Are We Magnesium Deficient Nation?

Magnesium is the seventh most abundant mineral in the human body.1 The body contains 21-28 grams of magnesium.1 About 50-60% of magnesium presents in the bone, 27% in muscles, 19% in soft tissues, and about 1% in serum and red blood cells.2

Magnesium plays an important role in many of our body functions, including:1,2

  • Participation in over 300 enzymatic reactions to carry out various chemical reaction involved in building strong bone and 
 regulating blood sugar as well as blood pressure.1
  • Help in the production of ATP (an energy molecule) by the mitochondria. Every cell uses ATP for various activities; it is the main energy currency of the cell.
  • Synthesis of our genetic molecules like DNA and RNA
  • Synthesis of protein and blood clotting
  • Maintaining normal nerve impulses and muscle contraction
  • Insulin production.2

Despite the importance of magnesium, about 45% of Americans are magnesium deficient.3

There are two types of magnesium deficiency, acute deficiency and chronic or subclinical deficiency. Acute magnesium deficiency is recognized by low serum magnesium (< 1.8 mg/dL or <0.85 mmol/L).

This condition is called hypomagnesemia.2,4

Symptoms of acute hypomagnesemia:

  • Fatigue, weakness
  • Severe cramps
  • Nystagmus (an involuntary eye movement)
  • Low serum potassium and calcium
  • Abnormal heart rate (tachycardia)
  • Eclampsia in pregnant women

On the other hand, chronic deficiency reflects a clinically silent reduction in magnesium within cells and bone and is often associated with normal serum levels. Normal serum magnesium levels are tightly controlled by our kidneys. Kidneys pull magnesium from muscles and bones when serum magnesium falls. Therefore, a normal serum magnesium level does not rule out magnesium deficiency and is unreliable guide to body stores of magnesium.3,4 As a result, chronic deficiency is hard to diagnose.

Chronic magnesium deficiency is associated with increased risk and prevalence of cardiovascular diseases, hypertension, type 2 diabetes, colorectal cancer, Alzheimer’s disease, bone mineral disease/osteoporosis, migraines, depression, asthma, poor sleep, and metabolic syndrome.4

What are the Causes of Chronic Magnesium Deficiency?

Magnesium deficiency may result from reduced intake, reduced intestinal absorption and/or increased gastrointestinal loss, increased kidney loss, and some medications use.

1. Reduced Magnesium Intake

About 60% of American adults do not meet the recommended dietary allowance (RDA) for magnesium, which is about 300 to 400 mg/day.3 This range is set to prevent acute magnesium deficiency.2 The highest food sources of magnesium are leafy greens (78 mg/serving), nuts (80 mg/serving), and whole grains (46 mg/serving).3 However, SAD diet, which stands for Standard American Diet, is low in fruits and vegetables, legumes, nuts and whole grains. SAD diet is high in processed foods, fat, refined grains, sugar, and alcohol. Food processing, such as grains bleaching and vegetable cooking, can cause a loss of 80% magnesium content in foods.3 For example, magnesium loss in white flour is ~82%, ~83% in polished rice, and ~97% in starch.2 In addition, soft drink containing high phosphoric acid and food containing phytates, oxalic acid, and polyphenols all reduce the availability and absorption of magnesium.3 Consumption of alcohol and coffee can increase kidney excretion of magnesium.3

2. Farming Practice

Dietary magnesium deficiency can also be attributed to farming practices and magnesium concentration in soil. For example, since 1968, magnesium content in wheat has dropped by 19.6% due to acidic soil, yield dilution, and the use of unbalanced crop fertilization that is high in nitrogen, phosphorous, and potassium.5 Guo et al. concluded “Magnesium deficiency in plants is becoming an increasingly severe problem with the development of industry and agriculture and the increase in human population.”5

3. Malabsorption and Other Risk Factors

Magnesium is absorbed in the small intestine (small bowel) and large bowel (colon).1

Magnesium deficiency can occur due to gut conditions such as prolonged diarrhea, vomiting, and gastrointestinal diseases.1 Gastrointestinal diseases include Crohn’s disease, ulcerative colitis, pancreatitis, celiac disease, ileostomy, liver diseases, bariatric surgery, and short bowel syndrome.1

Other risk factors of magnesium inadequacy:

  • Type 2 diabetes: high concentration of blood sugar results in magnesium loss in urine.
  • Alcohol dependence (alcoholism): poor dietary intake, gastrointestinal problems, and excess magnesium excretion can lead to magnesium depletion in these individuals.
  • Older adults: they have lower dietary intake than younger adults. Also, magnesium absorption decreases while its excretion in urine increases with age.

