Magnesium for RLS

[ChrisColumbus]

Merry Christmas!

While I've said the below in various Replies, I thought I'd put it in a post.

I've been taking at least 400mg a day of magnesium citrate for some years now, since I had it recommended to me by a relative: 600mg a day initially stopped my RLS within days, and 400mg a day (the amount suggested for 200mg tablets on UK packaging) has helped ever since.

Some still insist that there's no evidence that magnesium helps RLS, but in my view that's partly because too few substantial studies have been done, and those that have been done have been at too low a dose. (A recent one was at just 100mg a day). [UPDATE: I've now seen pics of some US Mg citrate bottles of 100mg a day tablets which advise against taking more than one a day. Over cautious in the extreme.]

NOTE: if someone has kidney problems they need to be careful with magnesium: normal kidney function will excrete excessive levels, but dangerous hypermagnesemia can occur in people with acute or chronic kidney disease.

It doesn't help everyone by any means, perhaps partly because some triggers and exacerbators will - as in my experience with statins, aspartame and others - overwhelm it. (It doesn't even help my brother). I also suspect it won't help much - if at all - if you're augmenting on a DA or something else.

Anyway, I knew I was running out of pills a few days ago but delayed getting more, thinking there must be enough magnesium in my system by now. So I didn't take any pills on one day and on that night I had the worst RLS I'd had in the last year (since coming off statins). So the next day I rushed out and bought more pills - and haven't had RLS again since.

So - it works for me. It may or may not work for you. Iron supplements never worked for me (and my serum ferritin has never been low anyway); magnesium oxide did not work (it's not easily absorbed, you're paying for expensive urine); magnesium oil spray didn't work for me, but it does work for some. Some people favour Epsom salts (magnesium sulphate) in the bath: I've not tried.

One caution: some people can't tolerate magnesium citrate because it can cause diarrhoea. I certainly don't recommend taking more than 200mg at a time: spread it out over the day if you're taking 400-600 mg.

Magnesium glycinate is sometimes recommended, particularly in the US, because it reportedly aids sleep and doesn't cause diarrhoea: I've not found this in retail outlets in the UK.

[Hidden]

Magnesium is a dopamine antagonist. pubmed.ncbi.nlm.nih.gov/920... This is just one article, there are many more. I, for one, believe that it’s possible to take a dopamine antagonist by day, up-regulate your receptors ever so slightly, then reap the benefit that night - provided you don’t fall into post DA category. I would hope that if taken long enough you could take a day off the dopamine antagonist and still have lessened RLS symptoms at night. Yet I can’t take a night off the iron. Or there might be a totally different reason the magnesium works to relieve the symptoms of RLS. I recently took Benedryl one afternoon (a dopamine antagonist as you know) and I didn’t have RLS that night. I need to repeat that about a 1000 more times before any conclusions can be drawn 😳

[ChrisColumbus in reply to Hidden]

Interesting. I'd read that magnesium was required for muscle relaxation and nerve impulse transmission so had assumed that this might be the connection with RLS....

[Hidden in reply to ChrisColumbus]

Maybe? But I would think that improvement in those areas would be over the long run, not immediate. And once improved, shouldn’t you be able to take a night off?

[Hidden in reply to ChrisColumbus]

Calcium on the other hand seems to be just the opposite of magnesium and probably why calcium channel blockers are so bad for the symptoms of RLS. link.springer.com/article/1...

[Madlegs1 in reply to Hidden]

Interesting - I find magnesium does settle me and help sleep ( maybe placebo ?)

I have to also take calcium channel blocker for hypertension, but it seems to have no effect on the RLS.

I suppose everyone is different!!

Great discussion, lads.

[Hidden in reply to Madlegs1]

It is fascinating isn’t it. But your experience is not adding any weight to my theories. 🙄

[Hidden in reply to ChrisColumbus]

This article is pretty darn amazing. Find a calcium supplement that can cross the BBB and we might have a new “it” supplement for RLS. Magnesium by day and calcium by night??? pubmed.ncbi.nlm.nih.gov/110...

