Magnesium deficiency
Minerals

Magnesium: RDA, Dietary Sources, Deficiency Symptoms, and Functional Assessment

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Abstract

In this article, we discuss the biological role of magnesium, the effects of magnesium deficiency, and current recommended dietary intakes:

  • the major purposes of this specific nutrient in the human body, 
  • its experimentally confirmed health uses, 
  • conventional ways to estimate nutrient status,
  • nutrient’s toxicities and deficiencies along with related symptoms,
  • experimentally confirmed and approved levels of nutrient intake for different demographics,
  • dietary sources of the nutrient.

Introduction

Magnesium, a mineral crucial for humans, is a cofactor in more than 600 enzyme systems that regulate diverse biochemical reactions in the body. That includes protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation. Magnesium is required for energy production, oxidative phosphorylation, and glycolysis. It contributes to the structural development of bone and is required for the synthesis of DNA, RNA, and the antioxidant glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction, and normal heart rhythm.

Magnesium deficiency, even sub-clinical one, distorts these crucial biological processes.

Magnesium: Biological Functions and Importance of Homeostasis

Magnesium homeostasis is essential for a wide variety of metabolically important reactions4,6,9,32,45,23. Magnesium deficiency, hypomagnesemia, disrupts these reactions leading to undesirable health outcomes.

Among well-known functions of magnesium, the following are the most important:

  • synthesis of DNA, RNA  
  • active transport of Ca/Na/K ions across cell membranes 
  • blood pressure regulation
  • blood glucose/insulin control 
  • energy production, glycolysis, ATP synthesis 

Emerging research also indicates the following biological functions:

  • nerve signaling pathways and neuromuscular conduction
  • aging
  • oxygen uptake 
  • bone mineralization & osteoblasts development 
  • endocrine function 
  • immune function;
  • co-factor in glutathione synthesis

In a nutshell, magnesium homeostasis is regulated by the balance between intestinal absorption and renal excretion. Kidneys typically excrete about 120 mg of magnesium into the urine daily.

Magnesium’s role as a drug has been realized and more accepted recently. The following functions of magnesium enable its use as a therapeutic agent1,2,11,15,19,20,25,28,35,38,40:

  • Natural calcium antagonist, vasodilator ⇨ hypertension, pre-eclampsia
  • Glutamate NMDA receptor blocker ⇨ epilepsy; depression, anxiety, deterioration of brain plasticity, learning and memory; chronic fatigue; migraine
  • Antioxidant, anti-inflammatory agent
  • Promotes nerve regeneration after trauma
  • Muscle relaxant
  • Anticonvulsant/antipsychotic ⇨ epilepsy/seizures; Alzheimer’s, Parkinson’s, stroke; eclampsia)
  • Painkiller ⇨ chronic pain

Symptomatic magnesium deficiency due to low dietary intake in otherwise healthy people is uncommon because the kidneys limit urinary excretion of this mineral. However, habitually low intakes or excessive losses of magnesium due to certain health conditions, chronic alcoholism, and/or the use of certain medications can lead to magnesium deficiency.

However, excessive magnesium content is also not benign, leading to some very unpleasant outcomes, such as

  • diarrhea
  • over-stimulation of the activity of osteoclasts and suppression of osteogenesis
  • active tumour cells found to contain more Mg

Too much magnesium from food does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine. However, high doses of magnesium from dietary supplements or medications often result in diarrhea that can be accompanied by nausea and abdominal cramping. Forms of magnesium most commonly reported to cause diarrhea include magnesium carbonate, chloride, gluconate, and oxide. The diarrhea and laxative effects of magnesium salts are due to the osmotic activity of unabsorbed salts in the intestine and colon and the stimulation of gastric motility.

Very large doses of magnesium-containing laxatives and antacids (typically providing more than 5,000 mg/day magnesium) have been associated with fatal hypermagnesemia. The risk of magnesium toxicity increases with impaired renal function or kidney failure because the ability to remove excess magnesium is reduced or lost.

An adult body Mg content is 24–29 g. From that, 60% is contained in the bone; 20% – in skeletal muscle; 19% – in other soft tissues; and only 1% – in extracellular fluid (blood plasma & interstitial fluid).

Serum magnesium concentration is regulated by the balance between intestinal absorption and renal excretion

Habitually low intakes of magnesium induce changes in biochemical pathways that can increase the risk of illness over time.

Magnesium deficiency risks will be explored further.

Assessing Magnsium Status

Assessing magnesium status is difficult because most magnesium is inside cells or in bone27,41,44. The most commonly used and readily available method for assessing magnesium status is the measurement of serum magnesium concentration, even though serum levels have little correlation with total body magnesium levels or concentrations in specific tissues. Other methods for assessing magnesium status include measuring magnesium concentrations in erythrocytes, saliva, and urine; measuring ionized magnesium concentrations in blood, plasma, or serum; and conducting a magnesium-loading (or “tolerance”) test. No single method is considered satisfactory. Some experts consider the tolerance test (in which urinary magnesium is measured after parenteral infusion of a dose of magnesium) to be the best method to assess magnesium status in adults. To comprehensively evaluate magnesium status, both laboratory tests and a clinical assessment might be required. That’s why magnesium status tests are not requested often.

