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Magnesium

What is magnesium and what does it do in the body?

Magnesium is an essential mineral necessary for the functioning of the nerves, muscles, heart and gut and for maintaining bone structure [1,2]. Magnesium is also necessary for proper functioning of calcium, potassium and vitamin D [2].

Magnesium is a natural calcium antagonist, for example, calcium enables muscle contraction and magnesium muscle relaxation [49,81].

A chemical symbol for magnesium is Mg.

How much magnesium do you need?

The Recommended Dietary Allowance (RDA) for magnesium for adults is 350-400 mg/day.

Chart 1. Recommended Dietary Allowance (RDA) for magnesium
AGE RDA (mg/day)
Infants 0-6 months 30 (AI*)
Infants 7-12 months 75 (AI*)
1-3 years 80
4-8 years 130
9-13 240
Males 14+ ~400
Females 14+ ~350
Pregnancy and breastfeeding 310-400

Chart 1 source: Institute of medicine (IOM) [20] *AI = Adequate Intake. Breast milk of healthy mothers should provide enough magnesium for exclusively breastfed infants 0-6 months of age [3,20].

Magnesium-Rich Foods

Major sources of magnesium are foods high in fiber, such as whole-grain cereals, green leafy vegetables (chlorophyll contains Mg), legumes, nuts and seeds, and certain fish. Meat, poultry and dairy are low in magnesium.

High-magnesium foods image

Picture 1. Examples of foods high in magnesium

Chart 2. List of Foods High in Magnesium
PLANT FOODS Magnesium (mg)
Formulated bar, certain brands (2 oz, 57 g) 170
Quinoa (1 cup, 185 g) 120
Brown rice (1 cup, 195 g) 90
Buckwheat groats (1 cup, 170 g) 90
Oat bran (1 cup, 220 g) 90
Spinach, Swiss chard (1/2 cup, 90 g) 80
Nuts (almonds, cashews, hazelnuts, peanuts); seeds (pumpkin, squash, sunflower) (1 oz, 28 g) 50-80
Soybeans (1/2 cup, 85 g) 70
Oatmeal, instant, fortified (1 cup, 234 g) 60
Bread, whole wheat (1 slice, 60 g) 60
Beet greens (1/2 cup, 70 g) 50
Figs, dried (1/2 cup, 75 g) 50
Molasses (1 tbsp, 20 g) 50
Dark chocolate (1 oz, 28 g) 50
Beans, peas, lentils (1/2 cup, 120 g) 30-50
Avocado, cubes (1 cup, 150 g) 45
Potato (1 cup, 160 g) 30
Banana (1 medium, 120 g) 30
Okra (1/2 cup, 80 g) 30
Bottled water in the North America (1 cup, 237 mL) [Mg sulfate and bicarbonate] 0-30
Drinking tap water in the North America (1 cup, 237 mL) 0-11
ANIMAL FOODS
Fish: pollock, salmon (chinook), mackerel (3 oz, 85 g) 70-100
Milk (1 cup, 237 mL) 35
Fish: halibut, sardines (3 oz, 85 g) ~30

Chart 2. source: US Department of Agriculture (USDA.gov) [3] NOTE: All foods listed are ready to eat.

Magnesium Absorption

About 30-50% of magnesium from foods and water is absorbed, mainly in the small intestine [1,5,25].

Are there any benefits of a high-magnesium diet?

Constipation. Magnesium-rich mineral water can help prevent constipation [83].

High blood pressure. In several studies in individuals with hypertension, high magnesium intake from foods was only weakly associated with lower blood pressure [2,24].

Heart disease. Results of several large studies are conflicting: high magnesium intake may or may not have a protective effect on the heart [2].

Stroke. In one large 2014 observational study, high magnesium intake was associated with lower risk of stroke [87].

Diabetes mellitus. In many, but not all, studies, consuming foods high in magnesium, mainly from whole grains, was associated with lower risk of diabetes mellitus type 2 [2,26,27,28,88].

Results of above studies do not show a clear cause-effect relationship between magnesium intake and diseases because foods high in magnesium are often high in fiber, potassium and other nutrients that might affect.

Normal Blood Levels

A normal blood magnesium level range for adults is 1.7-2.1 mg/dL (0.7-0.9 mmol/L or 1.4-1.8 mEq/L) [6].

