NJ Fibromyalgia Treatment of FMS in New Jersey

Malic Acid and Magnesium for Fibro Pain

For many years the pain associated with fibromyalgia was confusing to health care providers. The reason for this confusion stemmed from the fact that there appears to be no obvious damage to the muscles and soft tissue areas that are actually hurting. Much of this confusion has been cleared up recently due to new research. There is now mounting evidence that Fibromyalgia is primarily a disorder of the way we process our pain and therefore is a central nervous system processing problem. What that means is that sensations that should normally be interpreted by the brain as non painful can become extremely painful with Fibromyalgia. This is essentially the neurotransmitter component of the overall syndrome. There is, however, another major factor involved in pain and researchers have found that with Fibro there are decreased levels of oxygen in the muscles. In medical terminology this is known as muscle hypoxia. Basically this means that patients with FM have low muscle-tissue oxygen pressure in affected muscles. Studies have been done which show that muscle biopsies from those affected areas show muscle tissue breakdown and mitochondrial damage. Additionally, low levels of the high energy phosphates ATP, ADP, and phosphocreatine have been found. It has been hypothesized that in hypoxic muscle tissues glycolysis is inhibited, reducing ATP synthesis. This stimulates the process of gluconeogenesis, which results in the breakdown of muscle proteins to amino acids that can be utilized as substrates for ATP synthesis. This muscle tissue breakdown, found in these muscle biopsies taken from FM patients, is one of the reasons for the muscle pain characteristic of FM.

Many research studies that show that Malic Acid can help people that suffer from this type of pain associated with muscle and tissue hypoxia. Malic acid is found not only in food but also is synthesized through the (Krebs) cycle. In a study on the effect of the oral administration of malic acid to rats, a significant increase in anaerobic endurance was found. Interestingly, the improvement in endurance was not accompanied by an increase in carbohydrate and oxygen utilization, suggesting that malic acid has carbohydrate and oxygen-sparing effects. In addition, malic acid is the only metabolite of the citric acid cycle positively correlated with physical activity. It has also been demonstrated that exercise-induced mitochondrial respiration is associated with an accumulation of Malic acid.

Because of the compelling evidence that Malic acid plays a central role in energy production, especially during hypoxic conditions, Malic acid supplements have been examined for their effects on FM. Subjective improvement in pain was observed within 48 hours of supplementation with 1200 – 2400 milligrams of Malic acid, and this improvement was lost following the discontinuation of malic acid for 48 hours. While these studies also used magnesium supplements, due to the fact that magnesium is often low in FM patients, the rapid improvement following malic acid, as well as the rapid deterioration after discontinuation, suggests that malic acid is the most important component. This interesting theory of localized hypoxia in FM, and the ability of malic acid to overcome the block in energy production that this causes, should provide hope for those afflicted with FM.

With the vast majority of my Fibro patients I recommend that they supplement with approximately 1500 – 2000mg of Malic Acid and 500 -750mg of Magnesium daily. Magnesium should not only aid with muscle spasm but does help patients obtain a better quality sleep. Because of this I prefer not having them obtain a combination supplement but rather take their Malic and Magnesium seperately. Malic acid can be split up 3 times per day but the bulk of their Magnesium supplement should be taken approximately 1 hour before sleep.


  • Posted June 7, 2010 at 12:26 pm | Permalink

    I have been taking this for about a year. A chiropractor told me about it. But I was told to take it together 3 times a day. I do sleep better since I started taking it. But I think I will try the way you say, the magnesium before bed as My legs bother me when I lay down at times.

  • cara witzky
    Posted November 9, 2010 at 7:45 am | Permalink

    what kind of magnesium? I had been taking magnesium supplements (the ingredients said ‘magnesium stearate) and read elsewhere that that form of magnesium was useless.

