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Research
Management
of Fibromyalgia: Rationale for the Use of Magnesium and Malic Acid
A study in the Journal of Nutritional Medicine postulates
that certain metabolic abnormalities are the most likely cause of
fibromyalgia. The study also presents data supporting a critical role
for magnesium and malic acid in ATP production; and indirect evidence for
magnesium and malic acid deficiency in fibromyalgia. In the study,
fibromyalgia patients taking the combination of magnesium and malic acid
experienced less muscle pain and a reduction in tender points. The
test subjects reported a reduction in pain within 48 hours of taking the
supplements.
Source: Journal of Nutritional Medicine (1992) 3,
49-59.
Malic Acid Recommended As Effective Fibromyalgia
Treatment
In a report in the December 1999 issue of the Annals of
Internal Medicine, The American College of Physicians & American Society
of Internal Medicine listed malic acid among the treatments recommended
for fibromyalgia pain. The report was entitled “Management of
Fibromyalgia.”
Source: Annals of Internal Medicine 1999; 850-858.
Doctor's Views
“Magnesium and malic acid are also critical… When
malic acid and the other compounds … are low, the body often has to shift
to the very inefficient (anaerobic) means of generating energy. This
contributes to the abnormal buildup of lactic acid that occurs after
exercise in CFIDS/FM. This causes muscle achiness and fatigue,” Dr.
Jacob Teitelbaum, From Fatigued to Fantastic Newsletter and author of From
Fatigued to Fantastic, A manual for Moving Beyond Chronic Fatigue and
Fibromyalgia.
Jorge Flechas, M.D., M.PH., a FM and CFIDS specialist
from Hendersonville, NC strongly recommends the
combination of malic acid and magnesium for
fibromyalgia and has utilized the combination on nearly 500 FM patients. He
has also participated in 2 clinical studies that have tested these
ingredients on fibromyalgia patients. In the studies, patients reported a
significant reduction in pain and tenderness within 48 hours of taking the
supplements.
Reference:
G.E. Abraham and J.D. Flechas, Journal of Nutritional Medicine 1992; 3:
49-59.
Dr. Paul Cheney, founder of the largest CFS (Chronic
Fatigue Syndrome) clinic in the US, the Cheney clinic and Dr. Jay Goldstein,
director of the CFS Institute are among the other doctors who recommend
malic acid and magnesium for their patients.
Malic Acid and Magnesium
Malic acid, a fruit acid extracted from apples, plays a
central role in the energy-producing reactions in the body. Malic acid is
known to help the body produce energy more efficiently, even under
conditions of low oxygen. Magnesium is a mineral that is involved in more
than 300 enzymatic reactions in the body. It is essential to the metabolic
processes leading to the generation of cellular energy. It also functions as
a natural muscle relaxant. Several studies have shown that those with
fibromyalgia are deficient in magnesium.
Scientific evidence suggests that fibromyalgia and CFIDS
symptoms are due at least in part to abnormal cellular metabolism.
Mitochondria are the energy furnaces in cells that burn food for energy.
Many findings and studies suggest that these structures are not operating
efficiently in those with CFIDS/FM.
In order for the mitochondria to produce ATP, several
nutrients are required. These include magnesium, malic acid, NADH,
sufficient levels of oxygen and active forms of B vitamins. Deficiencies or
imbalances in these ingredients, which studies have show to exist in CFIDS
and FM, can cause the body to switch from oxygen-based metabolism to the
less efficient anaerobic metabolism. This contributes to an abnormal buildup
of lactic acid following even light exertion. This lactic acid buildup
results in fatigue, weakness, pain and muscle spasms.
A study in the Journal of Nutritional Medicine theorizes
that deficiencies of oxygen and other nutrients can also cause the body to
begin breaking down muscle tissue to use as fuel. According to the study
this causes the muscle pain and fatigue seen in fibromyalgia. This theory is
supported by data showing low muscle-tissue oxygen pressure in affected
muscles of fibromyalgia patients as well as muscle biopsies from affected
areas which show muscle tissue breakdown and mitochondrial damage. The study
also presents data supporting a critical role for magnesium and malic acid
in ATP production under aerobic and hypoxia conditions, and indirect
evidence for magnesium and malic acid deficiency in FM.
Evidence shows that malic acid and magnesium can help to
steer the body away from anaerobic metabolism and muscle tissue breakdown to
the more efficient oxygen-based metabolism. Studies have show that these
nutrients address the metabolic abnormalities of CFIDS and fibromyalgia and
can significantly improve symptoms.
Most doctors recommend starting slowly on the supplements
and working up to 1200-2400 mg malic acid and 300 mg or more of magnesium
per day. While some will experience a rapid response, others may take longer
to respond. It is recommended that the supplements be taken for 4-6 weeks to
see if they will be of benefit.
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