Though clinical methods of magnesium status testing exist, the test is rarely requested in clinical settings. Officially, hypomagnesemia is defined as a serum magnesium level of less than 0.75 mmol/L. However, even normal serum magnesium concentrations ranging between 0.75 and 0.95 millimoles (mmol)/L may be associated with magnesium deficiency.

Urinary excretion is reduced when magnesium status is low. This fact is used as a baseline for another clinical test, urinary excretion.

Finally, magnesium status can be assessed via Nutritional Intake questionnaires. However, magnesium absorption rates vary from 30% to 60%.

The RDA for magnesium is quite high. To meet this, we need approximately 10 (!) cups of cooked spinach daily. Besides, current RDAs (see below) do not take into consideration differences in body weight in the same groups.

We have to conclude that, despite of existence a well-defined RDA, there is no gold standard for magnesium status assessments, though results of these tests may be responsive to dietary intake changes.

Functional Assessment of Magnesium Status

Instead of relying upon inconclusive tests, the Nutri-IQ team suggests starting with the functional assessment of Mg status. Nutri-IQ™ is a unique tool that enables feasible identification of clients’ nutritional gaps as possible causes for the complaints, such as feeling stressed, tired, depressed; insufficient effect of prescription medications with significant side effects, and inability to achieve optimal wellness, prevent chronic disease, and manage the aging process.

Then, dietary adjustment recommendations can be issued based on the unique client’s symptoms.

Let’s consider and evaluate the applicability of these symptoms in the case of magnesium.

Symptoms with Proven Causation to Magnesium Deficiency (Group A)

These Mg deficiency symptoms are confirmed by the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes43:

  • Hypocalcemia
  • Impaired insulin secretion & insulin resistance
  • Neuro-muscular hyperexcitability (spontaneous muscular activity such as cramps and spasms)
  • Latent tetany signs:
    • Chvostek’s sign (twitching of facial muscles in response to tapping over the facial nerve)
    • Trousseau’s sign (carpopedal spasm, i.e. frequent and involuntary muscle contractions in the hands and feet with associated pain, induced by pressure applied to the arm, i.e. by blood pressure monitor or a ring)

That means that the symptom is uniquely identified with the fact of hypomagnesemia.

Symptoms Associated with Magnesium Deficiency

In certain circumstances, such as impaired renal excretion, a serious disease, or medications and treatments, magnesium homeostasis shifts towards imbalance, causing unpleasant but well-recognizable symptoms.

Emerging Research: Magnesium Deficiency Factors (Group B)

According to the latest research, the following symptoms (i.e. subjective client observations and complaints) are associated with hypomagnesemia1,4,5,10,11,14,15,26,28,32,33,38,40. Again, the studies showing a causation relationship are lacking as the relationship between symptoms and magnesium deficiency is not necessarily unique. For example, pre-eclampsia/eclampsia may be related to magnesium deficiency, but also may be caused by auto-immune factors.

  • Chronic fatigue
  • Tension-type headaches and migraines
  • Stress
  • Irritability, psychotic behaviour
  • Mild anxiety/nervousness
  • Aggression
  • Tremors, convulsions, seizures
  • Vertigo
  • Confusion, disorientation 
  • Decrease in pain threshold 
  • Photosensitivity
  • Tinnitus (ringing in the ears)
  • Muscle weakness
  • Gastrointestinal spasms
  • Vomiting
  • Nausea (also a symptom of Mg overdose)
  • Mild sleep disorders
  • Measurable signs:
    • low potassium and calcium levels 
      • impaired parathyroid hormone release/function 
  • Vitamin D resistance (rickets requiring doses of vitamin D in excess of RDA) 
  • Calcification of soft tissue
  • Cataracts
  • Arrhythmias, tachycardia

Risk Factors for Excessive Magnesium Losses (Group C)

Among risks for magnesium deficiency, current research recognizes these factors leading to increased loss4,10,37,39:

  • Gastrointestinal:  Diarrhea, pancreatitis, irritable bowel disease, bowel resection, protein-calorie malnutrition, total parenteral nutrition, bowel fistula
  • Renal: diuresis, tubular necrosis, renal transplantation, interstitial nephropathy
  • Medications: Proton pump inhibitors, corticosteroids, laxatives, diuretics, antivirals, heart medications (digoxin), antifungals (amphotericin B), colchicines (anti-gout medications), theophylline (anti-asthmatic, anti-COPD), macrolide antibiotics, petamidine (pneumonia drug), tobramycin (antibiotic for Gram-negative infections), amikacin (antibiotic for joint infections, intra-abdominal infections, meningitis, pneumonia, sepsis, and urinary tract infections), tacrolimus (immuno-suppressive drug); LABAs (long-lasting beta-antagonists for asthma treatment); aminoglycosides (Gram-negative antibacterial medications such asgentamicin, streptomycin); 
  • Chemotherapeutic/biologic agents: carboplatin, cisplatin (platinum chemotherapy); cetuximab (chemotherapy agent for colorectal, head and neck cancer); panitumumab (chemotherapy agent for colorectal cancer); cyclosporine (immunosuppressant); dupixent (biologic therapy; author’s assumption based on widely reported symptoms) 
  • Other:  burns; alcoholism, post-op rehabilitation; excessive lactation

Diagnoses Associated with Magnesium Deficiency Symptoms (Group D)

Another set of factors are diagnoses associated with magnesium deficiency1,3,4,5,6,8,10,14,15,26,28,35,37,40,42,49. Causative effect though was not proved:

  • Side effects of cancer and biological drugs
  • Neoplasms
  • Systemic inflammation, age-associated diseases
  • CVD, mitral valve prolapse, hypertension, cerebral vasospasm, atherosclerosis, stroke
  • T2DM/obesity/metabolic syndrome
  • Fatigue, worsening migraine, asthenia, sleep disorders, hyperemotionality
  • Chronic pain
  • Epilepsy/seizures, Alzheimer’s, Parkinson’s
  • Anxiety, depression
  • Pre-eclampsia/eclampsia
  • Asthma/COPD
  • Osteoporosis,  impaired secretion of PTH, hypocalcemia
  • Primary hyperparathyroidism, hypoparathyroidism (hypercalciuria); hypercalcemia owing to overtreatment with vitamin D
  • Primary aldosteronism

Understanding Magnesium Status

From the Functional Assessment standpoint, we recommend taking into consideration the association effect. In other words, we recommend offering adjunct measures, such as dietary intervention and/or Mg supplements, only if the client demonstrates symptoms from Group A, and/or symptoms from Group B accompanied by the risk factors from Group C and/or Group D

Magnesium Intake Recommendations

How much magnesium would prevent hypomagnesemia? The data below are provided based on decisions of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes43. There is scientific research though that recommends increasing this RDA by 25-50%4.

Recommended Dietary Allowances (RDAs) for Magnesium

AgeMaleFemalePregnancyLactation
Birth to 6 months30 mg*30 mg*
7–12 months75 mg*75 mg*
1–3 years80 mg80 mg
4–8 years130 mg130 mg
9–13 years240 mg240 mg
14–18 years410 mg360 mg400 mg360 mg
19–30 years400 mg310 mg350 mg310 mg
31–50 years420 mg320 mg360 mg320 mg
51+ years420 mg320 mg

*Adequate Intake (AI)

Dietary Sources of Magnesium

Magnesium is widely distributed in plant and animal foods and in beverages. Green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains, are good sources. In general, foods containing dietary fiber provide magnesium. Magnesium is also added to some breakfast cereals and other fortified foods. Some types of food processing, such as refining grains in ways that remove the nutrient-rich germ and bran, lower magnesium content substantially.

Tap, mineral, and bottled waters can also be sources of magnesium, but the amount of magnesium in water varies by source and brand (ranging from 1 mg/L to more than 120 mg/L).

Approximately 30% to 40% of the dietary magnesium consumed is typically absorbed by the body.

Selected Food Sources of Magnesium

FoodMilligrams
(mg) per
serving		Percent
DV*
Dry roasted almonds, 1 ounce8019
Boiled spinach, ½ cup7819
Dry roasted cashews, 1 ounce7418
Oil roasted peanuts, ¼ cup6315
Shredded wheat cereal, 2 large biscuits6115
Soymilk, 1 cup6115
Black beans, cooked, ½ cup6014
Cooked edamame, ½ cup5012
Smooth peanut butter, 2 tablespoons4912
Whole wheat bread, 2 slices4611
Avocado, cubed, 1 cup4411
Potato, baked with skin, 3.5 ounces4310
Brown rice, ½ cup4210
Plain yogurt, 8 ounces4210
Breakfast cereals, fortified with 10% of the DV for magnesium4210
Dark chocolate, 1 ounce 4110
Instant oatmeal, 1 packet369
Canned kidney beans, ½ cup358
Banana, 1 medium328
Cooked Atlantic salmon, farmed, 3 ounces266
Milk, 1 cup24–276
Halibut, 3 ounces246
Raisins, ½ cup235
Roasted chicken breast, 3 ounces226
Pan broiled ground beef, 3 ounces205
Broccoli, chopped and cooked, ½ cup123
White rice, ½ cup103
Apple, 1 medium92
Raw carrot, 1 medium72
  • *DV = Daily Value.
  • The DV for magnesium used for the values in the table above is 420 mg for adults and children age 4 years and older.
  • Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet.

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