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Does Epsom Salt Work?

The science of Epsom salt bathing for recovery from muscle pain, soreness, or injury
updated Dec 8, 2017 (first published 2006)
by Paul Ingraham, Vancouver, Canada bio

illustrations by Paul Ingraham, Gary Lyons

audio version available info

A cup or two of Epsom salt in a bath supposedly relieves pain — specifically, muscle pain
from over-exertion (delayed-onset muscle soreness), conditions like myofascial pain
syndrome (“trigger points”) and fibromyalgia — and speeds healing1from minor injuries
such as muscle strains and tendinitis. It is touted as being a good source of magnesium,
better than taking pills.

Claims and recommendations of this nature can be found by the thousands online. Bags
and cartons of Epsom salts are available at any drugstore. Why, I have a package right
here.2 It says:

Dissolve desired amount (1–2 cups) of crystals in a hot bath to produce a mineral water
treatment to aid in the relief of muscular aches and pains.

Says who? How does it work?

When I went to my super-duper advanced massage therapy college, my instructors

No
suggested Epsom salt baths as a good thing to prescribe to our clients.

scientific basis for this idea was ever presented:

it was just one of those things that everybody
“knew.”No scientific basis for this idea was ever presented: it was just one of those
things that everybody “knew,” a folk remedy justified by the generations of wise old wives
and bathers. The physiology of it certainly wasn’t explained.
Occasionally someone made a vague reference to “detoxifying” the muscles, perhaps “by
osmosis.” Nothing more exact was ever discussed because, frankly, I am sure that not one
person in the building could have even named the compound “magnesium sulphate.” 3 Me
included.

I have wondered ever since if there was anything to it. I am strongly skeptical of all health-
related claims involving “toxins,” mostly because people who toss that word around almost
never actually know which specific toxins they are talking about.4 I have thoroughly studied
the subject of post-exercise muscle soreness — which is probably the leading cause of hot
baths — only to discover that it’s basically been proven that there are no known remedies
for it.5 And after a long, hot Epsom salt bath of my own one night — which had no
apparent effect on my unusually sore muscles — I decided it was time for a reality check.

Does an Epsom salt bath do anything?

What is Epsom salt exactly? And why do people always stick an

S on the end?

Epsom salts are magnesium sulphate heptahydrate, usually shortened just to magnesium
sulphate (note also the American spelling “sulfate”). It was originally obtained by boiling
down mineral waters at Epsom, England. The magnesium specifically is widely considered
to be the active ingredient.

It is quaintly referred to in the plural — Epsom salts instead of Epsom salt — but it’s just
one kind of salt, and other than tradition there’s no more reason to say “salts” than there is
to say “please pass the table salts.”

Other than tradition there’s no more reason to say Epsom “salts” — plural — than there is to
say “please pass the table salts.”

The chemical structure of Epsom salts … so that you know this is a serious article.

A crystal of magnesium sulphate heptahydrate — Epsom salt.

Almost no Epsom salt science

My search for scientific evidence concerning Epsom salt baths was disappointing. I was
unable to find even a single scientific paper studying their effect on body pain. Folk
remedies are often generally neglected by researchers, but not usually so completely. There
are usually at least a few experiments testing popular remedies kicking around. Why
wouldn’t the use of Epsom salts for muscle soreness be similarly blessed?

There is plenty of research relevant to other medical uses of Epsom salts.6 For instance, on
my package of Epsom salts, instructions are also given for internal usage as a laxative —
which does work78 and is actually FDA approved and probably the most common and
generally known medical usage. Other uses of magnesium sulphate include the treatment
of irregular heart rhythm, low blood magnesium,9 eclampsia,10 and severe tetanus.11

There are also some incredibly bogus and dangerous “medical” uses of Epsom salts. For
instance, naturopaths may use it to try to dissolve gallstones — which doesn’t work, and can
cause serious poisoning.

But there appears to be simply nothing at all published about alleviating aches and pains or

Apparently, researchers just aren’t

“detoxification.”

interested in studying the effect of Epsom salts

on muscle painApparently, researchers just aren’t interested in studying the
effect of Epsom salts on muscle pain, or (more likely) they simply can’t get funding for the
work.

Strangely, Epsom salt baths do not even rate a mention in Home Remedies: Hydrotherapy,
massage, charcoal, and other simple treatments, a large and credibly referenced
compendium of traditional remedies assembled by a pair of doctors. They
describe five medicated baths — alkaline (soda) baths, starch baths, oatmeal baths,
peroxide baths, and sulfur baths — for conditions ranging from poison ivy rashes to diabetic
gangrene (!), but they never mention Epsom salt baths. Could they possibly have just
neglected it? Or is it more likely that Epsom salt baths simply have no (clear, known)
medical usage?

In the perfect absence of any testing, all we can do is speculate about the possible
mechanisms of action. Does brining yourself like a turkey do any good? Can you pickle your
pain away? Is there any plausible way that Epsom salts could have an effect on your sore
muscle tissue, or on the healing of injuries?

“(With) a grain of salt,” (or “a pinch of salt”) in modern

English, is an idiom which means to view something with
skepticism, or to not take it literally.

“Detoxification” and “osmosis” explain nothing about Epsom

salts
Regardless of whether Epsom salts baths work, it’s important to understand that the words
“detoxification” and “osmosis” are virtually the only explanations offered — and they are
both hopelessly misleading. Usage of these terms mostly just reveals a poor understanding
of both toxins and osmosis. If we are to understand Epsom salt, we need to get past this and
understand it for the right reasons.

The osmosis/detoxification explanation is never actually clarified in any detail by the people
tossing the words around. Presumably it is intended to mean — roughly — that
either osmosis is actually a mechanism of detoxification (getting something nasty out of the
body through the skin), or that osmosis is the mechanism by which something in Epsom
salts can get into the body and then have a detoxifying effect.

The osmosis mistake: it’s the water that moves around

People often mistakenly believe that osmosis refers to the movement of substances — ions
and molecules — across a membrane. Alas, that is simply wrong by definition.Osmosis does
not move particles. Osmosis refers to the movement of solvents only across thin
membranes, towards higher concentrations of the substances dissolved in them.12Take it
from the Osmosis Cats!show cats13

You can demonstrate this clearly by soaking a potato in salty water: the water is “sucked”
osmotically out of the cells, they lose their plumpness, and the potato goes limp. Poor little
potato. It’s the water that moves around. (Or cats.)

Can salt disinfect? Osmosis and all the wee beasties

Reader Dorrie B. pointed out something interesting: Epsom salts might be an effective
treatment for topical skin infections, as salt is certainly inhospitable to microganisms.
Osmosis may not be able (by definition) to transport salt ions across the skin, but it
certainly isn’t kind to bacteria in this equation: it sucks them dry.

An Epsom salt bath definitely cannot disinfect a puncture wound (as one of my readers was
told). A strong salt solution is anti-bacterial, but the problem with rusty nails is the risk of
deep injection of Clostridium tetani — beyond the reach of any soak.14

But this is also a great example of how complex these questions can be, because salt bathing
might also damage populations of other bacteria on the skin, resulting in higher
vulnerability to infection.15 Do people who bathe or swim in salt water regularly suffer any
ill effects? Are they more susceptible to new infections? They might well be: even a 10% or
20% difference would not be obvious to the victims, but would nevertheless be clinically
significant and biologically interesting.

