D-ribose

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[UPDATED JUNE 2022]

Introduction

Please see CFS - The Central Cause: Mitochondrial Failure for more detail and also CFS/ME - my book Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis

The pathological defect in patients with chronic fatigue syndrome is slow recycling of ATP. Normally there is enough ATP in a heart cell to last about ten beats - this means that roughly speaking ATP needs to be re-cycled every ten seconds. Top athletes like Steve Redgrave probably recycle ATP every five seconds, but patients with fatigue syndromes may only be able to recycle ATP every minute. Therefore I can do in ten seconds what Steve Redgrave can do in five seconds, but it might take one of my fatigue syndrome patients a minute to achieve the same!

"The Science Bit"

ATP in releasing energy is converted to ADP (2-phosphates) which is recycled back through mitochondria to ATP (3-phosphates). However, if the system is really pushed then the body can extract energy from ADP by converting it into AMP (1-phosphate). The problem is that AMP is very slowly recycled, if at all, and most is lost from the cell. This means that the body has to make brand new ATP. This it does from D-Ribose and this it can do very quickly. The trouble is the body making D-Ribose. Normally this is made from glucose. However if the cell is lacking in energy then any glucose lying around can be converted to lactic acid to generate energy. The problem here is twofold - first of all the lactic acid causes pain. Secondly any glucose that was previously swilling around is now not available to make D-ribose.

Even when glucose supply is plentiful, production of D-ribose in the cell by the glucose pentose shunt is very slow.

Usefulness of D-Ribose

D-ribose as a nutritional supplement is therefore useful because it is immediately available for the generation of new ATP

Because D-ribose is a simple sugar, it is extremely well absorbed. The clinical experience of cardiologists using D-ribose to treat heart failure due to mitochondrial failure is that it is very effective and free from side effects. The dose depends on the severity of the illness, but the clinical experience is that sufferers should be started on high doses and then it can be adjusted to a maintenance dose. Therefore I recommend that my CFS patients use 5 grams (1 scoop) three times a day. Effects should be seen within a few days. Whilst levels of energy improve and continue to improve then I recommend staying on 15 grams daily. At the point at which it levels off, experiment with lower maintenance doses. However, should the sufferer overdo things on a particular day then it is as well to take extra D-ribose in order to rescue the situation.

Occasional Problems with D-Ribose

Two problems I sometimes see:

  1. The fermenting gut. If there are bacteria or yeast in the upper gut then D-ribose may be fermented to produce alcohol and gas. In this event I suggest in the first place, dealing with the fermenting gut - see Fermentation in the gut and CFS. One can also reduce the daily dose to 5 grams, holding it in the mouth as long as possible - some will be absorbed here. Space doses throughout the day.
  2. Corn sensitivity. D-ribose is derived from corn and some PWME, who are corn sensitive, will react allergically to it. If this is a problem, please see Solgar Corn Free D-Ribose or Nutricentral Corn Free D-Ribose There are others available but they all seem to be expensive!

D-ribose is going to work best when the other aspects of mitochondrial metabolism are addressed, namely Co-enzyme Q10, L-carnitine, magnesium, niacinamide, detoxificiation and antioxidant regimes where appropriate.

Anything which can be done to prevent damage to mitochondria will also be extremely helpful. There are many ways in which mitochondria can be damaged such as viral infection, pesticides, heavy metals, hormone imbalances, allergies, low blood sugar or high blood sugar, micronutrient deficiencies, lack of sleep, etc. D-ribose is, therefore, an adjunct to my standard work up for treating chronic fatigue syndrome. Clinically I expect D-ribose to improve the symptom of delayed fatigue in sufferers as well as improve stamina.

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