I have written to a number of researchers as follows:
Dear Mg Researchers:
I have received numerous queries from patients and doctors about intractable Mg deficiency — cases where intravenous and oral supplementation has simply failed to replenish Mg levels, even though these patients are pushing the upper limits of intake to the point of loose bowels.
Can anyone please give me guidance on what I should tell these people who can't replenish their Mg?
Pasted in below are two typical messages from victims of recalcitrant Mg deficiency, and one of my typical, inadequate replies.
Paul Mason, Mg librarian
I had written to you before. I have low magnesium - I didn't need a test to tell me this - I don't sleep at night and further, my digestion is poor.
However, an intracellular test showed very low magnesium - so the test confirmed my symptoms. I was tested in Sept-October of 2001.
I've been taking 800-1000 mg of chelated (Mg glycinate) per day since late October. Back in October and November, my doctor gave me a series of SIX magnesium IV. Each IV contained 5 grams of Mg Sulfate and I got an IV once each week for SIX weeks.
At this point - 8 months or so later - I don't feel like I made any progress. I still sleep poorly and continue to have muscle tics (twitches).
Every few days, I have loose stools and need to cut back on the magnesium. I think that I can only take a total of 600-700 mg of magnesium per day - otherwise, I get loose stools. I don't digest most high magnesium foods - like nuts, avocados, etc. I do NOT take calcium supplements - but I do eat dairy products - mostly homemade yogurt.
Am I doing something wrong???? Should it be taking THIS long to make ANY notable progress??? Must I cut out ALL calcium - including the dairy products in order to restore my magnesium? By the way, I don't eat salt either - I've read that salt can depress magnesium stores.
I hope that you have some insight for me!! I'm really, really disgusted. I've tried liquid magnesium chloride, mag. oxide, mag. glycinate (which I'm currently using), mag. gluconate, and of course, the $800 worth of magnesium IVs.
I am HIV positive and my body isn't holding mag. I continue to have infusions but nothing seems to help. My Dr., I'm sure, is getting quite baffled and frustrated, as am I. At first we thought it was going through me because of diarrhea, but that stopped and I still can't keep mag in my body. Went in on a Mon. had infusions thru Wed. had blood checked Thurs, and I was still at 1.1 I have been at a very dangerous level for some time and I am starting to get worried.......for what I don't know???? Now I am instructed to go back on oral mag (400mg) once per day, along with 5 infusions starting next week Monday. A blood test is being ordered before my 5th treatment so we can see if anything is holding. If you have any suggestions, please let me know. I am getting weak, dizzy, and something is going on with my eyes now too, don't know if it has anything to do with mag but I hope something gets figured out soon.
I have CFIDS, and in 1992 started getting weekly IM injections of magnesium sulfate. They hurt, but gradually, very slowly and with much bed rest, the magnesium began to slowly build up. I can now go more than a week without an injection, and I no longer have to stay in bed. If I am not careful, it all comes back. It has taken ten years to build up my magnesium status to this point and that has included injection plus supplements all that time. I am very careful about taking magnesium by mouth every day and getting an injection at least every 3 weeks. I read in one article that a patient took over 3 years with i.v. magnesium to build up some magnesium health.
I am writing with a thought on how to help people with intractable magnesium deficiency. I am not a doctor or expert per se. I am a medical social worker who after 6 months am finally returning to my normal self after a serious magnesium deficiency. I was told by all my regular, allopathic doctors that I had nothing wrong. Long story short I figured it out on my own - stumbling across a lady's response on a neurology forum. The symptoms for magnesium deficiency she listed matched mine & so started the saga.
I have since found a great integrative medicine MD & utilized my children's ND to test & treat.
I talked my integrative med doc into testing my adrenal function thinking that my adrenaline & or cortisol would be high as a possibility for my magnesium deficiency. (I had significant stress in my life for the past few years with a life threatening car accident on 12-2-03 which preceded my symptoms by exactly one week). Well, my test shocked both me & my doctor. He didn't think I looked like, acted like or carried on the life of someone in adrenal exhaustion and I though my levels would be high. The test showed my adrenals were in an addison's like exhaustion state (stage 7). My cortisol & DHEA were critically low. He called the lab to verify the findings because, again, he didn't think I had the symptoms one would expect. The medical director at Meridian Valley Labs said it was actually quite common to see what he called "adrenal overflow" with magnesium deficiency. He said that I was basically running on adrenaline (which of course was flushing my magnesium as fast as I could down it).
