All About Magnesium, from a Functional Medicine Perspective

Hi everyone. As you can tell today I'm going to be talking about magnesium. Magnesium is a very important mineral for us. A lot of people are hearing more about it lately. I've had lots of questions come in about magnesium, thought I'd make a blog post and hopefully clear some things up for you. So magnesium, abbreviated Mg, as you can see here. Why should you care about magnesium? Why am I even bothering to make this blog post all about magnesium? Well, there is a large amount of magnesium deficiency in the US. Right now, it's considered a shortfall nutrient, meaning that roughly 80% of the population is likely deficient in magnesium. It's also very difficult for us to get because our soils are becoming much more depleted in magnesium and other minerals as time goes on. We continue to just apply chemical fertilizers to the soil and not rebuild the topsoil and take care of the microorganisms in the soil like we're supposed to.

Magnesium doesn't get taken up into the plant like it's supposed to, when we eat the plants or when animals eat those plants, and everybody ends up being magnesium deficient, so it's a major problem these days, at least here in the US. In fact, other undeveloped countries that are not industrialized like us that have not processed their food supply beyond recognition, they actually don't have a lot of the magnesium deficiency problems that we have here in the US. So be aware, magnesium deficiency is a major issue, kind of runs rampant here.  Mg is involved in over 500 different metabolic processes in our body, things like activating ATP, right? If you remember all the way back to high school biology, shout out to my high school biology teacher, Jack Mardel. Thank you. Good guy. Back in high school biology, we all learned that the Mitochondria are the powerhouses of the cell, right?

They go through these processes and these cycles, then end up producing something called ATP, adenosine triphosphate. That's the gasoline that all of our other cells run on, right? That's the currency in our body. Well, the problem with a magnesium deficiency is you can make adenosine triphosphate, but you can't activate it into anything useful. It's a lot like a refinery that can take crude oil and turn it into gasoline, but the pumps don't work at the gas stations, so none of us can put it in our cars. What good does it do you at that point? That's a very fundamental process that requires magnesium, but it's required to detoxify estrogen and process hormones properly. It's required for muscle contraction and relaxation to work properly. It's required for proper electrical conduction, the production of certain neurotransmitters. The list goes on and on and on and on.

Let me go through some symptoms of magnesium deficiency and that'll give you a little sense of what it's involved in. I'm going to actually look to the side a little bit and read a list because there are a lot of these. So cardiovascular disease, sudden cardiac death, cramps, tremors, poor sleep, constipation, brain fog, hormone imbalance, migraines, anemia, lack of other minerals. The list is long. Blood sugar imbalances in type two diabetics that had plenty of magnesium, their risk of complications later, their blood sugar numbers on down the road, those were all much better when they had a sufficient amount of magnesium compared to type two diabetics who were left magnesium deficient. Magnesium deficiency is considered to be one of the hallmark signs or one of the most accurate predictors of cardiovascular disease and sudden cardiac death. These are some pretty important things.

Now for most people, you get cramps in your calves, you get that little twitch in your face that won't go away. You can't process certain toxins appropriately, so they build up in you. Migraines, headaches, infection problems, all of those, bone softening like osteoporosis. You can throw all the calcium at it your want without enough magnesium. It's going to be difficult to make any difference, right? So all of that, just to generally give you the sense that magnesium is super important in how our bodies function. Why should you care? Hopefully I've given you enough reasons. Am I deficient? How do you know if you're deficient in magnesium? Well, if you have some of those symptoms, you likely are. If you live in the US you likely are, if we just look at it statistically.

But what about lab testing? Those of you that know me and come to my office, know that I do lab testing, so we look for deficiencies like this. The most common tests done to look for a magnesium deficiency is serum magnesium. Now, serum is the liquid part of the blood. If you've ever gotten a blister and you pop it, and there's that almost viscous yellowy kind of liquid in there, that's cirrus fluid or serum like, like from the blood. Cerebral spinal fluid comes from the serum in the blood. Lymphatic fluid comes from the serum in the blood. Serum magnesium tells you how much magnesium is in the serum of the blood. Problem is magnesium doesn't generally live in the serum of the blood. That's not where it does its job. I have a discussion with a lot of my patients when we're going over labs from other doctors and other offices about accuracy versus relevance when you're talking about lab testing.

