Ingredient review —Magnesium
What is it?
Description
Magnesium (Mg) is an element and essential mineral. It is a cofactor in over three hundred enzymatic reactions involved in protein synthesis, muscle contraction, nerve function, blood pressure, glucose regulation, hormone receptor binding, cardiac conduction, transmembrane ion flux, and calcium channel gating. (72) It is required for the production of ATP, (48) and the synthesis of RNA and DNA. (72)
Not to be confused with: Manganese
Main uses
Cardiovascular disorders
Metabolic, endocrine, and hormonal disorders
Musculoskeletal disorders
Neurological disorders
Respiratory disorders
Sleep and fatigue
Formulations
Dosing & administration
Age-related decline in physical performance
General outcomes from A-level evidence
No data currently available.
Dosing & administration
300 mg (Mg oxide) per day for 12 weeks
Outcomes
short physical performance battery score & walking speed
chair stand times (83)
Class of evidence
b
Asthma
General outcomes from A-level evidence
No data currently available.
Dosing & administration
1.2-2.0 g (i.v. Mg sulfate) over 15-30 minutes adjunct to standard therapy
Class of evidence
a
Dosing & administration
170 mg twice per day for 6.5 months
Outcomes
methacholine required to decrease FEV1, peak expiratory flow (PEF) rate, QoL & control scores (46)
Class of evidence
b
Dosing & administration
200-290 mg (Mg citrate) per day for 12 weeks in children
Outcomes
bronchodilator use (7)
Class of evidence
b
Dosing & administration
300 mg per day for 2 months in children
Outcomes
methacholine PC20 required to test bronchial reactivity
asthma exacerbations, used less salbutamol, antigen response on skin (34)
Class of evidence
c
Atrial fibrillation (AF)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
Up to 14.6 g bolus post-cardiac surgery
Outcomes
AF risk, ventricular arrhythmias risk (28)
Class of evidence
a
Dosing & administration
100 mg/kg (i.v. Mg sulfate) during aortic cross-clamp
Outcomes
AF incidence after coronary artery bypass graft surgery, ICU stay length (4)
Class of evidence
b
Dosing & administration
4.5 g (i.v. Mg sulfate) with AV nodal blocking agents in emergency rapid AF
Outcomes
ventricular rate
rhythm control rate (12)
Class of evidence
b
Dosing & administration
30 mg/kg (i.v. Mg sulfate) post cardiac surgery
Outcomes
arrhythmia incidence (56)
Class of evidence
b
Attention deficit hyperactivity disorder
General outcomes from A-level evidence
No data currently available.
Dosing & administration
200 mg per day for 6 months in children
Outcomes
hyperactivity (79)
Class of evidence
b
Chronic alcoholism
Chronic kidney disease
General outcomes from A-level evidence
No data currently available.
Dosing & administration
365 mg (Mg oxide) for 3 months in obese pre-diabetic px with hypo-magnesemia
Outcomes
uric acid
albumin, Mg (82)
Class of evidence
b
Dosing & administration
360 mg (Mg hydroxide) twice per day for 8 weeks
Outcomes
T50 propensity (delaying crystalline nanoparticle formation) (13)
Class of evidence
c
Chronic obstructive pulmonary disease
General outcomes from A-level evidence
No data currently available.
Dosing & administration
1.2 g (i.v. Mg sulfate) over 20 minutes after 2.5 mg nebulized albuterol
Outcomes
peak expiratory flow (PEF) over 45 mins (76)
Class of evidence
b
Dosing & administration
2 g (i.v. Mg sulfate)
Outcomes
functional respiratory capacity (FRC)
inspiratory capacity, max inspiratory pressure (MIP), max expiratory pressure (MEP) (21)
Class of evidence
c
Dosing & administration
2 g (i.v. Mg sulfate) alongside cycle ergometer exercise. Test performed 100 minutes after infusion
Outcomes
FRC, residual volume (RV), mean arterial pressure (MAP), cardiac double product at rest
max exercise load reached (& inspiratory capacity), respiratory expiratory ratio (22)
Class of evidence
c
Dosing & administration
2 g (i.v. Mg sulfate) with bronchodilator therapy
Outcomes
forced expiratory volume over 2 hours, forced vital capacity (55)
Class of evidence
c
Dosing & administration
151 mg (nebulized Mg sulfate) per dose with 500 µg ipratropium bromide
Outcomes
dyspnea
PEF rates (16)
Class of evidence
c
Coronary artery disease
General outcomes from A-level evidence
No data currently available.
Dosing & administration
365 mg total Mg (Mg citrate or oxide) twice per day for 6 months
Outcomes
Class of evidence
b
Dosing & administration
800-1200 mg (Mg oxide) per day for 3 months
Outcomes
platelet dependent thrombosis (73)
Class of evidence
c
Depression
General outcomes from A-level evidence
No data currently available.
