Magnificent Magnesium: Benefits, Form and Uses

Practically every day in practice during the history-taking, a patient will report any one of a variety of symptoms associated with magnesium deficiency.  “I am constipated”; “I am suffering horribly with insomnia”; “I seem to get frequent muscle cramps”; “my migraines and PMS are debilitating”; and “my anxiety level is continuing to rise,” are some of the most common complaints I hear.  Could one mineral in the proper dose and form be a simple fix for these common complaints?

Magnesium is an essential mineral that is used in over 300 biochemical reactions. Besides a myriad of symptoms, low levels of magnesium may elevate blood pressure and increase the risk of osteoporosis, two very common conditions seen in practice. Studies have also shown that lower levels of magnesium were associated with an increased risk of coronary heart disease. (1)

Dietary surveys of people in the United States consistently show that the intake of magnesium is lower than the recommended amounts. It is also common to see levels lower than normal on a routine RBC blood magnesium test.  Low levels can be from lack of ingestion or improper absorption from diet. Excessive deficiency of magnesium can be due to certain health conditions, chronic alcoholism, and/or the use of certain medications in our patient population.

Magnesium has been cited to interfere with more than 30 prescribed drugs. (2)   For optimal effectiveness, avoid combining a magnesium supplement with the following medications: aminoglycosides, antibiotics (ciprofloxacin, moxifloxacin, tetracycline, doxycycline, minocycline), blood pressure medications, calcium channel blockers (aamlodipine, diltiazem, felodipine, verapamil), diabetes medications, digoxin, diuretics, fluoroqinones, hormone replacement therapy, labetol, levomethadyl, levothyroxine, penicillamine, tiludronate and alendronate, amphotericin B, corticosteroids, antacids, and insulin. (3,4)

Knowing when to screen is important.  Although it never hurts to run an annual magnesium RBC test, always include it for patients who present as pregnant or nursing, or patients with diarrhea, diabetes, aging, depression, dementia, organ failure, or are on medications including antifungals, diuretics, proton pump inhibitors, some chemotherapy drugs and hormones.   Magnesium deficiency is also seen frequently in patients with anorexia, bulimia, or frequent vomiting such as in cyclic vomiting syndrome.

Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms can occur.

Severe magnesium deficiency can result in hypocalcemia or hypokalemia (low serum calcium or potassium levels, respectively) because mineral homeostasis is disrupted (5).

Getting enough magnesium in the diet can be challenging, but starting with foods is highly recommended.  Foods high in magnesium include almonds, spinach, avocado, bananas, beans, broccoli, brown rice, cashews, egg yolk, fish oil, flaxseed, green vegetables, milk, mushrooms, oatmeal, pumpkin seeds, sesame seeds, soybeans, sunflower seeds, tofu, and whole grains.  If RBC levels are still low and symptoms of deficiency persist, then oral ingestion of magnesium may be needed.

Recommended daily allowances for magnesium are based on age.  Birth to 6 months, 30 mg is recommended daily.  From 7-12 months: 75 mg, 1-3 years:80 mg, 4-8 years: 130 mg, 9-13: 240 mg, 14-18 years start a different recommendation for males and females:  410 mg for boys and 360 for girls, 19-30 years:  400 mg for males, 310 for females, 31-50 years:  420 mg for men and 320 for women and over 51: 420 mg for men and 320 for women.  When patients present with symptoms or low levels in blood work, we tend to use dosages starting at 200mg per day and work up to 800 or 1000 mg daily very safely and then rechecking blood levels and symptomatology.  Excessive intake from food does not pose a health risk in healthy patients since the kidneys will do their job and eliminate excess amounts in the urine.  If prescribing too high a dose, then patients typically will experience diarrhea, nausea or abdominal cramping, which is an indication to cut back.  Very high dosages in excess of 5,000 mg per day, such as in excessive antacid  or laxative use,  can lead to toxicity and should be avoided. More severe symptoms of toxicity may also include hypotension, vomiting, facial flushing, retention of urine, ileus, depression, and lethargy, leading to muscle weakness, difficulty breathing, irregular heartbeat and cardiac arrest. (6)

How to pick the right form of magnesium:  Different forms will be used with different presenting symptoms, so, to be effective, it is necessary to become familiar with the many forms:

Magnesium chloride

This is one of the most common forms on the market.  It comes from brine or ocean water. This form is useful to help sleep disorders, digestion, improve bone health and increase a sense of calm.  A typical side effect if too much is taken is diarrhea.  When taken in a topical form, such as in magnesium oil or lotion, it can reduce muscle spasms or cramps and also has been reported to help dermatitis, eczema, and acne.

