Article Series

  1. Magnesium - Functions And Health Benefits
  2. Daily Magnesium Requirement
  3. Magnesium Deficiency - Causes, Symptoms, Treatment

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Magnesium Deficiency - Causes, Symptoms, Treatment

Magnesium Deficiency - Causes, Symptoms, Treatment
Table Of Contents
  1. Risk Groups
  2. Causes of Magnesium Deficiency
  3. Symptoms of Magnesium Deficiency
  4. Consequences of Magnesium Deficiency
  5. Determining Magnesium Deficiency
  6. Treatment / Therapy
  7. Preventive Measures

Magnesium is involved in numerous bodily functions, so a magnesium deficiency can quickly lead to deficiencies. The mineral is responsible, among other things, for the activation of over 300 enzymes, which also play a crucial role in cellular and energy metabolism, as well as the formation of DNA and RNA. Magnesium, as an antagonist to calcium, which is required for muscle contractions, is also involved in muscle relaxation.

In medical terminology, a magnesium deficiency is referred to as hypomagnesemia. A decrease in magnesium concentration in the blood is a prerequisite for hypomagnesemia. Various causes can lead to a deficiency with corresponding symptoms.

Magnesium deficiency occurs in 2.5 to 15% of the population and is therefore relatively common 1 2.

Risk Groups

Especially in athletes involved in strength and endurance sports, symptoms of magnesium deficiency may occur 3.

Pregnant women have a higher magnesium requirement and may be affected by magnesium deficiency.

Older individuals are also at risk as intestinal absorption capacity decreases with age 4 5.

Patients with digestive tract disorders may be affected by magnesium deficiency. Conditions such as Crohn's disease, celiac disease, malabsorption syndrome, or surgical removal of sections of the intestine (especially the ileum) or a bypass can cause the deficiency 6.

Patients with kidney damage can also suffer from magnesium deficiency.

Alcoholics burden the liver and kidneys, resulting in fewer magnesium ions in the blood.

Also at risk are individuals who are exposed to excessive stress, both emotional and physical, as well as psychological stress. 7.

Patients with Type 2 diabetes are also part of the risk group for magnesium deficiency. 8 9 10 11 12. Deficiency occurs in 13.5% to 47.7% of patients with Type 2 diabetes. 13.

Causes of Magnesium Deficiency

The main reason for magnesium deficiency may lie in an inadequate supply of the body with magnesium-rich foods. The selection of foods should be made consciously, which includes avoiding heavily processed and nutrient-poor products. White flour products and heavily sugary foods should be avoided.

An impairment of magnesium absorption is also one of the main reasons for magnesium deficiency 14. Digestive tract disorders or intestinal diseases can lead to reduced absorption of magnesium in the intestines. The absorption of magnesium decreases with advanced age, and magnesium excretion through the kidneys increases 15.

Various food components, such as high phytic acid and oxalic acid content in foods, can also hinder or prevent the absorption of magnesium. Examples include phytic acid and oxalic acid, which chemically bind to magnesium ions, forming a complex that cannot be absorbed 16. Additionally, excessive intake of calcium can also negatively influence the absorption of magnesium. Calcium is the antagonist of magnesium, and both minerals compete for absorption in the intestine.

Disorders and inflammation in the digestive tract can also cause magnesium deficiency. In many cases, the underlying cause is kidney or liver dysfunction. Normally, the body reduces magnesium excretion through the kidneys when facing magnesium deficiency 17. Chronic vomiting or diarrhea can manifest such a disorder.

A disorder of the parathyroid glands can be a cause for increased magnesium excretion through the kidneys. The parathyroid gland produces the hormone parathormone, which, among other functions, instructs the kidneys to excrete less magnesium. Insufficient production of parathormone (parathormone deficiency) can lead to magnesium deficiency 18.

An insulin resistance, as seen in diabetics, can contribute to reduced magnesium levels. 19 20 21 22. Insulin is involved in maintaining magnesium concentrations.

