Homeopathic Remedies for Fibromyalgia

Also indexed as: Fibrositis


Homeopathy can often provide relief from the unpredictable, sometimes debilitating, aches and pains of fibromyalgia. Nutritional supplements, dietary monitoring, special types of exercise, and other natural approaches are also helpful and may be used along with remedies.

Although homeopathic substances listed in this article are generally not known to cause serious side effects, their effectiveness has not been demonstrated by scientific research. Consumers should check labels carefully, since a homeopathic product that is not diluted, or not diluted enough, can contain ingredients that cause allergic reactions, side effects, or interactions. It is always advisable to discuss any new treatment program with your healthcare practitioner.

For dosage information, please read the information at the end of this section. See also “Using Homeopathy With Professional Guidance” in What Is Homeopathy?

Arnica: This remedy is indicated when any body area feels bruised and sore, after exertion, overuse of muscles, or injury. Sometimes Arnica is enough to soothe a chronic condition; often, other remedies follow Arnica.

Bryonia: A person who needs this remedy tries to stay as still as possible, since even the slightest motion aggravates the pain. People who need this remedy often feel extremely irritable and grumpy, not wanting to be touched or interfered with. Warmth often makes things worse and cool applications may be soothing. Pressure on the painful parts (or lying on them) often helps, because it minimizes movement.

Calcarea carbonica: Muscle soreness and weakness that are worse from exertion, and worse from getting cold and damp, may be relieved by this remedy. The person often is chilly with clammy hands and feet, easily fatigued, and has a tendency to feel overwhelmed and anxious. Cravings for sweets and eggs often confirm the choice of this remedy.

Causticum: Soreness, weakness, and stiffness in the muscles—worse from being cold and worse from overuse—suggests a need for this remedy. The forearms often feel stiff, unsteady, and very weak. The muscles of the legs can feel contracted and sore, and the person may have restless legs at night. Problems tend to be worse when the weather is dry, and better in rainy weather (although getting wet aggravates the pain and stiffness). Warm applications and warming up in bed often relieve discomfort.

Cimicifuga (also called Actae racemosa): People who need this remedy are often energetic and talkative, becoming depressed or fearful when physical problems trouble them. Soreness and stiffness of muscles may be accompanied by shooting pains and are usually aggravated by getting cold. The neck and spinal muscles can be very tight, and the person may have headaches and other problems during menstrual periods.

Kalmia latifolia: Severe pain in the muscles, extending from higher areas to lower ones, often responds to this remedy. Shooting pains may occur, along with stiffness, neuralgia, and numbness or a cold sensation. Pains can come on suddenly, and often shift around, being worse from motion and worse at night.

Ranunculus bulbosus: This remedy is often helpful with fibrositis and muscle stiffness, especially when the neck and back muscles are involved. Stabbing pains and soreness may be felt near the spine and shoulder-blades, especially on the left. Problems may be aggravated by cold damp weather, walking, and alcoholic beverages.

Rhus toxicodendron: If a person feels very restless, with stiffness and soreness that find relief in warmth and motion, this remedy should be considered. Problems are aggravated in cold, damp weather. Stiffness and pain are worse on waking in the morning, and after periods of rest.

Ruta graveolens: Tremendous stiffness of the muscles, with lameness, pain, and weakness (especially after overuse) may be soothed with this remedy. The legs and hips are sore and weak, and the person may find it difficult to stand after sitting in a chair. Muscles in the back and neck feel bruised, the tendons may be sore, and the wrists and hands feel painful and contracted.

Homeopathy Dosage Directions

Select the remedy that most closely matches the symptoms. In conditions where self-treatment is appropriate, unless otherwise directed by a physician, a lower potency (6X, 6C, 12X, 12C, 30X, or 30C) should be used. In addition, instructions for use are usually printed on the label.

Many homeopathic physicians suggest that remedies be used as follows: Take one dose and wait for a response. If improvement is seen, continue to wait and let the remedy work. If improvement lags significantly or has clearly stopped, another dose may be taken. The frequency of dosage varies with the condition and the individual. Sometimes a dose may be required several times an hour; other times a dose may be indicated several times a day; and in some situations, one dose per day (or less) can be sufficient.

