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by Hyla Cass, M.D.
D-Ribose
The Energy BOOSTER
 Feeling tired and run down? You’re not alone.
Fatigue is the third greatest health concern
among Americans, and more than 33 million
cite energy loss as their greatest health challenge.
And no matter what their diagnosis,
many of my patients arrive at my office complaining of
fatigue as a major symptom.
What a contrast to childhood! Remember bounding
out of bed in the morning, eager to meet the new day?
Somehow, as adults, most of us have outgrown this
early exuberance, and we can’t always summon the
energy we want. We may find ourselves relying on artificial
energizers, from caffeine to sugar and over-thecounter
and prescription stimulants. However, there’s
a catch. While they may make us feel good in the shortterm,
their use, over the long-term, can be harmful. At
the same time, we are discovering more natural supplements
to aid in restoring our natural energy. One
that has captured my imagination lately is D-ribose, or
simply “ribose.” Found in every cell of the body, particularly
in muscle, its job is to make the energy that
keeps us going.
Fibromyalgia: A Case in Point
A good example of disrupted energy production is a
mysterious condition call fibromyalgia. Difficult both to
diagnose and to treat, fibromyalgia is often related to
chronic fatigue syndrome (CFS), a relatively common
condition affecting 500,000 Americans at any one
time, and twice as many women as men. If you are
exhausted to the point where it interferes with your life,
and paradoxically you cannot sleep, and the fatigue
does not go away with a vacation, and exercise makes
it worse, you probably have CFS. If you ache all over in
addition to these symptoms, you have fibromyalgia as
well. Patients with fibromyalgia may also have anxiety,
depression, headaches and, frequently, irritable bowel.
(In my recent book, 8 Weeks to Vibrant Health, you
will find details on the symptoms and diagnosis,
including the need to test for other conditions such as
hypothyroidism, adrenal exhaustion, autoimmune
conditions such as lupus and rheumatoid arthritis, and
infections such as Lyme disease, Epstein-Barr virus
and cytomegalovirus.)
Until now, we have had few tools to help these
patients. However, recent findings have led to the
exciting conclusion that ribose can provide improvement
in these patients, as in the following case
presented in a well-known medical journal:
Kris was a thirty-seven-year-old veterinary surgeon and researcher at a major university who became so debilitated
with fibromyalgia she had to give up her practice. She not
only had severe muscle and joint pain, but mental cloudiness,
insomnia, and digestive problems. Kris had tried all the traditional
medical interventions for fibromyalgia, which not only
were unsuccessful, but had debilitating side effects.
She then joined a clinical study and began taking five grams
of ribose two times per day (10 grams per day). Within a week
she felt better and, within two weeks, was back in the operating
room. Over the balance of the first month, she continued to
improve. Wanting to challenge this amazing result, Kris
stopped her treatment. Within ten days she was totally debilitated
again and could no longer perform surgery. She began
ribose treatment for a second time, again with dramatically
positive results. As a scientist Kris wanted to be sure, so she
stopped treatment after another four weeks, and again her
symptoms returned. She then resumed treatment and
remained symptom-free as long as she took the supplement
regularly.
Energy Metabolism—a Central Element of Fibromyalgia
How did the ribose work to turn Kris’s condition around? The
exact cause of fibromyalgia is unknown, but there is no question
that deficiencies in energy utilization and turnover are
involved. One consistent finding is the presence of abnormalities
in the capillaries (small blood vessels) that supply blood
flow to muscles, causing a decrease in tissue oxygenation. In
addition, the part of the cell in which energy (as ATP) is made,
called the mitochondria, appears to be abnormal. As a result,
people with fibromyalgia have lower levels of the energy molecule
called ATP and a reduced capacity to make ATP in their
muscles.
This combination of poor circulation and diminished ATP
production results in pain that keeps these individuals from
exercising, which makes muscle tension worse. Sustained
muscle tension uses even more energy, and the downward
spiral continues. Damage to the cell membrane comes next
because the membrane needs a full supply of ATP to control the
flow of ions into and out of the cell in order to relax. These ions
in the form of minerals (calcium, magnesium, sodium and
potassium) carry the electrical charge of the cell. Disruption in
ion balance causes a cascade of reactions leading to sustained
muscle tension and pain. This compromises the ability of
fibromyalgia patients to perform physical work, sustain aerobic
exercise, or, in many cases, perform even the most basic
of life’s everyday functions.
Conventional medical treatment is quite limited in what it
can do to alleviate symptoms of CFS and fibromyalgia. In my
own practice, I have found Coenzyme Q10 , L-carnitine and
magnesium to be invaluable, but I now have added the final
ingredient, ribose, to help my fibromyalgia and CFS patients.
Ribose—the Energy Booster
There is a large body of research on ribose with some 300 published
studies. The official chemical name of D-ribose is
D-ribofuranose. It is a simple five-carbon sugar, or pentose,
and is found in every cell in the human body. It is the fundamental
building block of the energy compound, adenosine
triphosphate (ATP). We must maintain healthy levels of ATP in
our hearts, muscles and other tissues to fuel basic tissue function
and preserve peak physiological performance.
