Zinc and Magnesium Deficiency Common in Fibromyaglia- and What are Zn and Mg Good For?

A recent article found a relationship of low zinc levels and tender point counts, and low magnesium and fatigue

Rheumatol Int. 2008 Sep;28(11):1117-21. The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia. Sendur OF, Tastaban E, Turan Y, Ulman C.
abstract

results compared to a normal parent control group

Low zinc levels p <.001 ; Low magnesium p<0.002

correlation with zinc and tender points – p = 0.008

correlation magnesium and fatigue p= 0.003

ZINC
If one wants to do safe supplementation, it is recommended one stay less than 35 mg elemental zinc = 154 mg zinc sulphate or 260 mg zinc gluconate.
Zinc sulphate (Orazinc, Zincate) comes in 110 and 220 mg – stick to the 110 mg which is a safe 25 mg elemental – higher doses could be toxic and deplete copper levels

Looks like zinc gluconate comes in 50 or 70 mg to get 25 mg would be 187 mg = maybe three 50 mg or 2-3 of the 70 mg/day

Comment –

• low zinc is particularly bad in children where it stunts growth.
• Low zinc can slow healing of wounds.

• Zinc supplementation does help heal plantar warts.

Br J Dermatol. 2002 Mar;146(3):423-31.
Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized
placebo-controlled clinical trial. Al-Gurairi FT, Al-Waiz M, Sharquie KE.

abstract

“Each patient had > 15 warts. Forty patients were treated by oral zinc sulphate at a dose of 10 mg kg(-1) daily up to 600 mg day(-1) and followed-up for resolution of their warts and for any evidence of recurrence for 2-6 months. Another 40 patients were given a placebo oral treatment in the form of glucose, and followed-up for the same period. RESULTS: Only 23 patients of the first group (zinc treated) and 20 patients of the second group (placebo treated) completed the study. In all patients the serum level of zinc was low. In the zinc-treated group, the overall response was complete clearance of warts observed in 20 patients (86.9%) after 2 months of treatment. Fourteen patients (60.9%) showed complete disappearance of their warts after 1 month. Three patients (13.3%) failed to respond to the treatment after 2 months of therapy. The response to treatment was directly related to the increment in serum zinc level. No patient of the placebo-treated group showed any response. CONCLUSIONS: We conclude that zinc sulphate at a dose of 10 mg kg(-1) daily seems to be a highly efficacious therapeutic option for recalcitrant viral warts and proved to be safe with few adverse effects.”Comment – that dose is huge and should not be used for extended periods.

• One Fibromyalgia researcher in the late 1990’s noted the relationship with low zinc but did not recommend supplementation.

• Low zinc is found in Crohn’s disease and its relation with abdominal pain is being studied.

• Low zinc might be related to Premenstrual tension and painful periods and supplementation helps:

Med Hypotheses. 2007;69(2):297-301. Epub 2007 Feb 7. Zinc treatment prevents dysmenorrhea. Eby GA. abstract
“In patients consuming 31 mg of zinc per day, premenstrual tension (PMT) symptoms did not occur, while in patients consuming 15 mg of zinc, PMT symptoms did occur (P<0.001). Protocols using 30 mg of zinc once to three times a day for one to four days immediately prior to menses to prevent dysmenorrhea are described and they are recommended for additional study

ADDENDUM – Low zinc levels were found associated with tongue pains:

Br J Oral Maxillofac Surg. 2009 Sep 5. [Epub ahead of print] Clinical study of tongue pain: Serum zinc, vitamin B12, folic acid, and copper concentrations, and systemic disease. Yoshida H, Tsuji K, Sakata T, Nakagawa A, Morita S. abstract
They found 1/10 of subjects had low zinc and wondered if there was a connection…

MAGNESIUM – migraines yes, cramps no

Low Magnesium is an epidemic that is not well understood. Blood measurements are not accurate because the vast majority of magnesium is intracellular. Some feel the only way to determine deficiency is to give magnesium and see how much is collected in the urine – much like a shilling test.

IV Magnesium is used to prevent Chemotherapy induced neuropathy:

Eur J Cancer. 2008 Jul;44(11):1507-15 Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Wolf S, Barton D, Kottschade L, Grothey A, Loprinzi C. abstract

“New evidence strongly suggests that intravenous calcium and magnesium therapy can attenuate the development of oxaliplatin-induced CIPN, without reducing treatment response.”

IV Magnesium can help sickle cell crisis pains:

Acad Emerg Med. 2004 Sep;11(9):968-72. The effect of magnesium on length of stay for pediatric sickle cell pain crisis. Brousseau DC, Scott JP, Hillery CA, Panepinto JA. abstract

“The initial 12 children received 40 mg/kg (maximum of 1.5 g) of IV magnesium in the emergency department (ED), and eight and 16 hours later. Seven subsequent children received 40 mg/kg (maximum of 2.5 g) of IV magnesium in the ED, and every eight hours for up to four inpatient days.”…”median LOS [length of stay], 3.0 days compared with 5.0 and 4.0 days for the previous two admissions.”