Likely that research hasn’t been done, but my point is just that it’s really surprisingly
difficult to say whether or not a given biological effect is “good” — it’s almost never that
simple, and it’s a good thing to bear in mind throughout this article.
Skin is definitely waterproof… and therefore osmosis-proof

So, however Epsom salts get into the body, if they do, it’s not by osmosis. Osmosis doesn’t
work through the skin. Skin is almost perfectly waterproof. If it weren’t, you would
dehydrate like an earthworm on a sunny sidewalk. (You do dehydrate significantly by
sweating in a bath, of course.16 But Epsom salts do not increase that.17)

The top layer of the skin, the stratum corneum, consists of dead cells stuffed with a kind of
embalming substance, keratin, a fibrous protein. Water can’t go through or around them,
thanks to a microscopic “uniquely structured fatty layer” between them, which no one knew
about until surprisingly recently (2012).18 Plus we have glands that coat the skin in
waterproofing oils. When those oils wash off, the dead skin cells can soak up a little water
and swell a bit, like soaked beans. (This is not the cause of skin pruning — that’s an old
myth.19)

Remember the main myth about osmosis, explained in detail above: osmosis is the movement of solvents(like water)
across membranes, notthe stuff dissolved in them (like ions of magnesium).

The swelling of the superficial skin cells is not due to osmosis, but rather to a limited
“capillary action” in which water molecules flow into small spaces. (Paper towels absorb
liquid the same way.) The stratum corneum is mostly waterproof precisely because osmosis
is not a significant factor here. Those cells are dead, containing mostly just dry keratin, and
surrounded by lipids — not fluid containing dissolved substances which could osmotically
“suck” water through the skin. The presence of lipids and their arrangement results in
“exceedingly low permeability.”20

Furthermore, the stratum corneum is generally an effective barrier to diffusion: ions and
molecules dissolved in water mostly cannot pass through the stratum corneum, again
because there is minimal water in the outer layers of skin for them to diffuse through. This
is not to say that nothing gets past the skin, just not much, and definitely not water.

“Human skin has unique properties of which functioning as a physicochemical barrier is one of
the most apparent. The human integument is able to resist the penetration of many
molecules.”21

Booze molecules, for instance. You can’t get drunk through your skin, alas. Contrary to the
Danish myth. As proven by Danish researchers in late 2010.22 It’s funny, but it’s not a joke.

The point is that it’s not exactly obvious to people what substances can get through the skin.
Ask your friends: most of them will guess that some alcohol probably does get through the
skin — maybe not enough to get drunk (or booze baths would be a more popular practice),
but some. In fact, none gets across.

Probably because alcohol molecules are just too dang big…

What does get across the skin? Obviously some things do

The skin is not a perfect barrier to all substances, which is obvious because of medicinal
patches and creams, allergic reactions, contact poisons and other examples that some things
clearly do get past that dead outer layer to interact with the living cells beneath, or even into
the interstitial fluids and blood stream. The skin keeps water and much else out,
but some things get through. How?

Size matters. If molecules are small enough, they can slip through the skin, like a small fish
through a loose net. In 2000, Bos and Meinardi argued that a teensy enough molecule,
smaller than 500 Daltons, can drift through the corneum23 — the 500 Dalton rule.

Magnesium ions are way smaller than 500 Daltons, at a barely-there atomic mass of just 24
Daltons. (Water molecules also extremely tiny — just 18 Daltons — but recall from above
that the skin is also built specifically to keep those molecules out.)

As in sex, so too in chemistry: size does matter,

but it’s definitely not the only thing that
mattersAs in sex, so too in chemistry: size does matter, but it’s definitely not
the only thing that matters. There are almost certainly other mechanisms involved. For
instance, cells in the living layer of the skin take an active role in managing the passage of
some substances. Topical allergic reactions are an obvious demonstration of this: the
immune system over-reacts to an “invader.” A complex and imperfect system, obviously.

The 500 Dalton rule means that it’s plausible in principle that magnesium ions might
diffuse through the stratum corneum, but “it’s complicated.” Magnesium ions have some
special properties. Like tapioca, they may swell when wet. In fact, this has been the
conventional wisdom for some time, and one of the main reasons that many experts have
dismissed the possibility of magenisum absorption.24

Okay, so it turns out there’s really some serious chemistry involved.

And it gets worse. Surprise surprise, the conventional wisdom has been challenged by some
recent research. And I’m going to get into it, because whee, science is fun! But let me
emphasize the point of it all first: no one bloody knows how this actually works, and if you
think you can guess whether or not magnesium ions get through the skin, please think
again. Biology and chemistry is mind-bogglingly complex and the details are truly, madly,
deeply non-guessable.

Testing magnesium absorption on harvested human skin

samples

Science: Hey, can I have that skin off your belly? You don’t need it right?

Tummy Tuck Patient: Um, sure…

 Science: Thanks! Got to find out if magnesium ions can get through that.

This section is all about one odd experiment25 that involves a number of strange rituals
performed on skin samples harvested from tummy tucks, like gluing hair follicles shut with
super glue. It almost answers the tricky scientific question of whether magnesium ions can
be absorbed through the skin, but still falls short.

It does convincingly show that magnesium ions can diffuse through the stratum
corneum, and that hair follicles facilitate that movement, but it does not establish that they
do so in clinically meaningful numbers, especially in the conditions of a typical Epsom salts

These chemists had

bath. Regardless, it’s neato science.

complicated chemistry reasons to believe that

damp magnesium ions actually do notswell up
too much to fit through the atomic-scale cracks
in stratum corneum.These chemists had complicated chemistry reasons
to believe that damp magnesium ions actually do not swell up too much to fit through the
atomic-scale cracks in stratum corneum.26

So they set out to test it. They tested absorption on patches of skin harvested from patients
who got tummy tucks. Don’t need that skin any more? Donate it to science! The main
features of their experiment:

 The tested the skin as-is, but for comparison they also tested skin that was
damaged by applying tape and ripping it off, 30 times!

 And they tested skin with hair follicles that they actually plugged with tiny little
microscopic dabs of super glue (the details are a bit technical, but basically that’s what
they were up to).

 And they used a flourescent die that binds to magnesium ions, so they could
track its progress through the skin.

Like I said: an odd experiment.

They tested 5, 15, and 60-minute exposures of two concentrations of magnesium solution,
medium and strong, corresponding to ocean water and the Dead Sea respectively. (Note that
these concentrations are quite a bit greater than the concentration of salt in a typical Epsom
salt bath.)

Their key findings:

 “topically applied magnesium permeates through human stratum corneum”

 “magnesium permeability varies based on concentration and time of exposure”

 “hair follicles have significant contribution towards magnesium penetration
through skin”

Magnesium ions diffusing through the stratum corneum. The brighter the warm-toned pixels here, the
more magnesium.

But there are some caveats. Of course.

 It’s clear from their imagery that a lot of Mg ions remain “stuck” in the most
superficial layer of the stratum corneum.

 Even at concentrations much higher than anyone would normally put in their
bath, “a significant increase was only observed at 60 minutes.” Almost nobody is taking
super salty hour-long baths. At 15 minutes, the medium concentration exposure is
barely different from none at all: it was “visible only after 60 minutes application to the
skin.”

 Although they claim a “significant” contribution of hair follices, this is a very

misleading word choice. They mean “statistically significant” not “important” or
“large”… and it’s right on the very margin of statistical significance (p <0.05).

I got into the details of this science not because it proves that magnesium soaks through
skin, but because it’s charmingly weird, and because it proves that the whole problem is so
absurdly complicated that we absolutely cannot guess the solution. Not even an extremely
educated guess. Walter White couldn’t guess it. There are just too many ways the messy
details of biology might surprise us. The only way to find that out is to set aside the
speculation about what’s possible in principle, and do some proper before-after testing of
magnesium absorption, in actual medicinal situations…

Some evidence against absorption: Israeli soldiers smear

magnesium all over themselves in high concentrations and it
doesn’t get inside

This quote from a book by a doctor27 was submitted to me by a reader as an “authoritative”

opinion on absorption:

Regularly bathing in hot water to which Epsom salts have been added can help draw out toxins
from the skin.