  • stephen zets
    Posted October 19, 2011 at 2:25 pm | Permalink

    i have a close friend who owns a large vit. store who has told me about malic acid and magnesium. he has told me that many of his customers with fibo, have had good results. he suggest that the product he sells, has 800mg of malic acid and 200mg ofmagnesium hydroxide, yielding 86mg elemental magnesium. also vit c, b6. the bottle says to take three capsules in the morning and evening with food. my doctor put me on lyrica two weeks ago, i just stopped taking them. got very bad nausea and gas. i think iam going to try this malic acid and magnesium. iam sure you know the pain people have with fibro. thank you

  • Pam Burt
    Posted August 10, 2012 at 3:08 am | Permalink

    Hi……..Can a person (me!) take malic acid and magnesium while taking Warfarin/Coumadin?? I have to be so careful with interactions. I have had to go to the emergancy room many times for a Vitamin K shot as my INR has been up at 9.5, 9.7 and then once 9.9!! I never did figure out why! I also have antiphospholipid syndrome with a Lupus anticoagulant. I was diagnosed in December of 2011 with the Fibromylagia and Ostio arthritis. There’s a lot going on inside my body!! I also have 2 discs in my back apparently that are not good! Oh well what can one do! I almost died back in 1992 as I had a blood clot in my aorta with 5% blood flow to my lower extremities! I had a very bleak outlook and was not expected to make it through the surgery! But here I am!! With a couple of more things added on since then, ha ha! Thanks for taking the time out to answer me.

  • Posted August 10, 2012 at 6:45 am | Permalink

    Hi Pam,

    Although interactions are unlikely with the vast majority of medicines and a small amount of extra malic and mag added to the diet, considering your history I would absolutely not start taking any supplements without being closely followed by your physician. I realize that with medicines such as Coumadin you do have to be careful. Everyone reacts differently and the Coumadin levels can fluctuate drastically with just the slightest change in diet. I believe the reasonable thing to do would be to ask your doctor who monitors your levels if they would be willing to work closely with you on this. Considering how sensitive you are to interactions, you may have to be tested more frequently to make sure your levels are within the preferred range. Unfortunately, at times, the risk of certain supplementation can outweigh the overall benefit. I wish you well Pam.
    Dr. Mark

  • Simone Pitre
    Posted March 16, 2013 at 10:56 am | Permalink

    I would like to share a personal comment. Yes the magnesium helps greatly. Have not added malic acid yet. Also, sam e has been shown to help fibromyalgia pain as well 400 mg bid. But you cannot take ssri with that ie. Paxil Prozac leapfrog etc. also, I know the use of mucinex. Long acting guafanesin is controversial for treatment of fibromyalgia but I am living proof it does help. I have been suffering from severe pain ,migraines ,joint pains , burning skin , numbness of extremities , burning painful feet,, bouts of seve fatigue , insomnia, cystitis, gi. Problems etc. I am an avid athlete, ate well gluten free , hypoglycemic diet and did everything I was supposed to be doing. Forced myself to go to gym even when I could barely walk straight due to imbalance issues. I am also a prominent health care provider. I hid my symptoms and pain well. 4 weeks on the guafanasin 600 mg in the am and 1200 in the evening , I lost 5 lbs of fluids out of my legs, and I have 5 good days and 2 bad days instead of 5 bad days and 2 days. My memory and thinking has never been clearer. Caution. You have to move , you have to eat right , you have to avoid all salicylate e orally and topically or it does not work . The salicylate block the Gui from working. And I don’t need ten hours of sleep any,ore I sleep 6 to 7 and I have had this much energy in ten yrs. I’m 45 and people have been asking me what’s different I look better. I have tried to keep a good attitude all these yrs but finally I can keep it even on bad days. Good luck. I know how you all feel,

  • mary
    Posted October 21, 2013 at 10:14 am | Permalink

    this information might help

  • Posted January 24, 2014 at 11:24 am | Permalink

    Interesting! It is so hard to know what to try and even trust the medical drs because they want to give you so much of the medicine and I can’t take that at all. So the small amounts of meds are not helping, and after botox in my head and neck and shoulders my pain is so much worse and I feel my neck a a stiff board – that is just terrible and the whole back and the whole body hurts so badly,. I think I will try malic acid and I take now different supplements from a holistic dr. also and make health drinks every day and has also been to a rheumatologist as my pain is also in hands, fingers, feet and toes and all over – it is really scary. I have taken more blood work also – would it be ok to try some malic acid and for the person describing the guafanacin – fid you try a lot of other supplements before? And where do you get your supplement? Greatful for an answer – by the way this symtoms of pain and ache have gotten much worse and Ihave had issues for 2 years and I am retired. Thank you….

