D-ribose supplements

Can D-Ribose Really Help Fibromyalgia, Fatigue and Heart?

[toc]Should you consume more sugar to boost your energy?

For a quick buzz, sure. For sustained energy, we all know that would be a fool’s errand. Ineffective after a matter of minutes. Long term, it can wreck your health in more ways than you can count.

Just look at the folks who drink soda all day long.

Ribose is a sugar, so supplementing with it to get more energy may seem ridiculous, too.

But this is no ordinary sugar.

What is D-ribose?

Contrary to popular belief, ribose is not an amino acid/protein. The reason it’s used in bodybuilding supplements is because it’s believed to support energy production in the muscles.

Ribose is a simple sugar (monosaccharide) that’s similar to glucose, except it’s made with 5 carbon atoms instead of 6.

molecular structures and chemical formulas for D-ribose and sugar (glucose) compared

The molecular formula for D-ribose is C5H10Oand glucose is C6H12O6.

The backbone of one less carbon atom also means fewer hydrogen and oxygen atoms are attached. This results in a different shape for ribose versus other simple sugars, like glucose and fructose which are larger. Unlike those which are oxidized to create energy, our bodies use the smaller ribose molecule for different purposes.

Ribose is an essential part of ATP (adenosine triphosphate), which is the chemical used to store and deliver energy within every cell of the body.

Ribose is also found in RNA (ribonucleic acid). RNA acts as a messenger of genetic information. RNA replicates fragments of encoded DNA and delivers them, so their instructions can be carried out.

A modified version of ribose, where one of the oxygen atoms has been removed, is used by the body to form DNA. That’s why DNA actually stands for deoxyribonucleic acid. The “deoxy” part is in reference to the missing oxygen atom.

Is ribose and D-ribose the same?

Generally, yes they are the same thing. The term D-ribose refers to the type naturally found in life forms. There is also L-ribose, but it is synthetic and not found in nature. Therefore when people say “ribose” they are generally talking about the D form.

It’s similar to how people shorten the names of other chemicals and amino acids. For example, carnosine is technically L carnosine, and alpha lipoic acid is either the R or S form (e.g. R alpha lipoic acid).

In short…

D-ribose is a sugar but its purpose is not to be “burned” for energy creation, like other types of sugar. The main function of D-ribose is to build a chemical for storing energy (ATP) and be used as a building block for copying genetic information (RNA).

Foods high in ribose include mushrooms, beef, chicken, milk, eggs, and fish. At only a few milligrams per serving, the content in these foods may be “high” relative to other things you eat, but it is still a trivial amount. Supplements provide hundreds of times more when compared to food sources of ribose.

In humans and animals, ribose sugar comes from internal biological processes which manufacture it. We aren’t getting it from food.

dosing instructions and supplement facts for Life Extension non-GMO ribose

Because it’s technically a sugar, D-ribose nutrition facts are published on supplements. It’s listed as having 20 calories per 5g (5,000 mg) and of that, all 5g are carb in the form of sugar. Since the human body doesn’t recognize it as fuel or oxidize it for energy creation, the calories in ribose are only correct in the sense of chemistry (a unit of heat energy). Humans can’t use it to create energy like glucose, fructose, or sucrose.

Health benefits of ribose

  • Increases energy
  • Decreases muscle pain
  • Improves chronic fatigue syndrome (CFS)
  • May support cardiovascular health
  • Fibromyalgia symptom improvement
  • Better looking skin
  • Better quality sleep
  • Weight loss aid

All of the above are unproven. These are merely things D-ribose has been used for, formally and informally. While there is preliminary evidence suggesting it might be beneficial for each of the above, there is inadequate clinical data to prove any benefit. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

You will only find around a dozen human clinical trials for D-ribose in the PubMed database. Here are the highlights…

Fibromyalgia pain and fatigue

There is some research to suggest that lower ATP levels may occur in fibromyalgia patients. In one study which compared 25 patients with the disease to 25 healthy individuals, it was found that ATP levels were approximately 80% lower for the men and women with fibromyalgia. (1)

If this is happening, then theoretically, boosting ATP production might help with side effects.

Doe ribose help fibromyalgia?

woman yawning at sporting eventWhile many people take ribose for fibromyalgia pain and claim it works, there is no clinical evidence to verify this. Only one human study has been done and it has a number of weaknesses:

  • 41 people with fibromyalgia and/or chronic fatigue syndrome (CFS) participated.
  • There was no placebo or control group.
  • 15g daily dosage of D-ribose, divided into 5g taken 3 times per day, was used.
  • Supplementation was used for 3 weeks.
  • Results were based on visual analog scale (VAS) categories: energy; sleep; mental clarity; pain intensity; and well-being, which were all self-judged.
  • Supplement manufacturer employed one of the study’s authors.

