Malic acid supplement, sumac

Thanks for the update! I’ll keep an eye out for further updates from you and I can add you to the “no effect” tally if the pattern holds.

I had not noticed any taste on the capsules as they came in the bottle. Maybe one of the capsules broke open in the bottle?

I wonder if it would be feasible to dip the “placebo” capsules in a tiny bit of the malic acid just to address that possibility? The effect of the malic acid was quite dose dependent for me, I highly doubt a few granules would have much of an effect physiologically.

Another idea I was tossing around is buying citric acid and gel capsules from a supplier as another placebo, though it might still be possible to taste the difference between lemony sourness and green apple sourness. I’m also hesitant since citric acid is technically involved in the TCA cycle as well (just after the point where I expect the problem is).

 

That could work. But if you're sure you don't notice a different taste on the outside of the capsules compared to other non malic acid capsules it's probably fine. Maybe ask someone else to compare too. Alternatively you or someone else could rinse the capsules before randomizing them, which removed the taste from a capsule I tried rinsing

 

Did rinsing them cause any noticeable texture difference with the capsule itself?

[Edit: or actually I suppose you could just rinse the malic acid and placebo to control for this!]

 

I just heard back from one of the folks that messaged me directly about sumac working for them—they confirmed that they also regularly take an ADHD stimulant. I know that another person who reported a benefit is definitely not on stimulants, so the whole effect does not seem to be dependent on them.

However, like I suspected from my earlier experience with my stimulant fully wearing off, it seems like noticing an immediate effect from the malic acid is much more likely with a stimulant.

That’s quite interesting, as it might point to a two-part explanation of how cellular metabolism is affected in ME/CFS—one at the malate-aspartate shuttle and one at the level of glucose availability or utilization. Perhaps one thing is a consequence of the other, explaining that “prodromic phase” that many of us suspected?

 

@jnmaciuch I missed where you wrote this up thread, but are you saying that you suspect that the stimulant use helps the sumac kick in immediately whereas without it you would need to take it over time before noticing a difference?

 

I think the main difference is whether it feels like it gives you more energy/endurance within 15-30 minutes (more than the stimulant alone), or whether you will only notice better endurance and no PEM once you’re already doing activity (like MeSci described).

But there’s still the possibility it doesn’t work at all for some people. The best way to know for sure would probably just be to take it consistently for a few days before and after an activity that you have to do anyway (e.g. Doctors appointment, errand) and that usually triggers PEM or other symptoms. OrganicChilli did this and still experienced symptoms from activity so it seems clear it doesn’t work for some folks

[edited for clarity]

 

Well, I took a slightly-heaped teaspoonful of sumac yesterday at about 11.00 in preparation for a visit from an engineer coming to fit a new electricity meter.

I felt fairly reasonable physically, but suffered brain fog, particularly when he was asking me questions at about 1500, which I couldn't answer properly.

I had had no reply from 2 messages I sent to the energy company trying to check whether the company he was from was genuine, despite having registered with them as needing extra support!

The engineer didn't seem to have taken my condition into account either.

Maybe l-glutamine would have worked better.

 

Thanks for letting me know! I think between me, you, and one other friend I’ve been chatting with privately, it seems consistent that malic acid gives physical energy at the expense of mental sharpness. Both me and the other person (I have permission to share details) noticed that coq10 at a higher dosage seemed to alleviate the brain fog side effect, and super b complex helped additionally for me.

Unfortunately coq10 is much more expensive so it might not be worth it for other people.

 

I have been taking Magnesium Malate tablets (Source Naturals) a few periods, these are the ingredients:





I don't remember noticing any difference if I took it or not.
Taking one tablet per day in the morning that's of 833 mg Malic Acid.

@jnmaciuch
Would one tablet of this be the right amount for testing?


I saw @Mij and @Arnie Pye also referring to Malic acid and Magnesium, maybe it's the same.

 

I’m taking 400mg at a time for the malic acid so yes I think what you have would be enough to tell if it works for you.