[AnotherRLScase in reply to Hidden]

I had wondered about Magnesium being a dopamine agonist. I took it for several years, and at first it was like a miracle. A couple of years on though, I needed more and more, and before I stopped taking it experienced what I can only describe as severe augmentation - symptoms affecting the whole body, all the usual things people experience with augmentation. I stopped taking it cold turkey after experiencing irregular heartbeats. On the plus side, after I stopped taking it the RLS settled back down to about where it was before I had started it.

[ChrisColumbus in reply to AnotherRLScase]

It sounds a bit like hypermagnesemia, although why this should have occurred when taking normal levels of supplements I can't imagine, unless you had some undiagnosed renal issues at the same time.

Having too much magnesium in the blood is uncommon without kidney problems. Western diets tend to be deficient in magnesium even when one eats plenty of foods traditionally high in the mineral. This has been linked with mineral depletion in the soil, which is particularly the case in intensive agricultural production without proper crop rotation.

Perhaps augmentation is an answer although I haven't previously heard of this in the context of magnesium. I've been taking it for many years without an issue, but then not everyone on DAs seems to augment.

[marsha2306 in reply to ChrisColumbus]

Agree about taking too much magnesium. My doc said I shouldn’t take more than 340 mg.

Also, I have never heard of it being a dopamine agonist…

[ChrisColumbus in reply to marsha2306]

340mg/day is one guideline sometimes quoted, but you'll also see figures suggesting anything from 250mg (for women) up to to 400mg. Both Solgar and Holland & Barrett 200mg tablets in the UK quote a daily dose of 400mg. I never found 600mg/day for a limited time to be a problem, but it depends like most things on personal sensitivity to the material. I find taking more than 200mg in one dose can be a problem, but I have mild radiation proctitis of the bowel...

[Hidden in reply to AnotherRLScase]

No, I think what you were experiencing were the effects of a good dopamine antagonist. The more you took the more symptomatic you became - no different then if you were to take melatonin. I think if you restricted the magnesium to mornings (and within the RDA) and maybe balanced it out with calcium you wouldn’t have gotten restless body at night. When you stopped the magnesium I would hope and almost expect your RLS to be even better than your baseline. If the magnesium had truly thrown you into augmentation - meaning it down-regulated your lousy receptors even further - then it would take months for your receptors to recover from the assault as it does with the DAs and you would be in unspeakable misery.

Why did you stop taking the nightly iron which seemed to work for you from the first night? It provides me with complete relief within one hour and has been doing so for close to a decade now. Gotta be ferrous bisglycinate and gotta be before bed.

[AnotherRLScase in reply to Hidden]

This was a couple years ago, before the iron & other things I'm taking now. Those are working wonderfully so far, and at present I don't have plans to change anything.

As to the magnesium, you may be right as I didn't experience a flare-up of symptoms after stopping it, and in fact it did seem milder.

In response to ChrisColumbus, I was taking way too much magnesium, not a normal dose at all. I had actually switched from mag. malate to mag. taurate in hopes that a different form would reduce the amount I needed to ease symptoms, but even though I took much less of the taurate it was too much for my system. It was also just a generally bad time for my health. I'm doing very well now, however.

[ChrisColumbus in reply to AnotherRLScase]

A warning to us all: more of anything isn't necessarily better! Glad you realised and it hasn't done permanent damage. Keep well!

[TeddiJ in reply to Hidden]

Hi and Happy Holidays! So, are you saying we shouldn’t be taking high doses of mag citrate? Because I do almost every day-I  usually take 4 pills of mag citrate from Life Extension.

[Hidden in reply to TeddiJ]

I really can’t say. I personally would only take the magnesium in morning or afternoon and stay pretty close to amount recommended on the bottle. Then I would probably balance it out by taking a calcium tablet with evening meal. Are you still taking the berberine?

So how are you doing in general? Are you able to live a full life despite RLS?Have you been able to keep Kratom at same dose as when you began? Have you given up on iron? Do you have any sense whether or not RLS is lessening? Do you feel like you have returned to baseline? I know you’ve mentioned the need for a long range plan, but I personally like the one you’re doing right now. You’re taking a dopamine antagonist(s) by day to up-regulate your receptors, then by night you have a few rescue meds to choose from - Kratom, Suboxone, Delta 8, iron. AND you’re not beholden to some unresponsive doctor. Maybe every post-DA sufferer should heed what you have devised?

