Can Coenzyme Q10 help in fatigue management?

A recent systematic review published in 2019, which assessed 16 interventional studies has ascertained the effect of coenzyme Q10 (CoQ10) supplementation on fatigue status and 10 studies showed CoQ10 supplementation significantly reduced fatigue status¹.

Fatigue is a very common ailment encountered by every individual at some point in their life that exacerbates with physical or mental activity and subsides with adequate rest¹. However, chronic fatigue syndrome is the prolonged fatigue with associated symptoms (headaches, muscles or joint pain, recurrent sore throat, tender lymph nodes, impaired sleep, memory and cognition, and worsening exhaustion after physical or mental activity) lasting at least 6 months after exclusion of other fatigue-related etiologies and persists despite adequate rest².

Stress as a result of the inability to cope with life’s demands often goes hand in hand with fatigue. Apart from sharing some of the common signs such as impaired memory and sleep, poor performance, anxiety, depression and muscular pain; it acts as an important precursor to chronic fatigue syndrome³. Therefore, stress management helps in alleviating the severity of fatigue symptoms and burden of the disease; thus, promoting fatigue management and quality of life^4,5.

There have been different pharmacological and non-pharmacological interventions for the management of chronic fatigue as well as stress. Pharmacological interventions range from non-steroidal anti-inflammatory drugs (ibuprofen, naproxen), narcotics (tramadol, morphine, codeine), antidepressants (nortriptyline, doxepin, bupropion, mirtazapine, fluoxetine, sertraline), anticonvulsants (gabapentin, pregabalin) to antiviral and immunomodulatory drugs (rintatolimod, interferons, immunoglobulins, rituximab, corticosteroids, hormones)⁶.

Non-pharmacological interventions include adaptive pacing therapy, graded exercise therapy, sleep hygiene, physical therapy, acupuncture, massage, transcutaneous electrical nerve stimulation, yoga, biofeedback, mindfulness-based stress reduction techniques, coping skills training, cognitive behavioral therapy and dietary management. Recently, the interest in nutritional supplements, such as vitamin D, vitamin B12, magnesium, essential fatty acids, acetyl-L-carnitine, antioxidants (vitamin E, vitamin C, alpha-lipoic acid), reduced form of NADH and CoQ10 has increased among healthcare professionals and researchers ^6,7.

CoQ10 or ubiquinone is one such nutritional supplement with antioxidative properties that has a significant role in mitochondrial energy metabolism⁸. Its deficiency results in reduced tolerance to physical activity and fatigue and its supplementation have been associated with increased exercise performance and anti-fatigue effects⁹.

The recent article published by Mehrabani et al.¹ reviewed 16 studies conducted between 2004 and 2016, which included participants from various countries of both genders between 13-69 years of age with different health conditions. Among them, 10 studies showed positive effects of CoQ10 supplementation on fatigue in healthy, fibromyalgia, statin-associated myopathy and other fatigue-related diseases (multiple sclerosis, end-stage heart failure). Researchers saw the greatest benefit of CoQ10 supplementation of 300 mg/day and 200 mg/day for 3 months in patients with fibromyalgia and statin-induced fatigue, respectively. In healthy participants, researchers saw a significant reduction in physical fatigue in groups receiving 300 mg/day CoQ10 for 8 days.

Although Mehrabani and colleagues concluded that CoQ10 could be an effective supplement in fatigue management; there is still a need for further high-quality clinical trials, which could establish a firm link of CoQ10 supplementation in alleviating fatigue, to support the use of CoQ10 as a definitive alternative therapy for fatigue.