This web page was the result
of my research regarding magnesium, and why it's important not only for the
average person, but especially for people with fibromyalgia. If you
aren't interested in reading lots of studies, and are already convinced of
magnesium's importance, then just click here to get
to my recommendations. Please note, magnesium is
only one of many possible treatments that can help fibromyalgia. It, by
itself, cannot effectively treat it.
Magnesium deficiency is very common in the general
The reason lack of sleep causes a magnesium
deficiency is probably due to the lower amounts of growth hormone secretion
which occurs due to a sleep disturbance, especially the type that is found in
people with fibromyalgia. Growth hormone is responsible for creating a
substance known as IGF-1, or insulin growth factor. IGF-1 has been found
to have many uses by the body. It's especially known for tissue
repair. However, it can influence intracellular levels of magnesium, as
the following studies show:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9851785&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9828151&dopt=Abstract
Also, IGF-1 affects excretion of magnesium
by the kidneys:
Magnesium deficiency is therefore one of
many problems in people with fibromyalgia which is due to or influenced by the
sleep disturbance. So while it's possible to attain some benefit from
taking magnesium, treating any sleep disorder is just as helpful, if not more
so.
Magnesium is extremely important to many
functions in the body, which is why a deficiency can cause many different
symptoms. It is most widely known for being needed for proper bone
formation. With a deficiency, bones will be soft, and it can play a role
in osteoporosis However, magnesium is also the activating mineral
for at least 350 different enzymes in the body, more than any other mineral, so
it is crucial for many of the metabolic functions in the body. Magnesium
is necessary for almost all the enzymes that allow the glycolytic and Krebs
cycles to turn the sugar and fat we eat into ATP. Low levels of ATP have
commonly been found in people with fibromyalgia, and it is believed that this
plays an important role in many of the fibromyalgia symptoms. Thus, a
magnesium deficiency would definitely be a factor in worsening those symptoms.
Magnesium is extremely necessary for proper
ATP synthesis, because ATP is stored in the body as a combination of magnesium
and ATP, which is known as MgATP. ATP requires magnesium in order to be
stable. Without magnesium, ATP would easily break down into other
components, ADP and inorganic phosphate.
The brain heavily relies
ATP for many functions. In fact, 20% of total body ATP is located in the
brain. Thus, low levels of ATP can diminish brain cognitive functions, a
common problem in people with fibromyalgia.
Adequate magnesium is necessary for proper
muscle functioning. Magnesium deficiency promotes excessive muscle
tension, leading to muscle spasms, tics, restlessness, and twitches. This
is due to an imbalance of the ratio of calcium to magnesium, as calcium
controls contraction, while magnesium controls relaxation. Plus, in
fibromyalgia, changes are seen in the muscles, such as "significantly
lower than normal phosphocreatine and ATP levels" and "values for
phosphorylation potential ... also were significantly reduced":
But all of these same changes are found also
in magnesium deficiencies:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8988330&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7847586&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8399369&dopt=Abstract
Magnesium may also help Myofascial Pain
Syndrome. According to Devin Starlanyl's web page "Myofascial
trigger points can be identified and documented electrophysiologically by
characteristic spontaneous electrical activity (SEA). They may also be
identified histologically (which means that the structure of
the cells have changed) by contraction knots-- the lumps and bumps we
know only too well. Both of these phenomenon
seem to result from excessive release of the neurotransmitter acetylcholine
(ACh) from the nerve terminal of the motor endplate (the complex end formation
of the nerve)." But magnesium is well known for being able to
inhibit ACh release:
And in fact, intravenous
magnesium sulfate is used in emergency situations because of this effect on
acetylcholine:
Magnesium is known
to regulate or inhibit many nerve receptors, such as NMDA or 5-HT3, which have
been considered as sources of certain types of fibromyalgia pain.
Neurontin, for example, is used because inhibits NMDA activity. Since
magnesium also blocks NMDA receptors, studies have used intravenous magnesium
therapy to try and treat similar types of neuropathic pain:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10687324&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9785788&dopt=Abstract
And it's because of magnesium's ability to
regulate nerve functions that other fibromyalgia symptoms occur. Migraine
headaches, mitral valve prolapse, and Raynaud's phenomenon, all problems
commonly found in people with fibromyalgia, are also problems that have been
associated with a magnesium deficiency. Without enough magnesium, nerves
fire too easily from even minor stimuli. Noises will sound excessively
loud, lights will seem too bright, emotional reactions will be exaggerated, and
the brain will be too stimulated to sleep, all symptoms commonly found in fibromyalgia.
