S05E106 Magnesium: Magic Mineral or Overhyped Supplement?

I started with a single multivitamin many years ago , but then I added more and more as I kept hearing or reading about other supplements , and recently I realized I have accumulated a lot , maybe too many , daily supplements at this point . So I've decided to go through and see if they all actually have real health value .

So I'm going to start a deep dive , one by one , into my supplements , do the research and share with you my thoughts and findings . So let's start with the first one , magnesium . First of all , remember , although I am a physician , this podcast represents my own anecdotal experience only . This show is for informational purposes only .

Don't do anything you hear on this podcast without first seeking the advice of your own qualified health provider with any questions you may have regarding your own medical care . So thank you . So to start , I first learned about the magic of magnesium supplements as a newly minted doctor who just graduated from medical school . This was almost 30 years ago .

On one of my first rotations as an intern , I was part of a general surgery team and one of our intern jobs was to check patient lab values after surgery and make sure they were normal . I remember having a patient whose potassium levels were very low . Normally potassium ranges from 3.5 to 5 , but this patient's was very low , maybe under 2.5 .

And the patient had just had abdominal surgery and so we couldn't give him anything to eat . So for two days I ordered intravenous potassium , for the patient had just had abdominal surgery and so we couldn't give him anything to eat .

So for two days I ordered intravenous potassium for the patient , which is tedious because it has to be given slowly over hours and you can't give very much at a time or you'll kill the patient . So I ordered a dose of 20 mil equivalents for the first day , then another 20 mil equivalents on a second day , but his potassium levels didn't budge .

So on the third day , then another 20 ml equivalents on a second day , but his potassium levels didn't budge . So on the third day . We were rounding on our patients one afternoon

and I told my senior resident about the patient with hypokalemia meaning low potassium , who wasn't responding to the IV boluses . Looking at me like the idiot intern I was , she asked if I had given any magnesium sulfate to the patient and I looked at her stupidly and I said no . So she rolled her eyes , sighed and moved on to the next patient .

So after rounds I talked to one of the more experienced nurses on the floor who suggested a typical IV magnesium sulfate dose , which I ordered . And then , of course , boom , the patient's potassium popped up to normal on his labs the next morning and problem solved Early magnesium light bulb moment .

So the second time magnesium popped into my life in a meaningful way was much later , about 20 years , after I was an intern . I had just started doing CrossFit and I was drinking the Kool-Aid and working out almost every day . Unfortunately , I was debilitated by severe cramps at least once or twice a week , usually at night .

If the barbell had a lot of heavy barbell , my hamstrings or adductors would just cramp up . Or if there was a lot of jump rope that day it would be my calves .

So whatever muscles the workout really hammered , I would suddenly wake up in the middle of the night , groan in excruciating pain and slide down on the floor trying to pound on the muscle and get it to stop cramping , trying to not make too much noise to wake others up , and about after five or ten minutes I could get it to relax and I would get back into

bed , making sure to hold my leg in the right position so it wouldn't start cramping again . But it would feel terrible the next morning . So people gave me all sorts of advice , like stretching more before and after workouts , massages and , of course , taking more potassium .

So I drank more coconut water , ate bananas , cantaloupe not so much the spinach and bok choy , but hey , there are limits to what I would do food-wise . But the cramps still kept happening for months until someone and I can't remember who read that magnesium could help with muscle cramps .

Boom , light bulb moment from my intern year and I thought to myself but wait a second , I don't need more magnesium . I take a multivitamin every day . And sure enough I checked and the label said magnesium oxide .

But then , when I googled magnesium oxide , I found out that while it was inexpensive , it didn't dissolve in water and only about 4% of the magnesium oxide was being absorbed by the body . So I then started taking a different kind of magnesium and the cramps really seemed to get better .

I very rarely get cramps at this point , but I didn't actually check to see if the magnesium was medically legit or maybe it was just a placebo effect . So now , finally , 10 years later , after I started taking magnesium , I'm actually checking to see what does the medical

literature say about people like me taking magnesium supplements . It may be the most popular mineral supplement in the world right now , and on social media , magnesium is often touted as a miracle mineral for muscle , sleep , mood , you name it .

