Malic acid supplements improves energy production:

What is Malic acid? Malic acid is a naturally occurring organic acid that plays a role in the complex process of deriving ATP, the energy currency that runs the body, from food. It is synthesized in the body through the citric acid cycle. Malic acid importance to the production of energy in the body during both aerobic and anaerobic conditions is well established.

Malic acid, an alpha-hydroxy organic acid, is sometimes referred to as a fruit acid. This is because Malic acid is found in apples and other fruits. Malic acid is also found in plants and animals, including humans. In fact, Malic acid, in the form of its anion malate, is a key intermediate in the major biochemical energy-producing cycle in cells known as the citric acid or Krebs cycle located in the cells' mitochondria.

Malic acid, also known as apple acid, hydroxybutanedioic acid and hydroxysuccinic acid, is a chiral molecule. The naturally occurring stereoisomer is the L-form. The L-form is also the biologically active one. There is some preliminary evidence that Malic acid, in combination with magnesium, may be helpful for some with fibromyalgia. Malic acid sold as a supplement is mainly derived from apples and, therefore, is the L-form. L- Malic acid has the following chemical structure.

Mechanism of Malic acid

Malic acid is absorbed from the gastrointestinal tract from whence Malic acid is transported via the portal circulation to the liver. There are a few enzymes that metabolize Malic acid. Malic enzyme catalyzes the oxidative decarboxylation of L-malate to pyruvate with concomitant reduction of the cofactor NAD+ (oxidized form of nicotinamide adenine dinucleotide) or NADP+ (oxidized form of nicotinamide adenine dinucleotide phosphate). These reactions require the divalent cations magnesium or manganese. Three isoforms of malic enzyme have been identified in mammals: a cytosolic NADP+-dependent malic enzyme, a mitochondrial NADP+-dependent malic enzyme and a mitochondrial NAD(P)+-dependent malic enzyme. The latter can use either NAD+ or NADP+ as the cofactor but prefers NAD+. Pyruvate formed from malate can itself be metabolized in a number of ways, including metabolism via a number of metabolic steps to glucose. Malate can also be metabolized to oxaloacetate via the citric acid cycle. The mitochondrial malic enzyme, particularly in brain cells, may play a key role in the pyruvate recycling pathway, which utilizes dicarboxylic acids and substrates, such as glutamine, to provide pyruvate to maintain the citric acid cycle activity when glucose and lactate are low.

Clearly, the metabolism of Malic acid is complex and what any of the above has to do, if anything, with Malic acids' putative activity in those with fibromyalgia is entirely unclear.

Malic acid is both derived from food sources and synthesized in the body through the citric acid cycle. Malic acid importance to the production of energy in the body during both aerobic and anaerobic conditions is well established. Under aerobic conditions, the oxidation of malate to oxaloacetate provides reducing equivalents to the mitochondria through the malate-aspartate redox shuttle. During anaerobic conditions, where a buildup of excess of reducing equivalents inhibits glycolysis, Malic acid's simultaneous reduction to succinate and oxidation to oxaloacetate is capable of removing the accumulating reducing equivalents. This allows Malic acid to reverse hypoxia's inhibition of glycolysis and energy production. This may allow Malic acid to improve energy production in Primary fibromyalgia (FM), reversing the negative effect of the relative hypoxia that has been found in these patients.

Important benefits of Malic acid supplementation can include:

Fibromyalgia. Chronic Fatigue Syndrome. Hypoxia-related conditions (respiratory and circulatory insufficiency) Many in the medical industry believe that Malic acid may be beneficial when used in connection with fibromyalgia. However, results have been mixed in studies of Malic acid's possible effects in those with fibromyalgia. In one study, fibromyalgia patients were randomized to receive a combination of 200 milligrams of Malic acid and 50 milligrams of magnesium per tablet (three tablets twice a day) or placebo for four weeks. This was followed by a six-month, open-label trial with dose escalating up to six tablets twice a day. Outcome variables were measures of pain and tenderness, as well as functional and psychological measures.

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