Magnesium Depletion Score and Metabolic Syndrome in US Adults

(academic.oup.com)

93 points | by voisin 13 days ago

13 comments

  • breadwinner 13 days ago
    Magnesium fixed my insomnia and muscle cramps. Here's my story:

    I have seen many doctors, including sleep specialists, regarding insomnia. They all pointed to one source as the reason for the sleep issues: stress. And they all wanted to put me on prescription sleeping pills. I said no to that. Sleeping pills are addictive and you have to take them for the rest of your life. As a software developer, I am used to finding and fixing the underlying problem as opposed to the quickfixes these doctors were offering me.

    After much research I figured out the underlying problem, and the fix for it. The underlying problem is magnesium deficiency. As a software developer I am using my brain more intensely than most people. This is the stress the doctors are talking about. Stress depletes magnesium. The cells in our body depend on two essential minerals for normal function: Calcium and magnesium. Cells go into ON state when calcium goes in, and OFF state when calcium goes out. Calcium doesn't go out on its own: magnesium has to go in and displace the calcium. When you are low on magnesium, cells can't go into OFF state. When that happens your muscles become stiff and you need massages, and your brain can't turn off and you can't sleep. The solution is magnesium supplements. This fixed my muscle stiffness issues and my sleep issues. A special compound of magnesium called magnesium l-threonate is especially helpful for sleep because it can penetrate what is known as the "blood brain barrier".

    • JackMorgan 12 days ago
      Well I've been having so much muscle soreness and difficulty sleeping the last couple months, when I've also been 23/1 fasting.

      My back felt like I was having a constant tension headache. I'd wake up uncomfortable.

      I just went and got some magnesium glysinate and after taking 66% daily amount I fell asleep taking a nap and woke up without a headache! All my upper back, shoulder, and neck stiffness just melted away! Thanks for writing this!

      • breadwinner 12 days ago
        Awesome! The weird part is that doctors don't know about using magnesium for fixing muscle soreness or sleep issues. No doctor has ever recommended it to me. But no doctor has advised against it either, when I mention I am taking magnesium for this purpose.
    • adrian_b 13 days ago
      > Magnesium fixed my insomnia and muscle cramps.

      I never had insomnia, but sometimes I had nocturnal leg cramps, when sleeping after intense physical exercises.

      For unrelated reasons, I have begun taking a magnesium supplement. Since then, I have never had again any cramp.

    • azinman2 13 days ago
      Did blood tests ever show low magnesium?
      • breadwinner 12 days ago
        Blood tests are not reliable for magnesium levels.
    • r0fl 13 days ago
      The underlying problem is magnesium deficiency.

      How did you come to that conclusion? Blood work? Something else?

      • breadwinner 12 days ago
        A breakthrough came when I saw a naturopathic doctor for my stiff muscles and she advised me to take Epsom salt baths. That seemed to help. I investigated more and found out that the ingredient in Epsom salt that helped me is magnesium. Then I found out that you can actually get magnesium pills and tried that. That worked remarkably well. But the big surprise was that I slept better the night I tried the magnesium pill! That's when I realized that magnesium is good for insomnia as well! I then worked backwards to understand the role played by magnesium.
    • andrekandre 13 days ago

        > your muscles become stiff and you need massages, and your brain can't turn off and you can't sleep.
      
      omg, this is exactly me right now... any good points of research for this (books etc)?
      • breadwinner 12 days ago
        It is very hard to find good info on this. I had to piece it together from multiple sources. But here's GPT-4 has to say on this topic:

        Magnesium plays a crucial role in the relaxation of muscles at a cellular level. Magnesium ions are necessary for the proper functioning of the muscle cell's contractile machinery. The muscle contraction and relaxation process is regulated by the movement of calcium ions into and out of the muscle cell. When a nerve impulse reaches a muscle cell, it triggers the release of calcium ions from the sarcoplasmic reticulum (a type of intracellular membrane) into the cytosol (the fluid inside the cell). This causes the muscle filaments (actin and myosin) to bind together, resulting in muscle contraction.

