Fibromyalgia represents a cellular energy crisis with many causes. Treatments that increase energy production can often be helpful. This includes the "SHINE" protocol (Sleep, Hormones, Infections, Nutrition, and Exercise), which was shown to be highly effective in an earlier RCT. A soon to be published multicenter study showed that D-ribose supplementation (Corvalen) increased energy an average of 61% at three weeks, while also improving sleep, cognitive function, pain, and overall well-being.
In previous Townsend Letter articles, we have discussed how chronic fatigue syndrome and its painful cousin fibromyalgia represent an energy crisis in the human body. Our earlier studies, including a randomized double-blind placebo-controlled study, showed that increasing energy by using what we call the SHINE protocol helped 91% of patients with an average 90% increase in quality of life (p < .0001 versus placebo) at 99 days.1,2 Another recent multicenter study, done at 53 different health clinics, was recently accepted for publication.3 It examined the use of supplemental D-ribose (Corvalen by Douglas Laboratories) in 257 subjects with CFS/fibromyalgia. The results were dramatic, with an average 61% increase in energy at three weeks.
What Is Fibromyalgia?
Fibromyalgia is characterized by exhaustion, widespread pain, and cognitive dysfunction in the presence of severe insomnia. It represents an energy crisis wherein the person is using more energy than he can make. The areas using the most energy for their size malfunction first, including especially the hypothalamus. This area controls hormonal function, temperature regulation, sleep, and autonomic function. Other areas that require a very large amounts of energy overall, such as liver detoxification, may also show altered function. For example, muscles, which take more energy to relax than to contract, get stuck in the shortened position, causing widespread pain. As with any chronic pain, this then can become amplified in the brain causing central pain called central sensitization.
In essence, people with fibromyalgia have an energy crisis wherein they have "blown a fuse" called the hypothalamus.
What Causes the Energy Crisis?
Looking at modern life, it seems like the "perfect storm" for a human energy crisis. Approximately half of the calories that we eat are largely devoid of micronutrients (e.g., vitamins and minerals) because of food processing. This has resulted in people's being both obese and malnourished for the first time in human history. In addition, the average night's sleep has gone from 9 hours a night 130 years ago (when lightbulbs became popular) down to 6½ hours a night. Added to this, people are dealing with the increased stress and speed of modern life. For example, when I was a child, the Madison Avenue advertising mantra was "sex sells." Now it is "fear sells." Sometimes I miss the good old days!
Another important and major stress contributing to many illnesses of modern life? I suspect that many people's immune systems are becoming overwhelmed. Why? In addition to sleep deprivation and zinc deficiencies contributing to immune dysfunction, there are several other important factors:
- severe dysbiosis caused by antibiotics, excess sugar intake, and acid blockers. With a normal bowel containing more organisms than the entire rest of our body, the widespread growth of toxic organisms in the colon is a major problem. To put this in perspective, it used to be that when babies were born, they breast-fed, developed a colon full of healthy bacteria, and then developed stomach acid which kept out all other bacteria for the rest of their lives. There were no antibiotics, acid blockers, or massive amounts of sugar added to the diet to disrupt this ecosystem;
- incomplete digestion of proteins caused by the rapid and chronic use of acid blocker medication, combined with the routine destruction of the enzymes present in food during food processing to prolong shelf life; and
- increased gut membrane permeability, often called "leaky gut," allowing dramatic increases in absorption of these partially digested proteins.
This trio of modern-day gut changes not only contributes to a marked increase in food allergies, but can also exhaust the immune system. Why? If you consider that the total body burden of many infections may be measured in under a milligram, and that people may eat more than 100,000 mg of protein a day, the concern is raised that even modest decreases in protein digestion, and the absorption of a small percent of partially digested amino acid chains, may increase the immune system's work dramatically.
To give an idea of the impact of these food sensitivities, a recently published study funded by our foundation showed that 23 of 30 autistic children were able to return to regular schools after one year of food allergy desensitization treatments with NAET (Nambudripad Allergy Elimination Technique) versus 0/30 in the untreated control group.4 Interestingly, many researchers in the field are seeing overlaps in the pathophysiology of autism and fibromyalgia.
