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1. Understanding Magnesium: The Body’s Workhorse
Magnesium is an abundant mineral in the human body and is naturally found in various foods. It is also added to some food products, available as a dietary supplement, and present in some medicines, such as antacids and laxatives. Magnesium is a cofactor in over 300 enzyme systems that regulate diverse biochemical reactions in the body. These reactions include protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation.
Magnesium is essential for energy production, oxidative phosphorylation, and glycolysis. It also contributes to the structural development of bone and is needed for the synthesis of DNA, RNA, and the antioxidant glutathione. Magnesium plays a role in the active transport of calcium and potassium ions across cell membranes. This process is crucial for nerve impulse conduction, muscle contraction, and maintaining a normal heart rhythm.
1.1. Magnesium’s Role in the Body
Magnesium has a far-reaching impact on numerous physiological processes:
- Energy Production: Magnesium is vital for converting food into energy.
- Muscle Function: It helps muscles contract and relax properly.
- Nerve Function: Magnesium supports healthy nerve transmission.
- Blood Glucose Control: It aids in regulating blood sugar levels.
- Blood Pressure Regulation: Magnesium helps maintain healthy blood pressure.
- Bone Health: It contributes to the structural development of bones.
- DNA and RNA Synthesis: Magnesium is required for synthesizing DNA and RNA.
- Antioxidant Production: It is needed for the production of glutathione, a powerful antioxidant.
1.2. Magnesium Distribution in the Body
An adult body contains approximately 25 g of magnesium. 50% to 60% of this magnesium is present in the bones, while the rest is mostly in soft tissues. Less than 1% of the total magnesium is found in blood serum, and these levels are tightly regulated. Normal serum magnesium concentrations range between 0.75 and 0.95 millimoles (mmol)/L. Hypomagnesemia is defined as a serum magnesium level less than 0.75 mmol/L.
Magnesium homeostasis is primarily controlled by the kidneys, which typically excrete about 120 mg of magnesium into the urine each day. When magnesium status is low, urinary excretion is reduced to conserve the mineral.
1.3. Challenges in Assessing Magnesium Status
Assessing magnesium status is challenging because most magnesium is inside cells or in bone. The most common method for assessing magnesium status is measuring serum magnesium concentration, even though serum levels have little correlation with total body magnesium levels or concentrations in specific tissues.
Other methods for assessing magnesium status include measuring magnesium concentrations in erythrocytes, saliva, and urine; measuring ionized magnesium concentrations in blood, plasma, or serum; and conducting a magnesium-loading (or tolerance) test. No single method is considered entirely satisfactory. Some experts consider the tolerance test (measuring urinary magnesium after parenteral infusion of a dose of magnesium) the best method to assess magnesium status in adults. However, others disagree.
To comprehensively evaluate magnesium status, both laboratory tests and a clinical assessment might be required.
2. Recommended Magnesium Intakes for Optimal Health
Intake recommendations for magnesium and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies. DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and sex, include the following:
- Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals. It is often used to plan nutritionally adequate diets for individuals.
- Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy. It is established when evidence is insufficient to develop an RDA.
- Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals. It is usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them. It can also be used to assess the nutrient intakes of individuals.
- Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects.
2.1. Daily Magnesium Recommendations
The Recommended Dietary Allowances (RDAs) for magnesium vary based on age and sex. Here is a detailed breakdown:
| Age | Male | Female | Pregnancy | Lactation |
|---|---|---|---|---|
| Birth to 6 months | 30 mg* | 30 mg* | ||
| 7–12 months | 75 mg* | 75 mg* | ||
| 1–3 years | 80 mg | 80 mg | ||
| 4–8 years | 130 mg | 130 mg | ||
| 9–13 years | 240 mg | 240 mg | ||
| 14–18 years | 410 mg | 360 mg | 400 mg | 360 mg |
| 19–30 years | 400 mg | 310 mg | 350 mg | 310 mg |
| 31–50 years | 420 mg | 320 mg | 360 mg | 320 mg |
| 51+ years | 420 mg | 320 mg |
*Adequate Intake (AI)
For infants from birth to 12 months, the FNB established an AI for magnesium that is equivalent to the mean intake of magnesium in healthy, breastfed infants, with added solid foods for ages 7–12 months.
