Magnesium is an essential mineral, serving as a cornerstone of human health by playing a multifaceted role in various physiological processes within the body. Magnesium's importance in maintaining good health and preventing chronic diseases cannot be overstated. It participates in over 300 enzymatic reactions, impacting everything from energy production to nerve function and muscle contractions. Furthermore, magnesium is a natural calcium blocker, regulating heart rhythm and supporting cardiovascular health. In functional medicine, understanding magnesium's pivotal role has led to a focus on its supplementation, dietary incorporation, and its impact on overall wellness. As we delve deeper, it becomes apparent that ensuring optimal magnesium status is crucial in pursuing optimal health and vitality. (32, 46) 

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Historical Context of Magnesium Therapy

The use of magnesium in therapeutic applications has a rich historical context that spans centuries. Its medicinal properties have been recognized and utilized by various cultures around the world. In ancient times, magnesium-rich mineral waters were sought after for their healing effects. In the 17th and 18th centuries, exploring natural springs and mineral waters became increasingly popular in Europe. In 1695, magnesium sulfate was isolated from the Epsom spring water by Nehemiah Grew. Epsom salt, a magnesium sulfate compound, is still widely used today for therapeutic purposes. (16) 

Since then, magnesium has continued to gain recognition for its importance in human biology and physiology. Magnesium deficiency has been linked to various health conditions, and this knowledge has paved the way for the development of magnesium supplements and therapies in modern medicine to treat conditions including muscle cramps, cardiovascular issues, and migraine headaches.

Sources of Magnesium in the Diet

There is a diverse array of natural sources of magnesium, and the body typically absorbs 30-40% of dietary magnesium consumed. In general, foods that are high in fiber are high in magnesium. Examples of magnesium-rich foods include green leafy vegetables, legumes, nuts, seeds, and whole grains. (26) 

Magnesium Deficiency: Causes and Symptoms

Magnesium deficiency is a prevalent global health concern, with varying rates influenced by factors such as age, gender, diet, and geographical location. The National Health and Nutrition Examination Survey (NHANES) 2005-2006 reported approximately 48% of the U.S. population had insufficient magnesium intake from food sources. (26) 

Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. As the deficiency worsens, numbness, tingling, muscle cramping, abnormal muscle movements, seizures, confusion, and heart arrhythmias can occur. Magnesium deficiency can also disrupt the balance of other electrolytes, causing hypocalcemia (low serum calcium levels) and hypokalemia (low serum potassium levels). Furthermore, magnesium deficiency has been associated with the development of many diseases, including asthma, atherosclerosis, diabetes,  hypertension, migraines, and osteoporosis. (26) 

Causes of low magnesium levels include:

• Habitually low dietary intake of magnesium
• Chronic health conditions: gastrointestinal diseases, type 2 diabetes, alcohol dependence
• Medications: diuretics, proton pump inhibitors, theophylline, digoxin, oral contraceptive pills
• Chronic stress

The Top 6 Therapeutic Uses of Magnesium

Magnesium powers many functions in our bodies. In this section, we will discuss six ways that magnesium can improve health. 

1. Cardiovascular Health

Magnesium plays a crucial role in maintaining optimal cardiovascular health, exerting its influence through various biochemical mechanisms. One of its primary functions is regulating heart rhythm. Magnesium's role in regulating heart rhythm is multifaceted; it influences ion transport, blocks excessive calcium entry into cells, stabilizes cell membranes, and modulates potassium levels. By performing these functions, magnesium helps maintain a steady and coordinated heartbeat. (24) 

Furthermore, magnesium supports healthy endothelial function. A meta-analysis concluded that taking magnesium for at least six months improves flow-mediated dilatation, a marker of endothelial function, in patients who are unhealthy, over age 50, or overweight (21). Endothelial cells help regulate blood flow, prevent clot formation, and maintain the flexibility of blood vessels. Magnesium promotes the production of nitric oxide, a molecule that relaxes blood vessels. This relaxation (vasodilation) helps reduce the risk of hypertension, or high blood pressure, a significant cardiovascular risk factor. Magnesium also supports the kidneys in regulating blood pressure by controlling the balance of sodium and potassium in the body. Evidence suggests that hypertensive patients with hypomagnesemia (low serum magnesium levels) usually require higher doses of antihypertensive medications than those with normal magnesium levels. (15)

By supporting endothelial health, magnesium also contributes to the prevention of atherosclerosis, a condition where plaque builds up in the arteries, narrowing them and potentially leading to heart attacks or strokes. 

Magnesium may improve lipid levels in people with hypercholesterolemia (high cholesterol). In one study, patients taking one gram of magnesium oxide daily for six weeks saw slight decreases in total and low-density lipoprotein (LDL) cholesterol levels and small increases in high-density lipoprotein (HDL) cholesterol.  

Higher magnesium intake from diet and supplements is also associated with a 31% lower risk of developing metabolic syndrome in healthy young adults. Metabolic syndrome is a cluster of conditions, including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels, which increase the risk of heart disease, stroke, and type 2 diabetes.

2. Muscle and Bone Health

50-60% of the body's magnesium is stored in the bones (26). Magnesium deficiency increases the activity of osteoclasts, cells responsible for resorbing (breaking down) bone. Data suggest hypomagnesemia may be associated with low bone mass and osteoporosis. Furthermore, clinical research shows oral magnesium increases bone mineral density and decreases bone loss in postmenopausal patients with osteoporosis.

