Magnesium

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Latest Edit: Hector 2014-3-28 (EDT)

See Also Minerals


Magnesium.jpg

Magnesium is an essential mineral and the fourth most abundant mineral in the body. It primarily acts as a key player in over 300 biochemical reactions, specifically those involved in energy production. Over 60% of magnesium in the body is found in bones, about 26% is found in muscle, and the rest is found in soft tissue and body fluids. The tissues that have the highest magnesium concentrations are the brain, heart, liver and kidney because they are highly metabolically active. [1]

Magnesium is abundant intracellularly, second only to potassium. When magnesium is deficient, it effects the potassium levels within cells and greatly effects cellular functioning. Magnesium and calcium also have a relationship in that when magnesium absorption is high, calcium absorption will be low; the opposite is also true. Magnesium has the ability to block calcium entry into vascular smooth muscle cells and the heart and therefore is used to treat many cardiovascular conditions. This essential mineral also regulate calcium metabolism via its action on parathyroid hormone and calcitonin, two hormones which act to keep calcium levels in the body in check. [2], [1]

Contents

Food Sources

Tofu salad.jpg

The following foods have the highest concentration of magnesium. For a more expansive list on food sources of specific nutrients visit Health Canada's Dietary Reference Intakes for Elements or USDA's National Nutrient Database


  • Most Americans consume a low magnesium diet because their diets are high in refined foods, meats, and dairy products, whereas magnesium is found in abundance in whole foods.

Other food sources include:[3]

  • grains: Whole grains (such as brown rice and millet)
  • vegetables: green leafy vegetables, peas and beans (legumes), seeds
  • fruit: bananas, dried apricots, and avocados
  • Other sources include: Soy products (such as soy flour and tofu)

Uses

The following is a list of the primary uses of magnesium. [1]

