Magnesiumhgilfe: Frequently Asked Questions

Frequently Asked Questions

answered by Prof. Dr. sc. nat. Dr. med. D.-H. Liebscher

Translation courtesy of Katrin Liebscher.

General Questions

What does the body need magnesium for?

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Magnesium, or rather magnesium ions are essential for every cell, every tissue, every organ and every living organism. Magnesium is indispensable for life and it has to be supplied to the body. No living organism is able to produce magnesium by itself. Without magnesium life cannot exist.

Magnesium is part of

  • the basic material active in energy processes (Mg ATP),
  • the 'power stations' of the cell (mitochondria),
  • different metabolic catalysts (enzymes),
  • cell membranes and
  • membrane pumps.

Magnesium also plays a role in

  • the proper functioning of approx. 300 different metabolic catalysts,
  • the stabilization of membranes, proteins and nucleic acids,
  • conduction in nerve and muscle cells,
  • the controlled release of certain hormones and transmitters and
  • producing solid bones.

All of these processes and functions are impaired if there is too little magnesium in the body.

It is no surprise that magnesium – due to the multitude and diversity of functions it influences – appears to be a sort of cure-all. However from a biochemical and physiological point of view, the connection is very easy to explain. It is therefore all the more important to not forget about magnesium.

How much magnesium does a healthy person need to ingest daily?

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The German Society for Nutrition DGE (Deutsche Gesellschaft für Ernährung e.V.) recommends an intake of 300-350 mg of magnesium (in the form of magnesium ions), depending on age, gender and level of activity. However, patients with magnesium deficiency will always need more magnesium.

Which foods contain high levels of magnesium?

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Magnesium is part of the earth's crust and is absorbed from ingesting plant and animal matter or in form of magnesium salts.

Certain brands of mineral water (unfortunately relatively few) are very good sources of magnesium for the human diet. According to German regulations mineral water containing only 50 mg of magnesium per liter are considered high in magnesium. From a practical point of view, however, only those brands of mineral water containing more than 100 mg of magnesium per liter should be recommended as high in magnesium.

One of these is

  • Fuldataler Mineralbrunnen (source in Malsfeld) containing 119 mg of magnesium per liter (with 147 mg of sodium per liter) (can be purchased e.g. at NORMA supermarkets).

In particular, mineral water from the region of Vulkaneifel is high in magnesium:

  • Gerolsteiner (e.g. at KAUFLAND, KAISERS supermarkets),
  • Appollinaris (e.g. at PENNY, KAISERS supermarkets),
  • Nürburgquelle (can be found in the region of Vulkaneifel) and
  • Vulkania (can be found in the region of Vulkaneifel).

(There is no claim that this list is comprehensive.)

The advantage of mineral water lies in the fact that the magnesium ions can be efficiently absorbed by the intestines (bioavailability) avoiding excessive calorie intake.

All other excellent sources of magnesium have the disadvantage of also being very rich in energy: chocolate, cocoa and nuts.

Grains high in magnesium are oats, wheat bran and rice. However, most producers omit labeling their products accordingly.

Of the different types of fruits, bananas are relatively high in magnesium.

Of the various types of green vegetables (magnesium is part of the green leaf pigment chlorophyll), magnesium is found especially in spinach, chard, broccoli, beans and peas.

Black salsify, potatoes and rhubarb should be mentioned as well.

What are the causes of magnesium deficiency?

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Magnesium deficiency is caused by insufficient intake with food, reduced absorption in the intestines and early elimination through the kidneys and skin.

For years many scientists have been warning that magnesium is increasingly being leached out from the soil and consequently plants will contain less and less of it. As a result, there is less magnesium present in the diet of animals – and therefore also in the human diet. The latest comprehensive study on nutrition in Germany (VERA study) showed that more than 40 percent of the population on average did not receive the recommended nutrition values of the DGE. Poor nutrition (often due to lack of awareness and insufficient knowledge) thus represents a major primary cause of magnesium deficiency.