I wasn't asymptotic before my car accident (I had suffered with papillophlebitis/CRVO, heart palpitations, hyperactive deep-tendon reflexes, panic attacks, borderline HTN with no risk factors etc). But after the car accident I believe my adrenaline overflow kicked in & I became 'very symptomatic'.
I started taking DHEA prepared by a compounding pharmacist & licorice root extract (again pharmaceutically provided - not store-bought). I opted to try the licorice vs the cortisone as it was the more natural route.
In a month my adrenal function was back to normal & my DHEA & cortisol levels were normal. I took physiologic doses of both. I am still on the DHEA and tapering. I ran out of the second Licorice Extract & am staying off until I test again. I feel like my old self just this month! (8/04)
I just finished a wonderfully informative book called: "The Miracle of Natural Hormones" by David Brownstein. I think everyone with unexplained (or even explained) medical symptoms should read it. But for some of us who are having a hard time 'holding' our magnesium it may be the ticket. I would suggest others have their adrenals tested as well. Perhaps they will need to plug the adrenal holes as it were before they fix the magnesium leakage problem. (You can't hold mag if you don't plug the leak & as all the studies show, if you have high adrenaline you waste magnesium in urine. And of course if you have low mag your adrenaline levels don't subside as they should - leading into a 'which-came-first-the-chicken-or-the-egg' magnesium deficiency/adrenal exhaustion). I also believe the need to take natural hormones may be temporary to give your adrenals a boost/jump-start so to speak. I also meditate for at least 15min each day and do many other relaxation promoting things throughout the day to take the stress off my adrenals, a whole food (whenever possible) and completely organic diet and of course taking magnesium (as well as a list of other supplements) and exercise.
Here is a link to the book on Amazon.com
A different hypomagnesemic (coined: a person with hypomagnesemia) may have different hormonal imbalances as well....
This is just a thought - something I put together from my experience & from my extensive reading (my library is huge now!).
Thanks for all the info I obtained on your website through my struggles. I have put a link to it on my webpage in hopes of reaching others who may be scared to death like I was.
Along with the suggestions, noted above, for correction of intractable Mg. deficiency, there are 2 other considerations:
1. Unrecognized malabsorption syndrome which would require parenteral Mg.and brings up the necessity of developing a suitable subcutaneous product ,which Prof. H.G. Classen has informed me is feasible
2. Enhancing the storage sites for Mg. in bone and skeletal muscle by a regular and aggressive isometric and endurance exercise program. Both of these problems exist on space flights www.femsinspace.com
William J. Rowe M.D.
Regarding the letter by J., she should take smaller doses of mag every few hours throughout the day. She probably needs 800-1000 mg/day (she should run this by her doc), divided into doses every 2 to 4 hours and when she awakens during the night.
Jay S. Cohen, M.D.
Department of Family and Preventive Medicine
University of California, San Diego
I will preface my answer to your question by stating I am a scientist, not a physician. Any thoughts I have are purely scientific opinion and not medical opinion.
Clearly, these seem to be examples of an inadequate magnesium uptake system. The alternative approach may therefore be to minimize magnesium loss. I have used amiloride (inhibitor of magnesium transport) in place of magnesium administration in experimental brain injury studies with great success. I would therefore suggest that the individuals in question approach their physician and ask about the potential use of amiloride to attenuate their magnesium loss. It is a weak antidiuretic/hypertensive agent usually prescribed as an adjunct to other diuretics so as prevent potassium/magnesium depletion. It is marketed in the USA as Midamor (Merck).
This is a long shot based on my animal research. Obviously a careful evaluation of possible contraindications and side-effects needs to be taken by the physician.
Robert Vink, PhDDepartment of Pathology
Advice about clinical treatment should be cautious...patients with renal insufficiency need to be followed closely for increased K and Mg if they take Mg/K retaining drugs,eg ACE inhibitors like captopril. Some AIDS related drugs (pentamidine,foscarnet,amphotericin )may cause renal loss of Mg.Also, another supplement is Maginex (Mg l aspartate) from Geist Pharmaceuticals in Indianapolis.
Dr. Bill Weglicki
One possibility suggested by work in Norway about 10 years ago is to also increase potassium in the diet (or by supplement) along with magnesium. This dual therapy may overcome a renal "leakage" problem of magnesium, more typically found in elderly subjects. Very little investigation has been conducted on this issue, to the best of my knowledge.
A taurine supplement is worth considering. Taurine transports magnesium (and potassium) into cells (both these minerals should reside primarily inside rather than outside the cell). Taurine seems to be very safe, is best taken apart from food (unlike other amino acids) partly because large doses sometimes upset the stomach. Sometimes 2000-3000 mg per day is needed (1000 mg at 2-3 meals), and high urinary taurine usually indicates high loss of taurine rather than excess intake (blood and urine taurine levels can be tested to check this out).
