Chewable D-Ribose 1500 mg Natural Orange Juice Flavor by NOW Sports

POSSIBLY INEFFECTIVE

• Athletic performance. Most studies show that oral ribose is not beneficial for improving athletic performance. Details: Clinical studies in trained cyclists show that taking ribose in various dosing regimens, including 10 grams daily for 5 days, 8 grams four times over 36 hours, or a single dose of 3 grams with folate 150 mcg, does not improve anaerobic cycling performance when compared with dextrose, cellulose, or maltodextrin (15724,15727,15728). In trained rowers, taking ribose 10 grams daily for 8 weeks was less beneficial than taking dextrose 10 grams daily for improving rowing performance in time trials (15725). One small study in healthy adults with various levels of fitness shows that taking D-ribose 10 grams daily for 5 days does not improve anaerobic cycling performance when compared with dextrose. However, in individuals with the lowest level of fitness, defined as a lower peak oxygen uptake at baseline, D-ribose might improve power output when compared with dextrose (100680). Research in untrained individuals has also failed to show benefit. Taking ribose 4 grams four times daily for 6 days or a single small dose of ribose (2D-Ribose ATP, GNC) 625 mg did not increase maximal intermittent exercise performance or power output when compared with placebo (15723,15729). Limited research has evaluated ribose in combination with other ergogenic ingredients. One small study in resistance trained males shows that taking a combination supplement of ribose 2 grams, glutamine 3 grams, and creatine 5 grams daily for 8 weeks does not improve muscle strength, endurance, or body composition when compared with control (15726).
• McArdle disease. Oral ribose does not seem to improve exercise tolerance in patients with McArdle disease. Details: A very small study shows that taking ribose 60 grams daily for 7 days does not improve exercise tolerance in patients with McArdle disease when compared with placebo (5678).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Chronic fatigue syndrome (CFS). It is unclear if oral ribose is beneficial in patients with CFS. Details: A small clinical study shows that taking a ribose supplement (CORvalen, Valen Labs) 5 grams three times daily might improve energy, sleep, and sense of well-being when compared to baseline in patients with CFS with or without fibromyalgia (15218). The validity of these findings is limited by the lack of a comparator group.
• Cognitive function. It is unclear if oral ribose is beneficial for improving cognition. Details: A small clinical study in healthy adults shows that taking D-ribose 1 gram twice daily 1 week before experimentation, in addition to 1 gram supplemental doses on the experimentation day, does not improve performance during fatigue-inducing mental tasks when compared with placebo (37735). This finding is limited because the dose of D-ribose may have been too low to produce an effect.
• Congestive heart failure (CHF). It is unclear if oral ribose is beneficial in patients with CHF. Details: A very small clinical study in patients with CHF shows that taking ribose 5 grams three times daily for 3 weeks does not affect left ventricular ejection fraction, but does seem to improve quality of life, when compared with placebo (15730). Another very small clinical study in patients with NYHA class III-IV heart failure shows that taking ribose 5 grams three times daily for 8 weeks might improve ventilatory efficiency and oxygen uptake when compared with baseline (71601). This second study is limited by a lack of placebo control group.
• Coronary artery bypass graft (CABG) surgery. Although there is interest in using oral ribose for improving recovery after CABG, there is insufficient reliable information about the clinical effects of ribose for this condition.
• Coronary heart disease (CHD). It is unclear if oral ribose is beneficial for improving exercise tolerance in patients with CHD. Details: A small clinical trial in patients with CHD shows that taking ribose 60 grams daily by mouth for 3 days increases time to onset of moderate angina and time to ST depression during treadmill walking exercise testing when compared with placebo (5664). Another small clinical trial in patients with CHD taking part in a physical exercise program shows that taking a combination product containing D-ribose 2.5 grams, creatine 1 gram, thiamine 0.33 mg, and vitamin B6 0.42 mg twice daily for 2 weeks, then once daily for 1 month, improves measures of exercise tolerance when compared with placebo (103291). However, it is unclear if these findings are due to D-ribose, other ingredients, or the combination.
• Fibromyalgia. It is unclear if oral ribose is beneficial in patients with fibromyalgia. Details: A small clinical study shows that taking a ribose supplement (CORvalen, Valen Labs) 5 grams three times daily might improve energy, sleep, sense of well-being, and pain when compared to baseline in patients with fibromyalgia with or without chronic fatigue syndrome (CFS) (15218). The validity of these findings is limited by the lack of a comparator group.
• Heart failure. It is unclear if oral ribose is beneficial in patients with heart failure with preserved ejection fraction. Details: A small clinical study of patients with heart failure with preserved ejection fraction shows that taking ribose powder 15 grams daily for 12 weeks increases Kansas City Cardiomyopathy Questionnaire scores, vigor scores, and ejection fraction while decreasing biomarkers associated with disease severity and worsened prognosis, including B-type natriuretic peptides and lactate/adenosine triphosphate ratio, when compared with placebo. However, ribose supplementation did not lead to improvements in walking distance (108959).
• Muscle soreness. It is unclear if oral ribose is beneficial for preventing muscle soreness from exercise. Details: A small clinical study in healthy untrained adult males shows that taking a solution containing D-ribose 15 grams one hour before and one hour after performing 140 plyometric frog hops, and another 3 doses every 12 hours afterwards, seems to reduce muscle soreness when compared with placebo (105899).
• Restless legs syndrome (RLS). Although there is interest in using oral ribose for RLS, there is insufficient reliable information about the clinical effects of ribose for this condition.
• Seizures. Although there is interest in using oral ribose for seizures, there is insufficient reliable information about the clinical effects of ribose for this condition. More evidence is needed to rate ribose for these uses.

