Magnesium

 

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Magnesium

Magnesium is an important part of the more than 300 enzymes found in your body. Enzymes are body chemicals that helps regulate many bodily functions, including the production of energy, body protein and muscle contractions.  

Do you need to take magnesium?

Although magnesium can be easily obtained through the diet and overt magnesium deficiency is uncommon, nearly half the U.S. population does not get adequate or optimal amounts of magnesium in their diet.In other words nearly half of the U.S. would benefit from increasing magnesium intake from food or supplements Age groups most likely to not get adequate magnesium are adolescents and those over age 70.

Common conditions likely to be associated with sub-optimal or inadequate magnesium

    • Diabetes
    • Cirrhosis / severe liver disease
    • Fibromyalgia
    • Migraine headaches
    • Osteoporosis
    • Gastrointestinal diseases: Inflammatory Bowel Disease (IBD)  – Crohns, Ulcerative Colitis
    • Use of Medications that decrease magnesium levels: methadone, antacids, proton pump inhibitors (Prilosec, Nexium), statins, diuretics, glucocorticoids (prednisone, cortisone etc.), birth control pill

 

The Impact of Magnesium Deficiency (MgD)

Early symptoms of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. Magnesium deficiency (MgD) impacts numerous biological processes at the cellular and molecular levels. Most importantly, magnesium  plays an important role in the highly recommended  anti-inflammatory diet, which is directed at reducing both systemic inflammation and oxidative stress. These two conditions are the driving forces behind transitioning from acute to chronic pain, maintaining chronic pain, vulnerability to developing type two diabetes, heart, disease, and stroke. This is especially important and relevant to the reader, since most people with chronic pain have abnormally high levels of systemic inflammation, and oxidative stress. and in context, since the diets of 4 out of 5 people may be sub-optimal in magnesium. Getting enough magnesium is important!

Additionally, these 2 conditions also drive a common feature of chronic pain known as central sensitization. Central sensitization is a process in which nerve cells throughout the nervous system and pain centers in the brain become hypersensitive to signals coming from pain reeeptors which leads to a magnification of the pain experience for that person. This means that an individual with chronic pain who develops sensitization continues to experience pain more severely over time. Additionally, the sensitization to pain also spreads to sensation to other noxious stimuli, leading to greater intolerance of heat, cold, weather change, as well as anxiety and stress has other organ systems also become involved.

There is also research suggesting that in addition to slowing the development of central sensitization, magnesium functions as an NMDA antagonist, so it may be helpful in treating nerve pain and reducing the development of analgesic tolerance to opioids.

See Neuropathic (nerve) Pain

 

Health Benefits of Magnesium

There are many health benefits associated with magnesium. It plays a role in maintaining a healthy heart and healthy bones. In fact, without adequate Magnesium, Calcium cannot be incorporated into bone as effectively. 

  1. Magnesium has been shown to be effective in reducing arthritis pain, muscle pain and muscle cramps.
  2. Magnesium is an effective laxative and antacid.
  3. Magnesium has an excellent record for reducing frequency and severity of migraine headaches. Magnesium’s  anti-migraine activity acts by inhibiting the activation of NMDA receptor, CGRP release. The effectiveness of CGRP inhibitor drugs such as Nurtec and Ubrelvy for migraine may be reduced in those who are magnesium deficient.
  4. Reduces pain of fibromyalgia
  5. Adequate intake of magnesium (from the diet and/or supplements) may optimize cognitive function and reduce the risk of developing dementia, although getting too much is not beneficial. Those with low blood levels of magnesium  (<1.9 mg/dL or <0.79 mmol/L ) may be 30% more likely to develop dementia (predominately Alzheimer’s disease).
  6. Magnesium may improve sleep, possibly by increasing melatonin production.
  7. Magnesium may improve menstrual pain
  8. Magnesium is purported to improve anxiety but studies have not confirmed this.
  9. Magnesium  may help depression. Some observational studies have found that low blood levels of magnesium and low magnesium intake from food are each associated with an increased risk of depression. Supplementing depressed individuals with magnesium has shown some promise in preliminary studies.
  10. Magnesium is important in cardiovascular health and  helps control high blood pressure
  11. Magnesium may also improve glucose status in people with prediabetes — especially if they are low in magnesium.
  12. Magnesium is required for the conversion of vitamin D into the active form and magnesium supplementation may improve vitamin D levels.
  13. Low dietary intake of Magnesium is associated with elevated CRP levels, a biomarker for systemic inflammation.
  14. Magnesium may help prevent calcium-oxalate kidney stones if taken with meals that contain oxalate, by binding oxalate so that it is excreted rather than absorbed. Oxalates are found in many vegetables and plant-based foods, as well as in eggs and dairy products. Larger, longer-term studies are needed to determine if regular magnesium supplementation prevents calcium-oxalate kidney stones in people prone to this type of kidney stone.
  15. Magnesium Sulfate (MgSO4), given intravenously, reduces post-operative pain and allow for reduced dosing of opioids.  MgSO4 appears to increase the analgesic potency of morphine.
  16. Despite claims that supplementing with magnesium may reduce leg cramps, research has generally not found magnesium to reduce the frequency, intensity or duration of leg cramps or nighttime leg cramps, regardless of the form of magnesium (e.g., aspartate,bisglycinate, citrate, hydroxide, lactate, or oxide) or dosage.