Magnesium Deficiency and Low Blood Magnesium Levels (Hypomagnesemia)

Magnesium deficiency means decreased magnesium body stores, which may or may not lead to low blood magnesium levels or hypomagnesemia (<1.7 mg/dL or 0.7 mmol/L). In healthy people who eat regularly, diet low in magnesium does not likely result in low blood magnesium levels.

Causes and Risk Factors:

  • Poor magnesium intake in chronic alcoholism, anorexia nervosa, prolonged starvation and old age
  • Poor magnesium absorption in celiac disease, Crohn’s disease, surgical removal of a large part of the small intestine, chronic pancreatitis, prolonged diarrhea or frequent vomiting, and possibly in protein malnutrition [45]
  • Excessive loss of magnesium through the urine in poorly controlled diabetes, kidney disorders, hypercalcemia or hyperaldosteronism
  • Long-term treatment with certain diuretics, proton-pump inhibitors or PPIs (omeprazole or esomeprazole magnesium for >1 year) [47], antimicrobials (amphotericin B, foscarnet), chemotherapy (cisplatin), immunosuppressants (cyclosporine)
  • Prolonged physical or emotional stress [77]
  • Increased magnesium loss through sweat during prolonged athletic training may result in slight magnesium deficiency but not likely in low blood magnesium levels [6,21,22].
  • Acute drop of blood magnesium levels:

Symptoms and Signs:

  • Mild hypomagnesemia: loss of appetite, nausea, fatigue, constipation
  • Severe hypomagnesemia: numbness, tingling around the mouth and in fingers, hyperventilation, muscle twitches or cramps (tetany), shaking (tremor), teeth grinding, difficulty breathing, migraine attacks, chest pain (due to spasms of the coronary arteries), abnormal heart rhythm (arrhythmia), seizures, hearing loss and tinnitus, hallucinations, coma or, rarely, death  [78].

Complications: hypocalcemia, hypokalemia, phosphate deficiency

Long-term magnesium deficiency might increase the risk of diabetes 2 (insulin resistance) [2] and stroke [84].

Assessment of magnesium status. Normal blood magnesium levels do not already mean normal body magnesium stores. For example, a chronic alcoholic may have normal blood magnesium levels but severe magnesium depletion ─ low magnesium levels within the cells and in the bones. In the body of an adult (70 kg), about 25 grams of magnesium is stored, mainly in bones and muscles [49]. Assessment of total body magnesium may include checking magnesium levels in the blood serum, red blood cells, urine or in a sample of muscle or mouth mucosa (biopsy) [48]. None of these methods are completely reliable and are rarely used.

Treatment. For magnesium deficiency and mild hypomagnesemia: oral magnesium supplements. For severe hypomagnesemia: magnesium injection and, in case of abnormal heart rhythm, intravenous calcium chloride or gluconate as an antidote.

References: [1,2,6,78]

Magnesium Supplements

Oral Magnesium

Magnesium can be part of multivitamin/mineral supplements or combined with calcium or vitamin B6 (pyridoxine). Available oral forms: tablets, effervescent tablets, extended-release tablets, chewables, capsules, powder for solution, liquids, syrups.

From the limited and conflicting data available (Chart 3), we are not able to conclude which magnesium supplement is most effective. One author from a German Pharmazeutische Zeitung beieves that all magnesium supplements have about the same bioavailability [45].

