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LE Magazine May 2007
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Enhancing Cardiac Energy with Ribose


By Stephen T. Sinatra, MD, and James C. Roberts, MD

After years of performing angiograms and emergency cardiac procedures, two cardiologists—Drs. Stephen Sinatra and James Roberts—grew weary of seeing their patients fail to achieve lasting cardiovascular health. As they began to integrate complementary therapies such as coenzyme Q10, L-carnitine, and D-ribose into their patient care protocols, they noticed an astonishing result: hospital admissions for their heart patients dropped dramatically.

In the following excerpt from their new book Reverse Heart Disease Now, these forward-thinking physicians report how they use D-ribose in their practice to help patients suffering from coronary artery disease, congestive heart failure, peripheral arterial disease, and more. Their impressive results may well herald a new era of preventive cardiology that uses integrative approaches to prevent and reverse cardiovascular disease, before catastrophe strikes.

D-ribose is the new kid on the heart supplement block. As a building block of ATP (adenosine triphosphate), it rapidly restores depleted energy in sick hearts.

You probably haven’t heard about D-ribose. But you will. It’s that good. Every cell in the human body makes some of this simple sugar molecule, but only slowly and to varying degrees, depending on the tissue. The liver, adrenal glands, and fat tissue produce the most—enough to serve their purpose of making compounds involved in the production of hormones and fatty acids. But tissue elsewhere has little.

Red meat, particularly veal, contains the highest dietary concentration of D-ribose, but not significant enough to provide any meaningful nutritional support, especially to unwell individuals. Heart, skeletal muscle, brain, and nerve tissue can only make enough D-ribose to manage their day-to-day needs when their cells are not stressed. Unfortunately, these cells lack the metabolic machinery to make D-ribose quickly when they come under metabolic stress such as blood and oxygen deprivation (ischemia). When oxygen or blood flow deficits are chronic, as in heart disease, tissues can never make enough D-ribose. Cellular energy levels become depleted.

The Doctor as Guinea Pig

When Dr. Roberts heard about D-ribose, a light bulb immediately went on in his head. For some time, he had been using L-carnitine and CoQ10 in his medical practice to boost energy metabolism in sick hearts, but neither L-carnitine nor CoQ10 can rebuild the metabolic energy pool once it has been depleted by heart disease. He wondered if D-ribose could be the missing link.

Before trying it on patients, he decided to try it first on himself. As a marathon runner, he knows the importance of energy recovery. It is the impaired recovery of the muscle ATP pool that causes the pain, soreness, stiffness, and fatigue that follow long-distance training runs. He found that taking D-ribose before and after a run eliminated these problems. The usual muscle pain and soreness that persist for a day or two, or even three, were gone. He was no longer fatigued in the days after a hard workout. He was convinced!

In his cardiology practice, he offers patients an enhanced external counterpulsation (EECP) program, a noninvasive method that restores the flow of oxygenated blood in patients with recurrent or inoperable coronary artery disease. Before D-ribose, most of the patients on EECP experienced good improvement. After adding D-ribose, improvement made a quantum leap to great. In hardcore cases like these, supplying oxygen alone to the chronically flow-deprived heart cells was not enough. Yes, the cells were deficient in CoQ10 and L-carnitine, but above all they lacked the precursors of ATP.

He began to put patients with angina and heart failure on D-ribose. They also improved. Time after time, Dr. Roberts found remarkable improvement in cardiac function measurements, exercise tolerance, quality of life, and recovery from fatigue. He was hooked and soon was lecturing about D-ribose at medical meetings.

The ABCs of D-ribose

Ischemia may cause the heart to lose up to 50% of its ATP pool. Even if blood flow and oxygen are restored to normal levels, it may take up to 10 days for an otherwise healthy animal heart to rebuild cellular energy and normalize diastolic cardiac function. In studies, when oxygen-starved animals receive D-ribose, energy recovery and diastolic function return to normal in an average of two days. When patients with CAD (coronary artery disease) are treated with D-ribose, symptoms and treadmill time improve significantly within one week.

Several factors determine who should take D-ribose supplements and when they should be taken. Age is one consideration. We believe 20-25% of people over 45, men and women alike, show early signs of diastolic cardiac dysfunction (stiff heart) and are at risk of contracting heart failure later in life. This is especially true in people with high blood pressure, people taking statin drugs, and in women with severe mitral valve prolapse. For these people, D-ribose supplementation increases the cardiac energy reserve and helps the heart restore normal diastolic cardiac function.

We also know that the health of our mitochondria suffers as we age. As a result, even minor metabolic stress can have a dramatic effect on cellular energy stores in an aging population.

Patients with heart disease on drugs intended to increase the contractile strength of their heart are also good candidates for D-ribose. These drugs, known as inotropic agents, make the heart beat harder. This places considerable strain on the heart’s ability to supply enough energy to support the extra metabolic stress. Long-term treatment with these agents drains the energy reserve, essentially running the heart out of energy. Patients with heart failure, chronic coronary artery disease, or cardiomyopathy should take D-ribose to offset the energy-draining effects of inotropic drugs such as digoxin. Research shows that supplementation reduces the energy drain without any negative impact on the activity of the drug.

Patients with coronary artery disease and persistent symptoms remain in a chronic state of energy depletion, constantly fatigued, weak, and with their heart function progressively worsening. These patients will almost certainly advance into congestive heart failure without improvement of the energy state of their heart. Restoration of their energy pool can only be accomplished through the pathway of energy metabolism regulated by the availability of D-ribose.

We cannot overstate the effect of D-ribose supplementation on maintaining energy levels. Any tissue that relies heavily on aerobic energy metabolism, such as the heart and muscles, will be severely affected by any amount of oxygen deprivation. The problem is ATP drain. The solution is to give it back!

Fibromyalgia patients are chronically fatigued and subject to muscle pain, soreness, and stiffness that can be associated with depleted cellular energy reserves. We are learning that patients with fibromyalgia and chronic fatigue syndrome have faulty ATP metabolism, so it makes perfect sense to use D-ribose to help them.

Unlike many other nutrients, we can’t really talk about a formal D-ribose deficiency in tissue. Deficiencies refer to tissue concentrations of nutrients that fall to below-normal levels. D-ribose is not stored in cells in its free form; thus, there is no “normal” level of D-ribose in tissue. Instead, cells are faced with the task of making D-ribose in response to a specific metabolic demand. And this is where they get into trouble, because making D-ribose is a slow and time-consuming process in virtually all cells.

“You Fixed Louis”

Louis came to Dr. Sinatra’s office suffering from severe coronary artery disease. Although previously treated with a stent placed in his left anterior descending artery, he still had severe blockage in an important arterial branch called the diagonal. The branch would have been difficult to dilate with a stent and unreasonable to bypass with surgery.

Louis had stubborn angina because of this unresolved situation. He experienced chest pain with normal activity, such as walking across a room, or from just mild emotional stress. He had visited several cardiologists for his heart problem. They gave him a number of standard heart drugs, but his situation persisted, and he decided to see Dr. Sinatra for a fresh opinion.

Testing showed that Louis had high levels of uric acid in his blood, indicating faulty ATP metabolism. He had already been taking low doses of L-carnitine and CoQ10. He needed higher doses, and he needed D-ribose to build his ATP pool. In just a few days, Louis showed such remarkable improvement that his son-in-law called and reported, “You fixed Louis!”

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