Though there are many triggers that can cause a person to "blow a fuse," the problem is that inadequate energy production is the rule rather than the exception in modern life – unless people take measures to optimize energy production (which we will discuss below). Against this background of inadequate energy production, people's fibromyalgia may then be triggered by numerous factors, including:
- dozens of infections (candida, parasites, rickettsial, viral, and a host of other infections have been associated with postinfectious chronic fatigue syndrome [CFS] and fibromyalgia);
- hormonal deficiencies; e.g., thyroid, adrenal, and reproductive;
- toxic exposures, such as toxic chemicals, bosses, or spouses;
- injuries, especially those that cause neck injury or disrupted sleep;
- autoimmune diseases (e.g., lupus, rheumatoid arthritis, MS)
- nutritional deficiencies and food sensitivities;
- sleep apnea, restless legs syndrome, or other sleep disturbances
This list is nowhere near all-inclusive, but does comprise many of the most common problems that will push somebody who is already energy deficient into fibromyalgia. Though these triggering factors need to be addressed, the person is unlikely to get well and stay well unless the underlying energy crisis is also taken care of.
Restoring Energy Production
In past articles, we have discussed the use of the SHINE protocol to restore energy production. SHINE stands for: Sleep, Hormones, Infections, Nutritional deficiencies, and Exercise as able
This is discussed at length in my book From Fatigued to Fantastic! and in earlier Townsend Letter articles. In addition, a free "Energy Optimization Program" at www.endfatigue.com can analyze people's symptoms and blood tests to determine the likely causes of their fatigue and fibromyalgia and tailor a treatment protocol to each individual case.
In this article, I would like to focus on new research showing a special nutrient to be dramatically effective at increasing energy production.
Ribose: The Backbone of Energy Production
In considering energy production, it helps to look at the "energy molecules" such as ATP, nicotinamide adenine dinucleotide (NADH), and the reduced form of flavin adenine dinucleotide (FAD). These represent the energy currency of the body and are like the paper that money is printed on. A person can have all the fuel (calories) that she wants, but if it cannot be converted to these molecules, it is useless. In particular, ATP is important because the amount that people have in their tissues determines whether they will be fatigued or have the energy needed to live vital, active lives.
For years I talked about the importance of B vitamins, a key component of many of these energy molecules. The Bs helped to a degree, but it was clear that yet another key component was still missing. Then, in looking at the biochemistry of these energy molecules, I saw that they are made of two other key components: adenine and ribose. Adenine (which used to be called vitamin B4) is plentiful in the body, and supplementing with adenine does not help CFS. So my coworkers and I then turned our attention to ribose.
Ribose provides the key building block of ATP, and the presence of ribose in the cell stimulates the metabolic pathway that the body uses to actually make this vital compound. If the cell does not have enough ribose, it cannot make ATP. So, when cells and tissues become energy starved, the availability of ribose is critical to energy recovery – and is often the rate limiting nutrient for ATP production.
Normal, healthy muscle and heart tissue has the capacity to make all of the ribose that it needs. When normal tissue is stressed by overexertion, several days of rest will usually allow it to fully recover. The muscle may be sore during recovery, but eventually energy levels will be restored and the soreness will disappear. But when the muscle is chronically stressed, as occurs in heart disease, fibromyalgia, other conditions that affect tissue energy metabolism, and quite possibly the energy crisis seen in day-to-day modern life, the cells and tissues may not be able to make enough ribose quickly enough to recover. The result is chronic, persistent pain, stiffness, soreness, and overwhelming fatigue that may never go away unless energy production is restored.
Ribose is made in the body by a slow, laborious process (called the pentose phosphate shunt) and cannot be found in food. From the published research, we knew that CFS/FMS caused the body to dump other key energy molecules, like carnitine. We then found that the body did the same with ribose, making it hard to get the mitochondrial "furnaces" working again even after the other problems were treated. We wondered if giving ribose to people with CFS/fibromyalgia would jump-start their energy furnaces.
Research in ribose and CFS/fibromyalgia actually began with a case study that was published in the journal Pharmacotherapy in 2004.5 This case study told the story of a veterinary surgeon diagnosed with fibromyalgia. For months, this dedicated doctor found herself becoming more and more fatigued, with pain becoming so profound that she was finally unable to stand during surgery. As a result, she was forced to all but give up the practice she loved.
Upon hearing that a clinical study on ribose in congestive heart failure was under way in the university where she worked, she asked if she could try the ribose to see if it might help her overcome the mind-numbing fatigue that she experienced from her disease. After 3 weeks of ribose therapy, she was back in the operating room, practicing normally with no muscle pain or stiffness, and without the fatigue that had kept her bedridden for many months.
Being a doctor, she was skeptical, not believing that a simple sugar could have such a dramatic effect on her condition. Within 2 weeks of stopping the ribose therapy, however, she was out of the operating room and back in bed. So, to again test the theory, she began ribose therapy a second time. The result was similar to her first experience and she was back doing surgery in days. After yet a third round of stopping (with the return of symptoms) and starting (with the reduction of symptoms) the ribose therapy, she was convinced, and has been on ribose therapy since that time.