2.2. Why Meeting Magnesium Recommendations Matters
Meeting the recommended magnesium intakes is essential for maintaining overall health. Adequate magnesium levels support:
- Optimal Physiological Functions: Ensuring that all enzyme systems function correctly.
- Prevention of Deficiency Symptoms: Avoiding early signs of magnesium deficiency, such as loss of appetite, nausea, and fatigue.
- Long-Term Health: Reducing the risk of chronic diseases associated with magnesium deficiency, such as cardiovascular disease and type 2 diabetes.
2.3. Tips for Ensuring Adequate Magnesium Intake
To ensure you’re meeting your daily magnesium requirements:
- Eat Magnesium-Rich Foods: Incorporate foods like spinach, nuts, seeds, and whole grains into your diet.
- Consider Fortified Foods: Include breakfast cereals and other fortified foods in your meals.
- Stay Hydrated with Magnesium-Rich Water: Drink tap, mineral, or bottled water that contains magnesium.
- Consult with Healthcare Provider: If you suspect you’re not getting enough magnesium, talk to your doctor about whether supplements might be beneficial.
3. Food Sources of Magnesium
Magnesium is widely available in both plant and animal foods, as well as beverages. Good sources include green leafy vegetables like spinach, legumes, nuts, seeds, and whole grains. Generally, foods containing dietary fiber are also good sources of magnesium. Additionally, some breakfast cereals and other foods are fortified with magnesium.
It’s important to note that some food processing methods, like refining grains (which removes the nutrient-rich germ and bran), can significantly reduce magnesium content.
3.1. Top Food Choices Rich in Magnesium
Here’s a detailed look at some of the best food sources of magnesium:
- Pumpkin Seeds: 1 ounce provides 156 mg (37% DV)
- Chia Seeds: 1 ounce provides 111 mg (26% DV)
- Almonds: 1 ounce provides 80 mg (19% DV)
- Spinach: ½ cup, boiled, provides 78 mg (19% DV)
- Cashews: 1 ounce provides 74 mg (18% DV)
- Peanuts: ¼ cup provides 63 mg (15% DV)
- Shredded Wheat Cereal: 2 large biscuits provide 61 mg (15% DV)
- Soymilk: 1 cup provides 61 mg (15% DV)
- Black Beans: ½ cup, cooked, provides 60 mg (14% DV)
- Edamame: ½ cup, shelled and cooked, provides 50 mg (12% DV)
- Peanut Butter: 2 tablespoons provide 49 mg (12% DV)
- Potato: 3.5 ounces, baked with skin, provides 43 mg (10% DV)
- Brown Rice: ½ cup, cooked, provides 42 mg (10% DV)
- Yogurt: 8 ounces, plain and low fat, provides 42 mg (10% DV)
- Fortified Breakfast Cereals: 1 serving provides 42 mg (10% DV)
- Oatmeal: 1 packet, instant, provides 36 mg (9% DV)
- Kidney Beans: ½ cup, canned, provides 35 mg (8% DV)
- Banana: 1 medium provides 32 mg (8% DV)
- Salmon: 3 ounces, Atlantic, farmed, and cooked, provides 26 mg (6% DV)
- Milk: 1 cup provides 24–27 mg (6% DV)
- Halibut: 3 ounces, cooked, provides 24 mg (6% DV)
- Raisins: ½ cup provides 23 mg (5% DV)
- Whole Wheat Bread: 1 slice provides 23 mg (5% DV)
- Avocado: ½ cup, cubed, provides 22 mg (5% DV)
- Chicken Breast: 3 ounces, roasted, provides 22 mg (5% DV)
- Ground Beef: 3 ounces, 90% lean and pan-broiled, provides 20 mg (5% DV)
- Broccoli: ½ cup, chopped and cooked, provides 12 mg (3% DV)
- White Rice: ½ cup, cooked, provides 10 mg (2% DV)
- Apple: 1 medium provides 9 mg (2% DV)
- Carrot: 1 medium, raw, provides 7 mg (2% DV)
3.2. The Importance of Dietary Variety
To ensure you are getting enough magnesium from your diet, it’s crucial to include a variety of these magnesium-rich foods in your meals. A balanced diet that contains a mix of vegetables, nuts, seeds, legumes, and whole grains will help you meet your daily magnesium requirements.
3.3. Impact of Water on Magnesium Intake
Tap, mineral, and bottled waters can also be sources of magnesium. However, the magnesium content in water varies significantly by source and brand, ranging from 1 mg/L to over 120 mg/L.
