Magnesium Deficiency: The Real Emperor of All Maladies?

Long-time forum readers know that magnesium deficiency typically lies at the “heart” of atrial fibrillation but it’s always refreshing to see a report coming from corporate medicine on the importance of recognizing magnesium deficiency …in this case, Medscape. There may yet be hope.

Jackie


Medscape Internal Medicine > George Lundberg: At Large at Medscape

COMMENTARY

Magnesium Deficiency: The Real Emperor of All Maladies?

George D. Lundberg, MD
May 11, 2015

Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

How is your magnesium level? I bet you don't know. You may not think much about it. How about your various patients' magnesium levels? If you think calcium metabolism in health and disease is complicated, and I do, you ain't seen nothing yet. Try magnesium. With calcium, serum levels give you a pretty good idea as to whether the body has enough. With magnesium, not so much.

Approximately 99% of total body magnesium is located in bone, muscles, and soft tissues; 1% is extracellular.[1] Thus, plasma or serum magnesium levels are only a rough approximation of amounts of magnesium. Substantial hypomagnesemia does indicate magnesium deficiency, but normal blood levels do not dependably exclude significant depletion of magnesium stores. We "manage what we measure." If we cannot reliably measure some metabolic substance, we have far less chance of sensibly understanding or managing it.

A "Really Big Deal"
Magnesium is an essential mineral, vitally involved in more than 300 regulatory enzyme systems controlling muscle, nerve, bone, protein, DNA, glucose, and energy metabolism. Magnesium is a really big deal.

The recommended daily intake of magnesium varies by age and gender, but 400 mg is a good round number for adults. The kidneys provide homeostasis, typically excreting 120 mg/day. Since the 1960s, we have known that consumption of alcohol, even in modest amounts, can double or even quadruple the excretion of magnesium.[1] Many over-the-counter and prescription drugs, such as proton pump inhibitors, can lower body magnesium levels.

Is Magnesium the True Emperor of All Maladies?
Magnesium deficiency has been blamed for various arrhythmias, hypertension, attention-deficit/hyperactivity disorder, anxiety, seizures, leg cramps, restless legs syndrome, kidney stones, myocardial infarction, headaches, premenstrual syndrome, fibromyalgia, chest pain, osteoporosis, altitude sickness, diabetes, fatigue, weakness, and other maladies.[1]
Whoaaa. Really? That is almost everything. Can that be true? Because of the vital nature of magnesium in so many cellular functions, it actually could be true. We simply do not know.

Calcium and magnesium interact in innumerable ways. Magnesium is considered "the calming mineral."

WHO: Americans Need to Consume More Magnesium
There has been no large systematic study of the adequacy of magnesium body stores in Americans. In 2009, the World Health Organization published a report[2] that stated that 75% of Americans consumed less magnesium than needed. Some say that we have a nationwide magnesium deficiency. Certainly, those named illnesses are common. Obviously, the National Institutes of Health or the Centers for Disease Control and Prevention should fund serious work to ascertain the status of Americans' magnesium body stores, and I call upon them to do so.

For most of my professional life, I have supported the adequacy of a balanced diet and opposed the addition of nutritional supplements as unnecessary, wasteful, possibly harmful, and mostly a scam. But as the "typical" American diet has evolved into one of fast foods and processed foods, my attitude has changed.

Eat Your Spinach, Take Supplements
Foods with high magnesium content include dark leafy greens, especially kale, chard, and spinach; tree nuts and peanuts; seeds; oily fish; beans, lentils, legumes, and whole grains; avocado, yogurt, bananas, and dried fruit; dark chocolate; and molasses. Supplemental magnesium is available over the counter in many forms: citrate, amino acid chelate, chloride, glycinate, malate, taurate, carbonate, and others, which vary in absorption, concentration, and bioavailability.

Because you cannot just draw a blood sample and ask the lab to identify a deficiency, I advise that if a patient has any of the symptoms I listed, you might best just try that old standby, "trial of therapy," and track what happens. Since I got interested in this topic a couple of years ago, I have emphasized the inclusion of magnesium-rich foods in my diet. Because I like to drink wine and I take occasional proton pump inhibitors, I supplement my balanced diet with an additional 400 mg of magnesium daily.

I feel terrific—better than before magnesium. I know that is subjective as all hell, but what better way would you like your patients to feel than "terrific"?

That's my opinion. I am Dr George Lundberg, at large at Medscape.


References:
1. Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J. 2012;5 Suppl 1:i3-i14.
2. World Health Organization. Calcium and Magnesium in Drinking Water: Public Health Significance. Geneva: World Health Organization Press; 2009.

Source: [www.medscape.com]

(The reader comments that follow the report are also interesting.)

