supplimentation in fibromyalgia

1. Deciphering the role of CoQ10 deficiency in
Fibromyalgia Syndrome: Implications on the
amelioration of its symptoms by Ubiquinol-10
supplementation
Dr. Ghizal Fatima
Assistant Professor,
Department of Biochemistry
Era’s Medical College and Hospitals,
Lucknow

2. What is Fibromyalgia Syndrome
• Fibromyalgia Syndrome (FMS) is now recognized
as a major health problem.
• The pathophysiologic mechanisms of FMS are
difficult to identify and current drug therapies
have demonstrated limited effectiveness.
• Its a chronic musculoskeletal syndrome
characterized by diffuse pain, stiffness, and
tenderness of specific anatomic sites which are
called tender points.

3. • FMS has been associated with a wide spectrum of
symptoms such as allodynia, debilitating fatigue, joint
stiffness, sleep disturbances, migraine headaches,
irritable bowel syndrome, numbness or tingling of the
extremities, restless legs syndrome, dizziness and
balance problems, cognitive and memory problems,
mood disturbance such as depression and anxiety.
• The prevalence of FMS ranges from 1 to 2% in the
general population and the condition is more common
among females than in males with a ratio of 9:1. The
etiology of FMS is still unknown.

4. This condition affects mainly women, with a
female-to-male ratio of 9:1, and its
estimated prevalence in various populations
varies between 2% - 5%.
Epidemiology of FMS

5. Diagnosis of patients: (FMS)
• Diagnosis is based on the standardized criteria developed by the American
College of Rheumatology (1990). The criteria is-
1)-Widespread musculoskeletal pain for at least 3 months.
2)-Tenderness is found in at least 11 out of 18 anatomical sites in making a
fibromyalgia diagnosis with the application of 4 kg pressure by palpation
through first three fingers.

7. What is CoQ10
• Coenzyme Q10 (CoQ10) is an essential
element for many daily functions and is
required by every single cell in the body.
• As an antioxidant it protects cells from the
effects of aging, CoQ10 has been used in
medicine practices for decades, in the case of
treating many diseases.
• It is a strong antioxidant, which protects the
body from damage caused by oxidative stress.

8. • CoQ10 is naturally present in small amounts in a
wide variety of foods, but levels are particularly high
in organ meats such as heart, kidney and liver as well
as beef, soy oil, sardines, mackerel, and peanuts.
• Coenzymes help enzyme to digest food and perform
other body processes, and they help protect
the heart and skeletal muscles.
• In its active form, it’s called ubiquinone or ubiquinol.
It’s synthesized within the body naturally and used
for important functions, such as supplying cells with
energy, transporting electrons and regulating many
important body functions.

9. Ubiquinol
• The problem with conventional CoQ10 is that
body must convert it into Ubiquinol (the more
advanced type of CoQ10).
• Ubiquinol is a very strong antioxidant that
helps neutralize free radicals that damage
healthy cells in the body. Starting around the
age of 30, body has a harder time turning
conventional CoQ10 into Ubiquinol.

10. • Both forms of CoQ10 have interested researchers for
many years, but Ubiquinol CoQ10 has been
commercially available in America for only 10 years. In
that short time, more than 60 research studies have
been performed into the health benefits of Ubiquinol
CoQ10 around the World.
• However, in India no such study on Ubiquinol has been
conducted till date on FMS patients. Despite its various
health benefits, conventional CoQ10 has an important
disadvantage: it’s not as efficiently absorbed by the
human body. But Ubiquinol is different its get easily
absorbed by the body.

11. • In every published comparative study to date,
Ubiquinol gets better absorbed by the body than
conventional CoQ10.
• This difference makes ubiquinol quite special,
According to these results; we postulated that
Ubiquinol-10 could be used as an alternative
therapeutic approach for FMS.
• We therefore plan out this first study on
supplementation of Ubiquinol-10 in Indian
patients with FMS.

12. Objectives
• To give the supplementation of ubiquinol-10 (200 mg/day for
12 weeks) to women with FMS.
• To examine the response of ubiquinol-10 supplementation, on
symptom severity and quality of life, by assessing subjective
pain intensity, Fibromyalgia Impact Questionnaire (FIQ),
quality of life (QOL), and general patients assessment by
different questionnaires.
• To test the oxidative and antioxidative parameters after
supplementation.

13. • Till now we have enrolled total number of 20
FMS women and gave them supplementation
of Ubiquinol.
• We have filled the General assessment
questionnaire and FIQR.
• Based on these questionnaire we are
presenting this work, with the hope to get
better results from Ubiquinol in the upcoming
days.

