Calcium & Magnesium - Cal-Mag Citrate

[Robin-Whittle]

Can anyone report their experiences with Magnesium and
Calcium?

I am not suggesting that getting these right will cure or even
affect everyone's RLS. RLS is clearly affected by many
things, and I suspect this is one aspect of nutrition which
many people could improve, with a chance of helping
reduce their RLS.


My wife's unusually low levels of RLS have continued for 3
weeks now. We think that the most important factors in this
improvement have been more exercise and the extra
calcium and magnesium she has been taking. However
there have been periods of several days with little exercise
and this hasn't caused a relapse, so I think the nutritional
changes are probably the major factor. (I wrote in another
message about the essential fatty acids Vitamin E and in
Fish Oil and Evening Primrose Oil, but she has taken these
regularly in the past and still had RLS.)

She is aiming to take 9 Jarrow Cal-Mag Citrate tablets a
day, but is probably averaging 6 to 8, since this is a lot of
tablets and they are large. Cal-Mag Citrate is not easily
obtainable in Australia - we order it from the USA.

Each tablet contains:

200 IU Vitamin D2 ergocalciferol
500 mg Calcium as calcium citrate
250 mg Magnesium as magnesium citrate

According to the label, 6 of these tablets provide 100% of
the recommended "Daily Value" of D2 and Calcium and
126% of the Magnesium, for a 2000 calorie diet.

I understand that Iron supplements need to be taken
separately from pretty much all food, except Vitamin C,
and this would mean taking Iron at completely separate
times from the Cal-Mag Citrate tablets.

Calcium and Magnesium for RLS gets a mixed response at:
http://remedyfind.com/rem.asp?ID=16117

Some people mentioned that it is best to increase
magnesium dosage until there was a "loose bowel
movement".

Some better responses are at:
http://remedyfind.com/rem.asp?ID=16946

A 1998 study - type in 9703590 to PubMed:
http://www.ncbi.nlm.nih.gov/entrez/

found that "magnesium treatment may be a useful alternative
therapy in patients with mild or moderate RLS-or PLMS-
related insomnia."

Recommended Daily Allowances:
http://ods.od.nih.gov/factsheets/calcium.asp
http://ods.od.nih.gov/factsheets/magnesium.asp

"Dietary magnesium does not pose a health risk, however
pharmacologic doses of magnesium in supplements can
promote adverse effects such as diarrhea and abdominal
cramping."

An RLS sufferer who found Cal-Mag Citrate really helped:
http://www.wemove.org/ubb/ultimatebb.ph ... 1/579.html

Magnesium helped some other people:
http://beta.restlesslegs.org/phpBB2/viewtopic.php?t=330
http://beta.restlesslegs.org/phpBB2/viewtopic.php?t=101

Searching this forum for "magnesium" also turns up some
reports of positive experiences with Epsom Salts
(Magnesium Sulphate).

- Robin

[ViewsAskew]

Robin, it does help me, but not enough to stop my meds. I take one mega B complex and 2 magensium tabs (sorry, don't know amounts off the top of my head) each night when I go to sleep. I take calcium earlier in the day. In the past, taking the B and magnesium at bedtime has allowed me to reduce my meds by about 1/5th. I've added the L-Tyrosine (up to 1500 mg) to this and it has not helped me reduce the meds any further.

Interestingly, when I have had the rare occasion to take a calcium-based antacid during the night, it had always caused some RLS. The few times this has happened (maybe 5-8 over the last year), I have taken it 1-3 hours after my medication having awakened with some heartburn. Each time I have again awakened within 1/2 hour to an hour with RLS. These are the only nights I've had breakthrough RLS unless I screwed up taking my meds on time.

Ann

[Robin-Whittle]

Thanks Ann for your response. I found various other threads
in this and other discussion lists indicating that for some
people, Magnesium and/or Cal-Mag Citrate was helpful.

I understand that the two are best taken together so it may
better to take Calcium and Magnesium in the 2:1 ratio, with
vitamin D2, all at the same time. It is common for nutrient
uptake systems to interact with each other - so it is important
to take them at the same time, not just the correct ratio at with
calcium at one time and magnesium at another. One nutrition
book I have here states that a cause of low magnesium levels
is high calcium intake.

Magnesium is a crucial atom in at least 300 enzymes, so it
affects every cell in the body and therefore every bodily
function. There is lots of scope for a lack of magnesium
affecting various systems which lead to RLS when they are
not working properly.

