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.

So Many Dietary Supplements – How Do You Choose?

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.

References and Resources:

© 2017 HeartMD Institute. All rights reserved.

Leave a Reply


  1. Terrie

    on January 20, 2017 at 8:14 pm

    if you have diabetes managed with medication (not insulin), High Blood Pressure also managed with medication, take Plavic blood thinner because you had a stroke, and take Prilosec for stomach issues, is it safe to take this D-Ribose supplement?

  2. Terrie

    on January 26, 2017 at 8:13 pm

    Follow up. This is not my first question to Heart MD institute. I think there is a lot that makes sense in what Dr. Sinatra says. However it is curious that no answers are ever supplied to the leave a comment section. How is a person to know which of Dr. Sinatra’s products to avoid given history with different diseases. The products are not cheap so who wants to waste money and time getting the wrong one. Or worst getting one that interacts badly with their current medication.

  3. Pam Aronson

    on February 8, 2017 at 2:39 pm

    I had the same questions regarding the safety (or not) of combining herbal medications with pharmaceuticals. There is an online database that provides copious amounts of information about natural remedies and their interaction with meds. It is at http://www.naturaldatabase.com. You have to subscribe to get the information you need, but I subscribed for one month (around $14) and in one evening (last evening) found out more than I ever could have imagined. I am on a blood thinner and three other meds after having had two stents put in last week and was hesitant to even take natural remedies that I thought of as “bening,” such as burdock root. My concern was justified. There are many such remedies that pose risk, especially when combined with blood thinners. I gave my cardiologist the name of this website becauce doctors also need to know that some natural remedies are, indeed, powerful, and can cause interactions.

  4. Corinne Z.

    on March 3, 2018 at 2:00 pm

    Dear Dr. Sinatra. I am an 80 yr. Old Italian woman. I adore bread!!!!! And I make mine. I am wondering whether you offer a service to interpret lab work. I would like you to analyze my latest labs and provide your opinion. I take my health very seriously. I really don’t want to die EVER, but since I have to at some point, I don’t want to suffer. Thank you. Corinne

  5. HeartMD Editor

    on March 8, 2018 at 10:25 am

    Hi Corinne,
    Dr. Sinatra is no longer in practice. We can refer you to Dr. Sinatra’s Top Docs List here if you want to consult with one these providers.

  6. Anita K.

    on May 30, 2018 at 8:31 pm

    The “awsome foursome” supplements for Mitochondrial diseases – D-Ribose, L-Carnitine, COQ10, and Magnesium sounds helpful. I have mitochondrial myopathy. It has effected my heart and trunk muscles -(muscles closest to the trunk), the most. I was wondering how much is suggested to take of each of these supplements and can you give a suggestion of a brand name that would be good.

  7. Pierre Aribaut

    on June 9, 2018 at 6:14 am

    How is the taste of d-ribose? Is it like sugar?

  8. HeartMD Editor

    on June 12, 2018 at 9:33 am

    Hi Pierre,

    D-ribose doesn’t have much of a flavor, it is a little bit sweet, but not as sweet as sugar. It can easily be mixed into juice, cereal, sprinkled on fruit, or even just mixed into water.

  9. Diane I.

    on June 26, 2018 at 1:58 pm

    I am an experienced RN. I have been taking D Ribose the last 4 years 3 x per day. One day, my MD said I want you to take these things. . I Also take CoQ10, NAC, Magnesiun and L Carnitine. I am taking them for HF and 2 leaky valves. I also have A Fib. Well, my echocardiogram gets better and better each time. I have never been hospitalized for CHF. I am 72 – my friends call me “the energizer bunny”.

  10. HeartMD Editor

    on July 9, 2018 at 8:32 am

    Hi Diane,
    Thank you for sharing your experience!
    We are so happy to hear you are doing so well and the targeted supplements you’re taking are helping

  11. Geri B.

    on July 16, 2018 at 7:43 am

    I recently had two stents in April of this year. I am on Brilinta for one year. Can I take D-Ribose?

  12. HeartMD Editor

    on July 16, 2018 at 2:45 pm

    Yes. The body makes D-Ribose so it’s a very safe nutrient to supplement with.

