Multicenter Study Shows Ribose Increases Energy an Average 61% in CFS and Fibromyalgia
Fibromyalgia represents a cellular energy crisis with many causes. Taking steps to increase energy production can often be helpful. One such method is outlined by the "SHINE Protocol" (Sleep, Hormones, Infections, Nutrition, and Exercise) which was shown to be highly effective in an earlier pilot and placebo-controlled study.1,2 A new just-published multicenter study of 257 people with CFS/FMS at 53 health clinics showed that d-ribose supplementation increased energy an average of 61% at three weeks, while also improving sleep, cognitive function, pain, and overall well-being.3
Have you been feeling like a zombie lately? You're not alone! But new research is again showing more reason for hope.
In a new study published yesterday in the Open Pain Journal involving 53 different health clinics, 257 people with CFS and fibromyalgia who felt like zombies were fed 5 grams of ribose 3 times a day for 3 weeks [Editor's note: the zombie part is just my assumption;-)]. At the end of the three weeks, participants' energy levels increased by an astounding average of 61%. In addition, sleep, pain, mental clarity, and overall well-being improved.3
This study confirmed what we had seen in an earlier study.4 Here are the numbers:
203 people completed the 3 week trial. Consuming D-ribose led to both statistically (p<.0001) and clinically highly significant average improvements in all categories:
- 61.3 % increase in energy
- 37% increase in overall well-being
- 29.3% improvement in sleep
- 30% improvement in mental clarity
- 15.6% decrease in pain
At the end of the study, improvement was continuing to increase, suggesting that continued supplementation with ribose would be associated with an even greater improvement. The current double-blind placebo-controlled study, which is being done at eight research centers, is being extended to 12 weeks to see at what point the benefit levels out.
So for those of you feeling like zombies, here's your chance to get a big boost in energy — so you no longer have to feel like you're in a "Night of the Living Dead" movie!
What Causes the Energy Crisis?
Looking at modern life, it seems like the perfect storm for a human energy crisis. Approximately half of the calories we eat are largely devoid of micronutrients (i.e., vitamins and minerals) because of food processing. This has resulted in people being both obese and malnourished for the first time in human history. In addition, the average night's sleep has gone from an average nine hours a night 130 years ago (when light bulbs became popular) down to 6 1/2 hours a night. Adding to this, people are dealing with the increased stress and speed of modern life. To give an example, when I was a child the Madison Avenue advertising mantra was "sex sells." Now it's "fear sells." Sometimes I miss the good old days!
Another side effect of how we live today that I believe contributes to the many illnesses of modern life is that people's immune systems are simply becoming overwhelmed. Sleep deprivation and zinc deficiencies are two reasons for this. But there are several other important factors contributing to immune dysfunction:
- Severe dysbiosis (unhealthy gut infections) caused by antibiotics, excess sugar intake, and acid blockers. With a normal bowel containing more organisms than the rest of your entire body, the widespread growth of toxic organisms in the colon is a major problem. To put this in perspective, it used to be that when babies were born they breast fed, developed a colon full of healthy bacteria, and then developed stomach acid that served to fight off all other bacteria for the rest of their lives. There were no antibiotics, acid blockers, or massive amounts of sugar added to the diet to disrupt this ecosystem.
- Incomplete digestion of proteins caused by the rapidly increasing and chronic use of acid blocker medication, combined with the routine destruction of the enzymes present in food during food processing to prolong shelf life.
- Increased gut membrane permeability, often called "leaky gut," allowing dramatic increases in absorption of these partially digested proteins.
This trio of modern day gut changes not only contributes to a marked increase in food allergies, but can also exhaust the immune system. Why? If you consider that the total body weight of many infections might be measured in under one milligram, and that people may eat upwards of 100,000 mg of protein a day, the concern is raised that even modest decreases in protein digestion, and the absorption of a small percent of partially digested amino acid chains, can dramatically increase the immune system's workload.
To give you an idea of the impact of these food sensitivities, a recently published study funded by our foundation showed that 23 of 30 autistic children were able to return to regular schools after undergoing just one year of food allergy desensitization therapy using NAET (Nambudripad Allergy Elimination Technique). None of the 30 autistic children in a control group were able to do so.5 Interestingly, many researchers in the field are seeing overlaps in the pathophysiology of autism and fibromyalgia.
Ribose — the Backbone of Energy Production
To understand energy production, it helps to look at the "energy molecules" ATP and NADH. These molecules represent the energy "currency" in your body, and the amount you have of them to spend determines how rich in energy you are. A person's body can have an abundant supply of energy-fueling calories, but if those calories can't be converted to ATP and NADH, then they're useless. And ATP is particularly important because the amount of it in your tissues largely determines whether you will be energetic and vital or completely fatigued.