They can accurately measure the amount of magnesium in the serum of your blood, but is that number relevant? If I were to judge, and you wouldn't want me doing this, if I were to judge your ability to retire. If I was looking at retirement income, retirement account money, but I looked in your checking account, I could accurately count up all the money in your checking account and give you a very accurate number, but is that relevant to your ability to retire? That money lives somewhere else, right? There's another account somewhere where you have the retirement money stored. Serum magnesium level is accurate. The labs can do it, and they're usually spot on when they do it, but is that relevant to the amount of magnesium actively in your body? Generally, no. The appropriate test to do here, and it's still a blood test, is called a red blood cell magnesium. You actually open up the red blood cell and see how much magnesium is contained inside the cell.

Magnesium does its job generally inside the cells, so that's where you look for it. This will be called either an RBC magnesium for “Red Blood Cell”, or it can be called an erythrocyte magnesium level. “Erythrocyte” is just another name for a red blood cell. Sometimes you'll see it as part of a red blood cell mineral panel or an erythrocyte mineral panel, but an RBC magnesium is the appropriate test. Not perfect, right? We're going to talk in a minute about one place where you need the magnesium to go where an RBC magnesium won't give you any information. It's not relevant to that part of it, but right now I think it's one of the best tests we have to gauge whether or not you have enough magnesium. Red blood cell magnesium level. We do it here at the office, but any doctor's office can do it if they're aware of it. I find in my patients, most of the time when they go to their family doctor and ask for a magnesium test, regardless of how they ask, they can give it to them written down, they ended up getting a serum magnesium test. Just be on guard about that.

Alright, foods containing magnesium...well, as I mentioned earlier, that's not as easy to find as it should be. There are foods that should be high in magnesium. All of your green leafy vegetables, you're talking kale, chard. By the way, chard, Swiss chard, for example, you notice they look a lot like the tops of beats. Hopefully some of you have bought beats in the past, but when you look at the leaves on the top of the beet, it looks a lot like chard. That's because it's the same plant. One was hybridized to accentuate the root area and give you a big beet, and the other was hybridized to not have that and put all that into the leaves. They are different hybrids of basically the same species. So Swiss chard, beet tops, basically, same thing. Buckwheat, the leaves of buckwheat. Buckwheat is not really a grain, it's a green leafy kind of ground cover looking plant, but buckwheat has a lot of magnesium in it.

Lots of different nuts are high in magnesium. Believe it or not, dark chocolate (until you sugar it up and add other stuff to it and make it more commercialized), but dark chocolate has quite a bit of magnesium in it, so there are lots of options to get your magnesium if those plants were grown in soil that still had magnesium in it. When we use chemical fertilizers on the soil, they generally don't include magnesium, right? They actually, tend to include things that can keep the plants from being able to absorb magnesium. High levels of potassium in the soil can keep the plants from being able to absorb what little magnesium is still in the soil.

So those are some foods that are high in magnesium, but that's a relative term, “high”.  Many of these don't have a whole lot of magnesium left in them just because of the way we've treated the soils over the past, I don't know, 100 years or so. You can look up the “dust bowl” and there's a great book by Bernard Jensen called “Empty Harvest”.  It's a little hard to get your hands on, but if you can find a copy of it, well worth reading. It will explain what we've done to topsoil. Those of you out there that are farmers that understand regenerative farming practices and understand that the soil is really what you're farming and the plants are just kind of what you get out of it, you'll understand what I'm saying and, and chime in here in and leave a note agreeing with me hopefully. But soils are, are vastly deficient in minerals, not just magnesium, iodine and all of them.

Anyway, so those are foods containing magnesium. So we've already established it's going to be kind of difficult for you to get all the magnesium you need from your food, so what do we do? You end up supplementing with magnesium, and this list is kind of why I'm making this blog post in the first place. People had questions about with all these different forms of magnesium, what do I take? Which one's the right one for me? I'm going to start down here near the bottom of the list, and then we're going to talk about the top and just a minute. So, magnesium oxide, magnesium bisglycinate, magnesium citrate, malate, magnesium sulfate, this one is Epsom salt down here. If you've ever taken an Epsom salt bath to kind of relax at the end of the day, that's magnesium sulfate. First of all, let me say, none of these are going to be bad forms of magnesium.

I'm not sure if there even is a bad form of magnesium, but there are forms that are better absorbed. There are forms that get into certain tissues. There are forms that do different things, so let's just briefly talk about this. The couple that I really want to point out, magnesium citrate. Magnesium citrate is generally used as a laxative. The way it moves through the body, it pulls water into the digestive track, liquefies the stool, or softens the stool and makes a bowel movement much, much easier for you. So magnesium citrate is generally a laxative. You can get a capsule form, you can get it in basically a soda form at the drugstore, but that's magnesium citrate. If you're trying to build up intracellular levels of magnesium, if you're trying to raise your RBC magnesium, magnesium citrate might not be your best option.

