This article expands on our previous articles addressing the science on magnesium for fibromyalgia and energy. It was written for submission to the Integrated Health Hub magazine and will be published in the fall of 2017.
Magnesium Supplementation for Fibromyalgia, Chronic Fatigue Syndrome, and Low Energy: Does It Work?
By Anna O’Byrne and Laura Young, Honours B.Sc., Student of the Canadian College of Osteopathy
A lack of energy or ‘tiredness’ is one of the most common complaints patients bring to primary care givers (Stadje et al., 2016). Surveys of adults in the US and Europe estimate that 20% to 30% experience significant fatigue (Nicholson, 2012). Fatigue, unfortunately, is often an intractable complaint; across several studies in Canada, the US and Britain, symptoms of fatigue persisted in most patients six months to a year after their initial complaint to a health care provider (Nicholson, 2012).
It is not surprising that the demand for energy supplement is on the rise. According to Nutraceuticals World (2017), “…for people who take dietary supplements, energy is now the number two health concern they’re looking to address, with 30% of users citing this need, according to the Council for Responsible Nutrition’s (CRN) 2016 Consumer Survey on Dietary Supplements (Nutraceuticals World, n.d.).”
In the quest for more energy, many people have turned to caffeine and other stimulants, natural and synthetic. Some of these have dangerous side effects, including nervousness and sleeplessness (Nutraceuticals World, n.d.). Market watchers have noted a shift in demand for alternatives to energy supplements that are natural, organic and non-stimulating (Nutraceuticals World, n.d.).
Magnesium supplements are one such natural, non-stimulating alternative, and the research shows promise for the role of magnesium in increasing energy.
According to Dr. Carolyn Dean, M.D., N.D. (2014), “One of the most amazing effects of magnesium on the neuromuscular system is that it provides more energy, even though the mineral generally acts as a relaxant and not a stimulant (pg. 71).” Magnesium activates “enzymes that control digestion, absorption, and the utilization or proteins, fats and carbohydrates (Dean, 2014, p. 15). It’s also important to note that of “the 700-800 magnesium-dependent enzymes, the most important enzyme reaction involves the creation of energy by activating adenosine triphosphate (ATP), the fundamental energy storage molecule of the body (Dean, 2014, p. 15).
To better understand the efficacy of magnesium, here we’ll look at the clinical data on magnesium supplementation for fibromyalgia, chronic fatigue syndrome (CFS), and athletics.
Magnesium for Fibromyalgia (FM)
The symptoms of FM include prolonged fatigue and widespread muscular pain. In fact, because of the characteristic fatigue, FM is sometimes confused with CFS and commonly considered comorbid conditions (The New York Times, n.d.).
Among those with FM, magnesium is one of the supplements most recommended, according to a recent study (Arranz, Canela, & Rafecas, 2012).
Dating back to the 1990s, a number of studies have examined the effects of magnesium supplementation on fatigue and pain associated with FM.
One of the earliest studies postulated that FM symptoms are caused by a “deficiency of oxygen and other substances needed for ATP synthesis (Abraham & Flechas, 1992).” In the study, FM patients were administered 1200 to 2400 mg of malate and 300-600 mg of magnesium daily for eight weeks, and the outcomes were compared with placebo tablets. The resultant data supported a “critical role for magnesium and malate in ATP production under aerobic and hypoxic conditions; and indirect evidence for magnesium and malate deficiency” in FM (Abraham & Flechas, 1992).
Romano and Stiller (1994), evaluated red blood cell (RBC) and plasma levels to determine whether individuals with FM also present with low magnesium. The study reported that FM patients do, in fact, have significantly lower RBC magnesium levels compared with reference laboratory and the control group. However, there was no significant difference in plasma magnesium levels between the groups (Romano & Stiller, 1994).
