Medications - Other Options (incl. Magnesium types - detailed)

Hello my friends, I’ve had Fibro for years and have tried a wide variety of drugs. In fact I was on so many I could hardly function. I’m not a big one on taking drugs and if you read the side effects it pretty much scared the hell out of you.

With all that being said I with my doctors guidance weaned myself all but on drug Trazadone 100 mg at night to sleep.

For me the side effects I was having was worse than the pain.

I tried Acupuncture, chiropractor, bio-feedback etc etc etc searching for the one perfect therapy. For me I do a few things like red light therapy, water therapy, chair yoga just to name a few. I also worked with a nutritionist and with all that being said I think I’m in the best place I can be right now.

I’m not saying I don’t have flare ups and I am definitely in some level of pain each day.

But I try to create a weekly activity chart so it gives me a reason to get up. I have been doing some light volunteer work which warms my heart.

My message to all of you, find your path and wishing you all success in your journey.

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Hi there - nice to meet you… very similar here: no meds any more, mainly physio-type stuff like you say, but necessary, and still many steps upwards “possible” - wdnt mind if it got better and still have a lot of ideas, altho the amount of treatments I’ve tried is probably now 80+.
Got lighter work and loads otherwise to do, so I love getting up, but having to try to get 9.5h of sleep somehow takes a while…

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I’ve only tried one drug so far, but the side effects were definitely worse than no drugs. For now, the most important thing for me is getting better sleep. I’m generally okay with just Advil and Tylenol for pain. If I have another terrible flare up I may try a different drug, but it would have to be pretty bad to get me to try that again.

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Less drugs is better for the long term thats for sure…

So far i have not been able to drop the anti inflamatory, ugh…i just lock up…one of my PT s said our inflammation does not show at the blood tests, but its there in the cellular level.red light, also called low level laser, always helps a bad area…also microcurrent unit, acupressure pad. Magnesium and malic acid are a must for fibro muscles

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Quite a few of us believe this, but it’s no more than belief, unproven, researchers are working at it.

2 different things, if I read it correctly here…

Malic acid alone? Or do you mean the combination as magnesium malate, which really is seemingly helping me quite well! Aside from that some people have good results with the various kinds of magnesium, e.g. glycinate, or Epsom bath salts (magnesium sulfate), both not inducing diarrhea etc. like the most common sorts of magnesium. I need to take the magnesium malate to meals tho, all the same, otherwise I get “hungry” at night, i.e. stomach burning/acidity…

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Magnesium types and - scant/‘promising’ - research

Overview of magnesium types: 10 Interesting Types of Magnesium (and What to Use Each For)
The lactate, malate & orotate (expensive) are the ones said to be easiest on the gut.

  1. Mg citrate for constipation; perhaps calming: depression & anxiety.
  2. Mg oxide (in milk of magnesia): heartburn, indigestion, and constipation, migraines.
  3. Mg chloride: heartburn, constipation, replenishing. Topically for muscle soreness.
  4. Mg lactate (also food additive): stress and anxiety. Less laxative.
  5. Mg malate: FM & CFS? - little evidence. Less laxative.
  6. Mg taurate: Blood sugar & pressure.
  7. Mg L-threonate: Perhaps brain health, depression & age-related memory loss.
  8. Mg sulfate: Epsom salt, but little evidence for skin absorption.
  9. Mg glycinate (Glycine for sleep & inflammatory incl. heart & diabetes): Praps calming: anxiety, depression, stress, and insomnia.
  10. Mg orotate: Less laxative, but expensive, for heart health (improving cardiovascular energy production).

