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How magnesium supports metabolic and musculoskeletal health
Magnesium serves as a cofactor for more than 300 enzymes and is essential for the functioning of every organ in the human body.[1],[2],[3],[4] It is the fourth most abundant mineral in the body, following calcium, phosphorus, and potassium. However, it remains one of the least understood and appreciated elements in human nutrition.[5]
Although magnesium is essential for good health, nearly two-thirds of adults are not achieving the recommended dietary allowance (RDA) for this mineral.[6] The use of medications that deplete magnesium, strenuous exercise, indigestion, and stress all further contribute to magnesium insufficiency.[5],[7],[8],[9] Unfortunately, most cases of magnesium deficiency go undiagnosed.[4],[10]
Magnesium insufficiency has been associated with a plethora of diseases, including Alzheimer’s disease, diabetes, fibromyalgia, heart disease, migraine, muscle weakness, osteoporosis, premenstrual syndrome, Raynaud’s syndrome, stroke, and many other ailments. In today’s article we’ll focus on the role of magnesium in the support of musculoskeletal and metabolic health.
Magnesium for energy production
Inadequate magnesium levels disrupt ATP production, which explains why fatigue can be an early sign of magnesium deficiency.
Magnesium forms active complexes with adenosine triphosphate (ATP), the primary energy source for the cell.[11],[12],[13] Inadequate magnesium levels disrupt ATP production, which explains why fatigue can be an early sign of magnesium deficiency.[14],[15],[16]
One enzyme that uses massive amounts of ATP is the sodium-potassium pump (Na-K pump).[17] It pumps sodium out of the cell and potassium in, and maintains the critical electrical gradient that is needed for cellular activity. A shortfall of magnesium can disrupt the Na-K pump, and thus interfere with the day-to-day activities of the brain, muscles, heart, lungs, kidneys, and other organs.[18] It’s easy to see why magnesium deficiency has widespread consequences throughout the body.
Magnesium for your bones
Approximately 60% of the body’s total magnesium is stored in the bones.
Many people reach for calcium and vitamin D supplements to support bone health, but research has shown that magnesium is equally important.[19] In fact, approximately 60% of the body’s total magnesium is stored in the bones.[20] Magnesium is required for calcium absorption in the small intestine, and for the deposition of calcium and other minerals in the bone matrix.[21] Magnesium also assists in the activation of vitamin D, which helps regulate calcium and phosphate homeostasis to influence bone formation.[22] It’s not surprising, then, that adequate magnesium helps reduce the risk of osteoporosis and fractures.[21] In a study of 3,765 individuals, those with the highest intakes of magnesium had a 50% to 60% lower risk for bone fractures, compared with those with the lowest level of intake.[23]
Magnesium for your muscles
Magnesium intakes were found to be directly associated with handgrip strength.
Magnesium status has an impact on muscle strength and performance.[24],[25] For example, magnesium intakes were found to be directly associated with hand grip strength and jumping performance in basketball and volleyball players.[26] Higher magnesium intakes are also associated with lower oxygen needs during aerobic exercise.[27] Magnesium supplementation may help facilitate muscle recovery from intense exercise.[28]
Magnesium may also help preserve muscle strength as we age.[29],[30],[31] In a study of middle-aged men and women, magnesium intake was positively associated with hand grip strength and skeletal muscle mass, as well as bone mineral density.[29] The authors conclude that magnesium has relevance for the prevention of sarcopenia (age-related muscle loss) as well as osteoporosis and fractures.
Magnesium for your heart and circulation
Higher magnesium intakes may be associated with a 20-40% reduction in coronary heart disease mortality and stroke.