This is not an authoritative opinion: it’s a vague and unsupported one. That anyone would
mistake it for authoritative is rather depressing.28 The only thing that can determine
whether magnesium heptahydrate is absorbed from a bath is careful, thorough testing —
opinion is irrelevant, even from a real expert.
Fortunately, not all my mail is depressing. Hat tip to reader Bryan B. who found an
interesting study and sent it to me. (I love it when readers do that.) It’s a safety study of a
lotion developed “to improve protection against chemical warfare agents.”29 Like suntan
lotion, but for chemical burns. Yikes.

This lotion had rather a lot of magnesium in it. And soldiers were not poisoned by the
magnesium. Indeed, it didn’t appear to cross the skin at all: “there were no significant
differences in magnesium levels between the placebo and the study groups in any of the
applications.” The delivery system — lotion — could be quite different than soaking in
water with dissolved magnesium sulfate. But I agree it’s pretty good evidence that
absorption is minimal or nil.

Awkward.

Frequently cited evidence for absorption: Rosemary Waring’s

little unpublished 2006 study

In 2006, Rosemary Waring, a British biochemist at the University of Birmingham, did a nice
science experiment with Epsom salts.30 She did more or less exactly what any curious
person would do if she wanted to know whether or not Epsom salts can get past skin: she
measured magnesium and sulphate in the blood and urine both before and after people
bathed in Epsom salts.

Dr. Rosemary
Waring

She found them to be higher after the baths! 16 out of 19 people had more magnesium and
sulphate in their blood after the baths than they did before the baths.31 Fascinating!

Dr. Waring’s results are straightforward. No therapeutic effects of Epsom salt were studied
or claimed — she just studied absorption, and did not try to make any more of it, showing
the restraint of a pro. What could be simpler?

I was so interested in these results (although still a bit skeptical) that I contacted Dr. Waring
by email. “I agree that it is a bit surprising,” she replied, “but the results are certainly there
and in fact there are hints in the past literature that this could happen.”

Better still, Dr. Waring told me that a colleague of hers in London has done another
experiment which showed that “magnesium sulphate can cross human skin using pieces of
excised human skin in a special apparatus.”

Now twelve years later, neither experiment has yet actually been published,32 and that’s a
significant reason for caution.33 It is a basic rule of science that evidence can’t really be
taken too seriously until it has been exposed to peer review and repeated by other scientists.
 Just because experimental results haven’t been replicated yet doesn’t mean we ignore them,
but it does mean that we have to take them with a grain of salt. (That pun was simply
unavoidable — so sorry.)

Meanwhile, what can we make of Dr. Waring’s results? One thing only so far …

1. There might be a mechanism for getting magnesium and sulphate across the
skin!

It’s not much, but it’s important. And when I found the new evidence, I embraced its
implications. (That’s how science works. That’s why being anti-science is like being anti-
honesty.34 I happily admit that Dr. Waring’s results might mean that I was simply dead
wrong about the absorption question originally.)

How would it work, this crossing of the skin, if it’s happening? Dr. Waring:

I don’t have any evidence as to how magnesium sulphate crosses the skin, though I have always
assumed that it simply diffuses across the stratum corneum, helped by the fact that it’s in a hot
bath.

Hot hot hot! Does heat increase absorption?

Enough of it sure does. But probably not bath heat.

A 2008 experiment study showed that brief, intense heating of the skin can dramatically
increase its permeability.35 Park et al tested short burts of heat: 5 milliseconds to 5 seconds
at 100 to 315 degrees Celcius. With more heat, dramatically more molecules could cross (the
duration of exposure had less effect). Skin permeability was increased by a few multiples in
the low end of the range, all the way up to three orders of magnitude at the most extreme
temperatures. Wow.

Enough heat can basically burn

The mechanism is fascinating:

microscopic holes in the surface of the skin,

creating artificial poresenough heat can basically burn microscopic
holes in the surface of the skin, creating artificial pores. Ouch? It sounds awful, but it’s
actually painless, because the application of heat is so brief. At lower temperatures, the
increased permeability is due to messing with the stratum corneum lipid and keratin
structures, making them a less effective barrier.

Is any of this applicable to baths and the absorption of magnesium sulphate? Maybe, but it’s
unlikely.

The highest comfortable bath temperature for most humans is around just 40˚C (109˚F),
which is less than half the lowest temperature studied in this experiment. The effect studied
mostly depends on actually damaging the skin. It is conceivable that permeability starts
increasing at lower temperatures with longer exposures … but 60˚ lower? For the duration of
a bath? Probably not for most substances. Skin probably evolved to be a good barrier across
the range of temperatures humans are exposed to, which would certainly include 40˚C.

Also, not all substances will respond the same way to heat. If you studied transdermal
delivery of many different substances at 100˚, you would probably see a wide range of effects.
The only way to know if the skin is more permeable to magnesium at 100˚ or 40˚than at
room temperature (as with a cream) is to check — and no one has, to the best of my
knowledge.

Maybe up your bum? Um …

When you encounter surprising results in science, don’t just settle on the first explanation
that comes to mind — it could easily be wrong. Dr. Waring says that she “assumed that it
simply diffuses across the stratum corneum,” and that certainly is possible. But
what other explanation could there be for the results? How else could magnesium sulphate
have gotten into the bloodstream in her experiment? Reader Adrian J. had an unusual idea:

Is it possible that the salt diffuses across the epithelium in the anus if the rectum relaxes to some
degree in the warm water?

Wow, that’s some awesome lateral thinking! And I think it’s plausible. But I find myself
(uncomfortably) wondering ... just how much do I relax in a hot bath? That much? And
how much salt could diffuse across that more permeable but much smaller membrane? It’s a
small target! And I shudder to think of the measures required to test this hypothesis! For
what it’s worth, we know that alcohol absorbs quite handily through the rectum — rather
too well, in fact, so do not try at home.36 But it has to be pretty much injected. (Live a little:
click that footnote!)

A number of readers have asked if the vagina might be an absorption route. A fair question,
but this has the same problem as anal absorption: too small and too tight. After quizzing
several amused female friends about it, I am confident that it would be highly irregular for
any respectable quantity of bath water to percolate into one’s ya-ya.

And you thought an article about salt baths would be boring! No wonder this the most
popular Epsom salts analysis on the internet!

What about inhalation? Another possibility for absorption?

Perhaps salt can be inhaled with steam. There’s actually a therapy (“halotherapy”) based on
this, but it’s a weak idea in general and impossible as a salt delivery system: when water
evaporates, it leaves most solutes behind, salt in particular.37 Many substances evaporate
with water and “contaminate” steam — lots of volatile compounds and assorted tiny
particles basically just getting thrown around, which is why we can smell a bubbling pot of
soup — but these occur only in trace amounts, mostly nowhere near enough to be plausibly
medicinal. Human olfaction, despite being shabby by animal kingdom standards, can still
get a nice rich scent from a mind-bogglingly small number of molecules. Water from a soup
is still remarkably pure despite the odour, and definitely has no salt in it.
Another related possibility is that we might inhale tiny droplets of water (aerosols of salt
water) that float over the surface of a bath. Such droplets would contain dissolved salts at
the same concentration as the bath, but these are nearly microscopic tiny water droplets.
Remember that most people can swallow an entire magnesium pill with no obvious effect,
which contains insanely more magnesium than you could ever absorb from the air over an
Epsom salt bath, assuming there’s any at all, most of which would never even come close to
a mucus membrane. Again, not really a plausible source of medicinal absorption.

Absorption “conclusions”

I’ve presented several lines of evidence, demonstrating that the absorption question is
surprisingly complicated (and interesting). None of it is conclusive. We will have to live with
the mystery.