3.4. Absorption Rate of Dietary Magnesium
Typically, the body absorbs approximately 30% to 40% of the dietary magnesium consumed.
4. Magnesium Supplements: Types and Absorption
Magnesium supplements come in various forms, including magnesium oxide, citrate, and chloride. The Supplement Facts panel on a dietary supplement label indicates the amount of elemental magnesium in the product, not the weight of the entire magnesium-containing compound.
Absorption of magnesium varies depending on the type of supplement. Forms of magnesium that dissolve well in liquid are more completely absorbed in the gut than less soluble forms. Small studies have found that magnesium in the aspartate, citrate, lactate, and chloride forms is absorbed more completely and is more bioavailable than magnesium oxide and magnesium sulfate. One study found that very high doses of zinc from supplements (142 mg/day) can interfere with magnesium absorption and disrupt the magnesium balance in the body.
4.1. Types of Magnesium Supplements
- Magnesium Oxide: A common but less bioavailable form.
- Magnesium Citrate: Well-absorbed and often recommended.
- Magnesium Chloride: Easily absorbed and gentle on the stomach.
- Magnesium Aspartate: Highly bioavailable.
- Magnesium Lactate: Another well-absorbed form.
- Magnesium Sulfate: Also known as Epsom salt, often used for baths.
4.2. Factors Affecting Magnesium Absorption
- Solubility: Magnesium forms that dissolve well in liquid are better absorbed.
- Dosage: High doses of other minerals like zinc can interfere with magnesium absorption.
- Individual Factors: Gut health and overall diet can influence absorption rates.
4.3. How to Choose the Right Supplement
When choosing a magnesium supplement, consider the following:
- Bioavailability: Opt for forms like citrate, chloride, or aspartate.
- Tolerance: Some forms can cause digestive issues in sensitive individuals.
- Dosage: Follow the recommended dosage and consult with a healthcare provider if necessary.
5. Magnesium in Medicines: Laxatives and Antacids
Magnesium is a primary ingredient in some laxatives. Phillips’ Milk of Magnesia, for example, provides 500 mg elemental magnesium (as magnesium hydroxide) per tablespoon. The directions advise taking up to 4 tablespoons/day for adolescents and adults. Although such a dose of magnesium is well above the safe upper level, some of the magnesium is not absorbed because of the medication’s laxative effect.
Magnesium is also included in some remedies for heartburn and upset stomach due to acid indigestion. Extra-strength Rolaids, for example, provides 55 mg elemental magnesium (as magnesium hydroxide) per tablet, although Tums is magnesium-free.
5.1. Magnesium as a Laxative
Magnesium-based laxatives work by drawing water into the intestines, which softens the stool and promotes bowel movements. Common types include:
- Magnesium Hydroxide: Found in Milk of Magnesia.
- Magnesium Citrate: Available as a liquid or powder.
- Magnesium Sulfate: Also known as Epsom salt, used as a saline laxative.
5.2. Magnesium in Antacids
Magnesium helps neutralize stomach acid, providing relief from heartburn and acid indigestion. Examples include:
- Magnesium Hydroxide: A common ingredient in antacids.
- Magnesium Carbonate: Used in some antacid formulations.
5.3. Considerations When Using Magnesium-Based Medicines
- Dosage: Follow the directions on the product label.
- Side Effects: Be aware of potential side effects like diarrhea.
- Interactions: Check for potential interactions with other medications.
6. Magnesium Intakes and Status: Are You Getting Enough?
Dietary surveys in the United States consistently show that many people consume less than the recommended amounts of magnesium. An analysis of data from the National Health and Nutrition Examination Survey (NHANES) of 2013–2016 found that 48% of Americans of all ages ingest less magnesium from food and beverages than their respective EARs. Adult men age 71 years and older and adolescent males and females are most likely to have low intakes.
In a study using data from NHANES 2003–2006 to assess mineral intakes among adults, average intakes of magnesium from food alone were higher among users of dietary supplements (350 mg for men and 267 mg for women, equal to or slightly exceeding their respective EARs) than among nonusers (268 mg for men and 234 for women). When supplements were included, average total intakes of magnesium were 449 mg for men and 387 mg for women, well above EAR levels.
