Ribose supplement for fibromyalgia, heart failure, exercise, and fatigue, how effective is this pill? What is the right dosage? by Ray Sahelian, M.D.
Feb 3 2014


Ribose is a carbohydrate, or sugar, used by all living cells and is an essential component in our body’s energy production. It has many important roles in physiology. Among them, it is a necessary substrate for synthesis of nucleotides, and it is part of the building blocks that form DNA and RNA molecules. The claim made is that ribose enhances athletic performance. If you would like to take a pill for more energy, consider MultiVit Rx.

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During strenuous exercise, large amounts of ATP, the body's primary energy-carrying molecule, can be depleted in heart and skeletal muscle cells. D-Ribose is a simple sugar that is used by the body to synthesize nucleotides, ATP, nucleic acids, and glycogen.*
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D-Ribose - 3 grams per 3 chewable tablets

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Ribose benefit review
As of 2014, I have not come across any data to support the claims that ribose, by itself, is a helpful nutrient in athletes in terms of athletic performance enhancement but it may reduce oxidative stress. It appears that it may be beneficial to individuals with congestive heart failure and perhaps may offer some relief in those with chronic fatigue syndrome or fibromyalgia.

Antioxidant benefit during exercise
The role of ribose on oxidative stress during hypoxic exercise: a pilot study.
J Med Food. 2009. Department of Health and Human Development, Montana State University, Bozeman, USA.
We tested the effect of d-ribose, a pentose carbohydrate, in a double-blinded, crossover study on markers of free radical production during hypoxic exercise. Seven healthy volunteers cycled at their lactate threshold for 25 minutes while inhaling 16% O(2) with a subsequent 60-minute resting period at room air. Subjects ingested either placebo or 7 g of ribose in 250 mL of water before and after the exercise session. Urinary malondialdehyde (MDA) and plasma reduced glutathione levels increased significantly during placebo ingestion but were lower with ribose supplementation. Uric acid levels were similar between groups. Ribose demonstrated a beneficial trend in lower MDA and reduced glutathione levels during hypoxic stress.

Athletic performance, muscle strength, exercise capacity
Effects of a carbohydrate-, protein-, and ribose-containing repletion drink during 8 weeks of endurance training on aerobic capacity, endurance performance, and body composition.
J Strength Cond Res. 2012.
This study compared a carbohydrate-, protein-, and ribose-containing repletion drink vs. carbohydrates alone during 8 weeks of aerobic training. Thirty-two men performed tests for aerobic capacity (V(O2)peak), time to exhaustion (TTE) at 90% V(O2)peak, and percent body fat (%fat), and fat-free mass (FFM). Testing was conducted at pre-training (PRE), mid-training at 3 weeks (MID3), mid-training at 6 weeks (MID6), and post-training (POST). Cycle ergometry training was performed at 70% V(O2)peak for 1 hours per day, 5 days per week for 8 weeks. Participants were assigned to a test drink (TEST; 370 kcal, 76 g carbohydrate, 14 g protein, 2.2 g d-ribose; n = 15) or control drink (CON; 370 kcal, 93 g carbohydrate; n = 17) ingested immediately after training. Body weight (BW; 1.8% decrease CON; 1.3% decrease TEST from PRE to POST), %fat (5.5% decrease CON; 3.9% decrease TEST), and FFM (0.1% decrease CON; 0.6% decrease TEST) decreased, whereas V(O2)peak (19.1% increase CON; 15.8% increase TEST) and TTE (239.1% increase CON; 377.3% increase TEST) increased throughout the 8 weeks of training. Percent decreases in %fat from PRE to MID3 and percent increases in FFM from PRE to MID3 and MID6 were greater for TEST than CON. Overall, even though the TEST drink did not augment BW, V(O2)peak, or TTE beyond carbohydrates alone, it did improve body composition (%fat and FFM) within the first 3-6 weeks of supplementation, which may be helpful for practitioners to understand how carbohydrate-protein recovery drinks can and cannot improve performance in their athletes.