  • Brenda
    Posted March 13, 2015 at 11:22 am | Permalink

    I have tried many things for fibromyalgia but have been looking into taking magnesium & malic acid to ease some pain not sure what brand is best to take with all the research? I have been suffering for 4 months before they diagnosed me & having no energy with having a 6 & 14 month old has been a challenge with me slowing down a lot! Any information would help struggling mum brenda

  • Melissa
    Posted May 2, 2015 at 4:02 pm | Permalink

    Having searched for both just malic acid through amazon and Google, I have found basically 2 frontrunners coonsistently: one being a malic acid and magnesium combo and the other one being BioSpec’s FibroEase which is very well reviewed and that has not only malic acid and magnesium but trace minerals and very high concentrations of vitamins especially the B’s for the obvious nerve component. What are your thoughts on that? Also, many fibro ‘s like myself are on gabapentin (Neurontin) which shouldn’t be taken within 2 hours or so of taking a magnesium supplement. So there in lies the struggle…

  • Melissa
    Posted May 3, 2015 at 8:01 pm | Permalink

    Well I hope that it doesn’t violate this website ‘s rules, and if so, I apologize, but I went right to Amazon and my mother had told me to look for Fibro-Ease by Biospec. It’s a rather expensive multi-vitamin but with the trace minerals, its great. I actually just started and its doing wonders. I’m actually going to drop my cymbalta dosage to 30mg a day even though I know it’s not the therapeutic dose because ever since I started taking it, I’m actually more painful than I ever was to start with. So actually I just want to ween off, just haven’t “confessed” it to my pain specialist because I know he’ll be irritated. But I have empathy/sympathy on the mom front. I have a 3 year old girl that is a handful lately and I work full time but it’s also a 2 hour a day commute! Anyway… big point on the magnesium supplement: IF YOU ARE ON GABAPENTIN/NEURONTIN OR LYRICA, don’t take within 2 hours or so.
    Good luck!

  • michele perez
    Posted May 8, 2015 at 10:24 pm | Permalink

    When I first tried Nature’s Sunshine Fibralgia, I thought I’d found a miracle for pain. It helps immensely, except it wears off quickly. Has anyone else tried this brand?

  • Peggy
    Posted May 17, 2015 at 4:26 pm | Permalink

    Have been taking Fibro-ease for several weeks now and it has been life changing! I felt my pain begin to melt away after my first dose. You start out taking 1tab twice a day and after a week increase to 2 tabs twice a day. I feel better than I have in years…not perfect but imagine all those years of just wanting to not move due to pain have taken a toll on my overall physical ability. Hopefully with time I will be able to continue improving and increase my physical activity. Along with listening to my body and trying to not overdo I am now enjoying life!

  • Sherry
    Posted August 9, 2015 at 7:59 pm | Permalink

    I found a product called Fibrosense. I purchased it at my local health store ( Nutters). It took 2.5 weeks but by taking this product which has (2400mg of malic acid, 500mg of magnesium and 750mg of Celdrin) I have come off Lyrica!! My symptoms are not totally gone, but the side effects associated with Lyrica were not worth being on it any longer. I am still on the cymbalta but have been able to lower from 60mg to 30mg. So far so good!!

  • Judith
    Posted September 14, 2015 at 6:28 am | Permalink

    I am 69 and have had fibro since 20’s. I do find the malic acid is helpful. I found a sparkling water from Aldi’s that contains some vitamins and noticed it was high in malic acid and magnesium. It comes in flavors. I actually add this to some Tangy Tangerine drink that I mix by Youngevity. Previous to doing this I was craving chocolate. I notice my extreme chocolate habit is decreasing. I am curious if NAC would be helpful also, since it works a bit like guafanasin?

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