Journal of Nutritional Medicine
No. 3, 1992 pp. 49-59-Management of Fibromyalgia:
Rationale for he use of Magnesium and Malic Acid
Guy E. Abraham M.D. and Jorge D. Flechas, M.D. M.P.H.
Also another article with similar info…The Journal of Rheumatology, May 1995;22(5):953-8 “Treatment of Fibromyalgia syndrome with Malic Acid”
1 “Fibromyalgia (FM) is a common clinical syndrome of generalized musculoskeletal pain, stiffness and chronic aching, characterized by reproducible tenderness on palpation of specific anatomical sites, called tender point.”
2. Fibromyalgia is primary when not associated with systemic causes, trauma, cancer, thyroid disease and pathologies of rheumatic or connective tissues.
3. “FM is nine times more common in middle-aged women (Between the ages of 30 and 50 years) than in men.”
4. The best proposed etiology for Fibromyalgia is chronic hypoxia.
5. These authors propose that Fibromyalgia symptoms are predominantly caused by enhanced gluconeogensis with breakdown of muscle proteins, resulting from deficiency of oxygen and other substances needed for ATP synthesis.
6. Magnesium and malate have a critical role in ATP production and therefore fibromyalgia symptoms may be caused by magnesium and malate deficiency.
7. Fibromyalgia is associated with irritable syndrome, tension headache, primary dysmenorrhea, mitral valve prolapse and chronic fatigue syndrome.
8. Various treatment modalities have been tested in FM patients with poor results, including tryptophan, ibuprofen, and tricyclic drugs.
9. “Elevated catecholamine are observed in urine of FM patients.” [Important side note: elevated catecholamine (norepinephrine and epinephrine) are the result of increased sustained sympathetic tone. Which can be the consequence of reduced mechanical integrity, such as a decreased functioning spine.]
10. Reduced oxygen reduces ATP synthesis. Oxygen is reduced by hypoxia, magnesium deficiency, malate deficiency.
11. Magnesium is reduced by excess aluminum and/or excess calcium.
12. ATP production is controlled by the vitamins thiamine (B1), riboflavin (B2), and pridoxine (B6) because they are essential for the electron transport system, and all three vitamins require magnesium to become biologically active.
13. During anaerobic glycolysis, from glucose to acetyl-Co A, there are 11 distinct steps; 9 of 11 [82%] steps require magnesium.
14. The Krebs Cycle (Citric Acid Cycle) has 9 steps, and 3 of them require magnesium.
15. An “adequate oxygen supply enhances ATP yield by 18-19 fold.”
16. Fibromaylgia symptoms improve following anerobic conditioning.
17. Aluminum has high affinity for phosphate and blocks the absorption and utilization of phosphate for ATP syntheses, causing decreased mitochondrial ATP levels. Adequate levels of magnesium prevent this toxic effect of aluminum.
18. Malic acid is one of the most potent chelators of aluminum and is most effective in decreasing brain aluminum levels.
19. “The most common symptoms associated with FM-muslce pain, chronic fatigue, irritable bowel, mitral valve prolapse, tension headahce and dysmenorrheal-have been reported in patients with magnesium deficiency, and magnesium supplementation improves these symptoms.”
20. Malate deficiency is the cause of the ATP deficiency seen with exhaustive physical activity.
21. “In humans as well as in other animals tested, when there is increased demand for ATP, there is also an increased demand and utilization of malate.”
22. Malate demands are greater in hypothyroid fibromylgia patients.
23. Fibromyalgia patients supplemented with a daily dose of 300-600 mg magnesium plus 1200-2400 mg of malic acid “all patients reported significant subjective improvement of pain within 48 hours of starting.” Additionally, the fibromyalgia tender point scores were reduced by about 60% at 4 weeks and 66% at 8 weeks.
Some Biochemistry: Oxygen is required to make ATP. Chronic hypoxia results in reduction of ATP. The body will respond by increasing anaerobic glycolysis, resulting in increase pyruvate production and increased lactic acid, both of which increase pain perception.
The pain of firbromyaliga is caused in part by hypoxia (which is in itself painful) and the increase of lactic acid from increased anaerobic glycolysis.
Glucose is also required to make ATP. Therefore, the body will also respond by attempting to increase the genesis of glucose. The body can make glucose for the purpose of producing ATP by assembling it from smaller molecules, especially from amino acids.
The process of assembling glucose from smaller molecules is termed gluconeogenesis. To make glucose from amino acids, the body has to breakdown proteins, a process termed proteolysis, and the best source of protein for this purpose is from the muscles.
The pain of fibromyalgia is also caused by the proteolysis of muscle tissue that occurs in order for the required gluconeogenesis to increase ATP synthesis in the patients.