That's if you haven't gone in a few days and you need to clear out, that's a good option. Magnesium sulfate, I already mentioned, that's Epsom salt. Any type of topical magnesium, whether it's an Epsom salt bath, whether it's one of the magnesium lotions that you can put on, they tend to do a good job in and under the skin, like getting into some of the muscle tissue, relaxing you that way. They probably get into some of the lymphatic system, but what we know about that from some of the research has been done recently is topical magnesium is generally will not raise your red blood cell magnesium. They may raise your serum magnesium but not your red blood cell magnesium, and we've already established that that's the one that's more important to knowing whether or not magnesium is doing its job inside your body.

That leaves us with magnesium, malate, magnesium bisglycinate, both good forms of magnesium, fairly easily absorbed. They move around the body, they generally do what they, what you need them to do, so if you're looking to just get bulk magnesium, just increase your RBC magnesium level. Malate and bisglycinate, both great choices. Bisglycinate, now there is a company that is adding B12, B6, and folic acid, methylation nutrients, to the glycinate, and finding that that almost gives it a time release action. It gets into your body over a period of time, and there are some benefits to that. Bisglycinate mixed with B12, B6, and folic acid may have some distinct benefits. Magnesium oxide, not very well absorbed. You'll get some of it, but not very well absorbed, and probably the cheapest form. You normally don't even find this in supplements.

That leaves us with the top three. Magnesium lactates', one of the ones I use in my office when I just need to give bulk magnesium, right? I just want to raise their magnesium. They're not really having any of the symptoms. Lab work said it was low. We're going to give them some magnesium, or we need, we've done, let's say, like a Dutch test on them, which looks at both hormone production and hormone metabolism. How you get rid of hormones, and if we see that one of the enzymes that gets rid of that called COMT, catechol-O-methyltransferase, if that one isn't working properly, we know we need more magnesium. We'll use something like magnesium lactate in that case. It's a capsule. It's easy to take. It's not all that expensive, fairly well absorbed, doesn't really usually cause much of the digestive upset, so easy one to use. In my office, that's one of the ones I choose. I could just as easily choose malate or bisglycinate, same thing.

That leaves us with the top two: threonate and multiform. Those are two that are getting a lot of press these days, so I want to talk about those. Both great forms. What I'm going to act out, kind of pantomime for you, is a study that I saw recently at a presentation about magnesium getting into the nervous system. They took rats, and they put them on a magnesium deficient diet for a period of time and depleted them for the most part of magnesium, and then started giving them different forms of magnesium, not only to see what would raise RBC magnesium, but to see what would raise magnesium inside the cerebral spinal fluid. Meaning it got from the bloodstream through the blood brain barrier into the central nervous system, into the brain and the spinal cord. Now, there are distinct advantages to getting magnesium into that area for people with anxiety, for people with seizures, for people with migraines, for people with an ADD or ADHD, for people with any kind of spontaneous brain activity that you're not looking for, for people that need to calm, for people that need to make neurotransmitters or process them a little bit better.

All of those things require magnesium in the nervous system, so a lot of these other forms don't do a very good job of getting it in the nervous system. They took these rats, gave them magnesium in different forms, and they did little spinal taps on them, and then looked at how much magnesium ended up in the cerebral spinal fluid. None of these really got it into this cerebral spinal fluid. When you look at the graph, their magnesium levels were kind of trending down, and then they instituted all of these different magnesium types, and most of them just continued to trend down in the cerebral spinal fluid. But these top two started to trend up above baseline. They actually made a positive difference or had a positive effect on the amount of magnesium inside the nervous system, so magnesium threonate was one of them that worked well.

It had roughly a five or six percent increase in the level of magnesium in the cerebral spinal fluid. Multiform magnesium, which is a whole food form of magnesium from Swiss chard and buckwheat leaves. It had close to a 20% increase in the amount of magnesium inside the nervous system, so definitely the top performer in that particular study for getting magnesium into the central nervous system where a lot of times you need it, and a lot of times your most defficient. That also is where we have trouble measuring it. That's where your red blood cell magnesium falls short. It does not measure magnesium it the in the nervous system, and it's a little bit difficult to send patients out to get spinal taps just to find out if you've got magnesium in their nervous system. Nobody does that, and they shouldn't do that.