[edit: malic acid would have to get converted into malate anyways to be used in the TCA cycle so it probably ends up being more malate total from the magnesium malate as well]

It’s possible that the formulation with magnesium makes it less effective somehow, but since others have reported benefits from magnesium malate on other forums, that’s probably not the case.

I’d be interested to know if you notice any effect re: activity tolerance! I might make a separate tally for the folks that did and did not notice a difference from magnesium malate/other malate salts. So far it seems more people reported no effect from that.

 

I decided to carefully test the upper limits of my activity since I knew I’d have extra recovery time coming up if I needed it. I think what I learned is quite useful.

After cleaning my whole apartment for a few hours I decided to go for a walk. I had been taking less malic acid and more Coq10 at one time to alleviate the brain fog issues. Halfway through the walk, I could feel the exact moment when the malic acid wore off. I started getting the pain and muscle stiffness that normally is triggered when I overdo it.

Taking malic acid as soon as I got home seemed to alleviate it for the evening, but I woke up with quite a bit of pain and muscle stiffness and had to take much more malic acid to counteract it.

 

This gives me a couple hints as to how the malic acid works.

Based on my hypothesis, you’re supplementing malate that would normally be endogenously produced and cycled in the body. So if you’re trying to replace it, you’d need to account for how much the body needs. I.e. for best effects it requires regular adjustment like a diabetic would do for insulin.

Unfortunately, at higher doses you’ll need much more coq10 to counteract the brain fog issues, so that might be prohibitive for others.

The second hint is that there’s normally some stimulus causing pain and fatigue that is triggered by activity, but malate keeps it suppressed. I strongly suspect that the reason it got worse once I woke up is because the “signal” persisted overnight, but the malic acid wears off after a few hours.

All in all, this was a very enlightening experience for me, but I would caution people very strongly to limit their activity increases so as not to end up in the same position. I was only comfortable doing it because I knew I’d be able to stop immediately and get home at the first sign of anything going wrong.

For what it’s worth, taking malic consistently and not doing more than 4 hours of physical activity at a time seemed to help me avoid this issue completely prior to my “challenge test.” If I’m right about why this works, you’re not fixing what’s wrong in the body but rather replacing an important downstream substrate, so it is definitely not a cure but rather an aid that must be used with caution.

If I can predict how much malic acid I need correctly and keep taking it through the “PEM” timeline, I can completely avoid negative effects, but it requires a careful balancing act that will likely not be possible for everyone.

 

@jnmaciuch

Out of curiosity, have you had an OAT done? There has been evidence that oxaloacetate is low in pwME. I took oxaloacetate supplements years ago but it didn't make any difference on how I felt.

My oxaloacetate levels were the lowest on my OAT panel at -33%. I remember years ago my doctor explaining to me that I was 'missing enzymes' to make the conversion. I often wondered why taking malic acid years ago was beneficial short term for me during the PVFS phase.

to add:

I was not experiencing delayed PEM during that time period btw.

 

I have not had it measured, though interestingly looking at the oxoaloacetate trial, the “subset of super responders” seems to roughly line up with the percentage of people reporting a boost from malic acid.

obviously that trial had several major issues so I’m not putting too much stake in it. Though if it does actually work for a subset of people, somebody should really let those people know that a $13 bottle of supplements will be just as effective because it’s not actually oxoaloacetate but it’s downstream form that’s helping things.

I suspect that there’s two things happening in ME: the malate part and then another glucose uptake part (which can be affected by stimulants, for those who tolerate them). I think it’s also possible that the changes in the glucose uptake part might be some kind of systemic reaction to the first part.

Malic acid might only help if the glucose uptake part is up and running sufficiently.
And I suspect delayed PEM also has to do with that glucose uptake somehow.

As always, it’s just speculation until I have hard data.

 

Interestingly, that study specifically excluded stimulant users. I really wonder if it would have been higher or the same if they had been included.