Most healthcare consumers, I would assume, are well aware that we have a profound, unnecessarily so, epidemic of chronic disease, as well as a widespread deficiency of nutrients. Medical education is often lacking in these areas, so this isn't often recognized or assessed in day-to-day medical practice. Many of my clients implement magnesium into their routine supplement regimen as a result of their own research and desire to improve their overall health and vitality.
Magnesium is the fourth most common mineral in the human body after calcium, sodium, and potassium, and it's the second most common intracellular cation after potassium. In an individual about 145 pounds, they will have approximately 25 grams of magnesium in reserve with 53% of that in their bones, 27% in their muscles, 19% in their soft tissues, and less than 1% in their blood. The serum concentration is pretty tightly controlled, with a normal level about 75-90mmol/L, although there is some research that indicates levels less than 85mmol/L should be considered deficient (Schwalfenberg & Genuis, 2017).
Magnesium is involved in about 300 enzyme systems and is required for a plethora of fundamental processes, such as energy production and nucleic acid synthesis. Within the cell, magnesium stores are quite concentrated in the mitochondria, where it plays a vital role in the synthesis of ATP. More than 3,500 human proteins are thought to bind to magnesium, so deficiency, which seems to be quite common, seems to play a role in chronic disease. And again, because nutrition hasn't been a big part of modern medicine or conventional healthcare, this goes ignored in spite of magnesium having an profound role in metabolic functioning and homeostasis in the human body.
When magnesium is evaluated, it is most often done by evaluating total levels in the serum, which has limited clinical benefit as it does not accurately reflect intracellular or total body magnesium status. In other words, the less than 1% of total body magnesium found in the serum, particularly because the body works to maintain a very stable level within the blood, doesn't well reflect the intracellular level of magnesium.
Serum ionized magnesium levels are significantly lower than the total serum magnesium concentration in diabetes, and in those with mild-to-moderate Alzheimer's disease. Serum ionized magnesium ad tissue magnesium are more reflective of magnesium, but these tests aren't available to all clinicians (Schwalfenberg & Genuis, 2017).
Magnesium Deficiency
It is estimated that between 56% and 68% of Americans do not obtain enough magnesium in their diet on a daily basis to meet the recommended daily allowance. There is less magnesium in processed foods and most foods in the grocery store are processed. Nonorganic foods also have less magnesium, which is the bulk of our produce. Meat, sugar, and white flower contribute less than 20% of the daily requirements of magnesium, and cooking or boiling produce reduces its magnesium content (Schwalfenberg & Genuis, 2017). Processed white flour or rice, has been found to lower magnesium by up to 300-400%. Phytic acid, a natural chelator found in some nuts, seeds, and grains, can also diminish the abortion of elements, such as calcium, iron, magnesium, and zinc. The most common pesticide in the world today, glyphosate, also chelates minerals.
When our vitamin D is deficient, the ability of our gut to absorb magnesium is reduced and many of our medications diminish absorption, such as antibiotics, antacids, and hypertensive drugs (Schwalfenberg & Genuis, 2017). Alcohol causes us to excrete more magnesium, as does both types of diabetes. Smoking reduces our plasma levels of magnesium. Aging also decreases our ability to absorption magnesium by at least 30%. Chronic low intake though, may be the main reason for a total body magnesium deficit. It is estimated that at least 42% of young adults have an ongoing magnesium deficiency.
Ingestion of plants and more traditional foods can greatly improve magnesium status. Acidification by using sourdough, for example, can improve magnesium availability. This grows increasingly important as we age, as our absorption of magnesium can decrease by more than 30% in the elderly (Schwalfenberg & Genuis, 2017). Discussion about magnesium, food sources, and its various forms is available to clients in our Eden Wellness group.
There aren't typically symptoms when one is magnesium deficient, but when they are present, often individuals will experience weakness, muscle fasciculations, difficult swallowing, facial twitching, arrhythmias, ECG changes, depression, agitation, psychosis, nystagmus, and seizures (Schwalfenberg & Genuis, 2017).
Magnesium & Asthma
Those with severe asthma, may in fact have low magnesium levels, and this is appreciated so much so that in acute exacerbations, magnesium will be administered intravenously to support treatment. Studies have found that these treatments, intravenous magnesium, improves overall care and can decrease hospitalization stay (Schwalfenberg & Genuis, 2017).
Magnesium & Vitamin D
We know that low magnesium will also impede our ability to convert vitamin D into its active form, so if your levels are persistently low, it might behoove you to supplement magnesium as it may improve absorption by as much as 300% (Schwalfenberg & Genuis, 2017). Magnesium supplementation helps bone health into our senior years, especially so for postmenopausal women, although even in young male athletes, fractures are reduced with magnesium supplementation.