[TeddiJ in reply to Hidden]

Hi. Thanks! No, I do not feel I have returned to baseline at all. Things actually seem much worse than they used to be, including when I was taking the DA’s. I don’t take a lot of kratom, I don’t think, but I do worry about taking it every night. The suboxone gives me the strangest stomach “sit-up” contractions. A little of it does help here and there. I lead a full life but am also afraid to have my boyfriend, or anyone, spend the night with me. I often sleep late and need to piece together the 8 hours of sleep. The Delta 8 definitely helps, so thank you for that tip! I had assumed it would be like taking the THC gummies from the pot shop but the 50 mg delta 8’s are much stronger and work much better. I tried iron again the other night, late evening, but it did not stop the rls I had that time. I have not yet gone back to the berberine-stopped it around TDay. At least I can usually go through late morning, and all afternoon/evening, without taking anything…which is good, relatively speaking.

I feel like I have less rls but more plmd symptoms now.

And, yes, not feeling that monthly stress of getting opioids is definitely MUCH better for my mental health.

I will start taking the magnesium much earlier, and less of it!

Thanks for your input and perspective!

[Hidden in reply to TeddiJ]

Did the worsened symptoms begin with the magnesium?

[TeddiJ in reply to Hidden]

I don’t know but I will definitely test it out. All this time I thought I needed more of it for the constipation issues from the opioids and the kratom. Years ago I was low on magnesium and I thought I had some dread disease-I couldn’t even turn the pages of a book and my legs were weak and shaky until I upped the magnesium. So, I have been conscious of taking it for years and then this forum encouraged magnesium big-time. I never heard  that it had to be taken early in the day!

Basically, things have been bad since I stopped the DA’s. Last night I had to take 2 teaspoons of kratom every 2-3 hours-not ideal. Honestly, I will keep trying but I don’t remember it being this bad and sleep this difficult while on the DA’s.

[Hidden in reply to TeddiJ]

yes, please take magnesium earlier in the day. It may not help but worth a try. Or give it a break for a few days and see if that helps.

[SueJohnson in reply to TeddiJ]

It is usually taken at night, but you can certainly try it earlier in the day.

[ChrisColumbus in reply to SueJohnson]

Which magnesium salt are you recommending Sue, and what dosage?

I'm not sure that there's any particular benefit in taking magnesium at night: I've found that it appears to work spreading it through the day.

And for people taking e.g. iron and/or gabapentin in the evening, taking magnesium earlier in the day helps to avoid absorption clashes.

[SueJohnson in reply to ChrisColumbus]

Magnesium glycinate is the one usually recommended and has fewer side effects than others. I don't have a recommendation as to the amount.

[ChrisColumbus in reply to SueJohnson]

I think MgGlycinate may be more readily available retail OTC in the US than it is in the UK: I'm not saying that it's impossible to find here (and I'm sure I could get it over the web). But I think the important thing - for RLS - is to get either the glycinate or citrate, whichever you can find, but not to settle for the oxide. Oxide is fine as a laxative but that's about it!

[ChrisColumbus in reply to TeddiJ]

"almost every day.... 4 pills of mag citrate"

100mg or 200mg pills?

(UPDATE: I see that Life Extension do 100mg MgCit pills, 160mg pills - although I'm not sure that these are available at present - and other pills combining various forms of Mg)

But even if it's 4x200mg pills, while it's much higher than recommended, your body may handle it if it's for a short period - and excrete the excess - as long as your kidney function is very good. But you're probably not gaining anything by (potentially) taking up to 800mg a day, just wasting some money and pouring it down the drain. BUT if your kidney function is in any way compromised you could be building up trouble.

(UPDATE again: if you're taking Life Extension 500mg magnesium caps containing magnesium oxide, citrate and succinate I'd be very cautious about taking more than 1 or just possibly 2 a day).

[TeddiJ in reply to ChrisColumbus]

They are the veggie capsules at 100 mg’s each. It says 1 per day as the serving. I am very healthy other than this awful rls issue, at least as far as I know. Thank you for checking and your thoughts.