The results?

“Approximately 66% of patients experienced significant improvement while on D-ribose, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%.”

While the results sound as if ribose works for fibromyalgia and CFS, without a placebo-controlled group is difficult to know. This was an open label study, so the patients all knew what they were getting. Plus, there were no measurements of ATP levels, so it’s unknown if ribose sugar increased ATP. (2)

The placebo-effect, which is the effect of experiencing pain/symptom relief simply because you are receiving something, averages anywhere from 30-50% across various diseases and disorders. It’s unknown how many patients truly improved versus those who were just experiencing the placebo-effect in this study. (3)

Congestive heart failure study

 electrocardiogram (ECG or EKG) heart monitorThe authors of a double-blind and randomized trial believe D-ribose benefits heart failure patients. While there is animal research to suggest that possibility, the University of Bonn in Germany conducted the first trial using humans with chronic coronary artery disease, stable angina (chest pain), and class II or III heart failure classification.

  • 15 patients participated; 14 men and 1 woman.
  • Average age was 61 years.
  • Each received D-ribose supplements or a placebo (dextrose).
  • Dosage was 5 grams of D-ribose powder dissolved in 8 oz of water, taken 3x daily with food (15 gram daily total).
  • Each group took their treatment for 3 weeks.
  • After a 1 week washout period, each group was given the opposite treatment (the one they hadn’t received) and that was taken for another 3 weeks.
  • Before and after each 3 week treatment, heart health was measured using echocardiography (heart ultrasound), functional capacity using cycle ergometer testing, and quality of life using the SF-36 questionnaire.

The results?

  • Enhancement of atrial contribution to left ventricular filling (40±11% vs. 45±9%)
  • Smaller left atrial dimension (54±20% vs. 47±18%)
  • Shortened E wave deceleration by echocardiography (235±64% vs. 196±42%)

While this may sound like foreign language to you, for those with CHF, there’s a good chance these parameters come up in discussions with doctors.

“Further, D-ribose also demonstrated a significant improvement of the patient’s quality of life (417±118 vs. 467±128, P=0.01). In comparison, placebo did not result in any significant echocardiographic changes or in quality of life.”

Why was this occurring? Here is what the authors theorize:

“Several studies have shown that the pentose sugar, D-ribose, shortens the time to regenerate deficient myocardial ATP levels following ischemia. D-Ribose aids cardiac metabolism by entering the pentose phosphate pathway to form ribose-5-phosphate and bypasses the rate-limiting enzymes of glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Decreased availability of myocardial ATP may allow calcium to remain fixed to troponin longer in diastole, leading to diastolic dysfunction, as previously reported in animal studies.”

Translated to plain English, scientists theorize that D-ribose works for heart failure by increasing the amount of ATP available to the cardiac cells.

They say that during ischemia (reduced blood flow) and hypoxia (reduced oxygen) there isn’t enough ATP available. Both of those conditions occur during CHF, as well as with heart attacks and some heart valve problems. Ischemic strokes too, obviously. Heart palpitations don’t always reduce blood flow and oxygen. (4)

Weight loss, exercise and muscle

young buff bodybuilder holding protein drinkAt the University of Nebraska, a clinical study was done using 32 men undergoing endurance training. Over an 8-week period, a ribose drink was pitted against other sports drinks; protein-based and regular sugar-based. Although it didn’t improve body weight, VO2 max or time to exhaustion, its usage did correlate with lower body fat percentage and fat-free mass. (5)

At Montana State University, a small double-blinded and placebo-controlled study was done with 7 people in a cycling test. They cycled at their lactate threshold for 25 minutes with reduced oxygen air (16%), followed by a 60 minute rest in a room with a normal oxygen level (21%). For those who supplemented with a 7 gram dose prior to exercise…

“Ribose demonstrated a beneficial trend in lower MDA and reduced glutathione levels during hypoxic stress.”

