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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 are Dr. Daniel Peterson of Incline Village, CA, Dr. Paul Cheney, a North Carolina clinician, and Dr. Jay Goldstein, director of the CFS Institute.

Dr. Peterson comments, "the patients who improved reported diminishing symptoms... and an increase in exercise tolerance." He reports that 40% of those who try the supplement will benefit from it.

Similarly, Dr. Goldstein has found malic acid to be a safe, inexpensive nutritional supplement for CFS symptoms and suggests it be added to the list of potential therapeutic approaches. He currently prescribes it for his patients with symptoms associated with CFS, and those diagnosed with Fibromyalgia. 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."

One of the many people who have benefited by taking malic acid and magnesium hydroxide is Ann Lessel of Westlake Village, CA. She noticed improvements in her symptoms almost immediately.

"After about four days I noticed my energy level and stamina was beginning to increase," she reports. "After taking the product for three weeks I had an incredible amount of energy. For the first time in the six years that I have been sick, I can say I feel normal. I now have been on the product for about two months, and am keeping up a pace that would make a healthy person tired."

The effectiveness of the product 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 normal activity, including those enzymes that function in energy transfer.

"Malic acid is a primary ingredient in apples," explains Dr. Cheney. "It is a primary component of the Kreb's citric acid cycle where fats and glucose are converted to energy. It may promote cellular production of energy (cellular respiration)."

A study in the Journal of Nutritional Medicine postulates that muscle pain and fatigue are predominantly caused by the breakdown of muscle proteins due to a deficiency of oxygen and other substances needed for ATP production. Further, the study presented data supporting the critical role of magnesium and malic acid in ATP production under hypoxic conditions.

Jorge Flechas, M.D., M.P.H., a holistic practitioner in Hendersonville, N.C., has participated in two medical studies that have tested the combination of malic acid and magnesium hydroxide 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 these combination supplements 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 Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome, reports impressive results in fibromyalgia patients. Several years ago, she conducted a study with 12 fibromyalgia patients. All 12 reported a significant improvement taking a supplement of malic acid in combination with magnesium and other nutritional cofactors. "The sooner malic acid and magnesium are started, the faster patients begin to return to their normal lifestyles," remarks Sahley.

Most physicians start their patients on malic acid/magnesium hydroxide slowly, working up to between 6 and 12 capsules daily. Malic acid/magnesium hydroxide should be taken with food and water. Although a few people may experience slight gastrointestinal problems, reducing the dosage can eliminate these problems. Finally, patients must try it for a period to see whether they will benefit from its use.

G.E. Abraham and J.D. Flechas, J of Nutr Medicine 1992; 3: 49-59.