Magnesium: What you need to know

WHY IS MAGNESIUM IMPORTANT?

Magnesium is an essential mineral that plays a number of important roles in the body. It is involved in over 300 enzymatic reactions in the body, Some of those enzymatic reactions include:

• Adenosine triphosphatase (ATPase): This enzyme is involved in the production of ATP, the main source of energy in the body. Magnesium is required for ATPase to break down ATP and release energy.
• Alkaline phosphatase: This enzyme is involved in the metabolism of nucleic acids and proteins, and is also important for bone and teeth development. Magnesium is required for alkaline phosphatase to function properly.
• Creatine kinase: This enzyme is involved in the production of energy in muscle cells. Magnesium is required for creatine kinase to convert ATP to phosphocreatine, which helps to supply energy to muscles.
• Glutathione peroxidase: This enzyme is involved in the detoxification of harmful substances in the body, such as free radicals and toxins. Magnesium is required for glutathione peroxidase to function properly.
• Lactate dehydrogenase: This enzyme is involved in the production of energy in the body, and is also important for the metabolism of carbohydrates and fats. Magnesium is required for lactate dehydrogenase to convert pyruvate to lactate.

As well as being involved in many enzyme reactions, magnesium also plays a supporting role in the following key areas:

• Metabolism of food.
• Synthesis of DNA, RNA, and proteins.
• Maintenance of normal muscle and nerve function and a deficiency can lead to muscle cramps, twitching, and weakness.
• Maintenance of normal heart rhythms. It helps to regulate the activity of the heart muscle and the conduction of electrical impulses through the heart.
• Maintenance of strong and healthy bones. It helps to regulate the levels of calcium and other minerals in the body, and it is necessary for the proper formation and maintenance of bone tissue.
• Regulation of blood sugar levels and blood pressure.
• Some forms may have a calming effect on the body and may help to promote a good nights sleep.
• Helps prevent migraines, pain, insomnia and can help to improve depression and anxiety

Most people can get enough magnesium from their diet, but in some people are at risk of developing a deficiency, such as older adults, people with poor diets and those taking certain medications, such as proton pump inhibitors.

TESTING FOR MAGNESIUM DEFICIENCY

Standard blood tests for magnesium levels are not always reliable because magnesium is primarily found inside cells and bones, rather than in the bloodstream. As a result, a standard blood test may not accurately reflect the total amount of magnesium in the body. Additionally, magnesium levels can fluctuate rapidly in response to changes in diet, stress levels, and other factors, making it difficult to accurately measure magnesium levels with a single blood test.

Because of these limitations, healthcare providers may use other methods to diagnose magnesium deficiency. At Evinco Health we recommend the Red Blood Cell (RBC) magnesium test, which is a laboratory test that is used to measure the amount of magnesium in the red blood cells. Unlike a standard blood test, which measures the amount of magnesium in the bloodstream (serum), red blood cells tests provide a clearer picture of magnesium levels in the body over a period of months because they have a longer lifespan. The RBC magnesium test provides a longer-term view of the magnesium status and is a good indicator of your magnesium stores, Unfortunately this test is not readily available on the NHS, so this would need to be requested and performed privately.

CAUTIONS AND CONTRAINDICATIONS

Magnesium supplements are generally considered safe when taken at recommended doses and under the guidance of a healthcare professional. However, there are certain conditions in which magnesium supplements may be contraindicated or should be used with caution. These include:

• Kidney disease: People with kidney disease may have difficulty eliminating excess magnesium from the body, which can lead to an accumulation of the mineral in the bloodstream. This can cause dangerous side effects such as irregular heartbeats and cardiac arrest.
• Irregular heartbeat: People with irregular heartbeat should avoid magnesium supplements as it may cause a worsening of symptoms and therefore should be used with caution.
• Postural Orthostatic Tachycardia Syndrome (POTS): in some people with POTS, magnesium can be problematic because it can have a relaxing effect on the muscles of the heart and blood vessels, which can exacerbate the symptoms of the condition.
• Myasthenia gravis: People with this condition characterised by muscle weakness, magnesium supplements should be avoided as it can worsen the symptoms.
• Bowel obstruction: Magnesium supplements may cause diarrhoea, which can be dangerous for people with bowel obstruction.
• Pregnancy and breastfeeding: Magnesium supplements are generally considered safe for pregnant and breastfeeding women when taken at recommended doses, but one should still consult with a healthcare professional before taking any supplements

THE DIFFERENT FORMS OF MAGNESIUM

Magnesium is found in several different forms that have varying effects, so it is important to choose the right form that supports your body in a safe and clinically relevant way. Magnesium supplements may cause stomach upset, diarrhoea, and nausea when taken in high doses. Some forms of magnesium exert a calming effect of the body whereas some forms can have a slightly stimulatory effect due to their ability to support energy production pathways.