Research
As is mentioned and linked in above article, malate is the one that’s been most connected with FM, but without evidence (‘little or no difference in pain’): Magnesium and malic acid supplement for fibromyalgia - PubMed
2020: Magnesium and Pain - PubMed Reported to alleviate fibromyalgia and others, as well as neuropathic pain.Prevents central sensitization and attenuates preexisting pain hypersensitivity at the NMDA receptor.
2020: Psychological and Sleep Effects of Tryptophan and Magnesium-Enriched Mediterranean Diet in Women with Fibromyalgia - PubMed Reduced anxiety symptoms, mood disturbance, eating disorders, and dissatisfaction with body image but not improve sleep quality.
2020: mentions promising magnesium trials Nutritional Interventions in the Management of Fibromyalgia Syndrome - PubMed

I have been taking magnesium malate (2x400) for months and now added (bis)glycinate (2x500): they may be helping a bit. After optimizing the amino acids I’ll be weaning them off and see if anything changes.

A post on a thread from 2013 mentions several, incl. the above-mentioned magnesium malate, but I thought I’d develop on this newer more general thread.

Wow!
Great research and thanks for sharing.

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As mentioned above I’m now having another look at what the magnesium types do - to me, as I’m fairly pleased about my balance of amino acids at the moment (2021-08-28):

Leaving off magnesium glycinate has in my case actually seemingly improved sleep, altho it’s said to be for: insomnia, anxiety, chronic stress, inflammatory conditions. Here it adds that it can be for symptoms of too much stomach acid such as stomach upset, heartburn, and acid indigestion: The Secret Magnesium Miracle – Transform Your Life in 2021 so I need to be watching what my acid is doing.
My reason for testing stopping it was that I read about glycine seperately. Altho it’s sposed to help GABA cross the BBB (don’t know where Dennis got that from yet) and it usually works like GABA, as inhibitory neurotransmitter, helps normalize sleep patterns like glutamine & theanine, to relax and calm, Cynthia Perkins: says glycine is often excitatory and Mg glycinate can cause insomnia in some and it’s a GABA antagonist, it says here: https://www.reddit.com/r/Nootropics/comments/8xmbi2/magnesium_glycinate_gives_me_insomnia/ - and that seems to have been the main thing (2021-08-28) keeping me from deep sleep.

BTW for those that say you have to wait for a long time for supps to kick in: This improvement when stopping glycinate was quick. So either it’s fake, i.e. was something else, or it’s really quick. I could test that again if everything else is stable.

:new: I now also want to stop taking the magnesium malate and see what happens, altho it’s good for migraines, mood, chronic pain, blood sugar control, exercise performance, and depression. The only thing relevant here for me would be how I feel after exertion. Which is OK-ish, but not great so I’d be interested if it’s helping there.

Now what if the magnesium in my roseroot is a bad form? (I’ve got 60mg of Mg in the roseroot already, that’s about 240mg - praps of the pure stuff, never quite sure - together with the malate & glycinate!

(Never take these three forms of magnesium | Dr. Marc Micozzi).

Forms of magnesium you should avoid

  • Magnesium glutamate: Glutamic acid is an excitatory amino acid, meaning it helps to cause neurons to fire in the brain. However, when ingested in excess, free glutamic acid doesn’t bind to other amino acids (like a neuropeptide or protein), and causes an overload rise in blood level. This can become neurotoxic and poison nerve tissue. This supplement has also been linked to worsening depression or anxiety symptoms.

  • Magnesium aspartate: Aspartate or aspartic acid is a component of the dangerous, neurotoxic artificial sweetener aspartame. I shared with you the dangers of aspartame earlier this month.

  • Magnesium oxide: This is the most common form of magnesium, found in the majority of pharmacies. But it’s non-chelated, which essentially means it’s not an “organic” form. Thus, your body has a hard time absorbing it compared to other forms. It’s actually like trying to get nutrients from eating rocks. Clinical research also shows it causes inflammation of the heart membrane.

In my last post above it says magnesium oxide is quite good… But I can’t do with inflammation of my heart membrane. (It is being checked regularly, last time 3 weeks ago, all in best condition and I have been taking the roseroot for half a year again I’d guess, after a few months last year as well.)

