Thank you very much for your information and contribution, much appreciated.

The Use of D-Ribose in Chronic Fatigue Syndrome and Fibromyalgia: A Pilot Study JACOB E. TEITELBAUM, M.D.,CLARENCE JOHNSON, M.S.,2and J.A. St. Cyr, M.D., Ph.D.2

35 INTRODUCTION Fibromyalgia (FMS), which currently affects an estimated 3 to 6 million Americans,1,2and chronic fatigue syndrome (CFS) are disabling syndromes that often coexist. Patients suffering with these syndromes commonly report severe persistent fatigue, diffuse migratory pain, cognitive dysfunction, and disordered sleep. Many of the clinical symptoms found in FMS/CFS may be related to a decrease in tissue energy levels with altered energy metabolism. Previous reports claim that abnormal muscular energy metabolism frequently can be reflected in pain because of chronic muscle shortening,3postexertional fatigue, and low exercise tolerance associated with decreased cardiac output and stroke volumes.4In addition, it has been postulated that a decrease energy production in these syndromes also may result in hypothalamic dysfunction, which can be reflected clinically as disordered sleep, hormonal imbalances, and autonomic dysfunctions.5Causes and mechanisms for this mitochondrial dysfunction are unknown; however, an alteration in muscle adenine nucleotide metabolism is found, mainly in lower adenosine triphosphate (ATP) levels and depleted energy reserves.6,7 D-Ribose, a naturally occurring pentose carbohydrate, is a key structural component in DNA, RNA, ATP, FADH, coenzyme-A, and NADH needed by the mitochondria to maintain cellular energy homeostasis. Supplemental doses of D-ribose in patients with congestive heart failure and ischemic heart disease have shown a significant improvement in diastolic dysfunction, physical function, exercise tolerance, and quality of life.8D-Ribose has also been reported to be effective in restoring tissue energy levels following intense exercise9 and in an isolated case report of a patient with FMS.10Because of the known energy and functional 1Fibromyalgia and Fatigue Centers, Dallas, TX. 2Valen Labs, Minneapolis, MN.

CONCLUSIONS This pilot study suggests that D-ribose may provide subjective benefits in patients with FMS and/or CFS. Given the biochemical benefits of D-ribose on increasing muscular energy pools and reducing metabolic strain in affected muscles, the use of this supplement may offer a valuable option for improving quality of life in patients afflicted with FMS and/or CFS.

I think in the same issue of The Journal of Nutrition an editorial ran by energy expert Jacob Teitelbaum, MD, in which he states, “Energy production is an increasingly important topic as the human energy crisis is dramatically escalating. This is reflected in the prevalence of Chronic Fatigue Syndrome (CFS) and its painful cousin Fibromyalgia(FMS), increasing in prevalence from 2% to as high as 8% in the last decade alone 1-6. These syndromes have been associated with hypothalamic dysfunction 7,8 associated with decreased levels of tissue ATP 9,10. Unfortunately, people often deal with fatigue, CFS, and Fibromyalgia by attempting to stimulate systems that are already exhausted, instead of offering treatments that restore energy production. This can give short term benefit, but causes long term problems-which is why caffeine has often been called an energy “loan shark.”