By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

D-ribose is a simple sugar found in every cell of your body. Not only is it a structural component of the ATP molecule, D-ribose also helps comprise genetic materials, deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). While coenzyme Q10 (CoQ10) and L-carnitine both directly support ATP recycling, the most efficient means of cardiac energy metabolism, D-ribose helps ensure there’s enough original ATP synthesized for your mitochondria to recycle.

Unlike other sugars, D-ribose is not normally used by your body for fuel. Instead, so that it can make ATP and genetic material, your body saves some of the glucose it would use for glycolysis, or fuel production, to produce D-ribose. As you synthesize D-ribose in response to specific metabolic demands, and don’t store this sugar in its free form in your body, there is no “normal” level to measure deficiency against.

Whether one needs to supplement with D-ribose depends on one’s lifestyle and state of health. Generally, the body makes enough D-ribose in tissues like the heart, skeletal muscle, nerve tissue, and the brain to meet its daily metabolic needs. However, people whose cells and tissues are oxygen depleted, or because of illness are otherwise metabolically challenged, may be deficient in D-ribose. Because their energy demands exceed what their bodies are able to produce, people with ischemic heart disease, congestive heart failure (CHF), hypertension, fibromyalgia, and chronic fatigue syndrome, in addition to serious athletes, need to supplement with D-ribose.

Oxygen deprivation, which characterizes ischemic heart disease, forces the body make energy through a means other than oxidative phosphorylation. To survive, the body will switch to glycolysis, or glucose metabolism, a much less metabolically efficient, albeit very important, process which provides the body large amounts of energy in short bursts. The problem with glycolysis replacing oxidative phosphorylation as the primary means of energy production is that it will cause exhaustion over time. The body, no longer able to recycle ATP, will also become unable to synthesize it de novo, as the glucose it would have reserved for D-ribose synthesis is eventually used for fuel.

Remember in energy utilization, the body breaks ATP down into ADP, which it recycles into ATP again. Under disease conditions of greater energy need, the body will start breaking down ADP for energy rather than recycle it back into ATP. The resulting AMP molecules, incompatible with sustained cellular function, are quickly broken apart. The byproducts of AMP molecules, D-ribose and adenine, get washed out of cells, which deprives the body of an energy substrate supply with which to synthesize ATP de novo.

People with ischemia, diastolic dysfunction, or other compromising conditions need to supplement with D-ribose to replenish their energy pool and normalize cardiac function. For healthier individuals, D-ribose supplementation can alleviate symptoms of discomfort following exercise. Athletes can attenuate shaky weak limbs and fatigue following strenuous exercise and non-athletic people can avoid delayed onset muscle soreness. Supplementation with D-ribose serves as a rate-limiting step: it surpasses the need for D-ribose synthesis, a slow process which must be accomplished before ATP synthesis can begin. In other words, supplementing with D-ribose helps one faster generate energy.

D-ribose is quickly and easily absorbed through your gut into the blood. The amount of supplemental D-ribose you need generally depends on whether you have been subject to chronic oxygen depletion or have circulatory problems. Circulation is the most important consideration, as ischemic blood flow can result in delayed D-ribose delivery. Since D-ribose only stays in your blood for 30 minutes, higher doses taken daily are recommended if you suffer from an ischemic condition.

The Sinatra Solution:

I recommend:

  • 5 – 7 grams daily as a cardiovascular disease (CVD) preventative, for athletes on maintenance and healthy people doing strenuous activity;
  • 7 – 10 grams daily for CHF, other forms of ischemic CVD, peripheral vascular disease, patients recovering from surgery, and athletes participating in chronic high intensity exercise; and
  • 10 -15 grams daily for those with awaiting a heart transplant or with CHF, dilated cardiomyopathy, frequent angina, fibromyalgia, or neuromuscular disease.

© 2010 HeartMD Institute. All rights reserved.

Leave a Reply


  1. Ribose.

    on May 19, 2013 at 5:34 pm

    Regarding Ribose, how can it help a heart problem if it only stays in the blood 30 minutes? And it looks like 5-7 is the amount you need. ALso, can you put in in coffee, or what is the best way to use this?

  2. david jhonson

    on June 16, 2013 at 5:23 am

    thank u. for the sea of info on ur website. I am a big fan of ur honest opinion of years worth of research. I have learned a lot and educate my self from ur interviews/seminars and sharing with others. GOD BLESS U.

  3. Rich Sherman

    on July 14, 2014 at 8:12 pm

    Thank you again for this information. I’m on the Vit C protocol with L Lysine and L Proline for CHD and doing great. Thought to add D Ribose to the formula and wanted to know what brands to either consider or stay away from (not sure if you can recommend any). Appreciate it and thanks

  4. Stephen Blackbourn

    on September 21, 2014 at 11:46 am

    I wonder if D Ribose would be helpful for post viral fatigue?