        To relax the muscle, the calcium ions need to be pumped back into the sarcoplasmic reticulum. This process is facilitated by the protein called Calcium-ATPase. Magnesium ions are necessary to activate this protein and pump the calcium ions back into the sarcoplasmic reticulum. Additionally, magnesium ions also inhibit the release of calcium ions from the sarcoplasmic reticulum into the cytosol, helping to prevent muscle contraction.

        Therefore, adequate levels of magnesium are required to maintain normal muscle function and prevent muscle cramping and spasms. If magnesium levels are too low, muscles can become overactive, leading to cramps and spasms.

    • mackross 13 days ago
      Exact same thing happened to me
    • moltar 13 days ago
      Can you recommend any specific formulations or brands?
      • breadwinner 12 days ago
        Magnesium Lysinate Glycinate, and Magnesium Taurate seem to work well for me. Brands: Doctor's Best and Double Wood.
  • Modified3019 13 days ago
    Be warned, magnesium oxide and magnesium citrate can double as laxatives until you get used to them. I recommend starting them on a weekend where you can run to your own bathroom.

    For the magnesium bound to other things like glycine for better absorbability, this is usually less of an issue. Usually.

    Personally I just got a 4 pound bag of food grade magnesium chloride for $25 several years ago. I’ll throw a dash of lite-salt (half sodium, half potassium) and a teensy scoop (something like 1/16th-1/32rd of a teaspoon) of mag-chloride into my water bottle for electrolytes, or when I add salt to soups or something. I could very well die of old age before going through the entire bag.

    For the fancy kinds of mag (orotate, glycinate, etc) different people will sometimes ascribe different effects to them, ranging from stimulating in some way or sedating. Changes in dreams can also be reported.

    I’ll also add that a typical magnesium level reported in a blood plasma test is worthless. What actually needs to be measured is intra-cellular mag levels, because it’s possible to have plenty of magnesium hanging out in the blood, but something is preventing the cells from properly uptaking what’s available. The tests for this are hard to find and expensive last I checked years ago. At this point you are looking at levels of magnesium research I am not able or willing to commit to digging into further, so I couldn’t tell you why (may possibly be related to diabetes) or how to ultimately resolve that condition.

    Magnesium is one of the safest things you can supplement (unlike potassium or calcium supplementation), typically just giving you the shits long before you can reach or maintain a harmful level of intake. That said, people with kidney complications should always discuss with their doctor about adding any electrolyte, since even sodium is no longer safe to take as desired.

    • jbotz 13 days ago
      > magnesium level reported in a blood plasma test is worthless.

      This is true, and the reason is more interesting and illuminating than what you stated here. Blood magnesium levels are a significant part of how your body regulates the speed of the heartbeat... so in a normally functioning body they need to be kept pretty constant. So if you don't get enough Mg in your diet, your body will start extracting Mg from tissues and bones keep the levels in your blood high enough. But it will be missed there, because Mg plays important roles there, too, it's just that regulating your heart-beat takes precedence.

      This is why, if you have any doubts at all that you're getting enough Mg in your diet, it's a good idea to supplement Mg. A bit too much doesn't do any harm, but too little can cause all sorts of problems (especially neurological) but it won't show up on any simple tests as being the cause of those problems. Mg supplements, even the "fancy ones", are relatively cheap... just know that Magnesium Oxide (the most common from in cheap multi-vitamins) is very poorly absorbed and probably useless, but pretty much any other form is fine as a supplement.

      • Jensson 13 days ago
        > Magnesium Oxide (the most common from in cheap multi-vitamins) is very poorly absorbed and probably useless

        I read the opposite, the others you absorb so fast and get peed out (resulting in high magnesium in urine) while magnesium oxide gets absorbed the most since it is so much slower.

        But I can see everyone saying the oxide one is bad due to it not increasing magnesium in urine as much, but you don't really want to increase magnesium in urine you want to increase magnesium in your body and that is done better when absorption is slow since you don't want it all to go to your urine.

    • modeless 13 days ago
      Yes, there's no reason you need to swallow a bunch of giant pills to get magnesium or potassium. It's far better to just get bulk magnesium chloride and potassium chloride and mix them into drinks or food. Also, nobody should ever take magnesium oxide as a supplement. It's only useful as a laxative.
    • arcticbull 13 days ago
      Humans cannot absorb magnesium oxide. It’s a laxative, not a magnesium supplement.
      • Jensson 13 days ago
        Humans do absorb magnesium oxide, what nonsense are you talking bout?