If no response is seen within a reasonable amount of time, select a different remedy.

For more information, including references, see What is Homeopathy? and Understanding Homeopathic Potencies.


Also indexed as: Fibromyositis, Fibrositis, Myofascial Pain Syndrome, Myofibrositis, Primary Fibromyalgia Syndrome


Fibromyalgia—an unsolved mystery—is a complex syndrome with no known cause or sure cure. According to research or other evidence, the following self-care steps may be helpful:

What you need to know

  • Exercise
  • Low-intensity exercise (like walking or swimming) is the best known treatment
  • Address your stress
  • Reducing stress and unpleasant emotions may also reduce symptoms
  • Try 5-HTP
  • 100 mg of the supplement 5-hydroxytryptophan three times a day may ease symptoms
  • Check out SAMe
  • 800 mg of the supplement S-adenosyl-l-methionine a day may help symptoms

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full fibromyalgia article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About fibromyalgia

Fibromyalgia is a complex syndrome with no known cause or cure. Its predominant symptom is pain in the fibrous tissues, muscles, tendons, and ligaments, although other symptoms may be experienced.

Research has demonstrated that the axis connecting the three glands primarily responsible for the stress response (hypothalamus, pituitary, adrenals) may be dysfunctional in people with fibromyalgia.1 Inflammation of the involved structures is generally absent in fibromyalgia.

Of the estimated three to six million people2 affected by this disorder in the United States, the vast majority are women between 25 and 45 years of age.

Product ratings for fibromyalgia

Science Ratings Nutritional Supplements Herbs







Malic acid



Vitamin B1

Vitamin E

See also:  Homeopathic Remedies for Fibromyalgia
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Trigger-point pain at characteristic locations is the defining symptom of fibromyalgia. The most commonly affected locations are on the occiput (nape of the neck), the neck itself, shoulders, trunk, low back, and thighs. Other symptoms may also be experienced, including fatigue, chest pain, low-grade fever, swollen lymph nodes, insomnia, frequent abdominal pain, irritable bowel syndrome, and depression.3

Dietary changes that may be helpful

A vegan diet (includes no animal products) that is also low in salt may help women with fibromyalgia. In a controlled clinical trial,4 women with fibromyalgia were put on a special diet consisting only of raw foods—primarily fruits, vegetables, nuts, seeds, legumes, and cereals (such as rolled oats). The diet also contained several fermented foods, including a fermented yogurt-food made from oats, a fermented beverage made from wheat berries (called Rejuvalac), and several types of fermented vegetables, particularly cabbage. During the three-month trial, women following the therapeutic diet experienced a significant reduction in body weight, pain, morning sickness, use of painkillers, depression, and the number of sore fibromyalgia points, compared with those who continued to eat their regular diet. Due to the liberal use of nuts and seeds, this diet was not low in fat; for example, 31% of all calories came from fat. Nonetheless, the total number of calories was relatively low (less than 1,900 calories per day), which was probably responsible for the decrease in body weight.

In a preliminary report, four women with fibromyalgia experienced marked improvement or complete resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. In each case, symptoms recurred whenever MSG was ingested.5

Lifestyle changes that may be helpful

Low-intensity exercise may improve fibromyalgia symptoms. People with fibromyalgia who exercise regularly have been reported to suffer less severe symptoms than those who remain sedentary.6 7 8 In a controlled trial, a program consisting of two 25-minute exercise classes plus two educational sessions per week for six weeks resulted in immediate and sustained improvement in walking distance, fatigue, and well-being in a group of people with fibromyalgia;9 however, no reductions in pain, anxiety, or depression were seen. In a more recent controlled trial, a 35-minute exercise program in a warm pool once a week for six months, coupled with counseling sessions, led to improvements in hand-grip strength and endurance, as well as to reductions in pain, distress, depression, and anxiety.10 The results of this trial, and other similar trials, suggest that underwater exercise training, in combination with a counseling intervention, should be considered by people with fibromyalgia.

Other therapies

Low-impact exercise programs to improve aerobic fitness, stretching techniques to relax tense muscles, and cognitive therapy for coping with stress and emotional disorders are recommended treatments.