Magnesium sulfate

This is commonly known as Epsom salts.  Typical uses include putting in the bath to help decrease muscle soreness.  This also has significant laxative effects. 

Magnesium citrate

Citrate has great bioavailability and is a derivative of citric acid.  This is a very common form recommended to support digestion and alleviate constipation and indigestion.  This form pulls water into the intestines, so adequate water intake should be evaluated and dehydration markers monitored.

Magnesium glycinate

Glycinate has great bioavailability and may have the best effect on muscle relaxation.  It also does not typically act as a laxative, so for those who are not constipated, higher doses may be given to achieve maximum benefits. For patients who cannot handle oxide or citrate, this is a great alternative.  This form is also good for promoting better sleep.

Magnesium oxide

Oxide is less bioavailable but can aid in digestion, specifically, heartburn. Even though it is the least absorbed form, it can deliver the highest percentages of elemental magnesium per dose, because the oxide molecule is very small, thus having a water-attracting effect in the colon helping with occasional constipation. However, some studies still recommend against taking this form, stating it may not be better than a placebo.

Magnesium orotate

This is a popular form among athletes because it helps support the repair of tissues and enhances stamina and performance. This is also a great form of magnesium for heart health. 

Magnesium malate

This is a gentle form and is good for those experiencing fatigue.  Malic acid is present in most cells in the body, so it plays a role in ATP synthesis and energy production.

Magnesium L-threonate

This is one of my favorites, as it can improve cognitive function.  The National Institute of Health reported that one of the potential benefits of magnesium L-threonate may be that it can improve short term memory loss caused by chronic pain.  In a 17-year-old study following more than 1000 Japanese people over the age of 60, those who consumed more than 200 mg per day were 37% less likely to develop any type of dementia. With any traumatic brain injury, and especially concussion or post-concussive syndrome, this would be the form best suited to help with cognitive deficits.

Magnesium aspartate and glutamate

Use these with caution as they are considered excitatory and excess amounts can cause excitotoxicity.

In an internal medicine-based chiropractic office, we routinely include RBC magnesium in our blood panels.  Where the lab range will typically be between 4.4 and 6.4, most patients will exhibit symptoms when it is below 6.  Optimally, that is the level we shoot for while eliminating any associated symptoms.  While anxiety, headaches, muscle aches and pains, insomnia and many other conditions can have many causes, a simple common one is a lack of magnesium.  Routinely, not a week goes by that I don’t hear these common complaints, and a majority of the time, supplementing with magnesium eliminates the patients’ symptoms. Magnesium, a magic mineral?  Maybe not magic, but certainly necessary.

1. Kieboom, J Am Heart Assoc 2016, Kunutsor, Our J Epidemiol 2016.

2.  Walker, Ann F.; Georgios Marakis; Samantha Christie; and Martyn Byng. “Mg citrate found more bioavailable than other Mg preparations in a randomized, double-blind study.” Magnesium Research. Vol. 16.3 (Sept. 2003):183-91. http://www.ncbi.nlm.nih.gov/pubmed/?term=14596323.

3. Magnesium: Fact Sheet for Health Professionals. National Institutes of Health, Office of Dietary Supplements. February 2016.

4. Magnesium Supplement (Oral Route, Parenteral Route).Mayo Clinic. January 2016.⁵ Jahnen-Dechent, W., Ketteler, M. “Magnesium Basics.” Clinical Kidney Journal 5, 3-14 (2012).

5. Bailey RL, Fulgoni III VL, Keast DR, Dwyer JD. Dietary supplement use is associated with high intakes of minerals from food sources. Am J Clin Nutr 2011;94:1376-81.

6. Magnesium, University of Maryland Medical Center. August 2015. https://umm.edu/health/medical/altmed/supplement/magnesium.

7. Seelig, Mildred S. “The Requirement of Magnesium by the Normal Adult.” The American Journal of Clinical Medicine. Vol. 14. 6 (June 1964). http://ajcn.nutrition.org/content/14/6/342.abstract.

8. “Information for Consumers on Using Dietary Supplements.” U.S. Food and Drug Administration. September 2015.

9.  U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 28. “Nutrients: Magnesium, Mg (mg)” 2015.

10. Institute of Medicine (IOM). Food and Nutrition Board. Dietary Reference Intakes: Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride. Washington, DC: National Academy Press, 1997.

11.  Lindberg JS, Zobitz MM, Poindexter JR, Pak CY. “Magnesium bioavailability from magnesium citrate and magnesium oxide.” J Am Coll Nutr. 1990 Feb;9(1):48-55.