TGI Friday! Our weekly round-up of recently published research abstracts | 6 May 2016

May 6, 2016

From Biofactors, published online 29 April 2016.

Ubiquinol-10 [ie, Co-enzyme Q10] supplementation improves autonomic nervous function and cognitive function in chronic fatigue syndrome.

Fukuda S(1,2,3), Nojima J(4), Kajimoto O(5), Yamaguti K(3,6), Nakatomi Y(3,6), Kuratsune H(1,3,6), Watanabe Y(2,3).
1) University of Kansai Welfare Sciences, Kashiwara, Osaka, Japan
2) RIKEN Center for Life Science Technologies, Kobe, Hyogo, Japan
3) Department of Physiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
4) Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi, Japan
5) Department of Medical Science on Fatigue, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
6) Department of Endocrinology, Metabolism and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan


The aim of this study was to evaluate the benefit of oral ubiquinol-10 supplementation in CFS patients using an open-label study and a randomized, double-blinded, placebo-controlled (RCT) study.

Twenty patients with CFS were randomly enrolled in an 8-week open-label oral ubiquinol-10 (150 mg ubiquinol-10/day) study. The patients and the attending physicians were not blinded to the supplementation.

Forty-three patients with CFS were randomly assigned to receive either ubiquinol-10 (150 mg/day) or placebo every day for 12 weeks. The patients and the attending physicians were blinded to the supplementation, and a total of 31 patients (N = 17 in the ubiquinol group and 14 in the placebo group) completed the study.

The beneficial effects of ubiquinol-10 were observed in the open-label study we conducted prior to the RCT. The RCT results suggest that supplementation with ubiquinol-10 for 12 weeks is effective for improving several CFS symptoms.


Although this supplement is quite often used by people with ME/CFS, there has been no sound evidence from a clinical trial until now to indicate that it could be a safe and effective form of treatment for ME/CFS.


MEA information on co-enzyme Q10 from an MEE Question and Answer below

We also have an MEA information leaflet summarising the evidence for all the ‘muscle energy supplements' available to download at

QUESTION: Coenzyme Q10 – does it work?

My nutritionist has advised me to start taking a supplement called coenzyme Q10 (CoQ10) which, she says, will boost my energy levels. So what is CoQ10 and is this claim correct? Are there any side-effects? And can I take it with prescription only medicines?


Coenzyme Q10 (CoQ10), which is also known as ubiquinone, is often referred to as a vitamin. However, this isn't strictly true as it is made in the liver from an amino acid called tyrosine. CoQ10 is also present in a wide variety of foods. So deficiency can occur as a result of reduced dietary intake, decreased production, or increased usage – or a combination of all three.

CoQ10 is known as a coenzyme because it helps other enzymes in the body to carry out their normal functions. In relation to muscle fatigue, it is involved in energy producing chemical pathways inside the mitochondria – parts of the cell where energy in the form of a chemical called ATP is produced. It also has antioxidant activity. So there are clearly some theoretical reasons why CoQ10 might be helpful in ME/CFS.

However, despite all the claims being made for CoQ10, there is very little scientific evidence linking deficiency with disease. Neither is there much evidence of benefit in diseases where it is sometimes recommended such as heart failure, mitochondrial muscle diseases, and Parkinson's disease (where decreased levels have been found in the spinal fluid). The same situation applies to ME/CFS.

As far as side effects are concerned, CoQ10 is normally well tolerated with no serious side-effects. But it has not been properly assessed in pregnancy.

One important note of caution relates to its use with statins – prescription only drugs used for lowering blood cholesterol levels. Statins can lower the levels of CoQ10, and it has been suggested that this could make people more liable to develop statin-induced myopathy (muscle damage). This is a well recognised side-effect of statins, and is something that is occasionally reported by people with ME/CFS. So there may be a case for taking CoQ10 if you have ME/CFS and are also taking a statin. It has also been reported that CoQ10 can interfere with anticoagulants (blood thinning drugs such as warfarin) at high doses.

Overall, CoQ10 is a supplement that may be worth a try – bearing in mind that reports of benefit are speculative rather than scientifically proven.

From the Journal of Magnetic resonance Imaging, published online 28 April 2016.

Progressive brain changes in patients with chronic fatigue syndrome: A longitudinal MRI study.

Shan ZY(1), Kwiatek R(2), Burnet R(3), Del Fante P(4), Staines DR(1), Marshall-Gradisnik SM(1), Barnden LR(1).
1) National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Southport, Australia.
2) Division of Medical Subspecialities, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.
3) Endocrinology department, Royal Adelaide Hospital, Adelaide, Australia.
4) Healthfirst Network, Woodville, Australia.



