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The Use of D-Ribose in Chronic Fatigue Syndrome and Fibromyalgia: A Pilot Study

  [ 419 votes ]   [ 2 Comments ]
By J.E. Teitelbaum, et al. • • November 29, 2006

Journal: Journal of Alternative and Complementary Medicine. 2006 Nov;12(9):857-862.

Authors and affiliation: Teitelbaum JE, Johnson C, Cyr JS. Fibromyalgia and Fatigue Centers, Dallas, Texas, USA.

PMID: 17109576

Objectives: Fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS) are debilitating syndromes that are often associated with impaired cellular energy metabolism. As D-ribose has been shown to increase cellular energy synthesis in heart and skeletal muscle, this open-label uncontrolled pilot study was done to evaluate if D-ribose could improve symptoms in Fibromyalgia and/or Chronic Fatigue Syndrome patients.

Design: Forty-one (41) patients with a diagnosis of FMS and/or CFS were given D-ribose, a naturally occurring pentose carbohydrate, at a dose of 5 g t.i.d. for a total of 280 g. All patients completed questionnaires containing discrete visual analog scales and a global assessment pre- and post-D-ribose administration.

Results: D-ribose, which was well-tolerated, resulted in a significant improvement in all five visual analog scale (VAS) categories: energy; sleep; mental clarity; pain intensity; and well-being, as well as an improvement in patients' global assessment. Approximately 66% of patients experienced significant improvement while on D-ribose, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30% (p < 0.0001).

Conclusions: D-ribose significantly reduced clinical symptoms in patients suffering from Fibromyalgia and Chronic Fatigue Syndrome.

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re: pilot study
Posted by: Gerald Campbell PhD
Jul 3, 2012
I don't know if many people closely read this article (not just the abstract above), but I see one major flaw with it right away. They exclude anyone who has used D-ribose at any time in the past. By doing this they are excluding a significant patient population who has tried D-ribose previously and not responded; this could increase the proportion of patients responding and and average extent of response.

There was also no breakdown of how many responded, of CFS vs. FM (altho the raw data is present it is not analyzed or discussed), or of response vs. any of the other data they did (or should have) collected including how long the patient has been ill, age, sex, or any clinical lab tests.

In addition, they cite the "increase" in CFS prevalence without even a mention of the changes in definition and diagnostic criteria in the interim.

Overall, to me this seems more like a product-promotion study than a scientific one.

As a matter of full disclosure, I have CFS for nearly 20 years, and tried D-ribose without any success. I have no financial interest in Corvalen, nor any relationship with any of the authors.

Gerald R. Campbell, Ph.D.
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Response to Previous Comment
Posted by: ElizabethEdwards,Aus
Nov 3, 2017
Great points; I also feel strongly that along with considering each subject's duration of illness, consideration of their current illness severity level (as measured on a clearly defined functional scale from mild to very severe) is crucial in virtually any trial involving people with ME/CFS.

Two main reasons: firstly, it distinguishes between the responses of the 'walking wounded' who may be holding down a job or other occupation, but have greater than normal need for rest outside of work hours, and the 'living dead' who are in bed 95% or more of the time, unable to move or bear even minimal sensory stimulation. Stimulating energy by biochemical means may help one group but be intolerable, even harmful for another.

Secondly, duration of illness doesn't necessarily match with illness severity, for example, a person may initially have moderate to mild symptoms, then at some point - perhaps after re-entering full-time employment or undergoing GET (graduated exercise therapy) - may suffer a severe relapse and be confined to bed thereafter. It's not a smooth curve.

The other factor I believe should ALWAYS be stringently followed up with any ME/CFS trial, is the after effects of any treatment protocol, for all participants including any who dropped out.

Searching questions need to be asked, eg: how long-lasting are any positive effects? Does there appear to be a healing/curative element to the treatment or does it merely temporarily relieve and/or mask symptoms? Are people better or worse after they discontinue treatment? Is there a beneficial effect for a while, then a levelling off? Is there an apparent beneficial effect for a few weeks or months, followed by a 'crash'?

Such after-trial investigation and reporting is essential because of the extreme, generalised sensitivity of many patients, especially the most severely ill, and the likelihood of relapse/ crashes/ flare-ups in response to stimulus of any kind. Boosting energy with stimulants may cause a crash. ME is not just fatigue/lack of energy. It involves an as yet poorly medically understood, complex multi-system over-reaction to stimulation and/or stress of any kind, whether 'positive' or 'negative', pleasurable or uncomfortable.

Artificially boosting energy in any way, unless it has addressed the root cause of the lack of energy, may simply encourage over-exertion, leading to crash as the (as yet unknown) root causes of the disease reassert themselves.

Anecdotally, I've heard reports of extreme exacerbation of symptoms, with a new type and severity of pain, after discontinuing d-Ribose.

I should repeat, that I believe all these factors should be considered in ALL treatment trials involving ME/CFS patients, and I note that in fact, few of them are EVER considered or given anything like due attention in reporting conclusions. Furthermore, the severe and severely ill categories of patient rarely if ever get to participate in trials, making the results skewed to show the effects on people with relatively high functionality, who may already be over the worst of their illness and actually on the mend. This is the point where some treatments may be helpful, though not essential, in aiding and accelerating the body's natural recovery process.

They may equally well be highly damaging to very sick people - but, while trials continue to ignore those in most need of help, we will really never know.


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