On average the human body contains 1.6 milligrams (mg)
of ribose per 100 milliliters (ml) of blood. Ribose can be made
naturally in the body, but it is a slow process limited by several
enzymes that are lacking in heart and muscle cells. There are
no foods containing ribose in any substantial amounts. Under
normal circumstances the availability of ribose to tissue is not
a problem, but when hearts or muscles are challenged from
the stress of exercise or lack of oxygen due to cardiovascular
disease, circulatory disorders, chronic fatigue syndrome or
fibromyalgia, they need an extra ribose boost to restore ATP
levels. If your energy metabolism process is not working correctly,
it drains energy reserves and depletes the cellular energy
pool. This frequently leads to pain, soreness, stiffness and an
overall feeling of fatigue. Supplementing these stressed cells
with ribose restores cellular energy. This then promotes ion
balance which allows the muscles to relax, stop hurting and
function more fully—and eliminates fatigue as well.
If the body makes ribose, why do we need to supplement it?
Unlike the main energy turnover pathways—glycolysis, the
Kreb’s cycle and the electron transport chain of oxidative
metabolism—the metabolic route to ribose synthesis is slow
and sluggish. This pathway can make enough ribose to keep
our bodies going at a normal performance level, but it can’t
keep up when our tissues are stressed by strenuous exercise,
disease or metabolic dysfunction. This holds for athletes who
have overstressed their energy-production mechanisms, as in
sprinting, basketball, hockey, weightlifting, power lifting, volleyball,
soccer and tennis. For those of you who run
marathons, you may be familiar with the post-marathon sevenday
slump in energy, accompanied by muscle pain. The body
has to replete the lost ribose stores in order to recover. By
taking ribose before and after exertion, athletes have been able
to avoid this pain and fatigue cycle. Medical research is very
clear on one point—taking ribose both before and after
ischemia (impaired blood flow) or strenuous exercise will
increase the benefits.
Like other supplements—pyruvate, COQ10, and L-carnitine
for example—a manufacturing process needs to be found
before supplements become available. Until now the manufacturing
processes for making ribose were so expensive that it
was out of reach for the consumer. Now, there is new technology
for ribose production.
Ribose is Safe
One of the best parts of the ribose story is that it is a powerful
natural chemical health aid, with almost no side effects. The
toxicology and safety of ribose has been well studied, and it is
100 percent safe if taken as directed. Thousands of patients
have taken ribose in doses up to 60 grams per day with minimal
side effects. However, even though there are no known
contraindications of ribose therapy, I recommend that pregnant
women, nursing mothers, and very young children refrain
from taking ribose simply because there is not enough published
data on its use in these groups.
How can we be so sure that ribose is safe? First, ribose is
made naturally by the body, and works with the body’s own chemistry. Glucose, the main sugar
of the body, is converted to ribose in the
cells. The supplemented form of ribose,
Bioenergy RIBOSE., is exactly the same as
the ribose made by the body from glucose.
Second, the amount of ribose recommended
for supplementation is very
modest, only about 5 grams one to three
times per day. For athletic recovery ribose
is only needed on exercise days, but
many people take it every day to keep
energy levels at their peak. Third, there is
virtually no chance of over supplementation.
We safely eliminate any that our
body doesnft need. Most of all, ribose
has been used by thousands of people
for many years with no reports of significant
adverse reactions.
How Much Ribose Should You Take?
No matter what end of the health spectrum
you are on, ribose may help restore
energy levels. To keep cellular ATP levels
at their highest, ribose should be taken
daily. It can be taken in any form—tablets, bars, drinks, and a slightly sweettasting
powder. Maintenance doses of
five grams per day should be enough to
maintain normal ATP levels. Five grams is
about 1 teaspoonful. If you are a serious
competitor or are concerned about your
cardiovascular health, you may want to
take more—perhaps five to 10 grams per
day. However, you should try the lower
dosage first and move up as needed. For
fibromyalgia sufferers, I recommend 5 g
two to three times daily. Although ribose
is a sugar, for those of you watching your
carbohydrate intake, including diabetics,
ribose does not act like glucose to raise
blood sugar. In fact, it causes a brief dip in
glucose which then normalizes. It has 20
calories per 5 g serving.
Maintaining normal, physiologically
active levels of ATP is vital in controlling
energy charge in the heart and muscle
cells and in regulating the function of
enzymes, electrolyte activity and other
important cell functions. The good news
is now ribose is available as a safe
and effective supplement that can build
or restore energy in all the cells of the
body.
References:
- ’Benefit of Ribose in a Patient with Fibromyalgia“ (Pharmacotherapy, Benjamin Gebhart, Pharm.D., and James A. Jorgenson, M.S., FASHP 2004 Vol. 24(11) pp. 1646—48)
- 8 Weeks to Vibrant Health, Hyla Cass M.D. and Kathleen Barnes (New York, McGraw-Hill 2005)
- Natural Highs, Hyla Cass M.D. and Patrick Holford (Penguin Putnam 2002)
Hyla Cass, M.D. is an oft-quoted expert
in the field of integrative medicine and
psychiatry, combining the best of
leading-edge natural medicine with the
modern science, in her clinical practice,
writings, lectures, and nationwide media
appearances. She is assistant clinical
professor at UCLA School of Medicine
and author of several books including
Natural Highs: Supplements, Nutrition
and Mind-Body Techniques (with Patrick
Holford) and 8 Weeks to Vibrant Health: A
Womanfs Take-Charge Program to Correct
Imbalances, Reclaim Energy, and Restore
Well-Being (with Kathleen Barnes). She
also serves on the board of Vitamin Relief
USA which provides daily nutritional supplements
to at-risk children across the
country. For more information see
www.drcass.com.
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