D-ribose

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.

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.

D-ribose is offered as heart failure support by analogy with its theoretical role in myocardial ATP synthesis. The 2023 ESC 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 a small ejection-fraction gain, not reproduced in larger studies. Replacing evidence-based therapy with D-ribose risks decompensation.