In 2013, a study published in Rheumatology International demonstrated that magnesium supplementation affected significant improvements in several FM markers (Bagis et al., 2013). Many of the positive outcomes reported were related to pain reduction, but most relevant to this discussion, patients in the magnesium citrate treatment group, receiving 300 mg/day over 8 weeks, saw marked improvements in Beck depression and FM impact questionnaire (FIQ) scores (Bagis et al., 2013). The FIQ is “an instrument that measures physical functioning, work status (missed days of work and job difficulty), depression, anxiety, morning tiredness, pain, stiffness, fatigue, and well-being over the past week (American College of Rheumatology, n.d.).” The authors hypothesized that low magnesium levels may be a factor in the symptoms of FM (Bagis et al., 2013).
Magnesium for Chronic Fatigue Syndrome (CFS)
CFS is notoriously difficult to diagnose and poorly-defined (The New York Times, n.d.). The most distinctive feature is persistent fatigue. CFS patients also experience pain, headache, poor sleep and cognitive symptoms (The New York Times, n.d.).
A review published in The Journal of Chronic Fatigue Syndrome examined the relationship between CFS and magnesium (Seelig, 1998). Seelig noted that, “the evidence that Mg deficiency causes a variety of both humoral and cellular defense disturbances, among which are several that have been identified in CFS and FM, is a reason to suspect that either Mg deficiency or its abnormal utilization might be a pathogenic factor in CFS (p. 106).”
A 1991 study published in The Lancet essayed to demonstrate that patients with CFS have low magnesium and that symptoms can be improved with supplementation (Cox, Campbell, & Dowson). Twenty CFS patients were tested for red blood cell magnesium concentration and were found to have lower levels than 20 healthy control subjects (Cox et al., 1991). In a double-blind, placebo-controlled clinical study, patients were randomly assigned to either 6 weeks of magnesium sulphate supplementation or placebo. The treatment group was demonstrated to have improved energy, a better emotional state and less pain, as measured by the Nottingham health profile (Cox et al., 1991). In the treatment group, 7 of the patients had a significant change in their energy score, contrasted with 1 patient in the control group (Cox et al., 1991).
Unfortunately, no further studies have been published on the topic since these results published over 20 years ago. Clearly, more research is required.
Magnesium and Energy for Athletic Performance
The ceiling on athletic performance is often determined by energy or lack thereof.
A 2002 study in The Journal of Nutrition demonstrated that induced magnesium depletion results in an increased need for energy and adversely affects cardiovascular function (Nielsen & Lukaski, 2002). The researchers arrived at this conclusion by supplementing and restricting the magnesium intake of postmenopausal female participants and measuring the effects on exercise (Nielsen & Lukaski, 2002).
In 2006 the same authors published an “Update on the relationship between magnesium and exercise (Nielsen & Lukaski, 2006).” Nielsen and Lukaski found that “exercise induces a redistribution of magnesium in the body to accommodate metabolic needs. There is evidence that marginal magnesium deficiency impairs exercise performance and amplifies the negative consequences of strenuous exercise (e.g., oxidative stress) (p.180).” The authors concluded “magnesium supplementation or increased dietary intake of magnesium will have beneficial effects on exercise performance in magnesium deficient individuals (Nielsen & Lukaski, 2006) (p. 180).”
In healthy elderly women, a randomized, controlled trial found that magnesium supplementation induced a significant improvement in short physical performance battery (a group of measures that combines the results of the gait speed, chair stand and balance tests) as well as chair stand times and 4 metre walking speeds. The most significant outcomes were observed more notably in subjects whose diets were lower in magnesium (Veronese et al., 2014).
Other studies contrasting athletes under magnesium supplementation with control groups have found that “magnesium supplementation positively influences performance (Cinar, Nizamlioglu, Mogulkoc, & Baltaci, 2007)” and that it “improved alactic anaerobic metabolism” even in athletes who were not magnesium-deficient (Setaro et al., 2014).
Is Magnesium an Energy Supplement?
As this paper describes, positive, significant results have been demonstrated among patients with FM, CFS, and healthy individuals during exercise. The research suggests that magnesium supplementation can improve energy and performance, even among those who are not magnesium deficient.