14. Materials and Method
We enrolled 20 FMS women for the present study based on the standardized
criteria developed by the American College of Rheumatology (1990).
Clinical assessment was done by following questionnaires
1- General Assessment Questionnaire (self designed)
2- Fibromyalgia impact Questionnaire Revised (Bennett et al, 2009)
Oral Ubiquinol-10 supplementation:
• 20 patients were supplemented with Solgar Ubiquinol soft gel capsules for 3
months Morning and Bed time (200 mg/day))
• After 3 months of supplementation, heparinized blood samples were collected
after 12-hours fasting, and clinical symptoms were evaluated.

15. Inclusion and exclusion criteria
Inclusion Exclusion
Patients who fulfilled the criteria
developed by the American
College of Rheumatology (1990)
were included in the study.
Smokers and those using any oral
contraceptives were excluded from the
study as these factors can influence the
oxidative stress parameters.
Informed consent for inclusion in
the study were taken from all the
subjects.
Moreover, subjects with known co-morbid
conditions like diabetes mellitus, psychiatric
and those suffering from Rheumatoid
arthritis or other inflammatory joint disease
were also excluded from the study.

16. Clinical and Biochemical Characteristics among Study and Control groups
Parameters FMS with Ubiquinol
supplementation=20
[mean ± SD]
FMS without
supplementation=20
[mean ± SD]
P-value
Age (years) 40.1±6.2 46.2±6.8 N.S
ESR 24.2±9.7 27.9±8.2 N.S
FIQR 47.2±7.4 89.0±8.3 <0.05
Tender Points 12.6±2.1 16.8±1.8 <0.05

17. Clinical characteristics of FMS patients with and without supplementation
Variables FMS with
supplementation
(n=20)
FMS without
supplementation
(n=20)
p-value
Muscles twitching
Yes 4 19
<0.05No 16 1
Disequilibrium in Climbing stairs
Yes 0 17
<0.05No 20 3
Frequent awakening
Yes 5 18
<0.05
No 15 2
Sleep status
Sound sleep 11 4
<0.05
Disturbed sleep 9 16

18. Morning Stiffness
Yes 3 19 <0.05
No 17 1
Morning fatigue
Yes 3 18 <0.05
No 17 2
Headache
Yes 4 15 <0.05
No 16 5
Lack of energy
Yes 4 18 <0.05
No 16 2
Clinical characteristics: cont.

19. Oxidative stress parameters among FMS patients
with and without supplementation
Oxidative stress
parameters
FMS with
suppl. n=20
FMS without
suppl. n=20
p-value
Lipid Peroxides
(LPO)
2.2±0.3 3.6±0.7 <0.01
Protein carbonyl
1.3±0.2 1.9±0.8 <0.01

20. Antioxidative parameters among FMS patients with and
without supplementation
Antioxidative
parameters
FMS with
suppl. n=20
FMS without
suppl. n=20
p-value
Catalase 57.3±8.6 41.0±5.1 <0.01
Glutathione
peroxidase (GPx)
38.7±5.1 28.2±3.7 <0.01
Glutathione
Reductase (GR)
28.1±6.2 24.4±4.2 <0.01

21. Pearson correlation analysis in between Oxidative stress
parameters, Antioxidative parameters and age, TPC and FIQR
Parameters Groups FIQR TPC Age
r r r
Lipid Peroxides
(LPO)
FMS supple. -.151 -.053 -0.049
FMS -.413* .132 0.031
Protein Carbonyl
FMS supple. .181 .096 -0.177
FMS -.391* -.256 0.097
Catalase
FMS supple. -0.093 .064 -0.182
FMS .114 -.179 0.072
Glutathione
peroxidase (GPx)
FMS supple. -0.138 -.116 0.081
FMS -.133 .130 0.125
Glutathione
Reductase (GR)
FMS supple. 0.058 -.156 0.084
FMS -.101 .064 0.043

22. The rationale for studying Ubiquinol in FMS
The rationale for studying Ubiquinol, in FMS women is based on
diverse aspects:
• It has given us better understanding in part for origin and
pathogenesis of this complication.
• It has improved our knowledge of inter-individual variation in
the development and progression of FMS.
• In a clinical setting, identification of lower CoQ10 that regulate
symptoms of FMS, has offered the prospect of identifying novel
drug design in the search for new treatments for FMS.

23. • Accordingly, this study might help in designing of
new anti-FMS drugs that could be used in the
prevention and treatment of FMS.
• Another potential application of this may be in
the field of diagnostics.
• The fact that patients with FMS are coenzyme
Q10-deficient led us to conduct a study of
ubiquinol- 10 supplementation in FMS patients.