Effects of ribose as an ergogenic aid.
J Strength Cond Res. 2006. Department of Health and Kinesiology, Mississippi University for Women, Columbus, MS, USA.
Ribose, a naturally occurring pentose sugar, helps resynthesize ATP for use in muscles. There have been claims that ribose supplements increase ATP levels and improve performance. Other studies have provided mixed results on the effectiveness of ribose as an ergogenic aid at high doses. None of these studies have compared the impact of the recommended dose of ribose on athletes and nonathletes under exercise conditions that are most conducive for effectiveness. The purpose of this study was to evaluate the effectiveness of ribose as an ergogenic aid at the dose recommended for supplements currently on the market during an exercise trial to maximize its efficacy. Male subjects (n = 11) performed 2 trials 1 week apart. Each trial consisted of three 30-second Wingate tests with a 2-minute recovery between each test. Trials were counterbalanced, with 1 trial being performed with 625 mg of ribose and the other with a placebo. We found no significant differences between ribose and placebo. These results suggest that ribose had no effect on performance when taken orally, at the dose suggested by the distributor.

Effect of ribose supplementation on resynthesis of adenine nucleotides after intense intermittent training in humans.
Am J Physiol Regul Integr Comp Physiol. 2004.
The effect of oral ribose supplementation on the resynthesis of adenine nucleotides and performance after 1 wk of intense intermittent exercise was examined. Eight subjects performed a random double-blind crossover design. The subjects performed cycle training consisting of 15 x 10 s of all-out sprinting twice per day for 7 days. After training the subjects received either ribose (200 mg/kg body wt) or placebo (Pla) three times per day for 3 days. An exercise test was performed at 72 h after the last training session. Immediately after the last training session, muscle ATP was lowered by 25 and 22 in Pla and ribose, respectively. In both Pla and Ribose, muscle ATP levels at 5 and 24 h after the exercise were still lower than pretraining. After 72 h, muscle ATP was similar to pretraining in Ribose but still lower in Pla and higher in Ribose than in Pla. Plasma hypoxanthine levels after the test performed at 72 h were higher in Ribose compared with Pla. Mean and peak power outputs during the test performed at 72 h were similar in Pla and Ribose. The results support the hypothesis that the availability of ribose in the muscle is a limiting factor for the rate of resynthesis of ATP. Furthermore, the reduction in muscle ATP observed after intense training does not appear to be limiting for high-intensity exercise performance.

Effects of effervescent creatine, ribose, and glutamine supplementation on muscular strength, muscular endurance, and body composition.
J Strength Cond Res. 2003.
The purpose of this study was to examine the effects of a combination of effervescent creatine, ribose, and glutamine on muscular strength (MS), muscular endurance (ME) and body composition (BC) in resistance-trained men. Subjects were 28 men who had 2 or more years of resistance-training experience. A double blind, randomized trial was completed involving supplementation or placebo control and a progressive resistance-training program for 8 weeks. Dependent measures were assessed at baseline and after 8 weeks of resistance training. Both groups significantly improved MS and ME while the supplement group significantly increased body weight and fat-free mass. Control decreased body fat and increased fat-free mass. This study demonstrated that the supplement group with creatine, ribose, and glutamine did not enhance MS, ME, or BC significantly more than control after an 8-week resistance-training program.

Effects of oral D-ribose supplementation on anaerobic capacity and selected metabolic markers in healthy males.
Kreider RB. Int J Sport Nutrition Exerc Metab. 2003.
Oral D-ribose supplementation has been reported to increase adenine nucleotide synthesis and exercise capacity in certain clinical populations. Theoretically, increasing adenine nucleotide availability may enhance high intensity exercise capacity. This study evaluated the potential ergogenic value of D-ribose supplementation on repetitive high-intensity exercise capacity in 19 trained males. Subjects were familiarized to the testing protocol and performed two practice-testing trials before pre-supplementation testing. Each test involved warming up for 5 min on a cycle ergometer and then performing two 30-s Wingate anaerobic sprint tests on a computerized cycle ergometer separated by 3 min of rest recovery. In the pre- and post-supplementation trials, blood samples were obtained at rest, immediately following the first and second sprints, and following 5 min of recovery from exercise. Subjects were then matched according to body mass and anaerobic capacity and assigned to ingest, in a randomized and double blind manner, capsules containing either 5 g of a dextrose placebo or D-ribose twice daily (10 g/d) for 5 d. Subjects then performed post-supplementation tests on the 6th day. Our results indicate that oral ribose supplementation (10 g/d for 5 d) does not affect anaerobic exercise capacity or metabolic markers in trained subjects as evaluated in this study.