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LIKELY SAFE ...when used in amounts commonly found in food. Consuming ribose up to 36 mg/kg daily from food sources is considered safe by the European Food Safety Authority (103292). ...when used orally and appropriately, short-term (15218,15723,15724,15725,15726,15727,15728,15729,15730). Ribose has been used safely at doses up to 15 grams daily for up to 12 weeks (15218,15725,15727,15730,71601,100680,103291,108959). ...when used intravenously and appropriately, short-term (5662,5663,5676,5680,71603). There is insufficient reliable information available about the safety of ribose when used long-term.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Theoretically, taking ribose in combination with antidiabetes drugs might increase the risk of hypoglycemia.  Details In clinical research, ribose decreases serum glucose levels in a dose-dependent manner (5667,92891).

INSULIN Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, taking ribose with insulin could increase the hypoglycemic effect of insulin.  Details In clinical pharmacokinetic studies, oral administration of ribose modestly increased serum insulin levels (5667,92891).

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General ...Orally and intravenously, ribose is generally well-tolerated for up to 1 month.
Most Common Adverse Effects:
Orally: Diarrhea, gastrointestinal discomfort, headache, hypoglycemia, nausea.
Intravenously: Hypoglycemia.

Endocrine ...Orally, ribose can decrease blood glucose levels (5667,92891). In one pharmacokinetic study, fasting plasma glucose declined after single ribose doses of 2.5-10 grams. At all doses, serum glucose returned to near normal 2 hours post-administration but remained slightly below pre-dose levels for up to 5 hours. One case of symptomatic hypoglycemia 70 minutes post-dose was reported in a 53 kg female who took ribose 10 grams. The reaction was considered mild; however, specific blood glucose levels were not reported (92891).
Intravenously, ribose has been reported to cause hypoglycemia, increased serum insulin levels, and decreased serum phosphate (5650,5662,5663,5676).

Gastrointestinal ...Orally, ribose can cause diarrhea, gastrointestinal discomfort, and nausea (5664,5676,15218,92891). In one study, lowering the dose of ribose resolved the nausea (15218).

Neurologic/CNS ...Orally, ribose can cause headache (5664,92891). It has also been reported to cause a hyperanxious feeling, lightheadedness, increased appetite, and mild anxiety (15218). In one study, lowering the dose of ribose resolved the feeling of anxiety (15218).

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