  13. CJ

    on October 5, 2018 at 10:29 pm

    I was just told that my precious dog has an enlarged heart! The vet put her on vetmedin 1.25mg. I read on line from other pet owners about the d-ribose and vetmedin providing wonderful results. Please tell since I started the vetmedin if it is safe to give her the d-ribose as well? If it is safe how much should I give her, and should I give them at the same time together or space it out through the day?…..She Only weighs a little over 11 pounds. Thank you so much!

  14. j. mvns

    on December 2, 2018 at 3:58 am

    Ive found Dr Sinatra recently and i begun D Ribose . The first sign was a strong recovery from workout in the pool , I swim 40 short pool in 30 minutes , non stop , for maintenance levels of muscular fitness , Without hipertrophy .
    Im increasing the level .
    The question is about the maximum level of D Ribose intake , Is it exceeding two times a day , 1 tea spoon ?
    Thank you .~
    JMVNS / 62 years of age and rising

  15. Mary Nelson

    on February 17, 2019 at 9:09 am

    Hello I have cardiomanopothy my heart fraction 40 im taking d-Ribose will i see better number at my next echo im working out in shape

  16. Ron Reagan

    on March 9, 2019 at 10:34 am

    Can I take D-Rebose with medications given for con heart failure?

  17. HeartMD Editor

    on March 11, 2019 at 9:25 am

    Hi Ron,
    Unfortunately, we cannot advise you in matters of medication/supplementation. D-ribose is produced by the body and is generally safe to take while on other heart medications. But please discuss the addition of any supplements to your medications with your doctor.

  18. Doro N

    on April 12, 2019 at 8:28 am

    My husband is being treated for A-fib and high blood pressure. His doctor dismisses supplements, except for magnesium. I would like to add D-ribose, L-carnitine, and CoQ10 to the magnesium he is taking,but I understand that CoQ10 may cause too much blood thinning because of the Eliquis he is taking. Can I use the other three awesome sand add the CoQ10 after the A-fib is under control and the Eliquis dose is (hopefully) reduced? He is using a grounding mat for 30 minutes a day.

  19. Doro N

    on April 12, 2019 at 8:33 am

    I just read your answer to “Ron” so I’m sure you can’t answer my question. Thank you anyway.

  20. Karen

    on December 2, 2019 at 2:14 pm

    Is it known why D-ribose can sometimes cause a headache? I’m curious about why it can trigger that effect since it happens to me every time I try it.

  21. Randy

    on December 13, 2019 at 1:47 am

    Pam Aronson, you said you subscribed to naturaldatabase.com for one month at a cost of about $14. However, I just now visited that website and I do no see where they have a monthly subscription. Instead, all I see is that they have a YEARLY subscription and it is a lot more than $14. How were you able to get only 1 month of it without having to pay the full year subscription?

  22. Joe Taylor

    on May 17, 2020 at 3:04 pm

    I first learned about D-ribose around a decade ago, when I was first officially diagnosed with atrial fibrillation and read lots of stuff, including “REVERSE HEART DISEASE NOW” by Drs. Sinatra and James Roberts. I finally got the a-fib resolved with a catheter ablation in 2012, but my next complication was an aortic dissection in November of 2018, which resulted in two stents in my aorta, and multiple lectures regarding things like being diligent with hypertension pharmaceuticals (although I strongly suspect there was a definite genetic component to the aortic situation). Anyway, I don’t know if it’s purely coincidental or not, but it seems as though when I take D-ribose I experience more heart “palpitations.” I don’t know if this might be due to lowered blood sugar, or what . . . or if it’s all, again, just coincidental. Have you ever heard to this kind of side effect with D-ribose? Thanks for all your help, counsel, and input over the years.

  23. Sandi B.

    on May 21, 2020 at 2:20 pm

    Hello Joe,
    Thank you for reaching out. this is what Dr. Sinatra had to say:
    Actually, Joe, I have had a few patients taking D-ribose report having palpitations like you are experiencing. D-ribose can cause a little hypoglycemia for some folks, so we found a remedy that helped them. They took 1/2 the usual dose of D-ribose (so, 1/2 teaspoon instead of 1) and they put it in 8 ounces of orange juice. As they tolerated that with no problem, they slowly increased to 3/4 of a teaspoon for a while, then back to 1 teaspoon. So, you may want to give that a try. And, please do be diligent about your blood pressure.
    We hope this helps.

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