Vitamins that may be helpful

In a double-blind trial, supplementation with acetyl-L-carnitine in the amount of 1,500 mg per day for ten weeks was significantly more effective than a placebo in improving musculoskeletal pain, depression, and general health in people with fibromyalgia.11

People with fibromyalgia often have low serotonin levels in their blood.12 13 14 Supplementation with 5-HTP may increase serotonin synthesis in these cases. Both preliminary15 16 and double-blind trials17 have reported that 5-HTP supplementation (100 mg three times per day) relieves some symptoms of fibromyalgia.

Some studies have found low vitamin B1 (thiamine) levels and reduced activity of some thiamine-dependent enzymes among people with fibromyalgia.18 19 The clinical significance of these findings remains unknown.

One early preliminary study described the use of vitamin E supplements in the treatment of “fibrositis”—the rough equivalent of what is today called fibromyalgia. Several dozen individuals were treated with vitamin E using amounts ranging from 100–300 IU per day. The results were positive and sometimes dramatic.20 Double-blind trials are needed to confirm these preliminary observations.

Intravenous SAMe (S-adenosylmethionine) given to people with fibromyalgia reduced pain and depression in two double-blind trials;21 22 but no benefit was seen in a short (ten-day) trial.23 Oral SAMe (800 mg per day for six weeks) was tested in one double-blind trial and significant beneficial effects were seen, such as reduced pain, fatigue, and stiffness, and improved mood.24

In a preliminary trial, supplementation with ribose in the amount of 5 grams three times per day for approximately three weeks improved energy, sleep, mental clarity, pain, and general well-being in people with fibromyalgia.25 Placebo-controlled trials are needed to rule out the possibility that these improvements were due to a placebo effect. If ribose is effective for people with fibromyalgia, it may work by improving the body's capacity to produce energy.

A preliminary trial found that a combination of magnesium and malic acid might lessen muscle pain in people with fibromyalgia.26 The amounts used in this trial were 300–600 mg of elemental magnesium and 1,200–2,400 mg of malic acid per day, taken for eight weeks. A double-blind trial by the same research group using 300 mg magnesium and 1,200 mg malic acid per day found no reduction in symptoms, however.27 Though these researchers claimed that magnesium and malic acid appeared to have some effect at higher levels (up to 600 mg magnesium and 2,400 mg malic acid), the positive effects were not demonstrated under blinded study conditions. Therefore, the evidence supporting the use of these supplements for people with fibromyalgia remains weak and inconclusive.

Melatonin supplementation may be useful in the treatment of fibromyalgia. In a preliminary trial, 3 mg of melatonin at bedtime was found to reduce tender points and to improve sleep and other measures of disease severity, though pain and fatigue improved only slightly.28

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Holistic approaches that may be helpful

Stress is believed by some researchers to be capable of aggravating fibromyalgia symptoms. Stress-reduction techniques, such as meditation, have proven helpful in preliminary research.29

Acupuncture may be useful for short-term relief of fibromyalgia symptoms. In one preliminary trial, acupuncture produced a significant decrease in pain and point tenderness along with related biochemical changes measured in the fibromyalgia patients’ blood.30 Another uncontrolled trial used electroacupuncture (acupuncture with electrical stimulation) treatment in people with fibromyalgia who were unresponsive to conventional medical therapies. After an average of seven treatments per person, 46% claimed that electroacupuncture provided the best relief of symptoms when compared to all other therapies, and 64% reported using less medication for pain relief than prior to electroacupuncture.31 A double-blind trial compared fake acupuncture to electroacupuncture and reported significant differences in improvement in five of eight outcome measurements among people with fibromyalgia.32 Short-term pain reduction in people with fibromyalgia has been reported in other studies, some of which were at least partially controlled; however, long-term benefits have never been investigated in a controlled clinical trial.33 Long-term controlled trials are necessary to conclusively determine whether acupuncture is a useful treatment for fibromyalgia.