Accurate testing of magnesium deficiency is, in any case, not widely available. According to Carolyn Dean, M.D., N.D. (2014), the best method is via Ionized Magnesium Testing, which is not widely available. The Magnesium RBC test is more accessible to the public but less accurate, and serum magnesium testing is less accurate still (p. 217).
Whether healthy or presenting with a fatigue related condition, patients should be made aware of the role of magnesium in energy. If a reliable test is not available but symptoms of magnesium deficiency are present, supplementation is a safe, effective option for most.
Abraham, G. E., & Flechas, J. D. (1992). Management of Fibromyalgia: Rationale for the use of Magnesium and Malic Acid. Journal of Nutritional Medicine, 3(1).
Arranz, L. I., Canela, M. Á., & Rafecas, M. (2012). Dietary aspects in fibromyalgia patients: results of a survey on food awareness, allergies, and nutritional supplementation. Rheumatology International, 32(9), 2615–2621.
Bagis, S., Karabiber, M., As, I., Tamer, L., Erdogan, C., & Atalay, A. (2013). Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatology International, 33(1), 167–172.
Chronic Fatigue In-Depth Report. (n.d.). In The New York Times online. Retrieved August 15, 2017, from http://www.nytimes.com/health/guides/disease/chronic-fatigue-syndrome/print.html
Cinar, V, Nizamlioglu, M., Mogulkoc, R., & Baltaci, A. K. (2007). Effects of magnesium supplementation on blood parameters of athletes at rest and after exercise. Biological Trace Element Research, 115(3), 205–212.
Cox, I. M., Campbell, M. J., & Dowson, D. (1991). Red blood cell magnesium and chronic fatigue syndrome. The Lancet, 337(8744), 757–760.
Dean, C. (2014). The Magnesium Miracle. New York: Ballantine Books.
Energy Trends: The Market Charges On. Brands appeal to a broad audience with natural ingredients that provide sustained benefits (n.d.). In Nutraceuticals World online. Retrieved August 15, 2017, from http://www.nutraceuticalsworld.com/issues/2017-01/view_features/energy-trends-the-market-charges-on/1170
Fibromyalgia Impact Questionnaire (FIQ). (n.d.). In American College of Rheumatology online. Retrieved August 15, 2017, from https://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Fibromyalgia-Impact-Questionnaire-FIQ
Nicholson, K. A. (2012, July). The Symptom of Fatigue in Primary Care: A Comparative Study of Health Care Utilization Patterns Using Electronic Medical Records.
Nielsen, F. H., & Lukaski, H. C. (2002). Dietary magnesium depletion affects metabolic responses during submaximal exercise in postmenopausal women. The Journal of Nutrition, 132(5), 930–935.
Nielsen, F. H., & Lukaski, H. C. (2006). Update on the relationship between magnesium and exercise. 19(3), 180–189. http://doi.org/10.1684/mrh.2006.0060
Romano, T. J., & Stiller, J. W. (1994). Magnesium Deficiency in Fibromyalgia Syndrome. Journal of Nutritional Medecine, 4(2), 165–167.
Seelig, M. (1998). Review and hypothesis: might patients with the chronic fatigue syndrome have latent tetany of magnesium deficiency. Journal of Chronic Fatigue Syndrome, 4(2), 77–108.
Setaro, L., Santos-Silva, P. R., Nakano, E. Y., Sales, C. H., Nunes, N., Greve, J., & Colli, C. (2014). Magnesium status and the physical performance of volleyball players: effects of magnesium supplementation. Journal of Sports Sciences, 32(5), 438–445.
Stadje, R., Dornieden, K., Baum, E., Becker, A., Biroga, T., Bösner, S., et al. (2016). The differential diagnosis of tiredness: a systematic review. BMC Family Practice, 17(147), 1–11.
Veronese, N., Berton, L., Carraro, S., Bolzetta, F., De Rui, M., Perissinotto, E., et al. (2014). Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program: a randomized controlled trial. American Journal of Clinical Nutrition, 100(3), 974–981.