Magnesium & Migraines
Magnesium can help with migraines, which makes sense especially in those suffering with irritable bowel or frequent diarrhea. One study found that oral supplementation of magnesium reduces migraine frequency, duration and intensity by 41% (Schwalfenberg & Genuis, 2017). When migraines are accompanied by an aura, an intravenous administration of magnesium can be really helpful. Even at just 600mg a day though, oral supplementation can reduce migraine.
Magnesium & Blood Sugar Regulation
A recommendation I've been giving for many years, including my pregnant clients with gestational diabetes, we know that magnesium is low in those with metabolic syndrome and diabetes. When this is supplemented, 71% of the time, elevated insulin levels can be reduced (Schwalfenberg & Genuis, 2017). Another study, that followed-up for 20 years, found magnesium had an inverse relationship with cRP-hs, IL-6, fibrinogen and HOMA-IR as well as a 47% reduced incidence of diabetes in those with the highest levels of magnesium. My own family has many T2DM variants, so I've been adding magnesium powder to my kid's water bottles for years now.
Another meta-analysis including 15 studies (CHARGE) found magnesium was inversely related to fasting glucose and insulin, and when supplementing magnesium, glucose parameters are improved as well as insulin sensitivity in pre-diabetics (Schwalfenberg & Genuis, 2017; Veronese et al., 2016). This is the most commonly found electrolyte abnormality in diabetes, hypomagnesium. Studies have found as many as 88.9% of diabetics have low magnesium, lower than the daily recommended amount, and in at least 37%, this was identified in their clinical laboratory findings (Sheehan, 1991). In this same study, when magnesium was supplemented, not only did their diabetic measurements improve, but so did their good cholesterol (HDL), the lipids that carry out the bad lipids associated with heart disease and stroke.
Yep, even more... the better the magnesium, the better one's triglycerides, waist circumference, body fat percentage, and body mass index (excuse me while I go add some magnesium to my own water bottle). Just 100mg per day of magnesium has been found to reduce diabetes by 15% (Larsson & Wolk, 2007). Long-term magnesium supplementation improves outcomes in neuropathy in type 1 diabetes (Leeuw et al., 2004). Lower magnesium levels are associated with worsening renal decline in diabetics, and depression in those with diabetes is also associated with low magnesium. In fact, treating depressed individuals with diabetes with magnesium is just as effective as treating with 50mg of imipramine (Barragan-Rodriquez et al., 2005).
Magnesium & Depression
Magnesium has been used to treat depression as far back as 1921, and it works quickly and rather effectively (Weston, 1922; Eby & Eby, 2006; Jacka et al., 2006). Magnesium is required, as a coenzyme, to convert tryptophan into serotonin, an important neurotransmitter recognized as a major determinant of mental health and mood. It is thought that supplementing with magnesium can enhance the efforts of antidepressants as well.
Magnesium, Sleep & Restless Leg Syndrome
At least half of all adults suffer insomnia. Magnesium is a natural N-methyl-D-aspartic acid (NMDA) antagonist and a GABA agonist, both biochemical actions which have a relaxant effect and facilitate sleep (Schwalfenberg & Genuis, 2017). Supplementation of 500mg of magnesium is associated with significant improvement in the insomnia severity index, sleep time, sleep efficiency, sleep onset latency, serum cortisol concentrations, serum renin, and melatonin. Magnesium also decreases periodic limb movement during sleep, improving sleep.
Magnesium & Cancer
Magnesium can help reducing smoking via the cholinergic and NMDA receptors, but I am not going to speak too much on that as my clients really aren't smokers. If you are though, four weeks of magnesium can help. With regards to cancer, if magnesium is low in our cells, then it will reduce our body's ability to activate ATP, which are the energy centers in the cell, so we won't be able to create healthy cells as easily. The calcium channel pathway though can still be activated (TRPM7) which provides the milieu for development of cancer (Hanano & Hara, 2004). When our cells have more calcium than magnesium, our risk of postmenopausal breast cancer is increased (Sahmoun & Singh, 2010).
Dietary magnesium intake appears to be inversely related to a lower risk of developing colorectal adenomas and colorectal cancer (Wark et al., 2012). Supplementing magnesium is inversely related, with one study showing a 13% reduction in colorectal adenomas for every 100mg consumed each day.
Magnesium & Kidney Stones
Most kidney stones or renal calculi are made of calcium oxalate, so increasing magnesium would inversely impact calcium, decreasing risk of stones. The magnesium binds the oxalates within the intestinal tract so they aren't as easily absorbed. The use of potassium citrate 1500mg and magnesium citrate 250mg daily reduced the number of stones by 85%, over a three year period, in one study (Ettinger et al., 1997).