OK, looked it up, it’s actually magnesium carbonate in my roseroot. The drmicozzi link says "Magnesium carbonate is another popular form. It helps neutralize the pH of your stomach acid, helping to soothe acid reflux, heartburn and indigestion (as the name “carbonate” implies)." Good; but not really what I was hoping… The antacid effect works by taking the Cl of the HCl to Magnesium chloride. Best forms of Magnesium and The 4 Worst - Healthy Focus contains 42% elemental magnesium. Bioavailability estimates vary from as low as 5% up to 30%.

Additions from drmicozzi to #3 above: * Magnesium chloride: Magnesium chloride is essentially a salt or electrolyte. Instead of a sodium atom bound to a chlorine atom (salt), it has two chlorine atoms bound to magnesium.It’s only 12 percent elemental magnesium. But as a salt, it’s rapidly absorbed from the GI system into blood and tissues. It also functions as an electrolyte (electrolytes are essential to our metabolism) and helps excrete toxins from tissues in the body. The chloride helps kidney function, but without the sodium. This supplement can be taken in oral form or you can use it in the form of bath salts for a warm, detoxifying soak.

As a reminder I already eat loads of whole food stuff with magnesium in it: a bit of dark chocolate, loads of nuts (almonds, cashew etc.), lots of legumes (beans), tofu, whole grains every day.

The dose drmicozzi recommends is 400mg of any of the ‘not bad’ forms - if GI is an issue increasing from 200mg. But does he mean the compounds or the magnesium itself (which is slightly above 10% of the compounds)? Also he cites the bioavailability, but then doesn’t base his recommendations on that…

Magnesium glycinate

For the last 10 days my sleep has greatly improved, deeper, stints longer, breaks less & shorter.
This is due to stopping magnesium glycinate & magnesium malate while increasing passiflora to 4x289mg (a high dose, max./d I’ve found cited is 1000mg).
I’d found a comment by Cynthia Perkins: that “Glycine can be inhibitory or excitatory, and in people who tend to lean towards excess glutamate it typically becomes excitatory, so it may need to be avoided.” This could be the case for me, as I seem to be needing to take 1050mg GABA vs. 450 glutamate.
But now I’m having more problems getting/feeling awake in the mornings, something the theanine had helped with. (So maybe I ought to try increasing it to 300mg again.)
As the magnesiums weren’t helping well at night, I’ve done a search here to see if it helps anyone at daytime, for waking up (and praps energy):
@Ahava31 found that with the 2x400 glycinate Found a little energy?
@Meow used it for sleeping, but with 2.5mg melatonin Uncontrollable anger with my physician - #2 by Meow
Nighttime and leg pain, RLS neuropathy? - #2 by BaltimoreBaby
@BaltimoreBaby for RLS Nighttime and leg pain, RLS neuropathy? - #2 by BaltimoreBaby

This is supported “everywhere” on the web, with https://draxe.com/nutrition/magnesium-glycinate-benefits/ recommending to take it at night, not at daytime. Also says the 2x500 malate and 2x400 glycinate might have been too much, they say max. dose of 400mg altogether (which contradicts other suggestions I’ve seen as well as @Ahava31). However I’m never sure if people mean the compound or the mineral itself, which is only 10-15% of the compound.
I’m wondering now if there is a time of the day where it can help without being excitatory.
What I also may be missing now is a bit of blood pressure regulation, but esp. muscle relaxation. I’m not normally tenser, but yesterday’s table tennis was energized & pressurized…

Interesting stuff about details of magnesium types on a German blog:

Important function

  • improves mitochondrial activity, e.g. energy
  • It’s important for so much and usual diets do not contain enough.
  • Helps increase D3. And vice versa.
  • improves depression, stress and burnout.

