D-Ribose and Fibromyalgia
Ribose is a type of naturally-occurring sugar that is required by the body to maintain adequate energy levels. Other names for ribose include beta-d-ribofuranose, D-ribosa, D-ribose, and ribose. Research shows supplemental ribose may help to prevent muscle fatigue in people with genetic disorders that limit the amount of energy the body produces, such as myoadenylate deaminase deficiency (MAD) and AMP deaminase deficiency (AMPD deficiency) (Zollner et al., 1986; Wagner et al., 1991). Ribose supplements have also been used by athletes to improve overall performance, however its effectiveness in such a role remains questionable (Peveler et al., 2006; Kerksick et al., 2005; Kreider et al., 2003; Berardi & Ziegenfuss, 2003). In addition, supplemental ribose has been used to treat symptoms associated with coronary artery disease (Pliml et la., 1992).
Ribose is generally safe when taken as an oral supplement and used on a short-term basis; however, it can also cause some side effects including diarrhea, upset stomach, nausea, headache, and low blood sugar. Diabetic individuals who take various blood sugar-lowering medications, such as glimiperide (Amaryl), pioglitazone (Actos), rosiglitazone (Avandia), glipizide (Glucotrol) and/or insulin, should not take supplemental ribose, as it may cause blood sugar levels to dip too low. In addition, ribose should not be consumed along with alcohol, aspirin, choline magnesium trisalicylate (Trilisate), propanolol (Inderal), or salaalate (Disalcid), as these combinations can also result in a severe drop in blood sugar levels.
Ribose and Fibromyalgia
Very little research has been conducted to evaluate the use of ribose as a treatment for fibromyalgia symptoms or related co-morbid conditions. However, combined findings from a number of researchers has demonstrated that the muscles of patients with fibromyalgia and /or chronic fatigue syndrome may have altered abilities to adequately metabolize energy. These findings offer a potential link to explain how ribose supplementation may in fact help fibromyalgia patients.
In order to understand this link, one must first understand the basic nature of cellular energy metabolism in the body. Although a thorough explanation of this process is beyond the scope of this article, the underlying principles can easily be described. ATP (adenosine triphosphate) is the primary energy source for all living cells. When cells do not have enough ATP (which can occur for a variety of reasons), normal energy metabolism is disrupted. This disruption can impact the ability of cells to function properly and result in various clinical symptoms. Prior research has suggested that individuals with fibromyalgia may have abnormalities related to muscular energy metabolism (Bengtson et al., 1986). For example, tissue samples taken from the muscles of fibromyalgia patients, as well as imaging studies conducted using MRI (magnetic resonance imaging) scans, have shown significantly reduced levels of ATP and a number of other chemicals essential to proper energy metabolism (Strobl et al., 1997; Park et al. 1998; Sprott et al., 2000). In addition, research has shown that fibromyalgia patients have fewer numbers of capillaries (the smallest blood vessels, where oxygen is deposited into the blood), which decreases the amount of available oxygen to the muscles and can result in increased pain (Olson & Park, 1998; Bengtsson & Henriksson, 1989).
In 2007, Teitelbaum et al. conducted a small pilot study to evaluate whether D-ribose could improve symptoms in patients with fibromyalgia and/or chronic fatigue syndrome. Of the 41 subjects who originally enrolled in the study, five were determined to be non-compliant to the study requirements, therefore the analysis covered the remaining 36. Of these, 12 had fibromyalgia (diagnosed according to American College of Rheumatology [ACR] criteria), nine had chronic fatigue syndrome (diagnosed in accordance with Centers for Disease Control and Prevention [CDC] criteria), and 12 had a diagnosis of both fibromyalgia and chronic fatigue syndrome.
For the purposes of the study, each subject took 5grams of D-ribose three times per day until they had consumed a total cumulative dose of 280 grams. The D-ribose was in a powder form, and each subject was allowed to mix the powder with either food, water, or another beverage. In addition, all subjects were assessed both pre- and post-treatment using a visual analog scale (VAS) questionnaire. This questionnaire asked each subject to rate the following outcomes on a scale of one to 10, with 10 being the best: energy levels, sleep disturbances, mental clarity, pain, and overall well-being and quality of life.
Based on comparisons of the subjects’ pre- and post-treatment questionnaire responses, significant improvements were seen for energy levels, sleep patterns, mental clarity, pain threshold, and overall well-being (Teitelbaum et al., 2006). In their discussion of the findings, the authors mention several plausible mechanisms by which ribose might work to improve symptoms for fibromyalgia and chronic fatigue patients, focusing primarily on the potential role of ATP. The authors do point out a number of limitations to their study, including the lack of a placebo (sugar pill) group for comparison, the need for a follow-up, randomized, placebo-controlled trial (the “gold standard” of research study design when trying to compare treatment efficacy), and the fact that all outcomes measured in this study were subjective and relied solely on patient and physician input. In addition, subjects were instructed to continue any current therapies that they were on at the start of the study, therefore the effects (if any) of any concurrent therapies on the outcome measures were not controlled for.
In addition to this pilot study, one case report pertaining to the use of ribose in the treatment of fibromyalgia has also been published. In 2004, Gebhart and Jorgenson reported that ribose was added to the existing treatment of a female fibromyalgia patient, which resulted in symptom improvement. Much like Teitelbaum et al., Gebhart and Jorgenson suggest that ribose supplementation may be useful to help improve energy metabolism in fibromyalgia patients (Gebhart & Jorgenson, 2004).
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