Restless Legs Syndrome Foundation Blog

Managing Your Magnesium

By Norma G. Cuellar, PhD, RN, FAAN

This is an excerpt from the spring 2016 edition of NightWalkers, the Foundation's quarterly magazine. To get your subscription to NightWalkers and to enjoy other benefits, become a member of the Restless Legs Syndrome Foundation today!

Individuals suspecting they may have RLS should consult a qualified healthcare provider. Literature posted by the RLS Foundation, including this blog post, is offered for informational purposes only and should not be considered a substitute for the advice of a healthcare provider. Prior to making any changes to your treatment plan, please discuss treatment options with your healthcare provider.

Many persons with RLS ask about the use of magnesium (Mg) to help with symptoms. While research in this area is scant, magnesium can certainly affect other health conditions, thereby affecting RLS symptoms.

What is magnesium?

Magnesium is an element found throughout the body in blood, bones and soft tissues. Magnesium works with over 300 enzymes that regulate protein synthesis, muscle and nerve function, blood glucose control and blood pressure. It plays an important role in hydration, muscle relaxation, energy production and, crucially, the deactivation of adrenaline. In addition, magnesium plays a role in the transport of calcium and potassium across cell membranes, which is imperative in nerve impulse conduction, muscle contraction and normal heart conduction.

What are the symptoms of low magnesium?

Deficiency of magnesium can cause a variety of health issues. Early signs may include loss of appetite, nausea, vomiting, fatigue or weakness. As hypomagnesemia (low magnesium levels in the blood) worsens, signs include numbness, tingling, muscle twitching, cramps and muscle soreness. More serious symptoms include abnormal heart rhythms, coronary spasms (remember, the heart is a muscle) and seizures. Magnesium has a direct effect on calcium and potassium levels, so people who take magnesium should have these electrolytes monitored by a healthcare provider through blood testing.

Low magnesium can result from a variety of causes, including chronic diseases, medication use, poor nutrition, lifestyle choices and pregnancy. Older adults are at added risk because of decreased absorption of magnesium with age and renal insufficiency.

How does magnesium affect sleep?

Magnesium is essential for every stage of sleep because of its neuroprotective effect of slowing the metabolic process, lowering brain temperature, and regulating hormones responsible for sleep onset. Magnesium is also known to cause muscular relaxation, which may help with falling asleep.

There are two hormones that are affected by magnesium levels: cortisol (known as the stress hormone) and melatonin (which helps regulate sleep patterns). Magnesium has been reported to decrease cortisol, thereby promoting relaxation and sleep. Magnesium is vital for the function of gamma aminobutyric acid (GABA) receptors in the brain, which initiate sleep. Sufficient magnesium is required to regulate all hormones in the body. With age, the natural decline of these hormones worsens if there is not enough magnesium.

Where can I find magnesium?

You can find magnesium in foods, some bottled water, dietary supplements and medications (antacids and laxatives). Green leafy vegetables, cereals and fortified foods are good sources of magnesium.

Foods containing fiber usually have some magnesium. Keep in mind that food processing removes magnesium. Many foods drain the body of magnesium and should be avoided, especially by people who have low magnesium levels. These foods include carbonated beverages, sugar, high-carb foods, caffeine and alcohol. Also, some medications will deplete the body of magnesium including diuretics, cardiac medications, asthma medications, birth control medications and estrogen. Calcium and magnesium have an inverse relationship, so if you take calcium supplements, then your magnesium level could be low.

An interesting study was published in 2015 on balneotherapy in older adults. Balneotherapy is the use of mineral water baths to improve health and is usually practiced at spas. After a 12-day balneotherapy program, 52 older adults from Spain showed significant improvement in sleep, mood and depression. The water at Balneario San Andrés was hypothermic (at or above 20 C, or 60 F) hard water of medium mineralization with bicarbonate, sulfate, sodium and magnesium as the dominant ions (Latorre-Román et al., 2015).

How much magnesium should I take?

The recommended dietary allowance (RDA) for magnesium varies by age. Dosing also depends on gender and whether a person is pregnant or breastfeeding. For adults, 400 mg daily is usually safe. If you are using magnesium to help with sleep, you may want to take this before bedtime. For some people, magnesium may be stimulating rather than calming. In this case, you should take magnesium in the morning.

Magnesium can be purchased over the counter. Make sure your healthcare provider knows you are taking magnesium, as it may affect other medications you take. If you take magnesium supplements, you should have your magnesium level checked routinely through blood tests. Magnesium can have significant impact on health outcomes and should be carefully monitored.