Article Orthomolecular Medicine and Heart Health: Unmasking the Magnesium Link to Multiple Risk Factors for Cardiovascular Disease, J Orthomolecular Med; 2013; Vol28(1)
  • Cardiovascular Disease (CVD): Magnesium is essential for proper functioning of the entire cardiovascular system.
  • Acute myocardial infarction: People dying of heart attacks have lower magnesium levels than people of the same age dying of other causes. IV magnesium is a valued treatment for acute myocardial infarction. The benefits of using magnesium are it: (1) improves production within the heart; (2) dilates the coronary arteries, which results in improved delivery of oxygen to the heart; (3) reduces peripheral vascular resistance, which creates reduced demand on the heart; (4) inhibits platelets from aggregating and forming blood clots; (5) reduces the size of the infarct (blockage); (6) improves heart rate and arrhythmias [1].
  • Angina: angina is caused be a spasming of a coronary artery and usually responds to magnesium supplementation. IV magnesium supplementation can also help with angina due to atherosclerosis by the same mechanisms as described above for myocardial infarctions.
  • Cardiac arrhythmia: The current understanding of why magnesium helps to treat arrhythmia is due to magnesium's role in proper potassium levels. When these two electrolytes are out of balance or deficient, proper nerve and muscle firing cannot occur.
  • Cardiomyopathy: Several studies have shown that magnesium supplementation produces improvements in heart functioning for individuals with a variety of cardiomyopathies.
  • Congestive Heart Failure: is characterized by an energy depleted state and many CHF patients are deficient in both magnesium and Co Q10. Magnesium supplementation is also beneficial because many conventional treatments for CHF cause magnesium depletion.
  • High Blood Pressure: Population studies have shown a correlation between higher magnesium intake and lower blood pressure. Studies which have used magnesium as an intervention to treat high blood pressure show mixed results. Cases in which magnesium supplementation has been shown to be helpful is, first, when a patient is taking a diuretic which depletes magnesium. Second, when high blood pressure is associated with high renin output. Finally, magnesium may be helpful when a patient has elevated intracellular sodium or decreased intracellular potassium (measured by red blood cells studies). A 4 week trial of magnesium supplementation is often recommended to see if magnesium supplementation is beneficial.
  • Intermittent Claudication: is a peripheral vascular disease. Atherosclerosis causes this condition, and like coronary artery disease, peripheral vascular disease is also associated with a magnesium deficiency.
  • Low HDL Cholesterol Levels: Magnesium deficiency is associated with an increase in both LDL (bad) cholesterol and triglycerides and a decrease in HDL. *Mitral Valve Prolapse: Research has shown that 85% of patients with mitral valve prolapse have magnesium deficiency.
  • Prevention of Strokes and Transient Ischemic Attacks (TIAs): Blood vessels supplying the brain are particularly sensitive to magnesium status. Vascular spasming can result from magnesium deficiency and this spasming can sometimes cause strokes or TIAs. Supplementation with magnesium can cause relaxation in the vessels and improve blood flow to the brain. Magnesium can also protect against strokes just as it may reduce risk of heart attack.
  • Diabetes and Hypoglycemia: Magnesium plays a key role in the secretion and action of insulin. Without adequate magnesium levels, it is impossible for the body to properly control blood sugar levels. Magnesium may also helps to prevent diabetic sequelae such as retinopathy and heart disease. Diabetics may actually require more than the RDA for magnesium. Vitamin B6 is also critical for the transport of magnesium into cells and therefore must also be considered in a comprehensive treatment.
  • Eosinophilia-Myalgia Syndrome: This syndrome was first recognized in 1989 and in most cases is caused by contaminated L-tryptophan. It is characterized by early peripheral eosinophilia, severe muscle pain, inflammation, and in some cases neural and visceral involvement. It has been found that individuals with EMS have a selective decrease in skeletal muscle ATP concentration, possibly due to a magnesium deficiency (recall that magnesium plays a key role in ATP manufacturing). In preliminary studies, it appears that magnesium injections may be helpful in treating this disease.
  • Fatigue: Magnesium deficiency, even if subclinical, can lead to chronic fatigue syndrome. Studies have shown improvement of symptoms for individuals suffering from CFS with intramuscular injection of magnesium sulfate and also with oral magnesium and potassium aspartate.
  • Fibromyalgia: Intracellular magnesium deficiency may be a contributing factor to fibromyalgia. One study shows that magnesium malate supplementation helps to improve the number and severity of tender points. Others suggest using magnesium chelated to the entire family of Kreb cycle intermediates[1].
  • Glaucoma: Magnesium supplementation has been shown to improve peripheral circulation and has benefited those suffering from glaucoma in terms of improvements in visual fields.
  • Hearing Loss: There is an association between low magnesium and noise-induced hearing loss.
  • Kidney Stones: Magnesium increases the solubility of calcium in the urine, thereby preventing stone formation and also prevents recurrent stone formation. Concomitant use of vitamin B6 actually increases magnesium's effectiveness even more. Magnesium citrate is the most effective form for this purpose.
  • Migraine and Tension Headaches: Due to magnesium's role in blood vessel tone, magnesium deficiency is linked to tension and migraine headaches. In fact, low levels of magnesium are found in the serum, saliva, and red blood cells of migraine sufferers. In addition, migraines are also linked to mitral valve prolapse. Changes in blood platelets which result from mitral valve prolapse cause the platelets to release substances that cause expansion in blood vessels in the head leading to migraines.
  • Osteoporosis: Calcium and magnesium go hand-in-hand in terms of their importance in treating and preventing osteoporosis. Women with osteoporosis have indicators of magnesium deficiency including low bone magnesium. In addition, the conversion of vitamin D to its more active form relies on adequate magnesium levels.
  • Pregnancy: One's need for magnesium increases during pregnancy. Adequate magnesium during pregnancy is critical for the prevention of pre-eclampsia, pre-term delivery, and fetal growth retardation and supplementation decreases one's risk of developing these conditions.
  • Premenstrual Syndrome and Dysmenorrhea: Red blood cell magnesium levels in those suffering from PMS symptoms are significantly lower than those who do not have PMS. Magnesium supplementation has shown beneficial effects in treating PMS symptoms such as emotional instability, generalized aches and pains and lower premenstrual pain threshold. Effects are even greater when vitamin B6 and other nutrients are added to treatment.
  • Attention Deficit or Hyperactivity Disorder (ADD/ADHD): Symptoms of ADHD look a lot like symptoms of magnesium deficiency such as excessive fidgeting, anxious restlessness, psychomotor instability, and learning disabilities. In one study, 95% of the ADHD patients had magnesium deficiency when levels were measure in their serum, red blood cells, and hair. In another study, individuals who were supplemented with magnesium showed improvement in terms of hyperactivity compared to the control group [2].
  • Cancer: Magnesium is important in controlling growth of cells and may be helpful in treating cancer [2].

