Magnesium Deficiency

What Is Magnesium?

[dropcap]M[/dropcap]agnesium is an essential mineral predominantly found in the body within cells, where it is vital for their functions.

Here is a summary of what magnesium does in our body:

1. Co-factor for over 300 enzymes involved in the metabolism of food components and synthesis of many compounds.
2. Required for nerve transmission.
3. Required for muscle activity (acts to relax muscles in opposition to calcium which acts to contract).
4. Acts to maintain heart rhythm.
5. Required for membrane transport and interactions.
6. Required for glucose metabolism and energy production within cells.
7. Component of bone mineralization and tooth formation.
8. Plays a key role in calcium and phosphorus metabolism and management by parathyroid hormone.
9. Maintains the structural and functional integrity of vital eye tissues such as lens.¹

Only 1% of magnesium is found in blood, but the body must keep blood levels of magnesium constant.

What Is Magnesium Deficiency In Celiac Disease and/or Gluten Sensitivity?

• Relationship between magnesium deficiency and celiac disease. Magnesium deficiency is a classic symptom of celiac disease that results when the level within cells is too low to meet needs of the body for this mineral.
• Deficiency is characterized by these effects:

1. Impaired nerve conduction and muscle contraction by interfering with ATP (adenosine triphosphate) enzyme functions, causing calcium and sodium to abnormally increase within cells and potassium concentration to abnormally decrease within cells.
2. Altered metabolism.
3. Impaired energy production within cells.
4. Decreased parathyroid hormone (PTH) secretion and action to maintain a normal blood level of calcium.
5. Reduced bone density.
6. Impaired brain function.
7. Impaired use of EPA fatty acid.

• Relationship between magnesium deficiency and inflammation. Magnesium deficiency activates inflammatory chemicals (cytokines) and immune cells (leukocytes and macrocytes) in response to gluten.
• Relationship between magnesium and deficiency and patient types. Research found magnesium deficiency present in all patients with classical celiac disease, but only in 1/5 of patients with celiac disease on a gluten free diet and 1/5 of patients with silent celiac disease.²
• Relationship between magnesium deficiency and magnesium within cells. A study investigating magnesium status and bone mass in clinically asymptomatic celiac disease patients on gluten free diet and their response to magnesium therapy demonstrated that celiac disease patients have reduction of magnesium within cells (intracellular), despite not having symptoms. 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. Bone mineral density increased in response to magnesium therapy.³
• Relationship between magnesium deficiency and inadequate diet. A study investigating life-long gluten-free diet in celiac disease patients shows that inadequate intake of magnesium is common (more than 10% of patients) and may relate to habitual poor food choices in addition to inherent deficiencies in the gluten free diet. “Dietary education should also address the achievement of adequate micronutrient intake.”⁴
• Relationship between magnesium deficiency and depression: “There is more than sufficient evidence to implicate inadequate dietary magnesium as the main cause of treatment-resistant depression (TRD), and that physicians should prescribe magnesium for TRD. Since inadequate brain magnesium appears to reduce serotonin levels, and since anti-depressants have been shown to have the action of raising brain magnesium, we further hypothesize that magnesium treatment will be found beneficial for nearly all depressives, not only TRD.”⁵

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

Magnesium deficiency is common in patients with untreated celiac disease.⁶

What Are The Symptoms Of Magnesium Deficiency?

Magnesium deficiency is marked by these symptoms:

• Anorexia.
• Ataxia.
• Bone Loss –  Contributes to Osteoporosis.
• Brain Fog meaning difficulty thinking.
• Bruxism (teeth grinding/jaw clenching) and this causes “scalloped tongue” meaning indentations of teeth are see along the sides of the tongue.
• Burning sore tongue.
• Cataracts develop in chronic deficiency.⁷
• Confusion.
• Constipation.
• Convulsions.
• Eye Floaters.
• Fatigue.
• Headache.
• Hemolytic Anemia.
• Hyperlipidemia (Elevated Cholesterol).
• Hypertension.
• Immune Function, Depressed.
• Insomnia (sleep problems).
• Irregular Heartbeat.
• Irritability and Personality Change.
• Muscle Pain – widespread.
• Muscle Spasms (including facial tics).
• Nausea.
• Poor Wound Healing.
• PTH (Parathyroid Hormone), Decreased, which can cause a Parkinson-like tremor.
• Serious neuromuscular disturbances may develop including cardiac dysrhythmias, myocardial ischemia, decreased reflexes, and slow pulse.
• Tetany.
• Thrombophlebitis (Blood Clots).
• Vertigo (Dizziness).

How Does The Body Get Magnesium?