The most common (perhaps the only?) calcium based
antacid is calcium carbonate - AKA limestone, chalk etc.
Hydrochloric acid in the stomach converts it to water and a
calcium chloride solution. Calcium carbonate is used in
plenty of supplement tablets. I wouldn't necessarily explain
your experience of suffering worse RLS within hours after
taking the antacid as being due to a drop in magnesium
absorption, since you probably weren't going to absorb any
at that time anyway. Can you let us know the ingredients of
the antacid? It would be good to know what to avoid, and this
adverse reaction you experienced could be another clue to
understanding the various processes which affect RLS.


I don't suggest taking tyrosine during the day, assuming the
worst RLS problem is at night. It is my clear impression
that its benefits last 1, 2 or 3 hours - so I suggest using it
only when you really need it. Maybe that would be in the
middle of the night to help you get enough non-REM
sleep so you get to REM sleep, which seems to stop RLS
for the rest of the night (or by now 3 to 7AM . . . ).

- Robin

[Guest]

Robin, I've tried the calcium mag together and separate - no difference in the RLS. I am religious about the magnesium and casual about the calcium.

Not sure what I said earlier, but I have only taken the L-Tyrosine at night before bed when the legs are acting up or when I've tried to reduce my med dose.

The brand of the antacid had varied; DH has GERD and sometimes screws up with his meds or what he eats and so keep them in the house at all times. He's had different brands. The non-calcium based ones have not affected me when I've tried them, but all the ones with calcium carbonate have all affected my RLS. He's has the name brands (US - Tums, Rolaids, etc.) and store brands. When he has Gaviscon, an aluminum hydroxide and magnesium antacid, and I take it, my RLS is not worsened.

Ann

[georger]

Robin,
I started my efforts at finding an RLS solution with Minerals and Vitamins. I didn't have any outstanding results from anything....I tried most everything.

Sherry

[Robin-Whittle]

Hi Sherry,

I am glad you found this Calcium and Magnesium thread.

While I am happy that you find Tyrosine helpful, (as you
mentioned in the "Tyrosine experiment" thread) at least for a
few hours, I think that the best idea is to sort out longer-term
nutritional needs which might affect RLS. Then, hopefully,
you will need little or no Tyrosine or medication. As far as I
know, Tyrosine in these quantities is unlikely to cause harm,
but I have no qualifications etc. It is, however, well recognised
that the Mirapex (pramipexole) and other Dopamine agonists
have potentially serious adverse consequences:

http://www.rxlist.com/cgi/generic2/prampex_ad.htm

So, I think it makes sense to go to a *lot* of trouble with
nutrition in every effort to reduce or eliminate the need for
drugs.

I am guess that there are some people with high levels of
Calcium and Magnesium who still get RLS. There is reason
to believe that low levels of these are a strong contributing
factor to RLS, so it is reasonable to think that RLS sufferers,
on average are worse in their Calcium and Magnesium
nutrition than non sufferers. Likewise, I recall research that
RLS sufferers on average have lower Iron (Ferritin) levels than
the general population.

Therefore, I think most RLS sufferers could probably benefit
from nutritional supplements, especially Iron, Calcium and
Magnesium.

Here is my response to what you wrote:

> I started my efforts at finding an RLS solution with Minerals
> and Vitamins. I didn't have any outstanding results from
> anything....I tried most everything.

on the assumption (which may well be wrong) that you took
ordinary multivitamins, but not the largish dosage of Iron,
Calcium and Magnesium which might be needed. Maybe
you did try these largish dosages.

Nutrition is a daunting subject, because there is so much
detail and because there is considerable disagreement
among the experts. Also, our understanding of the body is far
from complete, and people's needs and experiences differ
enormously.

At first, I guess many people might think that one vitamin is
good for one or two bodily functions and another vitamin is
good for some other function etc. However, I think that if they
understood, even partially, our current best knowledge about
all that is happening in a single human cell, they would realise
that almost all of these vitamins, minerals and essential fatty
acids are absolutely essential for every single cell.

From an initial position such as this, it might seem sufficient
to take a gutsy looking multivitamin and maybe a few other
specific vitamin or mineral tablets. I figure that there is little
chance of harm in this, and that probably quite a few of the
extra vitamins will help in some way with RLS and other
aspects of health.

However, as I describe below, to actually get the
"recommended daily allowance" (RDA) of some of these
essential nutrients in tablets requires a lot of tablets. Also,
it requires taking them at proper times. For instance Iron
needs to be taken (as far as I know) with Vitamin C and not
with any other kinds of food - so maybe it is best to take Iron
before going to bed, or in the middle of the night.

I think that the supplementation which may really help an RLS
sufferer is probably going to be more involved than what most
people do when they first look at vitamins and minerals.

My wife had been taking 3 Cal-Mag Citrate tablets a day, for
a while, but then she realised she needed to be taking 6 to
get about the RDA. I am not suggesting that she needs to
be taking 9, or that anyone else should take this, since people
do get some Calcium and Magnesium in their diet anyway.

