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.

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