        > However, the difference in urinary Mg2+ levels between Mg2+ citrate (7.2±1.48 mmol) and Mg2+ oxide (6.7±1.43 mmol)-although statistically significant-is marginal

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/

        • arcticbull 12 days ago
          If you continue to read that section of the paper you linked, they cite several human studies that all showed how poorly magnesium oxide was absorbed relative to all the other magnesium supplementation options, especially in the Table 4 link in section 4.2.5 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/table/T...).

          > Siener et al. administered 404 mg/day of magnesium oxide to healthy volunteers and analyzed the magnesium concentration in blood and urine. There was no significant change in blood concentration of magnesium, but urinary magnesium excretion increased by 40% after administration of magnesium oxide. Yoshimura et al. performed a pharmacokinetic study of orally administered magnesium oxide in rats. They showed that 85% of magnesium is excreted in feces, while 15% of magnesium is absorbed from the intestinal tract and excreted in urine. [2]

          > A 2017 rat study demonstrated its low absorption rate, concluding that only 15% of orally administered magnesium oxide was absorbed, while 85% was excreted in the feces. Older research suggests the absorption rate is even lower in humans [1,2]

          This study puts the absorption at 4%. [5]

          It's normally used as an antacid or laxative.

          > Magnesium oxide is an inorganic salt of magnesium. Even though it contains high amounts of magnesium, it has low absorbability in the body. Still, it has been shown to offer health benefits like constipation relief. [3]

          Oxide is among the least bioavailable form of magnesium, right down at the none-to-almost-none tier with magnesium stearate. Which is what this study comparing various supplements shows, too. [4]

          What I meant was that it's a waste of time due to its ultra-low bioavailability. If you're trying to supplement, pick one of the many options that your body can actually use. Unless you're constipated I guess.

          Yes, I know it's sold as a supplement, and included in many multivitamins. You should know that doesn't mean much, vitamins and supplements in the US are not FDA regulated and there's no real guarantee they (a) do anything or (b) are in a form that does anything.

          Never hurts to be polite ;)

          [1] https://pubmed.ncbi.nlm.nih.gov/28123145/

          [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911806/

          [3] https://www.healthline.com/nutrition/magnesium-oxide

          [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683096/

          [5] https://pubmed.ncbi.nlm.nih.gov/11794633/

  • arcticbull 13 days ago
    Remember not all magnesium supplements are absorbable by humans. Absorption of magnesium oxide and stearate is as low as 0-10% (common in supplements) while glycinate, orotate and L-threonate is closer to 100% and the latter seems particularly able to cross the blood brain barrier.
    • clumsysmurf 13 days ago
      It would be very expensive to meet your RDAs with L-threonate alone, in both absolute and relative cost. Mg glycinate probably does as well, the evidence for / against L-threonate form having any impact in the brain is marginal at best.
      • arcticbull 13 days ago
        Yeah that makes sense, I think my point was to avoid magnesium oxide and stearate since it’s completely useless - rather than advocating for a specific bioavailable form. I think folks assume the form of magnesium in their multivitamin is useful when overwhelmingly it’s not useful at all.
  • james4k 13 days ago
    Magnesium is very important but of course the big confounding factor is that a higher magnesium depletion score is also a good indicator that you're consuming more processed foods and fewer whole foods.
    • singularity2001 13 days ago
      do processed food deplete magnesium or do they just lack it?
      • zadokshi 13 days ago
        It’s not clear to me which foods you would need to “only eat” to not have enough magnesium. Meat, vegetables, and grains all contain magnesium. I wonder if you process meat into (for example) hot dogs, you are eating meat mixed with grains, so the grain content might decrease the total magnesium.

        Perhaps a high calorie diet (soft drinks, potato chips, etc…) would lead someone to eat less “real food” (meat, vegetables, and grains), and thus overall magnesium would be less.

        But still, I don’t know what one would have to focus on eating to avoid magnesium.

      • james4k 13 days ago
        I don't know but I could imagine the extra oxidative stress and inflammation etc. might mean your body would need more of certain minerals than it otherwise would? Just speculating, not a doctor/nutritionist/biologist.