  5. James Quinones

    on November 20, 2015 at 7:47 pm

    [quote]Regarding Ribose, how can it help a heart problem if it only stays in the blood 30 minutes? And it looks like 5-7 is the amount you need. ALso, can you put in in coffee, or what is the best way to use this?[/quote]

  6. Shasha

    on May 20, 2017 at 12:22 am

    No gluten/hidden gluten gave me 1000X more energy and I felt 20 years younger in 2 weeks as my intestines healed and I absorbed more nutrients that help rebuild my cells to work right.. I tried Ribose, but didn’t keep taking it. It was ok. Coenzyme Q10 (spask plug for the cells)/carnitine/acetylcarnitine (help fatty acids get into the mitochondria)/Amour thyroid (if gluten made antibodies to the thyroid and more may help.

  7. Lowery R Farley

    on June 30, 2017 at 10:13 am

    does d-ribose have any effect of INR readings?

  8. Teddy Jacobus

    on August 25, 2017 at 1:33 pm

    What about someone with muscle spasms and vascular dementia?

  9. Dr James Fenoli

    on November 2, 2017 at 6:53 pm

    Take 15 mg’s of D-ribose with ATP on an empty stomach with 30mg’s of CoQ10 twice a cardiac failure and arrhythmia’s, such as atrial fib. Put the ribose in water!!

  10. John M.

    on May 18, 2018 at 5:31 pm

    I currently have insomnia from leg muscle spasms. I previously had AFib (contained by ablation 4 years ago) and occasional PVCs.
    I have already restricted my diet and my supplements to your recommendations except D-ribose .
    What dosage of D-ribose do you recommend for me?

  11. Gary Anderson

    on January 27, 2019 at 4:49 pm

    Why doesn’t your website sell D-Ribose?
    Since it’s part of the FAB Four

  12. Mike Malino

    on March 24, 2019 at 10:38 am

    I had lone Afib for several years. It mostly came on at night while sleeping and lasted about 8 hours before converting itself. This happened about twice a month. Doctors tried me on sever drugs that made me worse. Then I tried D-Ribose Bio-energy brands, 5 grams with 5 ounces of water, three times daily (total 15 grams per day). 1 dose before bedtime, 1 dose at 2 am, and 1 dose when I woke up.
    NOTE: I am NOT a diabetic and DO NOT have high blood pressure.
    End result on the Ribose is 2 years and I never had an Afib attack again!!!!!! CURED?
    Please post your results if any of you ever tried this.

  13. richard m

    on April 28, 2019 at 11:43 am

    any update on d-ribose for pvcs?

  14. Phyllis

    on June 3, 2019 at 8:32 pm

    I have been taking D-Ribose powder for almost 2 months and have Hypoglycemia. No effect on that. I am taking it for a heart issue which has not been determined as yet. I am sleeping better. My question is can D-Ribose be used instead of sugar in baking and if so what would the measurement be per ONE cup of sugar? I am gluten free and avoid all sugars. Thank you.

  15. Prem

    on November 11, 2019 at 10:38 pm

    Great info
    Thank you
    Can one take the d ribose while on a blood thinner such as eliquis and beta blocker for afib?

  16. HeartMD Editor

    on November 14, 2019 at 10:14 am

    Hi Prem, Dr. Sinatra had many, many patients on blood thinners and beta blockers who and also took D-ribose (as well as CoQ10, Carnitine, and Magnesium – his “Awesome Foursome” protocol for heart health). Since D-ribose is a sugar that the body naturally makes, it is completely safe. The only potential drug interaction would be with a supplement that can thin the blood, like omega-3, nattokinase, or garlic – you’d want to carefully monitor intake to make sure blood doesn’t get too thin.

  17. Eric R.

    on December 11, 2019 at 2:01 am

    Hello, and thanks for the information given. I am 85 years of age and have just recently started taking D-Ribose (15 grams a day). The one thing I have noticed is that the quality of my sleep has improved enormously. I would recommend this supplement, particularly to anyone of advanced age, as our bodies, unlike wine, do not improve with age. Over the years, I have accumulated a shed-full of supplements and would say that this is one of the most beneficial yet.

  18. Sally

    on February 24, 2020 at 8:53 am

    I had a heart attack 6 years ago but it was mild and my heart was just stunned, not damaged. I had a stent put in. Then my body rejected it in 6 months. Had a new stent out in and have been fine since. I have always taken CoQ10 and Acetal L-Carnitine and Alpha Lipoic Acid daily so was wondering if I still need d-ribose?
    Thank you!

  19. HeartMD Editor

    on March 13, 2020 at 6:34 pm

    Hi Sally, Dr. Sinatra says: “you do not need d-ribose unless you are having symptoms of concern that may be indicating your heart needs more energy. Women can experience less obvious symptoms that their heart is struggling for oxygen, such as fatigue and more: https://www.drsinatra.com/women-and-heart-disease-symptoms-risk-factors-and-prevention
    You may want to add an Omega 3 product to your plan.”

  20. Gail Lee

    on November 17, 2020 at 12:04 pm

    I took 2 teaspoons of D ribose with my vinegar tea this morning and I became very shaky. Any thoughts?

  21. HeartMD Editor

    on November 23, 2020 at 9:04 pm

    Hi Gail, Dr. Sinatra says that two teaspoons is double the standard dose. He recommends starting at a half teaspoon a day and see what happens. You should also rule out the possibility of diabetes, as this also can lead to such symptoms.

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