Friday, February 27, 2009

Ribose or comatose

Nearly comatose with fatigue last week, an article crossed my desk entitled “D-ribose, chronic fatigue and fibromyalgia.” The author, Tori Hudson, is a noted naturopath, a clinical professor, and director of a medical clinic dedicated to women’s health. She writes: “I have found D-ribose to be the single most important nutrient in the search for alleviation of symptoms and a path towards heath.”

Why did I stop taking ribose? I try to recall when I tried it. It was shortly after Jacob Teitelbaum published his pilot study in November 2006 J. Altern Complement Med I read a short summary of the research in The Townsend Letter, where Teitelbaum wrote a monthly column, and decided to order it. Perhaps because I was already taking a small dose in Vibe, or perhaps because I was on the downhill slope of a miserable relapse, I didn’t notice any difference. When I used up the second container, I didn’t reorder. Then I forgot all about it.

Now I’m pulled back to read more carefully. My attention settles on a summary of laboratory findings of deficiencies. Apparently, those of us with CFS have been found to have
• 20% less energy in our muscles. Yup, I feel this every time I go to the gym.
• defective or inefficient mitochondria. Hmmm, the mitochondria are the energy factories of each cell, so that makes sense.
• nutrient deficiencies in cells and tissues needed to process food into energy. Like what? Magnesium? B vitamins?
• thickened capillary walls slowing the rate of energy synthesis.

There is no citation for the last claim, so I get curious. And soon I am on an internet search.

What I want to understand is: what does ribose have to do with any of this? I already know ribose is a component of ATP, the substance needed by every cell in the body to produce energy for its function. I also know ribose is a component of RNA, whose full name, ribo-nucleic-acid, lets us know it contains ribo(se). RNA, in case you slept during high school biology, is needed by the body to make DNA, which is needed every time a cell duplicates or repairs itself – an activity happening a million times a day. I also learn that ribose is in NADH, a rather expensive supplement I’ve tried before physical exercise. The box advertises that it improves cellular energy & elevates mental clarity – cell regeneration – DNA repair – boosts immune system – a potent antioxidant. Anything that can do all that has to be good. Right? Fourth, ribose forms part of Coenzyme-A, which is needed to run the Krebs cycle where fat is burned for energy. A Wikipedia article informs that Coenzyme A helps transfer fatty acids from the cytoplasm to the mitochondria. Coenzyme A is made from panthothenate, also known as vitamin B5, which is an important nutrient for adrenal function. So many things work together.

I wonder if ribose has any relationship to the glutathione - methylation cycle. Could it screw up the Simplified Five protocol in which I have already invested three months of time.

There is some old discussion about ribose on the Yahoo group, Yasko CFS_Experimental, where it is grouped with other supplements that support mitochondrial activity. Rich van Konynenberg contributed his opinion that lowered mitochondrial activity could be one way the body protects itself; that this symptom from which we PWC's suffer is a compensation against excessive oxidative stress. Taking things to increase mitochondrial activity, he warns, could increase oxidative stress, further damage cell membranes, and ultimately make the body worse. But Dr. Amy Yasko recommends Beyond C with ribose as appropriate supplementation for many genetic profiles, as well as other supplements that support healthy mitochondrial activity. (See p 148 ff of Genetic Bypass).

Despite having parted with a year’s worth of massage money to consult with Rich, I’m not ready to listen to him. Perhaps it is hubris, perhaps skepticism, perhaps sheer desperation to get past this near comatose stage of my healing journey. I order a jar of d-ribose on Wednesday. Then I read more.

Normally ribose is formed in each cell through a process of bio-chemical reactions known as PPP (pentose phosphate pathway). This pathway also helps to make a very important substance called NADPH (nictinamide adenine dinucleotide phosphate) which the body uses to convert the bad, oxidized form of glutathione to the good, reduced form of glutathione. Both forms of glutathione are measured in the methylation panel. Reduced glutathione is good because it removes peroxides from the system, hopefully before they can damage cell membranes. The red blood cells are really good at this; but heart and muscle cells are not as well equipped to do this because they lack certain enzymes. They like to use glucose for fuel, and so let ribose stores get low. Hence, it takes a while to recover when we work our heart and our muscles hard.

People with CFS presumably get caught in a vicious cycle. When ribose gets low, ATP gets low, and reduced glutathione gets low. This does not make for happy cells but rather cells as stressed out as a peri-menopausal woman with PMS on a 1000 calorie diet. They look at all the ADP which has accumulated, and wishing they could make it into ATP, but can’t, they go bonkers; they break down the excess ADP and throw out the nucleotides and the purines. Ha! Then they sigh and take a rest. That’s all they can do now. Gees! You’d think they’d know better. But it’s not as if they can reason. They do what is necessary to maintain balance, which means recovering a certain, normal ratio of ATP to ADP.

So the theory is: give the body abundant ribose so it has the stuff available when it needs it. Maybe, if you’re lucky, it will make more nucleotides and rebuild ATP stores; then it can rebuild glutathione. It’s a long shot, perhaps, since we all know that rebuilding glutathione depends upon proper methylation. But the good news is that taking extra ribose isn't likely to send the mitochondria on an energy-producing binge only to leave us with the Mack-truck-hit-me hangover the next day from unrepaired oxidative stress.

Teitelbaum's study found that 66% of the patient with CFS and Fibromyalgia who took 5 gms (1 small scoop) of ribose three times a day for about three weeks showed a significant improvement in energy, sleep, mental clarity, pain, or general well-being. Nearly half had a significant increase in energy.

I’ve been taking ribose for a week, and I’m glad to report that I have increased energy, increased mental clarity, and increased well-being. I no longer fell comatose. Yeah! I suspect that once I replenish the ribose stores, my improvement will plateau. I’m not sure I’ll even need to continue taking it. But for now, I’m grateful to the researchers and clinicians who decided to explore whether ribose could help people with CFS.

Have you tried d-ribose? What results did you get? Leave a comment by clicking on the word "comments" below.

2 comments:

Please add your comments here. If you have a question specific to your own condition, please e-mail me directly at drjanisbell@gmail.com I cannot give medical advice. If you want to suggest a product or therapy you think I should try, please let me know if you have used it, what you used it for, and how it helped you.