Meanwhile, it is reasonable to be skeptical, as many experts are. A thorough 2017 scientific

review of both the evidence and rationale for transdermal absorption of
magnesium38 makes a critical point: although there may now be adequate evidence to
suggest that transdermal evidence is possible in the right conditions, that evidence is not
nearly strong enough to support claims that it is superior to oral supplementation.
Gröber et al conclude that they “cannot yet recommend the application of transdermal
magnesium.”

It’s not just a matter of whether Epsom salts can be absorbed… it also has to be a betterway
of getting magnesium into the body than simply swallowing it. And that’s a much higher
bar to clear.

And then there’s the question of whether or not it ever matters.

What could magnesium and sulphate ions do once they cross

the skin?

If Epsom salts do get across the skin … so what? Is it any good to have a few extra ions of
magnesium and sulphate kicking around your bloodstream? The rest of this article
continues to mostly cast doubt on the possible therapeutic effects.

There might well be a therapeutic effect, but we have no information about what it is, how it
works, what it works for, how strong the effects are, what side effects there might be, and so
on. The increased levels of these ions shown by Dr. Waring’s experiment are small, about a
10% increase on average (and none in some subjects, remember). The concentrations could
also be quite different in the fluids between cells — she didn’t measure that. It is still
completely unclear what effects these ions could have on your tissues when they arrive.
There is no doubt that magnesium sulphate has effects on physiology. Several of those
effects are reasonably well known, including a few common medical applications
mentioned earlier. There are also unpleasant effects. But, judging from the established
medical uses of Epsom salt, there is definitely no particular reason so far to believe that
having more magnesium or sulphate in your blood is going to be much use to you — unless
you have eclampsia or tetanus or autism.39

The closest thing there is to a relevant science experiment on this is one study
of injectedmagnesium sulphate which found that it “did not reduce muscle pain” and caused
“unpleasant side effects.”40 Yuck! Not exactly encouraging!

So there’s not really any particular reason to believe anything about the therapeutic effects
of Epsom salts for aches and pain. We can really only speculate. And speculating about basic
biology is really difficult. It’s a great way to be wrong.

No matter what it can do, it can’t do everything

This is a classic problem with all kinds of supposedly amazing pain cures: pain has too many
different causes for one medicine to be really effective.

There are many types of muscle and joint pain that have little or nothing at all in common
with each other physiologically. For instance, the pain of fibromyalgia originates in
dysfunction of the central nervous system, which is completely different from the pain
caused by exercise, which in turn is completely different than the physiology of trigger
points. Even “basic” muscle pain is incredibly complex and has many flavours.41

While it’s certainly conceivable that increasing levels of magnesium and/or sulphate ions in
the bloodstream could help with some pain problems, it’s extremely unlikely that it would
help enough different sorts of pain to be generally “good for” pain. This is an important
logical problem: in principle, nothing can possibly help all types of pain, or even more than
a couple of them.

Similarly, Epsom salts probably cannot simultaneously perform the two tricks most often
touted: “relieve pain” and “speed healing.” Those are completely different things.

They might even be mutually exclusive. For instance, the primary source of injury pain is
inflammation — a complex and painful physiological process intended to … wait for it
… speed healing. Indeed, the only known mechanism by which you could recover faster from
an injury would be to increase inflammation. If bathing in Epsom salts did that, it would
make you hurt more, not less. Of course, there could be other ways to speed up healing —
in an “anything’s possible” kind of way — but it’s still pretty far-fetched that a single
molecule could pull off both that miracle and reduce pain at the same time.

The point here is just that the conventional wisdom is pretty murky.

ZOOM
 Salt has been used for well, just about everything. Like these effervescent brain salts. Cory Doctorow:
“The best thing about effervescent brain salt is that it’s not immediately clear whether it’s salt to make
effervescent brains even more delicious, or salt to give you an effervescent brain, or effervescent salt for
brains. Also, it appears to come in a Tabasco bottle & everything that comes in a Tabasco bottle is
always awesome.”

What’s a calcium channel, how do Epsom salts block it, and who
cares?

Generally speaking, explanations for the benefits of Epsom salts are really vague, as
discussed above: “osmosis and detoxification.” Once in a blue moon, you’ll see Epsom salts
(or magnesium in particular) more exactingly described as a “calcium channel blocker” with
the implication that this is obviously “good for pain.”

Unsurprisingly, this is another misleading oversimplification. Although it’s more specific

and impressive sounding, it’s not a heck of a lot more meaningful than “detoxification.”

Calcium channels are itsy bitsy — molecular scale42 — holes in cell walls that let calcium in
and out as a trigger for a bunch of biochemical business. They exist primarily in muscle
tissue (including the heart), blood vessels, and neurons. There are a number of druggy ways
to interfere with them, including magnesium. Calcium channel blockage is a reasonably
well understood bit of physiology, and the main clinical usage of calcium channel blockers
is to decrease blood pressure by reducing the strength of muscle contraction in the heart
and blood vessels. Although other effects undoubtedly exist, there is no particular reason to
believe that they have any potent effect on any flavour of pain.

Lots of people are walking around with calcium blockers in their blood. Calcium blockers
aren’t rare drugs. Since there are numerous drugs that block calcium channels in various
ways, it’s a bit implausible that there would be some kind of powerful pain-killing effect that

I don’t think that people on calcium

no one’s noticed.

channel blockers are walking around feeling no

pain, like a superpower.I don’t think that people on calcium channel
blockers are walking around feeling no pain, like a superpower.

Yes, it is possible that magnesium absorbed through the skin does something different,
something good, for certain kinds of pain. After all, different calcium blocker drugs have
different effects! But there’s not a shred of good, direct evidence of it. So it really boggles the
mind that anyone would toss this idea around with any confidence. Seriously, they’re pretty
much making it up as they go — wild speculation.
Magnesium as a pain-killer after surgery

There is some limited evidence that magnesium (just that ion) may reduce pain, perhaps
because it is a “calcium channel blocker and N-methyl-D-aspartate antagonist,” as in a 2009
experiment.43 However, this is uncertain science. Several studies have been done, with
conflicting results. Most were reviewed in 2007:44 four showed a positive
effect, seven showed no effect greater than a placebo, and in one experiment the subjects
actually experienced more pain (ouch).

And so, although “the biological basis for its [magnesium’s] potential antinociceptive effect
is promising,” the authors actually concluded that no pain-killing effect could be found. So
much for the miracle of calcium channel blockage: it fails the “impress me” test. It seems
unlikely that magnesium would fail to relieve pain in those tests, and yet somehow succeed
when absorbed from Epsom salts baths.

Clearly, this mystery is not solved yet. While there is a plausible mechanism for magnesium
ions reducing pain, it is clearly neither well understood nor reliable. Do you suppose the
picture is any clearer for Epsom salts in your bath? Don’t bet on it!

Sulphate supplementation

I asked Dr. Waring to speculate about the therapeutic effects. She pointed out that patients
with rheumatoid arthritis are known to have low sulphate levels. Molecules produced by the
inflamed tissues in these patients may interfere with the production of a protein that is used
to produce sulphate from another molecule (cysteine), thus lowering sulphate levels.45

However, low sulphate levels are a possible result of having rheumatoid arthritis, not a cause
— and thus boosting them back up again will not necessarily solve anything. And even if it
did, that’s a therapeutic effect that is very particular to rheumatoid arthritis — a serious,
agonizing joint disease — which probably has little or nothing to do with the kinds of pain
that most people put Epsom salt in their baths for.

It would be great if Epsom salt baths helped people with rheumatoid arthritis, but good
evidence of that would, in a way, pretty much shoot down the other claims of therapeutic
effect, which rely on completely different ideas about how and why Epsom salt might work.
But, of course, there is as yet no evidence one way or the other.

Mixing up the effects of salty and non-salty baths

Obviously non-salty baths have some benefits of their own. Epsom salts routinely get the
credit for these benefits. It goes like this:
1. Patient has a problem and tries non-salty hot baths or soaking. However,
because it’s just a bath and expectations are low, this effort is never particular diligent.
This is key to the setup: the patient has never really given non-salty soaking a good try.

