The essential mineral magnesium (Mg) “is like King Arthur,” says metabolic cardiologist Stephen Sinatra, MD. “All the other nutrients are the knights of the round table.” 1 Mg, found in a wide variety of foods and mineral-containing water, “is needed for more than 300 biochemical reactions in the body,” according to the National Institutes of Health.2 Yet the populations of only four U.S. states obtain even 40 percent of the recommended dietary intake (RDI) of Mg from their diet.3
Importantly, clinical studies have consistently found that FM and CFS patients tend to be magnesium deficient,4,5,6 and that Mg supplementation supports improvements in muscle comfort and energy for many of them.7,8 Additionally, leading researchers and practitioners report the superior performance of Mg when used in combination with malic acid, an extract of tart apples, as a dietary supplement for individuals with below-normal Mg in the blood and tissues.9
The importance of magnesium for energy and comfort. One of magnesium’s many functions in the body is that it activates almost all the enzymes involved in transforming fat and sugar into high-energy adenosine triphosphate (ATP), the body’s energy source, explains Georges Ramalanjaona, MD, an expert on the benefits of Mg supplementation for FM patients based at Seton Hall University’s School of Graduate Medical Education.4 A low level of Mg leads to a low level of ATP, which is especially crucial in the brain, where 20 percent of the body’s ATP is stored, he continues.
Magnesium is also an essential in muscle metabolism and function, and researchers and clinicians have emphasized the importance of sufficient Mg in the tissues of FM/CFS patients – for support of quality-of-life measures such as tiredness and muscle discomfort.8,9 For example, as CFS researcher Paul Cheney, MD, explains it, standard blood tests alone don’t tell the whole Mg story, because they are not sensitive to intra-cellular magnesium.4 “Magnesium, like potassium, is pumped into the cell, so normally there’s a higher concentration inside the cell than there is in the blood. And that pump mechanism may not work very well in people with CFS, so their magnesium levels can be normal in the blood and low in the cell,” says Dr. Cheney, who is currently focused on studies of heart function in CFS.
Mg has been shown to inhibit many nerve receptors related to the origins of certain types of FM pain. So when Mg is deficient in the body, it is borrowed from muscle cells, and “calcium [moves] in to replace it, causing the muscles to grow stiff and tense,” writes Richard Firshein, DO, author of The Nutraceutical Revolution.10
Malic acid, for its part, allows the body to make ATP more efficiently, even under low oxygen, or “hypoxic” conditions. Chemical analyses of tissues have identified low “oxygen pressure” in the muscles of many FM patients studied, and indicated that these patients’ “tender points” were often deficient in ATP.4 Tender points are areas of muscle attachment to bone, ligaments, and tendons which may be painful when pressed in FM patients.
Jay Goldstein, MD – known for his CFS studies focused on disturbances in neurotransmitters, the chemical substances responsible for transmitting cell-to-cell information – indicated he found malic acid to be a safe, inexpensive nutritional supplement which he recommends for CFS and FM patients suffering continuing or recurring muscle soreness, discomfort, and fatigue.11
Other top CFS clinicians who recommend a combination of Mg and malic acid for improved quality of life measures include Dr. Cheney and Daniel L. Peterson, MD – who together earned their places in medical history by documenting the 1985 CFS outbreak in Incline Village, Nevada – and leading CFS clinician Dr. David Teitelbaum, as discussed in his book From Fatigued to Fantastic.12
In their 1999 book Making Sense of Fibromyalgia,13 noted rheumatologist Daniel J. Wallace, MD, and Janice Brock Wallace cite controlled studies in England and Texas supporting the success of a proprietary combination of malic acid and magnesium in FM patients with recurring soreness or tenderness in the muscles. “If subjects take a dose larger than recommended on the bottle… its effects become apparent within a week,” they note, and “side effects are uncommon. This combination may work as a result of interactions between magnesium and calcium channels within muscles and the generation of adenosine triphosphate (ATP).”
Jorge Flechas, MD, MPh, a holistic practitioner in Hendersonville, ND, has participated in two studies that have tested a combination of malic acid and magnesium for discomfort and energy. In these studies, subjects diagnosed with Fibromyalgia reported a significant reduction in discomfort and tenderness within 48 hours and without any side effects. Dr. Flechas writes that, based on his practice over a period of five years with about 500 individuals who used this combination, he “found the results are positive 90 percent of the time.”14
Billie J. Sahley, PhD, a San Antonio-based nutritional specialist and author, has also reported improved energy and comfort with the Mg/malic acid combination for some FM and CFS patients.7 “The sooner malic acid and magnesium are started, the faster individuals begin to return to their normal lifestyles,” he stated.