Dr. Russ Jaffe recommends using choline with magnesium supplements to enhance assimilation. It is available in capsules or from Perque Labs in liquid form.
Nutrition Counseling Service
Here are some possible answers to your questions...Also...Mg is best given with Calcium...if not...there might be MORE spasms due to calcium blocking effect of magnesium doses.
If the intracellular magnesium were tested within 48 hours using the EXAtest one would find a rise in cellular Mg. If after 10 days the test was repeated Mg may be lost in chronic magnesium wasters. This is the only test that can show that relationship since it measures what is happening on the day of the test in Tissues!
Use of a spectrum of antioxidants and B complex vitamins help replenish lost Mg stores.
Exercise also helps transport magnesium. However some people may have a genetic predisposition to loss of magnesium with no regard to their intake.
Entrez-PubMed See this article:
J Am Soc Nephrol 2000 Oct;11(10):1937-47 Related Articles, Books, LinkOut. Inherited disorders of renal magnesium handling. Cole DE, Quamme GA. Department of Laboratory Medicine & Pathobiology, University of Toronto, Ontario, Canada.
The genetic basis and cellular defects of a number of primary magnesium wasting diseases have been elucidated over the past decade. This review correlates the clinical pathophysiology with the primary defect and secondary changes in cellular electrolyte transport. The described disorders include (1) hypomagnesemia with secondary hypocalcemia, an earlyonset, autosomal-recessive disease segregating with chromosome 9q12-22.2; (2) autosomal-dominant hypomagnesemia caused by isolated renal magnesium wasting, mapped to chromosome 11q23; (3) hypomagnesemia with hypercalciuria and nephrocalcinosis, a recessive condition caused by a mutation of the claudin 16 gene (3q27) coding for a tight junctional protein that regulates paracellular Mg(2+) transport in the loop of Henle; (4) autosomal-dominant hypoparathyroidism, a variably hypomagnesemic disorder caused by inactivating mutations of the extracellular Ca(2+)/Mg(2+)-sensing receptor, CASR: gene, at 3q13.3-21 (a significant association between common polymorphisms of the CASR: and extracellular Mg(2+) concentration has been demonstrated in a healthy adult population); and (5) Gitelman syndrome, a recessive form of hypomagnesemia caused by mutations in the distal tubular NaCl cotransporter gene, SLC12A3, at 16q13. The basis for renal magnesium wasting in this disease is not known. These inherited conditions affect different nephron segments and different cell types and lead to variable but increasingly distinguishable phenotypic presentations. No doubt, there are in the general population other disorders that have not yet been identified or characterized. The continued use of molecular techniques to probe the constitutive and congenital disturbances of magnesium metabolism will increase the understanding of cellular magnesium transport and provide new insights into the way these diseases are diagnosed and managed.
Dr. Burton Silver
IntraCellular Diagnostics Inc.
The body is extremely complex and there can be many different causes of what seems to be the same problem. With that caveat here are some possible issues to consider.
If someone has low stomach acid, this can cause difficulty in breaking down various nutrients to an absorbable form. Chloride deficiency can cause low stomach acid. If someone had low stomach acid and they were taking magnesium oxide they could have difficulty in converting it to magnesium chloride for absorption.
Osmolality is another issue that can affect absorption of
various nutrients including magnesium. The high osmolality of
Magnesium chloride when taken in liquid or tablet form can
hinder absorption and also increase the laxative effect of the
product. What happens is that the substance once it enters the
gut can have a more powerful pull than the stomach and can draw
water out and then flush through the system rather than being
the system, absorbed and utilized. Although it seems counterintuitive when someone is experiencing diarrhea, if people will drink larger amounts of water with the product it will have the tendency to drop the osmolality
down through dilution and decrease this effect. Some people have also reported that if they experience the laxative affect when they first start taking a magnesium chloride product they can overcome this by starting out with small doses and then steadily increasing the dose over a two-week period so that the body can adjust.
Many people can have better absorption of they will have smaller doses of the nutrient spread out throughout the day in their food or water rather than in one large dose. This is due to the issue described above but also because there are only so many active receptor cites available at any given time. There is also some research that suggests even the taste, smell and presentation of a food will affect nutrient absorption rates.
We have done a great disservice to the human race when we started to process all of our food and water to be "pure." Our salt is not a balanced electrolyte but "pure" NaCl. Our water no longer provides an array of minerals including magnesium but is "pure" H2O. The modern processing of our food supply for shelf life and "purity" is an experiment where the human race is the lab animal and it has only lasted about a hundred years with serious negative consequences that have not been recognized.
