Effective magnesium regimens for fatigue/fibromyalgia … - Literature Review & Commentary

Townsend Letter for Doctors and Patients,  Feb-March, 2004  by Alan R. Gaby

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Eighty-six patients with chronic muscular complaints including myofascial pain, relapsing soft tissue injuries and fibromyalgia were treated with intramuscular or intravenous magnesium (Mg) in doses of 500-1,600 mg (Note: Presumably, this dose refers to the amount of Mg sulfate or Mg chloride, not the amount of elemental Mg used). Mg was given alone or in combination with B-vitamins, calcium, and either low dose (600-3,000 mg) or high dose (10-25 g) ascorbate. Of the acute cases, 74% improved; 53% of those who improved required only one injection and 32% required 2-4 injections for optimal results. Of the chronic patients, 74% improved; 64% of the cases required 4 or fewer injections for optimal results. A minority of patients required long-term oral or parenteral Mg to maintain their improvement. Side effects leading to discontinuation of therapy occurred in 4% of the chronic cases. Drug prescriptions for NSAIDs and muscle relaxants were virtually eliminated.

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In a second study, the mean red-blood-cell Mg concentration was significantly lower in 20 patients with chronic fatigue syndrome (CFS) than in healthy controls. Thirty-two patients with CFS received intramuscular Mg sulfate (1 g) every week for 6 weeks or a placebo, in a randomized, double-blind trial. Twelve (80%) of the 15 patients treated with Mg reported improvement (more energy, better emotional state, and less pain) and fatigue was eliminated completely in 7 cases. Only 3 (18%) of 17 placebo-treated patients improved (p = 0.0015), and in none was fatigue completely eliminated. Red-blood-cell Mg returned to normal in all patients receiving Mg injections, but in only one patient given a placebo.

In a third study, 32 patients complaining of chronic fatigue received potassium magnesium aspartate (1 g, twice a day) orally for 4 weeks and a placebo for an additional 4 weeks, in a double-blind crossover trial. Twenty-one patients (66%) improved during the active-treatment period, compared with 3 (9%) during the placebo period.

Comment: There is evidence that impaired mitochondrial energy production is a factor in both chronic fatigue and fibromyalgia. This abnormality may be related, at least in part, either to Mg deficiency or to impaired intracellular uptake of Mg. Intramuscular or intravenous administration of Mg raises the serum concentration to a degree that is not achievable with oral administration. That might explain why parenteral administration of Mg appears to be more effective than oral Mg in the treatment of chronic fatigue and fibromyalgia. In my experience, approximately 50% of patients with chronic fatigue syndrome or fibromyalgia show considerable improvement after receiving several intravenous injections of a combination of Mg, calcium, B vitamins, and vitamin C (the so-called "Myers' cocktail"--see Gaby AR. Altern Med Rev 2002;7:389-403). This observation has been confirmed by Reed (see citation below) and others.

Earlier work demonstrated that an oral preparation, potassium magnesium aspartate, is also beneficial in the treatment of chronic fatigue. Aspartate is a purported mineral transporter, which is said to facilitate the entry of potassium and magnesium into the cells. I have found potassium magnesium aspartate to be an effective treatment for general fatigue, muscle spasms (including exercise-induced muscle cramps), and some cases of ventricular ectopic beats.

Reed JC. Magnesium therapy in musculoskeletal pain syndromes--retrospective review of clinical results. Magnesium Trace Elem 1990;9:330.

Cox IM, et al. Red blood cell magnesium and chronic fatigue syndrome. Lancet 1991;337:757-760.

Shaw DL Jr, et al. Management of fatigue: a physiologic approach. Am J Med Sci 1962;243:758-769.

by Alan R. Gaby, MD

301 Dorwood Drive * Carlisle, Pennsylvania 17013

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