Other primary causes of magnesium deficiency include insufficient intake of magnesium

  • through an unbalanced diet,
  • due to insufficient food consumption (especially in elderly people), or
  • when the need for it is increased due to strain, stress, physical activity, or pregnancy.

Primary causes of magnesium deficiency however also include genetic ones, such as an impaired absorption mechanism of magnesium in the intestines or magnesium reabsorption in the kidneys. Unfortunately, this is given minimal attention only.

Secondary causes include various illnesses which contribute to a deterioration of the magnesium balance in our body:

  • alcoholism,
  • chronic intestinal illnesses (such as coeliac disease, short bowel syndrome, malabsorption syndrome), and
  • chronic renal diseases which contribute to high magnesium losses, as well as
  • diabetes.

Various medications also have a detrimental effect on the magnesium balance in the body (such as diuretics, antibiotics, chemotherapeutics).

How often does magnesium deficiency occur?

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Magnesium deficiency is definitely far more common than most doctors believe, since they are still generally being educated that magnesium deficiencies occur only very rarely. This is certainly not true.

According to nutrition studies, the general assumption is that 20 to 40 percent of the population have latent magnesium deficiency. If all regulatory mechanisms are working well in a healthy body, the intestines can efficiently absorb magnesium and the kidneys can reabsorb magnesium extremely efficiently, so that the magnesium balance is nearly kept in equilibrium.

Genetic magnesium deficiency occurs in approximately 0.1-1 percent of the population, which means around 80,000 to 800,000 people are affected by it in Germany. In these cases the body's own regulatory mechanisms are no longer able to achieve the necessary balance. Such cases require a considerable increase in the magnesium intake, and food supplements containing magnesium or medication containing magnesium can be used to this end. Intake of 600-1200 mg of magnesium is necessary in such cases. Unfortunately, little attention is usually given to these facts.

In intensive care units, about 20 percent of patients have a magnesium concentration in blood that is too low (a condition called hypomagnesaemia).

In a study on nutrition involving young people, researchers at the University Hohenheim found hypomagnesaemia in 11 percent of cases.

In a general practitioner's practice, you will find approx. 7 percent of patients with hypomagnesaemia.

Questions on the Manifestation (Symptoms) of Magnesium Deficiency and Self-Medication

Which manifestations (symptoms) indicate magnesium deficiency?

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Due to the numerous functions of magnesium in the body mentioned previously, magnesium deficiency generally causes several symptoms at a time. Therefore it is called magnesium deficiency syndrome (also tetanic syndrome). Symptoms can be multifarious: Prof. Dr. sc. med. Roland Fehlinger, neurologist and psychiatrist, founder of the self-help organisation Mineralimbalancen, published the most common symptoms of the tetanic syndrome (syndrome = the typical coincidence of different symptoms) in his brochure for patients. The list below contains the symptoms most commonly named in a patient self-assessment based on a rating scale using a questionnaire with 86 symptoms:

  • Irritability
  • Tiredness
  • Rapid exhaustion
  • Inner restlessness
  • Cold feet
  • Headaches
  • Weariness/lack of energy
  • Sensitivity to noise
  • Brooding
  • Numbness in hands and feet
  • Excessive need to sleep
  • Palpitation, tachycardia
  • Weakness
  • Backaches
  • Muscle cramps, e.g. calf cramps, spasms of the masticatory muscles, twitching of the eyelid – they are considered the cardinal symptom.

Prof. Fehlinger declared that patients had particularly complained about a very unspecific "irritable weakness", which is often the result of overpowering depressions, anxieties, panic attacks, but also of an agonizing search and brooding of whether a serious illness may lie behind all this (hypochondriacs).

But magnesium deficiency, i.e. the tetanic syndrome (magnesium deficiency tetany) – if not detected, not recognized nor treated – is an illness that must be taken very seriously. The testimonies of patients having an unreasonably long history of suffering show that this illness is not taken seriously enough. In the opinion of affected patients, the reason for this lies in the fact that this clinical picture is not given enough priority in medical education and training.