Magnesium deficiency has been shown to contribute to hypertension (high blood pressure), coronary artery disease, cardiac arrhythmias, heart attack, and stroke.[4],[32],[33],[34] Dr. Andrea Rosanoff, a leading researcher in the field, has proposed that low magnesium levels may contribute more to heart disease than cholesterol or even saturated fat.[35]
Magnesium deficiency causes excessive contractions in the smooth muscle surrounding arteries, thereby contributing to hypertension.[36],[37] Oral magnesium supplements, however, have been shown to reduce blood pressure in individuals already taking anti-hypertensive medicines,[38],[39] as well as in those with insulin resistance and other chronic non-communicable diseases.[40] In the general population, studies suggest that higher magnesium intakes may be associated with a 20-40% reduction in coronary heart disease mortality and stroke.[34],[41],[42] In adults with type 2 diabetes mellitus (T2DM, commonly known simply as “diabetes”), higher magnesium intakes were associated with a 60% lower risk of heart disease.[43]
Insufficient magnesium levels may also contribute to circulatory problems in other parts of the body, such in Raynaud’s syndrome, where the extremities become very cold due to vasoconstriction of the peripheral blood vessels.[44] The study’s authors found that during the winter months, women with Raynaud’s syndrome had significantly lower red blood cell magnesium concentrations than healthy individuals.
Magnesium for blood sugar control
Even a 100 mg per day increase in magnesium intake may significantly reduce the risk of developing diabetes.
Magnesium plays a crucial role in blood sugar balance through its role in enzymes regulating insulin secretion and insulin sensitivity.[45],[46] In a study of 8,555 individuals without diabetes followed for a median period of six years, a decreasing serum magnesium level was associated with increased risk for developing prediabetes (mildly elevated blood glucose levels) and diabetes.[47]
In a placebo-controlled trial of subjects with prediabetes who already had low magnesium levels, magnesium supplementation (382 mg daily) significantly reduced blood glucose levels after four months.[48] The evidence further suggests that even a 100 mg per day increase in magnesium intake – by either diet or supplementation – may significantly reduce the risk of developing diabetes.[49]
Further studies have shown that 88.6% of individuals with T2DM had magnesium intakes below the RDA,[50] and that serum HbA1c (hemoglobin A1c, an indicator of blood glucose control) was significantly higher in T2DM patients with low magnesium levels, suggesting poorer glucose control.[51] Low serum magnesium levels also were associated with peripheral neuropathy in patients with T2DM.[52],[53] In other words: the lower a person’s magnesium levels, the greater their risk of developing diabetes and diabetes-related complications.
In closing
Adequate magnesium levels are essential for good health, but two-thirds of adults are not getting enough of this nutrient. Major dietary sources of magnesium include whole grains, nuts, and green leafy vegetables, but many scientists advise supplementing with magnesium to ensure adequate cellular stores. Organic forms of magnesium, such as magnesium citrate, are more bioavailable than magnesium oxide, and may thus be more effective.[54] The RDA for magnesium for adults is 310-420 mg per day, depending on age and gender.[55]
Click here to see References[1] Gröber U, et al. Magnesium in prevention and therapy. Nutrients. 2015 Sep 23;7(9):8199-226.
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[3] Vormann J. Magnesium: nutrition and metabolism. Mol Aspects Med. Feb-Jun 2003;24(1-3):27-37.
[4] DiNicolantonio JJ, et al. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart. 2018 Jan 13;5(1):e000668.
[5] Workinger JL, et al. Challenges in the diagnosis of magnesium status. Nutrients. 2018 Sep 1;10(9):1202.
[6] Schwalfenberg GK, Genuis SJ. The importance of magnesium in clinical healthcare. Scientifica (Cairo). 2017;2017:4179326.
[7] Gröber U. Magnesium and drugs. Int J Mol Sci. 2019 Apr 28;20(9):2094.
[8] Seelig MS. Consequences of magnesium deficiency on the enhancement of stress reactions; preventive and therapeutic implications (a review). J Am Coll Nutr. 1994 Oct;13(5):429-46.
[9] Boyle NB, et al. The effects of magnesium supplementation on subjective anxiety and stress – a systematic review. Nutrients. 2017 Apr 26;9(5):429.
[10] Razzaque MS. Magnesium: are we consuming enough? Nutrients. 2018 Dec 2;10(12):1863.
[11] Yamanaka R, et al. Mitochondrial Mg(2+) homeostasis decides cellular energy metabolism and vulnerability to stress. Sci Rep. 2016 Jul 26;6:30027.