I am new to the Magnesium .. I purchased Nature Made Magnesium 250MG from CVS .. It is Magnesium Oxide .. Should I just take 2 soft gels a day .. Or is this the wrong kind of Magnesium to take .. I have afib and tske Cartia XT 120MG and 325MG Aspirin daily .. Thanks in advance for any help

Charlene in Tulsa, OK
started this journey 05/06/2013
have chalked up 45 hours in AFib (3 events)
wish I didn't belong to this club
but grateful to find 'afib friends'

Hi Charlene - Unfortunately, the oxide form of magnesium is the least desirable but very commonly available. It won't do you much good. If you haven't opened it, perhaps you can return it. Do some reading first before buying another.

In the yellow box at the top of the page titled Afib Resources - click there and you'll see a report about Magnesium - Absorption and Assimilation that should be helpful for your dosing questions. Here's the link to save you time... [www.afibbers.org] but you should go back and read the other reports there as well as in the Conference Room on other critical nutrient... potassium. Start here: [www.afibbers.org]

For an overall guide to nutritional support for afibbers read the guidelines in The Strategy... [www.afibbers.org]

If you have a health food store in your area, you should be able to find a true chelated amino acid magnesium product that does not contain magnesium oxide) or one that is labeled magnesium taurate or magnesium glycinate which are not chelated but offer a source of magnesium. You'll see magnesium citrate as well, but be aware that in order to take in enough in the way of milligrams/dose, the citrate form has the tendency to cause bowel tolerance issues and when you have diarrhea, you lose electrolytes rather than restore the intracellular levels.

If you don't have a local HF store... then consider ordering online at iHerb... this is the link to a magnesium product many afibbers find useful. It's a powder and pure in form. Easy to use. [www.iherb.com]

There are other magnesium products as well at iHerb...

Consider also making the homemade version of bicarbonate water...which we call WW or Waller Water... it's easy, economical and a very beneficial source of magnesium bicarbonate...plus it helps alkalize tissue which is also an important goal.

If you'd like to try this... go to this link and scrolldown to the abbreviated (quick and easy) version of making the WW in the post by Anonymous [www.afibbers.org]... Ask questions ...many of us make it regularly and it takes less than a minute once the ingredients are assembled.

I also wish you didn't belong to this club..... no one really wanted to become a member, but we are all here to help you so read at the links I've provided and then ask all the questions you like.

Best to you,
Jackie

Very good report Jackie, thanks for sharing it!

Shannon

thanks Jackie .. you are very knowledgeable .. I will just toss the magnesium and purchase some that is beneficial to use

Charlene in Tulsa, OK
started this journey 05/06/2013
have chalked up 45 hours in AFib (3 events)
wish I didn't belong to this club
but grateful to find 'afib friends'

Thanks, J!

/L

Dr. Lundberg is very late. It has been known for a very long time, and extensively documented, that magnesium deficiency is the real Emperor of ALL maladies !

Magnesium (Mg) facts:

IntraCellular (IC) range: 34.0 - 42.0 mEq/L
Serum (EC) range: 1.5 - 2.5 mEq/L
IC:EC gradient ~20:1 (Mg-ATPase pumps)

RDA: Adult males 420 mg/day. Adult females 320 mg/day. [lpi.oregonstate.edu]

Adequate intracellular magnesium is essential to normal tissue and organ function. Next to potassium it is the most abundant cation in cells and tissues. Determination of intracellular levels is vital to maintain and treat many medical syndromes. Serum levels, RBCs, and lymphocytes do not adequately reflect cell or tissue levels of magnesium.

Magnesium modulates tissue transport of potassium (K), sodium (Na), chloride (Cl), calcium (Ca), and phosphorus (P) ions and participates in hundreds of enzyme systems including formation of high-energy compounds such as ATP. All physiological activity, secretion, bone formation, cardiac and neuromuscular activity is affected by magnesium in tissues.

Optimal tissue levels of magnesium help prevent cardiac irregularities and tend to maintain lower blood pressure. Magnesium concentrations in optimal ranges indicate possible lowered risk factor for hypertension, angina, arrhythmias and vascular spasm.

Determination of low IC tissue magnesium is vital to the objective treatment of depleted patients. Magnesium loss affects normal tissue and organ function while modulating transport of potassium, sodium, calcium, and phosphorus ions within tissues. Causative factors of Mg deficiency include diabetes, use of diuretics and digitalis, excessive stress, exercise, malabsorption, poor diet, alcoholism, and heavy metal poisoning.

Low magnesium has been associated with EKG and cardiac abnormalities, fibrillation, vascular and muscle spasms. Correlations with migraine headaches, asthma, eclampsia, PMS, and chronic fatigue syndrome are abundant in the medical literature. Low magnesium is seen in cardiac failure and prolonged QT syndrome. Neurological disorders, panic attacks, and nerve irritability are often associated with low tissue magnesium levels.

Since the kidneys excrete excess magnesium, it is rare to find tissue levels which exceed optimal levels. Excess tissue magnesium has a sedative and hypotensive effect.