Types categorized (unclear whether organic or AA chelates are better):

  • Organic compounds (e.g. malate, gluconate, lactate, citrate) (better bioavailability?)
  • chelates with amino acids (e.g. glycinate, threonate, taureate, lysinate) (better absorption?)
  • anorganic compounds (e.g. carbonate, chloride, hydroxide, oxide, sulfate)
    Magnesium alone is a shiny, silvery-white alkaline earth metal, not particularly digestible!

Magnesium (bis)-glycinate: highest bioavailability, well tolerated, probably good for sleep, no diarrhea.
Magnesium (acetyl) Taureate (with taurine): heart functions via the taurine, seems to be very brain friendly. Good bioavailability (as acetyl).
Magnesium malate (as di- or trihydrate).: Mitochondria, fatigue, good bioavailability,superior to that of citrate and oxide.
Magnesium gluconate: highest bioavailability → take with a meal.
Magnesium citrate (di-basic) and TriMag (tri-basic): Widely used, probably well absorbed, inexpensive, enters blood quite quickly (peak), but bioavailability varies widely.
Can have a laxative effect in high doses (>400 mg), unless TriMag → with a meal.
Good for kidney stones and also fill alkaline buffers. People with histamine problems do not tolerate citrate well.
Magnesium chloride: also supposedly well absorbed, good for viral stress, diseases.
Magnesium oxide Time-delayed absorption, interesting for combinations - less bioavailability, 4%? Positive & negative reports. Praps laxative effect, neutralizes gastric acid.
Magnesium compounds for special applications
Magnesium L-threonate (developed by MIT, recent studies): Goes thru blood-brain barrier very well, considered nootropic. Interesting, expensive.
Magnesium Orotate regenerate muscle cells well, for the heart, nerve cells, tension headaches, well studied. Short-term, as can increase uric acid. Very high amounts of orotate (>100 mg/kg) may have be mutagenic. 50 mg/kg is OK. Probably passes cell membranes very well and thus can transport Mg well into cells and mitochondria.
Magnesium ascorbate: a form of buffered vitamin C - not so much a magnesium form. May well be laxative, had no problems with it. Combines the two.
Magnesium carbonate: Probably well tolerated, cheap, in mineral waters. 32% magnesium content. Neutralizes stomach acid, good for some.
Magnesium 2-AEP: may protect myelin layers (nerve cells).
Magnesium ZMK: Has all Mg forms of the citrate cycle: citrate, fumarate, malate, succinate, and alpha-keto-glutarate.
Magnesium fumerate, succinate, and alpha-keto-glutarate (similar to ZMK).
Magnesium arginate (with arginine)
Magnesium lysinate (with lysine)

Magnesium compounds that might better be avoided:
Magnesium sulfate: Only for (Epsom) bath salts and infusions, otherwise rather laxative.
Magnesium-Aspartate: Probably not so good because of the aspartic acid, but possibly better absorption than citrate and probably good for chronic fatigue. However, it may also have toxic side effects.
Magnesium hydroxide: Poor absorption, more stool.
Magnesium lactate: Probably lowers performance - often in detergents.
Magnesium peroxide: probably only something for intestinal cleansing…
Sango coral: Dangerous - high calcium content (10% magnesium, 20% calcium).

There is no perfect compound, study results contradict each other as well as using different dosages etc. It’s important to see what you need them for, and mixing them is a good idea.
Glycinate for RLS, sleep (not for me!), malate for pain, FM, aspartate for chronic fatigue, threonate for fog, taurate & orotate for heart/vessels.
Bloods: Use full blood, not just serum.
Dosage: It’s often forgotten that gross/net is very different! He recommends 400-800mg net, as long as you don’t get loose stools. Best taken spread over the day. Calcium (e.g. milk) reduces it, potassium and taurine increase it (making mg taurate interesting).
He lists all his sources. It’s a whole big personal blog about all supps a German forum pointed me to.

The various lists above have made looking up the types complicated, here it’s re-arranged & bits added:

After all is said and done it still looks to me as if magnesium malate & (bis)glycinate are best for FM.