[12] Tardy AL, et al. Vitamins and minerals for energy, fatigue and cognition: a narrative review of the biochemical and clinical evidence. Nutrients. 2020 Jan 16;12(1):228.
[13] Tomas C, et al. The effect of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) severity on cellular bioenergetic function. PLoS One. 2020 Apr 10;15(4):e0231136.
[14] Cox IM, et al. Red blood cell magnesium and chronic fatigue syndrome. Lancet. 1991 Mar 30;337(8744):757-60.
[15] Johnson S. The multifaceted and widespread pathology of magnesium deficiency. Med Hypotheses. 2001 Feb;56(2):163-70.
[16] Takahashi H, et al. [A case of chronic fatigue syndrome who showed a beneficial effect by intravenous administration of magnesium sulphate]. Arerugi. 1992 Nov;41(11):1605-10.
[17] Apell H-J, et al. Modulation of the Na,K-ATPase by magnesium ions. Biochemistry. 2017 Feb 21;56(7):1005-16.
[18] Suhail M. Na, K-ATPase: ubiquitous multifunctional transmembrane protein and its relevance to various pathophysiological conditions. J Clin Med Res. 2010 Feb;2(1):1-17.
[19] Reddy P, Edwards LR. Magnesium supplementation in vitamin D deficiency. Am J Ther. Jan/Feb 2019;26(1):e124-32.
[20] de Baaij JHF, et al. Magnesium in man: implications for health and disease. Physiol Rev. 2015 Jan;95(1):1-46.
[21] Castiglioni S, et al. Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients. 2013;5:3022-33.
[22] Uwitonze AM, Razzaque MS. Role of magnesium in Vitamin D activation and function. J Am Osteopath Assoc. 2018 Mar 1;118(3):181-9.
[23] Veronese N, et al. Dietary magnesium intake and fracture risk: data from a large prospective study. Br J Nutr. 2017 Jun;117(11):1570-6.
[24] Marino MM, et al. Influence of physical training on erythrocyte concentrations of iron, phosphorus and magnesium. J Int Soc Sports Nutr. 2020 Jan 29;17(1):8.
[25] Zhang Y, et al. Can magnesium enhance exercise performance? Nutrients. 2017 Aug 28;9(9):946.
[26] Santos DA, et al. Magnesium intake is associated with strength performance in elite basketball, handball and volleyball players. Magnes Res. 2011 Dec;24(4):215-9.
[27] Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am J Clin Nutr. 2000 Aug;72(2 Suppl):585S-93S.
[28] Cordova A, et al. Impact of magnesium supplementation in muscle damage of professional cyclists competing in a stage race. Nutrients. 2019 Aug;11(8):1927.
[29] Welch AA, et al. Dietary magnesium may be protective for aging of bone and skeletal muscle in middle and younger older age men and women: cross-sectional findings from the UK Biobank cohort. Nutrients. 2017 Oct 30;9(11):1189.
[30] Domingues LJ, et al. Magnesium and muscle performance in older persons: the InCHIANTI study. Am J Clin Nutr. 2006 Aug;84(2):419-26.
[31] Veronese N, et al. Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program: a randomized controlled trial. Am J Clin Nutr. 2014 Sep;100(3):974-81.
[32] Severino P, et al. Prevention of cardiovascular disease: screening for magnesium deficiency. Cardiol Res Pract. 2019 May 2;2019:4874921.
[33] Rosique-Esteban N, et al. Dietary magnesium and cardiovascular disease: a review with emphasis in epidemiological studies. Nutrients. 2018 Feb 1;10(2):168.
[34] Bain LKM, et al. The relationship between dietary magnesium intake, stroke and its major risk factors, blood pressure and cholesterol, in the EPIC-Norfolk cohort. Int J Cardiol. 2015 Oct 1;196:108-14.
[35] Schaeffer J. Magnesium and heart disease: what’s the link? Today’s Geriatric Medicine. 2013;6(3):30.
[36] Han H, et al. Dose-response relationship between dietary magnesium intake, serum magnesium concentration and risk of hypertension: a systematic review and meta-analysis of prospective cohort studies. Nutr J. 2017;16:26.
