Magnesium, calcium, and vitamin D supplementation

This past month I realized my lack of awareness about the value of magnesium, calcium, and vitamin D.  So I thought I’d share what I’m learning that I think we all deserve to know. These three micronutrients actually have much in common, but I’ll address each one separately, beginning with magnesium.

7 of 10 adults have low magnesium but don’t realize it

You probably know magnesium best for its role in laxatives (Milk of Magnesia, magnesium citrate) or in antacids (Maalox, Rolaids). But magnesium plays a part in more than 300 metabolic reactions such as energy production, DNA synthesis, insulin action, glucose regulation, lipid metabolism, blood pressure control, muscle contraction, nerve innervations, bone strength and much more.

5-nutrient-deficiencies-300What about deficiency? Low magnesium levels are linked to a number of common illnesses including heart disease. [1]  So when I you consider that a mere 1 in 4 adults in the U.S. consume even the recommended daily allowance (RDA) of approximately 400 mg daily, [2] it makes sense to consider taking supplements.

The challenge comes in discovering whether a magnesium deficiency exists. Why doesn’t a routine blood (serum) test conducted by your doctor reflect tissue magnesium levels or function? One reason is because your blood is the homeostatic fluid of your body and will adjust to keep your blood levels optimal—even when your tissue magnesium may be insufficient.

Consider that 99.7 percent of total body magnesium is found in bones, muscles and tissues, while you’ll only measure 0.3 percent in serum. Therefore, serum magnesium levels have little correlation with your magnesium level in specific body tissues. [3] Even the other methods of detecting low magnesium (from red blood cells, saliva, urine, and magnesium tolerance tests) are similarly not satisfactory. Moreover, magnesium serum levels reference range for normal is too low and already represents a mild magnesium deficiency.

Thus, because the diagnosis of low magnesium by lab tests is vastly underestimated, [4] magnesium deficiency is now considered the silent epidemic of our times. Since we cannot look to lab tests to discover low magnesium, I recommend you know the illnesses associated with it and its symptoms and signs. Of course, it’s better just take a daily supplement if you are at risk for low levels.

Low magnesium linked to illnesses

Recently I’ve had several middle-age patients with the complaint of leg cramps—one symptom of low magnesium, calcium or potassium in the muscles. Don’t be fooled into thinking you have to have obvious signs of low magnesium, such as fatigue, nausea, muscle weakness, numbness, tingling, muscle spasms or depression. There are many very common illnesses related to low magnesium that easily get overlooked and which you probably have never been told about which I’ll now share.

Low magnesium levels are linked to an increased risk for osteoporosis, anxiety, irritability, depression, attention deficit hyperactivity disorder (ADHD), and many other illnesses. Low magnesium is proven to be associated with migraine headaches: a small case control study [5] in 2007 of 140 migraine patients were analyzed for magnesium levels and researchers reported that serum magnesium was significantly lower in migraine patients compared to the normal population—and that the lower the magnesium level, the more frequent the migraine attacks.  Also, it is known that magnesium deficiency is well-established in patients with diabetes mellitus [6] and cardiovascular disease. [7]

Magnesium supplementation linked to improved health

Magnesium is standard medical treatment for certain conditions. For example, it is used to treat preeclampsia to prevent seizures in pregnancy (called eclampsia). It has been used with some success in heart attacks and heart arrhythmias. Magnesium has a muscle-relaxing effect so it can sometimes work to treat restless leg syndrome and insomnia. Magnesium has also been reported to reduce symptoms in multiple sclerosis, fibromyalgia, and chronic fatigue syndrome (CFS). For skin, magnesium chloride is used for disinfection, plus it has been shown to treat skin infections and speed up wound healing as is demonstrated from Dead Sea salt (its most abundant minerals are magnesium and chloride). [8] Magnesium may help those suffering with chronic fatigue or pain from fibromyalgia according to the National Institutes of Health.  There is some evidence that it reduces symptoms of premenstrual syndrome, kidney stones, hearing loss, asthma and chronic obstructive pulmonary disease (COPD).