And if the oversensitivity to light and noise reminds you of someone suffering
from a hangover, they are one and the same problem, as alcohol is known for
decreasing magnesium levels, and magnesium supplementation has been found to
relieve hangover symptoms.
Another commonly found condition in
fibromyalgia which has nervous related symptoms is reactive hypoglycemia.
Anxiety related symptoms occur after carbohydrate intake, and this is believed
to be due to either an excess release of adrenaline, or a higher sensitivity to
adrenaline. In either case, a deficiency of magnesium could be a
factor, as magnesium
deficiency appears to associated with anxiety and high
levels of adrenaline.
Not only that, but magnesium also affects
carbohydrate metabolism in a different manner, as a magnesium deficiency
appears to create resistance to insulin, Insulin resistance increases levels
of insulin, which may result in a form of diabetes. Additionally,
insulin resistance by itself can distrupt
intracellular magnesium levels, as the following web page explains.
Thus, "insulin resistance and magnesium
depletion may result in a vicious cycle of worsening insulin resistance and
decrease in intracellular Mg(2+) which may limit the
role of magnesium in vital cellular processes."
Magnesium also appears to be able to also
affect the nervous system by regulating the release of hormones, which occurs
due to many different forms of stress. However, this hormonal activity is
disrupted in fibromyalgia. Often there is an exaggerated release or high
levels of noradrenaline (also known as norepinephrine), as the following
studies show:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2532682&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10765933&dopt=Abstract
However, magnesium appears to play a role in
regulating noradrenaline levels. For example, in the following study on
mitral valve prolapse, magnesium supplementation not only relieved symptoms,
but also reduced the high level of urinary noradrenaline excretion:
And genetically bred mice with low magnesium
levels have also been found to have high noradrenaline levels:
And ,as was previously mentioned, sleep deprivation appears
to lower magnesium levels. However, in another study, sleep
deprivation was found to raise noradrenaline levels:
Thus, there appears to be a strong link
between high noradrenaline levels, and low magnesium levels. And this imbalance
of hormones could play a role in exercise tolerance in fibromyalgia. High
noradrenaline levels are associated with low exercise tolerance. This
might be due to the fact that noradrenaline causes constriction in blood
vessels, and this could reduce oxygen flow during exercise. This is made
worse by the lower than normal adrenaline levels in fibromyalgia, as adrenaline is able to dilate blood vessels in the
skeletal muscles and the liver. However, magnesium is able to relax
smooth muscles around blood vessels, and thus has a strong vasodilatory effect,
which could counteract the vasoconstriction effect of the hormones.
Related to this is the previously mentioned
study of patients that were sleep deprived which resulted in low magnesium
levels. They were also found to have lower levels of exercise
tolerance. But in a subsequeent study, it was found that magnesium
supplementation was able to raise that tolerance:
Respiratory problems such as asthma have
also been associated with high levels of noradrenaline, and thus magnesium
might be of help for those conditions.
A magnesium deficiency also increases levels
of substance P, a chemical which has been implicated as being responsible for
increased pain levells in FMS. Several studies, such as the following,
show this:
However, even just as important is the fact
that this study also shows a rise in inflammatory cytokines. Cytokines
are part of the immune system. However, raised levels of certain
cytokines have been implicated in many health problems and diseases, and some
researchers feel that they may be responsible for many of the symptoms of FMS
and CFS, as these cytokines play a role in metabolic and many other functions.
Sleep deprivation studies also show an increase these cytokines, not surprising
since we have shown that sleep deprivation can cause a magnesium
deficiency. The following study showed a significant increase in one of
these cytokines, interleukin-6. This cytokine appears to play a role in
the fatigue and other health symptoms that directly result from lack of sleep:
Since a sleep disturbance could cause a rise
in these cytokines, and since this study also postulates that these cytokines
themselves play a role in regulating sleep, a spiraling effect could occur, as
the high levels of these cytokines could cause sleep to be constantly disturbed Such a circular effect has been proposed for the
cause of FMS.
Magnesium is thus involved in many functions
in the body, and so it's no wonder that the chemical brain imbalances in
fibromyalgia somehow seem connected to processes involving magnesium.
Surprisingly, little is known about magnesium, as compared to other minerals in
the body. So it could be that magnesium even has more effects that we are
not yet aware of. And it's because magnesium is involved in so many
processes in the body, that a deficiency has a spiraling effect. Low magnesium levels causes metabolic functions to decrease,
causing further stress on the body, reducing the body's ability to absorb and
retain magnesium. A marginal deficiency could easily be transformed into
a more significant problem. Any stressful event could trigger magnesium
loss. So one could postulate that stressful events which
trigger fibromyalgia are doing so by creating a high loss of magnesium.
