Malic Acid and Magnesium:
A Powerful Combination?
By Kenna Simmons
Malic acid and magnesium.
This so-called "natural cocktail" is touted on the Internet and in print as offering relief from the pain and fatigue that accompany fibromyalgia. While they don't work for everyone, some evidence suggests that malic acid and magnesium supplements may indeed be helpful as part of a well-rounded treatment regimen.A 1995 study in the Journal of Rheumatology explains the following hypothesis for the cause of muscle pain experienced by people with fibromyalgia. Tender points are areas deficient in ATP, a phosphate that acts as a source of energy for many metabolic processes. ATP is a kind of "energy currency" - that is, the calories in food are converted to ATP before being used as fuel by the body. Malic acid and magnesium are two substances involved in generating ATP more effectively.
The study tested this hypothesis by measuring the effects of malic acid and magnesium on fatigue in a randomized, double blind, placebo-controlled test. For four weeks, participants received three tablets of Super Malic, each containing 200 milligrams (mg) of malic acid and 50 mg of magnesium, every day. They refrained from taking other medications except acetaminophen for severe headache. Patients taking Super Malic showed no significant improvement over those taking placebos during this part of the study. Most patients also participated in a later, open-label phase, however, during which they took three tablets of Super Malic (no placebo) and increased the dosage every three to five days until they reported improvement. They took this combination for four months.
"Using low dosage didn't seem to help much," says I Jon Russell, MD, PH, associate professor of medicine at the University of Texas Health Science Center in San Antonio and one of the study's authors. "With open-label trial and higher dosage, most patients believed it was helping them". A placebo-controlled study needs to be repeated using higher dosages, Dr Russell says. In the meantime, he tells his patients that malic acid and magnesium are not proven to work, "but if it does reduce their fatigue, it might be a reasonable addition to other measures because it is likely to be relatively free of side effects."
The most common side effect of malic acid is loose stools; people with poorly functioning kidneys should avoid the combination because they may not be able to eliminate the magnesium properly.
DOSAGE RECOMMENDATIONS
Malic Acid: 1,200mg to 2,400 mg of malic acid daily, in several doses
Magnesium: 300mg to 600 mg of magnesium daily, in several doses
CAUTIONS
Avoid these supplements if you have kidney problems.
Always consult your doctor first.
The dosage Dr Russell recommends is a total of 2,000 mg of malic acid daily and 500mg of magnesium, which can be divided into two to four doses taken throughout the day.
James McKoy, MD, a rheumatologist at Kaiser Permanente of Hawaii in Honululu, recommends similar daily doses of 1,200 to 2,400 mg of malic acid and 300 to 600mg of magnesium.
Dr. McKoy emphasises that although these supplements may help, they are not a cure. "I tell patients that these supplements play a very small role in the overall treatment of fibromyalgia," he says. "Many patients try one or two supplements, and they are disappointed when they don't feel much better."
He tells his patients they must consider a variety of factors: nutrients, sleep, mood, stress, sexuality, fitmess, pain and psychological influences. "Many patients stop helpful supplements when they continue to have pain and fatigue because these other issues are not dealt with," he says.
For further reading:
