Fatigue. In many disorders, patients experience fatigue, even extreme fatigue, e.g., heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More patients, chronic fatigue syndromeChronic fatigue syndrome (CFS) is a complicated disorder with an unknown cause. CFS is characterized by persistent fatigue that does not improve with rest and that cannot be explained by any identifiable medical condition. CFS is also known as myalgic encephalomyelitis (ME) and systemic exertion intolerance disease (SEID). It is sometimes abbreviated ME/CFS. CFS patients typically have low levels of... More and fibromyalgiaFibromyalgia is characterized by widespread muscle and bone pain. The pain is accompanied by fatigue, sleep, memory problems, and mood issues. Fibromyalgia seems to amplify the brain's processing of painful signals and sensations. Whereas the emphasis in chronic fatigue syndrome is on the persistent fatigue, the emphasis in fibromyalgia is on the widespread pain. Some studies have shown that CoQ10... More patients, multiple sclerosis patients, post-treatment Lyme disease syndrome patients, etc.

The chronic fatigue may well be associated with cellular energy depletion and impaired mitochondrial function [Mantle 2022].
- Research studies have implicated mitochondrial dysfunctionMitochondrial dysfunction is the loss of efficiency in the process of ATP energy production. As such, mitochondrial dysfunction is a factor in the ageing process and in virtually all chronic diseases including cancer, cardiovascular diseases, chronic fatigue syndrome and fibromyalgia, diabetes and metabolic syndrome, and neurodegenerative diseases. Coenzyme Q10 is an essential component in the mitochondrial production of ATP energy. More in the development of chronic fatigue syndromeChronic fatigue syndrome (CFS) is a complicated disorder with an unknown cause. CFS is characterized by persistent fatigue that does not improve with rest and that cannot be explained by any identifiable medical condition. CFS is also known as myalgic encephalomyelitis (ME) and systemic exertion intolerance disease (SEID). It is sometimes abbreviated ME/CFS. CFS patients typically have low levels of... More and fibromyalgiaFibromyalgia is characterized by widespread muscle and bone pain. The pain is accompanied by fatigue, sleep, memory problems, and mood issues. Fibromyalgia seems to amplify the brain's processing of painful signals and sensations. Whereas the emphasis in chronic fatigue syndrome is on the persistent fatigue, the emphasis in fibromyalgia is on the widespread pain. Some studies have shown that CoQ10... More and in the resulting fatigue [Mantle 2022].
- The outcomes of randomized controlled clinical trials have shown that CoQ10 supplementation significantly improves symptoms in chronic fatigue syndromeChronic fatigue syndrome (CFS) is a complicated disorder with an unknown cause. CFS is characterized by persistent fatigue that does not improve with rest and that cannot be explained by any identifiable medical condition. CFS is also known as myalgic encephalomyelitis (ME) and systemic exertion intolerance disease (SEID). It is sometimes abbreviated ME/CFS. CFS patients typically have low levels of... More and fibromyalgiaFibromyalgia is characterized by widespread muscle and bone pain. The pain is accompanied by fatigue, sleep, memory problems, and mood issues. Fibromyalgia seems to amplify the brain's processing of painful signals and sensations. Whereas the emphasis in chronic fatigue syndrome is on the persistent fatigue, the emphasis in fibromyalgia is on the widespread pain. Some studies have shown that CoQ10... More patients [Mantle 2022].
- A 2019 systematic review of CoQ10 supplementation studies has shown significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant. More benefits of CoQ10 supplementation on fatigue following exercise, statin intake, the development of multiple sclerosis, and the development of end-stage heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More [Mehrabani 2019].
- Supplemental CoQ10 has been shown to significantly improve plasma and skeletal muscle CoQ10 levels, exercise tolerance, and exercise recovery time in chronic fatigue patients. The response is not rapid. It takes months of supplementation to allow mitochondriaThe mitochondria are the bean-shaped organelles in the cells. They are the key organelles with responsibility for the production of ATP energy molecules. More regeneration and the improvement in exercise tolerance. If the supplementation of CoQ10 is stopped, then the chronic fatigue will slowly return [Judy 2018a, 2018b].
Coenzyme Q10, Inflammation, and Fatigue
Mantle et al [2022] make the point that that inflammationInflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... More, which involves the release of pro-inflammatory cytokines, is not a wholly negative process in the body. InflammationInflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... More is the body’s normal response to infection or injury; it is essential for tissue healing.
InflammationInflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... More – in the form of chronic systemic inflammationInflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... More – occurs when the initial immune response to infection or injury does not resolve itself without releasing the so-called cytokine storm, which is the uncontrolled release of pro-inflammatory cytokines that cause tissue injury.
- Chronic systemic inflammationInflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... More promotes fatigue through its effect on the brain and nervous system, the immune system, and the mitochondriaThe mitochondria are the bean-shaped organelles in the cells. They are the key organelles with responsibility for the production of ATP energy molecules. More in tissue cells.
- Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More is known to play a role mediating this pro-inflammatory process [Mantle 2021].
- The outcomes of randomized controlled clinical studies have shown significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant. More reductions in various circulatory inflammatory bio-markers following supplementation with Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More in patients diagnosed with cardiovascular disease, non-alcoholic fatty liver disease, and polycystic ovary syndrome.