Perhaps people in a fibromyalgia flare could be helped by additional magnesium.
Unfortunately, magnesium deficiency is not
easily detected, as serum levels do not reflect the levels of magnesium in
tissues. This is the reason why it is so overlooked and ignored, both by
doctors and by studies. And unfortunately, oral magnesium supplementation
can be difficult because of absorption problems. Digestion and diet play
a key role in absorption. People with fibromyalgia often have conditions
like Irritable Bowel Syndrome, gluten intolerance, or other problems that might
limit absorption. Excess amounts of certain substances, such as
fructose, may interfere with magnesium absorption. Phosphate can bind to
magnesium in the gut, creating magnesium phosphate, an insoluble salt that
can't be utilized. Many forms of oral magnesium supplements are hard to
assimilate. The most common, magnesium oxide and citrate, happen to be
the worst to assimilate, which is why both have a strong laxative effect.
If you suffer from that effect when you take magnesium, it is often not because
you are taking too much, but because you are not assimilating it well.
And it may take long term use of supplements before magnesium levels are raised
in all the tissues, and for damaged cell functions to be restored.
A magnesium deficiency increases cell
membrane permeability, and this condition is believed to lead to a decrease in
the intracellular antioxidant system, shown in the following study, one of
several in MEDLINE:
Changes in cell membranes and subsequent
intracellular imbalance in cells reduces the body's defenses against toxins
such as heavy metals. A long term magnesium deficiency may lead to many
other secondary problems that have their own host of symptoms.
A magnesium deficiency causes an increase in
intracellular calcium levels, which may lead to calcification and cell
death. And a few more studies for those interested on the effects of a
magnesium deficiency on cell disturbances and mitochondria damage:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9529585&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9641824&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7738680&dopt=Abstract
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8988330&dopt=Abstract
And if you are still skeptical of the
importance of magnesium, I suggest you read the following: http://www.mgwater.com/dur30.shtml
While most symptoms which are directly due to a
magnesium deficiency are reversible, magnesium deficiency indirectly causes
problems that may not be reversible. "With a high aluminum diet
alone, aluminum content in the nervous system in rats showed no difference with
a control group aluminum serum aluminum was
high. However, with an insufficient intake of magnesium the same aluminum
load induced an increase in aluminum and calcium concentrations in the nervous
system and neurodegeneration with precipitation of insoluble
hydroxyapatites." Combined aluminum intoxication with
calcium-magnesium deficiencies is not reversible through physiological oral
magnesium supplementation. And also from that web page: "nervous
consequences of magnesium deficiency" ... "are completely reversible
since they can be restored to normal with simple oral physiological magnesium
supplementation but it should also be pointed out that a prolongation of
untreated chronic magnesium deficiency can produce irreversible lesions with
histological changes.
If you are considering taking magnesium, I
would suggest looking for a form that allows to you start with a low amount,
and then slowly increase that dose.
Unabsorbed magnesium will cause a laxative effect, so the amount that
you can tolerate will be limited by this effect. This effect often isn’t seen until a
day later, which is why you should only slowly increase the dose. The RDA for magnesium is 400mg. If this amount helps any of your symptoms,
then you may be helped by taking more than that. Magnesium is often better absorbed when taken
with food. Also, you can absorb more
magnesium, if you take it in small doses, such as some with each meal. This is
what I do. And if possible, you might
also want to avoid taking magnesium with foods that are high in phytic acid,
such as whole wheat, as this might bind to the magnesium.
Taking magnesium with calcium is often
suggested, because the 2 minerals work together in buildling bones. Another good reason for taking the calcium, is that calcium (especially calcium carbonate) can
offset some of the laxative effect from the magnesium. Traditionally,
it's been recommended to take calcium and magnesium in a ratio of 2/1, as that
is the ratio of the RDA of calcium and magnesium. However, magnesium is
often poorly absorbed, so many doctors believe the
ratio should be closer to 1/1.
Please note that not all forms are the
same. Magnesium oxide is one of the most common, but studies have shown
it to be poorly absorbed, due to low solubility. Studies show that other
common forms, such as citrate, chloride, aspartate, are all better
absorbed. However, some people instead recommend chelated forms,
believing that they are the best absorbed..
Although in theory this might be true, surprisingly there are no published
studies to back up this claim. .
If one brand of magnesium does not work for
you, or if you experience a side effect, consider switching to a different
brand, as the substance which is combined with the magnesium may be the cause
of the side effect. Many people have found that liquid forms of magnesium
help when pills do not help.. This is probably
due to increased solubility. There are various forms of liquid magnesium,
i.e. magnesium chloride, gluconate, and citrate. Magnesium chloride is
well absorbed, although the liquid form has to be kept refrigerated.