Deficiency Symptoms

Magnesium deficiency is common in the geriatric population as well as in women during the premenstrual period. Deficiency is often secondary to conditions that reduce absorption or increase secretion such as: high calcium intake, alcohol, surgery, diuretics, liver and kidney disease, and oral contraceptive pill use. Signs and symptoms of deficiency include:

  • fatigue
  • mental confusion
  • irritability
  • weakness
  • heart disturbances
  • problems in nerve conduction and muscle contraction
  • muscle cramps
  • loss of appetite
  • insomnia
  • predisposition to stress

Excess Symptoms

Magnesium excess is rare and is typically iatrogenic from IV magnesium, from laxatives or antacids containing magnesium, or intramuscular injections. Signs and symptoms of excess or toxicity may include:

  • diarrhea (most common, does not occur with parenteral administration)
  • drowsiness
  • weakness
  • lethargy
  • nausea and vomiting
  • hypotension
  • urinary retention
  • bradycardia
  • respiratory depression
  • depressed mental status
  • electrocardiographic (ECG) abnormalities
  • possibly death

Assessment Procedure

Best Specimens to Collect: [4]

Article Use of Serum Magnesium Measurements to Exclude Magnesium Deficiency is Cause for Concern, NMJ, [2], 2012 August

Low serum magnesium reflects end-stage deficiency as most of the body's magnesium concentrates in the cells and not in the serum. The best test to detect deficiency is the level of magnesium in the red blood cells.

Prescribing Considerations

The different types of magnesium include:

  • magnesium oxide: Has a strong laxative effect due to its poor bioavailability and stool-loosening effect. Common source is milk of magnesia products.
  • magnesium sulfate: Can be absorbed through the skin and may be used in IV preparations. Common source is Epsom bath salts.
  • magnesium citrate: Rapidly absorbed in the digestive tract, yet also has a stool-loosening effect. Commonly found in supplements for magnesium replacement and in the treatment of acute headaches and constipation.
  • magnesium asparate: Bioavailability is greater that oxide or citrate. Commonly found in supplements as a magnesium replacement and to address muscle hyper-excitability.
  • magnesium glycinate: Rapidly absorbed in the digestive tract without the stool-loosening effect. Commonly found in supplements used to treat chronic pain and muscle hypertonicity.
  • magesium malate: Malate is a substrate in the cellular energy cycle. Commonly used in supplements used to treat fibromyalgia, fatigue and muscle pain.
  • magnesium orotate: Orotate combined with magnesium increases the ability of magnesium to be absorbed into the cellular mitochondria. Orotate is also involved in the formation of RNA and DNA which can support cardiovascular function. Commonly found in supplements used to treat heart conditions, especially hypertension and congestive heart failure.
  • magnesium taurate: Both magnesium and the amino acid taurine are able to support cardiovascular health, insulin sensitivity and have a calming effect on neuromuscular excitability. Commonly found in supplements designed to support cardiovascular health, especially arrhythmias.
  • Other forms of magnesium are magnesium oxide, gluconate, sulfate, chloride, and carbonate [1].
  • Taking magnesium supplements with food is less likely to cause diarrhea.
  • The recommended dosages varies based on age and health status. To determine what your specific requirements are talk to your naturopathic doctor or other trained medical professional.
  • Infant: 40mg (under 6 months); 60mg (6-12 months)
  • Child: 80mg (1-3 years); 120mg (4-6 years); 170mg (7-10 years)
  • Adolescent: 270mg (Males 11-14 years); 280mg (Females 11-14 years); 400mg (15-18 years); 300mg (Females 15-18 years)
  • Adult: 350mg (Males 19+ years); 280mg (Females 19+ years)
  • Pregnancy: 320mg
  • Lactation: 280mg

Safety

  • Children: No problems have been reported with normal intake in infants and children.
  • Pregnancy and Breastfeeding: No problems have been reported with normal intake during pregnancy and nursing.
  • Contraindications: individuals with impaired kidney function can accumulate magnesium (some medications such as aminoglycosides and amphotericin-B cause both renal tubular damage and magnesium depletion patterns); individuals with high-grade atrioventricular blocks or bifascicular blocks must avoid magnesium supplementation because it can slow cardiac conduction.
  • Precautions: Due to magnesium's effect on blood sugar, for individuals with diabetes or hypoglycemia, it should be introduced slowly to prevent complications.