Dosing & administration
500 mg (Mg oxide) per day for 8 weeks
Outcomes
Mg levels
Beck score (63)
Class of evidence
b
Dosing & administration
50 ml (Mg chloride 5% solution = 450 mg elemental Mg) in type II diabetics with depression & hypomagnesemia
Outcomes
Yasavage and Brink Scores of depression equivalently to 50mg of imipramine
serum Mg (5)
Class of evidence
c
Diabetes - gestational
General outcomes from A-level evidence
No data currently available.
Diabetes - prediabetes
General outcomes from A-level evidence
No data currently available.
Dosing & administration
30 mL (MgCl2 5% solution = 382 mg elemental Mg) per day for 4 months in prediabetes px with Mg deficiency
Outcomes
fasting & post-load glucose, HOMA-IR, TGs
glycemic status, HDL-C (39)
Class of evidence
c
Diabetes - type I (TID)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
300 mg per day for 5 years in TID with chronic Mg depletion
Outcomes
erythrocyte Mg
polyneuropathy in 39% of participants, no change in 49%, or worsening in 12% (19)
Class of evidence
b
Diabetes - type II (TIID)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
360 mg per day for 12 weeks in TIID
Outcomes
FBG
HDL-C (77)
Class of evidence
a
Dosing & administration
50 mL (MgCl2 5% solution = 450 mg) per day for 4 months in hypertensive TIID with Mg deficiency
Outcomes
SBP & DBP
HDL-C (38)
Class of evidence
b
Dosing & administration
374 mg (unspecified form) for 4 weeks in TIID
Outcomes
insulin dependent glucose disappearance, glucose disposal & oxidation (59)
Class of evidence
b
Dosing & administration
4.5 g (Mg pidolate) per day for 1 month in TIID
Outcomes
total-C, LDL-C;
HDL-C (17)
Class of evidence
c
Diabetic foot ulcers (DFU)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
250 mg (Mg oxide) per day for 12 weeks in px with diabetic foot ulcers
Outcomes
ulcer length, width, & depth, FBG, insulin, HBA1C, & hs-CRP
insulin sensitivity, total antioxidant capacity (65)
Class of evidence
b
Heart failure
General outcomes from A-level evidence
No data currently available.
Dosing & administration
8 g (i.v. Mg sulfate) over 12 hours
Outcomes
ventricular ectopic beats, couplets & nonsustained ventricular tachycardia (15)
Class of evidence
b
Dosing & administration
6000 mg (Mg orotate) for 1 month and 3000 mg for 11 months
Outcomes
survival rate, improvement in NYHA scale (80)
Class of evidence
b
Dosing & administration
365 mg (Mg chloride) per day for 6 weeks
Outcomes
mean arterial pressure (MAP), systemic vascular resistance, epinephrine, isolated ventricular premature complexes, couplets & nonsustained ventricular tachycardia frequency (6)
Class of evidence
c
Dosing & administration
970 mg over 24 hours (i.v. Mg sulphate)
Outcomes
Stabilizes cardiac repolarization (42)
Class of evidence
c
Dosing & administration
800 mg (Mg oxide) per day for 3 months
Outcomes
small arterial compliance (33)
Class of evidence
c
Hypertension
Insomnia/sleep
General outcomes from A-level evidence
No data currently available.
Dosing & administration
320 mg (Mg citrate) per day for 7 weeks
Outcomes
serum Mg only in Mg-deficient px
plasma CRP only in px with >3.0 mg/L (an indicator of chronic inflammatory stress) (58)
Class of evidence
b
Dosing & administration
500 mg (Mg oxide) twice per day for 8 weeks
Outcomes
sleep time, sleep efficiency, serum renin & serum melatonin
ISI score, sleep onset latency, serum cortisol (1)
Class of evidence
c
Dosing & administration
Effervescent tablets titrated from 10 mmol to 20 mmol for 3 days each, up to 30 mmol per day for 14 days in elderly subjects
Outcomes
slow-wave sleep, delta & sigma power, renin, aldosterone
cortisol (41)
Class of evidence
c
Metabolic syndrome
Migraine
General outcomes from A-level evidence
No data currently available.
Dosing & administration
600 mg (Mg dicitrate) per day
Outcomes
migraine prophylaxis (84)
Class of evidence
a
Dosing & administration
600 mg (tri-Mg dicitrate) per day for 12 weeks
Outcomes
attack frequency, number of days with migraine (60)
Class of evidence
b
Dosing & administration
1000 mg (i.v. Mg sulphate) once
Outcomes
photophobia & phonophobia intensity in px without aura
pain in px with aura (10)
Class of evidence
b
Dosing & administration
600 mg (Mg citrate) per day for 3 months
Outcomes
attack frequency, intensity, P1 amplitude
inferolateral frontal, inferolateral temporal, insular blood flow (49)
Class of evidence
c
Muscle cramps
General outcomes from A-level evidence
No data currently available.
Dosing & administration
300 mg (Mg citrate) per day for 6 weeks
Outcomes
mean number of nocturnal cramps during Mg use (68)
Class of evidence
c
Muscle cramps in pregnancy
General outcomes from A-level evidence
No data currently available.