Things to know about Mg supplementation. In addition to maintaining normal muscle and nerve function, “magnesium keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong” by aiding with calcium absorption, according to the National Institutes of Health fact sheet. “It also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis. It is essential in the conversion of vitamin D to its biologically active form, which then helps the body absorb and utilize calcium.” And, especially important for CFS and FM patients, studies indicate that sleep deprivation is associated with low levels of magnesium in the red blood cells.15 The many sources of Mg range from milk to “sunshine” foods such as spinach, whole grains, and bananas.
A blood test is one way to identify suboptimal Mg levels, though as noted this may not tell the whole story, since most of the body’s magnesium is found within the cell membranes. The U.S. recommended RDI of Mg for an adult is 400 milligrams per day. Therapeutic doses may be higher, ranging from 500 to 1500 mg, and “while many prescription medicines can cause side effects,” by comparison healthcare practitioners have found dietary magnesium supplements “extremely safe,” says Mg expert and author Alan R. Gaby, MD.16
Individuals with kidney disease are generally advised to avoid Mg supplementation. Anyone taking prescription or over-the-counter drugs should consult their doctor or a pharmacist: Certain diuretics, antibiotics, and other drugs may reduce Mg absorption. Laxatives and antacids often contain Mg. Watery diarrhea is the most common side effect of Mg supplementation, and Mg “toxicity” is rare as healthy kidneys excrete any reasonable excess.17
- Heart Sense for Women, Stephen Sinatra, MD, Eagle Publishing, 2000.
- NIH Clinical Center, Office of Dietary Supplements, at dietary-supplements.info.nih.gov/factsheets/magnesium.asp 3. “Percentage of Individuals Meeting DRI – Magnesium” by state, USDA Community Nutrition Research Service site, at www.ba.ars.usda.gov/cnrg/services/magnesium.html
- Go to ImmuneSupport.com to find a review summarizing the findings of 16 studies addressing Mg deficiencies in FM patients and benefits of supplementation, titled “Magnesium in the Treatment of Fibromyalgia,” by Georges Ramalanjaona, MD, DSc, FACEP, MBA, from Alternative Medicine Alert, March 2002.
- Go to ImmuneSupport.com to find “A magnesium deficiency?” an abstract of “Review and hypothesis: Might patients with the Chronic Fatigue Syndrome have latent tetany of magnesium deficiency?” by Mildred Selig, MD, MPH, in the Journal of Chronic Fatigue Syndrome, Vol. 4, #2, 1998.
- “NMR spectroscopy of muscle in Fibromyalgia Syndrome patients and sedentary controls,” R.W. Simms, et al., Arthritis and Rheumatism 1993.
- Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome, by Billie J. Sahley, PhD, Pain & Stress Therapy Center Publications, San Antonio 1995.
- “Top CFIDS Researchers and Physicians Find Nutritional Supplement to Reduce Muscle Pain and Fatigue in Some Cases,” CFIDS Association of America, October 1994, ImmuneSupport.com
- “Magnesium and Malic Acid: Partners in Muscle Health,” by Molly Hozschlag, December 1, 1994; and “American College of Physicians on Malic Acid, by ImmuneSupport.com Editor, June 6, 2006.
- “Magnesium’s Profound Effect on CFS,” by Richard Firshein, DO, from The Nutraceutical Revolution, Riverhead Books, 1998.
- Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Related Neural Network Disorders, by Jay Goldstein, MD, Haworth Medical Press, 1998.
- From Fatigued to Fantastic, Dr. David Teitelbaum, Avery Penguin Putnam, 2001.
- Dr. Wallace is Medical Director of the Wallace Rheumatic Study Center in Los Angeles, an Attending Physician at Cedars-Sinai Medical Center, and Clinical Professor of Medicine at UCLA’s David Geffen School of Medicine. He has written numerous books on “central pain syndromes.”
- “Malic Acid and Magnesium for Fibromyalgia and Chronic Pain Syndrome,” by G.E. Abraham and J.D. Flechas, published in the March 1992 issue of the Journal of Nutritional Medicine, archived at http://www.immunesupport.com/message/malic.htm
- “Erythrocyte magnesium and prostaglandin dynamics in chronic sleep deprivation,” K. Tanabe, et al., Clinical Cardiology, March 1997.
- “Magnesium is the Missing Link in Many Chronic Ills,” from Magnesium, by Alan R. Gaby, MD, Keats Publishing, 1994.
- Drug-Induced Nutrient Depletion Handbook, 2nd Edition, by Ross Pelton, RPh, PhD, CCN, et al., Lexi-Comp, Inc., 2001.