[ChrisColumbus in reply to TeddiJ]

The two main brands of MgCit in the UK recommend a daily dose of 400mg, 2x200mg. (They should - but don't- make it clear that it's best not to take 400mg in one go, as that's more likely to cause diarrhoea...) Taking 4×100mg pills throughout a day *shouldn't* be a problem for most people, but it will depend on renal and general health.

[TeddiJ in reply to ChrisColumbus]

Thank you-good to know. I actually want the loose stools, due to the constant constipation I now have. Even taking the 4 pills barely gets things moving, if at all! 

[rmbroadh]

I started taking magnesium glycinate (sp) for 5 nights and have not had any rls. Take 100mg after dinner. Suggested daily is 200mg but wanted to start low.Am praying this will really work!

[Abby2525]

I’ve read that one mustn’t take magnesium within three hours of taking pregabalin. I’ve been on pregabalin now (350 mg) in the evening and that is working to control the RLS symptoms.

I have the best results with the pregabalin if I don’t eat after 2 or 3 in the afternoon and then take the pregabalin about 8:00. So I don’t know how I could take magnesium at night.

[ChrisColumbus in reply to Abby2525]

I take 200mg of Magnesium Citrate at breakfast and 200mg at lunch; when I was taking 600mg a day I took the additional 200mg in the evening - but then I wasn't taking any other medication in the evening (and still don't). [The dosage recommended on the packaging is 2x200mg a day taken with meals, with a warning not to exceed this dose. I in fact had no problem when I was taking 3x200mg a day at the beginning, but I wouldn't exceed that (and didn't do it for very long): AnotherRLScase says they were taking much more magnesium than they should have, and in my view that's what caused their problem rather than augmentation].

[Abby2525 in reply to ChrisColumbus]

Thank you for the information!! I will start taking it as you do.

[ChrisColumbus in reply to Abby2525]

Take care if you are particularly susceptible to the laxative effects of magnesium citrate. But on the other hand, my bowel was (advisedly mildly) damaged during radiotherapy last year, making me more susceptible than I used to be, but even so I find that if I take it as recommended it doesn't cause me any problems.

[Abby2525 in reply to ChrisColumbus]

thank you for the advice! I think any effect like that will probably be okay because the pregabalin does the opposite.

[marsha2306 in reply to Abby2525]

I take my last dose of Gabapentin at 7:45 in the evening and magnesium oxide at 11:00 pm. No issues with it.

[ChrisColumbus in reply to marsha2306]

Any relief you are getting *may* be solely from the gabapentin.

While magnesium oxide is generally the easiest and cheapest magnesium salt to find, and it is often used in medical contexts primarily as a laxative, a 2019 study testing 15 magnesium supplements found that magnesium oxide had the lowest bioavailability.

A 2017 study concluded that in rats only 15% of orally administered magnesium oxide was absorbed, while 85% was excreted.

Earlier research suggests the absorption rate is even lower in humans.

Magnesium citrate, magnesium acetyl taurate, magnesium malate, and magnesium glycinate all have high absorption rates and are more effective at increasing magnesium levels.

[Grammieof4 in reply to ChrisColumbus]

I started taking it due to constipation. A friend of mine swore by 3A Magnesia and it definitely helps that.

My point was that I do wait 3 hours after taking the gabapentin (which I take for nerve damage as well as RLS.)

[ChrisColumbus in reply to Grammieof4]

I'm a little confused, as the post that I replied to appeared to have come from marsha2306 whereas the follow-up appears to be from Grammieof4 ? Are you one and the same, or is there some profile confusion? The two profiles were set up on the same day...

Understood that whoever this is from you're taking magnesium oxide primarily for constipation, and you're doing so without clashing with gabapentin!

[Grammieof4 in reply to ChrisColumbus]

yes, same person but I honestly don’t know how that happened.

So now this is my user name

[Abby2525 in reply to marsha2306]

Thank you. I don’t know if the magnesium interferes with gabapentin the way it does with pregabalin if you take it within three hours. But I can try to time all of it and take magnesium if I’m still up after three hours have passed after taking the pregabalin. I’m first going to try taking it with breakfast and lunch.