Chart 3. Oral magnesium supplements available OTC
COMPOUND % ELEMENTAL Mg* BIOAVAILABILITY SAFETY, PREGNANCY CATEGORY
Chelates with non-amino organic acids
Ascorbate (Mg + ascorbic acid or vitamin C)  6.4% Well absorbed [39] Considered safe by EFSA [39]
Citrate (Mg + citric acid)  16% Well absorbed (30%) [44,89] Also used as a laxative. Pregnancy category: C
Citramate (Mg + citric acid + malic acid) Probably absorbed similar to citrate and malate
Potassium-magnesium citrate (Mg + K + citric acid) Well absorbed [39,40]
Fumarate (Mg + fumaric acid) Well absorbed [44]
Gluconate (Mg + gluconic acid)  5.4% Well absorbed (20%) [79] Considered safe by FDA [42]. Pregnancy category: C
Lactate (Mg + lactic acid)  12% Well absorbed  [33] Pregnancy category: C
Malate (Mg + malic acid)  6.5%
Pidolate (Mg + pidolic acid)  8.7%
Salicylate (Mg + salicylic acid)  12% ? To treat rheumatoid arthritis. Overuse of salicylates can cause peptic ulcer and kidney damage. Pregnancy category: C
Threonate (Mg + threonic acid)  7.7%
Chelates with amino acids
Arginate (Mg + arginic acid)  30%** Pregnancy category: C
L-Aspartate (Mg + aspartic acid)  20% Well absorbed [33,44] Aspartate is an excitatory neurotransmitter. EFSA: “Magnesium aspartate may be of safety concern.” [79] Pregnancy category: C
Glutamate (Mg + glutamic acid) Glutamate is an excitatory neurotransmitter. Pregnancy category: C
Glycinate (Mg + glycine)  5.5% ? Pregnancy category: C
Lysinate (Mg + lysine) Pregnancy category: C
Orotate (Mg + orotic acid)  6% Bioavailability is probably comparable to other similar Mg supplements [36]. Expensive. EFSA: “…in the light of the tumor-promoting effect of orotic acid in animal experimentation… the use of orotate as a source of minerals…is of safety concern” [36]. Pregnancy category: C
Taurate or Taurinate (Mg + taurine)  9% Bioavailability is probably comparable to other similar Mg supplements [75]. Pregnancy category: C
Inorganic magnesium compounds
Carbonate (Mg + carbonic acid)  40-45% “High” bioavailability [46] Mainly used as an antacid and food additive. Pregnancy category: not classified
Magnesium chloride  12% Well absorbed [33] Pregnancy category: C
Magnesium hydroxide or milk of magnesia  42% Conflicting reports: from poor to good absorption [31,43] Used as an antacid and laxative. Pregnancy category: Not classified
Magnesium oxide  60% 4-23% absorption but “extremely low” bioavailability [33,44,89] Used as an antacid or laxative. Pregnancy category: C
Magnesium sulfate or Epsom salt (Mg +sulfuric acid)  10-17% Well absorbed (50%) from mineral water [25] Used as a laxative. Pregnancy category: A
Enteric-coated (any compound) Probably less well absorbed than regular formulations [30]

Chart 3. sources: GlobalPRh [43], Purdue University [46], PubMed [29,30,31,32,33], Drugs.com, producers, EFSA (European Food Safety Authority), FDA (Food and Drug Administration in the US). *Elemental Mg is the actual magnesium in the supplement.

“Natural magnesium” is a commercial term for magnesium chloride obtained from sea. “Organic magnesium” is a commercial term for magnesium chelates with organic acids (see Chart 3 above). Organic magnesium supplements are artificially produced and do not meet the criteria for “USDA organic” substances. “Ionic magnesium” is a mixture of various salts, such as magnesium chloride and sulfate, in a liquid form. There is no scientific data about eventual superiority of ionic magnesium over other magnesium forms.

Topical (Transdermal) Magnesium

Magnesium oil contains magnesium chloride. It is available as a spray, gel, lotion or bath flakes. It is not known if magnesium from magnesium oil can be absorbed through the skin in significant amounts.

Epsom salt. A small amount of magnesium is absorbed through the skin during bathing in water with added Epsom salt (magnesium sulfate) [37].

Magnesium Injection

An injection of magnesium sulfate, or rarely, magnesium chloride or gluconate, into a vein or muscle (a shot) is used to treat severe hypomagnesemia.

Other Magnesium Uses

  • Antacids for heartburn in gastroesophageal reflux disease ─ GERD: magnesium carbonate, hydroxide, phosphate, trisilicate
  • Laxatives: magnesium citrate, oxide, hydroxide (milk of magnesia), sulfate (Epsom salt)
  • Food additives: magnesium acetate, phosphate, silicate (talc), trisilicate
  • Magnesium bromide is used as a sedative and anticonvulsant.
  • Magnesium mandelate is used as an urinary antiseptic.
  • Magnesium salicylate is an analgesic often used in rheumatoid arthritis.
  • Magnesium stearate is used as a flow agent in liquid dietary supplements.

What are magnesium supplements good for?