        Edit: Processed food definitely lacks magnesium to be clear, but it's interesting to think about how it might even be more costly than it appears.

      • Jensson 13 days ago
        Magnesium is often in the brown/full grain parts of the food, which is removed in most processing. I don't think it depletes it just lacks it.
        • zadokshi 13 days ago
          So if someone lives off white bread and pasta with little to no meant/veg, that could possibly deplete magnesium.

          Is that true, there is more magnesium in the husk?

        • Sammi 13 days ago
          Unfortunately a lot of brown grain food is mostly just dyed brown :/

          The food industry is evil.

  • NalNezumi 13 days ago
    Recently started to take magnesium supplements, after some Googling and finding an old HN post about experiences around it, going for glyciate rather than oxide (latter was the only one I could find at pharmacies).

    In 1 week I've yet to experience any of the positive effects often listed (maybe slightly better sleep?) bar one surprise: I don't wake up for bathroom visit anymore.

    Used to wake up once a night for toilet visit, but that disappeared. Anyone have had similar experience? My (old) father have been complaining about 2-4 toilet visit per night and was wondering if I should suggest magnesium supplement to him, or if this is just placebo.

    I've read that too much magnesium hinder Zinc uptake, so I assume blindly suggesting it to others might have adverse effects depending on lifestyle

    • mondocat 13 days ago
      1. Sleeping through the night, regardless of how you feel otherwise, is a great benefit. 2. Salt is anti-diuretic, so I'd suspect the effect is real, but not specific to magnesium. And like any supplement, it works for you because you presumably weren't already getting enough in your diet, so.. ymmv.
    • asciimov 13 days ago
      If you are peeing overnight on the regular, get your blood sugar and A1c checked to make sure you don't have diabetes.
    • random3 13 days ago
      Waking up for bathroom affects sleep quality which, in turn, can lead to many other issues. Stop drinking water 4h (not 2h) before going to bed.
      • NalNezumi 13 days ago
        Oh definitely. Well the problem with not drinking water before bed is that, then I wake up due to thirst. Which was originally why I started drinking more water (I still chronically drink too little water every day) and then caused waking up for toilet visit.
        • nradov 13 days ago
          If you're waking up thirsty then that might be a symptom that you're mouth breathing at night. Have you tried video recording yourself at night to check?
          • NalNezumi 13 days ago
            That's an interesting point! Nope haven't recorded myself, I rarely wake up being dry in my mouth, if that's an indication, nor do I snore a lot or have the tendency to mouth breathe.

            I would think (?) I would notice if I mouth breathe excessively, sine I hurt my throat while sleeping when I catched covid, and then I could only mouth breathe for several days due tapped nose. Noticeable difference

            But recording / asking SO to check could be a good thing. Thanks for the suggestion!

      • tayo42 13 days ago
        How do you not feel thirsty?
    • ipaddr 13 days ago
      I found it had the opposite effect taking before bed.
    • tedd4u 13 days ago
      What amount is your daily dosage?
      • NalNezumi 13 days ago
        As per suggestion, 105mg (25% DRI) recommend on the label. I've noticed some stomach ache now and then so I'm not sure if I'd like to take more than that
  • worstspotgain 13 days ago
    This is another suspect observational study, IMO. The 0-5 Magnesium Depletion Score is computed from variables that pre-correlate with Metabolic Syndrome irrespective of Magnesium: 2 points for kidney disease [1], 1 for alcohol use, 1 for GERD pills, 1 for magic-diet pills.

    When they try to control for alcohol use, they find another MetS correlation: non-drinkers. But people with diagnosed MetS/(pre-)diabetes/obesity often quit drinking, so they should have checked for heteroscedasticity wrt alcohol use.

    I'd wait for a randomized study before stocking up on Magnesium tablets. But a multivitamin supplement is usually a good idea anyways.

