Malic acid as a therapeutic supplement
Malic acid is a naturally occurring substance that is produced by the body during the conversion of carbohydrates into energy. It is often marketed as a therapeutic supplement, particularly for conditions such as fibromyalgia, where individuals may have difficulty utilizing malic acid effectively. Despite its widespread availability in combination products aimed at alleviating fibromyalgia symptoms, there is limited scientific evidence to support its efficacy. Some research indicates that malic acid, when combined with magnesium, may provide benefits, but more rigorous studies are needed to confirm these findings.
In addition to fibromyalgia, malic acid has been explored for other therapeutic uses, including the treatment of dry mouth, where it has shown positive results in double-blind, placebo-controlled trials. It is also recognized for its role in skin care, serving as an exfoliant that may help improve acne and reduce fine lines. Furthermore, malic acid is believed to support athletic performance recovery and potentially prevent kidney stones.
Generally considered safe at recommended dosages, malic acid may cause mild gastrointestinal issues in some individuals. However, its safety profile in specific populations, including pregnant or nursing women and those with severe liver or kidney conditions, has not been thoroughly established.
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 prove its benefit.
Requirements and Sources
The body produces its own malic acid. Many fruits and vegetables also supply malic acid, most notably apples.
Therapeutic Dosages
In studies and commercial products, the usual dose of malic acid for fibromyalgia is 1,200 to 2,800 milligrams (mg) per day, generally combined with magnesium and other nutrients.
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. Finally, malic acid may help to prevent 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.
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.
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.
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. 953-958.
Thorpe, Joelle, et al. "Combination Pharmacotherapy for the Treatment of Fibromyalgia in Adults." The Cochrane Database of Systematic Reviews, vol. 2018, no. 2, 2017, https://doi.org/10.1002/14651858.CD010585.pub2. Accessed 19 Aug. 2023.