It is important to know that the forms of manifestation related to tetanic syndrome change with age.

In infants you will find labor complications, mild failure to thrive, susceptibility to infections, increased propensity to develop cramps (teething and febrile convulsions) as well as delayed dentition.

Manifestations of magnesium deficiency in grade schoolers include concentration and sleeping disorders, "nervousness", abdominal pain and headaches, collapses; in children 10 years and older, muscle cramps; in children over 15, a feeling of constriction and laboured breathing. Girls often have a delayed onset of menstruation and menstrual pains; sometimes there are also irregularities in the duration of cycles.

The symptoms in adults include rapid exhaustion, increased need to sleep, anxiety, depression, muscle cramps (in the calf muscles and in t he vascular and visceral smooth muscles), headaches, migraines (diffuse and/or migraine-like headaches are very common), discomfort of uncertain origin in the upper abdomen and stomach pains. People aged 30+ tend to also suffer from typical tetanic spasms (obstetrician's hand), and those older than 40 also have neurologic deficits called TIAs (transient ischaemic attacks) leading to temporary disruption of the blood flow to the brain.

Muscle weakness is often much more distressful to patients than muscle cramps. The classical tetanic seizure, i.e. the continuous spasm of the body including the lip muscles, occurs in not more than 20 percent of patients.

Women tend to develop pregnancy complications such as vomiting, edemata, protein in the urine, high blood pressure (pre-eclampsia and eclampsia) and miscarriages.

When should I take magnesium or additional magnesium?

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In case you have any of the symptoms described above, which were initially felt as being mild and which do not make you go and see a doctor straight away, self-medication with magnesium should always be preferred to painkillers, sedatives and sleeping pills. If your discomfort is due to a magnesium deficiency, our experience has shown that the symptoms will decrease or disappear completely after taking magnesium supplements. A successful treatment is a relatively safe indication of this fact.

In principle however, it is recommended to consult a physician who knows more about magnesium deficiency syndrome, tetanic syndrome or magnesium deficiency.

Which supplements are recommendable? Which are the best?

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There is a large number of magnesium supplements which can be bought over the counter in your local pharmacy; however, there are also numerous food supplements available in drugstores and supermarkets.

The most economical food supplements contain 20 tablets with 150 mg of magnesium each in form of magnesium carbonate and cost about EUR 0.70. Magnesium carbonate has the advantage that the carbonate anion simultaneously binds with excessive gastric acid. These food supplements are available from numerous manufacturers. The supplements differ from each other mainly by the flavourings used. For this reason, you should try to find the one that tastes best to you. A certain disadvantage of these supplements is that the intestines do not absorb magnesium into the blood (bioavailability) as well as would be the case with magnesium supplements containing organic acids, such as aspartate (by Verla), citrate (by Protina), or orotate (by Wörwag).

Magnesium supplements containing organic acids are often medications and can be bought in pharmacies. Granules containing at least 300 mg of magnesium are particularly recommended. Try to always buy the large package size N3 (about EUR 27), which contains approx. 100 individual packages, for instance bags of granules. It turns out to be less expensive than buying 5 packages with 20 bags each! Please be aware that pharmacies do not always have everything in stock, however they will commonly place an order and receive the delivery from their pharmaceutical wholesalers within 3 to 4 hours after ordering.

Also the digestibility of the different magnesium supplements mentioned above can vary from person to person. You will need to find the most suitable supplement on your own.

How fast does magnesium help?

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As the bioavailability of magnesium is good, it will usually begin to take effect within 1-3 hours (e.g. in cases of tiredness). You can take advantage of this fact to help you fall asleep more easily at night. Those suffering from muscle cramps will notice that their cramps will disappear or at least subside considerably. Those suffering from muscle weakness ("heavy legs") will also notice an improvement quite soon.

