Comprehensive Guide to Malic Acid

Malic AcidDr. James Meschino DC, MS, ND
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General Features
Malic Acid is synthesized in humans as one of the steps in the Kreb’s cycle during the production of ATP, which is the body’s primary source of energy. 1 It occurs in high concentrations in apples and is often referred to as apple acid. In food processing it is used to acidify wines, acid drinks, fruit juices, soda water and various soft drinks. Malic Acid is also used in cosmetic products to adjust the pH of the product and to act as a moisturizing agent, often in the form of sodium malate.
Clinical Application and Mechanism of Action
1. Fibromyalgia - Malic Acid supplementation in combination with magnesium supplementation has been shown to improve fibromyalgia in a six-month, double-blind, cross-over trial, involving 24 fibromyalgia patients. In this study, the treatment group demonstrated a significant reduction in the severity of pain and tenderness and in some psychological symptoms associated with their condition, during the period they ingested 1200-2400 mg of Malic Acid and 300-600 mg of magnesium per day. During the cross-over period, when placed on the placebo, their muscle pain scores rose from 6.8 to 21.5 within two days, in the six patients comprising this sub-group. However, in a shorter trial of only four weeks, the combination of Malic Acid (1200 mg) and magnesium (300 mg) was not effective in reducing pain in a double-blind, cross-over trial of patients with fibromyalgia. This may indicate that a longer period of treatment is required to realize improvement in these cases.
2. Chronic Fatigue Syndrome - It is speculated that Malic Acid supplementation in combination with magnesium supplementation may be helpful in the treatment of chronic fatigue syndrome. There is one published report to support this contention, but better controlled studies are required to substantiate this application. However, chronic fatigue syndrome is similar in nature to fibromyalgia, thus practitioners may wish to utilize this intervention on a therapeutic trial basis.
Dosage and Standardized Grade
Fibromyalgia (and Chronic Fatigue Syndrome) - Malic Acid, 600 mg, twice per day and magnesium, 150 mg, twice per day (up to 2400 mg of Malic Acid and 600 mg of magnesium have been used safely).
Adverse Side Effects and Toxicity
Current research does not indicate any adverse side effects from the use of Malic Acid at the above-cited levels of intake.
Drug-Nutrient Interactions
At present there are no known drug-nutrient interactions with Malic Acid.
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the developing fetus and there is generally insufficient evidence at this time to determine an absolute level of safety for most dietary supplements other than a prenatal supplement. Any supplementation practices beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium and the treatment of preeclampsia.)

References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine. Institute of Applied Complementary Medicine Inc. 1997.
References
1. Baynes J, dominiczak M. Medical Biochemistry. New York: Mosby, 1999:182-3
2. Fiume Z. Final report on the safety assessment of Malic Acid and Sodium Malate. Int J Toxicol 2001;20(Suppl1):47-55
3. Russell IJ, Michalek JE, Flechas JD, Abraham GE. Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study. J Rheyumatol, May1995;22(5):953-8
4. Abraham GE, Flechas JD. Hypothesis: Management of fibromyalgia rationale for the use of magnesium and malic acid. J Nutr Med 1992;3:49,59
5. Anonymous. A follow-up on malic acid: CFIDS Buyers Bluc Health Wathc. Spring, 1993
6. Healthnotes, Inc. 2001. Malic acid:www.puritan.com
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