 

Magnesium Needs
Recent studies show that 70-80% of Americans diets may be deficient in magnesium. The average person needs to consume between 300 and 400 milligrams of magnesium a day. As per the United States Food and Nutrition, Recommended Daily Allowance (RDA) of magnesium is 420 mg for males and 320 mg for females. Around 10% of it is obtained through drinking water. Other sources of magnesium include green vegetables, unprocessed cereals, nuts, seeds, fish, meat, and milk products.

Most people who pay attention can get their daily recommended magnesium (300 to 400 mg) from their diet. Therefore, it is recommended that one simply turned to specific foods (see below) to supplement their magnesium intake when they need for increase.However, if one is not getting at least 300 to 400 mg of magnesium from diet, a supplement should be considered.

Supplementing with about 200 mg/day should generally be sufficient and safe since one should easily get the rest of their required magnesium from their diet. Ideally, one can determine their magnesium needs based on blood tests.

Supplementing guided by blood test (red blood cell levels):

Red blood cell magnesium concentration is the best marker for magnesium deficiency status. Serum magnesium level is less likely related with body magnesium content because it represent only 0.3% of total body content.

Normal red blood cell (RBC) magnesium level typically ranges between 4.2 and 6.8 mg/dL (or 1.73–2.79 mmol/L)

When treating known deficiency, magnesium is often recommended at doses of 250 to 600 mg daily. However, unless treating a deficiency, limit daily intake of magnesium from supplements and fortified foods to no more than 350 mg to avoid side-effects.

Some studies evaluating supplemental Mg for specific therapeutic benefits  – for example, migraine headaches – may include doses that range from 300 mg daily (as magnesium citrate and oxide) to 600 mg/day in divided doses, of magnesium citrate or trimagnesium dicitrate. 

Side-effects of Magnesium Supplements

Magnesium supplements may upset the stomach and cause nausea or diarrhea. If one uses a powder form of magnesium, be sure to completely dissolve the powder in water before taking it to avoid injury to the esophagus. Although rare, excessive intake of magnesium can cause thirst, low blood pressure, drowsiness, muscle weakness and slowed breathing. Be aware that magnesium can interact with many supplements and drugs including cholesterol-lowering statins, such as rosuvastatin, antibiotics, sotalol, gabapentin, levothyroxine, and triamterene.

 

Recommended Supplement Forms

How forms of magnesium differ

It is important to read product labels as they are required to show the amount of elemental magnesium in each serving, but one need to read labels carefully. Magnesium comes in many forms and liquid forms rather than tablets are preferred, as tablets tends to attract and hold water causing them to disintegrate and create problems with storage.  Forms that are more water soluble, such as magnesium chloride, magnesium citrate and many chelate forms (e.g., bisglycinate), may be better absorbed.

In people with Crohn’s disease, magnesium supplementation should be considered during bouts of severe diarrhea — the form of magnesium should be one that is not likely to have a laxative effect and sipping an oral rehydration formula containing magnesium throughout the day may be better tolerated than taking a large dose of magnesium.

Magnesium chloride is less likely to cause diarrhea and is recommended if one is taking a higher dose. Some magnesium chelates are also less likely to cause diarrhea but are bulky, requiring larger pills to get the same amount of elemental magnesium.

