Iron + magnesium - bothered

[PoorRichard]

I am experimenting with magnesium following some recent posts. I believe someone (jools?) is taking 100mg. I'm using magnesium bisglycinate and took one (88mg) last night, about 30 min before taking my alternate day iron bisglycinate (25mg) [on an empty stomach, of course]. The prior night had been RLS free with no meds or supplement. Last night, I drifted off to sleep (yay) but suddenly was yanked awake by a giant PLM contraction. It was all downhill from there - major RLS episode. Finally at 2am a 2nd iron dose seemed to calm the system. I'm feeling frustrated and discouraged. I'm close to resuming gabapentin* but, first, a few questions:

- Is timing of the magnesium important?

- Most medical advice is to take iron supplement on alternating days to aid in absorbtion - does taking it everyday (or, like last night 2x) generate any issues, like increased hepcidin?

- Similarly, is there a build up of tolerance to iron that makes it less effective?

- I've been vigilant about known triggers - why was two nights ago with no meds a "successful" night and lastnight such a disaster?

- What's the word on dipyridamole? Should I look into that instead of gabapentin/pregabalin?

*Note - my reluctance to resume gabapentin is because of side effects - loss of daytime focus, especially. I am a woodworker hobbyist. I am at risk around potentially lethal equipment if my wits aren't about me.

[Hidden]

Hi PoorRichard

To answer your questions:

- Is timing of the magnesium important?

I can't comment on this, only to say if you resume gabapentin, you should leave at least two hours between gabapentin and magnesium.

- Most medical advice is to take iron supplement on alternating days to aid in absorbtion - does taking it everyday (or, like last night 2x) generate any issues, like increased hepcidin?

Yes it does. This is why the advice is to take it on alternate days.

- Similarly, is there a build up of tolerance to iron that makes it less effective?

No. However it is always recommended to take iron supplements under medical guidance so that iron levels can be monitored.

- I've been vigilant about known triggers - why was two nights ago with no meds a "successful" night and last night such a disaster?

RLS / PLMD symptoms can differ from night to night. Triggers can "trigger" RLS but that's not to say that the symptoms won't be there in the absence of a trigger.

- What's the word on dipyridamole? Should I look into that instead of gabapentin/pregabalin?

Gabapentin/pregabalin is an established therapy for RLS/PLMD. Dipyridamole is not. That's not to say it isn't effective. There are several papers suggesting that it can be effective but that doesn't mean it's effective for everyone. If you search this forum, you'll see others have tried dipyridamole without success.

All the best.

[PoorRichard in reply to Hidden]

Thank you - my sleep doctor (who trained under Dr. Winkleman in Boston) also suggested alternating days for iron. When symptoms flare, I take it regardless of the schedule (hence my question about hepcidin and whether I'm compounding the problem). Duly noted about magnesium and gabapentin. I'm still experimenting with magnesium timing - I moved it earlier last night. Better.

[Hidden]

By taking your magnesium supplement about 30 minutes before the iron I BELIEVE you effectively negated a good portion of the benefit of that first iron tab hence requiring the need for a second one.

"Magnesium and manganese, two common minerals found in multivitamin supplements, also interact with iron. Magnesium may decrease non-heme iron absorption if the two nutrients are taken together. Manganese takes the short end of the stick here, as concomitant intake of both iron and magnesium is thought to negatively impact manganese absorption."

I forget, are you one of the people on here who stop eating any and all food in the early part of the evening? If you're not, then you might want to try fasting from about 7pm (or earlier) until breakfast, every single night. I would try that before going back on the Gaba. Even if you cheat one night, I think you know by now that one or two iron tabs and you're home free.

[PoorRichard in reply to Hidden]

Yes, I routinely fast ~7pm - 8am. Last night I took the magnesium two hours prior to iron. Better. Any concern on daily iron vs. hepcidin levels?

[Hidden in reply to PoorRichard]

No concern. Hepcidin is not like ferritin, not cumulative. Hepcidin follows a circadian rhythm similar to iron. It's very low in the morning and increases through-out the day and then makes it way back down by early evening...I believe. Thus best to take iron in the latter part of the evening or morning. Since I'm interested in stopping the symptoms of RLS, rather than raising my ferritin, I would never take it in the morning. Taking an iron supplement, or eating one of those 72 ounce steaks they have at a restaurant in Amarillo Texas, I'm sure elevates hepcidin but it still follows that circadian rhythm. I'd have to research it, but I bet even in the face of infection when hepcidin is elevated it still follows that circadian rhythm... just at a higher level.

[agapepilgrim]

Only magnesium citrate works for me, and I take it about an hour before bedtime without iron. From my research, iron supplements should be taken alone. I take 600 mg of magnesium citrate to be effective. Gabapentin caused me to lose control of my bladder. I tried other forms of magnesium and only the citrate works for me. Also, if I am on my feet a lot during the day, the RLS seems to be worse, and I take 100 mg more.

[Hidden in reply to agapepilgrim]

How wonderful that the magnesium rids you of the symptoms of RLS. I peeked at your profile and saw that you have MS. May I ask you if you know your blood type? I have blood type O. My husband has blood type B and my mother had A. There is also the very rare AB blood type.

[WideBody in reply to Hidden]

Why blood type? Just wondering.

[Hidden in reply to WideBody]

Many years ago I read a book called "Eat Right for Your Blood Type." According to the author it is mainly people with Blood Type B that get these "exotic" auto-immune diseases like MS and ALS (as opposed to Rheumatoid Arthritis, Cancer). So for over 10 years now whenever I ask someone who has an "exotic" auto-immune disease what their blood type is sure enough it is always B. Jools is the 10 year exception. My little personal survey does not a clinical trial make. I'm sure there are plenty of people with the other blood types who have these diseases.

[Joolsg]

Others have given excellent advice. Magnesium Citrate doesn't help my RLS in the slightest but I still take it every evening as a laxative to counter any opioid induced constipation.Whether you continue with the iron/Magnesium regime depends on the severity of your RLS. If it's mild, then supplements may be all you need. If it starts to affect your daily life through sleep loss, you may want to consider medications.

Gabapentin and pregabalin are known to cause dizziness and, as in your case, lack of focus. Most side effects of gabapentin tend to settle after about 3 months and taking only in the evening should minimise the dizziness/ lack of focus.

[PoorRichard in reply to Joolsg]

Thank you. I'm determined to try other routes before resuming gabapentin, but I'm not ruling it out. Currently, I have occasional nights with no symptoms at all; then, there's the other nights. Hard to want to resume gp as a routine - but I understand it's not an "as needed" drug, like aspirin or paracetamol.

[Joolsg in reply to PoorRichard]

Unfortunately not. Most people will need daily meds.

[Hidden in reply to PoorRichard]

I don't think the iron will fail you on those "other" nights.

[Hope61]

I am curently on 1300mg of Gabapentin and try to take iron with Vit C every other night. I am feeling kind of feeble and I'm only 57. I am forgetful and don't feel 100% if that makes any sense. Wondering if these are all side effects of the med.? I have tried to get into John Hopkins and all I get is a form letter saying they are not taking any new patients. I was going to try the hospital in Mass. next. I think that is Dr. Winkleman? The NP I am with is not responsive. I called last monday and left a message, I called last Tuesday and left another and I still have not heard from her I am really tired of all this