In a recent study [9] it was found that patients with type 2 diabetes, magnesium supplementation with 300mg daily for three months significantly lowered fasting blood sugars (184 mg/dl to 125 mg/dl) and two-hour postprandial blood sugars (from 239 mg/dl to 189 mg/dl but no change in those taking placebo). Magnesium supplementation also improved lipid panels and blood pressure in this study. Another study show found similar findings, [10] and yet another found that low magnesium levels correlates with worsened diabetic retinopathy and blindness. [11]Another fairly recent study took this even further and found that for those of us who do not have diabetes, there is a protective (preventive) effect from magnesium supplementation.

In this study [12] researchers found that it improved the metabolic profile, insulin sensitivity, and blood pressure of normal weight people with high insulin levels. This is very important because approximately one in three (or more) American adults already have insulin resistance and/or metabolic syndrome, but most don’t know it yet. Another study [13] showed the same thing in non-diabetic subjects, and emphasized the need to “optimize magnesium status” to prevent insulin resistance and subsequent type 2 diabetes.

What about the effect of magnesium supplementation on lowering risk of heart attack? Two new studies have shown that a higher magnesium intake significantly helps reduce heart disease. For example, a recent study [14] of 414 consecutive heart disease patients <50 years had their serum magnesium levels measured and were then followed for two years. Researchers found an eight-fold higher heart attack rate among those with low magnesium levels (bottom one-fourth) compared to those in the highest levels (top one-fourth).  Equally compelling data [15] from the ongoing Framingham Heart Study recently discovered that the lower the magnesium intake the higher the atherosclerosis seen on imaging in people with no prior heart trouble. Even a 50 mg/day increment increase of magnesium had a 22 percent lower arterial calcification, and a 58 percent lower arterial calcification in the lowest magnesium intake group compared to the highest magnesium intake group. This association was stronger in women than men.  As for stroke (another form of atherosclerosis), a meta-analysis of seven studies, totaling more than 241,000 people found that an extra 100 milligrams of magnesium a day reduced their risk of stroke by 8 percent as reported in the Feb 2012 American Journal of Clinical Nutrition. [16]

What lowers your magnesium?

Be aware of the ways your body magnesium levels can be reduced:

  1. Refined sugars cause increased urinary losses.
  2. Stress uses it up more quickly (anxiety, insomnia, heavy exercise, surgery, etc.).
  3. Medications: diuretics (Lasix); proton-pump inhibitors (Prilosec); [17] [18] zinc supplements (over 142 mg/day); [19] gentamicin, digoxin, penicillamine, and chemotherapy drugs.
  4. Calcium supplementation with more than 1:1 ratio calcium to magnesium.
  5. Alcohol consumption increases urinary losses (30 percent of alcoholics).
  6. Kidney, liver or heart disease.
  7. Poor intestinal health reduces absorption. Crohn’s, colitis, celiac, diarrhea states.
  8. Hyperthyroidism, diabetes mellitus, SIADH (anti-diuretic hormone excess)
  9. Age over 55 decreases absorption and increases urinary losses.
  10. Diet: some evidence indicates our soil and crops are becoming depleted.

Which magnesium supplements?

Did you know that magnesium oxide is the second most abundant compound in the Earth’s crust (35 percent)? Yes, and it’s also the most prevalent form of magnesium supplement I see being used.

Much better are magnesium compounds that dissolve well in liquid, are more completely absorbed in the gut and are bioavailable. According to studies [20] [21] these are not magnesium oxide or magnesium sulfate, but rather magnesium aspartate, magnesium citrate, magnesium lactate and magnesium chloride.

Also, magnesium is absorbed easily through your skin and you can supplement with magnesium oil or Epsom salt baths.  Even if you feel you eat enough magnesium from nuts, fish, meat, dark green vegetables, legumes, whole grains and fruits, you can still supplement and be the better for it.