Supplementation must be used with caution in renal disease. Kidney function is the major excretory pathway for magnesium. In kidney disease, excess retention of magnesium can cause impairment of kidney and CNS function. Patients with cardiac failure and renal disease may retain magnesium in the tissues. ACE Inhibitors and ARBs also cause magnesium retention.

(Source: Burton Silver PhD, IntraCellular Diagnostics Inc. [www.exatest.com])



Edited 2 time(s). Last edit at 05/29/2015 02:20PM by Moerk.

Many medical reference sources quote the RDA for vitamins and minerals.

In the case of magnesium, the RDA of 420 mg a day is a good start but from what we know based on testimonials here, often afibbers require much more than 420 mg... sometimes double and more. It all depends on the degree of deficiency and how efficient the individual's body is at optimizing the intracellular levels. Some individuals have a high stress lifestyle either from heavy exercise or tension or emotional stress and lose Mg almost more rapidly than they can take replenish it.

So... let the RDA values serve as a bare minimum as a starting dose but be aware that progress might not be made until the intake amounts are much higher. I typically have those new to magnesium supplementing starting doses of 200 mg for 4- 5 days and then adding in another 200 mg for 4 -5 days and then adding in yet another 200 mg (600 mg total each day) and upward until the signs of bowel tolerance start to surface. Then... cut back down to the last dose and coast at that level for a while. It may be necessary to increase dosing again after a while. More elaboration in those two links offered to Charlene.

I'm glad to see the reference to Exatest, Mork, (thanks!) because as we know it's the most reliable indicator of IC Mg status and it's extremely useful to have the test if at all possible once afib begins. Absent the Exatest, we just know that most always, afibbers are deficient in magnesium. Cardiologists, however, almost never go to the extent of monitoring accurately magnesium status in afibbers.

Jackie

Oddly, none of the Research Reports under Afib Resources are dated, including Magnesium Absorption and Assimilation; is the brands listing still valid ?

Mork~

That is an annoying feature of all those reports.... they should all be dated as new developments do happen...and probably all reports should be updated periodically. Hopefully, when Shannon revamps the website and if he keeps those reports going as a "library of reference materials," I would hope they would be dated.

As far as the magnesium report and current product availability goes ... the magnesium bisglycinate amino acid chelate product is still available and several brands are now offering a pure (quality) bulk powder... as I noted in the link to Charlene.

Several of the amino acid chelate magnesium product brands were including some magnesium oxide calling it a 'buffer' which is totally unnecessary since the product, as designed, requires no buffer but companies are apparently adding magnesium oxide as a filler that wasn't previously showing on labels, but now we need to scrutinize the labeled ingredients and be on alert if it indicates "buffered" or mag oxide.

Hope this helps clarify.

Jackie

Hi Jackie,

Do remind me if you recall too, when we start the website revamp which Im aiming to get going in the coming next month or two, about adding the dates. I'll need your help too since you penned a number of those articles and will costact Hans and see if he has dates on the rest to at least list them in date context as well.

Shannon

Here's a Magnesium Deficiency report by cardiologist, William Davies, MD - Author of Wheat Belly, and published by Life Extension. Definitely support for the thread.


Life Extension Magazine February 2007

Report
Is Your Bottled Water Killing You?
by William Davis, MD

Here's an excerpt

Low Magnesium Tied to Risk of Sudden Death

“Results from the early epidemiological studies suggest that sudden-death rates in soft-water areas are at least 10% greater than sudden-death rates in hard-water areas.

If magnesium supplementation causes even a modest decrease in sudden-death rates, a substantial number of lives might be saved.” 7

—Mark J. Eisenberg, MD, MPH - McGill University

Magnesium deficiency may have potentially dire consequences. Critically ill patients, who often have very low magnesium levels, suffer the risk of seizures, life-endangering heart rhythms, and fatal heart attack.8

Magnesium has a stabilizing effect on cell membranes, particularly in heart muscle. A healthy heart generates stable, predictable electrical impulses. Lack of magnesium permits unstable electrical impulses in the heart to emerge, generating abnormal heart rhythms.9,10 In fact, much magnesium research over the years has focused on its administration during heart attack to reduce death from fatal heart rhythms.11

Magnesium blood levels are routinely monitored in hospitalized patients, particularly those who are receiving diuretic medications. It is well known in hospitals that if magnesium blood levels drop too low, abnormal heart rhythms can suddenly develop, necessitating intravenous replenishment of magnesium.9 Dangerous rhythms of the heart’s ventricles, in particular, can occur. People suffering from congestive heart failure are especially susceptible to dangerous heart rhythms when magnesium is low.

Scientists have observed that people in areas with higher levels of magnesium in their drinking water exhibit rates of sudden cardiac death that are three to four times lower than those of people living in municipalities with the lowest magnesium levels in drinking water.7,12,13 This has drawn the attention of national and international public health officials.

Very well done... Be sure to read both pages. 46 references included.

Jackie