulnerability to COVID-19 infection. Daily CoQ10 supplementation may restore a CoQ10 deficiency that is associated with increased susceptibility to viral infections [Mantle 2024].

Randomized controlled clinical trials have demonstrated significant symptomatic benefits in the treatment of fibromyalgia and chronic fatigue syndrome. CoQ10 supplements in the clinical trials has been well-tolerated; there have been no reports of serious adverse effects. Given this background, testing of the effects of CoQ10 supplementation in long-COVID patients is warranted [Mantle 2024].

In addition, there is a need for clinical testing of the effects of co-supplementation with Coenzyme Q10 and selenium on PVFS disorders. This need is especially pronounced in individuals with low selenium intakes and low selenium and Selenoprotein P status. Mantle et al point to the following potential benefits of combined CoQ10 and selenium supplementation [Mantle 2024; Alehagen 2013; Castro-Marrero 2022]:

  • Both supplements play an important role in immune function.
  • Combined CoQ10 and selenium supplementation can reduce the excessive inflammation associated with virus infections.
  • CoQ10 and selenium in combination have reduced the risk of developing heart disease in normal individuals.
  • Supplementation of chronic fatigue syndrome patients with CoQ10 and selenium is associated with a significant improvement in overall fatigue severity and global quality of life.

Importance of the Formulation of the CoQ10 Supplement

Consumers of CoQ10 supplements should be wary of claims made by manufacturers. From one commercial product to the next, there is considerable variability in the absorption and bioavailability of Coenzyme Q10 from supplements. In a cross-over double-blind placebo controlled clinical trial, Lopez-Lluch et al showed that the formulation of the CoQ10 supplement is decisive for absorption and bioavailability [Lopez-Lluch 2019].

In the Lopez-Lluch cross-over study, the CoQ10 supplement that had been subjected to a patented CoQ10 crystal modification process had the highest level of bioavailability. Absorption of the same CoQ10 raw material in a supplement that had not been subjected to this process was reduced by 75%. Similarly, the Lopez-Lluch study showed that a well-formulated ubiquinone CoQ10 product had a significantly better absorption and bioavailability than a ubiquinol supplement did [Lopez-Lluch 2019]. In other words, the formulation of the CoQ10 supplement was more important for absorption and bioavailability than was the form of the supplement, i.e., whether ubiquinone or ubiquinol [Mantle & Dybring 2020].

Conclusion: Coenzyme Q10 and Post-Viral Fatigue Syndrome

Worldwide, post-viral fatigue syndrome affects millions of people.

PVFS includes such conditions as chronic fatigue syndrome, fibromyalgia, and long COVID.

There are no approved pharmacological therapies for PVFS.

CoQ10 supplementation has documented beneficial effects on mitochondrial dysfunction, on oxidative stress, and on systemic inflammation.

CoQ10 supplementation should be investigated as a possible therapeutic strategy.

Sources

Alehagen U, Johansson P, Bjornstedt M, Rosen A, Dahlstrom U. Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: A 5-year prospective randomized double-blind placebo-controlled trial among elderly Swedish citizens. Int. J. Cardiol. 2013;167:1860–1866.

Castro-Marrero J, Domingo JC, Cordobilla B, Ferrer R, Giralt M, Sanmartín-Sentañes R, Alegre-Martín J. Does Coenzyme Q10 plus selenium supplementation ameliorate clinical outcomes by modulating oxidative stress and inflammation in individuals with myalgic encephalomyelitis/chronic fatigue syndrome? Antioxid Redox Signal. 2022 Apr;36(10-12):729-739.

López-Lluch G, Del Pozo-Cruz J, Sánchez-Cuesta A, Cortés-Rodríguez AB, Navas P. Bioavailability of coenzyme Q10 supplements depends on carrier lipids and solubilization. Nutrition. 2019 Jan;57:133-140.

Mantle D, Hargreaves IP, Domingo JC, Castro-Marrero J. Mitochondrial dysfunction and Coenzyme Q10 supplementation in post-viral fatigue syndrome: an overview. Int J Mol Sci. 2024 Jan 1;25(1):574.

Mantle D, Dybring A. Bioavailability of Coenzyme Q10: An Overview of the Absorption Process and Subsequent Metabolism. Antioxidants (Basel). 2020 May 5;9(5):386.

The information presented in this review article is not intended as medical advice. It should not be used as such.