Firstly, things that can be said about magnesium generally are:

  • improves mitochondrial activity, e.g. energy.
  • It’s important for so much (muscles, nerves, pain (central sensitization), perhaps sleep, migraine…)
  • usual diets do not contain enough.
  • Helps increase vitamin D3. And vice versa.
  • improves depression, stress, anxiety, mood, burnout…

However it’s not the type of supplement which you immediately feel the benefit of (like amino acids or enzymes).
Dosage is a problem if a product isn’t clear on if the amount stated is net (just magnesium) or gross (the compound).
Often it isn’t clear what form(s) is/are contained, which is very important.
Studies are often unclear and contradictory, so it’s hard to see how true the following details about what they are good for are.
As it’s a silverish metal, we need to take it as a compound with something else, and the characteristics of that influence the effect.

  • Organic compounds (‘salts’) (better bioavailability), e.g.
    • Mg malate: (little) evidence for FM & CFS. Less laxative. Migraines, mood, chronic pain, blood sugar control, exercise performance, depression, mitochondria (energy), fatigue. Bioavailability superior to that of citrate and oxide.
    • citrate: constipation = laxative; perhaps calming: depression & anxiety . Widely used, inexpensive, enters blood quite quickly (peak), but bioavailability varies widely. Good for kidney stones. Bad if histamine intolerant.
    • gluconate (highly bioavailable): take with meals.
    • lactate: (also food additive): stress and anxiety . Less laxative. Probably lowers performance - often in detergents.
    • orotate (expensive): Less laxative. Heart (cardiovascular energy production), blood pressure, other muscle cells, nerve cells, tension headaches, well studied. Short-term, as can increase uric acid. Passes cell membranes very well.
    • (Magnesium ascorbate : buffered vitamin C - not so much a magnesium form, combines the two. Praps slightly laxative.)
  • chelates with amino acids (better absorption), e.g.
    • (bis)glycinate (highly bioavailable): Praps calming - anxiety, depression, stress, and insomnia, restless legs, spasms, & inflammation, heart & diabetes.
    • taurate: Blood sugar & pressure. Brain friendly. Good bioavailability (as acetyl taurate).
    • L-threonate (expensive, MIT-developed, new studies): Perhaps brain health, depression & age-related memory loss.
    • (aspartate: Not good, overexcites NMDA receptors, perhaps toxic side effects. But probably good for chronic fatigue…)
    • (glutamate : can cause overload, become neurotoxic & poison nerve tissue. Possibly worsens depression or anxiety.)
  • anorganic compounds (bad bioavailable & less absorption), e.g.
    • carbonate: Probably well tolerated, cheap, in mineral waters. 32% magnesium content. Neutralizes stomach acid.
    • chloride: heartburn, constipation, replenishing. Topically for muscle soreness (but little evidence for skin absorption). Viral stress, diseases.
    • oxide (in milk of magnesia): heartburn / ctomach acid, indigestion, and constipation: laxative (!), migraines. Time-delayed absorption, interesting for combinations, but much less bioavailability.
    • sulfate: infusions & Epsom bath salts, but little evidence for skin absorption (magnesium generally). Otherwise laxative.
    • (hydroxide: Poor absorption, more stool: avoid.)
    • (peroxide: probably only something for intestinal cleansing…)

Sango coral: Dangerous - high calcium content (10% magnesium, 20% calcium).

Here in the table at the bottom the portion of magnesium of some types are listed, all 7-15%, except oxide: ~60%.

  1. Can Epsom salts help?
  2. taurate not taureate (typo above)
  3. How good is the product “Magnesium Breakthrough”?
  4. If magnesium citrate clears out the gut, should we take it?
  5. Epsom salts because of sulphates?!

1) Can Epsom salts really help?

Epsom Salts are magnesium sulfate. There is actually no medical evidence to date that magnesium can be absorbed thru the skin, I’ve read several studies about this and this article is a great (long and detailed) take on it (but well structured, so reading the intro and the summary or just parts is well possible).