Here are my current impressions about the most important
minerals for RLS.

The first of these is clearly Iron. Iron deficiency is very
common and requires careful supplementation. People who
eat lots of red meat probably don't have such a problem, but
many people - my wife and I included - don't. (We eat plenty
of fish and she eats poultry too. She makes fabulous meals
and I have never eaten so well!) Menstruating women have
higher needs because they lose some iron every month. Iron
is an essential part of Tyrosine Hydroxylase and everything I
know about RLS research indicates that people with low iron
and RLS can improve their situation by taking iron.

I think that even for people such as my wife, who has had
RLS since childhood, that improving Iron and other nutrient
levels will reduce the RLS problem.

I do not have the expertise to say anything definitive about Iron,
but here are my current impressions. I think the "time constant"
of iron supplementation is weeks and months - that it takes this
amount of time to build up Ferritin levels (the iron storage
protein). I have read that it can take many months to deplete
these levels, perhaps a year or so. This is in stark contrast
to taking Tyrosine which seems to rise and fall in the
bloodstream (with no storage anywhere) over a period of
20 minutes or so (rise) and an hour or two or maybe three (fall).

I don't know what the time constant of Calcium and Magnesium
is, at least as they affect RLS. I guess it is days to weeks.
The main storage of Calcium is in the bones and many people,
women especially, take Calcium supplements with the intention
of reducing the chance of bone problems in older age.

I understand that Iron regulation in the body is poor. While the
efficiency of uptake falls off as the Iron (presumably as Ferritin)
levels increase, the body will still take in iron even when it has
more than enough. Too high a level of iron has serious health
consequences. One problem is that it makes bacteria
happier and leads to greater risk of bacterial infection. There
are many other problems, as far as I know. I recall that Iron
poisoning is the most common cause of childhood poisoning
in the USA: http://www.cfsan.fda.gov/~dms/qa-wh10.html.
"Iron is the leading cause of poisoning deaths in children
under 6, despite child-resistant packaging. Since 1986, over
110,000 such incidents have been reported , including 33
deaths."

So while I think that for many RLS sufferers, iron
supplementation would probably be helpful, I also think that
after quite a few months, it would be best to have Iron and
Ferritin levels checked to make sure they are not excessive.
My wife's levels were close to the low end of the allowable
range, and a year after taking moderate iron supplements
they are better, but still not high. She is taking more iron now
and we will continue to have the the tests in order to keep
an eye on it. http://www.irondisorders.org

There are no-doubt a bunch of vitamins which are important
to RLS. My view is that all the vitamins are vital for life and
health - and since RLS is clearly affected by failures in lots of
different bodily subsystems, it is reasonable to expect that
almost any deficiency of vitamins, minerals or essential fatty
acids would worsen RLS.

I think that most people could probably benefit from taking a
comprehensive multivitamin tablet, with the following extras
(unless it is known there is no shortage) because the
multivitamin tablets never have enough of these things in them:

Vitamin C
Vitamin E
Fish Oil (an excellent source of Omega 3)
Evening Primrose Oil (and excellent source of Omega 6)
Zinc (multivitamins never have the required 25mg)
Calcium and Magnesium

Probably some other things might help, such as Chromium
Picolonate, Selenium, Iodine (if not eating iodized salt, or fish)
etc. Just because humans survived in the past on particular
diets doesn't mean that those diets provide the optimal levels
of all the various nutrients.

The point I am getting to is that the quantities of Calcium and
Magnesium, which are recommended daily allowances are
*far* greater than fits into a single multivitamin capsule or
tablet.

Right now, my wife and I feel that the substantial dosage of
Cal-Mag Citrate (6 or more large tablets a day) has made a
a far bigger impact in reducing her RLS than any other factor.
We know that Iron is important, and we strongly suspect a
salty meal will make RLS more likely that night. We know
Tyrosine can help her for a few hours, but in recent weeks
(since aiming to take 9 Cal Mag Citrate a day) she has only had
RLS on the two occasions when she had a salty meal.

- Robin

[Jenne1950]

Can't quite compare with that last answer, but please be careful not to take too MUCH calcium. It can interfere with the absorption of iron by the body and lead to SEVERE anemia without any hint it's occurring!!

[becat]

I'm so sorry about the last post Jenn,
I didn't wake up as normal last night and got up a bit late this morning. So, I deleted the last post Jenn spoke of.
I can't stand trolls.........
Carry on about cal/mag ya'll.
Lynne

[Jenne1950]

Oh, I just take it with a grain of salt, Lynne! I didn't wake up right this morning either! I slept 4 hours in my bed, then the chair, then my bed again! Finally woke up with a sleep hangover! Too much of a good thing, I guess.