Our initial pilot study on patients with either CFS or fibromyalgia was published in 2006, and resulted in marked improvement.6 As a result of this, the second study was begun, looking at 257 people with CFS or fibromyalgia done at 53 different health clinics to see if this effect would be generalized to the population at large. This study was recently accepted for publication.3
Patients were given ribose (Corvalen by Douglas Labs) 5 g three times a day for three weeks. The results were dramatic.
203 patients completed the 3 week treatment trial. D-ribose treatment led to both statistically (p < .0001) and clinically highly significant average improvements in all categories:
- 61.3 % increase in energy
- 37% increase in overall well-being
- 29.3% improvement in sleep
- 30% improvement in mental clarity
- 15.6% decrease in pain
Improvement began in the first week of treatment, and was continuing to increase at the end of the 3 weeks of treatment. A current double-blind placebo-controlled study is under way at eight research centers, and will extend the treatment period out to 12 weeks to explore at what point maximal benefit will be seen.
The D-ribose was well tolerated, with the main side effect being that a small percent of subjects found themselves to be overenergized or hyper. This generally responded well to simply lowering the dose or giving the ribose with food. In my clinical experience, this often suggests that the patient also needs adrenal support. This is because ribose has a negative glycemic index, causing a drop in blood sugar rather than a rise. In these cases, I add adrenal support to the ribose, usually resulting in additional benefit.
An added important clinical note? Ribose and the other treatments that I mention below are also dramatically beneficial in patients with heart disease, where increased energy production will result in increased cardiac muscle efficiency. This is beneficial whether the patient has CHF, arrhythmias, or angina, and I have found clinical improvement to be dramatic in these patients as well within 6 weeks.
A Recipe for Dramatically Improving Energy Production
Take for 6 to 12 weeks to see the optimal effects, and then as needed:
1. Ribose (Corvalen) 1 scoop (5 g) 3 times a day for 3 to 6 weeks, then twice a day. I recommend that patients get a 280 g container, which will give an adequate therapeutic trial. It looks and tastes like sugar and can simply be added to food or to hot or cold beverages.
2. Coenzyme Q10 200 mg/day. Take with a fat-containing meal
3. Magnesium 200 mg/day and B complex 50+ mg/day. I have patients get these plus over 40 other key nutrients easily by simply taking a high-potency multivitamin powder, such as the Daily Energy Enfusion by Integrative Therapeutics or the Energy
Revitalization System by Enzymatic Therapy. This is a multivitamin that I recommend for almost all of my patients. For day-to-day energy, I recommend ½ to 1 scoop of the vitamin powder and a 5 g scoop of ribose each morning. Most people see dramatic improvements within a month.
4. Acetyl-L-carnitine 500 mg 2× day for 6 weeks. After this, 500 mg/day is enough (and it can often simply be stopped).
There are very few nutritional therapies that have been shown to have this profound an effect on the tissues that they target. Ribose is a unique and powerful addition to our complement of metabolic therapies. I recommend that all CFS/fibromyalgia patients add D-ribose to their treatment regimen.
Notes: for those of you treating people with CFS or fibromyalgia, I am happy to offer a free "Treatment Tools File" that will include questionnaires and treatment checklists. These will dramatically simplify the care of these patients. Simply e-mail me at EndFatigue@aol.com to request these.
A much more detailed list of ribose study references is available upon request.
1. Teitelbaum JE, Bird B, Weiss A, et al. Effective treatment of CFS and FMS: a randomized, double-blind placebo controlled study. J Chronic Fatigue Syndr. 2001;8(2):3–28.
2. Teitelbaum JE, Bird B. Effective treatment of severe chronic fatigue: a report of a series of 64 patients. J Musculoskelet Pain. 1995;3(4): 91–110.
3. Teitelbaum JE, Jandrain J, McGrew R. Effective treatment of fibromyalgia and chronic fatigue syndrome with D-ribose – a multicenter study. Open Pain J. 2012; in press.
4. Teitelbaum, J; Nambudripad D, Tyson Y et al. Improving communication skills in children with allergy-related autism using Nambudripad's Allergy Elimination Techniques: a pilot study. Integr Med Clinicians J. Oct/Nov 2011;10(5):36–43. Available at www.NAET.com.
5. Gebhart B, JA Jorgenson. Benefit of ribose in a patient with fibromyalgia. Pharmacotherapy. 2004;24(11):1146–1648.
6. Teitelbaum JE, St. Cyr JA, Johnson C. The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. J Altern Complement Med. 2006;12 (9):857–862.
Jacob Teitelbaum, MD
Medical Director, Fibromyalgia and Fatigue Centers
Author, From Fatigued to Fantastic! and the Free iPhone and Droid apps "Cures A–Z"