Accurate Education – Magnesium

Vitamins & Minerals:

Magnesium

 

See also:

• Integrative, Complimentary and Alternative Medicine
• CAM – Depression
• Antioxidants

• NRF2 Activators
• Mitochondrial Dysfunction
• Minerals
• Vitamins

 

Individual Vitamins & Minerals:

• Vitamin B-12
• Vitamin D
• Vitamin D and Pain
• Calcium
• Zinc

 

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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.  

For a recent summary review of magnesium (9/28/25), including overviews  of it’s role in chronic pain and in muscle cramps, including a review of conditions associated with low magnesium, information regarding measurement of blood levels of magnesium, treatment options and other information. This is a recent AI compilation of information and so may have errors. The document does include extensive list of references for the readers review.

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 maintaining chronic pain, transitioning from acute to chronic pain and vulnerability to developing Type 2 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.  

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.

 

CLINICAL PEARLS

1. Magnesium deficiency is common in chronic pain: Up to 50% of chronic pain patients may have suboptimal magnesium status; consider screening[1][2]

2. Serum magnesium is insensitive: Only 1% of total body magnesium is in serum; normal serum levels don’t exclude deficiency

• Better tests: RBC magnesium, ionized magnesium (not widely available)
• Clinical approach: Trial of supplementation reasonable even with normal serum levels

3. Strongest evidence for migraine: Magnesium has Level B evidence for migraine prevention; should be first-line nutraceutical for migraine[3][4]

4. Combination therapy for migraine: Magnesium + riboflavin (400 mg/day) + CoQ10 (100-300 mg/day) highly effective for migraine prevention

5. Formulation matters: Bioavailability varies dramatically; glycinate, citrate, malate, and threonate preferred over oxide

6. Divide doses for tolerability: Taking 200-300 mg 2-3 times daily reduces GI side effects compared to single large dose

7. Diarrhea is dose-limiting: If diarrhea occurs, reduce dose or switch to better-absorbed formulation (glycinate)

8. Time to effect:

• Acute effects (muscle relaxation): May occur within hours to days
• Chronic pain conditions: Typically require 8-12 weeks for meaningful benefit                                                                                                          

9. Correct vitamin D deficiency concurrently: Magnesium and vitamin D deficiencies often coexist; both required for optimal musculoskeletal health

10. PPI (Nexium,Prilosec) users need more magnesium: Chronic PPI use reduces magnesium absorption; higher doses or monitoring needed

11. Diuretic users often deficient: Loop and thiazide diuretics increase magnesium excretion; supplementation often beneficial

12. Renal function is key safety consideration: Magnesium safe in normal renal function; use caution in GFR <60, avoid in GFR <30

13. Separate from key medications: Take 2-4 hours apart from bisphosphonates, fluoroquinolones, tetracyclines, levothyroxine

14. Magnesium glycinate for sleep: Glycine has calming effects; magnesium glycinate taken at bedtime may improve sleep quality

15. Topical magnesium has limited evidence: Epsom salt baths and magnesium oil popular but weak evidence for systemic absorption; not substitute for oral supplementation

16. Safe in pregnancy: Magnesium safe and often beneficial during pregnancy; may help with leg cramps and preeclampsia prevention

17. Excellent safety profile: One of the safest nutraceuticals; serious adverse effects extremely rare with oral supplementation

18. Low cost, high value: Magnesium is very affordable ($10-25/month for most formulations); excellent cost-effectiveness

19. NMDA antagonism is key for pain: Magnesium’s voltage-dependent NMDA receptor blockade reduces central sensitization and wind-up[5][2]

20. Consider in opioid-tolerant patients: NMDA antagonism may reduce opioid tolerance and enhance opioid analgesia (preclinical evidence; limited clinical data)

 

 

Magnesium Supplementation and Pain

There is growing evidence identifying benefits for supplementing with magnesium although much of the evidence remains moderate to weak.