No current data on magnesium status in the United States are available. Determining dietary intake of magnesium is the usual proxy for assessing magnesium status. NHANES has not determined serum magnesium levels in its participants since 1974, and magnesium is not evaluated in routine electrolyte testing in hospitals and clinics.
6.1. Prevalence of Low Magnesium Intake
Many individuals do not meet the recommended daily intakes of magnesium through diet alone. Factors contributing to low intake include:
- Poor Dietary Habits: Diets low in magnesium-rich foods.
- Food Processing: Refining grains reduces magnesium content.
- Lifestyle Factors: Stress and certain medications can deplete magnesium levels.
6.2. Impact of Supplement Use on Magnesium Intake
Individuals who take dietary supplements tend to have higher magnesium intakes compared to non-users. Supplementation can help bridge the gap between dietary intake and recommended levels.
6.3. Challenges in Assessing Magnesium Status
Assessing magnesium status remains a challenge due to the lack of routine testing and the limitations of current assessment methods.
7. Magnesium Deficiency: Symptoms and Risks
Symptomatic magnesium deficiency due to low dietary intake in otherwise-healthy people is uncommon because the kidneys limit urinary excretion of this mineral. However, habitually low intakes or excessive losses of magnesium due to certain health conditions, chronic alcoholism, and/or the use of certain medications can lead to magnesium deficiency.
Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. As magnesium deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms can occur. Severe magnesium deficiency can result in hypocalcemia or hypokalemia (low serum calcium or potassium levels, respectively) because mineral homeostasis is disrupted.
7.1. Early Signs and Symptoms
Recognizing the early signs of magnesium deficiency is crucial for timely intervention. These signs include:
- Loss of appetite
- Nausea
- Vomiting
- Fatigue
- Weakness
7.2. Advanced Symptoms of Magnesium Deficiency
As magnesium deficiency progresses, more severe symptoms can manifest, including:
- Numbness
- Tingling
- Muscle contractions and cramps
- Seizures
- Personality changes
- Abnormal heart rhythms
- Coronary spasms
7.3. Severe Consequences of Magnesium Deficiency
Severe magnesium deficiency can lead to serious health complications, such as:
- Hypocalcemia: Low serum calcium levels
- Hypokalemia: Low serum potassium levels
- Disruption of Mineral Homeostasis: Imbalance in essential minerals
8. Groups at Risk of Magnesium Inadequacy
Magnesium inadequacy can occur when intakes fall below the RDA but are above the amount required to prevent overt deficiency. The following groups are more likely than others to be at risk of magnesium inadequacy because they typically consume insufficient amounts or they have medical conditions (or take medications) that reduce magnesium absorption from the gut or increase losses from the body.
8.1. People with Gastrointestinal Diseases
The chronic diarrhea and fat malabsorption resulting from Crohn’s disease, gluten-sensitive enteropathy (celiac disease), and regional enteritis can lead to magnesium depletion over time. Resection or bypass of the small intestine, especially the ileum, typically leads to malabsorption and magnesium loss.
8.2. People with Type 2 Diabetes
Magnesium deficits and increased urinary magnesium excretion can occur in people with insulin resistance and/or type 2 diabetes. The magnesium loss appears to be secondary to higher concentrations of glucose in the kidney that increase urine output.
8.3. People with Alcohol Dependence
Magnesium deficiency is common in people with chronic alcoholism. In these individuals, poor dietary intake and nutritional status; gastrointestinal problems, including vomiting, diarrhea, and steatorrhea (fatty stools) resulting from pancreatitis; renal dysfunction with excess excretion of magnesium into the urine; phosphate depletion; vitamin D deficiency; acute alcoholic ketoacidosis; and hyperaldosteronism secondary to liver disease can all contribute to decreased magnesium status.
8.4. Older Adults
Older adults have lower dietary intakes of magnesium than younger adults. In addition, magnesium absorption from the gut decreases and renal magnesium excretion increases with age. Older adults are also more likely to have chronic diseases or take medications that alter magnesium status, which can increase their risk of magnesium depletion.
8.5. Strategies to Mitigate Risk
- Dietary Adjustments: Increase intake of magnesium-rich foods.
- Supplementation: Consider magnesium supplements under medical supervision.
- Monitoring: Regular monitoring of magnesium levels for at-risk groups.