A magnesium deficiency can also be triggered by medications. It is recommended to read the package insert for such drugs. These medications can include proton pump inhibitors, EGFR inhibitors, and calcineurin inhibitors. 23 24 25 26. However, diuretic medications are often the main cause of a deficiency.

Magnesium is also lost through sweat 27. Therefore, athletes and individuals engaged in sweat-inducing activities may experience a decrease in magnesium levels. High temperatures accelerate sweat production and the excretion of magnesium.

Stress can also be the cause of magnesium deficiency, as the body's magnesium requirement increases during physical stress (such as exertion, heat, cold, burns), emotional stress (such as pain, anxiety, excitement, or depression), or dyspnea (shortness of breath) as in asthma 28 29. A progressive deficiency, in turn, leads to an amplification of the body's stress reactions.

The extracellular concentration of magnesium is carefully controlled. However, when magnesium shifts from the extracellular space into cells and bones, this can lead to magnesium deficiency 30 31. This can be caused, for example, by acute pancreatitis and metabolic acidosis (metabolic acidification of the blood) 32.

Symptoms of Magnesium Deficiency

Early signs or symptoms of magnesium deficiency include 33 34 35:

  • Muscle weakness / Weakness attacks
  • Rapid exhaustion
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Low stress tolerance
  • Irritability
  • Lethargy / Lack of drive
  • Restlessness

Since some symptoms of magnesium deficiency occur simultaneously, it is also referred to as magnesium deficiency syndrome (hypomagnesemia syndrome) in summary.

If the magnesium deficiency progresses, the following additional symptoms may occur due to neuromuscular hyperexcitability (tetany): 36 37 38 39:

  • Muscle cramps / seizures
  • Cramps in the soles of the feet, legs, face, jaw muscles
  • Muscle twitches
  • Muscle tremors
  • Muscle tingling
  • Back pain / neck pain / menstrual pain (dysmenorrhea)
  • Movement disorders
  • Numbness in hands and feet
  • Coronary spasms (constriction of the coronary arteries)
  • Heart rhythm disturbances
  • Bladder dysfunction
  • Hypersensitivity of hearing (dysacusis)

Additional symptoms that can occur with severe magnesium deficiency include 40 41:

  • Anxiety, including panic attacks
  • Agoraphobia (fear of open spaces, crowds, and traveling)
  • Inner restlessness
  • Altered mental activity
  • Confusion
  • Dizziness
  • Sleep disturbances
  • Dysphagia (difficulty swallowing)
  • Seizures
  • Chest tightness and bronchial spasms leading to shortness of breath and asthma attacks

In addition, some symptoms of calcium deficiency may also occur (including Chvostek's sign, Trousseau's sign, paresthesia) 42 43.

Consequences of Magnesium Deficiency

If magnesium deficiency is not corrected, it can lead to serious health conditions.

First and foremost, in the case of prolonged magnesium deficiency, damage to the central nervous system can occur due to increased excitability of the nervous system 44. A deficit can lead to the occurrence or exacerbation of headaches, migraines, depression, psychoses, and in children, ADHD (Attention Deficit/Hyperactivity Disorder) 45 46 47 48 49 50 51 52. Increased susceptibility to physiological damage from stress, such as sensitivity to noise, hearing loss, and tinnitus, can also be a consequence 53. Additionally, low magnesium levels are associated with Alzheimer's disease 54.

A magnesium deficiency leads to increased neuromuscular excitability, reduced cellular respiration, and decreased ATP production, ultimately resulting in less energy available to the body 55. Furthermore, a magnesium deficiency generally reduces the performance and endurance of athletes 56 57 58 59.

Another consequence can be premature cell death, leading to faster aging of the body. This is due to magnesium acting as an antioxidant in protecting mitochondria against free radicals. Mitochondria are the powerhouses of the cell. Damage to mitochondria and a decline in mitochondrial energy metabolism are associated with an accelerated aging process 60.

