CISRA’s Synergy Health Newsletter

Issue 6. Magnesium Supplementation: Tips on How to Restore Magnesium Levels Successfully and Without Side Effects (2000)

by J. C. Waterhouse, Ph.D.

Summary of Key Points

Western diet and lifestyle factors have a tendency to lead to low magnesium levels and the types of tests used are often inadequate to detect the deficiency. Some types of magnesium, such as amino acid chelated forms like magnesium glycinate, are better absorbed. Chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS), and a number of other conditions may be helped by magnesium supplementation. Taking more magnesium than the gastrointestinal system can absorb (particularly of the more poorly absorbed types) can cause gas and diarrhea.

Magnesium is being increasingly viewed as a mineral that may play an important role in treating a variety of illnesses. Our current diet of refined and processed foods in industrialized countries seems to put more and more people at risk for magnesium deficiency. This article will discuss some issues related to successfully detecting and reversing magnesium deficiency in the context of chronic fatigue syndrome and fibromyalgia. Then, a brief discussion of the role of magnesium deficiency in heart disease, diabetes, headaches, urinary incontinence and other diseases will follow.

Ever since the report in the medical journal, Lancet (March 30, 1991), of low magnesium inside red blood cells in chronic fatigue immune dysfunction (CFIDS or CFS) patients, many have taken magnesium in various forms and found it helpful, as the study did. Intracellular testing of sublingual epithelial (buccal) cells has shown magnesium to also be low in the vast majority of fibromyalgia patients tested (unpublished data using IntraCellular Diagnostics Lab’s test, Norman Shealy, M.D., Ph.D., Springfield, MO, personal communication). However, there are potential problems in fully restoring the intracellular magnesium levels throughout the body and doing it without side effects of excess gas and diarrhea. I will give here a brief account of my experience with supplementing with magnesium to show some of the problems that may be involved and how they may be overcome.

Some types of magnesium that have been available for many years, like magnesium carbonate and magnesium oxide, are absorbed by the body to a fairly limited extent. It turned out that when I tried to increase my dose of magnesium oxide or carbonate above 400 mg per day I had increased diarrhea (Note: others may not be quite as sensitive as I was, since I was prone to diarrhea from my food sensitivities and irritable bowel syndrome). About 7 years ago I tried magnesium sulfate injections, which I continued for several months and received some benefit from (I felt stronger, more relaxed and had a little more energy). However, when I increased the injections to twice a week I began to get allergic reactions at the site of the injection. The injections are also rather painful and so I finally discontinued them. I continued taking lower doses of magnesium oxide tablets thinking that perhaps this would be sufficient. However, a year later, laboratory testing showed my serum and red blood cell levels of magnesium were still too low. The red blood cell levels must be distinguished from the serum level (the serum is the fluid portion of the blood, without red or white blood cells). Serum tests are the ones usually used, although they are not usually automatically included in standard blood chemistry panels now. The serum magnesium levels may be normal even when the magnesium levels within cells are abnormally low. The red blood cell tests may not even be the most sensitive intracellular tests (see below), so my actual tissue levels may have been even lower than the test indicated.

After finding that my magnesium levels were still low, my environmental and nutritional physician, Dr. Michael Rosenbaum (author, with Dr. Murray Susser, of Solving the Puzzle of Chronic Fatigue Syndrome, 1992, Life Sciences Press) recommended that I take magnesium glycinate. He said this was a newer, better absorbed amino acid chelate form of magnesium. He also told me to take the magnesium with food and at separate meals from the calcium and from zinc (there appears to be disagreement on whether calcium and magnesium should be taken separately and now I seem to do fine with a combination calcium and magnesium tablet). I was skeptical at first, as my past experience led me to believe I would require injections in order for my body to absorb it adequately and avoid diarrhea. However, Dr. Rosenbaum assured my that this newer type of magnesium was very well absorbed and that it was safer than the injections. So I began taking it and found I could take 1000 mg or more per day without getting diarrhea. I continued for several months until I began to have diarrhea again. I then cut back my dose to about 400 mg of magnesium per day and the diarrhea stopped. The body tends to reduce its rate of absorption when magnesium is no longer deficient, so presumably my body now had plenty of magnesium and thus was absorbing less. On the whole, my experiences showed that although the effect of magnesium supplementation on my chronic fatigue syndrome and fibromyalgia symptoms was a modest one, it did produce a significant increase in muscle strength, my ability to relax, and my general sense of well-being.