    [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220353/

  • qwerty456127 13 days ago
    A relevant anecdote: I unqualifiedly (being not a doctor) prescribed supplementing 400 mg of magnesium (in form of orotate or glycinate) daily to a number of volunteers (19-39 years old, both males and females) with signs of moderate to severe burnout, some of the them having mild forms of eating, alcohol abuse and sleeping disorders. Most of them reported quick yet sustaining life-changing improvements. One of them (having a history of severe psychological trauma) reported increase in nightmares though (nevertheless she lost a fair amount of excess weight and came to looking really great now). I concluded it is probably true that we all should supplement magnesium unless we know of a specific counter-indication in a specific case.
    • hn_throwaway_99 13 days ago
      I'm confused by your story. You say you had a number of volunteers daily, with "signs of moderate to severe burnout". Was this some sort of study? What was your role in this? As the other responder said, to say "prescribing" doesn't make sense in this context.
    • clumsysmurf 13 days ago
      Not sure I would go with the orotate form of Mg. If someone else has the links to toxic effects, please chime in ... There are plenty of Magnesium forms to use (glycinate, taurate, malate, citrate) that are very safe.

      I do use Lithium Orotate because there are not that many choices: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413749/

      • qwerty456127 13 days ago
        Magnesium orotate is the form which works the best for me personally (strongest positive subjective effects). Orotic acid is itself a vitamin of a kind. It used to be called B13 but was stripped of this title once found produced by the gut microbiome (which is a questionable criteria as there still are official vitamins which are produced by the gut microbiome or parts of the body itself). Needless to say any vitamin is more or less dangerous when you supplement too much for too long. Any supplementation should be done cautiously, moderately and only in context of at least a reasonable guess (better a lab test) indicating you probably are deficient in this specific element.
    • WaxProlix 13 days ago
      What sorts of timelines are we talking here? You say quick but that can mean a range of things.

      I've tried magnesium in the past for a couple weeks but didn't notice a change in that period that was likely attributable to it.

      • qwerty456127 13 days ago
        I would guess you either just have no magnesium deficiency or have some other condition which causes your symptoms unrelated to magnesium or prevents magnesium from doing its job. A couple weeks is more than enough to feel serious difference.

        Another chance is you are using a form of magnesium which is not the best choice for you. It generally is recommended to try different. There are many.

    • wolfi1 13 days ago
      that's why in medicine you do trials randomized and double blind so that no one knows if it's the drug or the placebo, could have been the placebo effect after all
      • Nevermark 13 days ago
        We all experiment personally. I make a point of not looking for, or attributing any causality, to any immediate change.

        Then see how I fair over time.

        Obviously not a high standard, but reduces bouncing around between different regimens chasing coincidences and placebo effects.

        After several extended periods of taking multi-minerals and not taking them, I am convinced I get better sleep when I take them. I could add less anxiety and more, but better sleep alone could account for other benefits.

      • qwerty456127 13 days ago
        Isn't the placebo effect mitigated by negative belief? In many experiments I conducted on myself I was extremely skeptical to the point of "I can bet this is a bullshit 'snake oil' but let's give it a try to prove just that before I can safely forget about trying this ever again" before getting surprisingly positive results for me. Similar attitude was also present in many friends I gave anything to.
        • armada651 13 days ago
          That doesn't work unfortunately, because even though you're skeptical you're still hoping that it might work, which is enough for the placebo effect to kick in.
          • qwerty456127 13 days ago
            Nevertheless this probably is much less relevant than a full-blown drug research case where you expect to be given a product of credible bleeding-edge science worth many millions of dollars in research, already tested thoroughly and proven effective on all kinds of animals.
        • adrianN 13 days ago
          Probably no, but the research on that topic is not very good.
    • arvinsim 13 days ago
      I take my magnesium in the mornings most of the time because it causes me nightmares too.

      I noticed that if I take it in the evening, I would be okay if I took it at least 4 hours before sleeping.

    • hiddencost 13 days ago
      No.

      You did not prescribe anything.

      You told them to get it.

      Prescribe is a word freighted with technical and legal weight, and should not be used lightly.

