Effect of dietary Coenzyme Q10 plus NADH supplementation on fatigue perception and health-related quality of life in individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: a prospective, randomized, double-blind, placebo-controlled trial, by  Jesús Castro-Marrero, Maria Jose Segundo, Marcos Lacasa, Alba Martinez-Martinez, Ramon Sanmartin Sentañes and Jose Alegre-Martin in Nutrients 2021, 13(8), 2658; [doi.org/10.3390/nu13082658] 30 July 2021 (This article belongs to the Special Issue Dietary Supplements in Cardiovascular and Metabolic Diseases)


Research abstract:

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, multisystem, and profoundly debilitating neuroimmune disease, probably of post-viral multifactorial etiology. Unfortunately, no accurate diagnostic or laboratory tests have been established, nor are any universally effective approved drugs currently available for its treatment.

This study aimed to examine whether oral coenzyme Q10 and NADH (reduced form of nicotinamide adenine dinucleotide) co-supplementation could improve perceived fatigue, unrefreshing sleep, and health-related quality of life in ME/CFS patients.

A 12-week prospective, randomized, double-blind, placebo-controlled trial was conducted in 207 patients with ME/CFS, who were randomly allocated to one of two groups to receive either 200 mg of CoQ10 and 20 mg of NADH (n = 104) or matching placebo (n = 103) once daily. Endpoints were simultaneously evaluated at baseline, and then reassessed at 4- and 8-week treatment visits and four weeks after treatment cessation, using validated patient-reported outcome measures.

A significant reduction in cognitive fatigue perception and overall FIS-40 score (p < 0.001 and p = 0.022, respectively) and an improvement in HRQoL (health-related quality of life (SF-36)) (p < 0.05) from baseline were observed within the experimental group over time. Statistically significant differences were also shown for sleep duration at 4 weeks and habitual sleep efficiency at 8 weeks in follow-up visits from baseline within the experimental group (p = 0.018 and p = 0.038, respectively).

Overall, these findings support the use of CoQ10 plus NADH supplementation as a potentially safe therapeutic option for reducing perceived cognitive fatigue and improving the health-related quality of life in ME/CFS patients.

Future interventions are needed to corroborate these clinical benefits and also explore the underlying pathomechanisms of CoQ10 and NADH administration in ME/CFS.

5. Conclusions

To the best of our knowledge, this is the first study to assess the effects of oral CoQ10 plus NADH supplementation administered to a substantial number of ME/CFS patients (n = 207). Our findings suggest that, over a two-month period, this combination is potentially effective in reducing cognitive fatigue (also known as “brain fog”) and overall fatigue perception, thus improving HRQoL in ME/CFS.

The study shows that CoQ10 and NADH can be safely co-administered to ME/CFS patients and are generally well-tolerated at the dosages indicated. A therapeutic effect was also demonstrated on sleep quality within the experimental group.

Long-term RCTs in larger ME/CFS cohorts should now be performed to confirm the effectiveness of CoQ10 and NADH co-supplementation in treating the hallmark symptom of post-exertional malaise using two-day consecutive cardiopulmonary exercise testing (2-day CPET).

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