However, now since my magnesium levels are restored, I find I have to remember to be careful not to take too much magnesium, since any kind of magnesium now causes diarrhea if I exceed my usual 400-475 mg level from all sources, including my diet. Since my body has plenty of magnesium, less is absorbed, leaving more in the gastrointestinal tract. Too much extra unabsorbed magnesium in the intestines causes retention of fluid in the stool and results in increased gas and diarrhea. This effect is widely known and is the basis of the use of the laxative, Milk of Magnesia, which is made from the poorly absorbed magnesium oxide form of the mineral. The knowledge of this laxative effect can be useful, since now I know I can take a small amount of extra magnesium when needed to help relieve occasional constipation (e.g., in my case, I raise the dose to 500-550 mg once or twice a week, as needed to soften the stool; for others the amount needed may differ).

According to the National Research Council, the recommended daily intake of magnesium per day is 350 mg for men and 280 mg for women, with lower levels for children (see Kirschmann & Kirschmann, 1996, Nutrition Almanac , McGraw-Hill). I have seen other sources recommending somewhat higher levels (e.g., 450 for men and 315 for women). As discussed above, if your intracellular levels of magnesium have been depleted, as they have in many people eating the overly-refined and processed Western diet, you may need to take higher levels of the well-absorbed types of magnesium for a while, until the levels inside the cells have returned to normal. In my case, it took several months at 1000 mg/day of magnesium. For those who prefer to rely on dietary sources, foods that are rich sources of magnesium include seafood, whole grains, dark green vegetables, molasses and nuts.

The CFIDS Chronicle’s article on Dr. Mildred Seelig’s work indicates there are other, probably more accurate means of testing your magnesium levels than the red blood cell measurements (Winter, 1997, The CFIDS Association, Charlotte, NC). The sublingual epithelial buccal cell test she refers to in her article is available from IntraCellular Diagnostics (800-874-4804). The serum and red blood cell test I had done was from Balco Lab (415-697-6708). Or if you can’t afford testing, you might just consider taking the magnesium until your body indicates by the gas and diarrhea that it probably doesn’t need any more (but be sure to get your doctor’s approval for the trial–taking extra magnesium may not be advisable for certain patients, particularly those with certain types of kidney disease; if you want to find a nutritionally-trained doctor, sources include the AAEM: 316-684-5500, http://aaem.com, or ACAM: 714/583-7666, http://acam.org). It might be best to start with 200 mg magnesium and then increase the dosage over several days. This method seems to be a “common sense” approach, though it has not been strictly verified to my knowledge.

There are many types and brands of magnesium supplements. There are two different types of magnesium available from CFIDS, Fibromyalgia and MS Health Resource, Inc., a mail order supplement company (formerly CFIDS Buyer’s Club, 800-366-6056, www.Immunesupport.com). One type is combined with malic acid and is sometimes recommended for CFS or fibromyalgia. I could not take the type with malic acid, probably due to my immune sensitivity/allergy to apples, one of the sources of malic acid often used. The other type of calcium and magnesium supplement they have, uses an amino acid chelate form (Bio Balanced Calcium Magnesium), which like the magnesium glycinate, should be well absorbed. There is also the Tyler brand available by mail order from N.E.E.D.S. (800-634-1380). It comes in capsules and is composed primarily of magnesium glycinate, with smaller amounts of magnesium lysinate and aspartate (it is hypoallergenic and contains no binders or fillers and may be removed from capsules). N.E.E.D.S. (http://needs.com) also carries the less expensive KAL brand magnesium glycinate (Editor’s Note, 2006: I have recently found that the KAL brand contains a more allergenic form of cellulose and I now use Solgar’s Chelated Magnesium or Tyler’s magnesium aspartate — see Issue 9 for my current list of supplements), which may sometimes be found in health food stores as well. I have heard some people recommend magnesium aspartate, however I have heard others have problems with too much aspartate. Magnesium citrate is another form that some people tolerate and others do not. A few people may be so magnesium deficient or have difficulty taking pills due to nausea and may instead use weekly intravenous magnesium sulfate to restore their levels to normal.