9. Magnesium and Health: Addressing Key Conditions
Habitually low intakes of magnesium induce changes in biochemical pathways that can increase the risk of illness over time. This section focuses on four diseases and disorders in which magnesium might be involved: hypertension and cardiovascular disease, type 2 diabetes, osteoporosis, and migraine headaches.
9.1. Hypertension and Cardiovascular Disease
Hypertension is a major risk factor for heart disease and stroke. Studies to date, however, have found that magnesium supplementation lowers blood pressure, at best, to only a small extent. A meta-analysis of 12 clinical trials found that magnesium supplementation for 8–26 weeks in 545 hypertensive participants resulted in only a small reduction (2.2 mmHg) in diastolic blood pressure. The dose of magnesium ranged from approximately 243 to 973 mg/day. The authors of another meta-analysis of 22 studies with 1,173 normotensive and hypertensive adults concluded that magnesium supplementation for 3–24 weeks decreased systolic blood pressure by 3–4 mmHg and diastolic blood pressure by 2–3 mmHg. The effects were somewhat larger when supplemental magnesium intakes of the participants in the nine crossover-design trials exceeded 370 mg/day. A diet containing more magnesium because of added fruits and vegetables, more low-fat or nonfat dairy products, and less fat overall was shown to lower systolic and diastolic blood pressure by an average of 5.5 and 3.0 mmHg, respectively. However, this Dietary Approaches to Stop Hypertension (DASH) diet also increases intakes of other nutrients, such as potassium and calcium, that are associated with reductions in blood pressure, so any independent contribution of magnesium cannot be determined.
In 2022, FDA approved a qualified health claim for conventional foods and dietary supplements that contain magnesium. One example of this claim states, “Consuming diets with adequate magnesium may reduce the risk of high blood pressure (hypertension). However, FDA has concluded that the evidence is inconsistent and inconclusive.” FDA also specifies that foods and dietary supplements carrying this claim on their labels must provide at least 84 mg of magnesium per serving and, for dietary supplements, no more than 350 mg.
Several prospective studies have examined associations between magnesium intakes and heart disease. The Atherosclerosis Risk in Communities study assessed heart disease risk factors and levels of serum magnesium in a cohort of 14,232 White and African-American men and women age 45 to 64 years at baseline. Over an average of 12 years of follow-up, individuals in the highest quartile of the normal physiologic range of serum magnesium (at least 0.88 mmol/L) had a 38% reduced risk of sudden cardiac death compared with individuals in the lowest quartile (0.75 mmol/L or less). However, dietary magnesium intakes had no association with risk of sudden cardiac death. Another prospective study tracked 88,375 female nurses in the United States to determine whether serum magnesium levels measured early in the study and magnesium intakes from food and supplements assessed every 2 to 4 years were associated with sudden cardiac death over 26 years of follow-up. Women in the highest compared with the lowest quartile of ingested and plasma magnesium concentrations had a 34% and 77% lower risk of sudden cardiac death, respectively. Another prospective population study of 7,664 adults age 20 to 75 years in the Netherlands who did not have cardiovascular disease found that low urinary magnesium excretion levels (a marker for low dietary magnesium intake) were associated with a higher risk of ischemic heart disease over a median follow-up period of 10.5 years. Plasma magnesium concentrations were not associated with risk of ischemic heart disease. A systematic review and meta-analysis of prospective studies found that higher serum levels of magnesium were significantly associated with a lower risk of cardiovascular disease, and higher dietary magnesium intakes (up to approximately 250 mg/day) were associated with a significantly lower risk of ischemic heart disease caused by a reduced blood supply to the heart muscle.
Higher magnesium intakes might reduce the risk of stroke. In a meta-analysis of seven prospective trials with a total of 241,378 participants, an additional 100 mg/day magnesium in the diet was associated with an 8% decreased risk of total stroke, especially ischemic rather than hemorrhagic stroke. One limitation of such observational studies, however, is the possibility of confounding with other nutrients or dietary components that could also affect the risk of stroke.
A large, well-designed clinical trial is needed to better understand the contributions of magnesium from food and dietary supplements to heart health and the primary prevention of cardiovascular disease.
9.2. Type 2 Diabetes
Diets with higher amounts of magnesium are associated with a significantly lower risk of diabetes, possibly because of the important role of magnesium in glucose metabolism. Hypomagnesemia might worsen insulin resistance, a condition that often precedes diabetes, or it might be a consequence of insulin resistance. Diabetes leads to increased urinary losses of magnesium, and the subsequent magnesium inadequacy might impair insulin secretion and action, thereby worsening diabetes control.
