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Malate will result in increased urinary excretion of aluminum when given in therapeutic dosages to many patients with a diagnosis of FMS

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Hadley ME, Hruby VJ, Blanchard J, et al

Strategies to minimize side effects: Eat smaller meals, avoid fatty or greasy foods, eat slowly and stop when you start feeling full, stay hydrated, and be patient as your body adjusts (side effects typically improve after 4-8 weeks)

This cycling can be coordinated with menstrual cycles for women, using the luteal phase (when water retention already masks progress) for maintenance weeks