D-Ribose

What D-ribose is

D-ribose is a sugar with five carbon atoms. The body produces it itself and needs it as a building block for ATP, RNA and other nucleotides. As a supplement, D-ribose is produced by fermentation and sold as a powder.

In the BK-Score, D-ribose stands at 4 out of 10 points for human evidence. The studies are small, some without a control group or combined with a second active substance.

How it is supposed to work

When heart or skeletal muscle consumes ATP under oxygen deficiency or heavy exertion, building blocks are lost and rebuilding takes time. Additional ribose is supposed to speed up this rebuilding and thus improve the cell’s energy supply.

Whether this works in humans is open. In the skeletal muscle of athletes it was tested directly: ATP content did not recover faster after maximal exercise with ribose than with placebo (Op ’t Eijnde 2001). For the heart, there are no such direct measurements in humans in the studies evaluated here.

What the studies show

Coronary heart disease: more time until impaired blood flow

Pliml 1992 selected 20 men with severe coronary heart disease whose exercise tests were reproducible and gave them 60 g of ribose per day or placebo for 3 days. Afterwards, with ribose, they walked longer on the treadmill until the ECG showed an ST depression of 1 mm (276 versus 223 seconds). The time to moderate angina pectoris did not differ between the groups.

Heart failure: small and combined studies

Omran 2003 studied 15 patients with heart failure due to coronary heart disease in a double-blind crossover, with 3 weeks each of ribose and placebo. Under ribose, the atrial contribution to filling of the left ventricle rose from 40 to 45 percent, and quality of life on the SF-36 improved. Pierce 2022 assigned 216 patients with heart failure with preserved ejection fraction to placebo, ubiquinol, 15 g of D-ribose per day, or both. The authors report better symptoms, a higher ejection fraction and lower BNP levels for the treatment groups; walking distance in the 6-minute test remained the same. How D-ribose alone fared against placebo is not reported separately in the abstract. An open-label pilot study with 11 patients found better ultrasound values in 7, but only 1 patient felt better (Bayram 2015).

Fibromyalgia and chronic fatigue syndrome: only one open-label study

Teitelbaum 2006 gave D-ribose to 41 patients with fibromyalgia or chronic fatigue syndrome, without a control group and without blinding. Around 66 percent reported a clear improvement; energy on the scale rose by 45 percent on average. Without a comparison group, a placebo effect cannot be distinguished; a controlled study on these conditions is not available in the sources evaluated here.

Sport: no effect

Op ’t Eijnde 2001 gave 19 men 4 g of ribose 4 times daily or placebo for 6 days alongside hard knee-extensor training. Power output, lactate, ammonia and ATP recovery in the muscle did not differ. A single dose of 3 g before five sprints on the cycle ergometer did not change performance or metabolic values in 12 cyclists either (Kerksick 2005).

Where the data stop

• Chronic fatigue and fibromyalgia. The strongest marketing argument rests on a single study without a control group.
• Heart failure in everyday life. The studies measure ultrasound values, questionnaires and laboratory values over days up to 12 weeks. Hospital admissions or mortality were not studied, and in the largest study ribose was tested together with ubiquinol.
• Athletic performance and recovery. No effect in the controlled studies, not even on ATP recovery in the muscle.
• Long-term use. EFSA based its upper limit partly on a subchronic study in rats; long-term data in humans are missing.

Status, approval and legal

D-ribose has been authorized in the EU as a novel food since 2019 (Implementing Regulation (EU) 2019/506), with maximum levels for foods such as cereal bars, baked goods, sports drinks and meal replacements. These foods must carry the notice that they should not be consumed on the same day as food supplements containing D-ribose. The basis was the EFSA assessment of 2018: safe for the general population up to 36 mg per kilogram of body weight per day, around 2.5 g at 70 kg. D-ribose is offered as a food supplement in Germany. Health claims relating to the heart or energy are not authorized for D-ribose in the EU. Ribose is not on the prohibited list of the World Anti-Doping Agency.

Safety

Ribose lowers blood sugar. In 9 healthy people, serum glucose fell by 25 percent under continuous administration, without insulin explaining this (Gross 1991). EFSA assessed drops in blood sugar and transient hypoglycemia from 10 g as the critical effect and set the NOAEL with regard to hypoglycemia for adults at 70 mg per kilogram of body weight. Human data for children are missing. Anyone who has diabetes or takes blood-sugar-lowering medication should therefore use D-ribose only after consulting a physician, as should women during pregnancy and breastfeeding. In heart failure, ribose does not replace guideline-based treatment. This text is information and does not replace medical advice.

Sources

• Pliml W et al., Lancet 1992 – ribose in exercise-induced ischemia, 20 men with coronary heart disease (PMID 1354276)
• Omran H et al., Eur J Heart Fail 2003 – D-ribose in heart failure, crossover with 15 patients (PMID 14607200)
• Pierce JD et al., Am J Cardiol 2022 – ubiquinol and/or D-ribose in heart failure with preserved ejection fraction, 216 patients (PMID 35644694)
• Bayram M et al., Ther Adv Cardiovasc Dis 2015 – open-label pilot study, 11 patients with diastolic dysfunction (PMID 25701016)
• Teitelbaum JE et al., J Altern Complement Med 2006 – open-label study in fibromyalgia and chronic fatigue syndrome (PMID 17109576)
• Op ’t Eijnde B et al., J Appl Physiol 2001 – ribose, repeated maximal exercise and ATP recovery (PMID 11641371)
• Kerksick C et al., Int J Sport Nutr Exerc Metab 2005 – ribose and anaerobic performance (PMID 16521849)
• Gross M, Zöllner N, Klin Wochenschr 1991 – blood glucose, insulin and C-peptide under D-ribose (PMID 1901925)
• EFSA 2018 – safety of D-ribose as a novel food (PMID 32625902)
• Implementing Regulation (EU) 2019/506 – authorization of D-ribose as a novel food