Joint manipulation, chiropractic, and related treatments may be helpful for relieving some of the symptoms of fibromyalgia. A preliminary study34 found that almost half of people with fibromyalgia who received chiropractic care had “moderate to good” improvement. A small preliminary trial35 evaluated the effect of four weeks of chiropractic treatment (three to five times per week) consisting of soft tissue massage, stretching, spinal manipulation, and general advice and information. Treatment resulted in a significant decrease in pain and an increase in range of neck movement, but there was no improvement in tender points or in ability to function in daily life. Another preliminary trial36 evaluated a longer treatment period (30 sessions) consisting of spinal manipulation and deep pressure massage to tender points in the muscles. More benefit was reported by this study, as 60% of the patients experienced significant pain reduction, reduced sensed of fatigue, and improved sleep. These benefits persisted one month after the treatment was completed. People who did not feel better after 15 treatments were not likely to benefit from this type of treatment. No controlled research has evaluated manipulation therapies for fibromyalgia.

1. Griep EN, Boersma JW, Lentjes EG, et al. Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. J Rheumatol 1998;25:1374–81.

2. Anonymous. Is fibromyalgia caused by a glycolysis impairment? Nutr Rev 1994;52(7):248–50.

3. Wolfe F, Ross K, Anderson J, Russell IJ. Aspects of fibromyalgia in the general population: Sex, pain threshold, and FM symptoms. J Rheumatol 1995;22(1):151–5.

4. Kaartinen K, Lammi K, Hypen M, et al. Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol 2000;29:308–13.

5. Smith JD, Terpening CM, Schmidt SOF, Gums JG. Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother 2001;35:702–6.

6. Wilke W. Fibromyalgia: Recognizing and addressing the multiple interrelated factors. Postgrad Med 1996;100(1):153–70.

7. Carette S. Fibromyalgia 20 years later: What have we really accomplished? J Rheumatol 1995;22(4):590–4.

8. Mengshail AM, Komnaes HB, Forre O. The effects of 20 weeks of physical fitness training in female patients with fibromyalgia. Clin Exp Rheumatol 1992;10:345–9.

9. Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res 1999;12:120–8.

10. Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol 2000;27:2473–81.

11. Rossini M, Di Munno O, Valentini G, et al. Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol 2007;25:182–8.

12. Fava M, Rosenbaum JF, MacLaughlin R, et al. Neuroendocrine effects of S-adenosyl-L-methionine, a novel putative antidepressant. J Psychiatr Res 1990;24:177–84.

13. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15–8.

14. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15–8.

15. Puttini PS, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. J Int Med Res 1992;20:182–9.

16. Moldofsky H, Warsh JJ. Plasma tryptophan and musculoskeletal pain in non-articular rheumatism (“fibrositis syndrome”). Pain 1978;5:65–71.

17. Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1990;18:201–9.

18. Eisinger J, Zakarian H, Plantamura A, et al. Studies of transketolase in chronic pain. J Adv Med 1992;5:105–13.

19. Eisinger J, Bagneres D, Arroyo P, et al. Effects of magnesium, high energy phosphates, piracetam, and thiamin on erythrocyte transketolase. Magnesium Res 1994;7(1):59–61.

20. Steinberg CL. The tocopherols (vitamin E) in the treatment of primary fibrositis. J Bone Joint Surg 1942;24:411–23.

21. Tavoni A, Jeracitano G, Cirigliano G. Evaluation of S-adenosylmethionine in secondary fibromyalgia: A double-blind study. Clin Exp Rheumatol 1998;16:106–7 [letter].

22. Tavoni A, Vitali C, Bombardieri S, et al. Evaluation of S-adenosylmethionine in primary fibromyalgia: A double-blind crossover study. Am J Med 1987;83(suppl 5A):107–10.

23. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol 1997;26:206–11.

24. Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia: Double-blind clinical evaluation. Scand J Rheumatol 1991;20:294–302.

25. Teitelbaum JE, Johnson C, St Cyr J. The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. J Altern Complement Med 2006;12:857–62.

26. Abraham G, Flechas J. Management of fibromyalgia: Rationale for the use of magnesium and malic acid. J Nutr Med 1992;3:49–59.

27. Russell IJ, Michalek J, Flechas J, et al. Treatment of fibromyalgia syndrome with SuperMalic: A randomized, double-blind, placebo-controlled, crossover pilot study. J Rheumatol 1995;22(5):953–7.