Magnesium sulfate is the common form of magnesium used in medicine but they are not considering the issue of balance. Magnesium is a macro mineral requiring large doses on a daily basis. Sulfate is a micro mineral which is used in small amounts. Even though they have the pairing of anion and cation the ratios can cause problems. In the case of magnesium chloride, both anion and cation are macro minerals, making it a better balance over all.
The magnesium deficiency problems in these cases could be either absorption or wasting disorders and could be caused by nutritional imbalances or deficiencies, hereditary problems, stress, illness or even other problems. Some of the problems might not have a good answer. Others are rare and will require unique problem solving such as experimenting and learning from trial and error but this can be greatly aided if the individual and/or the physician are aware of the different issues and ask the right questions.
If it is a serious wasting disorder, my guess is that the best way to handle it would be to increase consumption of the most easily absorbable forms of Mg throughout the day, especially by adding it to all food and water.
President, Mineral Resources International
Please try magnesium+potassium+coenzyme Q10+aldactone thrice daily with meals for a week in patients with normal renal function for desired benefit. The later two would be able to retain intracellular and blood Mg.
This treatment may cause hypermagnesemia, hyperpotassemia if renal functions are not maintained. Addition of insulin in the glucose solution with Mg and K would provide further benefit.
Let me know what did you get.
Prof. R.B. Singh, M.D.
Since there have been already stated most of the more or less known sources of idiopathic mg deficiency one or two more possibilities:
If I could have been of any help, please feed back
I would guess that these individuals have an impaired ability to have a normal reabsorption in the renal nephron. They just excrete it. This suggests some kidney damage. How to correct it? I don't know, since I am not a clinician.
If any of these patients have insulin resistance, it would also be difficult for the insulin-requiring cells to take up Mg. Insulin is necessary for Mg uptake in those tissues that require insulin.
Many years ago, I worked with a woman who had severe hypertension. I measured some minerals in 24 hour urines. Mg was very low, as was zinc. When she was hospitalized with a hypertensive crisis, her physician gave her a modest Mg load test. She excreted nearly 100% of the load. This woman's diet had been poor for many months. She had been eating a vegetarian diet, which she interpreted to be salads. Her protein intake was negligible, as were many other nutrients. She now started a regimen of a better diet and took supplements that included fluid meal replacers, Mg, zinc, and other nutrients. After about 6 weeks, she was again hospitalized with another hypertensive crisis. She was given another Mg load test. This time she retained 100% of the load. What was the difference? I think that the cells in her body were damaged somewhat by the poor nutrition she had been taken previously. After building up her total nutrition, including Mg, her cell membranes had begun to be repaired. Now the transport mechanisms for Mg uptake were working so she was able to retain the Mg from the load. And the kidney was able to retain the Mg it filtered.
Whether something similar can be operating among the people who e-mailed you, I have no idea.
Mg Aspartate Hydrochloride (marketed as Maginex) is good for people who need large doses because it doesn't generally cause diarrhea, according to Dr. Mildred Seelig's book, The Magnesium Factor.
Coconut oil is antifungal and three heaping tablespoons though the day seems more effective than anything else in preventing diarrhea from excess (therapeutic) doses of magnesium. Yet, we are told that magnesium, not the yeast + magnesium, is the cause of diarrhea. We are told that coconut oil is bad for us (too much lipids) when eminent researchers like Dr. Mercola say different, that in fact some of the healthiest people on earth, pacific islanders, eat tons of coconuts and its oil and never have heart problems. George Eby
Quotes supplied by Erling Waller
1) From the booklet Magnesium by Alan R. Gaby M.D. (also M.S. bio-chemistry), Keats Publishing, Inc., 1994, ISBN 0-87983-602-4, $3.95:
"As disease progresses, cells lose their ability to function properly. Most of the cells of the body maintain a very high magnesium concentration relative to that in the blood serum. For example, there is about ten times as much magnesium inside the cells of a healthy heart as there is in the serum. This high concentration of magnesium is necessary for cells to perform their various biochemical tasks. However, maintaining this steep concentration gradient between cells and blood requires a great deal of energy. The laws of random motion cause magnesium ions to leak continually out of the cells and into the bloodstream. Each time a magnesium ion leaks out, another one must be pulled back in by special pumps that reside on the cell membrane. Pulling against a concentration gradient is analogous to swimming upstream or to carrying bowling balls up a hill, only to see them roll right back down. As inefficient as that sounds, that is how the body works. Indeed, a substantial proportion of the calories you burn each day are used to maintain higher concentrations of some nutrients inside cells than in the bloodstream. When you become ill, some of the cells in your body may become less efficient in holding on to magnesium. The cell membranes may break down, allowing more magnesium to leak out. In addition, the cell membrane pumps that pull magnesium back in may also be weakened by disease. The end result is that disease itself can be a cause of magnesium deficiency. Since magnesium deficiency may have been one of the original causes of the disease, a vicious cycle of greater deficiency and increasingly severe disease may result."