[marsha2306 in reply to Abby2525]

it does interfere with gabapentin too. I take my gabapentin when I wake up, 3:00 and then at 7:45. So I can take the magnesium any time after 10:45 at night.

[Glory2022]

Hi ChrisThanks for your post.. I was wondering about when you ran out of the magnesium citrate tablets and got an extreme RLS all over body reaction. Do you think that means your body got addicted to the magnesium - therefore making it necessary to keep taking ongoing otherwise your RLS will get worse? ( Would you say the reaction to not taking the magnesium for a night is similar to when people suddenly stop taking DA drugs?) Thx Julie

[ChrisColumbus in reply to Glory2022]

Well, thanks for the thought - I guess anything's possible: I've been taking Mg for many years, but have not noticed a reaction on previous occasions when for one reason or another I've not taken it.

On the other hand, my system is currently a bit messed up by a recent first bout of Covid together with mild radiation proctitis of the bowel, so who knows what inflammatory processes are at work.

At least I don't have to keep taking more, or find that it's making RLS worse! But I may experiment in due course: perhaps as a start I'll try cutting back to 200mg a day - half the recommended dose given on the packaging.

[Glory2022 in reply to ChrisColumbus]

It's great you have been getting relief from your restless legs. I've tried magnesium in the past but it made zero difference to my RLS. I don't think I tried magnesium citrate.. so I might give it ago.

[ChrisColumbus in reply to Glory2022]

Citrate and advisedly glycinate are good oral supplements. Citrate packaging in the US sometimes suggests only taking 1x100mg pill a day, which in my view would be ineffective for most.

Oxide isn't bad as a laxative but isn't absorbable enough to help RLS much; I suspect the same of carbonate, but don't know that for sure.

[Glory2022 in reply to ChrisColumbus]

One other question.. I've read it's important to take Calcium in balance with magnesium in a two to one ratio, with twice as much calcium as magnesium. What are your thoughts?

[ChrisColumbus in reply to Glory2022]

I've read that, and I've also seen the minerals packaged together. But I've also read that increasing calcium in the diet significantly reduces the absorption of magnesium, that magnesium is necessary for the proper absorption of calcium and potassium, and that too much calcium and too little magnesium leads to heart problems.

I've not read anything that I'd consider both definitive and incontrovertible. I don't take any calcium supplements, but do eat plenty (possibly too much?) cheese, yoghurt, creme fraiche etc.

TL;DR: don't know

[Glory2022 in reply to ChrisColumbus]

Well my calcium number is within the normal range so I don't see why I would need to take supplements

[ChrisColumbus in reply to Glory2022]

Good luck with it whatever you decide!

[Glory2022 in reply to ChrisColumbus]

Thanks .. I hope you continue to get relief from your RLS. I've been searching for a cure for 30 years! I'm so glad I've never ventured down the drug path after reading some of the posts about augmentation and side effects!

[TeddiJ in reply to Glory2022]

you are SO lucky and wise to not have taken the DA drugs. I am surprised nothing has worked for you in 30 years, as it is those drugs that often make for limited solutions .

be sure to try 2 capsules of iron within one hour of going to bed….that would be the best and easiest solution for you. it doesn’t matter what your ferritin is, etc...just try it and see if the rls disappears before you fall asleep . Also, be sure to have some red vein kratom powder on hand for the desperate nights.

[Glory2022 in reply to TeddiJ]

I recently had an iron infusion which made a huge difference to my overall energy and general well being. I'm still waiting to see if kicks in to help my RLS symptoms. If it doesn't I will definetly try the capsules as you suggested👍

[Hidden in reply to Glory2022]

I agree with Teddi, ya gotta try two capsules of ferrous bisglycinate aka Gentle Iron (25mg each - some brands have 18 or 20mg) an hour before bed on an empty stomach. Don’t waste your time or money on ferrous sulfate.