Levels of Evidence:

• Postoperative pain (adjunct) – Grade B (moderate evidence)
• Migraine prophylaxis – Grade B (moderate evidence)
• Neuropathic pain (diabetic neuropathy, chronic low back pain with neuropathic component) – Grade C (emerging evidence)
• Fibromyalgia – Grade C (emerging evidence)
• Central sensitization – Grade C (limited evidence)
• Acute migraine attacks – Grade C (limited evidence)

PAIN PROCESSING BENEFITS

As noted above, magnesium plays important roles in the processing and manifesting of pain and research suggests that magnesium:

• Reduces systemic inflammation
• Reduces neuroinflammation
• Reduces oxidative stress
• Improves mitochondrial function
• Prevents central sensitization
• Reduces preexisting pain hypersensitivity

 

CLINICAL BENEFITS

1. Muscle relaxation: Magnesium reduces muscle contraction and spasm

2. Migraine Prevention:Reduction in migraine frequency, severity AND duration

• Particularly effective in menstrual migraine and migraine with aura

3. Fibromyalgia: Reduces pain sensitivity, depression

4. Postoperative Pain: Reduced postoperative pain and opioid consumption

• Typically 30-50 mg/kg IV bolus followed by infusion –
• Note: IV magnesium data may not directly translate to oral supplementation

5. Chronic Pain )General) Limited evidence,

• Magnesium deficiency is common with chronic pain.
• Patients with low magnesium levels respond better to magnesium replacement.

Conclusion: Magnesium supplementation may be recommended for chronic pain, especially with documented deficiency. Serum blood levels may not accurately identify total body deficiency nor necessarily identify those who may benefit with magnesium supplementation.

Magnesium is critical for maintaining normal pain processing – it has been shown to reduce systemic inflammation, neuroinflammation, oxidative stress, as well as to improve mitochondria function AND to reduce pre-existing pain hypersensitivity to help prevent central sensitization. Supplementation with magnesium is recommended.

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 DOSING

Elemental Magnesium Content:

When oral magnesium supplementation is recommended at doses such as 250 to 500 mg per day, this refers to elemental magnesium, not the total weight of the magnesium salt compound.

Product Label Reading:

• Look for “elemental magnesium” on the label
• Serving size may contain multiple capsules/tablets
• Check for third-party testing (USP, NSF, ConsumerLab)

When selecting a product, read the elemental magnesium content, not just the total weight of the magnesium compound:

• Example: 500 mg magnesium glycinate contains only ~70 mg elemental magnesium (14%)
• Example: 500 mg magnesium oxide contains ~300 mg elemental magnesium (60%), but only ~4% is absorbed

Net absorption:

• Magnesium glycinate 500 mg: ~70 mg elemental × ~80% absorbed = ~56 mg absorbed
• Magnesium oxide 500 mg: ~300 mg elemental × ~4% absorbed = ~12 mg absorbed

Conclusion: Higher bioavailability forms deliver more magnesium despite lower elemental content

Supplementing Magnesium by Condition

1. Migraine Prevention:

• Recommended dose: 400-600 mg/day elemental magnesium
• Formulation: Magnesium oxide, citrate, or glycinate
• Duration: Minimum 12 weeks for full effect; continue if beneficial
• Timing: Can be taken once daily or divided into 2 doses
• Evidence-based dose from clinical trials[1][3]

2. Fibromyalgia:

• Recommended dose: 300-400 mg/day elemental magnesium
• Formulation: Magnesium citrate preferred (used in RCT)[4]
• Duration: Minimum 8 weeks; continue long-term if beneficial
• Combination: May be combined with standard fibromyalgia medications

3. Chronic Pain (General):

• Standard dose: 300-500 mg/day elemental magnesium
• Higher dose: Up to 600 mg/day for refractory conditions
• Duration: 8-12 weeks minimum trial

4. Neuropathic Pain:

• Suggested dose: 400-600 mg/day elemental magnesium
• Duration: 8-12 weeks minimum
• Note: Limited clinical data; dose extrapolated from other pain conditions

5. Muscle Pain/Spasm:

• Dose: 300-500 mg/day elemental magnesium
• Timing: Evening dose may help with nighttime muscle cramps

6. General Health/Deficiency Prevention:

RDA (Recommended Dietary Allowance):

• Men: 400-420 mg/day
• Women: 310-320 mg/day
• Supplementation dose: 200-400 mg/day if dietary intake inadequate

Upper Limit (UL):

• UL for supplemental magnesium: 350 mg/day (from supplements only; does not include dietary magnesium)

Note: Many therapeutic doses (400-600 mg/day) exceed UL but are generally safe

• Primary risk at high doses: Diarrhea (dose-limiting side effect)
• Serious toxicity rare with oral supplementation in individuals with normal kidney function

Timing and Administration:

• Once daily: Can take full dose at bedtime (may improve sleep)
• Divided doses: Split into 2 doses (morning and evening) to reduce GI side effects
• With or without food:

1. 1. Taking with food may reduce GI upset
   2. Some forms (citrate, glycinate) better tolerated on empty stomach

