A reader emailed me “Can you do a PubMed breakdown of CoQ10 and how it might relate to gut bacteria? I’m struggling so much with energy, but things that are supposed to give me energy like Coq10, pretty much all the B vitamins, etc. often make me drowsy and spacey. Any thoughts?”
As a preamble: Many things have been found low in CFS which leads to an inference that supplementation of the low items could help. This happens sometimes, but more often it has little impact — often because of “co-factors” or some other process not being there. Studies finding low levels are not included, rather studies that tried supplementation..
First, the known results from studies on PubMed.
- Effect of coenzyme Q10 plus nicotinamide adenine dinucleotide supplementation on maximum heart rate after exercise testing in chronic fatigue syndrome – A randomized, controlled, double-blind trial. “The CoQ10 plus NADH group showed a significant reduction in max Heart Rate during a cycle ergometer test at week 8 versus baseline (P = 0.022). Perception of fatigue also showed a decrease through all follow-up visits in active group versus placebo (P = 0.03). However, pain and sleep did not improve in the active group.”
- Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome?  “oralCoQ10 (200 mg/day) plus NADH (20 mg/day).. A significant improvement of fatigue showing a reduction in fatigue impact scale total score … could confer potential therapeutic benefits on fatigue and biochemical parameters” — remember the word “significant” can mean a very very small change on average….
- “76 ME/CFS patients with initially abnormal autoimmune responses were treated with care-as-usual, including nutraceuticals with anti-IO&NS effects (NAIOS), such as L-carnitine, coenzyme Q10, taurine + lipoic acid, with or without curcumine + quercitine or N-acetyl-cysteine, zinc + glutamine. …. Although hypernitrosylation and nitrosative stress play a role in ME/CFS, reductions in these pathways are not associated with lowered severity of illness.”
- “Coenzyme Q10 deficiency in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is related to fatigue, autonomic and neurocognitive symptoms and is another risk factor explaining the early mortality in ME/CFS due to cardiovascular disorder. “lowered levels of CoQ10 play a role in the pathophysiology of ME/CFS and that symptoms, such as fatigue, and autonomic and neurocognitive symptoms may be caused by CoQ10 depletion. Our results suggest that patients with ME/CFS would benefit fromCoQ10 supplementation in order to normalize the low CoQ10 syndrome and the IO&NS disorders.”
- “A daily dose of 100 mg coenzyme Q(10) for 60 days does not alleviate the fatigue of the late-onset sequelae of poliomyelitis.” – this is not CFS, but a different illness with fatgiue being a strong characteristic.
CFS and FM both have low levels but do have differences
“Peripheral blood mononuclear cell showed decreased levels of Coenzyme Q10 from CFS patients (p<0.001 compared with controls) and from FM subjects (p<0.001 compared with controls) and ATP levels for CFS patients (p<0.001 compared with controls) and for FM subjects (p<0.001 compared with controls). On the contrary, CFS/FM patients had significantly increased levels of lipid peroxidation, respectively (p<0.001 for both CFS and FM patients with regard to controls) that were indicative of oxidative stress-induced damage. Mitochondrial citrate synthase activity was significantly lower in FM patients (p<0.001) and, however, in CFS, it resulted in similar levels than controls.” 
” Significant negative correlations between CoQ(10) or catalase levels in blood mononuclear cells and headache parameters were observed [in FM]” 
Levels are Low, Lab improves but most symptoms do not
It looks like the low CoQ10 is the result of other processes and not the cause of symptoms. Supplementation will improve lab results, but likely not bring noticeable relief to symptoms. Given the relative high cost of CoQ10 and NADH and no clear symptom relief, it is likely not a priority item for CFS and FM patients.
“Good responders had used significantly more frequent injections (p<0.03) and higher doses of B12 (p<0.03) for a longer time (p<0.0005), higher daily amounts of oral folic acid (p<0.003) in good relation with the individual MTHFR genotype, more often thyroid hormones (p<0.02), and no strong analgesics at all, while 70% of Mild responders (p<0.0005) used analgesics such as opioids, duloxetine or pregabalin on a daily basis…Dose-response relationship and long-lasting effects of B12/folic acid support a true positive response in the studied group of patients with ME/fibromyalgia..” 
- High-dose thiamine improves the symptoms of fibromyalgia.  “The oral therapy with 600–1800 mg/day of thiamine led to an appreciable attenuation of CWP, fatigue and all other symptoms in all patients within a few days”
“The lowest dose that we used is 600 mg/day (patient 1), and then a dose of 300 mg was increased every 3 days depending on the weight and the results obtained. Patient numbers 2 and 3 never reported any improvement until the dose was increased up to 1500 mg/day, orally. An abrupt improvement instead occurred at doses of 1800 mg/day.”
- “The absence of blood thiamine deficiency and the efficacy of high-dose thiamine in our patients suggest thatfatigue is the manifestation of a thiamine deficiency, likely due to a dysfunction of the active transport of thiamineinside the cells, or due to structural enzymatic abnormalities.”  The last phase would include dysfunctional microbiome.
- See post on B1 and post on Benfotiamine.
Vitamin B bottom line
Despite CFS patients being low in B-Vitamins being well documented for decades, there has been a surprising absence of studies finding positive effects. There can be two reasons: no one bother to study, or people tried studies and found insignificant results :-(.
Vitamin B-1 appears the best of the B-vitamins (mainly because there was no reports of significant differences of responses). The dosage reported to cause a change within one week is 600-1800 mg/day. This is 18x the typical daily dose of B-1 supplements (100mg), and 3-4x the typical daily dose of high potency supplements (500mg). Monthly cost: $14/month for 1500-2000 mg based on Amazon US pricing.
If you have tried B-1 in the past, there is a good chance that the dosage was well below that of the above study — so no change in symptoms would almost be expected.
CoQ10 and the Gut
We know that B-12 is produced by Lactobacillus Reuteri — which is very low in the gut of CFS patients. What about CoQ10? The answer is that many bacteria produces it — a shift of the microbiome may easily result in a decrease. One of these bacterium appears to be E.Coli which is very low in CFS patients.
- “these processes have relied on microbes that produce high levels of UQ-10 naturally.” 
- “We found Q9 in five other species of Pseudomonas, Q8 and Q9 in Pseudomonas fluorescens, and evidence for the presence of some form of Q in 32 cultures, representing 20 species out of 107 cultures which were examined.”
- [Production of coenzyme Q10 by metabolically engineered Escherichia coli].
300 mg/day – Studies in this post.