Rational Prescribing Article Series

Article 2: Rational prescribing – Magnesium for managing pain and cramps

If you suffer from pain in your muscles, joints or other tissues, or if you experience cramps, twitching, tremors or muscle spasms, you should consider magnesium.

While clinical trials have not yet confirmed its effectiveness, its low cost and low risk make magnesium a sensible therapy to try and see if it helps your symptoms. This is called rational prescribing, and you can do it on your own, or with your doctor or wellness provider.

About Magnesium

One reason to consider magnesium is that your body might be lacking this essential mineral. Magnesium deficiency is common for many reasons. Water was once an important source of magnesium, but this is missing from most municipal tap water and even most bottled water. A recent systematic review found nine studies that linked magnesium levels in water to cardiovascular mortality, and concluded that people who drank magnesium-rich water had a 25 percent lower risk of death.

This is one of many issues discussed in a recent review of the science of magnesium. Depleted soil, processed foods and other factors mean that the average diet contains less magnesium than it once did. Risk factors for deficiency include older age, digestive disorders, overconsumption of soft drinks or alcohol, and certain medications. Unfortunately, there is no accepted reliable test for measuring magnesium levels in the body. Blood levels can be measured, but they don’t reflect what is in the tissues, which matters more.

The recommended dietary intake of magnesium is about 400mg for men and 300mg for women. Magnesium-rich foods include wheat, quinoa and other whole grains, nuts and seeds, cocoa, beans and lentils. But the body typically absorbs only about 30 percent of the magnesium in food — much less than what is absorbed from drinking water.

Magnesium deficiency has been linked to cardiovascular disease and Type 2 diabetes in carefully conducted systematic reviews. It increases the risk of osteoporosis. It increases the risk of pain, migraines, depression, anxiety and other nervous system disorders. There are more than 600 enzymes in the body that rely on magnesium for their proper function. What we know about the risks of magnesium deficiency is likely just the tip of the iceberg.

How To Conduct Your Trial

While there is a lot of research linking magnesium deficiency to pain and other disorders, there is limited evidence that a magnesium supplement can effectively treat them. This is the case for most natural health products, and while the reasons for this are complex, millions of people are using them anyway.

Doctors typically only recommend treatments that have been proven effective in randomized controlled trials. This approach is called evidence-based medicine, and while it has major benefits, patients find themselves on their own when these treatments don’t work for them. Randomized controlled trials can provide evidence that a treatment is better than a placebo in a large group of people, but it does not confirm that it will work for you. If you are struggling with pain, you can use a process that the World Health Organization calls rational prescribing to find out if magnesium works for you.

First you should clarify what you want to improve and what improvement looks like. This is about goal-setting, so choose a specific, measurable, achievable, realistic and time-based (SMART) goal. An example of a SMART goal would be more hours of sleep with fewer night-time wakings due to pain within four weeks.

You can choose to try magnesium once you have considered your other options. It is hard for most people to do this on their own, and the internet is a big place filled with lots of information that can be hard to interpret without clinical experience or medical knowledge. If you have a good relationship with your doctor, consider asking them to supervise your trial. If you are working with a wellness provider, they will know a lot about the natural options available to you, but their advice will likely be based on the specific therapies they use most often and those they know best. Do your homework.

Next you need to find the right magnesium. There are many different formulations of magnesium. Studies suggest that some forms are better absorbed than others, but this is hard to confirm because the testing methods are not reliable. For problems involving the nervous system, some experts recommend using magnesium with taurine, because this amino acid helps the magnesium cross the blood-brain barrier. This includes pain, muscle cramps, migraine, depression and anxiety, all of which have been effectively treated with magnesium in clinical trials.

How much to take? Magnesium is absorbed in the small and large intestine, and what is not absorbed is eliminated, creating a laxative effect. Some have advised gradually increasing your daily dose until you experience this, in what is called a bowel tolerance protocol. A knowledgeable provider can help with this part, but trial-and-error is not a bad approach, as the toxicity of magnesium is low.

Once you have figured this part out, you can start your trial. Take your magnesium regularly, and if you are really keen consider keeping a daily record of your progress. You can use paper and pen, or find a smartphone app to help you track this information. For some people, remembering to take their medicine is a challenge, and it may help to set a phone reminder or just leave the medicine somewhere you will see it every day.

By the end of your trial, you should know whether magnesium has helped you. Many people don’t respond to proven therapies, but many people have also reported major benefits from unproven treatments. In a rational prescribing approach, your experience and your preferences are important and you are the only expert on these.

If you feel that magnesium has helped you make progress on your goal, you can keep things as they are, or you can try increasing the dose or adding something else. If it hasn’t, you may choose to try a different dose, a different formulation, or simply try something else.

Rational prescribing is a safer, more responsible and structured way to explore complementary and alternative medicine therapies. It can help you identify what works for you and what doesn’t, and by structuring your wellness journey as a series of trials, you can build a personalized regimen that will improve your life.

If we can find a way to crowdsource all of this data, learning what works, what doesn’t, and why, perhaps we can take a step towards more evidence-based integrative medicine. As an integrative MD grounded in evidence and science, I have used this kind of real-world data to help many people improve their lives. I hope it helps you.