Hypomagnesemia (Low Blood Level of Magnesium)

What Is Hypomagnesemia?

[dropcap]H[/dropcap]ypomagnesemia means the level of magnesium in the bloodstream is too low to meet metabolic needs of the body for this mineral.

Q: What are the metabolic needs of the body for magnesium?

A: The metabolic needs of the body for magnesium are numerous which gives rise to very many distressing symptoms when this mineral is deficient.

A major function of magnesium is to stabilize the structure of an enzyme called adenosine triphosphate (ATP) within cells for the production of energy. In the brain, magnesium plays important roles in all the major metabolisms such as oxidation-reduction and regulation of ions (charged minerals).¹

What Is Hypomagnesemia In Celiac Disease and/or Gluten Sensitivity?

• Relationship between hypomagnesemia and celiac disease. Hypomagnesemia is a classic feature of untreated celiac disease, with or without symptoms of deficiency.

• Relationship between hypomagnesemia and status. Celiac patients without symptoms of magnesium deficiency were found to have reduction in intracellular free Mg2+ (magnesium that is present within cells), despite being clinically asymptomatic on gluten free diet. On the other hand, in patients with hypomagnesemia reflecting severe magnesium depletion of stores, symptoms result from impaired parathyroid hormone secretion and action and altered nerve conduction, muscle contraction, and bone density.²
• Relationship between hypomagnesemia and osteoporosis. Study findings of a rise in parathyroid hormone and significant increase in bone density of the femur bone and femoral neck in response to magnesium therapy over 2 years suggests that magnesium depletion may be one factor contributing to osteoporosis in celiac disease.³
• Relationship between hypomagnesemia and hypocalcemia in celiac disease. Life-threatening conditions, such as laryngospasm which correlates with concomitant hypomagnesemia and severe hypocalcemia (low blood level of calcium), may develop in celiac disease.⁴

How Prevalent Is Hypomagnesemia In Celiac Disease and/or Gluten Sensitivity?

Significantly abnormal serology result was found in all study patients at diagnosis of celiac disease.⁵

Low plasma magnesium often occurs in celiac disease, affecting 100% of patients with classical celiac disease, one-fifth of patients with silent celiac disease, and one-fifth of celiac disease patients on a gluten free diet.⁶

What Are The Symptoms of Hypomagnesemia?

Hypomagnesemia is marked by any of these symptoms:

• Anemia, hemolytic.
• Anorexia.
• Anxiety.
• Ataxia.
• Blood clots.
• Bone loss.
• Brain fog.
• Bruxism (teeth grinding/jaw clenching).
• Cardiac arrhythmias.
• Confusion.
• Constipation.
• Convulsions.
• Depressed immune function.
• Fatigue.
• Hyperlipidemia.
• Hypertension.
• Irritability.
• Nausea.
• Muscle spasms.
• Parathyroid hormone (PTH), Decreased.
• Personality change
• Poor wound healing.
• Tetany.
• Thrombophlebitis.
• Vertigo.
• Contributes to osteoporosis.
• Serious neuromuscular disturbances may develop including cardiac dysrhythmias, myocardial ischemia, decreased reflexes, and slow pulse.
• Cataracts in chronic deficiency.⁷
• Laryngospasm when low blood level of calcium is present.

How Does Hypomagnesemia In Celiac Disease and/or Gluten Sensitivity Develop?

• Hypomagnesemia results from magnesium depletion in diarrhea/ steatorrhea, if present, and magnesium malabsorption in celiac disease.²

Does Hypomagnesemia Respond To Gluten-Free Diet?

Yes. Celiac disease-related hypomagnesemia responds to gluten free diet with supplementation.⁸

6 Steps To Improve Hypomagnesemia In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both magnesium deficiency and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁹
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹⁰
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹⁰
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹⁰.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹⁰
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹⁰
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹¹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, phytochemicals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources include tuna, salmon, cod, and others. Plant sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 for examples such as ginger.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely: 

[box type=”shadow” ]Certain prescription drugs deplete magnsesium which is the cause of hypomagnesemia. Ask your doctor or pharmacist about this possible adverse effect of these drugs if you have been prescribed. Do not stop prescribed medications without supervision.

This is not a complete listing.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Magnesium, and others.
• Loop Diuretics (Lasix®, Bumex,®) deplete Magnesium, and others.

ANTIVIRAL AGENTS

• Foscanet depletes Magnesium, and others.

ANTIBIOTICS  disrupt intestinal permeability.