Effects of ribose supplementation on repeated sprint performance in men.
J Strength Cond Res. 2003.
After familiarization, subjects performed 2 bouts of repeated cycle sprint exercise (six 10-second sprints with 60-second rest periods between sprints) in a single day. After the second exercise, bout subjects ingested 32 g of ribose or cellulose (4 x 8-g doses) during the next 36 hours. After supplementation, subjects returned to the laboratory to perform a single bout of cycle sprinting (as described above). After a 5-day washout period, subjects repeated the protocol, receiving the opposite supplement treatment. Ribose supplementation lead to statistically significant increases in mean power and peak power in sprint 2 (10.9 and 6.6%, respectively) and higher (although not significant) absolute values in sprints 1, 3, and 4. In conclusion, ribose supplementation did not show reproducible increases in performance across all 6 sprints. Therefore, within the framework of this investigation, it appears that ribose supplementation does not have a consistent or substantial effect on anaerobic cycle sprinting.

No effects of oral ribose supplementation on repeated maximal exercise and de novo ATP resynthesis.
J Appl Physiol. 2001.
A double-blind randomized study was performed to evaluate the effect of oral ribose supplementation on repeated maximal exercise and ATP recovery after intermittent maximal muscle contractions. Muscle power output was measured during dynamic knee extensions with the right leg on an isokinetic dynamometer before (pretest) and after (posttest) a 6-day training period in conjunction with ribose (R, 4 doses/day at 4 g/dose) or placebo intake. Oral ribose supplementation with 4-gram doses four times a day does not beneficially impact on postexercise muscle ATP recovery and maximal intermittent exercise performance.

I am a health food store owner in Sacramento, CA. I saw an ad by a company called Valen Labs, Inc.. The claims were "Patented, all-natural Bioenergy Ribose has been clinically proven to dramatically speed energy recovery. Strenuous exercise, had work, and many clinical conditions rob cells of energy. Bioenergy Ribose restores energy needed to minimize fatigue and reduce pain, stiffness and cramping. What is your opinion on ribose?
   I personally have not seen any studies that confirm that using it is helpful for those who exercise. Perhaps Valen Labs is familiar with research on this topic that I am not aware of.

Diabetes, blood sugar
I am about to start taking D-Ribose and inasmuch as this product is a sugar, will it raise my glucose sugar readings?

Would blood sugars increase dramatically if a person with diabetes takes ribose supplements?
    It may depend on the dosage. A small amount of ribose as a pill, liquid or powder may not make much of a difference on blood sugar levels, but a larger amount could. I have not seen any studies with diabetics taking ribose supplements, but it would seem logical for a diabetic to avoid large doses of ribose until studies are published that evaluate the influence of ribose supplements on blood sugar levels. Another option is take a 5 to 10 minute walk after taking the supplement in order to minimize any potential rise in blood sugar.

How safe is taking five grams of ribose supplement for a person with type two diabetes?
   I have not seen research with ribose and diabetes, hence we don't know for sure.

Heart disease
Ischemic heart disease: metabolic approaches to management.
Clin Cardiol. 2004.
The number of patients with coronary artery disease and its risk factors is increasing in Western nations. New treatments for these patients may soon include a class of agents known as the metabolic modulators. This group of agents consists of the partial fatty acid oxidation inhibitors trimetazidine and ranolazine, as well as dichloroacetate, which promotes carbohydrate utilization. Metabolic modulators also include the nutriceuticals L-carnitine and D-ribose. The available evidence regarding the benefits of each of these five agents is reviewed.