2. Patient gets the idea to try Epsom salts! This seems much more promising.

3. Thus inspired, the patient proceeds to soak quite diligently — much more
diligently than ever before.

4. When some benefit is then observed, patient attributes this to the salt — of
course. Maybe it is, but maybe it’s just the unusual regularity of the nice soaking. The
point is that we obviously can’t know … but the patient is now officially biased.

5. If the benefits are at all notable, this person will usually start proclaiming to
anyone who will listen that they "know" that Epsom salts work.

6. When challenged (“It might be just the hot bath, eh?”), they will almost
certainly object and claim (correctly!) that they have tried simple hot soaking without
results. They have indeed. But it was never actually tried well enoughto really know.

Tricksy, the human mind is.

Consider the source!

ZOOM

Dr. Waring’s results are irrelevant to the popular idea of “osmosis,” which refers to the
movement of water, notmolecules. Nor do her results imply anything about that other
popular concept associated with Epsom salts, “detoxification.” And yet, 99% of the time,
“osmosis” and “detoxification” are the concepts presented as the justification for bathing in
Epsom salts. Can you trust advice that simplistic?

The detoxification claim implies either that Epsom salts somehow “suck” toxic substances
out of your muscle tissues, or that Epsom salts get into your system and then somehow
“clean up” some toxic substances that they encounter. There is no scientific evidence at all
for either of those basic detoxification scenarios, and both involve some seriously optimistic
assumptions, leaps of logic, avoidance of detail … all made by people who are usually trying
to sell the stuff.

Epsom salt bath prescriptions are invariably brief, and are often accompanied by
really strange claims of healing powers. For instance, I found one website that
recommended taking Epsom salts internally as well as bathing in them:

Researchers in nutrition, through controlled experimentation, have found that Magnesium

sulphate accelerates the body’s healing time by 30%. As an example, if an injury required three
weeks to heal under normal or standard conditions, it would only require two weeks to heal if
Magnesium sulphate was added to the diet as a nutrition [sic].46

That’s really ludicrous. Accelerated healing time is a comic book concept — something
Wolverine does — not an even remotely legitimate medical concept. And imagine the
unpleasant surprise of the hapless reader who takes this advice when they discover
the laxative effects of ingesting Epsom salts! Naturally, no source for this alleged experiment
was given.

Epsom salts bathing is often recommended carelessly and overconfidently, without any
genuine knowledge of the physiology or science (or lack thereof). Those who claim to
“know” that Epsom salts work cannot seem to demonstrate that they also “know” much
about physiology or science. While it certainly remains possible that there is a therapeutic
effect, it’s pretty clear that we shouldn’t take their word for it.

Nice-feeling water and floatation therapy

Is there any other reason to put Epsom salts in your bath? Well, Epsom salts dissolved in
your bath does make the water feel nice. � No research is required to prove that: just try

Most people agree that the water feels

it!

smoother, slicker, silkier.Most people agree that the water feels

smoother, slicker, silkier.

And it makes you floatier! Infinitesimally floatier. High concentrations of Epsom salt in your
bath will increase the water’s specific gravity (density) to the point where you will start to
float — just like in the Dead Sea, or Utah’s Great Salt Lake — because the body is, on
average, much less dense than salty water. The concentrations of salt required for floatation
therapy are much higher than Epsom salt packaging recommends, by the way. 47 However,
any salt in your bath — Epsom or otherwise — is going to make you at least a little bit
lighter in the water.

The purpose of floatation therapy is primarily to reap the benefits of deep relaxation, which
are noteworthy.48 It sounds lovely to me — but irrelevant to the relief of muscle aches and
pains except via the straightforward (and perfectly legit) mechanism of relaxation. For more
detailed discussion of floatation and immersion therapies, see Get in the Pool for Pain:
Aquatic therapy, aquajogging, water yoga, floating and other water-based treatment and
injury rehab options.

Something like a conclusion about Epsom salts

I can do no better in defense of Epsom salt bathing for aches and pains than “anything is
possible.” There is no good or specific reason to believe that bathing in dissolved Epsom
salts will have the slightest effect on muscle soreness or injury recovery time. Although this
folk wisdom may someday prove to have a sound rationale, clearly there is none that its
advocates have thought of — or even tried to think of, it seems.

There’s even decent evidence that Epsom salts can’t even get past the skin barrier — Israeli
soldiers can smear on magnesium rich cream without the slightest effect on their blood
levels of magnesium. That’s pretty damning.

On the other side of the evidence, thanks to Dr. Waring, we know that it’s still possible that
we are a living experiment in absorbing magnesium sulphate ions every time we bathe in
dissolved Epsom salts! And maybe, just maybe, they do something worthwhile once they get
past the skin. And it’s very cheap, and almost certainly safe — just as no one is obviously
getting any miracle cures out of Epsom salt bathing, they aren’t suffering any obvious ill
effects either.

So, why not? At the very least, they’ll make your bath feel silkier! And at most? Who knows
— maybe those magnesium and sulphate ions do have some healing powers. It’s certainly
not impossible. Just don’t buy into all the crap about osmosis and detoxification. As the old
Scottish proverb says, “Always keep your mind open — but not so open that your brains fall
out!”

About Paul Ingraham

I am a science writer, former massage therapist, and I was the assistant editor
at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a
runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and
qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Selected Reader Comments and Questions

This is a new section that I’ve just started in the fall of 2012. It will grow.

Industry protectionism for baths? A reader asks, “Why would the FDA allow studies to
be published that show Epsom salts are more effective than their muscle relaxers and pain
pills? For $1/lb of epsom salt this would kill their market and profits.” The FDA has literally
nothing to do magnesium sulfate research. They cannot regulate it. Any Big Pharma/FDA
conspiracy against Epsom salt is clearly failing, because the stuff is available literally
everywhere, and the FDA actually approves it for use as a laxative and a variety of external
uses. Approval seems like kind of a funny way of implementing an anti-salt agenda. In
short, this question is just knee-jerk anti-mainstream medicine paranoia based on major
misunderstandings of what the FDA is and how it works. Nevertheless, it is a concern I’ve
often see expressed, so I decided it was time to address it here.

Ironically, if there is any relevant commercial bias, it is one in favour of Epsom salts. For
instance, the Epsom Salt Council exists to promote the industry and is “eager to let everyone
know the benefits of our product and … spread the word about the wonder that is Epsom
salt.” They prominently publish uncritical and unequivocal claims of medical benefit on
their website.

Ok so you don’t believe that Epsom salt will do anything in a bath. So how
about sea salt? You believe it’s the same? Useless for muscle aches and stuff
like that? Yes, I believe it is “the same,” at least insofar as it is “useless muscle aches and
stuff like that.” Of course there is much more chemistry going on in sea water than Epsom
salts, but not in any way that seems to make any practical difference. In fact, it’s pretty clear
that people who swim in the ocean a lot are not enjoying impressive pain-killing benefits
the rest of us are missing out on — which is yet another example of how the skin is a pretty
effective barrier.

ZOOM

Do not try at home

Oddly, there are a lot of electric baths in medical history. Electricity was a wonderful way to make
health ideas based on vitalism seem more real & science-y.

Maybe there’s a “bio-electric” function to epsom salts in water. There’s more

and more being discovered about small electric/magnetic fields and how we
are affected by them. Er, no, I think not. It’s not inconceivable, but it is pretty far-
fetched. It’s generally true that biology ingeniously exploits most properties of nature to get
things done, including electromagnetism, and we likely still have things to learn about that
(that’s what the book The Body Electric was about, and despite its age and flaws it’s a darned
interesting read). But whatever those systems might be, it’s super unlikely that they have
any meaningful interaction with a slightly salty bath, let alone one that’s relevant to aches
and pains. It’s even less likely that any such effect wouldn’t be much more obvious in, say,
sea water. Even if salty baths just bestowed a vague feeling of well-being and vitality, like
mountain air, that would be biologically remarkable … but still well short of a useful
medical effect. And in fact salty baths do not have an obvious mountain-air like goodness.

