Magnesium Deficiency: A Public Health Crisis?

I nearly fell off my chair as this statement is from an article in Open Heart Journal (in the BMJ stable) – so this is mainstream medicine calling for magnesium deficiency to be recognised and acted upon, calling it a primary driver of cardiovascular disease.

You can read the fascinating but very technical article in full below:

Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis

Subclinical magnesium deficiency is a common and under-recognised problem throughout the world. Importantly, subclinical magnesium deficiency does not manifest as clinically apparent symptoms and thus is not easily recognised by the clinician.

Despite this fact, subclinical magnesium deficiency likely leads to hypertension, arrhythmias, arterial calcifications, atherosclerosis, heart failure and an increased risk for thrombosis. This suggests that subclinical magnesium deficiency is a principal, yet under-recognised, driver of cardiovascular disease.

A greater public health effort is needed to inform both the patient and clinician about the prevalence, harms and diagnosis of subclinical magnesium deficiency.

Blimey, at last! I do go from feeling immensely frustrated that nutritionists have been pointing to the evidence for this for years (I was first trained in the importance of magnesium in any circulatory disorder back in the 90s!) to feeling thankful that mainstream medicine has at last woken up to it!

Heart disease is the number one killer in the UK, far ahead of cancer, so this is important news.

How do you test for magnesium deficiency?

As they say in the article, magnesium deficiency often goes undiagnosed because they are testing serum, which doesn’t show you what the true intracellular level is. This is why I always recommend red cell magnesium levels are tested (on the shop from Biolab or in the Genova Toxic & Essential Elements test).

Because serum magnesium does not reflect intracellular magnesium, the latter making up more than 99% of total body magnesium, most cases of magnesium deficiency are undiagnosed. Furthermore, because of chronic diseases, medications, decreases in food crop magnesium contents, and the availability of refined and processed foods, the vast majority of people in modern societies are at risk for magnesium deficiency.

Certain individuals will need to supplement with magnesium in order to prevent suboptimal magnesium deficiency, especially if trying to obtain an optimal magnesium status to prevent chronic disease. Subclinical magnesium deficiency increases the risk of numerous types of cardiovascular disease, costs nations around the world an incalculable amount of healthcare costs and suffering, and should be considered a public health crisis. That an easy, cost-effective strategy exists to prevent and treat subclinical magnesium deficiency should provide an urgent call to action.

Here, here!

The article goes on to suggest magnesium loading or retention tests are the best but the magnesium usually has to be injected so has to be done in the clinical setting – ask your GP or consultant. The labs have found red blood or other intracellular tests correlate well and those are easier to get done! I tend to use Biolab for this mostly and here is an interesting factsheet on magnesium testing for you from them.

I also look at the Morley Robbins testing parameters. He says anything below 6mg/dl or less than 2.46mmol/L is a deficiency level.

So what are the symptoms of magnesium deficiency?

These are taken from the article.

Potential clinical signs of magnesium deficiency

Less severe signs

  • Aggression.152

  • Anxiety.

  • Ataxia.

  • Chvostek sign80 (twitching of the facial muscles in response to tapping over the area of the facial nerve).

  • Confusion.

  • Cramps (spontaneous carpopedal spasm or painful cramps of the muscles in your hands and feet).

  • Disorientation.

  • Fasciculations (‘a brief, spontaneous contraction affecting a small number of muscle fibres, often causing a flicker of movement under the skin. It can be a symptom of disease of the motor neurons)’.91

  • Hyper-reflexia.

  • Irritability.

  • Muscular weakness.

  • Neuromuscular irritability.

  • Pain or hyperalgesia206 (decreases the nociceptive threshold).

  • Photosensitivity.207

  • Spasticity.

  • Tetany204 (involuntary muscle spasms).

  • Tinnitus208 (ringing in the ears).

  • Tremors.

  • Trousseau sign.

  • Vertigo.

  • Vitamin D resistance.

Severe signs

  • Arrhythmias (caused by overexcitation of the heart due to enhanced depolarisation susceptibility, especially torsades de pointes or ventricular tachycardia with a prolonged QT interval).

  • Calcifications (soft tissue).

  • Cataracts.209

  • Convulsions.

  • Coronary artery disease.

  • Depressed immune response.210

  • Depression.211

  • Hearing loss.152 212

  • Heart failure.

  • Hypertension.

  • Migraines/headaches.

  • Mitral valve prolapse.213

  • Osteoporosis.

  • Parathyroid hormone resistance and impaired parathyroid hormone release/function.214

  • Psychotic behaviour.

  • Seizures215 (overexcitation of the nervous system (nerve cells), which are more likely to fire due to a reduced electric potential difference between the outer and inner surfaces of the membrane).2

  • Sudden cardiac death.

  • Tachycardia.