Many deficiency symptoms however are due to an excessive depletion of the body's magnesium stores (for instance, in bones). In these cases, it will take more than 2 to 4 weeks to replenish the stores. If you take at least 600 mg of magnesium regularly, you might notice for instance that even persistent and painful tension headaches, ones that force you to get up at night and remain vertical for some time, will disappear. People exposed to stress should notice that their blood pressure will decrease slowly after several weeks. These people will also become more relaxed and restful; also hyperactive people including children and young persons will become calmer. Magnesium is rightly so described as the anti-stress mineral.

Those who are poor absorbers (meaning that they absorb magnesium ions relatively poorly through the intestines into the bloodstream) and/or poor reabsorbers (meaning they reabsorb too few magnesium ions from the primary urine in the kidneys), will have to take additional magnesium all their life in order to remain free of symptoms.

How do I know how much magnesium I need?

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In the experience of our self-help organisation Mineralimbalancen anyone will usually notice positive changes with a daily dose of at least 600 mg of magnesium, provided that the disturbing symptoms are due to a magnesium deficiency. Once a magnesium deficiency has been detected, many of us need to take 600-1200 mg of magnesium per day over the course of the day for the rest of our lives. It is essential for poor absorbers and/or reabsorbers to start taking additional magnesium (magnesium supplements) as early as possible. Early detection is only possible if affected patients, health care providers and pharmacists pay attention to this illness at an earlier stage, and to a greater extent than they do today.

What are the side effects of magnesium?

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If taken orally, magnesium has virtually no side effects.

What happens if I take too much magnesium?

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If you take an increased dose of magnesium at once (such as 600 mg), your body will react by producing soft stools because the increased concentration of magnesium salt will draw water from the body. You can avoid this situation by drinking magnesium dissolved in mineral water if possible, and distribute consumption over the course of the day. Many elderly people tend to suffer from constipation and many drugs they take rather lead to constipation. For this reason, magnesium even has an additional desirable side effect of softening the stool.

Patients who know they have an impaired renal function (because they are being treated for this) should ask their physician before beginning self-treatment to avoid an excessive concentration of magnesium in blood plasma.

Since magnesium is an essential material, our body has developed a sophisticated system for regulating magnesium metabolism. The easiest way for the body to react to excessive amounts of magnesium is for the intestines to absorb less of it than usual. Consequently bioavailability decreases. This is a self-defense mechanism.

However if you take more than 600 mg of magnesium per day over an extended period of time, you should do so under the care of a doctor (this should include annual laboratory tests of the minerals in your blood plasma). In most cases, however, the complaints, which may be very intense, will have forced you to see a doctor anyway, with whom you should openly discuss your symptoms and experiences.

I have heard that magnesium can cause diarrhea. Is that true?

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If you take too much magnesium, even though your body does not need it, you are likely to not only have soft stools (see above), but sometimes also diarrhea. However this is not the normal case of diarrhea, which is caused by an infection or spoiled food and where you can hardly leave the toilet. And this type of diarrhea can be avoided by taking magnesium in small doses, such as 4 x 150 mg of magnesium every 4 hours, or you can even dissolve the magnesium in two drinking bottles with 300 mg of magnesium and 200 ml mineral water each.

Do I need to change my habits because I take magnesium?

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If you are someone who is not used to routines, you will have to change some habits. The proper effect is based on a regular intake, starting with breakfast, at mealtimes or before going to sleep, or with drinking up "your bottle" between mealtimes, etc.

Questions on the Scientific and Medical Fundamentals

What clinical tests are available?

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The easiest test is to determine the magnesium concentration in blood. But this is not part of routine diagnostics! Physicians tend to rate its importance lowly, because the serum concentration (plasma concentration) will naturally not reflect the stores of magnesium, which is far more relevant indicator. On the other hand, it is well known that a decrease in the magnesium concentration (< 0.75 mmol/liter) will inevitably lead to symptoms of disease. Magnesium concentrations of up to 1.1 mmol/liter are considered to be within the normal range. Your aim should always be at keeping magnesium concentration in the upper normal range.

