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D-Ribose Overview Ribose is a simple five-carbon sugar that is made by every cell in the body and is an essential component of important biological molecules called nucleotides, which are used to make adenosine triphospahte (ATP) and the genetic material, RNA and DNA, as well as the vitamin riboflavin. D-Ribose is not an essential nutrient, because it can be made in the body from other substances such as glucose. However, despite its theoretical abundance in the body, research has shown that ribose administration is effective in treating heart and muscle disease, accelerating tissue recovery following strenuous exercise, reducing fatigue and myalgia, and a number of other conditions. What these all have in common is the need for cellular energy, or energy recovery. Ribose is extraordinarily effective in accelerating tissue energy synthesis. Virtually every cell in the body can benefit from ribose administration. The exceptions are the liver, adrenal cortex, mammary tissue, and adipose tissue. These tissues are able to make all the ribose they need. Unfortunately, they cannot make ribose and transport it to other tissues. Every other tissue in the body must make its own supply of ribose. These tissues lack the metabolic machinery to make ribose quickly when it is needed to restore cellular energy levels. No matter how well the cell recycles energy, through glycolysis or the oxidative pathways of energy metabolism, cellular energy supply cannot keep pace with demand. Maintaining a healthy energy pool is critical to cellular function. Ribose is the fundamental building block of ATP, so without sufficient ribose in the cell, ATP cannot be formed. If ATP cannot be formed, the energy pool cannot be re-supplied if the cell becomes energy starved. That’s why it takes so long for cells and tissues to recover following metabolic or physical stress.

D-Ribose

3 x Phosphates

Adenine

Adenosine Triphosphate Structure

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Cardiovascular Health D-Ribose improves oxygen utilisation efficiency in congestive heart failure patients. This is very important because the efficiency of oxygen utilisation is a strong predictor of morbidity and mortality in this patient population. Other studies show that ribose improves diastolic cardiac function, exercise tolerance, and quality of life in patients with coronary artery disease and congestive heart failure. Still other studies show that ribose increases the anaerobic energy reserve of healthy hearts (1,2,3,4,5,6,7,8). In one study of 20 men (aged 45 to 69 years) with severe coronary artery disease and a history of angina induced by normal daily activities, 60 grams of ribose (in four doses of 15 grams each) were tested against placebo. Treated subjects exhibited improvement in ECG readings and reduced time to onset of moderate angina (during exercise testing). No improvements were noted in the placebo group (9).

Athletic Performance In addition to heart function, several studies have looked at peripheral muscle health and recovery from athletic performance where D-Ribose has shown some clear benefits. The availability of ribose in muscle tissue is a limiting factor for the rate of ATP recycling during exercise, and therefore impacts exercise endurance (10). In one study 10 grams of D-ribose was administered twice per day during loading (pre exercise), intense exercise and recovery phases lasting a total of 11 days. Those subjects taking supplemental ribose had a larger increase in mean power over 5 days of training (4.2% vs. 0.6%), and greater peak power output at the last sprint session (11.4 watts/kg vs. 10.4 watts/kg) than the placebo group (11). An additional benefit of efficient ATP recycling is that ribose helps overcome soreness and fatigue that can last for days following unaccustomed exercise. Fibromyalgia/Chronic Fatigue Studies suggest a role for D-ribose in fatigue and myalgia. Fibromyalgia is linked to chronic fatigue syndrome and is characterised by muscle aches and stiffness in multiple sites around the body. Scientists think that it may be associated with a muscular imbalance between adenosine diphosphate and adenosine triphosphate (ATP), and as a key component of the nucleotide adenosine, D-ribose is thought to promote proper energy metabolism and thus help restore normal muscle function (12).

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Contraindications/drug interactions Pregnant women and nursing mothers should avoid supplemental D-ribose. May cause increased uric acid levels so should be avoided by those with gout. May cause hypoglycaemia so diabetics should use with caution and under medical supervision. Typical Intake Range for D-Ribose 5 to 7 grams daily as a preventative in cardiovascular disease, for athletes on maintenance and for healthy people doing strenuous activity. 7 to 10 grams daily for patients with cardiovascular disease, peripheral vascular disease, patients recovering from heart surgery or heart attack, for treatment of stable angina pectoris and for athletes working out in chronic bouts of high-intensity exercise. 10 to 15 grams daily for patients with advanced heart disease, patients awaiting heart transplant, and patients with dilated cardiomyopathy, frequent angina, fibromyalgia or neuromuscular disease. References:

1. Angello D, R Wilson, D Gee, N Perlmutter. Recovery of myocardial function and thallium 201 redistribution using ribose. Am J Card Imag 1989;3(4):256-265.

2. Asimakis G, J Zwischenberger, K Inners-McBride, L Sordahl, V Conti. Postischemic recovery of mitochondrial adenine nucleotides in the heart. Circ 1992;85(6):2212-2220.

3. Carter O, D MacCarter, S Mannebach, J Biskupiak, G Stoddard, EM Gilbert, MA Munger. D-Ribose improves peak exercise capacity and ventilatory efficiency in heart failure patients. JACC 2005;45(3 Suppl A):185A.

4. Chatham J, R Challiss, G Radda, A Seymour. Studies of the protective effect of ribose in myocardial ischaemia by using 31P-nuclear magnetic resonance spectroscopy. Biochem Soc Proc 1985;13:885-888.

5. Clay MA, P Stewart-Richardson, D Tasset, J Williams. Chronic alcoholic cardiomyopathy: Protection of the isolated ischemic working heart by ribose. Biochem Internat 1988;17(5):791-800.

6. Dodd SL, CA Johnson, K Fernholz, JA St.Cyr. The role of ribose in human skeletal muscle metabolism. Med Hypoth 2004;62(5):819-824.

7. Dow J, S Nigdikar, J Bowditch. Adenine nucleotide synthesis de novo in mature rat cardiac myocytes. Biochim Biophys Acta 1985;847(2):223-227.

8. Einzig S, J St. Cyr, J Schneider, R Bianco, J Foker. Maintained myocardial ATP with long term ribose. Pediatr Res 1986;20(4 pt 2):169A.

9. Priml W, von Arnim T, Stablein A, et al. Effects of ribose on exercise-induced ischaemia in stable coronary artery disease. Lancet. 1992; 340:507-510.

10. Hellsten Y et al. Effect of ribose supplementation on resynthesis of adenine nucleotides after intense intermittent training in humans. Am J Physiol Regul Integr Comp Physiol. 2004 Jan;286(1):R182-8

11. Witter, et al. Effects of ribose supplementation on performance during repeated high-intensity cycle sprints. Midwest Regional Chapter of the ACSM, October 2000.

12. Gebhart B, Jorgenson JA. Benefit of ribose in a patient with fibromyalgia. Pharmacotherapy. 2004 Nov; 24(11):1646-8