• Avoid with high-fiber meals: Fiber may reduce magnesium absorption
• Separate from certain medications: Take 2-4 hours apart from bisphosphonates and  antibiotics (tetracyclines, fluoroquinolones/Cipro)

Dose Titration:

• Start low: Begin with 200-300 mg/day
• Increase gradually: Increase by 100 mg every 3-7 days as tolerated
• –arget dose: 400-600 mg/day for most chronic pain conditions
• Adjust based on GI tolerance: If diarrhea occurs, reduce dose or switch formulation

Duration of Treatment:

• Minimum trial: 8-12 weeks to assess efficacy
• Long-term use: Safe for chronic supplementation (months to years)
• Reassess periodically: Check serum magnesium levels if long-term high-dose supplementation

ESTIMATED COSTS

Magnesium is very affordable; cost varies by formulation:

1. Magnesium Oxide:

• Cost: $5-10/month
• Dose: 400-500 mg/day elemental magnesium
• Note: Least expensive but poorest absorption

2. Magnesium Citrate:

• Cost: $10-15/month
• –ose: 300-400 mg/day elemental magnesium
• Note: Good balance of cost and absorption

3. Magnesium Glycinate:

• Cost: $15-25/month
• Dose: 300-400 mg/day elemental magnesium
• Note: Best absorption and tolerability; worth the extra cost for most patients

4. Magnesium Malate:

• Cost: $15-20/month
• Dose: 300-400 mg/day elemental magnesium
• Note: Good value for fibromyalgia patients

5. Magnesium Taurate:

• Cost: $20-30/month
• Dose: 300-400 mg/day elemental magnesium
• Note: More expensive; consider for cardiovascular comorbidities

6. Magnesium L-Threonate:

• Cost: $35-50/month
• Dose: 1500-2000 mg/day magnesium L-threonate (provides ~140-190 mg elemental magnesium)
• Note: Most expensive; reserve for central pain mechanisms and cognitive support

Cost-Effectiveness:

• Best value: Magnesium citrate or glycinate
• Budget option: Magnesium oxide (if tolerated)
• Premium option: Magnesium L-threonate (for specific indications)

Insurance Coverage:

• Generally NOT covered by insurance (over-the-counter supplement)

 SYNERGIES WITH OTHER NUTRACEUTICALS

Magnesium works synergistically with several other nutraceuticals for chronic pain management:

1. Vitamin D – Synergy: High

Mechanism:

• Magnesium required for vitamin D metabolism (conversion to active form)
• Vitamin D enhances magnesium absorption
• Both important for musculoskeletal health and pain modulation
• Evidence: Combined deficiency common; correcting both improves outcomes in chronic pain, fibromyalgia, musculoskeletal pain

Recommendation: Strongly consider combining; check and correct both deficiencies

2. Vitamin B6 (Pyridoxine) – Synergy: Moderate to High

Mechanism:

• B6 enhances magnesium absorption and cellular uptake
• B6 required for magnesium-dependent enzymatic reactions
• Both support neurotransmitter synthesis
• Evidence: Combination used for PMS, stress, anxiety; may enhance pain benefits
• Dose: 50-100 mg/day vitamin B6 with magnesium

Recommendation: Consider combining, especially for neuropathic pain and stress-related pain

3. Coenzyme Q10 (CoQ10) – Synergy: Moderate to High

Mechanism:

• Both support mitochondrial function and ATP production
• Magnesium required for ATP synthesis; CoQ10 supports electron transport chain
• Both have anti-inflammatory and neuroprotective effects
• Evidence: Combination beneficial for migraine prevention, fibromyalgia, mitochondrial dysfunction

Recommendation: Excellent combination for migraine and fibromyalgia

4. Omega-3 Fatty Acids – Synergy: Moderate

Mechanism:

• Complementary anti-inflammatory mechanisms
• Magnesium modulates inflammatory pathways; omega-3s provide anti-inflammatory lipid mediators
• Both support neuronal health
• Evidence: Both independently effective for chronic pain; combination may enhance anti-inflammatory effects

Recommendation: Safe and rational to combine

5. Curcumin – Synergy: Moderate

Mechanism:

• Complementary anti-inflammatory and antioxidant effects
• Magnesium modulates NMDA receptors; curcumin inhibits NF-κB and inflammatory cytokines
• Evidence: Both effective for inflammatory pain; combination may provide additive benefit