Magnesium & Cardiac Health
Magnesium deficiency may affect several different pathophysiological steps involved in heart diseases, such as arteriosclerosis and hypertension. Low magnesium contributes to vascular calcification, accumulation of connective tissue in the vessel wall, altered lipid exchange between the vessel walls and the blood, increased triglycerides, accumulation of oxalate in vessel walls, and reduced cholesterol transport by HDL (Rayssiguier, 1984). Supplementation in elderly diabetic patients, of just 368mg a day, has shown to improve vascular and endothelial function (Barbagallo et al., 2010).
Individuals with higher magnesium have the lowest risk for sudden cardiac death (Schwalfenberg & Genuis, 2017). It's truly incredible, but consider that oral magnesium acts as a natural calcium channel blocker which we prescribe as a pharmaceutical to manage heart conditions such as elevated blood pressure. Magnesium improves endothelial dysfunction, increases nitric oxide, and induces direct and indirect vasodilation. There is evidence that magnesium deficiency may induce resistance to the effects of antihypertensive agents. Just taking 500 to1,000mg a day reduces both systolic and diastolic blood pressure as much as 5.6/2.8mmHg.
Magnesium has also been found to be helpful for arrhythmias at a dose of 2 grams intravenously over 10 to 15 minutes and repeated once if necessary (Schwalfenberg & Genuis, 2017). Magnesium is given to reduce atrial fibrillation in those undergoing cardiopulmonary bypass or coronary artery bypass graft surgery. Low magnesium is associated with atrial fibrillation, and rapidly resolves with supplementation of magnesium.
There's more, magnesium supplementation for a year improves symptoms or even resolves symptoms of mitral value prolapse, and those with severe congestive heart failure have significant improvements in symptoms and survival outcomes when magnesium is optimal (Schwalfenberg & Genuis, 2017). Hypomagnesium may occur with dialysis, and supplementation with phosphate binders may improve magnesium levels that are important to prevent vascular calcification, decrease inflammation, and decrease mortality. Normal magnesium levels also prevent clotting, reduce inflammation, and prevent atherosclerotic plaques. Statin drugs yield lower LDL-C compared to magnesium supplements, but magnesium improves all aspects of dyslipidemia by also raising HDL-C and lowering triglycerides without the adverse effects linked to consumption of statin agents (Rosanoff & Seelig, 2004). A significant reduction in total cholesterol and LDL with an increase in HDL can occur with 600 mg of magnesium for just 12 weeks (Lal et al., 2003).
Magnesium & Premenstrual Syndrome
Using magnesium for just two cycles can reduce menstrual distress, with decreased pain and less mood changes. Women taking tamoxifen or aromatase inhibitors for breast cancer, also using magnesium, suffer fewer hot flashes by more than half, as well as fatigue, sweating, and distress (Schwalfenberg & Genuis, 2017).
Magnesium & Eye Health
Cataract from advancing age is the most common cause of blindness in both eyes, and it results from loss of transparency in the lens. Membrane transport mechanisms, utilizing several magnesium dependent pathways, play an important role in maintaining lens homeostasis. Magnesium supplementation may be helpful in preventing the onset and progression of cataracts in conditions related to magnesium deficiency, as well as diminishing the risk of glaucoma by improving ocular blood flow and preventing loss of ganglion cells (Schwalfenberg & Genuis, 2017).
Magnesium & Brain Health
Children with Attention Deficit Hyperactivity Disorder often have magnesium deficiency, and supplementation has shown significant improvements in their attention and hyperactivity (Mousain-Bosc et a., 2006; Starobrat-Hermelin & Koziclec, 1997). Low magnesium contributes to higher fatigue. Supplementing with magnesium increases memory in those with dementia, and improves cognitive function. Serum ionized magnesium correlates with each of these, but total serum magnesium does not (Schwalfenberg & Genuis, 2017).
Emerging evidence relates magnesium to several psychopathological states, including schizophrenia (Schwalfenberg & Genuis, 2017). It has been investigated as an adjuvant therapy for some mental health conditions. Low magnesium levels along with high aluminum levels are consistently seen in Parkinson's diseases and are believed to contribute to the pathogenesis of this disease.
Magnesium & Skin Conditions
We have long supplemented zinc for those with skin conditions, as we know these levels are particularly low in these individuals. Atopic dermatitis is significantly improved with supplementation of zinc, but more, magnesium salts are known to enhance skin hydration, dermal permeability, and barrier repair to facilitate epidermal proliferation and differentiation, ultimately reducing inflammation (Schwalfenberg & Genuis, 2017). A double-blind controlled trial using a magnesium cream to treat mild-to-moderate atopic dermatitis was found to be superior to hydrocortisone creams (Koppes et al., 2016). Magnesium is often recommended for a plethora of skin conditions.