A lot there, aren’t there? This is because magnesium is involved in over 300 different enzymatic pathways in the body, so lack of it will affect any or all of them. I can certainly attest to having either suffered or seen clinically quite a few of those that were helped by magnesium repletion. Mostly calcification – hard muscles and joint spurs – migraine, arrythmia, osteoporosis, anxiety, hypertension, cramps, muscle pain, tinnitus, twitching and vertigo.

What magnesium supplement form should you take?

There is a bit of debate about this as there are many different forms of magnesium. Definitely not oxide, which is very unabsorbable and causes diarrhoea, although for this very reason it is often be used for severe constipation or to help eliminate something from the bowel in acute doses ie. if you are looking for a parasite for a test or maybe have eaten something toxic. I tend to go for citrate because it has high bioavailability and much research on absorption behind it, or I use magnesium chloride spray on skin or flakes in the bath. Here is a really useful article all about magnesium and the various supplement forms from AOR, whose research I trust.

Magnesium-L-Threonate: This form of magnesium has recently been studied to improve memory and brain function. One preliminary study in animals found that it significantly enhanced both short-term and long-term memory, boosting scores by 15% for short-term memory and 54% for long-term memory compared to magnesium citrate.8 Based on this study, it appears that magnesium-L-threonate is a highly absorbable form of magnesium that can improve brain function. While this research is promising, more is needed to confirm its benefit.

Magnesium Picolinate: This form of magnesium has generated interest because it is very inexpensive and can easily be made into a liquid supplement. There really have not been any substantial research trials supporting its specific health benefits. The down side of this form is that the picolinate molecule does not have any additional health benefits.

Magnesium Oxide: Often used in milk of magnesia products since this form has a strong laxative effect. Even though this combination contains a large proportion of magnesium compared to the oxide molecule, it has poor bioavailability and readily causes loose stools; therefore it is considered the least optimal form to use as a supplement. Also referred to as “Magnesia”, magnesium oxide is commonly used therapeutically as a laxative and relief for acid reflux. This type of magnesium shows high levels of concentration, but poor levels of bioavailability (only 4%).

Magnesium sulfate/sulphate: This form is often used as an intravenous preparation but it is not used in oral formulations. Since it does have some absorbability through the skin, . An inorganic form of magnesium with an elemental concentration of 10% and lower levels of bioavailability. Magnesium sulfate contains magnesium and sulfer and oxygen; it’s commonly referred to as Epsom Salt.

Magnesium citrate: A commonly used form that has a good bioavailability compared to oxide. It is also very rapidly absorbed in the digestive tract but it does have a stool loosening effect.1 This form is found in many supplements and remains a solid option for delivering magnesium into the body. Derived from the magnesium salt of citric acid, this form of magnesium has lower concentration, but a high level of bioavailability (90%). Magnesium citrate is commonly used as to induce a bowel movement, but has also been studied for kidney stone prevention.

Magnesium Amino Acid Chelates

A mineral chelate form of magnesium containing an ion of magnesium oxide connected to a mixture of some other form of amino acid. This could be a lactate, a glycine, aspartate or arginate, etc. The best chelated amino acid form of magnesium is aspartate or arginate.

Magnesium Aspartate: This form has increased bioavailability compared to oxide and citrate. There were some promising clinical trials conducted in the 1960s that found a combination of magnesium and potassium aspartates had a positive effect on fatigue and they reduced muscle hyper-excitability. Physiologically this makes sense since both magnesium and aspartic acid are critical players in cellular energy production. This form is not commonly found but has been used for chronic fatigue syndrome.

Magnesium Chloride

A form of magnesium showing moderate concentrations, but higher levels of bioavailability when compared to magnesium oxide. Magnesium chloride has many uses, most commonly to help manufacture paper, some types of cements and fireproofing agents.

Magnesium Lactate

This type of magnesium shows moderate concentrations, but higher levels of bioavailability as compared to magnesium oxide. Magnesium lactate is a mineral supplement that is most commonly used for treating digestive issues. Magnesium lactate should be avoided by those with kidney disease or kidney-related problems.

Magnesium Carbonate

This form of magnesium has moderate levels of elemental concentration and 30% bioavailability rates. Magnesium carbonate has a strong laxative-effect when taken in high amounts. It is also commonly known as chalk, and is used as a drying agent by pitchers, gymnasts, rock climbers and weight lifters.

Magnesium Glycinate, Malate & Taurates

Chelated forms of magnesium holding moderate to low concentrations and higher levels of bioavailability. All three types of magnesium have a variety of uses, but none are as beneficial as the previous magnesium supplements listed above.

Magnesium Glycinate: Glycine is a well-known calming amino acid. This combination has good bioavailability and does not have a laxative effect since glycine is actively transported through the intestinal wall. Due to the calming and relaxing effect of both glycine and magnesium, this combination has been used successfully for chronic pain and muscle hyper tonicity.