Recommendation: Safe to combine

6. Alpha-Lipoic Acid (ALA) – Synergy: Moderate

Mechanism:

• Both support mitochondrial function and reduce oxidative stress
• Complementary antioxidant mechanisms
• Evidence: Both beneficial for neuropathic pain; combination may enhance neuroprotection

Recommendation: Rational combination for neuropathic pain

7. N-Acetylcysteine (NAC) –  Synergy: Moderate

Mechanism:

• Both reduce oxidative stress and neuroinflammation
• Magnesium modulates NMDA receptors; NAC activates mGlu2/3 receptors
• Complementary glutamatergic modulation
• Evidence: Both target central sensitization; combination may enhance glutamate modulation

Recommendation: Rational combination for neuropathic pain and central sensitization

8. Melatonin – Synergy: Moderate to High  for sleep and pain

Mechanism:

• Magnesium (especially glycinate) promotes sleep; melatonin regulates sleep-wake cycle
• Both have neuroprotective and anti-inflammatory effects
• Evidence: Combination may improve sleep quality in chronic pain patients; better sleep reduces pain

Recommendation: Excellent combination for patients with pain and sleep disturbance

9. Riboflavin (Vitamin B2) –  Synergy: High for migraine

Mechanism:

• Both effective for migraine prevention
• Riboflavin supports mitochondrial function; magnesium supports ATP synthesis
• Evidence: Combination (magnesium + riboflavin + CoQ10) highly effective for migraine prevention
• Dose: Riboflavin 400 mg/day + magnesium 400-600 mg/day + CoQ10 100-300 mg/day

Recommendation: Strongly recommend combination for migraine prevention

10. Taurine – Synergy: Moderate

Mechanism:

• Both modulate NMDA receptors and reduce excitotoxicity
• Both support mitochondrial function
• Magnesium taurate combines both
• Evidence: Limited direct evidence but complementary mechanisms

Recommendation: Consider magnesium taurate formulation for combined benefit

SAFETY AND ADVERSE EFFECTS

Magnesium supplementation is generally very safe, with the primary side effect being diarrhea (dose-limiting):[1][2]

Common Adverse Effects:

1. Diarrhea (most common):

• Dose-dependent; occurs when magnesium exceeds intestinal absorption capacity
• More common with poorly absorbed forms (oxide, sulfate, carbonate)Less common with well-absorbed forms (glycinate, malate, threonate)

Management: Reduce dose, divide doses, switch to better-absorbed formulation

2. Abdominal cramping:

• Often accompanies diarrhea
• Usually mild and transient

3. Nausea:

• Uncommon; may occur with high doses or on empty stomach
• Taking with food usually resolves

4. Bloating/gas:

• Occasional; usually mild

5. Uncommon Adverse Effects:

• Fatigue/lethargy: Rare; may occur with very high doses
• Muscle weakness: Rare; associated with hypermagnesemia
• Hypotension: Rare with oral supplementation; more common with IV magnesium

Serious Adverse Effects (Hypermagnesemia):

Hypermagnesemia (elevated serum magnesium) is rare with oral supplementation in individuals with normal renal function, but can occur with:

• Renal impairment (primary risk factor)
• Very high doses (>5000 mg/day elemental magnesium)
• Concurrent use of magnesium-containing antacids or laxatives

Symptoms of hypermagnesemia (serum Mg >2.5 mEq/L):

1. Mild (2.5-4 mEq/L):

• Nausea, vomiting
• Flushing, warmth
• Hypotension
• Bradycardia

2. Moderate (4-6 mEq/L):

• Decreased deep tendon reflexes
• Drowsiness, lethargy
• Muscle weakness
• ECG changes (prolonged PR interval, widened QRS)

3. Severe (>6 mEq/L):

• Respiratory depression
• Complete heart block
• Cardiac arrest
• Coma
• Treatment: Discontinue magnesium; IV calcium gluconate (antagonizes magnesium); dialysis if severe and renal impairment present

Long-Term Safety:

Safe for chronic use at recommended doses (300-600 mg/day)

• No evidence of tolerance or dependence
• No withdrawal symptoms upon discontinuation
• Monitor in renal impairment: Check serum magnesium levels periodically

Contraindications:

• Severe renal impairment (GFR <30 mL/min): High risk of hypermagnesemia; avoid or use very low doses with close monitoring
• Myasthenia gravis: Magnesium may worsen muscle weakness (theoretical; limited clinical data)
• Heart block or severe bradycardia: Magnesium may worsen conduction abnormalities
• Known hypersensitivity to magnesium (extremely rare)

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 – Topically Applied

Topically applied formulations are available commercially but research suggests that magnesium is not well absorbed through the skin

 

Epsom Salts: Another Alternative

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 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.