In plain English, there were fewer signs of free radical production when compared to those using placebo. Hypoxic exercise, which is exercising in an oxygen-deprived environment, normally generates higher oxidative stress. This means there may be anti-aging benefits, too. (6)

Side effects of ribose

As a dietary supplement, using ribose for energy, bodybuilding, weight loss, and fibromyalgia pain appears to be well-tolerated at dosages of 5 grams, taken up to 3 times daily. Adverse reactions were not observed in the related studies. The congestive heart failure study reported “all patients completed exercise testing with no adverse effects” for the functional capacity data, however the study remained silent as to whether or not there were other side effects/safety concerns.

ribose supplement label warning about side effects and dangers

D-ribose sugar is potentially dangerous for diabetics but for a reason you would not expect.

One human study reported 30% reduction in blood sugar (-26.3 mg/dL) within 60 minutes after taking it. Such an unexpected drop could be dangerous for diabetes. In conjunction with their medicine, using ribose may result in too low of blood sugar. (7)

Since ribose supplements have not been studied during pregnancy and breastfeeding, women should avoid using them during those times.

Since there is so little clinical data, it’s possible there are unknown side effects. You should not use this supplement without first consulting your medical doctor.

How to take?

500 mg capsule next to dime to show size
What a 500 mg (1/2 gram) capsule looks like. Taking 5 grams would require swallowing 10 of these.

D-ribose powder, which you can stir in a glass of water, is the preferred way to take it. This is because the typical dosage recommended by most manufacturers is 5 grams, which would equate to 5-10 capsules/tablets. That’s too many capsules for most people, which is why using powder is better.

The maximum dosage used in trials was 15 grams, divided into three equal dosages of 5 grams each.

Since it is a sugar, it is water soluble. It’s not a fat-soluble substance you need to consume with food. According to a study which measured bioavailability, taking ribose supplements on an empty stomach provides the best absorption.

The best time to take D-ribose will be at morning, mid-day and night, at times outside of meals; either 60 minutes before or 3 hours after eating.

Using D-ribose in coffee – as some people do – likely provides good absorption as long as it’s black. Adding milk or sugar to the coffee will likely reduce absorption, based on the study of taking it with and without food.

In the study, 12 healthy men and women used dosages of 2.5, 5, and 10 grams under fasting conditions. Later, the same people were tested with a 10 gram dosage of ribose powder that was taken with food; 6 ate a high-fat meal and 6 ate a high-carb meal. This is what was seen:

  • The supplement was absorbed quickly, with the max blood level (Tmax) reached between 18 and 30 minutes after taking. This was comparable when taken with food.
  • When taken with the high-fat meal, Cmax (max blood level reached) decreased 42.6% and AUC (amount in blood over time) decreased 40.8%.
  • When taken with the high-carb meal, Cmax (max blood level reached) decreased 69.1% and AUC (amount in blood over time) decreased 64.9%.

In short, it still got absorbed quickly when taken with food, but based on blood levels measured there was less absorbed. (7)

How long does it take for d-ribose to start working?

Since it is absorbed within 30 minutes, the benefits for fatigue and increased energy may be just as fast, based on the results seen in some of the studies about athletes, exercise, and mental energy.

Whether it works for fibromyalgia, muscle pain, cardiac health, and other diseases remains unknown. If it does help, the research suggests it would take more than one-time usage to see measurable results. This product is not intended to diagnose, treat, cure, or prevent any disease.

Best D-ribose supplement?

While a natural ingredient itself can’t be patented, the production method of manufacturing one can be.

The method, which is marketed as Bioenergy Ribose, uses microbial fermentation to make it. This process is protected by several U.S. patents (6,159,942, 6,534,480, 6,218,366 and 6,339,716). Since those were filed in 1998 and 1999 these are now coming off patent protection, which lasts 20 years.

Bioenergy Ribose brand supplement label

Bioenergy Ribose is the best-rated and most-reviewed supplement. All of the high quality supplement brands license this and use it in their products.

The powder by itself is vegan and allergy-friendly. It’s gluten free and doesn’t contain other major allergens like dairy, eggs, nuts, or soy. When the powder is placed inside capsules or pills, check the label because those might contain added ingredients that are non-vegan and potential allergens.

On Amazon you can buy Jarrow Formulas or Doctor’s Best in bottles. Those are chewable tablets and veggie (vegan) capsules, respectively. Their drawback is that they are only 1 gram (or less) per tablet/capsule. An easier and more efficient way to take the recommended 5 gram dose is to get pure D-ribose powder. You can stir that into hot/cold water or black coffee.

Your best bet is to buy a big bag of powder by BulkSupplements. It’s a great value. A small jar by Life Extension is also available. Based on personal reviews, powdered forms are optimal.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.