Magnesium & Longevity
Magnesium protects against aging from increased oxidative stress, insulin resistance, inflammation, and mitochondrial damage (Schwalfenberg & Genuis, 2017). Magnesium deficiency may explain many age related diseases as its impact is vital in so many pathophysiologic pathways. We know it's important in reducing adrenalin in autonomic dysfunction and emotional stressful scenarios.
References
Barbagallo, M., Dominguez, L. J., Galioto, A., Pineo, A., & Belvedere, M. (2010). Oral magnesium supplementation improves vascular function in elderly diabetic patients. Magnesium Research, 23(3), 131-137.
Barragan-Rodriguez, L., Rodgriquez-Moran, M., & Guerrero-Romero, F. (2005). Efficacy and safety of oral magnesium supplemetnation in the treatment of depression in the elderly with type 2 diabetes: a randomized, equivalent trial. Magnesium Research, 21(4), 218-223.
Eby, G. A., & Eby, K. L. (2006). Rapid recovery from major depression using magnesium treatment. Medical Hypotehses, 67(2), 362-370.
Ettinger, B., Pak, C. Y. C., Citron, J. T., Thomas, C., Adams-Huet, B., & Vangessel, A. (1997). Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. Journal of Urology, 158(6), 2069-2073.
Hanano, T. & Hara, Y. (2004). Involvement of TRPM7 in cell growth as a spontaneously activated Ca2+ entry pathway in. human retinoblastoma cells. Journal of Pharmacological Sciences, 95(4), 403-419.
Jacka, F., Overland, S., Stewart, R., Tell, G., Bjelland, I. & Mykletun, A. (2009). Association between magensium intake and depression and anxiety in community-dwellings adults: the Hordaland health study. Australian and New Zealand Journal of Psychiatry, 43(1), 45-52.
Koppes, S. A., Charles, F., Lammers, L. A., Frings-Dresen, M., Kezic, S., & Rustemeyer, T. (2016). Efficacy of a cream containing ceramides and magnesium in the treatment of mild to moderate atopic dermatitis: a randomized, double-blind, emollient- and hydrocortisone-controlled trial. Acta Dermato-Venereologica, 96(7), 948-953.
Lal, J., Vasudev, K., Kela, A. K., & Jain, S. K. (2003). Effect of oral magnesium supplementation on the lipid profile and blood glucose of patients with type 2 diabetes mellitus. The Journal of Association of Physicians of India, 51, 37-42.
Larsson, S. C., & Wolk, A. (2007). Magnesium intake and risk of type 2 diabetes: a meta-analysis. Journal of Internal Medicine, 262(2), 208-214.
Leeuw, I. D., Engelen, W., De Block, C., & Van Gall, L. (2004). Long term magnesium supplementation influences favourably the natural evolution of neuropathy in magnesium-depleted type 1 diabetic patients (T1dm). Magnesium Research, 17(2), 109-114.
Mousain-Bosc, M., Roche, M., Polge, A., Pradal-Prat, D., Rapin, J., & Bali, J. P. (2006). Improvement of neurobehvioral disorders in children supplemented with magnesium-vitamin B6. Attention deficit hyperactivity disorders. Magnesium Research, 19(1), 46-52.
Rayssiguier, Y. (1984). Role of magnesium and potassium in the pathogenesis of arteriosclerosis. Magensium, 3, 4-6.
Rosanoff, A. & Seelig, M. S. (2004). Comparison of mechanism and functional effects of magnesium and statin pharmaceuticals. Journal of American College of Nutrition, 23(5), 501-505.
Sahmoun, A. E., & Singh, B. B. (2010). Does a higher ratio of serum calcium to magnesium increase the risk for postmenopausal breast cancer? Medical Hypotehses, 75(3), 315-318.
Schwalfenberg, G. & Genuis, S. J. (2017). The importance of magnesium in clinical healthcare. Hindawi Scientifica.
Sheehan, J. P. (1991). Magnesium deficiency and diabetes mellitus. Magnesium & Trace Elements, 10(2), 215-219.
Starobrat-Hermelin, B. & Kozielec, T. (1997). The effects of magnesium physiological supplementation on hyperactivity in children with Attention Deficit Hyperactivity (ADHD). Positive response to magnesium oral loading test. Magnesium Research, 10(2), 149-156.
Veronese, N., Watutantrige-Fernando, S., & Luchini, C. (2016). Effect of magnesium supplementation on glucose metabolism in people with or at risk of diabetes: a systematic review and meta-analysis of double-blind randomized controlled trials. European Journal of Clinical Nutrition, 70(12).
Wark, P. A., Lau, R., Norat, T., & Kampman, E. (2012). Magnesium intake and colorectal tumor risk: a case-control study and meta-analysis. The American Journal of Clinical Nutrition, 96(3), 622-631.
Weston, P. G. (1922). Magnesium as a sedative. The American Journal of Psychiatry, 78(4), 218-223.
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