Still need help with myofascial pain?

If you think this article is detailed, you should see my tutorial about muscle pain and
myofascial pain syndrome! This kind of exhaustively researched writing about Epsom salts
is only possible because I sell some of the other articles on this website. No writer can afford
to create truly good, detailed content and then just give it all away: we have to make a living
somehow. Please reward my efforts by taking a look at my tutorials. Although Epsom salts
seem unlikely to be a significant source of relief, there are plenty of other options for self-
 treatment of muscle pain. PainScience.com publishes an extremely thorough tutorial about
myofascial trigger points (muscle knots):

ZOOM

Trigger Points & Myofascial Pain Syndrome

Myofascial trigger points — muscle knots — are increasingly recognized by all health professionals
as the cause of most of the world’s aches and pains. This detailed tutorial focuses
on advancedtroubleshooting for patients who have failed to get relief from basic tactics, but it’s also
ideal for starting beginners on the right foot, and for pros who need to stay current. 186 sections
grounded in the famous texts of Drs. Travell & Simons, as well as more recent science, this constantly
updated tutorial is also offered as a free bonus (2-for-1) with the low back, neck, muscle strain, or
iliotibial pain tutorials. Buy it now for $19.95 or read the first few sections for free!

BUY $1995

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Related Reading

 PS Save Yourself from Muscle Strain! — Muscle strain (pulled muscle) and
muscle pain explained and discussed in great detail, plus every imaginable treatment
option

 PS Post-Exercise, Delayed-Onset Muscle Soreness — The biology & treatment

of “muscle fever,” the deep muscle soreness that surges 24-48 hours after an unfamiliar
workout intensity

 PS Hot Baths for Injury & Pain — Tips for getting the most benefit from a hot
soak, the oldest form of therapy

 For fun, see this short, excellent example of a typically terrible popular
articleabout Epsom salt: its title asks, “Quick Cures/Quack Cures: Is Epsom Worth Its
Salt?” but there is not a critical thought anywhere to be found. The writer assumes that
Epsom salts are "effective, affordable therapy," and then proceeds to try to "explain" it
with a not-actually-a-quote from Dr. Waring. If Dr. Waring actually said that, she was
speculating beyond the reach of science, but it's more likely the journalist simply
paraphrased to make her speculation sound much more definite than it was. And of
course the article parrots the osmosis error: "draws foreign bodies." No no no! That's
not osmosis! Grade school chemistry fail!

Other interesting reading:

 Magnesium sulfate on Wikipedia.com.

What’s new in this article?

Fifteen updates have been logged for this article since publication
(2006). AllPainScience.com updates are logged to show a long term commitment to quality,
accuracy, and currency. more

This is one of the oldest and most regularly updated articles on PainScience.com, though no
updates were logged for at least the first four years of its lifespan. But it has always been
popular, and has always attracted lots of feedback, including some great comments that
have inspired many corrections and improvements.

2017 — New (short) section, “Absorption ‘conclusions’,” citing Gröber et al.

2017 — Really fun new section: “Testing magnesium absorption on harvested human skin
samples.” I laughed out loud repeatedly writing this one. Because what’s funnier than harvested
human skin, amiright?

2017 — New section, “Hot hot hot! Does heat increase absorption?” Based on Park et al.

2017 — Expanded on discussion of inhalation as a vector for salt magnesium absorption.

2017 — Correction about the size of water molecules, and some clarification about how skin
waterproofing works thanks to some interesting science.

2016 — Small but worthwhile clarifications of the 500 Dalton rule and the “Osmosis mistake”
(which I continue to get too much ignorant email about).

2016 — New section, “What does get across the skin? Obviously some things do.” Discussion of the
small size of magnesium ions and the 500 Dalton rule of absorption. This isn’t exactly a reversal of
my position on absorption, because I was always officially and openly agnostic about it. However, I
also clearly thought absorption was a priori implausible, and this update reverses that opinion,
which is worth emphasizing.

2015 — Fixed an incorrect premise of a minor point: water vapour is pure by definition and cannot
be salty, and therefore cannot be even a slightly plausible mechanism of delivery of salt to mucous
membranes.

2015 — Fixed incorrect information about skin pruning and added the actual (and much more
interesting) explanation; cited to substantiate the impermeability of the stratum corneum.

2013 — Added an explanation of why it is probably a bad idea to use Epsom salts as a replacement
for a tetanus shot after a dirty puncture wound.

2012 — Added the first piece of evidence against the absorption of Epsom salt.

2012 — Added a particularly awful example of a bad article about Epsom salts. See immediately
above in the Further Reading section.
 2011 — Added picture of cats demonstrating osmosis.

Some updates missed.

2010 — Added information about the effect of Epsom salt on bacteria on the skin.

2010 — Corrected several typographic errors.

Many earlier updates unlogged.

2006 — Publication.

Notes

1. “Relieves pain” and “speeds healing” are as different from each other as a flying dream is
from actual flying. Actually speeding up healing is kind of a big deal. BACK TO TEXT

2. Of course! Can’t very well debunk it without trying it, can I? I’ve had many Epsom salts
baths! BACK TO TEXT

3. I still can’t remember it reliably, because chemical names stick in my head about as well
as my cousins’ birthdays. Ambush me with the question sometime: “What’s the chemical name
for Epsom salts? Schnell, schnell!” I’ll be stumped as likely as not. BACK TO TEXT

4. The idea of “toxins” is usually used as a tactic to scare people into buying some kind
of de-toxifying snake oil. Obviously there are dangerous substances; the problem is with the
kind of people who toss the idea around, the reasons they do it (fear, profit, ignorance), and
because toxin claims are usually so vague that they are literally meaningless, except as a
marketing message. Indeed, “detoxification” may be the single most common marketing
buzzword in alternative health care.

The body deals with undesirable molecules in many ways. It eliminates some and recycles
others; some are trapped in a safe place; and quite a few can’t be safely handled at all (metals).
Most alleged “detox” treatments are focused on stimulating an excretion pathway, like sweating
in a sauna. But it’s not like sweating is broken and the sauna is fixing it! The only truly
“detoxifying” treatments help the body eliminate or disarm molecules the body cannot process
on its own. A stomach pump for someone with alcohol poisoning is literally “detoxifying.” So
are chelation for heavy metals, and antivenoms.

I cover the specific idea of “flushing” toxins in Why Drink Water After Massage?(Massage is
wonderful for all kinds of reasons — it doesn’t need the support of the idea that it
detoxifies.) For more general consumer advocacy and education about toxins,
see “Detoxification” Schemes and Scams (from QuackWatch.org).
 BACK TO TEXT
5. For more detail, see another article on PainScience.com, Post-Exercise, Delayed-Onset
Muscle Soreness: The biology & treatment of “muscle fever,” the deep muscle soreness that
surges 24-48 hours after an unfamiliar workout intensity. Basically what it boils down to is that
the top 5 effective treatments for muscle pain after exercise are:
1. diddly
2. zilch
3. zip
4. zero
5. maaaaybe massage, but probably not
BACK TO TEXT

6. Swain R, Kaplan-Machlis B. Magnesium for the next millennium. South Med J. 1999
Nov;92(11):1040–1047. PubMed #10586828. See also the Wikipedia article magnesium sulfate
(Wikipedia). BACK TO TEXT

7. Izzo AA, Gaginella TS, Capasso F. The osmotic and intrinsic mechanisms of the
pharmacological laxative action of oral high doses of magnesium sulphate. Importance of the
release of digestive polypeptides and nitric oxide. Magnes Res. 1996 Jun;9(2):133–
138. PubMed #8878010.