28. Citera G, Arias MA, Maldonado-Cocco JA, et al. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol 2000;19:9–13.

29. Kaplan KH, Goldberg DL, Galvin-Naduea M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry 1993;15:284–9.

30. Sprott H, Franke S, Kluge H, Hein G. Pain treatment of fibromyalgia by acupuncture. Rheumatol Int 1998;18:35–6.

31. Waylonis GW. Long-term follow-up on patients with fibrositis treated with acupuncture. Ohio State Med J 1977;73:299–302.

32. Deluze C, Bosia L, Zirbs A, et al. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 1992;305(6864):1249–52.

33. Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract 1999;48:213–8.

34. Wolfe F. The clinical syndrome of fibrositis. Am J Med 1986;81(Supp 3A):7–14.

35. Blunt KL, Moez HR, Rajwani MH, Guerriero RC. The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol Ther 1997;20:389–99.

36. Hains G, Hains F. Combined ischemic compression and spinal manipulation in the treatment of fibromyalgia; a preliminary estimate of dose and efficacy. J Manipulative Physiol Ther 2000;23:225–30.


Also indexed as: 5-HTP


5-HTP is used by the human body to make serotonin, an important substance for normal nerve and brain function. Serotonin appears to play significant roles in sleep, emotional moods, pain control, inflammation, intestinal peristalsis, and other body functions.1

Where is it found?

5-HTP is not present in significant amounts in a typical diet. The human body manufactures 5-HTP from L-tryptophan, a natural amino acid found in most dietary proteins. However, eating food that contains L-tryptophan does not significantly increase 5-HTP levels. Supplemental 5-HTP is naturally derived from the seeds of Griffonia simplicifolia, a West African medicinal plant.

5-HTP has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings Health Concerns




Migraine headaches

Sleep terrors

Tension headache

Weight loss and obesity


Bipolar disorder/manic depression

Eating disorders

Parkinson’s disease (with Sinemet)

Seasonal affective disorder

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Who is likely to be deficient?

Disruptions in emotional well-being, including depression and anxiety, have been linked to serotonin imbalances in the brain.2 People with fibromyalgia often have low serotonin levels in their blood.3 4 5 Supplements of 5-HTP may increase serotonin synthesis in these cases. The cause of migraine headaches is related to abnormal serotonin function in blood vessels,6 and 5-HTP may help correct this abnormality. Insomnia has been associated with tryptophan deficiency in the tissues of the brain;7 therefore, 5-HTP may provide a remedy for this condition.

How much is usually taken?

In a controlled trial, 5-HTP (300 mg per day) was shown to be effective in reducing many symptoms of fibromyalgia, including pain, morning stiffness, sleep disturbances, and anxiety.8

For depression, 300 mg per day is often effective, though much of the research used 5-HTP in combination with drugs or was uncontrolled.9 10 11 For insomnia, a single 100-mg nighttime dose of 5-HTP was sufficient to improve the duration and depth of sleep in one placebo-controlled trial.12 For migraine headaches, amounts ranging from 400–600 mg per day have been shown to be effective at reducing the frequency and severity of attacks in most clinical trials.13 14 15 16 17 For tension headaches, 100 mg of 5-HTP taken three times per day led to a significant decrease in consumption of pain-relievers, but no significant change in headache duration or intensity.18

Appetite reduction and weight loss (averaging 11 pounds in 12 weeks) has occurred with amounts of 600–900 mg daily.19 20 In another clinical trial, 750 mg per day has been shown to be effective at decreasing carbohydrate and fat intake, and promoting weight loss.21

Are there any side effects or interactions?

During the clinical trials described above, some people taking large amounts of 5-HTP experienced gastrointestinal upset (e.g. nausea) or, less often, headache, sleepiness, muscle pain, or anxiety.