Magnesium citrate:

Magnesium citrate is made by combining magnesium carbonate with citric acid. One of the main benefits of magnesium citrate is that it is highly bioavailable, meaning that the body can easily absorb and use it. Magnesium citrate is also commonly used as a laxative. The citric acid in the supplement can help to increase water in the intestines, which softens the stools and makes them easier to pass. This form of magnesium may have a calming effect on the muscles and nerves.

Magnesium chloride:

Magnesium chloride is made by combining magnesium and chlorine. It is similar to magnesium citrate in that it is highly bioavailable and can be easily absorbed by the body. Magnesium chloride is commonly used in preparations to manage heartburn and indigestion, and is also used in topical treatments applied to the skin. This form taken orally or transdermally can have a calming effect on muscles, respiratory system, cardiovascular system and nerves and can help to support skin conditions such as eczema.

Magnesium glycinate:

Magnesium glycinate is a chelated form of magnesium, meaning that it is bound to the amino acid glycine. The glycine component helps improve the absorption and bioavailability of the magnesium, but it is also an inhibitory neurotransmitter. Magnesium glycinate generally has a calming effect on the body by helping to reduce stress and anxiety, improve sleep quality, and promote relaxation. This form of magnesium is very well tolerated because it is more gentle on the stomach compared to other forms of magnesium. It is also more commonly used for people who have trouble sleeping, have stress-related conditions, or have muscle cramps.

Magnesium lactate:

Magnesium lactate combines magnesium and lactic acid and is known for its high bioavailability, which means that a high proportion of the magnesium can be absorbed and used by the body. It may also have a calming effect on the body and can help to improve sleep quality and reduce symptoms of anxiety and depression. It's important to note that while magnesium lactate is a good form of magnesium supplement, the studies regarding its effects are still limited, more research is needed to confirm its effectiveness and safety.

Magnesium L-threonate (MgT):

This form of magnesium is relatively new and has been specifically developed to cross the blood-brain barrier and is often used as a dietary supplement to increase intake of magnesium, especially for cognitive-related uses like memory and learning. Research suggests that MgT can improve sleep quality. It may also help to reduce symptoms of anxiety and depression and boost the overall cognitive function. Furthermore, MgT has been shown to help increase the levels of brain-derived neurotrophic factor (BDNF), a protein that supports the growth and survival of brain cells, which may also have a positive effect on cognitive function. However, it's important to keep in mind that this is a relatively new form of magnesium and more research is needed to confirm its overall benefits.

Magnesium bisglycinate:

Magnesium bisglycinate combines magnesium with the amino acid glycine. This form of magnesium is also believed to have a calming effect on the body and can help to improve sleep quality and reduce symptoms of anxiety and depression as well as support muscle cramps, twitching and weakness. It is generally well absorbed and tolerated which makes it a good option for people who have trouble absorbing or tolerating other forms of magnesium, or people with gastrointestinal issues.

Magnesium gluconate:

Magnesium gluconate contains magnesium and gluconic acid which is a carbohydrate that is derived from glucose. Magnesium gluconate appears to be well absorbed by the body and is also thought to be less likely to cause stomach upset compared to other forms of magnesium. Magnesium gluconate specifically, may have an added calming effect as it is known to have mild and gentle laxative properties which may be helpful for those experiencing muscle cramps, spasms and stiffness. Additionally, this form may help to improve sleep quality.

Magnesium Sulfate:

Otherwise known as epsom salts, is a naturally occurring mineral compound that is made up of magnesium, sulfur, and oxygen. Epsom salt is typically made by extracting the mineral from natural springs, or by refining the salt from seawater. The main component of Epsom salt is magnesium, but the sulfur it contains possesses anti-inflammatory properties and can help to relieve pain and swelling. It is also beneficial for skin health, and may help to reduce the symptoms of conditions such as eczema and psoriasis.

Epsom salts are often used as a bath soak and can be a useful way to increase magnesium levels in the body and also it can help to soothe sore muscles and ease stress and anxiety and support sleep.

IMPORTANT NOTE: Epsom salts are not recommended for people with kidney disease, heart disease, or high blood pressure, because the body can not excrete the sulfates and this can lead to an accumulation in these patients.