• Magnesium must be obtained from the diet or supplementation since the body is not able to make this nutrient.
• Magnesium may be absorbed along the entire length of the small intestine, but most absorption occurs in the jejunum, which is the middle section.
• When the amount of magnesium (ions) within the small intestine is LOW due to the amount consumed in the diet, magnesium ions are transported by a carrier molecule from the liquid mix inside the hollow of the small intestine into the absorbing cells (enterocytes) of the lining. From the absorbing cells, magnesium ions enter the bloodstream. This careful mechanism makes sure the magnesium ions do not leave the small intestine unabsorbed.
• Whereas, when concentrations are HIGH, magnesium enters the absorbing cells by simple diffusion throughout the length of the small intestine.⁸In this operation, magnesium must compete with other nutrients making their way by diffusion, so the actual amount absorbed is limited by competition.

What Does Magnesium Do In The Body?

Magnesium performs these functions in the body:

1. Role of magnesium in energy production. A major function of magnesium is the production of energy within cells by stabilizing the structure of the molecule adenosine triphosphate (ATP) in ATP-dependent enzyme reactions.

2. Role of magnesium in muscle function. In muscle contraction, the mineral potassium moves from inside muscle fibers out into the fluid surrounding them while the mineral sodium moves from the fluid surrounding cells into the muscle fibers. This exchange is reversed when muscle fibers relax. Calcium acts as the catalyst for contraction. Magnesium acts as the catalyst for relaxation. With a magnesium deficit, muscles cannot properly relax, causing weakness, spasm and pain.

3. Role of magnesium in digestion. Part of digestive function is to move food from the mouth through the esophagus and stomach to the intestines and out the anus. A magnesium deficit impairs the musculature of the gastrointestinal tract. This is the cause of constipation, nausea, vomiting and other digestive symptoms stemming from poor muscle movement.

4. Role of magnesium in bone health. Approximately 50% of total body magnesium is found in bone. Along with calcium and certain other nutrients, magnesium provides strength to the living bone tissue. With a magnesium deficit, this mineral will be pulled out of bone tissue for more vital functions elsewhere. This is a cause of osteoporosis.

5. Role of magnesium in nerve and mental function. In the brain, magnesium plays important roles in all the major metabolisms such as oxidation-reduction (free radicals) and in ionic regulation (electrolytes), among others described below.⁹ Nervous tissue is sensitive to low levels of magnesium. The resulting impaired nerve conduction causes fatigue, weakness, and tremors.

The mind requires magnesium for adequate neurotransmitter chemicals. Magnesium deficit can result in insomnia, faulty thinking, emotional problems, inappropriate behavior, and psychiatric problems such as depression but not  dementia. Adequate EPA ( an omega-3 fatty acid) depends in part on magnesium as a co-factor. EPA deficit causes its own set of nervous problems.

6. Role of magnesium in heart health. The heart is a muscle that depends on magnesium for relaxation following contraction. Serious magnesium deficiency causes poor heart action and strength and further stresses the heart by causing hypertension. That is, blood pressure rises because the muscle layer of artery walls cannot properly relax, constricting the arteries. Narrowed arteries in turn force the heart to pump harder to get the blood through them. Magnesium deficit is implicated in heart attack.

7. Role of magnesium in parathyroid health. The four small parathyroid glands sit next to the thyroid gland in the neck. Their function is to maintain a balance of calcium. When calcium is needed and not forthcoming from absorption in the small intestine, parathyroid hormone acts to remove calcium from bone to meet essential body needs. Inadequate magnesium impairs this function.

8. Role of magnesium in eye health. “It is important for maintaining the structural and functional integrity of several vital ocular tissues such as cornea, lens and retina. The magnesium content of lens, especially in its peripheral part, is higher than that in aqueous and vitreous humor. Magnesium has also been shown to play critically important role in retinal functions. Furthermore, magnesium deficiency is also a contributing factor in increased oxidative stress that can further contribute in the initiation and progression of ocular pathologies such as cataract, glaucoma and diabetic retinopathy.”¹⁰

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

Magnesium deficiency results from these mechanisms:

• Failure of magnesium to get ionized (gets a required positive charge) in the stomach due to low stomach acid because ONLY ionized magnesium can be absorbed.
• Binding with unabsorbed fatty acids that are present due to fat malabsorption because ONLY ionized free magnesium ions can be absorbed. Fat binding to magnesium forms soaps, which because they cannot be absorbed, pass into the colon and out of the body
• Inadequate absorptive surface area due to damage of the lining so magnesium passes out of the small intestine unabsorbed into the colon and out of the body.

Other factors that cause magnesium deficiency:

• Shift in electrolyte balance from loss of potassium in diarrhea and/or vomiting when present.
• Poorly controlled diabetes mellitus, if present as an associated disorder, due to loss by excessive urination.

Does Magnesium Deficiency Respond To A Gluten-Free Diet?