Dr. Gaby goes on to say:
2) From the Forum and Bulletin Board for magnesium headed by Walt Stoll, M.D. at http://askwaltstollmd.com/archives/mg.html
"Magnesium metabolism has one quirk in that, if the level is low enough (in that person) to cause symptoms, it is low enough that the body loses its ability to absorb it efficiently orally. Since it is almost impossible to hurt someone by giving them too much magnesium, doing a therapeutic trial of an easily absorbed (orally) form of chelated magnesium (orotate, aspartate or glycinate) might be tried by anyone."
"This paragraph is just to warn those who try it that way--and get no results--not to throw out the baby with the bathwater. They may just be not absorbing it orally. For those, they will need intravenous infusions of at least 2 grams of elemental magnesium/IV about 3 times a week for 2 weeks. This can be injected over a period of about 5 minutes with no risk or negative side effects. By then, they should be able to absorb it orally for maintenance. By then, they will also know if their bodymind laboratory says they needed it (Did they get better?)"
Three women have been struggling with Intractable Mg Deficiency, and each has some thoughts about intravenous infusions compared with shots and oral supplementation. Here is what they have to say:
I do give myself Mg shots. Have been for several years. It takes time to build up. My doctor first showed my husband how to do it, and when I travel I do it myself. Even so, I am, after 10 years of this, beginning to hold my magnesium. What a strange thing.
I am receiving infusions of mg, not shots. I didn't know there was such a thing as a mg shot???? I always said... wouldn't it be easier to give myself injections like I did when I was anemic? And they respond with.... they don't have such a thing ... yet. ... I do agree $400 is a lot for 1/2 hr of time and as of now if I didn't have insurance, I would have paid over $12,000 this year alone in mg infusions... yes it's ridiculous, but what do you do?
I have given shots to MANY, MANY animals. Giving myself a shot would be uneventful. EXCEPT for the fact that I have heard from folks who have received mag. shots that they are INCREDIBLY PAINFUL - to the point that people wondered whether the pain was worth the short lived benefit. From what others have told me, you cannot tolerate more than 1/2 cc of mag. sulfate per day - which equates to a minuscule amount of elemental mag. This is why at least one other doctor has experimented with some special mag. sulfate suppository. This one hasn't made much sense to me, personally, because I normally have loose stool problems from dietary mag.
A Mg suppository might make some sense, if there is such a thing as "transdermal uptake". Many cultures have found benefit in soaking in mineral baths (hence the term "bath salts", for which there are 70,000 pages on the web). Apparently, soaking in bath salts gives perceived benefits over and above soaking in normal tap water. (See Absorption of magnesium sulfate and MgSO4 Toxicity) Epsom Salts (MgSO4) is very cheap, about $2 for a half-gallon carton at Longs Drug Stores. You might try soaking in a hot tub of Mg-enriched warm water. I take a book or magazine to read in the tub, when I am tense and need to unwind.
In an article I wrote for the Water Quality Association, I suggested the Association fund research by Prof. Judith Turnlund at University of California at Davis re transdermal uptake of Mg. Water-softening has been removing Mg, but the industry could switch and add Mg to drinking water and bath water. A new study has shown that transdermal uptake of Mg does indeed happen through soaking in water enriched with Epsom Salts (MgSO4).
What else a sufferer can do, without prescriptions, is to prevent deficiency in any of the inexpensive nutrients that can prevent uptake of Mg: Copper, Boron, and Vitamin B-6. Common levels of supplementation are:
Copper 1 mg/day
Boron 3 mg/day
Vitamin B-6 38 mg/day
And, take oral Mg supplementation at each meal and at bedtime. And, drink Mg-enriched water between meals (either naturally Mg-rich water, or fortified with Mg sulphate (Epsom Salts) or Mg chloride --- both are inexpensive.
If anybody finds a regimen or treatment that works, please feed back the news.
--- Paul, Email: email@example.com
It's remarkable......my mg went up to 1.2 so it's climbing. Thanks for all the feedback...I guess it will take some time to get back on track.
This page was first uploaded to The Magnesium Web Site on April 26, 2002