A substance known as “Peak X” has been found in low concentrations in several over-the-counter 5-HTP preparations. Some researchers think this substance may be linked22 23 24 to toxicity previously reported25 26 27 in a 1989 L-tryptophan contamination incident. However, there is serious question about whether Peak X is actually the toxic agent and it may be unrelated to the problems previously associated with L-tryptophan.28 29 30 31 32 33 34 35 Although two articles reported possible associations between 5-HTP consumption and toxicity symptoms similar to those attributed to contaminated L-tryprophan,36 37 evidence linking 5-HTP or Peak X with any toxicity symptoms remains speculative. Although the structure of Peak X has recently been identified, there is no firm evidence that this substance has caused or contributed to any toxicity or disease.38

Very high intakes of 5-HTP have caused muscle jerks in guinea pigs39 and both muscle jerks40 and diarrhea in mice.41 Injected 5-HTP has also caused kidney damage in rats.42 To date, these problems have not been reported in humans. “Serotonin syndrome,” a serious but uncommon condition caused by excessive amounts of serotonin, has not been reported to result from supplementation with 5-HTP; in theory it could be triggered by the supplement.43 However, the level of intake at which this toxic effect might potentially occur remains unknown.

5-HTP should not be taken with antidepressants, weight-control drugs, other serotonin-modifying agents, or substances known to cause liver damage, because in these cases 5-HTP may have excessive effects. People with liver disease may not be able to regulate 5-HTP adequately and those suffering from autoimmune diseases such as scleroderma may be more sensitive than others, to 5-HTP.44 These people should not take 5-HTP without consulting a knowledgeable healthcare professional. The safety of taking 5-HTP during pregnancy and breast-feeding is not known at this time.

Are there any drug interactions?
Certain medicines may interact with 5-hydroxytryptophan. Refer to
drug interactions for a list of those medicines.



Also indexed as: S-Adenosyl-L-Methionine, S-adenosylmethionine


S-adenosyl-l-methionine (SAMe) is an important biological agent in the human body, participating in over 40 essential biochemical reactions.

Where is it found?

SAMe is not abundant in the diet, though its precursor, the amino acidmethionine is plentiful in many protein foods. It is not known whether increasing one’s intake of methionine will increase the body’s production of SAMe. Supplements of SAMe have been available in the U.S. since 1997.

SAMe has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings Health Concerns

Liver cirrhosis





Hepatitis (for liver cholestasis)

Pregnancy and postpartum support (for cholestasis only)


Bipolar disorder

Infertility (male)

Migraine headaches

Post-concussion syndrome

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Who is likely to be deficient?

SAMe is normally produced in the liver from the amino acidmethionine which is abundant in most diets. Folic acid and vitamin B12 are necessary for the synthesis of SAMe, and deficiencies of these vitamins results in low concentrations of SAMe in the central nervous system.1 Low blood or central nervous system levels of SAMe have been detected in people with cirrhosis of the liver,2 coronary heart disease,3 Alzheimer’s disease, and depression.4

How much is usually taken?

Healthy people do not need to take this supplement. Researchers working with people suffering from a variety of conditions have been using these amounts of SAMe: depression, 1,600 mg per day; osteoarthritis, 800–1,200 mg per day; fibromyalgia, 800 mg per day; liver disorders, 1,200 mg per day; and migraine, 800 mg per day.

Are there any side effects or interactions?

Clinical trials in thousands of people for up to two years have demonstrated that SAMe is very well tolerated, much better than the medications with which it has often been compared.5 6 Occasional gastrointestinal upset may be experienced by some people. Researchers treating people with bipolar disorder (manic depression) have reported that SAMe could cause them to switch from depression to a manic episode.7 8

Are there any drug interactions?
Certain medicines may interact with SAMe. Refer to
drug interactions for a list of those medicines.


Malic Acid


Malic acid is a naturally occurring compound that plays a role in the complex process of deriving adenosine triphosphate (ATP; the energy currency that runs the body) from food.

Where is it found?

Malic acid is found in a wide variety of fruits and vegetables, but the richest source is apples, which is why malic acid is sometimes referred to as “apple acid.”

Malic acid has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings Health Concerns


3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Who is likely to be deficient?

A deficiency in humans is unlikely, since the body can produce malic acid.

How much is usually taken?

Healthy people do not need to take malic acid as a supplement. Research has been conducted with 1,200–2,400 mg of malic acid in combination with 300–600 mg of elemental magnesium.

Are there any side effects or interactions?

Current research does not indicate any adverse effects from the use of malic acid in moderate amounts.

At the time of writing, there were no well-known drug interactions with malic acid.