• Oral Magnesium Citrate does help migraines:Cephalalgia. 1996 Jun;16(4):257-63. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Peikert A, Wilimzig C, Köhne-Volland R. abstract“After a prospective baseline period of 4 weeks they received oral 600 mg (24 mmol) magnesium (trimagnesium dicitrate) daily for 12 weeks or placebo. In weeks 9-12 the attack frequency was reduced by 41.6% in the magnesium group and by 15.8% in the placebo group compared to the baseline (p < 0.05).”This magnesium study was replicated this year:”The prophylactic effects of 600 mg/day oral magnesium citrate supplementation were assessed by means of clinical evaluation, visual evoked potential and statistical parametric mapping of brain single photon emission computerized tomography before and after a 3 month treatment period.” – Wow – fancy enough to add some plaisibility to why it helps.Magnes Res. 2008 Jun;21(2):101-8. The effects of magnesium prophylaxis in migraine without aura. Köseoglu E, Talaslioglu A, Gönül AS, Kula M. abstract“Migraine attack frequency, severity and P1 amplitude in visual evoked potential examination decreased after magnesium treatment with respect to pretreatment values (p < 0.001). In a comparison of the effects of magnesium treatment with those of placebo, post/pretreatment ratios of migraine attack frequency, severity and P1 amplitude in Mg treatment group were found to be significantly lower than those in placebo treatment group (attack frequency p = 0.005, attack severity p < 0.001, P1 amplitude p < 0.05). Cortical blood flow in inferolateral frontal (p < 0.001), inferolateral temporal (p = 0.001) and insular regions (p < 0.01) increased significantly after magnesium treatment with respect to the pretreatment; while such significant changes of cortical blood flow were not observed with placebo treatment. These results have made us think that magnesium is a beneficial agent in prophylaxis of migraine without aura and might work with both vascular and neurogenic mechanisms.”
  
  I have used Magnesium citrate (Citromag 1 tbsp bid ) for chronic migraines
• Given that Magnesium can temporarily put a “plug” in NMDA receptor pathways, I have tried Magnesium for chronic pain and headaches. When combined with IV lidocaine, there is almost a “high” from the relief they get. Unfortunately, the plug is only momentary. Studies using it for migraines have been disappointing. For neuropathic pain in cancer, IV Magnsium gave a four hour respite but I don’t know beyond that:J Pain Symptom Manage. 2000 Jan;19(1):35-9.
  The safety and efficacy of a single dose (500 mg or 1 g) of intravenous magnesium sulfate in neuropathic pain poorly responsive to strong opioid analgesics in patients with cancer. Crosby V, Wilcock A, Corcoran R. abstract“After receiving 500 mg, three patients experienced complete pain relief and two experienced partial pain relief for up to 4 hours duration; pain was unchanged in one patient. After receiving 1 g, one patient experienced complete relief and four experienced partial pain relief of similar duration; pain was unchanged in one patient”
• Magnesium supplementation has been tried in nocturnal leg cramps (900 mg magnesium citrate twice daily for 1 month) and was ineffective in a crossover randomized trial:
  J Fam Pract. 1999 Nov;48(11):868-71. Magnesium for the treatment of nocturnal leg cramps: a crossover randomized trial. Frusso R, Zárate M, Augustovski F, Rubinstein A. abstract
  “All patients improved over time regardless of the treatment sequence they received. CONCLUSIONS: Magnesium was not effective for the treatment of nocturnal leg cramps.”
• Magnesium failed to help leg cramps per se:(Magnesium citrate equivalent to 300 mg magnesium)
  Med Sci Monit. 2002 May;8(5):CR326-30. Randomised, cross-over, placebo controlled trial of magnesium citrate in the treatment of chronic persistent leg cramps. Roffe C, Sills S, Crome P, Jones P. abstract
  “There was a trend towards less cramps on magnesium (p=0.07)”
• It even failed to help cramps in pregnant women: (2 weeks with either magnesium (360mg=15mmol magnesium lactate and magnesium citrate, Nycoplus Magnesium((R))),
  Eur J Obstet Gynecol Reprod Biol. 2008 Sep 2. [Epub ahead of print] Does oral magnesium substitution relieve pregnancy-induced leg cramps? Nygaard IH, Valbø A, Pethick SV, Bøhmer T.
  abstract
  “No significant effect on frequency or intensity of leg cramps in pregnant women of magnesium treatment with 360mg daily could be detected in this trial.”

• One article found that magnesium levels could be either high or low in muslces and this was a secondary consequence of pain:

Magnes Res. 2001 Sep;14(3):225-6.
Serum magnesium and calcium in patients with dorsalgias.
Steidl L, Ditmar R, Dostál A.
Serum magnesium and calcium was examined in 70 patients with chronic dorsalgias. Values of calcium were stabilized, but values of magnesium were unstable and exceeded the 2SD lines, being more often over than under these lines. Lability of serum magnesium levels is considered a secondary consequence, caused by the stress of pain. These symptoms may be alleviated by Mg administration, by local application of Mg through transdermic iontophoresis or sonophoresis, or by hydropathy of the paravertebral muscles.

• I have found IV Magnesium can give a distressing burning in the arm if infused too fast. I often wondered if this was associated with a sympathetic overactivity or peripheral hypersensitivity.
• Orally, the most absorbable Magnesium form – the citrate – is used as a laxative (Citromag); this is useful for people on opioids with constipation.

I would be interested in experiences with using these agents. I have a patient who tried it on her own and feels it has helped her body pains. I would be particularly interested in articles showing Magneium is good for muscle pain and cramps (particularly randomized control trials). I was at a recent course where it was suggested I didn’t know much because there was lots of literature concerning that – but I guess I still don’t know much…