Why We Put Magnesium in Juice Doctor
Why Magnesium?
A study published in Nutritional Health by Thomas et. al in 2003, estimated that 75 percent of Americans do not meet the recommended dietary allowance of magnesium.
When you look at the literature to determine why this is, we see that 1) mineral content of food sources is declining, and 2) that chronic conditions (especially Gastrointestinal conditions) can affect absorption/utilization.
What is Magnesium?
Magnesium is the second-most abundant intracellular cation after potassium. It is one of the four major cations handled by the kidney, the others being sodium, potassium, and calcium. It plays an important role in intracellular signaling, serving as a co-factor for enzymes involved with protein synthesis and DNA production, and maintaining membrane potential in myocytes, especially of the heart, and bone density.
Magnesium is distributed approximately one half in the bone and one half in the muscle and other soft tissues; less than one percent is in the blood.
What do we know about food sources and digestion of Magnesium?
Spinach has the highest magnesium content. Other good sources of magnesium are chard, pumpkin seeds, yogurt, nuts, cocoa and banana. The intestine absorbs 30%–40% of ingested magnesium, but it can vary from 24% to 75% depending on the magnesium body content.
The stomach does not participate in magnesium absorption but almost the entire intestine is capable of absorbing magnesium. (Magnesium Applications in Clinical Medicine - 2019)
What does Magnesium Deficiency look like and how does it happen?
Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. In more severe deficiency, patients may experience numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms as magnesium levels decrease. Severe deficiency may also lead to hypocalcemia and hypokalemia.
Conditions that may lead to hypomagnesemia include poorly-controlled diabetes mellitus; chronic malabsorptive problems (e.g., Crohn disease, gluten-sensitive enteropathy, regional enteritis); medication use (e.g., diuretics, antibiotics); alcoholism; and older age (e.g., decreased absorption of magnesium, increased renal exertion).
What are the potential therapeutic benefits of Magnesium?
Magnesium is commonly used in clinical practice. The indications for its use extend to multiple organ systems.
This is a Review article from the American Academy of Family Physicians that helps summarize the different indications for magnesium:
You can see from the above table that there are both intravenous and oral indications for treatment with Magnesium. In some situations, low magnesium levels can actually contribute to the underlying medical condition For example, the heart rhythm abnormality “torsades des pointes” can lead to death, and can be secondary to very low magnesium levels. Low potassium and low Calcium may also play a role in patients who present with this abnormal heart rhythm.
Like many other electrolytes (i.e. potassium, sodium, calcium), too much Magnesium can have negative health consequences…
Contraindications, Adverse Effects, and Interactions
Although oral magnesium supplementation is well-tolerated, magnesium can cause gastrointestinal symptoms, including nausea, vomiting, and diarrhea. Overdose of magnesium may cause thirst, hypotension, drowsiness, muscle weakness, respiratory depression, cardiac arrhythmia, coma, and death.
Concomitant use of magnesium and urinary excretion– reducing drugs, such as calcitonin, glucagon (Glucagen), and potassium-sparing diuretics, may increase serum magnesium levels, as may doxercalciferol (Hectorol). Concomitant oral intake of magnesium may influence the absorption of fluoroquinolones, aminoglycosides, bisphosphonates, calcium channel blockers, tetracyclines, and skeletal muscle relaxants. Because of this, concomitant use should be monitored or avoided when possible.
Additionally, because magnesium is cleared renally, patients with renal insufficiency (creatinine clearance of less than 30 mL per minute [0.50 mL per second]) may be at increased risk of heart block or hypermagnesemia; therefore, magnesium levels should be monitored.
At Juice Doctor, we have carefully chosen a dose that takes into consideration the recommended dietary intake, while still providing an increased daily dose that can have potential health benefits.
What other data is out there on Magnesium?
Shifting from Guidelines for Practicing Physicians in the AAFP Article above, to a more recent Systematic Review (2019) on the health outcomes for magnesium.
Table 2 lists the quality of evidence that informs the different benefits of magnesium in the article by Veronese et. al. See our summary of the evidence below Table 2.
Based on this 2019 Systematic Review:
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There is strong evidence that Magnesium supplementation is linked to decrease the need for hospitalization in pregnant women
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There is strong evidence to say that people who suffer from migraines have a reduction in frequency and intensity of symptoms, when they supplement with magnesium
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Higher magnesium intake is associated with lower risk of Diabetes
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Moderate level evidence that Magnesium supplementation can decrease systolic blood pressure
When you couple the above information with the American Academy of Family Physicians Review article which concluded:
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“Magnesium is a widely accepted and effective approach to treat dyspepsia”
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“Magnesium is accepted as standard treatment for constipation”
… It’s easy to feel good about magnesium supplementation and the potential benefits to consumers!
