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D-ribose

Pentose monosaccharide; complemento alimenticio with a claimed role in energy metabolism

ATC code: A11JA-DRIBOSE

Brand names – supplements: D-Ribose, Corvalen, Bioenergy RiboseSupplements are not tested in clinical trials and are not registered as medications.

Updated · Methodology

Indications

C

Myoadenylate deaminase deficiency (AMPD1)

Individual decision

Myoadenylate deaminase deficiency (AMPD1) is a rare inherited metabolic disorder with poor exercise tolerance (pain, cramping, early fatigue). A small study by Wagner, Gresser and Zöllner (1991) in a few patients noted that oral D-ribose reduced exertional muscle symptoms. These are the only direct human data, the sample is tiny, and there are no controlled RCTs. A metabolic specialist decides on a trial individually, keeping in mind that the evidence base is minimal.

Sources

  1. Annals of Nutrition and Metabolism: Effects of oral ribose on muscle metabolism during bicycle ergometer in AMPD-deficient patients (1991)

ICD-10: E79.8 · ICD-11: 5C55.0Y

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Athletic endurance

Not recommended

D-ribose is positioned as a training supplement that «accelerates ATP recovery after exercise». The ISSN 2018 position stand explicitly classifies D-ribose among supplements with insufficient evidence – RCTs in trained athletes show no advantage over placebo for strength, power or time to exhaustion. ISSN further notes that the product causes hypoglycaemia on an empty stomach and does not justify its cost.

Sources

  1. ISSN: International Society of Sports Nutrition Position Stand: ergogenic aids (2018)
  2. NIH ODS: Dietary supplements for exercise and athletic performance (D-ribose section) (2023)
D

Chronic fatigue

Not recommended

D-ribose is marketed as a universal remedy for chronic fatigue and fibromyalgia, promising «cellular energy». The marketing basis is an open-label pilot by Teitelbaum (2006) in 41 people without placebo control. This is not an evidence level that supports a recommendation. No double-blind RCTs in fibromyalgia or chronic fatigue syndrome are in the Cochrane Library. NIH ODS rates the fatigue data on D-ribose as insufficient. Persistent fatigue requires workup (ferritin, B12, TSH, depression and sleep screening), not a supplement.

Sources

  1. Teitelbaum: The use of D-ribose in chronic fatigue syndrome and fibromyalgia (open-label pilot) (2006)
  2. NIH ODS: Dietary supplements for exercise and athletic performance (D-ribose section) (2023)

ICD-10: R53 · ICD-11: MG22

D

Heart failure

Not recommended

D-ribose is offered as heart failure support by analogy with its theoretical role in myocardial ATP synthesis. The 2023 guidelines do not mention D-ribose: first-line therapy is RAAS inhibitors, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors. The small Omran 2003 RCT (15 patients) showed improved diastolic function and quality of life, not reproduced in larger studies. Replacing evidence-based therapy with D-ribose risks decompensation.

Sources

  1. NIH ODS: Dietary supplements for exercise and athletic performance (D-ribose section) (2023)
  2. European Journal of Heart Failure: D-Ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study (2003)

ICD-10: I50 · ICD-11: BD10

D

Mitochondrial disease

Not recommended

D-ribose is included in empirical mitochondrial cocktails for MELAS, MERRF and other mitochondriopathies based on a theoretical role in ATP synthesis. For mitochondrial diseases themselves there are no controlled RCTs with D-ribose, and clinical guidelines do not list it. In most mitochondrial patients standard support relies on coenzyme Q10, riboflavin, L-carnitine and thiamine. D-ribose was separately studied in myoadenylate deaminase deficiency (AMPD1), a different, non-mitochondrial disorder, see its own card.

Sources

  1. NIH ODS: Dietary supplements for exercise and athletic performance (D-ribose section) (2023)

ICD-10: G71.3 · ICD-11: 8C73

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Five-carbon sugar that forms the backbone of RNA, ATP, NAD and FAD. Endogenously synthesised via the pentose phosphate pathway from glucose-6-phosphate. Manufacturers claim that supplementation speeds ATP synthesis in myocardium and skeletal muscle. After ischaemia or intense exercise, cellular adenine nucleotide pools are reduced and recover slowly (24–72 hours); exogenous ribose accelerates pool recovery in experiments. Healthy adults have a fully functioning pentose phosphate pathway, no ribose deficit and no physiological rationale for supplementation.

Safety

Contraindications

  • Hypersensitivity to D-ribose
  • Diabetes with hypoglycaemia risk (the product lowers blood glucose by 10–15% on an empty stomach)
  • Gout (theoretical risk of increased uric acid via purine turnover)

Serious adverse effects

  • Severe hypoglycaemia in diabetic patients on glucose-lowering therapy
  • Gout flare (rare, theoretical risk)

Common adverse effects

  • Hypoglycaemia on an empty stomach
  • Diarrhoea and flatulence at doses above 10 g
  • Nausea
  • Headache

Pregnancy: can you take D-ribose?

Pregnancy data for D-ribose are absent. AEMPS does not endorse use of complementos alimenticios without a therapeutic indication during gestation.

Breastfeeding: can you take D-ribose?

Breast milk excretion data are absent. There is no rationale for use as a complemento alimenticio in healthy mothers.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

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Frequently asked

What is D-ribose used for?

D-ribose is evaluated for the following indications with varying evidence strength: Myoadenylate deaminase deficiency (AMPD1) (evidence tier C), Chronic fatigue (evidence tier D), Athletic endurance (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of D-ribose?

Common side effects of D-ribose (≥ 1 in 100): Hypoglycaemia on an empty stomach, Diarrhoea and flatulence at doses above 10 g, Nausea, Headache. See the Safety section for uncommon and serious reactions.

Is D-ribose safe during pregnancy?

Pregnancy data for D-ribose are absent. AEMPS does not endorse use of complementos alimenticios without a therapeutic indication during gestation.

Is D-ribose compatible with breastfeeding?

Breast milk excretion data are absent. There is no rationale for use as a complemento alimenticio in healthy mothers.

Who should not take D-ribose?

D-ribose is contraindicated in: Hypersensitivity to D-ribose; Diabetes with hypoglycaemia risk (the product lowers blood glucose by 10–15% on an empty stomach); Gout (theoretical risk of increased uric acid via purine turnover). Full list in the Safety section.

Other drugs in this group

Diindolylmethane (DIM), Epigallocatechin-3-gallate (EGCG, main green tea polyphenol), Elderberry (Sambucus nigra), Eleutherococcus senticosus («Siberian ginseng»), Monolaurin (glycerol monolaurate), Pycnogenol (French maritime pine bark extract, Pinus pinaster), Sulforaphane (isothiocyanate from broccoli sprouts), Astaxanthin