Did me a world of good to vent yesterday, I guess, if I slept so much last night. Or I really was exhausted.

What I said about the calcium and iron--I took too much calcium, for both indigestion and my bones, and spent a week in the hospital over it, had 4 transfusions, and had never been anemic before! That was about 6 weeks ago or so. I'm limiting mine, for sure!

Jenny

[Robin-Whittle]

Here's another long message which is hopefully easier to read
than multiple short ones.

We are aware of the incompatibility of taking calcium and iron
supplements at the same time, so my wife aims to take three
cal-mag citrate tablets at a time, in the morning, afternoon and
before bed.

She takes her iron during the night, which used to be easy when
she was getting RLS regularly. Now, in general, she doesn't get
RLS and often sleeps through the whole night. The solution, in
part, is for me check to see if she has taken her iron when I wake
during the night - and to wake her just enough to take it if needed.

We assume that there is something like a 2 to 3 hour time
window for absorption of these tablets, so we try to leave this time
between the cal-mag citrate and the iron. To what extent high
levels of calcium and/or magnesium, in the citrate or other forms,
have a longer-term clash with iron, we are not sure. I am
assuming the problem is just in the digestive tract, rather than a
systemic high level of calcium interfering with iron absorption.
We have my wife's iron and ferritin (the long-term iron storage
protein) levels checked from time-to-time, so the next test will tell
us whether these cal-mag citrate arrangements are a problem for
iron absorption.

It is now over two months since we discovered our new friend -
Cal-Mag Citrate! My wife tries to take 3 sets of 3 tablets, but
often only takes 2 sets. Usually, if she takes just one set, it is in
the evening. I don't have exact records of this, so I am not sure if
there has been an instance of just one set of 3 tablets before bed
leading to no RLS.

My impression is that as long as she takes one set before bed
and one set sometime during the day, she will have NO RLS.

Yesterday, my wife forgot to take any cal-mag citrate - the first
time she had taken none in over two weeks. At bedtime I
suggested she take some - because I feared the RLS Monster
would come back back with a vengeance. She didn't take any -
saying she would see what happens. I was impressed by her
dedication to Scientific Reseach!

Sure enough, at 3AM, she awoke and soon had RLS and
spasms in her legs and arms. 1500mg of Tyrosine came to the
rescue. This was the first RLS episode in two weeks.

A proper research program could tease out some finer points
about timing of calcium and magnesium supplements (the two
need to be taken together) and what form they are in (citrate,
carbonate, chelate etc.) to find the most effective, minimal dosage
for preventing RLS. However, for us, in the context of iron and
other supplements and generally good eating and exercise, we
have all the information we need: take 6 cal-mag citrate a day,
with 3 before bed, and there will be no RLS.

There are three very different time-scales at work here.

Iron: seems to be weeks and months. It is a long-term process -
presumably building ferritin levels. I think an iron supplement
would be of limited value in making RLS go away in the next
minutes or hours.

Calcium and magnesium (at least in the citrate form): there is
clearly a time-frame of 8 to 24 hours at work here. I am not sure
to what extent it can make RLS go away on a time-scale of an
hour or so.

Tyrosine: helps very directly, causing significant improvement in
ten minutes with further improvement for another 20 minutes or so.
Effects typically last for 1.5 to 3 hours, which might be enough
(we think) to help the body get enough REM sleep, which for
some reason enables the body to stop the RLS processes for the
rest of the night. (I have a research reference on REM and RLS,
but can't find it now.)

I guess the absorption processes for tyrosine and
calcium-magnesium are very different - so perhaps taking both
supplements at the same time would be OK. However, the best
idea seems to be to take cal-mag citrate during the day and
evening, so there will be no need to use tryrosine as a short-term
fix at night.


While I think it is likely that quite a few RLS sufferers would find
cal-mag citrate (or perhaps some other effective calcium
magnesium combination) effective, I can't be sure. Also, I can't
be sure in general that the dosages my wife uses will have no
negative consequences, for her, or would have no negative
consequences for other people. Nutritional needs vary
considerably between individuals and there are many
complications in nutrient absorption - most of which, we hope,
can be alleviated by taking supplements several hours apart.

The package (Jarrow CalMag Citrates 2:1) recommends:
"Usage: Take 1 to 6 tablets per day with meals, preferably
dividing the number of tablets equally between each meal to
facilitate maximum absorption, or as directed by your qualified
health consultant." and, regarding long-term reduction of risk of
osteoporosis: "Daily calcium intake above 2,000mg is not likely
to provide additional benefit".

2,000mg would be 4 tablets. Maybe for some other RLS sufferers,
a significant reduction of RLS problems might be achieved with
somewhat less than 6 tablets a day.

- Robin