• Tetracyclines deplete Magnesium, and others.

ANTI-INFLAMMATORIES  disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Magnesium, and others.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Magnesium, and others.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Magnesium, and others.
• Alka Seltzer®, Baking Soda deplete Magnesium, and others.

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Magnesium and others.
  Correlation analysis shows significant association between some trace elements and the duration of contraception and body mass index of the participants.¹²
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Magnesium and others.

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• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multi-vitamin/mineral supplement once a day giving 100% (not thousands).
• Chelated magnesium to obtain 100% or as prescribed by your doctor.
• Always check with your doctor when taking supplements to avoid interactions with medications.

Storage Note for Supplements: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet  – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies:

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives are plant sources that tone muscle and improve peristalsis, and thus aid in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort. Puree any foods that cannot be thoroughly chewed. Cook meats well or make them into soups and stews for ease of digestion.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets stimulate and improve digestion and are easily digested.
• Cabbage stimulates and improves digestion and is also a liver decongestant.
• Lettuce stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
• Chamomile (as a tea) also promotes healing and help relieve nervous tension. Drink as a tea.
• Parsley relieves colic, gas and indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is a soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Hypomagnesemia In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Magnesium status in children and adolescents with celiac disease.” This study evaluating the magnesium status in celiac disease patients, demonstrated deficiency in all patients with classical celiac disease, 1/5th of patients with silent celiac disease, and 1/5th of those on a gluten free diet.⁶

“Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy.” This study investigating magnesium status, bone mass and response to magnesium therapy in 23 celiac disease patients who were clinically asymptomatic and on a stable gluten free diet, demonstrated that celiac disease patients have reduction in intracellular free Mg2+, despite being clinically asymptomatic on gluten free diet. Bone mass also appears to be reduced. Magnesium therapy resulted in a rise in parathyroid hormone (PTH), suggesting that the intracellular magnesium deficit was impairing PTH secretion in these patients. Rise in PTH and significant increase in bone density of the femur and femoral neck in response to magnesium therapy over 2 years suggests that Mg depletion may be one factor contributing to osteoporosis in celiac disease.⁸

CASE REPORT SUMMARIES

“Carpopedal spasm in an elderly man: an unusual presentation of coeliac disease.” This case report describes diagnosis of celiac disease in a 68-year-old single Caucasian man admitted to the hospital with a 24-hour history of carpopedal spasm of both hands. Apart from generalized weakness, he reported no other symptoms. Physical examination revealed carpopedal spasm, clubbing of fingers and cachexia (body mass index 14 kg/m2). This patient was found to have several unusual features of celiac disease, including the advanced age at presentation, severe hypocalcemia and electrolyte disturbances including hypomagnesemia (low blood magnesium) as the initial manifestations, minimal gastrointestinal symptoms, and negative tTG-antibodies.

Blood tests showed severe hypocalcemia, with a total serum calcium of 1.06 mmol/L (normal range [NR] 2.05-2.55 mmol/L). He also had low serum potassium (2.8 mmol/L; NR 3.5-5.5 mmol/L) and magnesium (0.36 mmol/L; NR 0.65-1.05 mmol/L). Other significant results included hemoglobin 10.6 g/dL (NR 13-18 g/dL), mean corpuscular volume 98.1 fl (NR 82-98 fl), vitamin B12 157 ng/L (NR > 165 ng/L), folate 2.8 g/L (NR 3.1-17.5 μg/L), ferritin 252 μg/L (NR 30-250 μg/L), prothrombin time 20 s (NR 11-14 s), thyroid stimulating hormone 0.87 mu/L (NR 0.35-4.5 mu/L), phosphate 0.57 mmol/L (NR 0.8-1.45 mmol/L), albumin 32 g/L (NR 34-48 g/L) and alkaline phosphatase 313 IU/L (NR 47-141 IU/L).  Subsequent results revealed vitamin D deficiency with a low serum 25-OH vitamin D of < 7 μg/L (NR 7-40 μg/L), a low 24-hour urinary calcium excretion of 0.9 mmol (NR 2.5-7.5 mmol) and a raised serum parathyroid hormone of 22.7 pmol/L (NR 1.6-6.9 pmol/L).

Serology for tissue transglutaminase (tTG) antibodies was negative, and a serum IgA level of 4.95 g/L (NR 0.8-4.0 g/L) excluded selective IgA deficiency.