Most investigations of magnesium intake and risk of type 2 diabetes have been prospective cohort studies. A meta-analysis of seven of these studies, which included 286,668 patients and 10,912 cases of diabetes over 6 to 17 years of follow-up, found that a 100 mg/day increase in total magnesium intake decreased the risk of diabetes by a statistically significant 15%. Another meta-analysis of eight prospective cohort studies that followed 271,869 men and women over 4 to 18 years found a significant inverse association between magnesium intake from food and risk of type 2 diabetes; the relative risk reduction was 23% when the highest to lowest intakes were compared.
A 2011 meta-analysis of prospective cohort studies of the association between magnesium intake and risk of type 2 diabetes included 13 studies with a total of 536,318 participants and 24,516 cases of diabetes. The mean length of follow-up ranged from 4 to 20 years. Investigators found an inverse association between magnesium intake and risk of type 2 diabetes in a dose-responsive fashion, but this association achieved statistical significance only in individuals who were overweight (body mass index [BMI] 25 or higher) but not in normal-weight individuals (BMI less than 25). Again, a limitation of these observational studies is the possibility of confounding with other dietary components or lifestyle or environmental variables that are correlated with magnesium intake.
Only a few small, short-term clinical trials have examined the potential effects of supplemental magnesium on control of type 2 diabetes and the results are conflicting. For example, 128 patients with poorly controlled diabetes in a Brazilian clinical trial received a placebo or a supplement containing either 500 mg/day or 1,000 mg/day magnesium oxide (providing 300 or 600 mg elemental magnesium, respectively). After 30 days of supplementation, plasma, cellular, and urine magnesium levels increased in participants receiving the larger dose of the supplement, and their glycemic control improved. In another small trial in Mexico, participants with type 2 diabetes and hypomagnesemia who received a liquid supplement of magnesium chloride (providing 300 mg/day elemental magnesium) for 16 weeks showed significant reductions in fasting glucose and glycosylated hemoglobin concentrations compared with participants receiving a placebo, and their serum magnesium levels became normal. In contrast, neither a supplement of magnesium aspartate (providing 369 mg/day elemental magnesium) nor a placebo taken for 3 months had any effect on glycemic control in 50 patients with type 2 diabetes who were taking insulin.
The American Diabetes Association states that there is insufficient evidence to support the routine use of magnesium to improve glycemic control in people with diabetes. It further notes that there is no clear scientific evidence that vitamin and mineral supplementation benefits people with diabetes who do not have underlying nutritional deficiencies.
9.3. Osteoporosis
Magnesium is involved in bone formation and influences the activities of osteoblasts and osteoclasts. Magnesium also affects the concentrations of both parathyroid hormone and the active form of vitamin D, which are major regulators of bone homeostasis. Several population-based studies have found positive associations between magnesium intake and bone mineral density in both men and women. Other research has found that women with osteoporosis have lower serum magnesium levels than women with osteopenia and those who do not have osteoporosis or osteopenia. These and other findings indicate that magnesium deficiency might be a risk factor for osteoporosis.
Although limited in number, studies suggest that increasing magnesium intakes from food or supplements might increase bone mineral density in postmenopausal and elderly women. For example, one short-term study found that 290 mg/day elemental magnesium (as magnesium citrate) for 30 days in 20 postmenopausal women with osteoporosis suppressed bone turnover compared with placebo, suggesting that bone loss decreased.
Diets that provide recommended levels of magnesium enhance bone health, but further research is needed to elucidate the role of magnesium in the prevention and management of osteoporosis.
9.4. Migraine Headaches
Magnesium deficiency is related to factors that promote headaches, including neurotransmitter release and vasoconstriction. People who experience migraine headaches have lower levels of serum and tissue magnesium than those who do not.
However, research on the use of magnesium supplements to prevent or reduce symptoms of migraine headaches is limited. Three of four small, short-term, placebo-controlled trials found modest reductions in the frequency of migraines in patients given up to 600 mg/day magnesium. The authors of a review on migraine prophylaxis suggested that taking 300 mg magnesium twice a day, either alone or in combination with medication, can prevent migraines.