There are a couple of studies that kind of correlate red blood cell magnesium level with nervous system magnesium level, but that really isn't well established yet, so I'm not going to say that's the best way to look at it. You're just going to have to go symptomatically. The difference between these two, the top one is definitely whole foods. Like I said, buckwheat leaves and a chard, so that's what goes into this. Organically grown juice powdered, and left as a powder. They add a little bit of berry flavor or berry powder to it to give it a little bit of berry flavor, but it's generally kind of earthy and green. But you don't need a whole lot of it. I think it amounts to maybe a tablespoon, tablespoon and a half once or twice a day.

If people are willing to take a powdered form, if they're doing a smoothie anyway, if they can just mix it in a little bit of water and drink it. What I'll do is I'll get down near the bottom of a bottle of water, and I'll just dump that in and shake it up and throw that back. It's certainly not bad. You're not necessarily going to crave it, but it's not really all that distasteful anyway. But if they won't or can't do a powder, then we move down to the magnesium threonate. The one I use, there are several companies that make it. I use one from Designs for Health called Neuromag, N-E-U-R-O, Neuromag. The form of the multiform magnesium I use is from Standard Process, and that's called the EZMag, the letters E-Z. EZMag.

Those are the two magnesium's that I probably use most often. Magnesium lactate would be a really second in line to that, and then most of the rest of these I don't really use in my practice, but I don't have a problem with people taking them as long as they get rid of the symptoms, the RBC magnesium comes up to where we want it. We're good. Now, let's talk about RBC magnesium one more time. When you're judging RBC magnesium, when you're judging magnesium deficiency, there's one more problem that I want to bring up. You can have a normal amount of RBC magnesium, roughly between five and a half and six and a half on the lab test, but still be deficient in magnesium and there are two reasons I say that. You also have to look at the ratio of calcium to magnesium.

If you take in a lot of calcium, if you're doing calcium supplementation or if you're orange juices fortified and your milk is fortifying your ice cream's fortified and your yogurts fortified, we pump calcium into everything, right? If that's what you're doing, you likely need a much higher level of magnesium than what we would consider normal, because you've got an an extra physiologic level of calcium. There is this whole section of functionally deficient people where they have enough magnesium, but they have so much calcium, it's not enough. It's almost like you have enough income until we start looking at your debt load, and then we realized, oh my gosh, no, you need way more than that. It would be okay for almost everybody, but once we look at the debt side of the equation, it's not enough. Same thing can happen with calcium and magnesium, so you can have a normal amount of magnesium, way too much calcium and now you're off your ratio and functionally deficient in magnesium.

The other problem is when you look at lab results for magnesium and you start to decide who's deficient, who's not, how rampant deficiency is, because serum magnesium is one of the more common tests that's done, that's where a lot of the data comes from. When they give out numbers, like 80% of the population is deficient in magnesium, a lot of that comes from just people reporting what they eat in a day, and then somebody looks at that and says, "Oh, there's not enough magnesium in that to support a person." Some of it comes from looking at serum magnesium levels and saying people are deficient in magnesium because their serum levels are too low, and that's a crummy way to look anyway. That's one of the last ways you're going to see it. Then some of it was done from RBC magnesium, which is a more accurate way to look at it.

We likely have even more than 80 percent deficient magnesium when you consider how they get their numbers. The science there is a little bit fuzzy. The science everywhere is a little bit fuzzy, but I'll leave it to this for today. Just be aware that deficiency is rampant, and if you're taking a lot of calcium, you have likely need more magnesium than the average person would. Go see your doctor. Find a functional medicine practitioner. Get a red blood cell magnesium test. You can go online and search. If I find one, I'll try to attach it to this, but go online and search for list of magnesium deficiency symptoms. Run yourself through kind of a checklist quiz, see how you come out, but definitely likely safe to just go ahead and add some magnesium, at least eat foods that are higher in magnesium.

Maybe consider taking something like a whole food form of magnesium or something really easily absorbable. See how you feel. All right? But magnesium is a major, major, major problem. We've got some good options for supplementing it. We've got some medium options and some not so great options for supplementing it. So now you're educated. Now you know what to go search and learn more about. if you want to. You're welcome to come into the office and will test you and get you set up with right magnesium for you.

Until we talk next time, until my next blog post, thank you for watching and remember, as I always say, eat for your health, train for performance, and live the life you love today. Thanks.