Magnesium Malate: This less well-known combination has been studied for use in fibromyalgia. Since malate is a substrate in the cellular energy cycle, it can help improve ATP production; there is some preliminary evidence that it may reduce muscle pain and tender points in fibromyalgia patients.

Magnesium Orotate: This is another relatively unknown chelate combination containing orotic acid. This form has good bioavailability has had been studied specifically for heart health. Orotates can penetrate cell membranes, enabling the effective delivery of the magnesium ion to the innermost layers of the cellular mitochondria and nucleus. Orotates themselves increase the formation of RNA and DNA which can help heart cells repair and therefore improve function. The combination has been shown to improve heart failure, symptoms of angina and exercise performance in clinical trials.5,6

The most effective form of magnesium supplement, created through the use of the mineral salts of orotic acid. Both plants and animals use orotates to create DNA and RNA. Extensive scientific research by Dr. Hans A. Nieper, M.D. shows orotates can penetrate cell membranes, enabling the effective delivery of the magnesium ion to the innermost layers of the cellular mitochondria and nucleus. Magnesium orotate contains many properties that can help protect you and your health, while offering your cells the most readily absorbable form of magnesium on the market today.

Magnesium Taurate: Both magnesium and the amino acid taurine share the ability to improve cardiac function; each has a potentiating effect on insulin sensitivity and also a calming effect on neuromuscular excitability. The actions of both have striking similarities when it comes to cardiovascular health. They both have blood pressure reducing effects, stabilize nerve cells, improve the contraction of the heart muscle and have an anti-thrombotic effect.7 Additionally, low levels of vitamin B6 have been shown to further deplete both magnesium and taurine.

Magnesium glycinate is well absorbed into your blood stream. Magnesium citrate is a bit less well absorbed with some remaining in the GI tract, which has the advantage of promoting bowel movements. Magnesium threonate is unique in that it can penetrate through the Blood Brain Barrier (BBB) and reach a high concentration in the brain.  It is often recommended as a sleep aid, cognitive function, mood issues and for migraine. (eg. 1 of this in the morning and 2 before bed for sleep). Magnesium chloride is well absorbed, and does not cause a laxative effect.

As you can see, you can mix and match magnesium types to suit what you need from them. You can get magnesium supplements of whatever type from either my shop here or from ND as usual (pls give my name). For some you might need my code at Amrita (4Y2AE7).

In terms of amount, I usually go up to about 500mg per day in a divided dose ie. 2 x 250mg twice a day. I stick to this level mainly because it can cause loose bowel movements and spark a detox. If it doesn’t, you can go higher if needed. Some experts (Morley, for example) recommend 650mg for women and 850mg for men, or 5 times your body weight in pounds. So, if you were 10st (140lb), you would take around 700mg. As I say, I would start lower (300-400mg per day) and see how you go. Titrate it up slowly.

If you do need a higher level, it might be worth thinking why that might be. Are you not absorbing properly – coeliac, gluten related disorder (see here)? Not got enough stomach acid or enzymes (see the factsheet here)? In this case, transdermal magnesium might be your best bet whilst you’re sorting the absorption issue out.

For transdermal, try magnesium oil spray. It can itch when you first use it – which the manufacturers say is a sign you need it. It is actually the residue that can itch – the magnesium gets absorbed pretty quickly within a few minutes – so rinse/flannel off the residue on your skin to get rid of it.

Alternatively, you can use magnesium oil in a footbath or an Epsom salts bath no more than 3 x week. These will help you replenish magnesium stores quite rapidly.  A good, fast way to boost your magnesium is:

Magnesium Boost

20 sprays of oil on your skin per day and 2-3 footbaths per week using 100ml of Magnesium Oil Original Soak. Some people may prefer to go more slowly; see how you get on.  To make a DIY, cheaper, magnesium oil, dissolve 333g magnesium chloride in 1 litre of warm water. (5 sprays is about 1ml)

I would always make sure you are taking the magnesium co-factors too so you can absorb and utilise it properly. Those include B6, B1, Vitamin D and boron mainly. B6 is the most important. I would also caution that you should be taking a general multivitamin and mineral too so that you don’t upset the balance of the other minerals like calcium and potassium. The electrolyte minerals (calcium, magnesium, sodium potassium) all work together in harmony so boosting one without making sure the others are OK is not a good idea. I did this once and realised the dizziness I felt was a potassium drop. A break, a lower dose and a boost of potassium solved it :).

In summary, I would say pretty much most people could use more magnesium. Biolab actually told me that they find about 70% of patients tested are found to be too low. That is huge – especially given the UK rates of heart disease, let alone all those other symptoms. For me: think magnesium, not calcium which is all you ever tend to hear about, isn’t it?!


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