Malic acid as a therapeutic supplement

DEFINITION: Natural substance of the human body used as a supplement to treat specific health conditions.

• PRINCIPAL PROPOSED USES: None
• OTHER PROPOSED USE: Fibromyalgia, dry mouth, skin health, energy, kidney stones

Overview

The body synthesizes malic acid during the process of converting carbohydrates to energy. Extremely preliminary evidence suggests that individuals with the disease fibromyalgia—a disorder that involves fatigue and chronic pain in the muscles—might have difficulty creating or utilizing malic acid. Such a deficiency could interfere with normal muscle function.

Based on this supposition, products containing malic acid and other nutrients were widely offered for sale to people with fibromyalgia. However, there is little evidence that these products are helpful. One study published in the 1990s appeared to show benefits for fibromyalgia patients who supplemented with malic acid. However, these study participants used malic acid in combination with magnesium. Studies on malic acid alone are necessary to demonstrate its benefit. 

Requirements and Sources

The body naturally produces malic acid, which is also found in many fruits and vegetables, especially apples.

Therapeutic Dosages

In clinical studies and commercially available supplements, doses of 1,200–2,800 mg of malic acid per day—often combined with magnesium—have been used for fibromyalgia.

Therapeutic Uses

Malic acid is a major ingredient in combination treatments used for fibromyalgia. However, there is little meaningful evidence that it works.

Malic acid has also been suggested as a treatment for dry mouth because it stimulates saliva production. Several double-blind, placebo-controlled trials have shown that malic acid is beneficial for dry mouth. Other proposed therapeutic uses for malic acid include skin care. Malic acid is a skin exfoliant that can help improve acne and fine lines. It may also support athletic performance recovery and fight fatigue. Potassium malate, a salt of malic acid, has been studied for reducing the risk of certain types of kidney stones.

Scientific Evidence

In a double-blind, placebo-controlled trial, twenty-four individuals with fibromyalgia were given either a placebo or malic acid (1,200 mg per day) combined with magnesium (300 mg daily). After four weeks of treatment, there was no significant difference between the placebo and malic acid groups.

The researchers then gave all participants the malic acid combination and increased the dose over six months. A significant improvement in fibromyalgia symptoms was found after the dose reached about 1,600 mg of malic acid with 400 mg of magnesium. However, because this part of the trial was not blind or controlled, the results may be entirely due to the placebo effect. Only a properly designed double-blind, placebo-controlled trial of the higher malic acid dose could demonstrate that it really works, and only a handful of very small trials have been undertaken. Due to the small size and methodological limitations of existing trials, the clinical benefit of malic acid in fibromyalgia remains uncertain.

Reliable scientific evidence in the form of double-blind, placebo-controlled studies has shown malic acid is effective in treating dry mouth. Due to its alpha hydroxy acids, malic acid is also an ingredient in natural skin care. It is added to soaps, shampoos, and skin creams and was believed to have anti-aging, anti-acne, and scar-lightening benefits.

A study in Antioxidants found that maternal malic acid supplementation in sows reduced oxidative stress and inflammation by modulating gut microbiota and metabolic profiles. While these results suggest potential benefits, the findings are limited to animals and cannot be directly extrapolated to humans.

Safety Issues

Malic acid appears to be safe at recommended dosages. A few people reported loose stools at the higher doses in the above studies, possibly because of the magnesium in the combination. Safety in pregnant or nursing women, children, and individuals with severe liver or kidney disease has not been established.

Bibliography

Abraham, G. E., and J. D. Flechas. "Management of Fibromyalgia: Rationale for the Use of Magnesium and Malic Acid." Journal of Nutrition and Medicine, vol. 3, 1992, pp. 49-59.

Cobb, Cynthia, and Zohra Ashpari. "Malic Acid: Your Key to Smoother, Younger Skin." Healthline, 19 Oct. 2021, www.healthline.com/health/malic-acid-skin-care#other-benefits. Accessed 20 Sept. 2024.

Chen, Meixia, et al. “Maternal Malic Acid May Ameliorate Oxidative Stress and Inflammation in Sows through Modulating Gut Microbiota and Host Metabolic Profiles during Late Pregnancy.” Antioxidants, vol. 13, no. 2, 2024, article 253.

Ferreira, Isadora et al. “Magnesium and malic acid supplement for fibromyalgia.” “Suplemento de magnesio y ácido málico para fibromialgia.” Medwave vol. 19, no. 4, p. e7633. 28 May. 2019, doi:10.5867/medwave.2019.04.7632. Accessed 9 Dec. 2025.

Lubeck, Brittany. "Malic Acid: Benefits, Side Effects, and Interactions." Verywell Health, 25 Oct. 2022, www.verywellhealth.com/the-benefits-of-malic-acid-89478. Accessed 20 Sept. 2024.

Russell, I. J., et al. "Treatment of Fibromyalgia Syndrome with Super Malic: A Randomized, Double Blind, Placebo Controlled, Crossover Pilot Study." The Journal of Rheumatology, vol. 22, no. 5, 1995, pp. 953-58.

Thorpe, Joelle, et al. "Combination Pharmacotherapy for the Treatment of Fibromyalgia in Adults." The Cochrane Database of Systematic Reviews, vol. 2018, no. 2, 2017, doi:10.1002/14651858.CD010585.pub2. Accessed 19 Aug. 2023.