D-Ribose: What It Is and Why Every Heart Patient Needs It

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

Whenever I write or speak about D-Ribose, most people are surprised to learn that we’ve been studying its benefits for more than 30 years.

“How can that be?” they ask. “I’ve never heard of it!” Well, unless you’ve recently been brushing up on your biochemistry, why would you?

D-ribose may not be as well-known as its fellow Awesome Foursome members—coenzyme Q10 (CoQ10), L-carnitine, and magnesium (my favorite combination of heart-health supplements) —but it’s no less important for supporting and restoring energy production in the heart.

What Is D-Ribose?

D-ribose is a sugar-like molecule that your body uses to make adenosine triphosphate, or ATP. ATP is the body’s most basic form of energy and the fuel burned by the cellular mitochondria.

Our cells naturally produce D-ribose, but the process is slow and different organs produce different amounts. The liver, adrenal glands, and fat tissue are high producers; the heart, brain, nerve tissues, and muscles, on the other hand, produce only enough to meet their daily needs.

The Critical Role of D-Ribose in Healthy Hearts

That last detail is vitally important when it comes to cardiovascular health.

The heart produces just enough D-ribose to maintain itself—under ideal circumstances. When conditions are less than perfect, such as when the heart doesn’t consistently get enough blood or oxygen, production slows. That means ATP production slows, too.

This dynamic is risky for heart patients because low oxygen levels and sluggish blood flow are common with cardiovascular disease—so these folks are uniquely prone to having low D-ribose and ATP levels.

Having an acute ischemic event, such as a heart attack, is even more problematic. In addition to rapidly and substantially depleting D-ribose and ATP, these events further draw down the heart’s energy reserves as the body repairs damaged tissue.

In all scenarios, a vicious cycle can emerge: The heart begins to fail because its energy levels are low, but it can’t produce more energy because it’s failing.

Avoiding this vicious cycle is the number one reason I recommend that all heart patients take daily D-ribose supplements.

What is Metabolic Cardiology?

Benefits of Supplementing With D-Ribose

When D-ribose first caught my attention, I was already using CoQ10, L-carnitine, and magnesium with my patients and seeing good results. After adding D-ribose to their regimen, I saw additional improvement in virtually everyone. Several patients told me they were amazed at how quickly it re-energized them.

One group that D-ribose seemed to benefit the most was patients with congestive heart failure.

Research confirms this. One study, a small double-blind crossover trial, divided patients with CHF and stable angina (most of whom also had a history of heart attack, bypass, or angioplasty) into two groups. One group was given supplemental D-ribose for three weeks, and the other a placebo. Then the groups switched places for another three weeks.

Follow-up testing showed that patients had improved diastolic function while taking D-ribose, meaning their hearts were better able to relax and fill with blood—a common problem in heart failure cases. Volunteers also reported improvements in quality of life and tolerance for physical activity while taking D-ribose, but no improvements while taking the placebo.

D-ribose can be uniquely beneficial to heart attack patients, as well. In fact, it remains one of the supplements I recommend taking after a heart attack. Animal studies have shown that D-ribose may help restore depleted ATP levels and lessen tissue scarring, improving overall recovery quality and time.

Even if you don’t have heart failure and you’ve never had a heart attack, you can still benefit from D-ribose—particularly if you have persistent symptoms and progressively worsening heart function, along with fatigue and weakness. These are signs that your heart is running an energy deficit. D-ribose can help close some of that gap.

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D-Ribose Benefits People with Fibromyalgia and Chronic Fatigue Syndrome Too

The muscle pain and stiffness characteristic of these conditions can have debilitating effects on quality of life. Yet, conventional medicine struggles to effectively treat them.

One theory about the cause of these diseases—fibromyalgia in particular—is that the muscle symptoms stem from faulty ATP production. This makes sense. If the heart is highly susceptible to failure when ribose production slows, the muscles would be as well.

A small study of 41 people with fibromyalgia and/or chronic fatigue syndrome found D-ribose supplementation an effective treatment. In the trial, patients received 5 grams of D-ribose three times daily, for approximately two and a half weeks. At the end of the test period, participants reported improvements in energy, sleep, mental clarity, pain intensity, and overall well-being.

How to Use D-Ribose

Since it’s sold in powder form, D-ribose is easiest to take mixed with a beverage. Its slightly sweet taste makes it perfect for coffee or tea. It also can be added to smoothies, or mixed with yogurt. My recommended dosage is 5 grams, 2–3 times a day.

As far as side effects go, don’t worry. I’ve seen D-ribose cause digestive upset in some people, but most folks tolerate it just fine. If you’re one of the unlucky few, simply reduce the dosage. That usually resolves any issues.

Because D-ribose is a sugar, some people worry it will raise blood glucose levels. The good news is that ribose will not increase your blood sugar level. In fact, there is evidence that D- ribose can lower it. If you’re taking insulin to manage diabetes—or are on another blood sugar–lowering medication—exercise caution with D-ribose, in order to avoid hypoglycemia.


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