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Management of Fibromyalgia

American College of Physicians on Malic Acid for Treating Fibromyalgia

In a report titled “Management of Fibromyalgia,” the American College of Physicians & American Society of Internal Medicine listed malic acid among treatments recommended for Fibromyalgia pain. The report was published in the December 1999 issue of the Annals of Internal Medicine and was authored by Lawrence J. Levanthal, M.D.

In their 1999 book, Making Sense of Fibromyalgia, by Daniel J. Wallace, M.D. and Janice Brock Wallace, the authors noted the success of malic acid and magnesium in FM patients with the following observations:

“An interesting preparation, containing magnesium and malic acid is now available… Controlled studies from England and Texas in peer-reviewed journals have documented modest effects of this preparation in muscle spasm, fatigue and pain in Fibromyalgia. If patients take a dose larger than recommended on the bottle…its effects become apparent within a week; side effects are uncommon. This combination may work as a result of interactions between magnesium and calcium channels within muscles and the generation of adenosine triphosphate (ATP), our cellular fuel.”

Research Confirms Malic Acid’s Use to Alleviate Pain and Fatigue

Leading healthcare professionals familiar with CFS are continuing to recommend malic acid for the chronic muscle soreness and fatigue that most patients experience.

They have found that patients using a combination of malic acid and magnesium hydroxide report improvements with reduction of muscle pain and tiredness.

Among those physicians recommending the malic acid/magnesium hydroxide combination are Daniel Peterson, M.D., of Incline Village, CA, Paul Cheney, M.D. and Jay Goldstein, M.D., director of the CFS Institute.

Dr. Peterson comments, “the patients who improved reported diminishing symptoms…and an increase in exercise tolerance.”

Similarly, Dr. Goldstein has found malic acid to be a safe, inexpensive nutritional supplement for CFS symptoms and suggests it should be added to the list of therapeutic approaches. He currently prescribes it for his patients with symptoms associated with CFS, and those diagnosed with FM. He explains,“…it may have a modest effect on fatigue and/or other symptoms.

Fibromyalgia pain may respond within 48 hours, while fatigue may take about two weeks.”

The effectiveness of the supplement has a sound scientific base. Malic acid, a fruit acid extracted from apples and widely used in the food industry, is essential in the formation of ATP, which is our body’s energy source. Malic acid has the ability to allow the body to make ATP more efficiently, even under low oxygen, or hypoxic, conditions. Magnesium is a mineral that is required for over 100 enymatic reactions in the body. Interestingly, many researchers such as Dr. Cheney, have noted that a large percentage of patients are magnesium depleted on an intra-cellular basis (inside the cell). Standard blood tests are not sensitive to intra-cellular magnesium.

In a study published in the May, 1995 edition of the Journal of Rheumatology, the results of FM treatment with malic acid were assessed in terms of pain, tenderness, ability to function, and psychological well-being.

The results showed no therapeutic effects on Fibromyalgia symptoms when malic acid was taken at the dosage of 600mg for twice a day for four weeks.

However, when the dosage of malic acid was increased to 1200mg twice a day there were significant reductions in the pain and tenderness of the Fibromyalgia symptoms. [Treatment of Fibromyalgia syndrome with Super Malic: a randomized, double-blind, placebo-controlled, crossover pilot study. Russell IJ; Michalek JE; Flechas JD; Abraham GE; J Rheumatol, 22(5):953-8 1995 May]

Jorge Flechas, M.D., M.PH., a holistic practitioner in Hendersonville, N.D., has participated in two medical studies that have tested the combination of malic acid and magnesium for Fibromyalgia patients. In these studies, patients reported a significant reduction in pain and tenderness within 48 hours and without any side effects. In his practice, Flechas has used this supplement combination for six years on about 500 Fibromyalgia patients. “I have found the results are positive 90 percent of the time,” he says.

Billie Jay Sahley, Ph.D., a San Antonio nutritional specialist and author of the indepth book, Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome reports impressive results in Fibromyalgia patients. ‘The sooner malic acid and magnesium are started, the faster patients begin to return to their normal lifestyles,” remarks Sahley. HW


Malic Acid and Magnesium for Fibromyalgia
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