Magnesium oxide and magnesium citrate are good for their whole-body health benefits, especially bone and cardiovascular health. Magnesium oxide tends to be less expensive than other forms but may also be less well absorbed and more likely to cause diarrhea

Magnesium Glycinate/Bisglycinate: Well-tolerated, gentle on the digestive system, they may be beneficial for relaxation, sleep, and muscle function. They may be a good option for people who require higher doses of magnesium or experience side effects with other forms. 

Magnesium acetyl taurinate is primarily used for stress management. 

Magnesium threonate (MgT) is a newer formulation of magnesium that is purported to have superior brain bioavailability due to enhanced delivery of magnesium through the blood-brain barrier into nerve cells so MgT may provide the most benefit for brain health.  It is purported to increase neural plasticity, improve sleep, memory and cognition as well as reduce anxiety and stress, although there appears to be limited reliable human clinical evidence to suggest that any particular form of magnesium is better than others at crossing the human blood-brain barrier to enter the brain (although some forms of magnesium are better absorbed than others from the gut).

A double-blind, placebo-controlled study published in 2022 evaluating MGT in group of healthy Chinese adults did conclude tha MgT is well tolerated and safe. Their data supported the benefits of MgT for improving learning, recall, memory and cognitive abilities among all ages, with older people demonstrating the most improvement. Their findings support cognitive function as well as other benefits in all age groups, especially older adults. It should be noted, however, that this study appears to have been funded by the manufacturers of their commercial MGgproduct, Magtein®PS.

MgT may also reduce neuropathic pain by reducing TNF-a production and by correcting the NMDA receptor dysfunction.

Magnesium threonate  for Sleep

A MgT supplement,  Magtein®, is a brain-bioavailable magnesium L-threonate, made by Threotech. that contains about 75 mg/g of elemental magnesium. A 2024 study in which participants took 500mg 2x/day demonstrated significantly improved sleep and daytime function compared to placebo. Additionally, MgT also significantly reduced grouchiness and improved mood and mental alertness. MgT was well tolerated with no report of major side effects.

 

Suggested recommendations for branded magnesium supplements

Based on one review only, for magnesium only: NOW (Mg Citrate) and Deva Vegan (Mg Glycinate) are recommended.  NOW is much less expensive than Deva and is therefore recommended when taking less than 350 mg magnesium/day. However, since the Mg Citrate form is more likely to give laxative side effects at higher doses (>350 mg/day), Deva Vegan is recommended which, due to its glycinate (as bisglycinate) form, is less likely to cause a laxative effect at a high dosage.

Another form of magnesium that is less likely to have a laxative effect when taking more than 350 mg of magnesium is the liquid form of Mg chloride (Mg chloride tablets can absorb water from the air and may decompose during storage).

 

Foods Rich in Magnesium

Dark green leafy vegetables, fish, bran, whole grains, legumes, beans, seeds and nuts (especially almonds). Fresh fruits and vegetables also provide a modest amount of magnesium.

  • Chia seed: 1 tablespoon 24 mg of magnesium, 2400 mg omega-3,  800 mg omega-6
  • Black seeds: 1 tablespoon 40 mg magnesium 2350 mg omega-3,  600 mg omega-6
  • Fresh spinac:h  one cup 24 mg magnesium
  • Salmon fillet: 26 mg magnesium 1500 mg omega-3,  200mg omega-6
  • Medium sweet potato: 300 mg magnesium
  • Pumpkin seeds: one handful 150 mg magnesium, 50 mg Omega-3, 6000 mg, Omega-6

 

Coconut Water

First, coconut water is not the same thing as coconut milk.
Coconut milk is creamy and comes from coconut meat, while coconut water is the liquid from young green coconuts. Coconut water is low-fat, with one-half gram of fat in one cup, and a good source of fiber, magnesium, potassium and vitamin C. The sodium content of coconut water can be high, so make sure to check the label.

Quinoa

Quinoa (pronounced KEEN-wah) is a grain native to South America. Although it is somewhat similar to other grains, it cooks faster, is higher in protein and is a good source of iron and magnesium. Since it has more protein than other grains, it is a great choice for vegetarians. The flavor of quinoa is bland so it can be used in soups or salads or on its own as a side dish. This grain can also be a great substitute for any dish that calls for rice.

Bananas

Everyone thinks of potassium when they think of bananas, but bananas also contain a significant amount of vitamin C, B6, folate, magnesium, iron and copper. A medium banana, seven to eight inches long, has 105 calories and three grams of fiber with 27 grams of carbohydrates.