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References

Latorre-Román PÁ, Rentero-Blanco M, Laredo-Aguilera JA, García-Pinillos F. 2015. “Effect of a 12-day balneotherapy programme on pain, mood, sleep, and depression in healthy elderly people.” Psychogeriatrics (15): 14–19.

Magnesium Fact Sheet: ods.od.nih.gov/factsheets/Magnesium-Consumer

New Support Group Leader in North Carolina

The RLS Foundation is pleased to welcome Erika Hallerman as the new support group leader in Cary, North Carolina. Thank you, Erika, and welcome!

Erika Hallerman (Cary, North Carolina)

Restless legs syndrome began to chronically affect my life just over three years ago. Confirming a diagnosis was a laborious process that required a great deal of patience and persistence. It is easy to become a victim of this neurological disease. I’ve lost count of the number of sleepless nights and have spent many days wondering why I was chosen to suffer in such a way.

There is currently no cure for RLS, so I knew that learning to live with it was my only option. I tried to find a support group along the way but was unsuccessful. The battle to live a better quality of life was much more difficult than I anticipated. After finally discovering the resources embedded in the RLS Foundation, I decided to start a support group in North Carolina.

The focus of my life has been to find a way to live a more comfortable life and help those who suffer with this condition during the process. Most days are hard work for me, but at the end of the day, the struggle is worth the challenge. I hope to share my strength with those who suffer from RLS.

Stay up to date with all upcoming RLS Foundation support group meetings on our website or Facebook page. All volunteer support group leaders and contacts are available via phone or email to provide support. Search by city or state to find one near you!

Interested in becoming a volunteer RLS Foundation support group leader? Visit our website to learn more about the role and how to apply!

Dopamine Agonists and the Worsening of RLS Symptoms

Augmentation, as many with restless legs syndrome know, is one of the most common and least understood problems with current RLS treatment. This phenomenon occurs after a patient starts a dopaminergic medication to treat their RLS - and over time it can make symptoms much worse.

Unfortunately, many who initially start on dopaminergic medications say that it is extremely effective in alleviating symptoms, at first. It may take years for augmentation to kick in, or just mere months. Warning signs of augmentation include an increase in symptom intensity, a shorter period of rest or inactivity before symptoms begin, an appearance of symptoms earlier in the day, or a return to what symptoms were like prior to starting treatment (worsening of symptoms). Many also report experiencing RLS symptoms that spread to their arms, trunk or even the face.

"Augmentation is a condition where RLS symptoms start to worsen after initially improving, while on dopamine agonist treatments such as pramipexole, ropinirole, rotigotine, and levodopa," said Dr. William Ondo, director of the Houston Methodist Neurological Institute RLS Quality Care Center. "Since most patients with an urge to move initially respond to properly dosed dopaminergic medicines, augmentation is arguably the biggest practical impediment to successful chronic management of RLS."

In 2015, to combat this gap in information and awareness, the RLS Foundation rolled out a far-reaching "Year of Augmentation" awareness and education program. This included distributing and promoting an augmentation consensus white paper, a collaboration between the International Restless Legs Study Group, the European Restless Legs Study Group and the RLS Foundation. The white paper was distributed by the RLS Foundation to nearly 50,000 US healthcare providers. Foundation volunteer support group leaders were provided with informational "augmentation toolkits" for their meetings. The RLS Foundation also released its first ever long-form video, RLS and Augmentation , which has been viewed by over 10,000 people.

If you think you may be experiencing augmentation, there is help. The Foundation's free What is Augmentation? handout discusses several approaches used to manage augmentation. Prior to making any changes in your treatment plan, it is important consult your healthcare provider to determine if you have augmentation and the treatment approach best suited for you. If you think that your doctor may lack an understanding of RLS, you can find an RLS Quality Care Center or RLS healthcare provider near you. You can also view and share the "Prevention and Treatment of Augmentation" webinar, presented by Dr. Mark Buchfuhrer of Stanford Sleep Medicine Center (an RLS Quality Care Center), from the Foundation's 2017 Webinar Series, available for free on our YouTube channel.

In the days since augmentation first surfaced, significant strides have been made. In 2016, Dr. William Ondo was awarded a $37,000 grant from the RLS Foundation's Research Grant Program to study a new treatment modality for RLS patients who are augmenting. His research team is currently recruiting subjects in Houston, Texas, to study the effectiveness of a new therapy specifically to RLS patients who are currently suffering from augmentation while still taking dopamine agonist medications. Learn more about how to participate here.

If you need additional information on augmentation, please call the RLS Foundation at 512-366-9109 or email info@rls.org and we will be happy to assist you. You are not alone!