D-Ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study.
Eur J Heart Fail. 2003.
Patients with chronic coronary heart disease often suffer from congestive heart failure (CHF) despite multiple drug therapies. D-Ribose has been shown in animal models to improve cardiac energy metabolism and function following ischemia. This was a prospective, double blind, randomized, crossover design study, to assess the effect of oral D-ribose supplementation on cardiac hemodynamics and quality of life in 15 patients with chronic coronary artery disease and CHF. The study consisted of two treatment periods of 3 weeks, during which either oral D-ribose or placebo was administered followed by a 1-week wash out period, and then administration of the other supplement. Assessment of myocardial functional parameters by echocardiography, quality of life using the SF-36 questionnaire and functional capacity using cycle ergometer testing was performed. The administration of D-ribose resulted in an enhancement of atrial contribution to left ventricular filling, a smaller left atrial dimension and a shortened E wave deceleration by echocardiography. Further, D-ribose also demonstrated a significant improvement of the patient's quality of life. In comparison, placebo did not result in any significant echocardiographic changes or in quality of life. This feasibility study in patients with coronary artery disease in CHF revealed the beneficial effects of D-ribose by improving diastolic functional parameters and enhancing quality of life.

How safe would D-ribose be for someone with atrial fibrillation?
   I have not seen any studies testing the influence of this sugar supplement on atrial fibrillation so I don't know at this time.

Fatigue and fibromyalgia
The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.
J Altern Complement Medicine. 2006. Teitelbaum JE, Johnson C, St Cyr J. Fibromyalgia and Fatigue Centers, Dallas, TX, USA.
This open-label uncontrolled pilot study was done to evaluate if D-ribose could improve symptoms in fibromyalgia and/or chronic fatigue syndrome patients. Forty-one patients with a diagnosis of fibromyalgia and/or chronic fatigue syndrome were given D-ribose at a dose of 5 grams three times a day for a total of 280 g.  D-ribose supplements improved all five visual analog scale categories: energy; sleep; mental clarity; pain intensity; and well-being, as well as an improvement in patients' global assessment. Approximately 66% of patients experienced significant improvement.

I suffer from fibromyalgia and recently read an article stating that ribose can "cure" it. Have you any information indicating that ribose cures fibromyalgia or that if not a "cure" can at least be helpful?
   I have seen one small study that showed a benefit.

How is this sugar supplement available?
Ribose supplements are available as a pill, liquid or powder. For the time being I don't see any major advantages of one form over another.

Questions
Does taking D ribose supplement have any negative effect on type 2 diabetes?
    I suspect low amounts would not have much of an impact, but, as of 2012, I have not come across any human trials with ribose supplements in those who have diabetes.

Why would i take a multivitamin for energy when ribose is available?
    There are many, many ways the human body produces energy, not just with ribose. You may ask why eat all kinds of different foods since bread alone can give calories.

Through my personal research and experience, I have found great relief with the use of d-ribose. Increased energy and reduced procrastination was a very pleasant effect for over a year. I began the regime (skeptically) with the recommended 3 tsps per day (1 tsp 3x per day) for 3 weeks, reducing it to 2 tsps for 3 weeks and finally to 1 tsp per day. This included the 6 days on, one day off for the entire time. Now, more than a year later, even one teaspoon once a week causes cardiac discomfort. My heart pounds like it wants to pop out of my chest. It appears that the highest dose I could risk is about a quarter tsp per week. Have you come across such a reaction in your experiences? Would you be able to cite any research which might help alleviate this reaction? I am currently 54 and I take many other supplements also. I have tried eliminating all supplements and only taking d-ribose over the course of a month with these reactions. Also, as a side note, I have a similar reaction with vitamin E. I can only tolerate about 50 IU per week, so I've removed it from my regime, many years ago.
    I don't have enough experience with use of daily d ribose supplement intake to know whether it causes cardiac issues. I have not had any previous reports from users that indicate cardiac problems. There are many supplements that can cause heart rhythm disturbances or increased heart rate.

My son has autism and I gave him d ribose one teaspoon daily in the morning, and the results were remarkable: increased sociability, increased social cognition, mood stabilization, etc. He is an average sized 11 year old (a little over 5' tall, around 80 pounds). The results are immediate, that day even, but they get progressively better over the span of about 4 to 5 days. At around that time, you get the full effect. What impressed me is how it improved the so-called theory-of-mind deficits: his maturity level seemed higher, we weren't having any trouble at school with bullies, his interaction with kids seemed seamless.