Yes. Magnesium deficiency responds to a nutritious gluten free diet in most patients with celiac disease.²,³ Supplementation may be needed.

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6 Steps To Correct Magnesium Deficiency:

• [dropcap]1[/dropcap]Meet, or Exceed the RDA (Recommended Dietary Allowances) for Magnesium in milligrams (mg) per day:

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80 mg for children 1-3 years;

130 mg for children 4-8 years;

240 mg for children 9-13 years;

410 mg for male teens 14-18 years; 360 mg for female teens 14-18 years;

400-420 mg for adult males and 310-320 mg for adult females;

350 mg for pregnancy; 310 mg for breastfeeding women.[/box]

• [dropcap]2[/dropcap]Diet – Include Food Sources Richest in Magnesium:

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Food Sources of Magnesium ranked by milligrams of magnesium per standard amount; also calories in the standard amount. (All are ≥ 10% of RDA for adult men, which is 420 mg/day.)

Food, Standard Amount	Magnesium (mg)	Calories
Pumpkin and squash seed kernels, roasted, 1 oz	151	148
Brazil nuts, 1 oz	107	186
Halibut, cooked, 3 oz	91	119
Quinoa, dry, ¼ cup	89	159
Spinach, canned, ½ cup	81	25
Almonds, 1 oz	78	164
Spinach, cooked from fresh, ½ cup	78	20
Buckwheat flour, ¼ cup	75	101
Cashews, dry roasted, 1 oz	74	163
Soybeans, mature, cooked, ½ cup	74	149
Pine nuts, dried, 1 oz	71	191
Mixed nuts, oil roasted, with peanuts, 1 oz	67	175
White beans, canned, ½ cup	67	154
Pollock, walleye, cooked, 3 oz	62	96
Black beans, cooked, ½ cup	60	114
Soybeans, green, cooked, ½ cup	54	127
Tuna, yellowfin, cooked, 3 oz	54	118
Artichokes (hearts), cooked, ½ cup	50	42
Peanuts, dry roasted, 1 oz	50	166
Lima beans, baby, cooked from frozen, ½ cup	50	95
Navy beans, cooked, ½ cup	48	127
Tofu, firm, prepared with nigaria , ½ cup	47	88
Okra, cooked from frozen, ½ cup	47	26
Soy beverage, 1 cup	47	127
Cowpeas, cooked, ½ cup	46	100
Hazelnuts, 1 oz	46	178
Great northern beans, cooked, ½ cup	44	104
Buckwheat groats, roasted, cooked, ½ cup	43	78
Brown rice, cooked, ½ cup	42	108
Haddock, cooked, 3 oz	42	95

^a Calcium sulfate and magnesium chloride.

Source: Nutrient values from Agricultural Research Service (ARS) Nutrient Database for Standard Reference, Release 17. Foods are from ARS single nutrient reports, sorted in descending order by nutrient content in terms of common household measures.  

Cook’s Note: Processing of whole grains strips them of their germ and bran layer, which contains magnesium and many other nutrients. The remedy is to buy and consume rice bran and more whole grains, such as brown rice and buckwheat that can be added to cooked cereals, baked goods, meat loafs and such.

Cooking can substantially reduce the magnesium in foods such as dried beans and leafy green vegetables. The remedy is to consume the liquid used for cooking rather than pouring it away. Making soups, stews, pot roasts and casseroles are excellent ways to preserve magnesium in food preparation. Nuts and seeds lose very little magnesium in roasting or making into butters.

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• [dropcap]3[/dropcap] Diet – Avoid, Limit, or Eat At Another Time These Foods That Deplete or Interfere With Absorption:

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• Refined oil from seeds such as safflower, canola, cottonseed, and sunflower refined oil.
• Refined sugar including table sugar (cane and beet), corn syrup and especially fructose.
• High oxalate-containing food like rhubarb, spinach, chard and beet greens.
• Coffee.
• Carbonated drinks.
• Alcoholic drinks.
• Milk products.
• Excessive fats.

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• [dropcap]4[/dropcap]Monitor Medications That Deplete or Interfere With Absorption:

Many prescription drugs can cause magnesium deficiency. Ask your doctor or pharmacist about possible interactions between magnesium supplements and medications you’re taking to make sure you time the doses correctly.