Current Evidence & Proposed Benefits:

Mechanisms of Action (relevant to Pain):

NMDA Receptor Antagonism: Magnesium blocks the NMDA receptor, a key player in central sensitization and chronic pain pathways. (However, achieving sufficient CNS concentrations via inhalation for significant NMDA blockade in pain pathways is unproven.

Calcium Channel Blockade: Modulates calcium influx, potentially affecting neurotransmitter release, muscle contraction, and pain receptor (nociceptor) excitability.

Anti-Inflammatory Effects: Mg may reduce pro-inflammatory cytokine release (e.g., TNF-α, IL-6) and substance P.

Muscle Relaxation: Smooth muscle relaxation in airways is well-established; but the potential for skeletal muscle relaxation systemically is limited to oral supplementation.

 

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.

References

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2. Overview on the Effects of -Acetylcysteine in Neurodegenerative Diseases. Tardiolo G, Bramanti P, Mazzon E. Molecules (Basel, Switzerland). 2018;23(12):E3305. doi:10.3390/molecules23123305.
3. The Mechanism of Action of N-Acetylcysteine (NAC): The Emerging Role of HS and Sulfane Sulfur Species. Pedre B, Barayeu U, Ezeriņa D, Dick TP. Pharmacology & Therapeutics. 2021;228:107916. doi:10.1016/j.pharmthera.2021.107916.
4. N-Acetylcysteine and Its Immunomodulatory Properties in Humans and Domesticated Animals. Tieu S, Charchoglyan A, Paulsen L, et al. Antioxidants (Basel, Switzerland). 2023;12(10):1867. doi:10.3390/antiox12101867.
5. N-Acetyl-Cysteine Attenuates Neuropathic Pain by Suppressing Matrix Metalloproteinases. Li J, Xu L, Deng X, et al. Pain. 2016;157(8):1711-1723. doi:10.1097/j.pain.0000000000000575.
6. N-Acetyl-Cysteine Causes Analgesia by Reinforcing the Endogenous Activation of Type-2 Metabotropic Glutamate Receptors. Bernabucci M, Notartomaso S, Zappulla C, et al. Molecular Pain. 2012;8:77. doi:10.1186/1744-8069-8-77.
7. N-Acetyl-Cysteine, a Drug That Enhances the Endogenous Activation of Group-Ii Metabotropic Glutamate Receptors, Inhibits Nociceptive Transmission in Humans. Truini A, Piroso S, Pasquale E, et al. Molecular Pain. 2015;11:14. doi:10.1186/s12990-015-0009-2.
8. The Neuroprotective Effects of N-Acetylcysteine in Psychiatric and Neurodegenerative Disorders: From Modulation of Glutamatergic Transmission to Restoration of Synaptic Plasticity. Chakraborty S, Shankaranarayana Rao BS, Tripathi SJ. Neuropharmacology. 2025;278:110527. doi:10.1016/j.neuropharm.2025.110527.
9. N-Acetylcysteine Antagonizes NGF Activation of TrkA Through Disulfide Bridge Interaction, an Effect Which May Contribute to Its Analgesic Activity. Govoni S, Fantucci P, Marchesi N, et al. International Journal of Molecular Sciences. 2023;25(1):206. doi:10.3390/ijms25010206.
10. Effect of N-Acetylcysteine on the Spinal-Cord Glutathione System and Nitric-Oxide Metabolites in Rats With Neuropathic Pain. Horst A, Kolberg C, Moraes MS, et al. Neuroscience Letters. 2014;569:163-8. doi:10.1016/j.neulet.2014.03.063.
11. Effects of N-Acetylcysteine on Spinal Cord Oxidative Stress Biomarkers in Rats With Neuropathic Pain. Horst A, de Souza JA, Santos MCQ, et al. Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas. 2017;50(12):e6533. doi:10.1590/1414-431X20176533.

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 – Treatises Based on AI

Efficacy and Indications for Oral Magnesium in Muscle Spasms OE 9:2025

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

 

Emphasis on Education

 

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.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

Supplements recommended by Dr. Ehlenberger may be purchased commercially online or at Accurate Clinic.

Please read about our statement regarding the sale of products recommended by Dr. Ehlenberger.

Accurate Supplement Prices

 

 

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