Barium meal and follow through showed dilated proximal bowel loops and absence of normal feathery pattern of the jejunum, features suggestive of a malabsorptive state. Upper gastroscopic examination was normal; however, the duodenal biopsy showed partial and subtotal villous atrophy with increased intra-epithelial lymphocyte infiltration, consistent with the diagnosis of celiac disease.¹³

“Severe hypocalcemia and hypomagnesemia in a 14-year-old boy–difficulties in treatment related to silent celiac disease.” This case report describes diagnosing celiac disease in a 14-year-old boy who was admitted to the ward because of tetanic seizure few days before. Severe hypocalcemia (1.49 mmol/L) with hypomagnesemia (13.8 mg/L) as well as metabolic alkalosis pH=7.65) and high phosphorus level (10.5 mg/dL) were noted. The boy was prepubertal, euthyroid and proportionally small. Severely low serum parathyroid hormone (PTH) level (2 pg/mL) excluded phosphorus intoxication. Magnesium salts treatment alone by mouth was introduced but this treatment did not improve serum magnesium level or calcium concentration.

Primary magnesium deficiency was excluded and therefore calcium salts supplementation and 1alpha(OH)D3 therapy, typical for hypoparathyroidism, was initiated combined with slow-released magnesium salts. Difficulties in the treatment prompted a look for the digestive tract defects and finally, based on endomysial antibodies and duodenal biopsy the celiac disease was confirmed. A gluten-free diet  produced significant improvement of calcium-phosphorus parameters.¹⁴

“Autoimmune hypothyroidism nonresponsive to high doses of levothyroxine and severe hypocalcemia.” This case report describes diagnosing celiac disease in a 50 year-old woman with autoimmune hypothyroidism of difficult compensation, associated with anemia, hypocalcemia with a previous episode of tetany, hypomagnesemia, psychologic alterations and important weight loss.

After compensation of the hypothyroidism with doses of L-thyroxine as high as 325 microg/day, the hypothesis of a malabsorptive syndrome was raised. Celiac disease was confirmed by elevated serum antigliadin antibody. A gluten-free diet was instituted which improved the symptoms associated with malabsorption and reduced the L-thyroxine requirement to 125 microg/day. Because several studies have shown an association of both diseases, a routine screening for celiac disease has been widely proposed in patients with autoimmune thyroid disease.¹⁵

Sources:

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2. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 1996;6(6):453-61. [↩] [↩]
3. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 1996;6(6):453-61. [↩]
4. Waeber G, Pralong G, Breitenstein E, Nicod P. Laryngospasm: unusual manifestation of celiac disease. Schweizerische Medizinische Wochenschrift. Mar 13, 1993;123(10):432-4. [↩]
5. Molteni N, Bardella MT, Vezzoli G, Pozzoli E, Bianchi P. Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet. American Journal of Gastroenterology. Nov 1995;90(11):2025-8. [↩]
6. Rujner J, Socha A, Wojtasik A, Kunachowicz H, Iwanow K, Syczewska M, Piontek E. Magnesium status in children and adolescents with celiac disease. Wiadomosci Lekarskie: Organ Polskiego Towarzystwa Lekarskiego. 2001;54(5-6):277-85. [↩] [↩]
7. Agarwal R, Iezhitsa I, Agarwal P, Spasov A. Magnesium deficiency: does it have a role to play in cataractogenesis? Exp Eye Res. 2012 Aug;101:82-9. doi: 10.1016/j.exer.2012.05.008. [↩]
8. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 1996;6(6):453-61. [↩] [↩]
9. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
10. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩]
11. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩]
12. Akinloye O1, Adebayo TO, Oguntibeju OO, Oparinde DP, Ogunyemi EO. Effects of contraceptives on serum trace elements, calcium and phosphorus levels. West Indian Med J. 2011 Jun;60(3):308-15. [↩]
13. Schmidt K, Powari M, Shirazi T, Vaidya B. Carpopedal spasm in an elderly man: an unusual presentation of coeliac disease. J R Soc Med. 2007 Nov;100(11):524-5. [↩]
14. Stacha W, Niedziela M. Severe hypocalcemia and hypomagnesemia in a 14-year-old boy–difficulties in treatment related to silent coeliac disease. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw. 2005;11(3):191-4. [↩]
15. Silva CM, Souza MV. Autoimmune hypothyroidism nonresponsive to high doses of levothyroxine and severe hypocalcemia. Arq Bras Endocrinol Metabol. 2005 Aug;49(4):599-603. [↩]