Magnesium is needed for literally everything in the body. When you don’t have enough, the most common problems are twitching, muscle cramps or spasms, heart palpitations, and weakness, plus other signs and symptoms discussed in the video. In this episode, I teach you how to look for its deficiency, how to use three different lab measurements to monitor your magnesium status, and how to fix a problem if you find one.
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Are you getting enough magnesium? Are you getting too much magnesium?
This is how to manage your magnesium status.
Hi. I’m Dr. Chris Masterjohn of chrismasterjohnphd.com, and this is Chris Masterjohn Lite, where the name of the game is “Details? Shmeetails. Just tell me what works!”
Today we’re going to talk about managing magnesium status. Magnesium is necessary for literally everything that happens in your body, but there are some things that stand out as being more likely signs of magnesium deficiency. These can include osteopenia and osteoporosis, soft tissue calcification, for example kidney stones, high blood pressure, in pregnancy preeclampsia and eclampsia, migraines, cardiovascular disease, and muscle cramps. In more extreme scenarios, you can get cardiac arrhythmia, which your doctor would have to see, but you may experience palpitations, which is an irregularity in your heart rate, in your heartbeat, excuse me, weakness and fatigue, ataxia, which is loss of full control over your own body movements, muscle twitches, and spasms. Your doctor could also find low levels of calcium or potassium associated with low levels of magnesium.
Why would you not have enough magnesium? Well, if you’re talking about the diet, the overwhelming dietary pattern is going to be a diet that is low in plant foods or high in refined foods. And that’s because unrefined plant foods are the main source of magnesium in your diet. Meat, even organ meats, not a great source of magnesium. Sugar, white flour, not a great source of magnesium.
But there are many other things that could cause a magnesium deficiency. For example, some things interfere with the absorption of magnesium. These include the proton pump inhibitors and other antacids that are used to control stomach acid. Vomiting and diarrhea causes you to lose magnesium before you absorb it. Ulcerative colitis and a bunch of other digestive disorders, including anything that causes fat malabsorption, can cause magnesium deficiency.
And then there are rare magnesium transporter defects at the genetic level that can interfere with your ability to absorb magnesium from your food. Then there are things that cause you to lose magnesium. So, most of the magnesium you lose is in your urine. Anything that increases urination increases loss of magnesium. Drinking too much water could be one of those causes. But when you have something like diabetes or the use of diuretics, you increase the loss even further. There are a variety of pharmaceutical drugs that increase urinary loss of magnesium. Chronic alcohol abuse hurts absorption and increases loss in the urine. Even though the urine is the main source of magnesium loss, you also lose it in your sweat. So anything that increases sweating, like being a high-level athlete or using a sauna, can increase magnesium loss through the skin. Burn injury can also ncrease loss of magnesium through the skin.
There are two medical conditions where you would expect magnesium to get low in the serum because the magnesium is being pushed elsewhere, which in and of itself is harmful because even though the other tissues need the magnesium, so do you need it in your serum. And those are hungry bone syndrome and refeeding syndrome. In hungry bone syndrome, you are medically fixing low bone density, and as you do that, the magnesium goes into the bone. In refeeding syndrome, you experience the period of starvation or anorexia, and you’re fixing that, and the magnesium starts going back into your other tissues as the food comes in, and that can lower serum magnesium levels.
The other side of this coin is too much magnesium. The most well-known aspect of this is diarrhea. The more magnesium you get, the higher—the the more soft your stools get, and diarrhea is the end result of that. In fact, if you go in for a colonoscopy, they’re probably going to give you a bottle of magnesium citrate to take and tell you to drink the whole thing so that you clean your own bowels out so when you go in for the colonoscopy, there’s no fecal matter left to get in the way of seeing what’s going on in there. But there are other problems that can come from levels of magnesium that are too high. If your blood levels of magnesium get near or above twice the top of the reference range, you can develop dangerously low blood pressure, or you can develop abnormalities in your heart rate that include slow or fast heart rate. So you don’t want to go up to that end either.
The best thing to do is to first fix your diet if that’s what needs fixing or address with your doctor the other medical conditions that could be involved here as a means of conserving the magnesium that you have. And then if you need to, supplement, but keep the dose low unless your blood work shows that you need a higher dose. As a general principle, I would say take 100 milligrams—once you’ve fixed your diet, if you need more magnesium, take 100 milligrams of magnesium glycinate with each meal, going up to about 300 milligrams per day as your first attempt at supplementation. Go up higher only if your blood work shows that you need it. When you’re looking at blood work, you want to get magnesium measured in red blood cells, serum, and urine. Why all three? Well, because they each have their own strengths and limitations. So, red blood cell magnesium can be a more sensitive marker of deficiency. You may see that decline before you see the serum magnesium decline.
But low red blood cell magnesium might not mean that you don’t have enough magnesium. It could mean that you aren’t good at getting magnesium into your cells. If your serum magnesium is normal or high, and your red blood cell magnesium is low, then you probably have a problem getting magnesium into your cells. That could be due to low insulin levels, or it could be due to inadequate vitamin B6, or the most probable scenario, it could be because you’re not eating enough salt. And this is especially true if you eat a whole-foods diet that you don’t add salt to.
A lot of people, most people in our society, get too much salt because they’re eating a lot of processed foods that have salt in it, and they’re pouring more salt on their food. But if you’re health-conscious and you get rid of the processed foods and you don’t add salt to your own food, you could easily wind up in the place where you’re not getting enough salt, and that could be hurting your ability to transport magnesium into your cells. If your urinary magnesium is high, and your serum magnesium is low, then you know that you’re losing magnesium in the urine, and that’s the problem, and that tells you that, yes, maybe supplementation is warranted, but you may well have to work harder on fixing the problem of what’s increasing the urinary loss. If urinary magnesium is normal, and serum and red blood cell magnesium are both low, then that’s when you’re probably dealing with a flat-out case of you just don’t have enough magnesium, and that’s where increasing the magnesium in your diet or supplements is the most warranted.
And that’s the reason for measuring all three.
You can find more details on managing magnesium status in the magnesium section of my e-book, Testing Nutritional Status: The Ultimate Cheat Sheet.