Exercise tests are more precise tests. Magnesium is given intravenously and it is checked how much magnesium is excreted after 24 hours. If too much magnesium is retained in the body, it is a strong indication that your body's stores are depleted and are being replenished because they need to be replenished! However these tests are costly and are hardly ever performed on an outpatient basis.

Magnesium deficiency is largely diagnosed on the basis of your medical history (anamnesis) and the clinical symptoms. You can consider the diagnosis to be confirmed if symptoms diminish or even disappear with the intake of magnesium.

My physician says all my values are normal. Is everything okay then?

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It is a known fact that magnesium deficiency may also exist even if magnesium concentration in serum appears to be normal. In up to 80 percent of the relevant cases, serum concentrations are within the normal range despite the magnesium deficiency. The clinical symptoms are the decisive factor! There is absolutely no reason for not trying it out for yourself whether magnesium can help if you have specific complaints.

My family doctor says that my magnesium intake is sufficient as long as I have a healthy mixed diet.

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As long as you are free of symptoms and regarded as healthy, it is very well possible to ingest sufficient amounts of magnesium with your food (enough according to the guidelines of the German Society for Nutrition–DGE). However it has been demonstrated that a large percentage of the population does not even receive the recommended amounts despite the education on this issue. Another problem is that there is no precise data on how many people are poor absorbers and/or reabsorbers due to reasons of hereditary or acquired defects.

Our self-help organisation believes that there are far more affected people than is widely known.

Questions on Genetics and Hereditary Factors

Magnesium had a positive effect on my parents. Do I also need magnesium supplements?

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Everyone who has both parents suffering from magnesium deficiency and where their complaints have improved with the intake of magnesium should generally consider that they are more likely to be affected by magnesium deficiency as well.

Even if only one parent has a magnesium deficiency, it is possible that you may also have a magnesium deficiency. It is established that a large number of children of tetanic mothers with magnesium deficiency also suffer from this deficiency.

Experience says once a case of magnesium deficiency has been diagnosed in the family, everyone will do well to treat specific symptoms with magnesium, or at least to try to see it if it helps!

On the other hand, however, anyone with a detected magnesium deficiency should consider their parents, sisters, brothers and other relatives. This situation has been given far too little attention so far. But it is just as important to consider this, as it is a common practice of doctors to ask about diabetes, hypertension or cancer in the family when recording a patient's medical history.

Is there a gene test?

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We already know several different gen loci having an effect on magnesium metabolism. Tests are being used only sporadically and only for research. Dr. Konrad's group in Marburg, Germany, is dealing with this problem very intensively. Researchers often have difficulties in finding suitable patients for designing effective tests. There are several "magnesium-deficiency families" in our self-help organisation. Several of them are willing to offer their support for research work if it is required.

Other Questions

I have osteoporosis. Isn't magnesium dangerous for the bones?

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Magnesium is not dangerous for the bones. On the contrary, it is indispensable for maintaining a healthy bone structure. Up to 50 percent of the body's magnesium is found in the bones. Even if there is a situation of deficiency, the bone will never release all its magnesium into the bloodstream. It is an established fact that magnesium deficiency will even promote osteoporosis. Although the importance of magnesium for bone metabolism has been demonstrated in scientific papers, the public pays far too little attention to this issue.

Where can I learn more about magnesium?

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As it is quite often the case, if you know where to look, there is plenty of literature on the role magnesium plays for our health! Prof. Fehlinger, who has published extensive material on the magnesium deficiency tetany in Germany and who takes most of the credit for the existence of our self-help organisation, wrote a patient manual, which anyone can request from the self-help organisation.

Moreover, we are also happy to send you recommendations for specialist literature written in understandable terms for patients in both German and English, if requested (please send us A4-sized self-addressed stamped envelopes).

You will find a summary of more in-depth literature at the end of each poster page as well.

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May. 1, 2006