You’re not taking any drugs like SSRIs, statins, Benedryl, HRT or melatonin that can make the symptoms of RLS worse than it has to be…are you? 🤨

[Glory2022 in reply to Hidden]

No I have never taken a drug for RLS (or any ailment for that matter). I feel so sorry for all the people who are suffering from side effects resulting in even more health issues (incl. worsening RLS). Thank you for your advice ... if the iron infusion doesn't work I may get one more and hope my ferriten levels go over 100. Otherwise I'll try the iron you suggested. 😊

[Hidden in reply to Glory2022]

Was there an event 30 years ago that seemed to set-off the RLS? This is somewhat personal, but do you have another condition (such as an auto-immune disease) that might be contributing to symptoms?

The infusion may very well be your ticket to RLS freedom, especially if you were anemic.

[Glory2022 in reply to Hidden]

Yes! 30 years ago I was pregnant and that's when it started. I was also anaemic. My B12, iron and ferritin levels have been low recently that's why I had the iron infusion. It's been over 3 weeks since I had it. It made an amazing difference to my energy levels but still no affect on my RLS. I might get another infusion and after that retest to see where my numbers are at.

[Hidden in reply to Glory2022]

Glory, do you recall what type of iron they used in the infusion?

[Glory2022 in reply to Hidden]

This is what they used for my iron infusion: ePrescription for Ferinject 1g/20mL Injection

[SueJohnson in reply to Glory2022]

Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, estrogen, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, using a standing desk, listening to music, meditation and yoga.

Many OTC supplements can make RLS worse. If you are taking any and you list them here, I can tell you if any make RLS symptoms worse and if so may be able to give you a safe substitute.

[SueJohnson in reply to Glory2022]

Dopamine agonists like pramipexole and ropinirole are definitely to be avoided as you have. However gabapentin or pregabalin do not lead to augmentation. Beginning dose is usually 300 mg gabapentin (75 mg pregabalin). It will take 3 weeks before it is fully effective. After that increase it by 100 mg (25 mg pregabalin) every couple of days until you find the dose that works for you. Take it 1 to 2 hours before bedtime. If you need more than 600 mg take the extra 4 hours before bedtime as it is not as well absorbed above 600 mg. If you need more than 1200 mg, take the extra 6 hours before bedtime. (You don't need to split the doses with pregabalin) Most of the side effects of gabapentin and pregabalin will disappear after a few weeks and the few that don't will usually lessen. Those that remain are usually worth it for the elimination of the RLS symptoms. According to the Mayo Clinic Updated Algorithm on RLS: "Most RLS patients require 1200 to 1800 mg of gabapentin (200 to 300 mg pregabalin) daily." Since you take magnesium don't take it within 3 hours of taking gabapentin or pregabalin as it will interfere with the absorption of them. Check out the Mayo Clinic Updated Algorithm on RLS which will tell you everything you want to know including about its treatment and refer your doctor to it if needed as many doctors do not know much about RLS or are not uptodate on it at Https://mayoclinicproceedings.org/a...

[Hidden in reply to ChrisColumbus]

Chris, I actually said that magnesium is just the opposite of a DA - I said it is a dopamine antagonist - and that’s from scientific articles. I’m not smart enough to make this stuff up

It was the member, AnotherRLScase, that thought it might act similar to a DA. If anything, it sounds like calcium (in the brain) facilitates the release of dopamine in the Striatum, similar to a DA. Hence, possibly the reason Calcium Channel Blockers worsen the symptoms of RLS. ..especially the ones that cross the Blood Brain Barrier. There are some people on here who indicate that their Calcium Channel Blocker does not worsen their RLS. That might be because they are taking the one class that does not cross the BBB.

Magnesium cuts down on the release of dopamine. Thus, it sounds like something you should not take close to bedtime because theoretically speaking it will make the symptoms of RLS worse. HOWEVER, I truly believe that short-acting dopamine antagonists, like magnesium, might be the closest thing to a cure (a cure that must be taken on and off for the rest of our lives) since they “up-regulate” our receptors (maybe) which is just the opposite of what the DAs do which is “down-regulate” (without a doubt) our already genetically lousy dopamine receptors.

Make sense?

[ChrisColumbus in reply to Hidden]

Ah, sorry, I misread/ misremembered - ref deleted!

[Hidden in reply to ChrisColumbus]

You didn’t need to do that. I just find it interesting actually and worth repeating.