Cardiovascular diseases can also be the result of a magnesium deficiency 61. An imbalanced electrolyte balance, which can also be caused by a magnesium deficiency, leads to high blood pressure and heart rhythm disorders 62.

Low intake of magnesium and the associated low magnesium levels are associated with both higher blood pressure and higher stroke risk 63. According to other study findings from 2014, low plasma magnesium levels (<0.82 mmol/L) can contribute to a higher risk of ischemic stroke (brain infarction) in women 64. Heart attacks are also associated with magnesium deficiency 65. In addition, there are arterial inflammations, higher inflammation levels (C-reactive protein), and endothelial dysfunction (blood vessel dysfunction) 66 67.

Moreover, it can become life-threatening due to ventricular arrhythmia (abnormally fast heart rhythm in the lower chambers of the heart) 68. Lower magnesium levels are generally associated with higher mortality and cardiovascular mortality rates 69 70. Specifically, in dialysis patients, magnesium deficiency is associated with an increase in cardiovascular risk factors and higher mortality 71.

Furthermore, a magnesium deficiency can also trigger and worsen hypokalemia (potassium deficiency), which can be responsible for neurological and cardiological symptoms 72 73 74. A magnesium deficiency leads to increased excretion of potassium 75. Simultaneously, sodium is retained 76.

A low magnesium level also causes an intracellular imbalance between calcium and magnesium. This leads to increased vascular tone (hypertension), which in turn impairs organ blood flow 77. The result can be either unusually high or low blood pressure.

Scientific studies show that a lack of magnesium has a negative impact on bone health 78 79 80 81 82. So, in the case of hypomagnesemia, the secretion of parathyroid hormone and the metabolism of vitamin D are negatively influenced 83 84. Additionally, there is a decreased formation of active vitamin D in the body 85 86. Vitamin D and parathyroid hormone are involved in the regulation and maintenance of calcium concentrations in the body. Due to magnesium deficiency, calcium concentrations decrease despite sufficient calcium intake through diet. The result is hypocalcemia (calcium deficiency) 87 88. The body increases the secretion of parathyroid hormone and tries to maintain the calcium level by extracting calcium from the bones. This process also attributes a magnesium deficiency to an increased risk of osteoporosis 89 90 91. Adequate magnesium supply reduces the risk of vitamin D deficiency and insufficiency significantly 92.

Magnesium ions are involved as cofactors for enzymes in the replication and repair of DNA. 93 94. Cofactors support enzymes during their chemical reactions. A deficiency in magnesium could cause enzyme malfunctions and lead to DNA mutations 95. Furthermore, according to scientists, a magnesium deficiency could trigger inflammation and lead to elevated levels of free radicals, which in turn can cause oxidative damage to DNA and tumor formation.

Magnesium can also cause insulin resistance since magnesium is involved in the secretion and activity of insulin 96 97. Insulin resistance is the starting point of diabetes. Insulin is responsible for the uptake of glucose (blood sugar) into body cells.

If a magnesium deficiency occurs during pregnancy, it can lead to complications such as miscarriage, premature labor, and eclampsia (occurrence of seizures up to coma). Eclampsia can be life-threatening for both mother and child. 98.

A magnesium deficiency is also associated with periodontal diseases. 99.

Determining Magnesium Deficiency

If the mentioned symptoms do not disappear within a few days of improved magnesium intake, it is suspected to be a magnesium deficiency. Changes in heart rhythm that may result from a magnesium deficiency can be determined using an EKG.

Measuring magnesium excretion and the calcium-creatinine ratio can be a first step in determining a possible magnesium deficiency. 100. Diagnosing magnesium deficiency through blood tests is difficult because less than 2% of measurable magnesium is found in the extracellular space (67% in bones and 31% in the intracellular space). 101 102 103. Therefore, the values obtained do not reflect the body's reserves 104. When there is suspicion of a deficiency or in acute cases, an examination of serum and plasma concentrations, as well as magnesium concentrations in red blood cells, should be carried out 105. Magnesium deficiency can also be detected during blood plasma donations.