Liquid gluocate (magonate) contains not only a lot of glucose, but several
additives to make it taste better, and also a perservative to keep it from
spoiling. Liquid magnesium citrate is the most common liquid form.. Some people believe that magnesium citrate is not
well absorbed, and point to the fact that magnesium citrate is marketed as a
laxative. On the other hand, almost any form of magnesium, taken in
excess, will cause a laxative effect. Magnesium citrate is probably used
as a laxative, simply because it's an inexpensive form, and very soluable.
Another form which some people find very
useful is the time released version. Having a steady source of magnesium
has been found to help in cases where plain magnesium did not help. One
can do this by taking lots of small doses, especially if one uses a liquid
form, but this is inconvenient. Time released supposedly is absorbed over
a 8-10 hour period. There are 2 available forms,
magnesium chloride and magnesium lactate Two
brands are available which contain magnesium chloride, Slow Mag and
Pro-Mag. Slow Mag contains several additives that Pro-Mag does not.
Plus, Slow Mag is enteric coated, which is done to avoid a stomach upset.. However, one study suggests that this may prevent
proper absorption. Pro-Mag is made by Douglas Laboratories, and I
personally have had good results with it. Another good alternative is
Mag-Tab. It contains magnesium lactate, and has been reported by some people
to be even better absorbed than the magnesium chloride, possibly because it is
released over a longer period of time. Time released forms are more
expensive, so many people recommend a combination of pills and time released,
and it may be more effective to combine a slow acting form with a quickly
acting form.
Also note that B vitamins are necessary for
proper utilization of magnesium. Some people with fibromyalgia might have
B vitamin deficiencies, especially B12. One study, has shown that homocysteine levels are high in
the cerebrospinal fluid, and this indicates low levels of B12 in the
brain. Additionally, homocysteine causes a depletion of intracellular
free magnesium:, and according to the following study,
only a combination of B6, B12, and folate acid can stop this depletion of
magnesium. Thus, some people with fibromyalgia might benefit from B
vitamin supplementation. (However, certain B12 deficiencies require B12
shots, as some people are unable to orally absorb enough B12.)
In some people, the problem might not be enough magnesium, but instead might be
not enough vitamin D, which has an effect on magnesium absorption. Up
until recently, doctors only associated a vitamin D deficiency with weak bones,
and they believed that a vitamin D deficiency in young people was rare in
countries like the
In some cases, the deficiency leads to
myopathy, with quite severe muscle weakness, especially affecting the legs and
ability to walk. On the other hand, sometimes the symptoms are less
severe, in which case it could be easily overlooked in fibromyalgia patients.
In fact, several small studies have shown that at least 40% of patients with
fibromyalgia have a vitamin D deficiency.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12810939
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11708429
And while some blood tests can possibly indicate a vitamin D deficiency, often
a deficiency can exist without any other biochemical changes.
Thus, the only definite way to tell if you have this problem,
is by testing vitamin D levels. Unfortunately, very few doctors do
this. So It's quite possible that some people
who have fibromyalgia, might also have a vitamin D deficiency. Or perhaps
they never had fibromyalgia to begin with. In the following study from
Canada, only 12% of patients referred to rheumatologists with the diagnosis of
fibromyalgia, actually had fibromyalgia:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12595620
I personally started taking magnesium for spasms and facial tics, only doing so
on my own after neurologists simply told me to either get better sleep or take
a prescription drug. The magnesium helped almost immediately, and I then
slowly increased the dose to about 225% the RDA (balanced with 100% calcium
RDA) At that point, all spasms and tics stopped completely, and they have not
returned since starting that dose several years ago. I doubt any
traditional doctor would have been willing to prescribe that much magnesium.
The RDA is 400mg, but many people believe this is too low. Traditionally,
it's been recommended to take calcium and magnesium in a ratio of 2/1.
But magnesium is less easily absorbed than calcium, so this ratio may not be
valid for a lot of people, and in fact many cal-mag combinations found in
health food stores often have additional magnesium.
Magnesium is just one of many helpful
remedies and/or supplements for that might be helpful for fibromyalgia.
It's not a cure, but it may be helpful in relieving some of the symptoms. For
more information about magnesium, click here to read Sandy
Simmons's web page on magnesium.
Copyright (c) 2007
Contents of this article are the property of Mark R. London, MRL@PSFC.MIT.EDU Contents can be forwarded to other people and posted
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used in any way in any other media, without permission of the author.
Mark London MRL@PSFC.MIT.EDU