Chronic Fatigue Syndrome, Fibromyalgia and D-Ribose

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Chronic Fatigue Syndrome, Fibromyalgia and D-Ribose

http://www.vitasearch.com/CP/experts/JETeitelbaumAT03-20-07.htm

E. Teitelbaum, M.D.

Fibromyalgia and Fatigue Centers

3230 Camp Bowie Blvd., #D

Ft. Worth, TX 76107

Endfatigue@...

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

Pilot Study,”

J Altern Complement Med, 2006 Nov;12(9):857-62. 45599 (4/2007)

Kirk Hamilton: Can you please share with us your educational

background and current position?

E. Teitelbaum: I am a board certified internist and

Medical Director of both the polis Research Center for Effective

Chronic Fatigue Syndrome and Fibromyalgia Therapies and the national

chain of Fibromyalgia and Fatigue Centers( www.fibroandfatigue.com ). I

am senior author of the study " Effective Treatment of Chronic Fatigue

Syndrome and Fibromyalgia -- A Placebo-Controlled Study " (which can also

be found at: www.Vitality101.com ) & “Effective Treatment of CFS &

Fibromyalgia with D-Ribose,” and also the author of the books “From

Fatigued to Fantastic!”, " Three Steps to Happiness! Healing Through

Joy " , and the recently released, “Pain Free 1-2-3- A Proven Program to

Get YOU Pain Free!“

KH: What got you interested in studying the role of D-ribose in

chronic fatigue patients?

What was the therapeutic rationale from a biochemical perspective?

JET: My interest in chronic fatigue syndrome (CFS) and fibromyalgia

(FMS) began when I came down with these syndromes in 1975. I had to drop

out of medical school for the year and was left homeless and sleeping in

parks. Once I recovered, I resumed medical school and have spent the

last 27 years researching these syndromes and treating over 3000 CFS/FMS

patients.

It became evident that hypothalamic dysfunction secondary to inadequate

mitochondrial energy production was the underlying “root cause” in these

multifactorial syndromes, so we looked for ways to restore energy

production. As D-ribose has been shown to increase cellular energy

synthesis in heart and skeletal muscle and research showed that

intracellular carnitine, another key “energy nutrient” was low, we

looked for ribose and other deficiencies as well. Cellular ATP

deficiency was demonstrated, and for ATP, FADH, and NADH, the backbone

structure of these molecules is made of 3 key components: 1) B vitamins,

which we supply in high dose to our patients; 2) Phosphate and adenine,

which are plentiful and have not been helpful to supplement and 3) D-ribose.

Research showed that in energy deficient states tissues are unable to

retain ribose and become deficient. We suspected since ribose production

in the body is a slow and laborious process, ribose deficiency could be

a rate limiting issue in production of ATP and energy in general. Ribose

is also a key component of both DNA (deoxyribonucleic acid) and RNA

(ribonucleic acid).

KH: Is there any assessment test that might indicate a need for ribose?

JET: Unfortunately, these are only available in research labs. The

need for D-ribose is based on clinical indications, especially: 1)

Cardiac dysfunction (e.g.-CHF, angina, arrhythmias, and even cardiac

surgery) in which treatment with ribose produces often dramatic results;

2) any chronic fatigue state (including CHF and fibromyalgia) and in

fibromyalgia/MPS; and 3) in athletes who seek to improve performance.

KH: Where did you come up with a dose of 5 g t.i.d. of ribose? How

was it given, with meals or away from meals?

JET: It was based on clinical and research data which found lower

doses to be ineffective for loading, and an initial large increase of

energy production at these levels. After tissues have recovered from

deficiencies through the loading process (~ 3 weeks), 5 gm BID is

adequate. It is very stable and well absorbed and it can be taken either

with or without food. It is best taken as a powder, and as it is a sugar

it can be added to hot or cold drinks as well

KH: Can you tell us about your study and the basic results?

JET: This open-label uncontrolled pilot study was done to evaluate if

D-ribose (Bioenergy Inc.) could improve symptoms in fibromyalgia and/or

chronic fatigue syndrome patients.

Forty-one (41) patients with a diagnosis of fibromyalgia and/or CFS were

given D-ribose 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.

The ribose was well tolerated, resulting 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). D-ribose significantly reduced clinical

symptoms in patients suffering from fibromyalgia and

chronic fatigue syndrome.

KH: Were there any side effects with the ribose? How was the patient

compliance?

JET: Two patients felt over-energized and hyper. One of these stopped

treatment and the other simply lowered the dose to a good effect. Of the

other 4 patients that were found to be noncompliant, 2 stopped taking

D-ribose because of lightheadedness (one patient), and increased

appetite (one patient). Two others changed their mind and simply did not

begin the study. Of the remaining 36 patients who completed the study,

one patient experienced transient nausea and another felt mild anxiety.

Both of these reactions were reversed by simply lowering the dose

of D-ribose. Overall it was very well tolerated. One patient in the

study had atrial fibrillation as well which resolved on ribose and he

was able to come off his medication because of ribose therapy (a common

effect of ribose).

KH: How do you determine which chronic fatigue patient is a candidate

for ribose therapy? Is there any testing?

JET: No. I recommend that all patients with CFS, fibromyalgia or

cardiac problems be given an empiric therapeutic trial using the dosing

above for 6 weeks. If benefit is seen, ribose should be continued.

KH: Are there any other synergistic nutrients that could be given

along with ribose that might enhance cellular energy production? If so

what are the nutrients and what would be their therapeutic doses?

JET: There are many nutrients critical in energy production. B

Vitamins(50-100 mg each), magnesium (200 mg), malic acid (900 mg):

iodine (200 mcg), selenium (200 mcg) and tyrosine 500 mg for thyroid

function; vitamin C 500 mg, glutamine, glycine, cysteine (500-1000 mg)

for glutathione production are but a few. In addition, I recommend

acetyl-l-carnitine 1000 mg/day and coenzyme Q10 200 mg/day.

KH: Is there any reason not to give a therapeutic trial of ribose in

chronic fatigue patients?

JET: Not really. The only caution is in brittle type 1 diabetics as

ribose actually lowers blood sugar slightly by increasing metabolism. In

these patients, I begin with a low dose and monitor sugars closely.

KH: Do you have any further comments you would like to make on this

interesting subject?

JET: A large double blind trial is underway, and there are many

studies on ribose. I suspect we will find that our understanding of

ribose may be the most important nutrient discovery of the decade. I’d

recommend it be used in all CFS, fibromyalgia and cardiac patients as

well as athletes. Though healthy, I take it daily myself as I like the

extra energy boost it gives me.

--

ne Holden, MS, RD < fivestar@... >

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

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