The following references provide information about the magnesium status in the body: 106 107 108 109 110 111 112 113:

ConditionSerum Magnesium Concentration
normal 1.8-2.8 mg/dL (0.75-1.15 mmol/L)

0.54–0.67 mmol/L (ionized Mg concentration)
Early stage magnesium deficiency
(with few to no symptoms)
≤1.8 mg/dL (<0.75 mmol/L)
Hypomagnesemia ≤1.5 mg/dL (≤0.61 mmol/L)
Severe magnesium deficiency ≤1.2 mg/dL (≤0.5 mmol/L)

Treatment / Therapy

Depending on the cause and severity of magnesium deficiency, an appropriate therapy should be initiated. The primary focus is to identify the cause so that the symptoms are not just temporarily alleviated and recur shortly after.

If magnesium deficiency is diagnosed, therapy usually begins with the administration of dietary supplements, depending on the magnesium levels. Treatment can be achieved through a magnesium-rich diet or supplementation when the levels range from 1.2 mg/dl to 1.7 mg/dl 114 115. Recommended dietary supplement amounts for a reduced magnesium intake through diet are 350 mg for men and 280 mg for women 116. Serum magnesium levels increase rapidly, whereas intracellular concentrations require more time to replenish (1-2 days) 117.

Recommended products with high bioavailability are organically bound magnesium salts such as magnesium citrate, magnesium gluconate, magnesium orotate, or magnesium aspartate. 118. The therapy can last for up to a month until magnesium levels return to normal. For long-term therapy, 300-600 mg of oral magnesium per day may be necessary. 119. It is advisable to consult with a primary care physician. It should be kept in mind that magnesium deficiency can only be permanently prevented by treating the underlying causes.

For severe magnesium deficiency (magnesium serum <1.2 mg/dL), magnesium is administered directly intravenously. 120 121. This also involves parenteral nutrition, bypassing the digestive tract. Patients with magnesium symptoms should receive 3 to 4 grams of magnesium sulfate slowly over a period of 12 to 24 hours. 122.

Since most cases of magnesium deficiency also involve hypocalcemia (calcium deficiency), the administration of 1 gram of calcium gluconate is also appropriate. 123.

Parenteral administration of magnesium is recommended for serum levels below 0.5 mmol/L or in cases of severe hypomagnesemia symptoms. 124.

In addition, potassium-sparing diuretics (which have a diuretic effect) may lead to reduced excretion of magnesium through the kidneys. 125.

In general, dietary supplementation and intravenous administration of magnesium are considered safe. 126. However, caution should be exercised in patients with impaired kidney function when supplementing with magnesium or administering it intravenously, as it can lead to a life-threatening buildup of magnesium in the body (hypermagnesemia). 127.

In most cases, a magnesium deficiency also leads to a loss of potassium and calcium 128. Therefore, additional administration of these minerals can be beneficial.

The extent to which the new treatment method using transdermal magnesium could support the therapy for magnesium deficiency is not yet precisely researched. In this method, magnesium chloride is applied to the regions of the skin with the corresponding symptoms, which is expected to lead to faster relief of symptoms. According to preliminary study results, such creams could be advantageous for patients with fibromyalgia 129. Fibromyalgia is a chronic condition characterized by pain in various regions of the body.

Preventive Measures

By following a balanced vegan diet, you can effectively prevent magnesium deficiency. Foods rich in magnesium include nuts, seeds, grains, as well as magnesium-rich fruits and magnesium-rich vegetables. According to a large British study, vegans have the highest intake levels of magnesium. 130.

Magnesium is partially washed out during food washing and cooking. Therefore, the respective foods should be steamed, baked, or roasted whenever possible. When cooking the foods, the cooking water can be used for soups so that magnesium, along with other minerals and vitamins, is not wasted.