Coenzyme Q10, Oxidative Stress, and Fatigue

Oxidative stress (an abundance of harmful free radicalsFree radicals are unstable and highly reactive molecules that are produced in the body during normal oxygen metabolism. Free radicals derived from oxygen are known as reactive oxygen species. Free radicals play both helpful and harmful roles in the body. Free radicals steal electrons from other substances in order to become stable. In so doing, the free radicals oxidize those... More in relation to protective antioxidants) causes damage to healthy cells and the mitochondriaThe mitochondria are the bean-shaped organelles in the cells. They are the key organelles with responsibility for the production of ATP energy molecules. More inside the cells, thus impairing cellular energy production and leading to fatigue [Lee 2018].
- Numerous randomized controlled clinical trials have demonstrated the statistically (and clinically) significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant. More benefit of CoQ10 supplementation on oxidative stress parameters in such fatigue-related disorders as heart disease, multiple sclerosis, non-alcoholic fatty liver disease, and type II diabetes [Mantle 2022].
- CoQ10 supplementation is associated with significantThe outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant. More reduction of oxidative stress and should, therefore, also be capable of reducing the fatigue associated with oxidative stress [Mantle 2022].
Coenzyme Q10, Mitochondrial Dysfunction, and Fatigue
CoQ10 supplements are safe and well-tolerated. Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More supplementation has been described as an indirect positive influence on the strength of the contraction of the heart muscle; CoQ10 supplementation is associated with the restoration of energy production in the mitochondriaThe mitochondria are the bean-shaped organelles in the cells. They are the key organelles with responsibility for the production of ATP energy molecules. More, leading to improved heart muscle cell performance [Mortensen 2014a].
- A sufficient supply of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More is particularly important in heart muscle tissues, which have high-energy requirements [Mortensen 2014a].
- Sub-optimal CoQ10 status has been implicated in the development of heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More [Mortensen 2014a, 2014b].
- In the Q-Symbio studyQ-Symbio is the abbreviated name for the two-year multi-center, randomized, double-blind, placebo-controlled study of Coenzyme Q10 supplements as an adjunct treatment of chronic heart failure patients. The name reflects the focus of the study on the SYMptoms, BIomarker status (BNP), and long-term Outcomes (hospitalizations and mortality) of the supplementation. The data from the Q-Symbio study show that long-term supplementation with... More, adjuvant supplementation with Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More significantly improved survival and symptoms in patients with chronic heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More [Mortensen 2014b].
Conclusions: Coenzyme Q10 to Fight Against Fatigue
CoQ10 supplementation is a key component against fatigue in three important ways [Mantle 2022]:
- Sufficient Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More is needed for the process of cellular energy generation within the mitochondriaThe mitochondria are the bean-shaped organelles in the cells. They are the key organelles with responsibility for the production of ATP energy molecules. More.
- Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More is a lipid-soluble antioxidantAntioxidants are substances that protect the cells and lipoproteins against the harmful effects of free radicals. They are substances that prevent the oxidation of other molecules and compounds. There are two broad categories of antioxidants: enzymatic and non-enzymatic. Non-enzymatic antioxidants are substances like Coenzyme Q10, vitamin C, vitamin E, glutathione, and various carotenoids. Prominent enzymatic antioxidants include catalase, glutathione peroxidase,... More that protects cellular and sub-cellular membranes from free-radical-induced oxidative damage.
- Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More protects against the tissue damaging effects of poorly regulated inflammationInflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... More.
CoQ10 supplements are safe, effective, and affordable. However, not all CoQ10 supplements are equally well absorbed and available to the cells and tissues. Buying an inexpensive CoQ10 product could be a waste of money if the Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More it contains is poorly formulated and poorly absorbed.
Sources
Judy WV. Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More: The Substance That Powers Life: An Insider’s Guide. Ny Videnskab, 2018a. ISBN: 978-87-7776-186-7. Book available from amazon.com.
Judy WV. Influence of CoQ10 supplementation on plasma and tissue CoQ10 levels and exercise tolerance. Presented at the International Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More Association meeting, New York, 2018b.
Lee JS, Kim HG, Lee DS, Son CG. Oxidative Stress is a Convincing Contributor to Idiopathic Chronic Fatigue. Sci Rep. 2018;8(1):12890.
Mantle D, Turton N, Hargreaves IP. Lyme disease: a role for Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More supplementation? Antioxidants. 2022;11:667. https://doi.org/10.3390/antiox11040667.
Mantle D, Heaton RA, Hargreaves IP. Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More and immune function: an overview. Antioxidants. 2021;10:759.
Mehrabani S, Askari G, Miraghajani M, Tavakoly R, Arab A. Effect of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More supplementation on fatigue: A systematic review of interventional studies. Complement Ther Med. 2019 Apr;43:181-187.
Mortensen SA, Mortensen AL. The mitochondriaThe mitochondria are the bean-shaped organelles in the cells. They are the key organelles with responsibility for the production of ATP energy molecules. More in heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More: a target for Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More therapy? Clin Pharmacol Ther. 2014a Dec;96(6):645-7.
Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, Alehagen U, Steurer G, Littarru GP. The effect of Coenzyme Q10Coenzyme Q10 molecules are fat-soluble molecules that are both synthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... More on morbidity and mortality in chronic heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... More: results from Q-Symbio: a randomized double-blindA double-blind study is a study in which neither the investigators nor the study participants know which participants are receiving the active treatment and which participants are receiving the control treatment until the study has been completed and the seal on the code has been broken. More trial. JACC Heart Fail. 2014b Dec;2(6):641-9.
The information presented in this review article is not intended as medical advice and should not be used as such.
15 April 2022