Drug Interactions

  • Drug Interactions include:[5]
Supportive or Beneficial:
  • Albuterol/Salbutamol and Related Beta-2-Adrenoreceptor Agonists (Inhalant Bronchodilators - Supplementation enhances albuterol efficacy and counters hypomagnesemia.
  • Amphetamines and Related Stimulant Medications - Magnesium salts may enhance drug retention and availability. Drug may elevate magnesium levels (mutual increased effect).
  • Fentanyl - Co-administration of IV magnesium sulfate may enable reducing analgesic dosage requirements, possibly by re-setting nerve activation thresholds.
  • Insulin - Magnesium can improve insulin sensitivity and secretion. Co-adminster.
  • Neuromuscular Blocking Agents - Magnesium salts can increase and prolong agent effects. Unintentional additive effects may be severe but co-ordinated use may allow lower drug doses.
  • Quinidine and Related Anti-arrhythmic Drugs - Quinidine-induced arrythmia aggravated by electrolyte abnormalities. Magnesium sulfate reverses torsades de pointes by unknown mechanism. Hypomagnesemia may increase quinidine adverse effects especially with hypokalemia (low potassium).
  • Sotalol and Related Beta-1-Adrenoceptor Antagonists - Magnesium salt may reduce drug absorption and availability; drug effect on magnesium (and other minerals) may increase adverse effects. Magnesium sulfate reverses torsades de pointes by unknown mechanism. Intentional co-administration can be acute therapy or long-term supportive; unintentional interference may be gradual. Separate intake.
  • Theophylline/Aminophylline - Theophylline may deplete magnesium and aggravate magnesium status. Patient population tends to be magnesium deficient and supplementation can support therapeutic outcomes.
Addresses Drug-Induced Deficiency:
  • Aminoglycoside Antibiotics - Drug-induced tubular damage, impaired magnesium absorption. Magnesium is important with extended therapy.
  • Amphotericin B - Hypomagnesemia caused by renal magnesium wasting and impaired reabsorption. Hydration and nutrients are nephroprotective.
  • Cisplatin - Drug impairs renal tubules' ability to conserve magnesium resulting in clinically significant hypomagnesemia. Co-administer.
  • Colchicine - Drug may impair absorption of magnesium and other nutrients, potentially causing depletion and adverse effects. Consider co-administration during extended therapy. Separate intake.
  • Corticosteroids, oral - Drug causes magnesium depletion and impaired absorption and is associated with steroid-induced bone loss.
  • Cyclosporine - Severe hypomagnesemia, renal magnesium wasting, and nephrotoxicity associated with drug use. Co-administer.
  • Digoxin and Related Cardiac Glycosides - Drug decreases magnesium and increases loss, increasing the risk of digoxin toxicity. Magnesium and digoxin may chelate causing reduced absorption and bioavailability of both. Co-ordinated use with separate intake.
  • Lopp and Thiazide Diuretics - Diuretics inhibit magnesium absorption and increase excretion, amplifying potassium depletion. Cumulative adverse effect of mineral depletion. Co-administer long-term (rapid correction may require IV or IM administration of magnesium).
  • Estrogens: Estrogen Replacement Therapy and Oral Contraceptives - Exogenous estrogens may shift magnesium to soft tissue and bone, lower serum levels and body stores. Magnesium depletion may amplify and supplementation may moderate possible adverse effects of PMS to bone and heart.
  • Foscarnet - Renal impairment caused by drug may be responsible for adverse effects on magnesium, calcium, potassium, and phosphorus. Depletion sequelae are common and can be rapid and severe.
  • Macrolide Antibiotics - Erythromycin and other macrolides may interfere with absorption of magnesium and other nutrients especially with extended use. Consider nutrient supplementation with extended macrolide therapy. Separate intake.
  • Pentamidine - Drug can decrease magnesium levels and produce adverse effects, especially on cardiac function. Co-administer as indicated.
  • Sodium Polystyrene Sulfonate - Drug may alter magnesium levels and contribute to depletion. Compensatory magnesium may prevent or reverse potential adverse effects.
Contraindicated:
  • Lithium Carbonate - Drug and magnesium may compete. Concomitant intake may elevate magnesium levels but adverse effects are unlikely. The clinical significance of this interaction is unstudied. Monitor.
  • Misoprostol - Probably additive effect of magnesium, increasing diarrhea. Drug's adverse effects on gastrointestinal tract may be aggravated. Temporarily discontinue magnesium use if possible.
Separate Intake:
  • Bisphosphonates - Minerals and bisphonphonates chelate which reduces absorption and bioavailability. Modify timing to prevent chelation.
  • Fluoroquinolone (4-Quinolone) Antibiotics, Particularly Ciprofloxacin - Magnesium and drug may chelate causing reduced absorption and bioavailability of both. Separate intake.
  • Penicillamine - These agents tend to complex which may reduce magnesium absorption. Simultaneous intake may interfere with and inhibit activity of both agents. High doses of drug for extended period can inactivate and deplete magnesium. Separate intake.
  • Warfarin and Related Oral Vitamin K Antagonist Anticoagulants - Binding and formation of chelate complexes may reduce absorption and activity of both agents. Evidence is mixed. Separate intake by at least 2 hours.
Other:
  • Calcium Channel Blockers - Concomitant use can produce additive effects that have the potential to be detrimental or beneficial depending on patient characteristics. There is an increased risk of adverse effects with co-administration during pregnancy and concomitant use at this time is discouraged except under close supervision. Coordinated use can allow for reduced dosage of the drug and reducing the risk of adverse effects. A complete understanding of both agents is encouraged before co-administration is suggested.
  • Sulfonylurea Hypoglycemics - Co-administration has the potential to address magnesium deficiency seen in diabetics and may enhance the blood-lowering effects of the medication. However, concomitant use outside of an understanding of both agents and careful monitoring can increase risk of hypoglycemia from an excessive additive interaction.
  • Tetracycline Antibiotics - In general, avoid magnesium based medications or supplementation concomitantly. Co-administration carries risk of increased adverse effects but may be efficacious in some cases. Separate intake.