“A common use for high doses of oral magnesium salts is to produce a laxative effect to treat
constipation,” explain the authors of this scientific paper. “In the intestinal lumen the poorly
absorbable magnesium ions (and other ions such as sulphate) exert an osmotic effect and cause
water to be retained in the intestinal lumen.”

BACK TO TEXT

8. James LP, Nichols MH, King WD. A comparison of cathartics in pediatric

ingestions.Pediatrics. 1995 Aug;96(2 Pt 1):235–238. PubMed #7630676.

This paper compared the effectiveness of different laxatives, showing that Epsom salts do
indeed move the bowels along … but not as quickly as sorbitol.

BACK TO TEXT

9. As occurs with chronic diarrhea, magnesium malabsorption, alcoholism, diuretic use

and a few other disorders. BACK TO TEXT

10. Eclampsia is a dangerous and fairly common complication of pregnancy. BACK TO TEXT
11. Muscle spasms caused by bacterial infection with Clostridium tetani, which produces
the neurotoxin tetanospasmin. BACK TO TEXT

12. I’m deliberately over-simplifying the definition of osmosis there, just for readability.
Osmosis actually involves the movement of any solvent across a membrane. And water is a
solvent, of course. I referred only to water in this context because, unless you bathe in
turpentine, the only solvent in your bathing-osmosis equation is going to be good ol’ H 2O. BACK
TO TEXT

13. A reader wisely asked: “Isn’t that cat diffusion?” Yes: this meme is actually making the
osmosis mistake! But it’s still cute and funny. If the cats represent solute (particles in a fluid),
then they aren’t representing osmosis, but diffusion. But just flip it around in your head:
imagine they represent solvent (water) … that makes it osmosis, and the cat is “flowing” across
the “membrane” like water. BACK TO TEXT

14. There are a lot of microorganisms that might be on a rusty nail, but CT is the scary
common one that can kill you very unpleasantly (a chance of death by muscle spasm, arg). The
reason you get a tetanus shot in that situation is that it is a very effective just-in-case
prevention, good bang for buck. The idea that anyone would recommend an Epsom salt bath as
a replacement for that is quite terrifying, a fine example of dangerous ignorance. While a very
strong Epsom salt solution might kill every bacteria in a shallow wound, a deep wound can put
bacteria into the bloodstream that leaves the site in seconds — completely inaccessible to any
topical antibacterial solution. Ironically, as mentioned above, magnesium heptahydrate is
actually treatment for the muscle spasms caused by CT — but it can’t prevent the infection via a
puncture wound in the first place. BACK TO TEXT

15. It is now well understood that every microscopic nook and cranny of our skin —
indeed, our entire body, inside and out — is thickly populated with an ecosystem of
microorganisms, more diverse than any jungle (see We Are Full of Critters). It is also likely that
one of the primary functions of these teensy jungles is to maintain a balance of power, where
it’s difficult for any organism to dominate. If soaking in salt water kills bacteria, it might kill off
the bacteria that normally live on the skin as well. BACK TO TEXT

16. If you weigh yourself before and after a bath or sauna, you may find a surprising 1-5
pound weight reduction. This fairly obvious effect is presumably due to fluid loss from
sweating. The amount is impressive, considering that you may well have consumed fluid at the
same time that you were getting rid of it through your sweat glands. However, it’s certainly
consistent with the well-known hazard of fainting in that context, which every public hot tub
has very clear warnings about. So I think it’s a reasonably safe assumption that we really do
sweat a lot in a hot bath! BACK TO TEXT

17. The sweat is not “sucked” out of you by salty osmosis, thank goodness, but actively
excreted by busy, clever cells that systematically squirt out a variety of waste products along
with water, regardless of what you are or are not bathing in. This process is entirely mediated by
the clever physiology of those glands, and has nothing (known or significant) to do with any
 fluid in contact with the skin. If there were, people playing in Great Salt Lake or the Dead Sea
(which are waaaaaay saltier than any Epsom salt bath) would experience a dramatically greater
and more obvious dehydration effect — to the point of being extremely unpleasant and
dangerous! They don’t, of course: they just float and have a good time, immune to any vampiric
syphoning of fluids from their bodies. BACK TO TEXT

18. Iwai I, Han H, den Hollander L, et al. The human skin barrier is organized as stacked
bilayers of fully extended ceramides with cholesterol molecules associated with the ceramide
sphingoid moiety. J Invest Dermatol. 2012 Sep;132(9):2215–25. PubMed #22534876. This is a really cool
paper; NewScientist.com has a nice plain English translation: “Strange fat explains skin’s
waterproof properties.” BACK TO TEXT

19. The stratum corneum swells, but only a little, and we know it’s not the cause of pruning
because it doesn’t happen when the nerve supply to the fingers is damaged, which means it’s a
neurologically regulated phenomenon. We’ve known this for a long time, but we didn’t have
any good idea why until quite recently. This video and this article in Nature explain in detail.
Basically, “wrinkly fingers improve our grip on wet or submerged objects, working to channel
away the water like the rain treads in car tyres.” The mechanism is constriction of the blood
vessels under the skin: as they constrict, they pull the skin with them. And testing has
confirmed that this actually improves grip on wet surfaces, which “could have helped our
ancestors to gather food from wet vegetation or streams.” I’ll be darned. BACK TO TEXT

20. Potts RO, Francoeur ML. The influence of stratum corneum morphology on water
permeability. J Invest Dermatol. 1991 Apr;96(4):495-9. PubMed #2007788. “The stratum
corneum (SC) provides the barrier to water loss for the skin of mammals. A significant body of
evidence now exists suggesting that extracellular SC lipids are primarily responsible for this
barrier. … These results are interpreted in terms of the unique morphology of the SC, where
lipids form an extracellular continuum that is highly tortuous. Thus, the exceedingly low
permeability of the SC may be due, in large part, to its unique morphology.” BACK TO TEXT

21. Bos JD, Meinardi MM. The 500 Dalton rule for the skin penetration of chemical
compounds and drugs. Exp Dermatol. 2000 Jun;9(3):165–9. PubMed #10839713. BACK TO TEXT

22. Hansen CS, Færch LH, Kristensen PL. Testing the validity of the Danish urban myth
that alcohol can be absorbed through feet: open labelled self experimental study. BMJ.
2010;341:c6812. PubMed #21156749. PainSci #54850.

Can you get drunk through your skin? In this MythBusters-style experiment, three adults were
“tested” in the office of a Danish hospital: specifically, their feet were submerged in a bowl
containting three 700 mL bottles of vodka. It’s hard to tell if the researchers are serious about
this, but they obviously had fun doing it!

However, the subjects did not become intoxicated, and their blood alcohol levels did not
change. They concluded: “Our results suggest that feet are impenetrable to the alcohol
 component of vodka. We therefore conclude that the Danish urban myth of being able to get
drunk by submerging feet in alcoholic beverages is just that; a myth. The implications of the
study are many though.”

Indeed.

BACK TO TEXT

23. Bos 2000, op. cit.

They argued it in three ways:

1. virtually all common contact allergens are under 500 Dalton, larger
molecules are not known as contact sensitizers. They cannot penetrate and thus
cannot act as allergens in man;

2. the most commonly used pharmacological agents applied in topical

dermatotherapy are all under 500 Dalton;

3. all known topical drugs used in transdermal drug-delivery systems are

under 500 Dalton.