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Here are common medications that increase risk and should to be monitored with blood testing for deficiency:

• Tetracycline® antibiotic.
• Magnesium and Aluminum Antacid Preparations (Gaviscon®, Maalox®, Mylanta®).
• Antacids (Alka Selzer, Baking Soda).
• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron®).
• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others).
• Loop Diuretics (Lasix®, Bume®x, Edecrin®).
• Foscanet (anti-viral).
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others).
• Medications for irregular heartbeat (Cordarone®, Cardioquin® and Betapace®).
• Female oral contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others). Correlation analysis shows significant association between some trace elements and the duration of contraception and body mass index of the study participants.¹¹[/box]

• [dropcap]5[/dropcap]Manage Nutritional Supplements to Obtain Magnesium:

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• A blood level concentration should be obtained to determine status before supplementing.
• Magnesium is available in tablet form as chelated magnesium (best absorbed), magnesium citrate, magnesium oxide, and is part of multivitamin/ mineral supplements.
• Large oral intakes of magnesium (400-1,000 mg daily), when spread throughout the day, are not considered harmful, except for some persons with impaired renal function.
• Magnesium can be taken with or without meals, but it is preferable to take it between meals for better absorption.
• Avoid taking magnesium with calcium because calcium is more easily absorbed and competes with absorption sites in the small intestine.

Caution: Excessive magnesium intake may cause diarrhea, nausea, vomiting, hypotension, slow heartbeat, dizziness, lightheadedness and central nervous system depression. Continued excessive intakes of magnesium may imbalance calcium and phosphorous metabolism.[/box]

• [dropcap]6[/dropcap]Other Supplements That Deplete or Interfere With Absorption:

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• Calcium supplements used for osteoporosis compete with magnesium for absorption. Generally, take 2 hours before or after each other. Check with your pharmacist.
• Vitamin D and protein supplements increase the need for magnesium.
• Phosphorus interferes with the balance of magnesium [/box]

Medical Research Findings On Magnesium Deficiency In Celiac Disease and/or Gluten Sensitivity:

RESEARCH STUDY SUMMARIES

“Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with celiac disease.” This study investigating life-long gluten-free diet (GFD) in celiac disease patients aimed to determine the nutritional adequacy of the ‘no detectable gluten’ diet. Results show that inadequate intake of magnesium is common (more than 10%) and may relate to habitual poor food choices in addition to inherent deficiencies in the GFD. “Dietary education should also address the achievement of adequate micronutrient intake.”

A seven-day prospective food intake was assessed in 55 patients who were adherent to a GFD for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18-71 years, 24% male) studied prospectively over 12 months on GFD. Historical pre-celiac intake was also assessed in the latter group. Intake was compared with Australian Nutritional Recommendations and the Australian population data.

RESULTS: Nutritional intake was similar between groups. Of macronutrients, only starch intake fell over 12 months (26% to 23%). Fibre intake was inadequate for all except in diet-experienced men. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin, folate, vitamin A, magnesium, calcium and iron intakes. More than one in 10 newly-diagnosed men had inadequate thiamin, folate, magnesium, calcium and zinc intakes. Inadequate intake did not relate to nutrient density of the GFD. Inadequacies of folate, calcium, iron and zinc occurred more frequently than in the Australian population. The frequency of inadequacies was similar pre- and post-diagnosis, except for thiamin and vitamin A, where inadequacies were more common after GFD implementation.  Because dietary intake patterns at 12 months on a GFD are similar to longer-term intake, researchers stress that fortification of GF foods also need to be considered.”¹²

“Magnesium status in children and adolescents with celiac disease.” This study investigating the magnesium status in patients at diagnosis demonstrated that magnesium deficiency was present in all patients with classical celiac disease, but only in 1/5 of patients with celiac disease on a gluten free diet and 1/5 of patients with silent celiac disease.²

“Magnesium deficiency: possible role in osteoporosis associated with gluten sensitivity enteropathy.” This study investigating magnesium status and bone mass in clinically asymptomatic celiac disease patients on gluten free diet and their response to magnesium therapy demonstrated that celiac disease patients have reduction in intracellular free Mg2+, despite being clinically asymptomatic. 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. Bone mineral density increased in response to magnesium therapy.³

CASE REPORT SUMMARIES

“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.¹³

Sources:

1. 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. [↩]
2. Rudjner J, 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 [↩] [↩] [↩]
3. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten sensitivity enteropathy. Osteoporosis International. 1996; 6(6):453-61. [↩] [↩] [↩]
4. Shepherd SJ, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111/jhn.12018. [↩]
5. Eby GA 3rd, Eby KL. Magnesium for treatment-resistant depression: a review and hypothesis. Med Hypotheses. 2010 Apr;74(4):649-60. doi: 10.1016/j.mehy.2009.10.051. [↩]
6. Rudjner J, 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. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩]
9. Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging. 2006 Sep-Oct; 10(5):377-85. [↩]
10. Agarwal R, Iezhitsa L, Agarwal P. Pathogenetic role of magnesium deficiency in ophthalmic diseases. Biometals. 2013 Nov 15. [↩]
11. 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. [↩]
12. Shepherd SJ1, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111/jhn.12018. [↩]
13. 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. [↩]