Magnesium helps nerves and muscles communicate properly by regulating electrical activity, ensuring the smooth functioning of the nervous system and muscles (23). When a nerve signal stimulates a muscle, it triggers the release of calcium ions within the muscle cells, initiating the contraction process. As a calcium antagonist, magnesium acts as a muscle relaxant, allowing muscles to contract and relax smoothly. This is why insufficient magnesium can lead to muscle cramps, spasms, and weakness. (37) 

3. Stress and Anxiety Reduction 

Magnesium is an effective natural remedy for stress and anxiety relief due to its significant impact on the nervous system. Magnesium is involved in modulating the hypothalamic-pituitary-adrenal (HPA) axis, the complex neuroendocrine system that regulates responses to stress, and influencing the transmission of excitatory neurotransmitters – both of which promote calming effects on the nervous system to prevent feelings of stress and anxiety (23). Data show that magnesium deficiency is linked to an increased risk of anxiety disorders; furthermore, a 2017 systematic review found that magnesium supplementation effectively reduced anxiety related to premenstrual syndrome, postpartum anxiety, and generalized anxiety. 

4. Sleep Aid

There is interest in using magnesium supplements for sleep disorders, such as insomnia. Low magnesium levels have been linked to poor sleep quality. Magnesium helps regulate sleep by reducing inflammation and oxidative stress and modulating neurotransmitter activity at NMDA and GABA receptors (34). In a clinical study for elderly patients with primary insomnia, magnesium supplementation increased levels of melatonin, reduced cortisol levels, and improved subjective markers of insomnia, including sleep efficiency, sleep onset latency, and early morning awakenings.

5. Migraine Relief

Migraine is the most common form of disabling primary headache, affecting approximately 12% of Western populations. The pathogenesis of migraine is multifaceted; however, magnesium deficiency is believed to be involved in many aspects of migraine development, including cortical spreading depression, platelet aggregation, the release of substance P, neurotransmitter release, and vasoconstriction. Numerous studies have found that oral magnesium doses between 300-600 mg daily reduce the frequency and severity of migraine headaches. (47) 

6. Regulating Blood Sugar

Hypomagnesemia has been observed in up to 38% of patients with type 2 diabetes. Low intracellular magnesium causes dysfunction of insulin receptors and enzymes involved in glucose utilization. (2, 12) This results in decreased insulin sensitivity and glucose uptake and higher blood sugar levels. Conversely, a higher dietary magnesium intake is associated with lower fasting insulin concentrations and a reduced risk of developing type 2 diabetes (22).

In clinical studies, oral magnesium improves glycemic control in patients with type 2 diabetes, improves insulin sensitivity, and reduces HbA1c levels in patients with type 2 diabetes and hypomagnesemia. 

How Can You Test Magnesium Levels in the Body?

Serum magnesium is most commonly used to assess magnesium status; however, this correlates poorly with magnesium status because less than 1% of the body's total magnesium is in blood serum (26). Individuals with serum magnesium levels between 0.75-0.85 mmol/L should have additional testing to confirm magnesium status. Red blood cell (RBC) magnesium better reflects body magnesium status than serum magnesium levels. (38)

Depending on the specific test, specialty micronutrient panels measure intracellular and/or extracellular magnesium levels, along with other nutrients that can affect magnesium absorption and utilization by the cells. These panels may be more clinically relevant when you suspect a patient is at risk for multiple nutrient deficiencies. Panel options include Genova Diagnostics' NutrEval and SpectraCell Laboratories' Micronutrient Test. 

Different Forms of Magnesium Supplements and Their Benefits

There are many types of magnesium supplements, each with unique properties and health benefits.

Magnesium citrate is highly absorbable and is often used to support digestive health. It can help relieve constipation due to its mild laxative effect. Magnesium citrate is also commonly chosen for its bioavailability, making it easier for the body to absorb and utilize. (25)

Magnesium oxide contains a higher percentage of elemental magnesium but has lower bioavailability than other forms. It is commonly used as a laxative and is effective for short-term constipation relief. However, it may cause gastrointestinal discomfort in some individuals.

Magnesium glycinate is a highly absorbable form of magnesium bound to an amino acid called glycine. It is often preferred for its calming effects and is widely used to promote relaxation, improve sleep quality, and reduce anxiety. This form is less likely to cause digestive upset, making it suitable for individuals with sensitive stomachs. (46) 

Magnesium L-threonate has the unique property of crossing the blood-brain barrier, which means it can enhance brain magnesium levels. It is often promoted for its potential cognitive benefits and is believed to support brain health and memory. (44, 48) 

Magnesium malate is a highly absorbable form of supplemental magnesium bound to malic acid. It tends to be gentler on the digestive tract, so it is a good option for patients who tend toward digestive upset and diarrhea. By participating in the Krebs cycle, malic acid contributes to the production of cellular energy (ATP), so magnesium malate is often recommended in the context of conditions associated with fatigue and muscle pain. (46) 

Safety and Considerations When Using Magnesium Therapeutically

Magnesium supplements are generally considered safe for most people when taken as directed. Taking excessive amounts of magnesium supplements can lead to side effects of magnesium toxicity, including diarrhea, nausea, and abdominal cramping. Extremely high doses can be dangerous and lead to irregular heartbeat, low blood pressure, and difficulty breathing. (26) 

Magnesium supplements can interact with certain medications, such as antibiotics, diuretics, and bisphosphonates (26). Magnesium supplementation may be unsafe for patients with heart block, kidney disease, myasthenia gravis, and bleeding disorders. People taking these medications or with these preexisting health conditions should discuss magnesium supplementation with their healthcare providers to ensure they take a safe magnesium dosage.

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Summary

Many people are deficient in magnesium, a risk factor for many chronic health issues. Standard and specialty labs can measure your magnesium level, and healthcare providers can guide you in using diet and supplements to optimize magnesium status to prevent and treat diseases, including anxiety, cardiovascular disease, insomnia, migraines, and musculoskeletal disorders.