Nutrient Interactions

  • Nutrient Interactions include:[5]
  • Alcohol - Hypomagnesemia is common in alcoholics due to increased renal excretion.
  • Calcium - High intake may decrease magnesium absorption.
  • Manganese - Concomitant magnesium use may be necessary during manganese supplementation.
  • Phosphate - High intake may decrease magnesium absorption. Separate intake by 2 hours.
  • Potassium - and magnesium deficiency often occur together and need to be treated concomitantly.
  • Vitamin B1 - One case report indicates that a patient developed cardiac beriberi with polyneuritis after protracted use of large amounts of magnesium trisilicate.
  • Vitamin B6 - is necessary for magnesium to enter cells. Using these two nutrients together may increase the therapeutic efficacy of magnesium supplementation.
  • Vitamin D - enhances the bioavailability of magnesium.
  • Zinc - supplementation may increase magnesium intake needs.

Resources

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Murray Michael T (2005) Encyclopedia of Nutritional Supplements, The Essential Guide for Improving Your Health Naturally, Prima Publishing.
  2. 2.0 2.1 2.2 Hoffer Abram, Prousky Jonathan (2006) Naturopathic Nutrition, A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimum Health, CCNM Press
  3. Medlineplus [1]
  4. Bralley J Alexander and Lord Richard S (2005) Laboratory Evaluations in Molecular Medicine, Nutrients, Toxicants, and Cell Regulators Institute for Advances in Molecular Medince, GA
  5. 5.0 5.1 Stargrove Mitchell Bebell, Treasure Jonathan, McKee Dwight L (2008) Herb, Nutrient, and Drug Interactions, Clinical Implications and Therapeutic Strategies. Mosby
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