Oral magnesium supplements are EFFECTIVE for:

  • Magnesium deficiency [62]

Oral magnesium supplements are POSSIBLY EFFECTIVE for:

  • Sour stomach, dyspepsia, heartburn in gastroesophageal reflux disease ─ GERD (Aluminium magnesium hydroxide carbonate hydrate or hydrotalcite or foaming antacid) [40,72,73]
  • Preparation of the bowel for colonoscopy or surgery (magnesium citrate, hydroxide, sulfate or phosphate); not optimally effective when used alone [10,51,63]

Intravenous injections of magnesium sulfate are possibly effective for:

  • Reducing seizures in women with high blood pressure during pregnancy (eclampsia) [17,66]
  • Certain types of irregular hear rhythm (arrhythmia) [8,74]
  • Decreasing symptoms of acute asthma in children but not in adults [15]
  • Relieving pain after a womb removal (hysterectomy) [16,55]

Oral magnesium supplements are POSSIBLY INEFFECTIVE in increasing exercise performance [82].

There is INSUFFICIENT EVIDENCE about magnesium supplements effectiveness in preventing or treatment of anxiety [65], asthma (inhaled magnesium [12], attention deficit-hyperactivity disorder (ADHD) [35], cluster headache [13,53,54], chronic constipation [50], chronic fatigue syndrome (CFS) [61], depression [34], diabetes type 2 [56], fibromyalgia [60], heart attack [70], high blood pressure [23], high blood pressure in pregnancy (pre-eclampsia) [67,68,69], kidney stones [11], leg muscle cramps in elderly or during pregnancy [58,71], migraine [52,54,64], multiple sclerosis (MS) [59], osteoporosis [1,2], premenstrual syndrome (PMS) [9,41], restless leg syndrome [57], tics (Tourette syndrome) [76] or stroke [2].

Magnesium Safety: Side Effects, Toxicity

The Tolerable Upper Intake Level (UL)–the dose unlikely causing side effects–for supplemental magnesium for 1-3 years old children is 65 mg/day, for 4-8 years 110 mg/day, and for 9 years and older children and adults 350 mg/day [1]. Magnesium from foods even in amounts exceeding 350 mg/day does not likely cause side effects.

The main side effect of oral–but not intravenous–magnesium supplements is diarrhea. Magnesium overdose may cause thirst, fainting, drowsiness, confusion, slow heart beat, drop of the blood pressure (hypotension), muscle weakness or difficulty breathing [19]. Magnesium sulfate injection can cause skin flushing and irritation at the injection site. Magnesium sulfate is pregnancy category D; it should not be used to stop preterm labor because it can harm the fetus [80]. Allergic reactions to magnesium supplements with difficult breathing and facial swelling are possible.

During Pregnancy

If you are pregnant or breastfeeding and intend to use magnesium supplements, speak with your doctor. For pregnancy categories of supplements check Chart 3 above.

Who may need to avoid magnesium supplements?

  • Individuals with increased blood magnesium levels, kidney disease, myasthenia gravis or other neurological disorders
  • Individuals allergic to magnesium compounds

Dosage

For treatment of magnesium deficiency, oral doses up to 350 mg of elemental magnesium per day are used.

High Blood Magnesium Levels (Hypermagnesemia)

Hypermagnesemia means blood magnesium levels above 2.1 mg/dL or 0.9 mmol/L. Hypermagnesemia does not likely result from eating foods high in magnesium.

Causes

  • Kidney failure in combination with overdose of magnesium supplements, antacids or laxatives
  • Other: cancer, lithium therapy, hypothyroidism, Addison’s disease, genetic metabolic disorders, milk alkali syndrome, extensive burns, shock, sepsis, severe muscle damage (rhabdomyolysis, crush syndrome)

Symptoms and Signs

Symptoms and signs, which occur only in severe hypermagnesemia, may include muscle weakness or paralysis, dizziness, low blood pressure (hypotension), abnormal heart rhythm (arrhythmia), heart attack, coma or even death.

References: [1,6,7]

Calcium : Magnesium Ratio

In several observational studies, low Ca/Mg intake ratio (<1.7) was associated with increased mortality in both women and men [85], but high Ca/Mg intake ratio was associated with increased risk of colorectal cancer, and high blood Ca/Mg ratio was associated with increased risk of menstrual migraine [86]. Results of these studies do not allow any firm conclusion about the importance of Ca/Mg ratio.

Magnesium ─ Drugs Interactions

Supplements that might reduce the absorption of magnesium if taken together: zinc or calcium supplements in high doses.

Drugs and supplements that may increase magnesium levels: certain diuretics (amiloride, spironolactone) and probably vitamin D (slightly) [1,2]. For other magnesium-drug interactions check the information leaflet within the supplement package.

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