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Understanding Magnesium Deficiency

“Magnesium has largely been farmed out of our nation’s soil without being replaced. Unfortunately, most foods are mineral deficient due to processing. Our soil has been depleted of minerals due to modern farming practices, so getting enough from the diet without supplementing is difficult.”

A gradual depletion of nutrients from our soil has left many plants (vegetables, nuts, whole grains and seeds) with lower levels of magnesium. Large-scale and non-sustainable agricultural practices often use nitrogen-based fertilizers to maximize crops, rather than aiming for qualitative outcomes. These practices neglect to restore trace minerals back into the soil.1 Acid rain further leaches magnesium from the soil. Food processing also causes a loss of magnesium from foods. For example, magnesium is found in bran and germ, which is lost while milling those whole grains into white flour.1 When nuts and seeds are roasted, or their oils extracted, magnesium is also lost. Our drinking water is also devoid of magnesium because the filtration and water treatment processes remove it. Higher levels of fluoride (which binds magnesium) and calcium that are often added during the water treatment process can also worsen magnesium deficiency. Low levels of vitamin D in the body can also cause magnesium deficiency.2 Despite eating a healthy and well-balanced diet, magnesium deficiency can occur over time.

The recommended daily allowance (RDA) for magnesium in adults is 4.5 mg/Kg/day (about 300mg/day). A dietary survey suggests that many North Americans do not get the minimum recommended amounts of magnesium daily.3 Even though the classic symptoms of severe magnesium deficiency are rare, health issues can occur well before overt deficiencies are easy to detect.

Furthermore, several common digestive disorders can also contribute to a depletion of magnesium. Since magnesium is absorbed in the small intestine, conditions that affect this area of the gastrointestinal system, such as Crohn’s disease, intestinal surgery, gluten sensitivity (celiac enteropathy) and other conditions may impair absorption.2 Frequent diarrhea and vomiting can also cause depletion. Irritable bowel syndrome (IBS) is the most common disorder diagnosed in North America, and it can often contribute to further magnesium excretion, in addition to impairing absorption.

Magnesium Depleting Drugs

PPIs (acid blockers)
Diuretics
ACE Inhibitors
Antibiotics
Chemotherapy

Many prescribed medications, such as proton pump inhibitors, diuretics, and some antibiotics, cause magnesium depletion4,3 Proton pump inhibitors (i.e. Omeprazole/Losec®, Esomeprazole/Nexium®, Lansoprazole/prevacid®) block stomach acid, which is required for the magnesium absorption (HCL breaks the chemical bond between magnesium and the anion). Acid blocking medications are often prescribed for digestive concerns without addressing the root cause of the symptoms (i.e. reflux is caused by inflammation not excess acid). Non-potassium sparing diuretics (i.e. thiazide) increase the elimination of magnesium and potassium through the kidneys and urine. Studies have shown that these drugs can specifically decrease intracellular magnesium while blood levels remain normal, meaning standard blood testing cannot identify the deficiency.5

Figure 4: Signs and Symptoms of Magnesium Deficiency

Fluoroquinolone antibiotics (i.e. Cipro®/Ciprofloxacin, Levaquin®/ levofloxacin, Avelox®/moxifloxacin and Floxin®/ofloxacin) also bind magnesium, leading to a deficiency by a process called magnesium chelation.6 Some experts believe this partly explains the emerging phenomenon known as being “floxed,” where people experience severe fatigue, muscle and nerve pain, and other debilitating symptoms after taking this class of medications.7,9 The alarming part of this effect is that up to 80% of people do not recover even after stopping the medication.8 The root cause of the “floxed” phenomenon is that fluoroquinolone antibiotics damage the mitochondria, where magnesium plays an integral role in energy production. Low magnesium and mitochondrial damage leads to severely impaired energy production resulting in pain and fatigue.9,10 The second issue is that this class of medications also contains fluoride (F) molecules that bind to magnesium, producing a compound called selliate (Mg+F), a brittle substance that is deposited in bones, tendons, and even sensitive hormonal organs, leading to impaired function and damage.