Are you interested in a more detailed look at the evidence behind the therapeutic indications for Magnesium? (If so, check out this summary below)
Guerrera, M. P., Volpe, S. L., & Mao, J. J. (2009). Therapeutic Uses of Magnesium. American Family Physician, 80(2), 157–162.
Eclampsia and Preeclampsia
Magnesium sulfate (intravenous and intramuscular) has been shown to be relatively effective for treating eclampsia and preeclampsia, although it has been considered the standard of care for decades. In 2003, two Cochrane reviews showed that magnesium use in patients with eclampsia was superior to that of phenytoin (Dilantin) and lytic cocktail, with another study showing magnesium to be more effective than nimodipine (Nimotop). A different 2003 Cochrane review showed that 1 to 2 g of intravenous magnesium sulfate per hour reduced the risk of eclampsia in patients with preeclampsia by more than one half. The use of magnesium does not appear to have harmful effects on the mother or infant in the short term.
Arrhythmia
A well-known use of intravenous magnesium is for correcting the uncommon ventricular tachycardia of torsade de pointes. Results of a meta-analysis suggest that 1.2 to 10 g of intravenous magnesium sulfate is also a safe and effective strategy for the acute management of rapid atrial fibrillation. A six-week randomized, double-blind crossover trial showed that oral magnesium supplementation reduced the frequency of asymptomatic ventricular arrhythmia in patients with stable congestive heart failure secondary to coronary artery disease.
Asthma
A 2000 Cochrane review of magnesium sulfate for exacerbations of acute asthma in the emergency department found that evidence does not support routine use of intravenous magnesium in all patients with acute asthma; however, it appears safe and beneficial for severe acute asthma by improving peak expiratory flow rate and forced expiratory volume in one second. In a meta-analysis of acute asthma in children, intravenous magnesium demonstrated probable benefit in moderate to severe asthma in conjunction with standard bronchodilators and steroids ; however, a randomized controlled trial showed that oral magnesium added no clinical benefit to standard outpatient therapy for chronic stable asthma in adults. In a 2005 Cochrane review of inhaled magnesium sulfate in acute asthma, nebulized magnesium in addition to a beta 2 agonist were shown to improve pulmonary function and trend toward benefit in fewer hospital admissions.
Headache
Studies have found that patients with cluster headaches and classic or common migraine, especially menstrual migraine, have low levels of magnesium. 3334 A prospective, multicenter, double-blind randomized study conducted in Germany showed that a single daily dosage of 600 mg oral trimagnesium dicitrate significantly reduced the frequency of migraine compared with placebo, whereas a lower twice daily dosage was found ineffective. 3536 For acute treatment of migraine, intravenous magnesium sulfate showed a statistically significant improvement in the treatment of all symptoms in patients with aura, or as an adjuvant therapy for associated symptoms in patients without aura.
Dyspepsia
Another common condition with several self-treatment options is dyspepsia, a key symptom of gastroesophageal reflux disease (GERD). Antacids are widely used for dyspepsia; however, studies comparing antacids with histamine H 2 receptor antagonists (H 2 blockers) have been limited. A randomized, double-blind, crossover study showed that on-demand treatment with the antacid hydrotalcite (aluminum hydroxide, magnesium hydroxide, carbonate, and water) was more effective than famotidine (Pepcid) or placebo. An editorial on these findings questioned the standard use of H 2 blockers, and recommended shifting to more individualized treatment of mild or intermittent GERD.
Constipation
Patients often self-treat constipation with over-the-counter products, such as magnesium hydroxide (Milk of Magnesia) or magnesium citrate. However, there are few studies demonstrating effectiveness, as shown in a systematic review of chronic constipation. Despite this, many physicians and patients have found these treatments helpful, which indicates that a lack of evidence is not necessarily synonymous with a lack of effect.
Other
Magnesium is associated with maintaining or improving bone mineral density as a dietary component in combination with potassium, fruits, and vegetables, or as an oral supplement. One study suggested that adults 18 to 30 years of age with higher magnesium intake have a lower risk of developing metabolic syndrome. Another study demonstrated a positive association between hypomagnesemia and metabolic syndrome in adults. A 2002 Cochrane review showed that magnesium lactate or citrate twice a day was effective for leg cramps in pregnant women. A 2001 Cochrane review of three small trials showed that in patients with dysmenorrhea, magnesium was more effective than placebo for pain relief and the need for additional medication was less. Studies have linked magnesium deficiency to myocardial infarction, congestive heart failure, primary hypertension, and angina pectoris, but evidence is still limited to recommend its use for these conditions.