But seeing how often people feel it helps and recommend it, either it has a good placebo effect, due praps to the connotations, our imagination: ‘Epsom salts’ sound traditional and good (the article says ‘folk remedy’). Maybe people wouldn’t get as much help if they only knew it under the name of magnesium sulfate or epsomite. Also as above article says the water feels silkier and there is a flotation effect from the salt. Definitely something to help placebo. BTW placebo is about the only thing the article has forgotten :wink: And I think placebo is one of the best self-healing mechanisms we have, esp. as it works on our body even if we know “it doesn’t”, or “there’s nothing in it”. We don’t have Epsom salts in Germany at all, poor us. ;-D

Or research just hasn’t found out how it works “under appropriate circumstances”, like this 2016 study on sulfates suggests: Sulphate absorption across biological membranes - PubMed - also I’ve seen more suggesting that, just can’t find it at the moment. It’s the sulfates that’s the problem, not (necessarily) the magnesium. However there doesn’t seem to be a different magnesium sort (‘compound’) which works better via the skin. So taking that as a supplement is recommended and has considerably more evidence for it helping. That said I’m never quite sure how much that is really helping (malate and glycinate), so do stop it sometimes. Started again, sleep better again…

Edit 1, as I’m allowed to edit, but not to answer 3x in a row (yet).

2) Taurate, not taureate

Only just realized that this info from a German site made me say taureate instead of correct in English: taurate as I’ve written everywhere else…

3) Suspicious vague product: Magnesium “Breakthrough”

Edit 2:
Someone recommended a product by a company called biOptimizers called “Magnesium Breakthrough” containing 7 sorts of magnesium.
It’s suspicious, because the product is hard to find on neutral sites, it seems more industry-driven, and neither the label nor the website specifies how much of which magnesium form is in there, something which I don’t think is allowed in Europe.
In their website chat, the producing company biOptimizers replied to me that “our formula is propietary information is not available to the general public”.
Interesting though as they have answered me that when they say “magnesium chelate” they mean a compound of several chelate forms (in this case e.g. aspartate & lysinate and/or threonate, seeing as glycinate & taurate are in in separately).
Also I’ve seen that it contains “sucrosomial magnesium”, which is supposed to increase magnesium oxide’s bioavailability (to 20% more than citrate, altho oxide is otherwise is 4%). Not sure if that can be believed!?!
Altogether a product I’d never take or recommend.

4) Magnesium citrate clears out the gut(?)

Morley Robbins is called the Magnesium Man, because he bases his Root Cause Protocol on magnesium (and copper and retinol). He does not recommend magnesium citrate, arguing that as it is the liquid you drink before a colonoscopy then clearly that is not good for you, because it wipes out the colon. MAGNESIUM & why it's SO IMPORTANT to our health | The Root Cause w/ Morley Robbins Pt. 3 - YouTube. He does think magnesium works transdermally by the way, recommending Epsom salt baths and using magnesium spray & creams esp. on your feet, and doesn’t recommend MagOx, being magnesium oxide, which is only 4% bioavailable. Magnesium and cortisol run on a seesaw - magnesium helps chill. As much as bowel movement can take. His wife (doc) recommends for baths: 2 cups of Epsom salts, 1/2 cup of baking soda and 1/4 cup of borax. Half that for a foot bath. Baking soda helps the delivery of the magnesium. Borax is 98,8% boron, mysterious, to detox… (These are no recommendations from me, just suggestions to think about. - I can’t take baths, so I’ve no idea if I’d feel stuff like this works.)

5) Epsom salt baths because of sulphate rather than magnesium?

Interesting idea here to take Epsom salt baths not because of the magnesium, but because of the sulphate in them - never read it put that way. https://www.nutritionist-resource.org.uk/memberarticles/why-do-i-react-to-histamine-sulphites-and-salicylate

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