Research Blog

April 29, 2024

More Magnesium Mojo

Subclinical magnesium deficiency is widespread globally but often goes unnoticed because it doesn't show obvious symptoms that clinicians can easily recognize.

Despite its hidden nature, this deficiency can significantly contribute to serious cardiovascular issues, including hypertension, arrhythmias, arterial calcifications, atherosclerosis, heart failure, and an increased risk of thrombosis. It is increasingly seen as a key factor driving cardiovascular diseases.

Modern lifestyles contribute to widespread risk of deficiency due to processed foods, decreased magnesium in crops, chronic diseases, and certain medications.

There is a strong need for enhanced public health initiatives to raise awareness among both healthcare providers and patients about the risks, prevalence, and detection of subclinical magnesium deficiency.

Potential clinical signs of magnesium deficiency

Less severe signs

  • Aggression
  • Anxiety
  • Ataxia
  • Chvostek sign (twitching of the facial muscles in response to tapping over the area of the facial nerve)
  • Confusion
  • Cramps (spontaneous carpopedal spasm or painful cramps of the muscles in your hands and feet)
  • Disorientation
  • Fasciculations (‘a brief, spontaneous contraction affecting a small number of muscle fibres, often causing a flicker of movement under the skin It can be a symptom of disease of the motor neurons)’
  • Hyper-reflexia
  • Irritability
  • Muscular weakness
  • Neuromuscular irritability
  • Pain or hyperalgesia (decreases the nociceptive threshold)
  • Photosensitivity
  • Spasticity
  • Tetany (involuntary muscle spasms)
  • Tinnitus (ringing in the ears)
  • Tremors
  • Trousseau sign
  • Vertigo
  • Vitamin D resistance

Severe signs

  • Arrhythmias (caused by overexcitation of the heart due to enhanced depolarisation susceptibility, especially torsades de pointes or ventricular tachycardia with a prolonged QT interval)
  • Calcifications (soft tissue)
  • Cataracts
  • Convulsions
  • Coronary artery disease
  • Depressed immune response
  • Depression
  • Hearing loss
  • Heart failure
  • Hypertension
  • Migraines/headaches
  • Mitral valve prolapse
  • Osteoporosis
  • Parathyroid hormone resistance and impaired parathyroid hormone release/function
  • Psychotic behavior
  • Seizures (overexcitation of the nervous system (nerve cells), which are more likely to fire due to a reduced electric potential difference between the outer and inner surfaces of the membrane)
  • Sudden cardiac death
  • Tachycardia

Lab and EKG signs of magnesium deficiency

  • Hypomagnesaemia
  • Hypocalcaemia
  • Hypokalaemia
  • Prolonged QTc
  • ST segment depression (in animals)

Possible cardiovascular manifestations of magnesium deficiency

  • Hypertension
  • Arrhythmias
  • Calcifications
  • Atherosclerosis
  • Heart failure
  • Increased platelet reactivity and thrombosis
  • Myocardial infarction
  • Stroke
  • Sudden cardiac death

Causes of magnesium deficiency

  • Acetaminophen toxicity
  • Alcoholism
  • Aluminum (environmental and dietary)
  • Aldosteronism
  • Alcohol
  • Aging (hypochlorhydria, ie, decreased acid in the stomach)
  • Antacids (including ranitidine and famotidine)
  • Bariatric surgery (small intestinal bypass surgery)
  • Calcium supplements (or a high calcium to magnesium diet)
  • Caffeine
  • Cancer
  • Celiac disease
  • Colon removal
  • Chronic stress
  • Cisplatin
  • Crohn’s disease
  • Ciclosporin
  • Type 1 and type 2 diabetes (uncontrolled glucose levels)
  • Diarrhea
  • Diet high in fat or sugar
  • Digoxin
  • Diuretics—non-potassium-sparing diuretics (thiazide and loop diuretics)
  • Excessive ingestion of poorly absorbable magnesium (such as magnesium oxide), leading to diarrhoea and magnesium loss
  • Emotional and/or psychological stress (overactivation of the sympathetic nervous system)
  • Enzymatic dysfunction (impaired magnesium distribution)
  • Oestrogen therapy (shifts magnesium to soft and hard tissues lowering serum levels)
  • Excessive or prolonged lactation
  • Excessive menstruation
  • Fasting (or low magnesium intake)
  • Foscarnet
  • Gentamicin and tobramycin
  • Hyperparathyroidism and hypoparathyroidism
  • Hyperthyroidism
  • Kidney diseases (glomerulonephritis, pyelonephritis, hydronephrosis, nephrosclerosis and renal tubular acidosis)
  • Heart failure
  • Haemodialysis
  • High phosphorus in the diet (soda, inorganic phosphates contained in many inactive ingredients in processed foods)
  • Hyperinsulinaemia (and insulin therapy)
  • Insulin resistance (intracellular magnesium depletion)
  • Laxatives
  • Low salt intake
  • Low selenium intake
  • Gastrointestinal disorders—malabsorption syndromes (coeliac disease, non-tropical sprue, bowel resection, Crohn’s disease, ulcerative colitis, steatorrhoea), prolonged diarrhea or vomiting
  • Liver disease (acute or chronic liver disease, including cirrhosis)
  • Metabolic acidosis (latent or clinical)
  • Pancreatitis (acute and chronic)
  • Parathyroidectomy
  • Pentamide
  • Peritoneal dialysis
  • Porphyria with inappropriate secretion of antidiuretic hormone
  • Pregnancy
  • Proton pump inhibitors
  • Strenuous exercise
  • Tacrolimus
  • Vitamin B6 (pyridoxine) deficiency
  • Vitamin D excess or deficiency (chronic kidney disease and liver disease can prevent the activation of vitamin D)

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DiNicolantonio, James J et al. “Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis.” Open heart vol. 5,1 e000668. 13 Jan. 2018, doi:10.1136/openhrt-2017-000668 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license 

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