The common occurrence of magnesium deficiency in CFS/CFIDS and FMS may turn out to be connected with Dr. St. Amand’s theory involving excess phosphate as the cause of fibromyalgia and related disorders. Excess phosphate is a contributing cause of magnesium deficiency (IntraCellular Diagnostics Lab manual and discussion and references, below). Thus, magnesium replacement might be a beneficial preliminary or adjunct to his treatment method using guaifenesin (see the new book by St. Amand, R. Paul, M.D. ,and Claudia Marek, M.A. 1999. What Your Doctor May Not Tell You About Fibromyalgia: The Revolutionary Treatment that Can Reverse the Disease . Warner Books, New York, see note at end of article regarding Dr. St. Amand’s opinion on this). Research in animals has also shown that a larger magnesium intake helps protect them, to some degree, from the effects of excess phosphate intake (Werbach, Nutritional Influences in Mental Illness ; Hogan, 1950, J. Nutr. 41:203).

Moderate to mild magnesium deficiencies are fairly common in the general population, even in those without CFS or fibromyalgia. Research done by IntraCellular Diagnostics in conjunction with the prestigious Johns Hopkins Medical School in 1993 has shown that correcting magnesium deficiencies are of great help in reducing the occurrence of heart attacks and arrhythmias. A recent study in the American Journal of Hypertension (1999, 12:747) has shown that low intake of magnesium may be linked with insulin resistance, which can contribute to obesity and diabetes. In another study, low magnesium intake was found to be an independent predictor for adult onset diabetes (Salmeron, 1997, J. Amer. Med. Assoc. 277:472-477). A study in the International Journal of Epidemiology (28: 645, 1999) showed low magnesium is a risk factor for heart disease. Studies have shown that magnesium supplements help mitral valve prolapse (Lichodziejewska et al, 1997, Am J. Cardiol, 79(6):768-72) and attention deficit hyperactivity disorder (Starobrat-Hermelin et. al., 1997, Magnes. Res, 44(4): 149-56). A double blind placebo controlled study of women with urinary incontinence and a sense of urine urgency found that 350 to 700 mg magnesium taken twice per day helped reduce symptoms in 55% of patients (Gordon et al, 1998, Brit. J. Obstetrics and Gynecology 105:667-669). There has also been some success using magnesium to relieve various types of headaches, including migraines (Mauskop et al, 1996, Headache 36(3):154-60).

To give an idea of severe magnesium deficiency that shows up in abnormally low serum magnesium (the most commonly used, but least sensitive measure), I will present some additional information below. It should be remembered that one may have a moderate to mild deficiency that may be significant, yet may not show up as deficient when measuring serum levels. Rather, the more sensitive red blood cell or buccal cell tests discussed above may be necessary to detect the deficiency.

