In a previous article, I touched on supplements and their role in fibromyalgia. Supplements play a supportive role but don’t replace recommendations to control symptoms like exercise, mindfulness, stress reduction, and sleep (click here to learn about the other approaches recommended, courtesy of the National Fibromyalgia Association). They don’t replace pharmacologic options either, understanding those have their own limitations as well. Instead, their role is to help reduce symptoms a little bit.

“A little bit” isn’t a bad thing! When you combine that little bit of relief with the relief provided from gradual exercise, getting sleep on track, and becoming more mindful, we end up with a sum greater than its parts.

With that in mind, I wanted to focus today on one of the better known and effective supplements, magnesium. I get asked about magnesium in my office on an incredibly regular basis. There’s been an interest in magnesium for fibromyalgia and a number of other disorders related to muscles for decades but probably only in the last 10 years or so we’re seeing more robust studies that really shed light on what magnesium can do for us.

Magnesium and Its Importance

Magnesium is a mineral that we use in our bodies to serve a number of different functions. Along with calcium, sodium, and potassium, these are essential for muscles to be able to contract effectively and to relax equally well. When we run deficient in magnesium, we can run into issues with muscle spasm, i.e., muscles failing to fully release.

This is where the theory comes in that there may be a benefit in fibromyalgia. While we don’t think that muscle tension is the source of the muscle pain we experience in centralized pain like fibromyalgia, we do think it plays a role in making things worse. For quite some time, we’ve been seeing a relationship between a boosted magnesium level and pain relief, stress relief, and even insomnia relief, particularly in this group.

Several studies have shown this in quality:

  • One randomized trial from 2022 shows 100mg of a magnesium salt per day reduced stress and pain severity over one month.1
  • Another group studied premenopausal women with fibromyalgia who received either magnesium citrate alone or in combination with amitriptyline, a medication we use to help regulate neurotransmitters in fibromyalgia (and other disorders). The magnesium on its own significantly decreased the number of tender points and improved overall quality of life and the effect was even more pronounced when combined with amitriptyline (a combination we commonly suggest and use any way!)2
  • One particular gem of a paper was a systematic review (where authors critically appraise a number of different trials and compile them to a conclusion) that was published in 2022. It showed that several dietary supplements, magnesium among them, significantly relieved pain in fibromyalgia patients.3
We need to be careful with supplements in general…

and look for the data, like the above, to back it. I’m overall picky with supplements I recommend to my patients. I don’t engage in snake oil; if I recommend something, I want to see the data that proves it can help instead of wholesale suggesting options that just end up raking through your savings without any benefit. Just a reminder too: supplements are NOT regulated by the FDA and there are so, so many out there who would fleece us for a dollar. That said, when it comes to magnesium, I’ve consistently seen enough evidence to say it’s worth a try for most.

Which Magnesium to Choose?

Quick background: magnesium is a mineral that, when bound to another substance, is called a magnesium salt (e.g., magnesium oxide, magnesium citrate, malate, glycinate, etc.). It doesn’t float through our body freely unless it’s attached to that salt (or something else). What it is attached to helps define how well that magnesium absorbs from our gut when we take an oral supplement. Some formulations, like magnesium oxide, don’t absorb well compared to magnesium citrate, malate, and glycinate. In fact, some forms of magnesium purposely do not absorb well and we use those as laxatives (see Milk of Magnesia here aka magnesium hydroxide). We want to choose a highly bioavailable (read: absorbable) magnesium salt for our purposes, and those salts would be glycinate, malate, and citrate.

Magnesium citrate actually has the most data supporting its use and is usually the type chosen in larger scale studies. Magnesium glycinate has been getting increasing attention since it has been shown to do even better than magnesium citrate but we overall have fewer studies specifically looking at that and fibromyalgia pain. There’s no reason to think it would provide less benefit than the more tried-and-true citrate versions but we just haven’t proven it yet. Magnesium malate is fantastic and actually appears to be the most bioavailable salt, even better than citrate and glycinate.

Does Bioavailability Matter?

Does the best bioavailability matter that much? I’d argue no. Even citrate, where magnesium malate and magnesium glycinate may have greater bioavailability, has still been shown to be extremely effective in studies dating back more than 10 years. I’d argue obtaining an affordable, reliable salt from a good brand matters more than choosing the absolute most bioavailable option in most scenarios. Everyone’s situation will be different, and ultimately this comes down to personal preference in my opinion. I recommend Nature’s Made brand as a particularly reliable (and affordable!) choice. They offer a glycinate and citrate option (but no malate, at least at time of writing).

Who Shouldn’t Take Magnesium?

Ultimately, magnesium is a mineral that we can run into trouble with if we have poor kidney function. Those who have advanced kidney disease with a glomerular filtration rate (GFR) lower than 30 (that’s chronic kidney disease stage 4 or worse) should ask their physicians for guidance. Otherwise, magnesium is a safe substance to take. In fact, most of us are found to be a touch magnesium deficient when running lab checks and therefore a dose of 200 to 400 milligrams per night, depending on the salt, can be perfect for a large number of us and brings our levels into a normal range.

Do not overdo it! Overdosing on magnesium is possible. The 200 to 400 milligrams a night is a good dose for the vast majority of us, although on occasion doubling this for a few days may be helpful for flares – ask your physician for guidance.

Conclusion

In conclusion, magnesium is a safe and essential mineral that we know is tightly associated with muscle function and has a host of other critical functions throughout the body. There may be a deficiency in magnesium in many of us that would benefit from regular supplementation, and this supplementation might be even more helpful for fibromyalgia sufferers than others. We can (not always, unfortunately!) see reductions in pain and stress, and improved relaxation leading to better sleep with magnesium supplementation. This is a non-starter with any significant, background with kidney disease and should be discussed with your physician before starting. You should always speak with your primary Physician BEFORE starting any supplement, including magnesium. Magnesium can decrease the absorption of some medications or interact with them. (Potential issues/caution with  medications for Parkinsons, certain antibiotics, gabapentin, blood thinners, muscle relaxers and diuretics)

If you’re interested in hearing a deep dive about other supplements, send me an email at ztfellows@synergyrheum.com and let me know what you’d like to hear about in a future post. Join my free mailing list as well for the latest access to the blog and other helpful resources here: https://synergyrheum.com/contact/

*******************************************************************************************************************************

  1. Macian N, Dualé C, Voute M, et al. Short-Term Magnesium Therapy Alleviates Moderate Stress in Patients with Fibromyalgia: A Randomized Double-Blind Clinical Trial. Nutrients. 2022;14(10):2088. Published 2022 May 17. doi:10.3390/nu141020882.
  2. Bagis S, Karabiber M, As I, Tamer L, Erdogan C, Atalay A. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia?. Rheumatol Int. 2013;33(1):167-172. doi:10.1007/s00296-011-2334-83.
  3. Lim KT, Lim KH, Zhou X, et al. Dietary Supplements for Pain Relief in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Chin Med. 2022;50(5):1197-1218. doi:10.1142/S0192415X22500495