Dried Figs are a good source of potassium and calcium and contain iron and magnesium.
Artichokes are high in potassium, low in calories, fat-free and contain some folate, magnesium, fiber and vitamin C.

 Other sources of magnesium:

Magnesium Supplements – Oral

Based on their absorption rates, the best forms to supplement with include chelated magnesium or magnesium glycinate, citrate and ascorbate. How much magnesium to supplement with will depend on individual needs. Oral magnesium can be taken up to bowel tolerance – meaning until you experience loose stool. The amount it takes to get there can vary significantly from person to person. If you experience loose stool, reduce your dosage.

Another way to supplement with magnesium is by absorbing it through the skin using a topical cream compounded by a pharmacist under the guidance of your physician or by bathing with epsom salts in your bath water. There is some controversy as to how well magnesium is absorbed topically so at this time oral magnesium replacement is preferred to maintain blood levels but supplementing with topical magnesium is warranted.

 

Magnesium Supplements – Topically Applied

Topically applied formulations are available commercially including MagneGel™ (Designs for Health), a transdermal magnesium gel available through the Accurate Clinic’s Supplement Store. Magnesium is generally believed to be well absorbed through the skin with the use of topical preparations and should be considered for use by those sensitive to the laxative effects of oral magnesium. Current research however suggests that magnesium is NOT absorbed through the skin when topically applied.

 

Epsom Salts: Another Alternative

Question: How is it possible to get any benefit from Epsom Salt (Magnesium Sulfate) just from soaking in it? Answer: Magnesium and sulfates can be ingested from foods or mineral supplements, but both substances are readily absorbed through the skin.

Question: Is all Epsom Salt the same?
Answer: While there are various ways of manufacturing and packaging Epsom Salt, chemically all Epsom Salt is the same. The Epsom salt you buy in a container at one grocery store or pharmacy is the same as what you would find at another grocery store or pharmacy.

Question: Why is Epsom Salt called Epsom Salt?
Answer: One of the earliest discoveries of magnesium sulfate, the scientific name of Epsom Salt, occurred back in Shakespeare’s day in Epsom, England, which explains the first half of the name. The term “salt” probably refers to the specific chemical structure of the compound, although many people mistakenly assume it refers to the crystalline structure of Epsom Salt, which has an appearance similar to that of table salt. (Table salt, of course, consists of sodium chloride, so it’s an entirely different substance than magnesium sulfate).

Question: How much Epsom Salt should I use in a bath and how often?
Answer: Add 1-2 cups (or up to 20 oz or 400-600 gms) into the bath while the tub is filling. If too much Epsom Salt is added, the water may become somewhat soapy in texture. Studies suggest that most people would find maximal benefit by bathing 2 or 3 times/ week.

Question: Does Epsom Salt dry your skin and leave a residue the way sea salt does?
Answer: No. In fact, Epsom Salt is widely reported to soften skin, and it rinses away completely. If needed, add 1 to 2 tablespoons glycerin to keep your skin from drying out (more for dry skin, less for oily skin), You can also add essential oils of choice for scent if desired.

Question: Is Epsom Salt safe to ingest?
Answer: Yes – in fact, Epsom Salt is an FDA-approved laxative when taken orally.

For Internal Use as a Laxative, dissolve the following doses in 1/2 glass water:
Adults 12 years or older – 1 to 2 teaspoons.
Children 6 to 12 years – 1/2 to 1 teaspoon.
Not recommended for children under 6.
Repeat in four hours if needed.
Limit two doses per day.
Lemon juice may be added to improve taste. Follow above directions only or as directed by a physician.

Question: Is it safe for pregnant women to use Epsom Salt?

Answer: Please consult with your obstetrician.

Question: Where can I buy Epsom Salt?
Answer: Most drug stores sell it in convenient, consumer-sized packages. Look for it where you find aspirin, Tylenol or Ace bandages (because it’s used as a treatment for muscle aches) or in the laxative section (magnesium sulfate is an effective, naturally occurring laxative).

Question: There are different kinds of Epsom Salt, some sold in supermarkets or pharmacies and some that’s agricultural or technical grade sold in hardware, co-op or farm stores. How do I know what’s safe for humans to use?