Magnesium malate:

Is a form of magnesium that is bound to malic acid. Malic acid is a compound that is found naturally in many fruits and vegetables. In addition to the potential benefits associated with magnesium, malic acid has its own potential benefits, because it acts as an intermediate in the citric acid cycle (Krebs cycle) which is responsible for producing energy in the cells, it can help to detoxify heavy metals from the body, supports the health of the nervous system and acts as a mild pain reliever. Magnesium malate has become the "go to" form of magnesium to help alleviate muscle pain, fatigue, and weakness, as well as support some of the symptoms associated with fibromyalgia and chronic fatigue syndrome (CFS).

Magnesium oxide:

Magnesium oxide combines magnesium and oxygen, it is generally used as an antacid to neutralise stomach acid and as a laxative to relieve constipation. Magnesium oxide has a high content of elemental magnesium per weight, however it has lower bioavailability compared to other forms of magnesium like citrate, chloride, and lactate. This means that it may not be as well-absorbed by the body, and a larger portion of the magnesium may be excreted in the faeces. This form of magnesium can have a stimulatory effect on the digestive tract due to its laxative properties and should be avoided in high doses unless advised by your doctor.

Magnesium carbonate:

Is also known as magnesite. In industry, magnesium carbonate is used as a filler and a source of magnesium in a variety of materials, including ceramics, electronics, and fireproofing agents. It is also used as a dietary supplement to increase intake of magnesium, as well as a mild antacid to neutralise stomach acid. You will also find magnesium carbonate in the chalk used in sporting activities as a grip-enhancing agent. It should be noted that magnesium carbonate may have a low bioavailability when consumed as a supplement, meaning that the body may not be able to absorb and utilise much of the magnesium present in it, therefore this is better as an antacid rather than a deficiency correcting agent.

Magnesium aspartate:

Magnesium aspartate combines magnesium and aspartic acid. This form of magnesium is well absorbed by the body and has been reported to have a mild stimulating effect on the body due to its effect on energy metabolism.

Magnesium taurate:

This is a form of magnesium bound to an amino acid called taurine, it is considered to be a well-tolerated form of magnesium supplement, with fewer gastrointestinal side effects compared to other forms of magnesium. Magnesium taurate is believed to have a positive effect on cardiovascular health, as taurine can help to regulate blood pressure, reduce inflammation and decrease platelet aggregation, which may contribute to the risk of blood clots. While magnesium has its own beneficial effects on cardiovascular health. Some preliminary research suggests that magnesium taurate may also have benefits for mood and cognitive function. It is thought that the combination of magnesium and taurine may help to improve the function of neurotransmitters, the chemical messengers in the brain, having the potential to alleviate symptoms of anxiety and depression.

Magnesium hydroxide:

Is a compound that is made up of magnesium and hydroxide ions. Magnesium hydroxide is primarily used for its antacid and laxative properties, so it is not typically considered to have a stimulatory effect on the body. However, it can have some mild stimulation effects on the digestive system, due to its ability to promote bowel movement. Magnesium hydroxide is generally safe to use and has few side effects. However, taking too much of it can cause diarrhoea, stomach cramps, and other unpleasant symptoms, especially at higher doses.

CONCLUDING REMARKS

Magnesium is readily available in many foods and before considering supplementation is always best to optimise your food intake first by ensuring that the diet contains plenty of green leafy vegetables, whole grains, legumes, nuts and seeds and dairy products if tolerated. If you suspect that you have a magnesium deficiency, get in contact with your healthcare provider and request an RBC magnesium test to determine the extent of your deficiency and work out the correct dose and form of supplement for your needs.

It is important to note that the effect of any form of magnesium may vary depending on the person, the dosage, and the reason for which it is being taken. Furthermore, many magnesium supplements are poorly produced and are often combined with various additives, fillers and binders, we have had reports that many people experiencing long covid can react so some of these additives to so make sure you always check your supplement label, and that includes any that have been recommended by your GP.

As always it is a good idea to work with a healthcare professional who can work with you to optimise your diet, test for deficiencies and provide guidance on the right way to supplement.

Written by

Rachel Jessey MSc

Rachel is a Registered Naturopathic Nutritionist with an MSc in Personalised Nutrition. She has enjoyed 12 years of clinical experience working with chronic health conditions. Rachel has become a leading voice in nutrition and lifestyle interventions for Long Covid and actively collaborates with a number of long covid research teams from around the world.