Some of these drugs are taken over a long period of time or repeatedly, which create a substantial magnesium deficiency. This is especially concerning when elderly people are on multiple medications over several years. Seniors can also be at a general risk over time since intestinal absorption usually decreases with age. They also have a lower intake than younger adults and often have increased excretion.1 The combination of a diet with low amounts of magnesium, poor intestinal absorption due to intestinal damage, and prescription drugs can all contribute to chronically low magnesium levels. It is important to note that while classic hypomagnesemia (shown on standard blood work with signs and symptoms) occurs in only 5-15% of the population, a low grade, chronic deficiency of magnesium can occur without standard lab values being out of range.13 This chronic deficiency can have a negative effect over months and years.

Why are we so deficient in Magnesium?

1. Our food intake is detrimentally low in the mineral. We don’t consume enough magnesium rich foods, and modern farming techniques often deplete magnesium levels in plants.   

2. Poor diet – Processed foods contain less magnesium.

3. Less magnesium in foods – Large scale commercial farming practices don’t return Mg into the soil.

4. Less magnesium in water – Filtering process removes magnesium out. 

5. Poor absorption – Celiac, GI inflammation, low stomach.  

6. Stress – Excess sympathetic activity reduces stomach acid. 

7. Medications – Acid blockers, diuretics (see Fig. 4)

8. Acid Rain – Magnesium buffers nitric acid making it inactive.

9. Fluoridated water – Fluoride binds Mg2+ reducing absorption.  

10. Excess loss from urine – alcohol, diarrhea, urination etc.

11. Anti-nutrients – Tannins, oxalic acid, phytic acid in food bind magnesium, preventing its absorption.

Did You Know?

For every molecule of sugar you consume, it takes fifty-four molecules of magnesium for your body to process it.


REFERENCES

1. The Magnesium Miracle, by Carolyn Dean, M.D., N.D., Ballantine Books, 2007.

2. Swaminathan. Magnesium metabolism and its disorders. Clin Biochem Rev. 2003 May; 24(2):47-66.

3. Ford ES and Mokdad AH. Dietary magnesium intake in a national sample of U.S. adults. J Nutr. 2003;133:2879-82.

4. Rude RK and Olerich M. Magnesium deficiency: Possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453-61.

5. http://www.fda.gov/drugs/drugsafety/ucm245011.htm

6. Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768–71.

7. Kroenke K, Wood DR, Hanley JF. The value of serum magnesium  determination in hypertensive patients receiving diuretics. Arch Intern Med 1987;147:1553–6.

8. Telfer. Fluoroquinolone antibiotics and type 2 diabetes mellitus. Med Hypotheses. 2014 Sep;83(3):263-9. doi: 10.1016/j.mehy.2014.05.013. Epub 2014 May 29.

9. http://www.fda.gov/Drugs/DrugSafety/ucm365050.htm

10. http://media.newsnet5.com/uplo…

11. http://www.hormonesmatter.com/fluoroquinolone-toxicity/

12. http://well.blogs.nytimes.com/2012/09/10/popular-antibiotics-may-carry-serious-side-effects/?_r=1

13. Ayuk and Gittoes. Contemporary view of the clinical
relevance of magnesium homeostasis. Ann Clin Biochem. 2014 Mar;51(Pt 2):179-88.


WHY ARE WE SO DEFICIENT IN MAGNESIUM?

Fawcett, W. J., Haxby, E. J. & Male, D. A. Magnesium: physiology and pharmacology. Br. J. Anaesth. 83, 302–320 (1999).

Dr. Paul Hrkal

About The Author

Dr. Paul Hrkal is a board-certified Naturopathic doctor with a passion to apply innovative and evidence-based nutritional, biological, and supplemental interventions to address underlying metabolic, endocrine and immunological dysfunctions. He is strong advocate of integrative medical education frequently writing and lecturing to both healthcare practitioners and public audiences. He also is the medical director for Advanced Orthomolecular Research, a leading Canadian natural health product company, and maintains a clinical practice in the Toronto area.

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