In their evidence-based guideline update, the American Academy of Neurology and the American Headache Society concluded that magnesium therapy is probably effective for migraine prevention. Because the typical dose of magnesium used for migraine prevention exceeds the UL, this treatment should be used only under the direction and supervision of a health care provider.
9.5. Summary of Health Benefits
- Cardiovascular Health: May help lower blood pressure and reduce the risk of heart disease.
- Diabetes Management: Aids in glucose metabolism and insulin sensitivity.
- Bone Health: Contributes to bone formation and density.
- Migraine Relief: Can help reduce the frequency and severity of migraines.
10. Health Risks from Excessive Magnesium
Too much magnesium from food does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine. However, high doses of magnesium from dietary supplements or medications often result in diarrhea that can be accompanied by nausea and abdominal cramping. Forms of magnesium most commonly reported to cause diarrhea include magnesium carbonate, chloride, gluconate, and oxide. The diarrhea and laxative effects of magnesium salts are due to the osmotic activity of unabsorbed salts in the intestine and colon and the stimulation of gastric motility.
Very large doses of magnesium-containing laxatives and antacids (typically providing more than 5,000 mg/day magnesium) have been associated with magnesium toxicity, including fatal hypermagnesemia in a 28-month-old boy and an elderly man. Symptoms of magnesium toxicity, which usually develop after serum concentrations exceed 1.74–2.61 mmol/L, can include hypotension, nausea, vomiting, facial flushing, retention of urine, ileus, depression, and lethargy before progressing to muscle weakness, difficulty breathing, extreme hypotension, irregular heartbeat, and cardiac arrest. The risk of magnesium toxicity increases with impaired renal function or kidney failure because the ability to remove excess magnesium is reduced or lost.
The FNB has established ULs for supplemental magnesium for healthy infants, children, and adults (see Table 3). For many age groups, the UL appears to be lower than the RDA. This occurs because the RDAs include magnesium from all sources—food, beverages, dietary supplements, and medications. The ULs include magnesium from only dietary supplements and medications; they do not include magnesium found naturally in food and beverages.
| Age | Male | Female | Pregnant | Lactating |
|---|---|---|---|---|
| Birth to 12 months | None established | None established | ||
| 1–3 years | 65 mg | 65 mg | ||
| 4–8 years | 110 mg | 110 mg | ||
| 9–18 years | 350 mg | 350 mg | 350 mg | 350 mg |
| 19+ years | 350 mg | 350 mg | 350 mg | 350 mg |
10.1. Common Side Effects of Excessive Magnesium
High doses of magnesium, particularly from supplements or medications, can lead to several side effects:
- Diarrhea: The most common side effect.
- Nausea: Often accompanies diarrhea.
- Abdominal Cramping: Due to increased intestinal activity.
10.2. Symptoms of Magnesium Toxicity
Severe magnesium toxicity can result in:
- Hypotension: Low blood pressure.
- Nausea and Vomiting: Persistent gastrointestinal distress.
- Facial Flushing: Redness of the face.
- Urinary Retention: Difficulty in urination.
- Ileus: Obstruction of the intestines.
- Depression and Lethargy: Mental and physical sluggishness.
- Muscle Weakness: Impaired muscle function.
- Difficulty Breathing: Respiratory distress.
- Irregular Heartbeat: Cardiac arrhythmias.
- Cardiac Arrest: In extreme cases.
10.3. Tolerable Upper Intake Levels (ULs) for Magnesium
The Tolerable Upper Intake Levels (ULs) for supplemental magnesium are set to prevent adverse health effects. These levels are:
- Children 1-3 years: 65 mg
- Children 4-8 years: 110 mg
- Children and Adults 9+ years: 350 mg
These ULs apply to magnesium from supplements and medications, not from food.
11. Interactions with Medications: What to Watch Out For
Several types of medications have the potential to interact with magnesium supplements or affect magnesium status. A few examples are provided below. People taking these and other medications on a regular basis should discuss their magnesium intakes with their health care providers.
11.1. Bisphosphonates
Magnesium-rich supplements or medications can decrease the absorption of oral bisphosphonates, such as alendronate (Fosamax), used to treat osteoporosis. Use of magnesium-rich supplements or medications and oral bisphosphonates should be separated by at least 2 hours.
11.2. Antibiotics
Magnesium can form insoluble complexes with tetracyclines, such as demeclocycline (Declomycin) and doxycycline (
