Magnesium is the fourth most common mineral in the body and an essential component of hundreds of daily enzymatic processes that occur across multiple organ systems. Based on NHANES data, the risk of inadequate intake is high. Magnesium is an essential mineral that we need to ingest through diet or supplementation. It is present in higher amounts in green leafy vegetables, pumpkin seeds, almonds, Brazil nuts, salmon, avocado, quinoa, legumes and dark (70%) chocolate.


Causes of Magnesium Deficiency

Unfortunately, even in those foods, magnesium levels seem to be declining due to soil nutrient depletion. In addition, many people are deficient in magnesium for other reasons, including the following:

  • Low amounts in the Standard American Diet (SAD)
  • Malabsorption, increased urinary excretion or bone loss in the elderly
  • Gastrointestinal disorders, such as IBD, celiac disease and chronic diarrhea
  • Alcohol abuse, which contributes to increased urinary excretion, poor diet and malabsorption
  • Excessive sweating, such as in athletes who exercise regularly

Finally, magnesium can also be low due to drug-induced nutrient depletion. This is seen with proton-pump inhibitors, diuretics, nephrotoxic drugs (e.g., digoxin, cisplatin and lithium), corticosteroids, birth control pills and macrolide antibiotics (e.g., azithromycin)—to name a few. If your patients take any of these medications, be sure to monitor their magnesium levels.


How Magnesium Affects the Body

Magnesium has pleiotropic effects on the body; it has been shown to reduce blood pressure, decrease cardiac arrhythmias, stop muscle cramps, improve sleep and relaxation, and reduce pain. It activates vitamin D, improves insulin sensitivity and supports mood by modulating GABA levels in the brain. It promotes both bone and brain health, aids digestion and supports methylation. Magnesium downgrades the stress response, which reduces cortisol levels. It also decreases oxidative stress by regulating NfR2 and NF-κB signaling pathways.

In terms of thyroid function, magnesium is necessary for the conversion of T4 to T3. It is also a co-factor in the production of diamine oxidase (DAO), which is the enzyme that degrades histamine, so deficiency results in higher histamine levels. Magnesium also decreases calcitonin gene-related peptide (CGRP) levels and thus may be helpful in treating and preventing migraines. As one practitioner noted, “Magnesium is helpful in my patients with 100 problems—even though it usually only helps 98 of them.”


Measuring Magnesium Levels

However, measuring magnesium levels can be tricky. Serum plasma levels are unlikely to be low as the body tightly regulates those levels. Intracellular or red blood cell magnesium is a better way to measure it. Organic acid testing (OAT) also helps to show the body’s need for magnesium.


Forms of Magnesium Supplementation

Mineral salts, such as magnesium oxide, tend to be poorly absorbed beyond the duodenum, are limited by passive diffusion, and must compete with other minerals and food for absorption. Mineral chelates instead use an active transport mechanism and absorb well throughout the GI tract, resulting in less diarrhea, a common side effect of magnesium. The following forms of magnesium may provide diverse benefits:

  1. Magnesium citrate is helpful for constipation.
  2. Magnesium threonate could be beneficial for cognitive function and mood disorders because it may cross the blood-brain barrier, based on some studies. However, further research is needed to substantiate these claims.
  3. Magnesium sulfate (Epsom salts) is suitable for detoxification and muscle relaxation.
  4. Magnesium taurate is useful for heart health and blood sugar balance.
  5. Magnesium malate has been used for fibromyalgia pain.
  6. Magnesium bisglycinate is helpful for pain, anxiety and insomnia.



Final Recommendations

Don’t forget about magnesium. Personally, I tend to recommend magnesium citrate for constipation and magnesium threonate for cognitive issues. For all else, I like to use a blend of dimagnesium malate, magnesium citrate and magnesium lysinate glycinate chelate. I recommend this blend because it contains highly absorbable chelates, allowing you to increase a patient’s nutritional reserve.

By incorporating these different forms, you enable the body to use multiple, active-absorption mechanisms in the GI tract to enhance mineral absorption, which allows for improved tolerability and better outcomes. It’s an inexpensive, safe and easy way to help your patients remain healthy. 




Steve Amoils, MD is the Co-Medical Director of the AIM for Wellbeing (AIM) in Cincinnati, together with his wife Sandi Amoils, MD. AIM is a large integrative medical center and part of the Christ Hospital Network. AIM has averaged over 30,000 visits per year since its inception in 1999 and offers accredited physician fellowship training in integrative medicine. Dr. Amoils is a former Assistant Professor at the University of Cincinnati and former President of the Ohio Chapter of the American Academy of Medical Acupuncture. He has received numerous awards for his achievements, including America’s Top Doctor in Family Medicine and Cincy Top Doctor yearly since 2007.

Trained in South Africa, London, and then in the United States, Steve is a board-certified family physician. After completing medical training in South Africa in 1984, he and Sandi spent two years traveling around the world, studying various indigenous medical systems. In 1987 they immigrated to the US, where they ultimately both practiced as family physicians in Cincinnati. In 1999, at the behest of a large hospital group, they opened Alliance Integrative Medicine (now called AIM for Wellbeing,) to offer patients a comprehensive, personalized, integrative approach to medicine. AIM has been recognized as a national leading center in integrative medicine since 2004, and Dr Amoils has been a site investigator on three major national studies on integrative medicine. 

Steve and Sandi are co-authors of two books. Get Well & Stay Well – Optimal Health through Transformational Medicine was published in 2012. The book expounds on their philosophy of helping patients transform illness into wellness through the best of conventional medicine, functional medicine and integrative therapeutic options. Its successor, AIM for Wellbeing, due out in early 2024, discusses the conglomeration of common diseases we see today, something they call the SAD SYNDROME.