Answer: Any package that has a “drug facts” box or that’s labeled “USP” has been manufactured, tested and certified to meet stringent regulatory standards that are safe and acceptable for human use. That’s true for ingesting Epsom Salt or soaking in it. Consult the package for directions.

Question: Is it safe to put Epsom Salt in my hot tub?
Answer: Yes, it should be, but please consult with your local spa dealer to confirm whether it is safe to add Epsom Salt to your hot tub or whirlpool.

 

Magnesium – Inflammation and Oxidative Stress

Magnesium deficiency (MgD) impacts numerous biological processes at the cellular and molecular levels. MgD is accompanied by increased levels of oxidative stress biomarkers related to lipid, protein and DNA oxidation. MgD is associated with a weakened antioxidant defense related to inflammation and endothelial dysfunction, as well as changes at the cellular level, including mitochondrial dysfunction and excessive fatty acid production.

Inflammation is an important result of MgD. MgD stimulates the production of acute phase proteins (e.g., C-reactive protein) and sensitizes immuno-competent cells to proinflammatory stimuli cause an immune response that further lead to increased oxidative stress. This excessive amount of free radicals damages biomolecules, particularly components of lipoproteins in cell membranes and blood vessels. Treating MgD  promotes an anti-inflammatory response and decreased levels of proinflammatory markers.

MgD promotes hyper-triglyceridemia, in which these numerous, easily-oxidized lipoproteins enter the blood stream contributing to atheroscerosis. Additionally, MgD contributes to insulin resistance and the over- production of anti-insulin hormones (epinephrine and cortisol), contributing to increased blood sugars.

 

Resources:

  1. Consumerlab.com: This website appears to provide unbiased lab-based assessments of commercial products quality as well as providing excellent clinical information that appeaars well backed by documented medical journal articles.

 

MentalHealthDaily.com

  1. Magnesium Deficiency Symptoms, Causes, & Treatments (excellent review)

 

References:

Nutritional Supplements – Overview:

  1.    Evaluating Supplements
  2.    Multi-Nutrient Supplements

 

Magnesium

Magnesium – new articles

  1. ‘Magnesium’-the master cation-as a drug—possibilities and evidences – 2021
  2. Bioavailability: magnesium is not just magnesium Effect of transdermal magnesium cream on serum and urinary magnesium levels in humans – A pilot study – 2017
  3. Magnesium – Are We Consuming Enough? – 2018
  4. Magnesium and Pain – 2020
  5. Magnesium as an Alternative or Adjunct to Opioids for Migraine and Chronic Pain – A Review of the Clinical Effectiveness and Guidelines – 2017
  6. Magnesium basics – 2012
  7. Management of pain using magnesium sulphate a narrative review – PubMed – 2022
  8. Myth or Reality—Transdermal Magnesium? – 2017
  9. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis – 2018
  10. Unraveling the role of Mg in osteoarthritis – 2016
  11. Magnesium Deficiency Symptoms, Causes, & Treatments – MentalHealthDaily
  12. Magnesium – Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency – 2021
  13. Magnesium-L-threonate improves sleep quality and daytime functioning in adults with self-reported sleep problems_ A randomized controlled trial – 2024 A Magtein®, Magnesium L-Threonate, -Based Formula Improves Brain Cognitive Functions in Healthy Chinese Adults – 2022
  14. Magnesium deficiency and oxidative stress- an update – 2016

 

Magnesium –  Overview

  1. Magnesium — NIH Health Professional Fact Sheet
  2. Magnesium — NIH Consumer Fact Sheet
  3. Magnesium Metabolism and its Disorders
  4. Magnesium basics 2012
  5. Magnesium in Prevention and Therapy – 2015
  6. Essential elements in depression and anxiety_PartI – 2014
  7. Essential elements in depression and anxiety. Part II – 2015
  8. Myth or Reality—Transdermal Magnesium? – 2017
  9. Magnesium-and-Ehlers-Danlos-Syndrome Part 1 – 2013
  10. Magnesium-and-Ehlers-Danlos-Syndrome Part 2 – 2013

 

Magnesium –  Anxiety

  1. The effects of magnesium supplementation on subjective anxiety – 2016.
  2. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress—A Systematic Review – 2017

 

Magnesium –  Depression

  1. Essential elements in depression and anxiety_PartI – 2014

 

Magnesium –  Fibromyalgia

  1. The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia. – PubMed – NCBI

 

Minerals

  1.    Calcium

 

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Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

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