Dosing & administration
120 mg in the morning, 240mg at night (Mg citrate or Mg lactate)
Outcomes
leg cramps (90)
Class of evidence
a
Dosing & administration
300 mg (Mg bisglycinate chelate) per day for 4 weeks
Outcomes
cramp frequency & intensity (81)
Class of evidence
b
Osteoporosis prevention
General outcomes from A-level evidence
No data currently available.
Dosing & administration
150 mg (Mg oxide) twice per day for 1 year in girls aged 8-14
Outcomes
hip bone mineral content (14)
Class of evidence
b
Dosing & administration
1830 mg (Mg citrate) per day for 30 days in post-menopausal women
Outcomes
serum iPTH, urinary deoxypyridinoline
serum osteocalcin (3)
Class of evidence
c
Post-operative cardiac arrhythmias
General outcomes from A-level evidence
No data currently available.
Dosing & administration
2 g (i.v. Mg chloride) intraoperatively post cardiopulmonary bypass surgery
Outcomes
ventricular dysrhythmias, supraventricular dysrhythmias, mechanical ventilatory support required
postoperative cardiac indices (25)
Class of evidence
b
Pre-eclampsia and eclampsia
General outcomes from A-level evidence
No data currently available.
Dosing & administration
4-15 g (Mg sulfate i.v./i.m) + maintenance doses up to 2g/hour (i.m)
Outcomes
initiation or recurrence of eclampsia at all doses (35)
Class of evidence
a
Dosing & administration
4 g (Mg sulfate i.v.) + 10 g (i.m.)
Outcomes
recurrence of eclampsia to same extent as listed dose + 5.0g/4 hours (i.m) (36)
Class of evidence
a
Premature ventricular and supraventricular complexes
General outcomes from A-level evidence
No data currently available.
Dosing & administration
3 g (Mg pidolate) per day for 30 days
Outcomes
premature complex density and symptoms (29)
Class of evidence
b
Premenstrual syndrome
General outcomes from A-level evidence
No data currently available.
Dosing & administration
250 mg per day for 2 cycles
Outcomes
depression, anxiety, water retention & somatic symptoms (30)
Class of evidence
b
Dosing & administration
360 mg (Mg pyrrolidone carboxylic acid) three times per day for 4 cycles
Outcomes
menstrual Distress Questionnaire (MDQ) score, pain & negative affect score
Mg in lymphocytes & polymorphonuclear cells (26)
Class of evidence
c
Dosing & administration
360 mg (Mg pyrrolidone carboxylic acid) for 4 months
Outcomes
pain, number of days with headache, MDQ score
Mg in lymphocytes & polymorphonuclear cells (27)
Class of evidence
c
Dosing & administration
200 mg (Mg oxide) per day for 2 cycles
Outcomes
weight gain, extremity swelling, breast tenderness, bloating after 2nd month (86)
Class of evidence
c
Supraventricular tachycardia (SVT)
General outcomes from A-level evidence
No data currently available.
Dosing & administration
5 g (i.v. Mg sulfate) per day, intraoperatively and post thoracic surgery for 2 days
Outcomes
SVT incidence in px undergoing pneumonectomy (69)
Class of evidence
b
Adverse effects
While Mg is generally well-tolerated, oral supplementation may cause diarrhea, nausea, or vomiting. Intravenous overdose may cause thirst, hypotension, drowsiness, muscle weakness, respiratory depression, headaches, flushing, cardiac arrhythmia, coma, and death. (37)(47) There is no evidence of adverse effects from dietary sources. (43)
Pharmacokinetics
Absorption
- Occurs in the ileum (56%), jejunum (22%), duodenum (11%), and colon (11%)
- At low GI concentrations, Mg is uptaken through active transport via the saturable Transient Receptor Potential Channel Melastatin members TRPM6 and TRPM7. (89)
- At high GI concentrations, Mg is absorbed primarily via passive paracellular transport. (70)
Distribution
- After absorption, Mg is distributed to bone (53%), muscle (27%), soft tissues (27%), and blood (0.8%). (31)
Metabolism
- In bone, Mg from the blood substitutes positions with the Mg in bone promoting, chondrocyte column development, osteoblast proliferation, and osteoclast activity. (18)
- In the brain, Mg inhibits post-synaptic NMDA receptor excitation by increasing chloride uptake by GABA receptor stimulation, and by antagonizing calcium, reducing pre-synaptic glutamate release. (18)
- In the heart and vascular system, Mg reduces ion channel activity in the myocardium, calcium availability and binding in cardiac muscle, and inflammation in the vascular system. Mg increases vasodilation. (18)
- In muscle, Mg maintains the level of muscle contractility with calcium. (18)
Excretion
- If not absorbed, Mg is eliminated in the feces (20-70%). (88)
- If absorbed, Mg can be eliminated in the urine (5-70%). This can occur in the proximal tubules (10-30% via passive paracellular pathways), or the thick ascending limb (40-70% via claudin proteins, 5-10% via active TRPM6 transport). (89)
- The half-life of Mg is approximately 1000 hours. (72)
References
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