      • qwerty456127 13 days ago
        They asked me for help (because they know I am an "amateur expert" in this subject), I gave them the pills and said take these and we'll see how it goes (because I know enough to reasonably assume this is very unlikely to cause serious harm in them short-term, incl. because pharmacy-sold FDA-approved supplements are meant to be proven-safe for people who lack specific counter-indications and follow the dosage manual). Surely I'm not a doctor and that's why I mention this whenever relevant, as I did here.
      • arcticbull 13 days ago
        You can prescribe supplements - they may have, it’s not fair to assume.
        • lazyasciiart 13 days ago
          Doctors can prescribe supplements. They are saying that random not-doctors should not call it prescribing when they tell someone to do something, whatever that thing is.
          • arcticbull 13 days ago
            Ah yes on re-reading I missed that important bit. My bad.
      • TeaBrain 13 days ago
        Prescribe can simply mean to advise on taking a course of action. The word is commonly associated with the medical profession, but isn't unique to it.
      • hooverd 13 days ago
        Nah, you should use it. Physicians need to have their wings clipped.
    • IAmGraydon 13 days ago
      Wow.
  • modeless 13 days ago
    Counter-anecdote: I took magnesium glycinate for a couple of months and saw no effect on sleep, blood pressure, or anything else.
    • cco 12 days ago
      Sounds like your body already had the right level of magnesium.
    • b0ner_t0ner 13 days ago
      Magnesium L-Threonate works better for cognition and sleep.
      • modeless 13 days ago
        Is there evidence of this? All I've seen so far is just vibes based on anecdotes and speculation about the blood-brain barrier.
  • danparsonson 13 days ago
    Lots of talk about supplements but remember the best way to get good nutrition is through eating the right food if possible - https://www.hsph.harvard.edu/nutritionsource/magnesium/
  • canucker2016 13 days ago
    Two things to watch out for concerning magnesium intake: phytic acid (in many non-sprouted grains) and oxalates (high in spinach).

    Both of these components will bind to magnesium (and other minerals in the case of phytic acid) preventing your body from metabolizing them.

    Phytic acid: https://www.webmd.com/diet/foods-high-in-phytic-acid

    Oxalate: https://pubmed.ncbi.nlm.nih.gov/15035687/ , https://pubmed.ncbi.nlm.nih.gov/15035687/

  • macawfish 13 days ago
    If I remember right, magnesium supports production of a range of neurotransmitters, including those involved in dealing with stress. Specifically I believe it supports the metabolic processes involved in regulating the nervous system. I believe there have even been studies finding people with certain mental health conditions known to cause stress have chronically low magnesium levels.

    But yeah it's an essential mineral and these days they don't feed the plants that grow food minerals as often as they used to. They feed them nitrogen but not necessarily minerals!

  • visarga 13 days ago
    When I started taking magnesium I felt 10 years younger. Better sleep, less tired
  • objektif 13 days ago
    Can anyone please recommend which type and even brand to take?
    • adrian_b 13 days ago
      The brand should not matter if the chemical composition is clearly specified and you can trust that what that brand claims is true.

      I have tried a few magnesium supplements and my opinion is that you must use pure powder instead of pastiles or capsules.

      The pastiles or capsules contain various excipients that are at best useless and at worst harmful. Moreover, using powder allows the choice of any fractional dose and mixing it uniformly with food, like you would do with table salt, which guarantees a more complete absorption.

      Among the available powders, I have settled on magnesium bisglycinate. The cheaper alternatives, like magnesium citrate, carbonate or oxide are not soluble in water and even after they become soluble in the stomach the magnesium ions can be precipitated by various food components, which prevents their absorption in the intestine.

      Magnesium bisglycinate is soluble in water and it remains soluble until it is absorbed. It is very easy to mix it in food, exactly like table salt.

      The slightly higher price of bisglycinate does not matter much, because at normal doses a box of a few hundred grams should last for many months or even over a year, adding only a few cents to the daily cost of food.

      When computing the daily dose of magnesium bisglycinate powder, you must pay attention that its magnesium content is 24/172 by weight, so you must multiply the desired dose with 172/24, i.e. about 0.72 g for 100 mg of Mg.

      To add it to food, I use the smallest measuring spoon of a set of measuring spoons, which has a capacity of 0.625 mL. I have determined the density of the powder by weighing the box after taking a measuring spoon from it for the first few days and averaging the results. The density of such powders is usually a little over 1, e.g. 1.1, so in my case one measuring spoon provides about 100 mg of Mg.

    • smt88 13 days ago
      I use and recommend ConsumerLab for such questions.

      https://www.consumerlab.com/reviews/magnesium-supplement-rev...

    • ezekielmudd 13 days ago
      I take 15mL Citro-Mag liquid in the morning.