According to a standard medical textbook, Harrison’s Principles of Internal Medicine (Fauci et al, 1997, McGraw Hill, pages 2263-2266), symptoms of severe magnesium deficiency (hypomagnesemia) include anorexia, nausea, vomiting, lethargy, weakness, paresthesia (a tingly or numb sensation), irritability, decreased attention span and mental confusion. Common causes of magnesium deficiency include: inadequate supply in diet, chronic diarrhea, diuretics, digitalis, fat malabsorption (which may arise from several gastrointestinal disorders), pancreatitis, prolonged cellulose phosphate ingestion (used to reduce calcium absorption), chronic alcoholism, alcoholic withdrawal, various endocrine and kidney diseases and total parenteral nutrition. With very low magnesium, hypocalcemia occurs and causes tetany, a condition with symptoms that include cramps, convulsions and twitching of muscles. In those with prolonged severe malabsorption or chronic alcoholism, there may be a number of other nutrient deficiencies as well, such as low potassium, phosphorous and B vitamins. Low potassium levels may be difficult to correct when there is a deficiency of magnesium, and this can be very important for certain heart conditions, particularly cardiac arrhythmias. The textbook also states that hypomagnesemic patients with potentially serious cardiac arrhythmias should be given intravenous magnesium sulfate. They note that magnesium can act in a way that resembles a calcium channel blocker (a type of drug used for high blood pressure), which partly explains its importance for normal heart function. The opposite condition, hypermagnesemia (excessively high magnesium in the blood) is rare, occurring mainly in patients with end-stage kidney disease (aggravated in patients taking large amounts of magnesium found in certain antacid and laxatives), or when excess magnesium is given to treat eclampsia. Hypermagnesemia is also found sometimes in adrenal insufficiency and rhabdomyolysis (due to release from muscle), and can cause a depression of the central nervous system.

Additional contributing factors in magnesium deficiency identified by Dr. S. A. Rogers’ book ( The E.I. Syndrome: An Rx For Environmental Illness, 1986, Prestige Publishing, Syracuse, NY) include exposure to toxic aluminum or cadmium, high phosphate diets, excessive calcium intake, eating cooked foods (particularly when the liquid is thrown out), eating processed foods, high doses of vitamin C, high fat diets, aging, chronic disease, malabsorption due to food allergy or the yeast Candida , fluoridation and inadequate stomach acidity. Rogers also stresses the role of magnesium deficiency in immune dysfunction, energy metabolism problems, muscle spasms, osteoporosis, premenstrual syndrome, periodontal disease, prevention of kidney stones, neurologic problems, chronic pain and impotency, as well as the importance of adequate manganese to accompany the magnesium. In addition, Haigney et al (1995, Circulation 92:2190-2197) refers to several scientific publications linking increased levels of sudden coronary deaths to areas with low magnesium levels in the water supply, providing further support for its role in maintaining health.

[Note: Dr. St. Amand believes that the primary benefit in fibromyalgia of additional calcium and magnesium in the form of supplements is that they bind phosphate in the gut, thus reducing a phosphate excess. He used to recommend calcium and magnesium to his patients because it reduced the dosage of uricosuric gout medication that his patients needed in order to achieve progress because of its binding the dietary phosphate. Now that he uses guaifenesin, which lacks the side effects at increased doses that occurred with the gout medications, he no longer needs patients to use calcium and magnesium supplements to help boost the medication’s effect. Instead, he just increases the dose of guaifenesin (up to 4800 mg/day) until they respond. I bring this up as evidence that calcium and magnesium supplements are not necessary for the improvement Dr. St. Amand has observed with guaifenesin or other uricosuric drugs. However, to avoid osteoporosis, Dr. St. Amand does usually recommend calcium supplementation, since it is often inadequately supplied by diet. He has no objections if patients choose to add magnesium, though he thinks it is usually unnecessary. He prefers the citrate forms of the minerals due to their alkalinizing effects (which can enhance phosphate excretion) and points out that both calcium and magnesium are better absorbed with food. Acknowledgements: The editor wishes to thank Dr. R. Paul St. Amand for reviewing and providing comments on this article and some of the other articles.] 

Editorial Note (2008):  For an overview of what has helped me most in the years following this article, see transcript of a talk I gave in 2005A Short Introduction to the Marshall Protocol (2007) and http://AutoimmunityResearch.org.  The Marshall Protocol reduces inflammation that probably contributes to low magnesium levels by eliminating hard-to-detect bacterial pathogens.

Disclaimer: All articles provided on the SynergyHN website are for information only and are not intended as medical advice. An effort is made to be accurate, however readers are advised to verify what is presented here and check with their own doctors. No guarantee of accuracy is expressed or implied. Neither CISRA nor the author receives any funding or income from any organization or manufacturer connected with the topics discussed.

Written by synergyhn

October 29, 2008 at 11:08 pm

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