BACK TO TEXT

24. Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J. 2012 Feb;5(Suppl

1):i3–i14. PubMed #26069819. PainSci #52761. Chandrasekaran et al regarding this paper: “The radius of
the hydrated magnesium ion has been reported to be 400 times higher than its dehydrated
form, leading to the assertion that it is almost impossible for magnesium ions to pass through
biological membranes.” BACK TO TEXT

25. Chandrasekaran NC, Sanchez WY, Mohammed YH, et al. Permeation of topically
applied magnesium ions through human skin is facilitated by hair follicles. Magnes Res. 2016
Jun;29(2):35–42. PubMed #27624531. BACK TO TEXT

26. For context, I’ll repeat this quote from Chandrasekaran et al: “The radius of the
hydrated magnesium ion has been reported to be 400 times higher than its dehydrated form
[Jahnen-Dechent et al], leading to the assertion that it is almost impossible for magnesium ions
to pass through biological membranes.”

However!

“When we re-examined this calculation, it was found that the volume of the magnesium ion is
451.76 Å3 [4 (4.76)3] in the hydrated state, but based on the ionic radii of dehydrated and
hydrated magnesium ions, i.e., 0.87 Å and 4.76 Å respectively [10-13], we calculated that the
hydrated radius of the ion is only 5.47 fold (4.76Å) greater than its dehydrated radius. Based on
our recalculation… we postulated that the hydrated magnesium ion could potentially penetrate
 by bulk diffusion through the 10 Å pores formed by protein subunits in the lipid membrane [5,
14], or by other means, such as hair follicles.

BACK TO TEXT

27. Singleton, Kenneth B. The Lyme Disease Solution. 2008. p396. BACK TO TEXT

28. Medical training credentials are not remotely a guarantee of an intelligent opinion, and
this demonstrates it beautifully. All it does is show the kinds of ridiculous things that get said
about Epsom salts without a shred of evidence or even an intelligible biological rationale. BACK TO
TEXT

29. Eisenkraft A, Krivoy A, Vidan A, et al. Phase I study of a topical skin protectant against
chemical warfare agents. Mil Med. 2009 Jan;174(1):47–52. PubMed #19216298. BACK TO TEXT

30. Waring RH. Report on Absorption of magnesium sulfate (Epsom salts) across the
skin.Unpublished. 2006. PainSci #56301. BACK TO TEXT

31. The others had increased urine levels of magnesium, implying that “the magnesium
ions had crossed the skin barrier and had been excreted via the kidney, presumably because the
blood levels were already optimal.” In other words, whatever magnesium was absorbed into the
bloodstream was promptly removed by the body. BACK TO TEXT

32. When I asked Dr. Waring about publication, she explained “we just haven’t got around
to it yet. I hope to do a bit more and then publish with my London colleague.” BACK TO TEXT

33. There are any number of flaws in the experiment that we can’t know about. For
example, one reader sent me this interesting point by e-mail: “Dr. Waring could not possibly
have measured absolute MgSO4 blood content: the only way to do that would be through
dialysis or post-mortem, only relative concentration. Any degree of dehydration would have an
absolute effect on relative concentration; i.e., all solutes would show increased concentration
due to dehydration, including any magnesium already present in the bloodstream. Since the
study is unpublished, it's not possible to know whether the Dr controlled for this.” BACK TO TEXT

34. Little rant there. It really gets my knickers in a twist when people gripe about science
“not knowing everything,” or “there’s other ways of knowing.” As if science doesn’t know it has
limits! If scientists thought everything was done, they would stop! Sheesh. BACK TO TEXT

35. Park JH, Lee JW, Kim YC, Prausnitz MR. The effect of heat on skin permeability. Int J
Pharm. 2008 Jul;359(1-2):94–103. PubMed #18455889. PainSci #52769. BACK TO TEXT
36. See 2007 Darwin Awards: The Enema Within, in which a man died from an alcohol
enema. “In order to qualify for a Darwin Award, a person must remove himself from the gene
pool via an ‘astounding misapplication of judgment.’ Three litres of sherry up the butt can only
be described as astounding.”

See also, if you dare, this real news item about a frat boy who almost killed himself “butt
chugging” — getting drunk from alcohol injected into the butt. Seriously. “The only thing more
embarrassing than almost dying from allegedly butt-chugging is hiring a lawyer to deny it.” No
doubt.

BACK TO TEXT

37. Water vapour is mostly pure H2O by definition. There is such a thing as solutes that get
“dissolved in steam” and carried along with it without technically “evaporating,” but that’s a
fairly exotic phenomenon. Your standard salts neither evaporate nor get carried away with
evaporated water. BACK TO TEXT

38. Gröber U, Werner T, Vormann J, Kisters K. Myth or reality-transdermal magnesium?

Nutrients. 2017 Jul;9(8). PubMed #28788060. PainSci #52771. BACK TO TEXT

39. Dr. Waring has done other research claiming to show that autism is correlated with
magnesium deficiency, and her primary reason for studying Epsom salt absorption through the
skin was to investigate it as a possible autism treatment. BACK TO TEXT

40. Chestnutt WN, Dundee JW. Failure of magnesium sulphate to prevent suxamethonium
induced muscle pains. Anaesthesia. 1985 May;40(5):488–490. PubMed #4014628.

Muscle pain is one of the side effects of suxamethonium chloride, an anaesthetic drug used to
cause short-term paralysis. In this study, injecting magnesium sulphate had no benefit
compared to doing nothing, and was “followed by unpleasant side effects.“

Granted, the relevance of this kind of muscle pain to the more common kinds is unknown. But
it is suggestive. BACK TO TEXT

41. Consider the seminal text, Muscle Pain: Understanding its nature, diagnosis and
treatment. It has nine chapters devoted to nine different kinds of muscle pain. It also doesn’t
mention Epsom salts. Not once. BACK TO TEXT

42. Learn.genetics.utah.edu [Internet]. Cell Size and Scale; 2010 [cited 17 Jan 21].

A beautiful animated tool for visualizing the scale of cells.

 BACK TO TEXT

43. Kogler J. The analgesic effect of magnesium sulfate in patients undergoing

thoracotomy.Acta Clin Croat. 2009 Mar;48(1):19–26. PubMed #19623867. BACK TO TEXT

44. Lysakowski C, Dumont L, Czarnetzki C, Tramèr MR. Magnesium as an adjuvant to

postoperative analgesia: a systematic review of randomized trials. Anesth Analg. 2007
Jun;104(6):1532–9, table of contents. PubMed #17513654. The authors of the review concluded:
“These trials do not provide convincing evidence that perioperative magnesium may have
favorable effects on postoperative pain intensity and analgesic requirements.” BACK TO TEXT

45. Dr. Waring: “The cytokines released in the inflammatory state actually depress the
expression of cysteine dioxygenase, the rate-determining step in the conversion of cysteine to
inorganic sulphate. About 80% of the in vivo requirement of sulphate goes through this
pathway as sulphate is not well-absorbed from the gut.” BACK TO TEXT

46. RacingSmarter.com [Internet]. Epsom Salt & Apple Cider Vinegar Treatments Nature's
Healing & High Energy Bath; 2006 [cited 10 Nov 2, page defunct]. BACK TO TEXT

47. Which actually suggests an interesting point: if modest amounts of Epsom salts in your
bath allegedly has therapeutic effects, then it is reasonable to guess that the much higher
concentrations of salt used in floatation therapy or found in the famous salt lakes would have a
really dramatic effect — perhaps even a toxic effect. But bathing in much higher concentrations
of salt has no significant effect at all … other than making people float. BACK TO TEXT

48. A UK floatation tank manufacturer’s website, floataway.com, admirably restrains itself

from extravagant claims of medical benefits, discussing only the benefits of relaxation. As for
Epsom salt, the website says it is used “because it raises the density of the water, making it easy
to float, and because it has a silky feel which is very good for the skin.” I’m not sure what they
mean by “good for,” but I’m guessing it just feels pleasant. BACK TO TEXT

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