4. Increased Kidneys Excretion

Magnesium is mainly excreted from the body by the kidneys. About 95-97% of magnesium is reabsorbed, whereas 3-5% is excreted in urine.1 Decreased plasma magnesium promotes magnesium reabsorption in the kidney.1 Magnesium deficiency is observed in advanced chronic kidney disease (CKD) stages 4-5 and dialysis patients.6 Hypomagnesemia also occurs in Gitelman syndrome (GS). It is a genetic disorder causes a defect in kidneys function. 7 Mutation in the gene results in abnormal functioning of the kidneys and leads to salt loss, dehydration, and low mangesium7,8

5. Use of Some Medications

Medications can lead to either decreased intestinal absorption of magnesium or increased its kidney excretion. Long-term use of blood pressure medicines like diuretic loop and thiazide medications (e.g., furosemide and bumetanide) and chemotherapeutic agents increase eliminating magnesium through kidneys.3 Antiacids (e.g., proton pump inhibitors like omeprazole) increase gastrointestinal pH and consequently impairs intestinal absorption.9 Other medications that can have negative effect on magnesium absorption include antibiotics (e.g., ciprofloxacin) and oral contraceptives.

What Science Tells us About Magnesium and Health

Chronic magnesium deficiency is hard to diagnose since its symptoms are non-specific and diagnostic tests such as serum magnesium and red blood cells magnesium concentrations are limited.4 However identifying those at risk is important to prevent and treat deficiency and related symptoms.

High risk individuals include those with:

  • Gastrointestinal and kidney diseases.
  • Dietary risk factors, for example high consumption of coffee, alcohol, soda, and processed foods.
  • Using medications known to affect magnesium status (listed above).
  • Clinical symptoms such as leg cramps, sleep disorder, depression, and chronic fatigue
  • Diabetes and metabolic syndrome.3

Here are some diseases and disorders in which increased magnesium consumption from food and/or supplements might be beneficial:10,13

  • High blood pressure and heart disease
  • Type 2 diabetes
  • Depression
  • Migraine
  • Bone health/osteoporosis
  • Insomnia.
  • Restless leg syndrome

Magnesium supplements

Magnesium supplements are available in a variety of forms, including magnesium oxide, citrate, malate, glycinate, and chloride. Absorption of magnesium supplements varies. Studies found that magnesium in the form of malate, glycinate, aspartate forms is absorbed more completely than magnesium oxide and sulfate.13

Toxicity from high levels of magnesium levels may occur with long-term use in high doses.

Tolerable Upper Intake Level (UL) for magnesium supplement is 350 mg/day, which is the maximum daily intake unlikely to cause adverse health effects.13

People with kidney disease have a higher risk of toxicity because their kidneys are not working properly and cannot flush out extra magnesium. Excessive magnesium from supplements often results in diarrhea, nausea, and abdominal cramping. Forms of magnesium most commonly reported to cause diarrhea include magnesium chloride, carbonate, gluconate, and oxide.

Remember to discuss the use of high-dosage magnesium supplements with your physician.

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  1. Gropper SS, Smith JL, Carr TP. Advanced Nutrition and Human Metabolsim. 7 ed. Cengage Learning; 2018:583.
  2. DiNicolantonio JJ, O’Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart. 2018;5(1):e000668. doi:10.1136/openhrt- 2017-000668
  3. Workinger JL, Doyle RP, Bortz J. Challenges in the Diagnosis of Magnesium Status. Nutrients. 2018;10(9):1202. doi:10.3390/nu10091202
  4. Ismail AAA, Ismail Y, Ismail AA. Chronic magnesium deficiency and human disease; time for reappraisal? Qjm. Nov 1 2018;111(11):759-763. doi:10.1093/qjmed/hcx186
  5. Guo W, Nazim H, Liang Z, Yang D. Magnesium deficiency in plants: An urgent problem. The Crop Journal. 2016/04/01/ 2016;4(2):83-91. doi:
  6. van de Wal-Visscher ER, Kooman JP, van der Sande FM. Magnesium in Chronic Kidney Disease: Should We Care? Blood Purification. 2018;45(1-3):173-178. doi:10.1159/000485212
  7. Filippatos TD, Rizos CV, Tzavella E, Elisaf MS. Gitelman syndrome: an analysis of the underlying pathophysiologic mechanisms of acid-base and electrolyte abnormalities. Int Urol Nephrol. Jan 2018;50(1):91-96. doi:10.1007/s11255-017-1653-4
  8. Urwin S, Willows J, Sayer JA. The challenges of diagnosis and management of Gitelman syndrome. Clin Endocrinol (Oxf). Jan 2020;92(1):3-10. doi:10.1111/cen.14104
  9. Park CH, Kim EH, Roh YH, Kim HY, Lee SK. The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis. PloS one. 2014;9(11):e112558-e112558. doi:10.1371/journal.pone.0112558
  10. Dolati S, Rikhtegar R, Mehdizadeh A, Yousefi M. The Role of Magnesium in Pathophysiology and Migraine Treatment. Biol Trace Elem Res. Aug 2020;196(2):375-383. doi:10.1007/s12011-019-01931-z
  11. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. Sep 23 2015;7(9):8199-226. doi:10.3390/nu7095388
  12. The Nutrition Source: Magnesium HARVARD T. H. CHAN School of Public Health.
  13. Magnesium: Fact Sheet for Health Professionals. 2022.

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