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.