[37] Banjanin N, Belojevic G. Changes of blood pressure and hemodynamic parameters after oral magnesium supplementation in patients with essential hypertension-an intervention study. Nutrients. 2018 May 8;10(5):581.
[38] Cunha AR, et al. Oral magnesium supplementation improves endothelial function and attenuates subclinical atherosclerosis in thiazide-treated hypertensive women. J Hypertens. 2017 Jan;35(1):89-97.
[39] Rosanoff A, Plesset MR. Oral magnesium supplements decrease high blood pressure (SBP > 155 mm Hg) in hypertensive subjects on anti-hypertensive medications: a targeted meta-analysis. Magnes Res. 2013;26:93-9.
[40] Dibaba DT, et al. The effect of magnesium supplementation on blood pressure in individuals with insulin resistance, prediabetes, or noncommunicable chronic diseases: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2017 Sep;106(3):921-9.
[41] Kieboom BCT, et al. Serum magnesium and the risk of death from coronary heart disease and sudden cardiac death. J Am Heart Assoc. 2016 Jan 22;5(1):e002707.
[42] Li J, et al. Association of dietary magnesium intake with fatal coronary heart disease and sudden cardiac death. J Womens Health (Larchmt). 2020 Jan;29(1):7-12.
[43] Gant CM, et al. Higher dietary magnesium intake and higher magnesium status are associated with lower prevalence of coronary heart disease in patients with type 2 diabetes. Nutrients. 2018 Mar 5;10(3):307.
[44] Leppert J, et al. The concentration of magnesium in erythrocytes in female patients with primary Raynaud’s phenomenon; fluctuation with the time of year. Angiology. 1994 Apr;45(4):283-8.
[45] Kostov K. Effects of magnesium deficiency on mechanisms of insulin resistance in type 2 diabetes: focusing on the processes of insulin secretion and signaling. Int J Mol Sci. 2019 Mar 18;20(6):1351.
[46] Gommers LMM. Hypomagnesemia in type 2 diabetes: a vicious circle? Diabetes. 2016 Jan;65(1):3-13.
[47] Kieboom BCT, et al. Serum magnesium and the risk of prediabetes: a population-based cohort study. Diabetologia. 2017 May;60(5):843-53.
[48] Guerrero-Romero F, et al. Oral magnesium supplementation improves glycaemic status in subjects with prediabetes and hypomagnesaemia: a double-blind placebo-controlled randomized trial. Diabetes Metab. 2015, 41, 202-7.
[49] Larsson SC, Wolk A. Magnesium intake and risk of type 2 diabetes: a meta-analysis. J Intern Med. 2007 Aug;262(2):208-14.
[50] Huang J-Y, et al. Correlation of magnesium intake with metabolic parameters, depression and physical activity in elderly type 2 diabetes patients: a cross-sectional study. Nutr J. 2012 Jun 13;11:41.
[51] Ilkay HO, et al. Association between magnesium status, dietary magnesium intake, and metabolic control in patients with type 2 diabetes mellitus. J Am Coll Nutr. 2019 Jan;38(1):31-9.
[52] Chu C, et al. Low serum magnesium levels are associated with impaired peripheral nerve function in type 2 diabetic patients. Sci Rep. 2016 Sep 7;6:32623.
[53] Zhang Q, et al. Low serum phosphate and magnesium levels are associated with peripheral neuropathy in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2018 Dec;146:1-7.
[54] Kappeler D, et al. Higher bioavailability of magnesium citrate as compared to magnesium oxide shown by evaluation of urinary excretion and serum levels after single-dose administration in a randomized cross-over study. BMC Nutrition. 2017 Dec;3(1):7.
[55] National Institutes of Health. Magnesium fact sheet for health professionals [Internet]. Bethesda (MD): U S Department of Health and Human Services; 2020 [cited 2020 May 31]. Available from: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
The information provided is for educational purposes only. Consult your physician or healthcare provider if you have specific questions before instituting any changes in your daily lifestyle including changes in diet, exercise, and supplement use.
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Marina MacDonald, MS, PhD
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