Ribose provides the key building block of ATP, and the presence of ribose in the cell stimulates the metabolic pathway our bodies use to actually make this vital compound. If the cell does not have enough ribose, it cannot make ATP. So, when cells and tissues become energy starved, the availability of ribose is critical to energy recovery — and is often the rate-limiting nutrient for ATP production.
Normal, healthy muscle and heart tissue has the capacity to make all the ribose it needs. When normal tissue is stressed by overexertion, several days of rest will usually allow it to fully recover. The muscle may be sore during recovery, but eventually energy levels will be restored and the soreness will disappear. But when the muscle is chronically stressed, as results from many health conditions that affect tissue energy metabolism (and quite possibly the energy crisis seen in day-to-day modern life), the cells and tissues may not be able to make enough ribose quickly enough to recover. The consequence is chronic, persistent stiffness, soreness, and overwhelming fatigue that may never go away unless energy production is restored.
Ribose is made in the body by a slow, laborious process called the "pentose phosphate shunt." It is not found in food. From the published research, we knew that CFS/FMS caused the body to dump other key energy molecules, like carnitine. We then found that the body did the same with ribose, making it hard to get the mitochondrial "furnaces" working again, even after the other problems were treated. We wondered if giving ribose to people with CFS/FMS would jump-start their energy furnaces.
Research in ribose and CFS/FMS actually began with a case study that was published in the journal Pharmacotherapy in 2004.6 This case study told the story of a veterinary surgeon diagnosed with fibromyalgia. For months, this dedicated doctor found herself becoming more and more fatigued, with pain becoming so profound she was finally unable to stand during surgery. As a result, she was forced to all but give up the practice she loved.
Upon hearing that a clinical study on ribose on congestive heart failure was underway at the university where she worked, she asked if she could try the ribose to see if it might help her overcome the mind-numbing fatigue she experienced from her disease. After 3 weeks of taking ribose she was back in the operating room, practicing normally with no muscle pain or stiffness, and without the fatigue that had kept her bedridden for many months.
Being a doctor, she was skeptical, not believing that a simple sugar could have such a dramatic effect on her condition. Within 2 weeks of stopping the ribose therapy, however, she was out of the operating room and back in bed. So, to again test the theory, she began taking ribose again. The result was similar to her first experience and she was back doing surgery in days. After yet a third round of stopping ribose (with the return of symptoms) and starting it (with the reduction of symptoms), she became convinced and has been supplementing with ribose ever since.
Our initial pilot study in which we gave ribose to people with CFS or FMS was published in 2006. That study also showed marked improvement in participants.4 The D-ribose was well tolerated, with the main side effect being that a small percent of subjects found themselves to be actually over-energized or hyper. This generally responded well to simply lowering the dose or giving the ribose with food. In my clinical experience, this often suggests that the patient also needs adrenal support. This is because ribose has a negative glycemic index, causing a drop in blood sugar rather than a rise. In these cases, I add adrenal support to the ribose, usually resulting in additional benefit.
Nutrients That Can Promote Energy
The following are four notable nutrients beneficial to helping promote and maintain healthy energy production in the body.
- Ribose (as described above).7
- Coenzyme Q10 — CoQ10 fuels the thousands of mitochondria responsible for your heart's energy production, helps maintain energy levels, and promotes sharp brain function.7
- Magnesium — Involved in more than 325 biochemical reactions, some of the early symptoms of magnesium deficiency include body aches, constipation, headaches, poor insulin sensitivity, leg cramps, muscle twitches, and more.7
- Acetyl L-Carnitine — Helps provide energy for the body at a cellular level by transporting fatty acids into the mitochondria of the cells, where it is burned for cellular energy.7
1"Effective Treatment of CFS and FMS: A Randomized, Double-Blind Placebo Controlled Study," Teitelbaum JE, Bird B, Weiss A, et al., Journal of Chronic Fatigue Syndrome, 8 (2) (2001).3-28.
2"Effective Treatment of Severe Chronic Fatigue: A Report of a Series of 64 Patients," Teitelbaum JE and Bird B, Journal of Musculoskeletal Pain 3 (4) (1995): 91–110.
3"Effective treatment of fibromyalgia and chronic fatigue syndrome with D-ribose– a multicenter study," Teitelbaum JE, Jandrain J, and McGrew R. The Open Pain Journal. 2012(5), 32-37.
4"The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study," Teitelbaum JE, JA St.Cyr, C Johnson, J Alternative and Complementary Medicine 2006;12 (9):857-862.
5"Improving Communication Skills in Children With Allergy-related Autism Using Nambudripad's Allergy Elimination Techniques: A Pilot Study," Teitelbaum, J; Nambudripad D, Tyson Y et al., Integrative Medicine- A Clinician's Journal • Vol. 10, No. 5 • Oct/Nov 2011. P36-43 (full text can be seen at NAET.com )
6"Benefit of ribose in a patient with fibromyalgia," Gebhart B, JA Jorgenson, Pharmacotherapy 2004;24(11):1146-1648
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.