This was all compelling information for me! I invite you to read my next article about calcium supplementation.

To feeling good for health,

Michael Cutler, M.D.
Easy Health Options

[1] King DE, Mainous AG 3rd, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. J Am Coll Nutr. 2005 Jun;24(3):166-71.
[2] Combs GF, Nielsen FH. Health significance of calcium and magnesium: Examples from human studies. In: World Health Organization. Calcium and Magnesium in Drinking Water: Public health significance. Geneva: World Health Organization Press; 2009.
[3] Gibson, RS. Principles of Nutritional Assessment, 2nd ed. New York, NY: Oxford University Press, 2005.
[4] Wilhelm Jahnen-Dechent, Markus Ketteler. Magnesium Basics. Clin Kidney J (2012) 5 (Suppl 1): i3-i14.
[5] Talebi M, Savadi-Oskouei D, et al. Relation between serum magnesium level and migraine attacks. Neurosciences (Riyadh). 2011 Oct;16(4):320-3.
[6] de Valk HW. Magnesium in diabetes mellitus. Neth J Med. 1999 Apr;54(4):139-46.
[7] King DE, Mainous AG 3rd, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. J Am Coll Nutr. 2005 Jun;24(3):166-71.
[8] Oyarzúa Alarcón P, Sossa K, Contreras D, Urrutia H, Nocker A. Antimicrobial properties of magnesium chloride at low pH in the presence of anionic bases. Magnes Res. 2014 Apr-Jun;27(2):57-68.
[9] Solati M, Ouspid E, Hosseini S, Soltani N, Keshavarz M, Dehghani M. Oral magnesium supplementation in type II diabetic patients. Med J Islam Repub Iran. 2014 Jul 15;28:67.
[10] Rodríguez-Morán M1, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double-blind controlled trial.  Diabetes Care. 2003 Apr;26(4):1147-52.
[11] de Valk HW. Magnesium in diabetes mellitus. Neth J Med. 1999 Apr;54(4):139-46.
[12] Rodríguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves the metabolic profile of metabolically obese, normal-weight individuals: a randomized double-blind placebo-controlled trial. Arch Med Res. 2014 Jul;45(5):388-93.
[13] Mooren FC, Krüger K, Völker K, Golf SW, Wadepuhl M, Kraus A. Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects – a double-blind, placebo-controlled, randomized trial.  Diabetes Obes Metab. 2011 Mar;13(3):281-4.
[14] An G, Du Z, et al.  Association between low serum magnesium level and major adverse cardiac events in patients treated with drug-eluting stents for acute myocardial infarction. PLoS One. 2014 Jun 5;9(6):e98971.
[15] Hruby A, O’Donnell CJ, et al. Magnesium intake is inversely associated with coronary artery calcification: the Framingham Heart Study. JACC Cardiovasc Imaging. 2014 Jan;7(1):59-69.
[16] Larsson SC, Orsini N, Wolk A. Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies. Am J Clin Nutr. 2012 Feb;95(2):362-6.
[17] Hoorn EJ1, van der Hoek J, de Man RA, Kuipers EJ, Bolwerk C, Zietse R. A case series of proton pump inhibitor-induced hypomagnesemia. Am J Kidney Dis. 2010 Jul;56(1):112-6.
[18] Matsuyama J1, Tsuji K, et al. Hypomagnesemia associated with a proton pump inhibitor. Intern Med.  2012; 51(16):2231-4.
[19] Spencer H, Norris C, Williams D. J Inhibitory effects of zinc on magnesium balance and magnesium absorption in man. Am Coll Nutr. 1994 Oct;13(5):479-84.
[20] Ranade VV, Somberg JC.  Bioavailability and pharmacokinetics of magnesium after administration of magnesium salts to humans. Am J Ther 2001;8:345-57.
[21] Firoz M, Graber M. Bioavailability of US commercial magnesium preparations. Magnes Res 2001;14:257-62.


Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.