To examine progressive brain changes associated with chronic fatigue syndrome (CFS).


We investigated progressive brain changes with longitudinal MRI in 15 CFS and 10 normal controls (NCs) scanned twice 6 years apart on the same 1.5 Tesla (T) scanner. MR images yielded gray matter (GM) volumes, white matter (WM) volumes, and T1- and T2-weighted signal intensities (T1w and T2w). Each participant was characterized with Bell disability scores, and somatic and neurological symptom scores. We tested for differences in longitudinal changes between CFS and NC groups, inter group differences between pooled CFS and pooled NC populations, and correlations between MRI and symptom scores using voxel based morphometry. The analysis methodologies were first optimized using simulated atrophy.


We found a significant decrease in WM volumes in the left inferior fronto-occipital fasciculus (IFOF) in CFS while in NCs it was unchanged (family wise error adjusted cluster level P value, PFWE < 0.05). This longitudinal finding was consolidated by the group comparisons which detected significantly decreased regional WM volumes in adjacent regions (PFWE < 0.05) and decreased GM and blood volumes in contralateral regions (PFWE < 0.05). Moreover, the regional GM and WM volumes and T2w in those areas showed significant correlations with CFS symptom scores (PFWE < 0.05).CONCLUSIONThe results suggested that CFS is associated with IFOF WM deficits which continue to deteriorate at an abnormal rate.

From BMC Pediatrics, 26 April 2015.

Research article:
Tracking post-infectious fatigue in clinic using routine Lab tests

Jeanna M. Harvey, Gordon Broderick, Alanna Bowie, Zachary M. Barnes, Ben Z. Katz, Maurice R. G. O’Gorman, Suzanne D. Vernon, Mary Ann Fletcher, Nancy G. Klimas and Renee Taylor
Corresponding author:Gordon Broderick



While biomarkers for chronic fatigue syndrome (CFS) are beginning to emerge they typically require a highly specialized clinical laboratory. We hypothesized that subsets of commonly measured laboratory markers used in combination could support the diagnosis of post-infectious CFS (PI-CFS) in adolescents following infectious mononucleosis (IM) and help determine who might develop persistence of symptoms.


Routine clinical laboratory markers were collected prospectively in 301 mono-spot positive adolescents, 4 % of whom developed CFS (n = 13). At 6, 12, and 24 months post-diagnosis with IM, 59 standard tests were performed including metabolic profiling, liver enzyme panel, hormone profiles, complete blood count (CBC), differential white blood count (WBC), salivary cortisol, and urinalysis. Classification models separating PI-CFS from controls were constructed at each time point using stepwise subset selection.


Lower ACTH levels at 6 months post-IM diagnosis were highly predictive of CFS (AUC p = 0.02). ACTH levels in CFS overlapped with healthy controls at 12 months, but again showed a trend towards a deficiency at 24 months. Conversely, estradiol levels depart significantly from normal at 12 months only to recover at 24 months (AUC p = 0.02). Finally, relative neutrophil count showed a significant departure from normal at 24 months in CFS (AUC p = 0.01). Expression of these markers evolved differently over time between groups.


Preliminary results suggest that serial assessment of stress and sex hormones as well as the relative proportion of innate immune cells measured using standard clinical laboratory tests may support the diagnosis of PI-CFS in adolescents with IM.

From The Indian Journal of Public Health Research and Development, published online 26 April 2016.

Chronic Fatigue Syndrome – A Study of 70 Cases – Efficacy of Drug and Rehabilitation

Jindal Shilpi(1,*), Jindal Meenakshi(2)
1) Head of Department and Lecturer, Department of Physical Medicine and Rehabilitation, MMC, Muzaffarnagar
2)Assistant Professor, Department of Pharmacology, MMC, Muzaffarnagar
*Corresponding author: Dr. Shilpi Jindal, Head of Department and lecturer, Department of Physical Medicine and Rehabilitation. LLRM Medical College, Meerut, E-mail


Chronic Fatigue Syndrome or CFS is a debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. Symptoms affect several body systems and may include weakness, muscle pain, impaired memory and/or mental concentration and insomnia, which can result in reduced participation in daily activities. A prospective study was conducted on 70 cases of various age groups. Aim of the study was to assess the role of rehabilitation in general and mobility exercises and aerobics in particular in patients with chronic fatigue syndrome. Result showed that patients feel better with aerobics, fatigue is persistent. Aerobics increase concentration. Patients on exercises feel better as they sleep better.

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