Now , normally we absorb magnesium from foods like leafy greens , nuts , seeds , whole grains and beans , but many people still don't get enough , and one survey found that almost half of all Americans consume less magnesium in their diet than the recommended daily amount .

So , with so many of us running consume less magnesium in their diet than the recommended daily amount . So with so many of us running low on magnesium , it's no wonder that the magnesium supplement business is booming . So why is there so much hype about magnesium ?

A lot of people do take it for muscle cramps or to improve exercise recovery , but a lot of others now take it to help with sleep relaxation or even blood pressure and migraine control , and more . So let's take a deeper dive into the evidence . To start , what is the evidence for athletes regarding magnesium for muscle cramps and athletic performance .

Let's start with a gym scenario , like me using magnesium to prevent muscle cramps or aid recovery . There are physiologic mechanisms , as I've mentioned , where magnesium seems like it would help reduce cramping . So , as I learned , as an intern , magnesium can help the overall absorption of other electrolytes .

So , as I learned , as an intern , magnesium can help the overall absorption of other electrolytes . It can also act as a natural calcium blocker , helping muscles relax after contracting , and this relaxation can help prevent or alleviate muscle cramps . But scientifically the results have been mixed .

For routine muscle cramps , like those that strike older adults at night , magnesium supplements often don't show much benefit . A recent rigorous review concluded that magnesium is unlikely to provide meaningful cramp relief for older adults with frequent cramps , and in these studies people taking magnesium had about the same number of cramps as those taking placebo .

So for typical leg cramps unrelated to a clear deficiency , popping a magnesium pill might not make a big difference . But what about athletes and exercise performance ? Here the research suggests that magnesium will help if you are deficient . But again , if you have enough magnesium in your system , more might not boost your performance .

If you are a well-nourished athlete , the study suggests that you won't find more strength or aerobic performance from higher dose magnesium supplementation .

However , intense exercise might deplete your magnesium sufficiently , which you lose in sweat and urine , and in some athletes such as me back in the day , which you lose in sweat and urine , and in some athletes such as me back in the day , who never hydrated properly , probably got insufficient electrolytes , will probably run low on magnesium and in those cases ,

supplementation would help prevent deficiency that would otherwise hurt performance . There are also a few small studies suggesting magnesium might reduce post-exercise muscle soreness or markers of muscle damage , but this evidence wasn't very strong or consistent . So magnesium is not a magic bullet for recovery .

Just making sure you have enough magnesium would probably be sufficient , but if you are someone who does a lot of intense exercise , supplementation probably wouldn't hurt .

What about magnesium for general health and heart health ? Magnesium's benefits have been purported to extend beyond the gym . There's a lot of observational research linking good magnesium levels to various health benefits . For example , people who eat magnesium-rich diets tend to have a lower risk of high blood pressure and heart disease .

In fact , the FDA even recently allowed a qualified health claim on magnesium saying quote consuming diets with adequate magnesium may reduce the risk of high blood pressure , but the evidence is inconsistent and inconclusive . End quote . So that sums it up . Magnesium might actually help keep blood pressure in check , but scientists aren't 100% sure .

There are some studies in hypertensive patients which do show a small reduction in blood pressure with magnesium , especially at higher doses , around 300 to 500 milligrams a day , but that reduction in blood pressure is not a huge effect .

So more robust clinical trials are needed to know how much taking magnesium can truly prevent heart attacks or strokes by blood pressure reduction . One review did note that while higher magnesium intake is associated with lower heart disease risk , it's hard to tease out that cause and effect .

So until we get larger , better , well-controlled studies , we'll have to wait for definitive answers . Of course , magnesium is crucial for heart function .

I learned as a newbie intern that we use IV magnesium for certain arrhythmias as well as severe asthma attacks , because it can stabilize excitable cell membranes and low magnesium can definitely cause problems such as heart rhythm disturbances .

So maintaining adequate magnesium is part of overall heart health but again , won't replace your blood pressure meds undo a heavy cheeseburger diet , but might play a supporting role In terms of diabetes . Magnesium has been suggested to play a role in blood sugar .

In terms of diabetes , magnesium might also play a role in blood sugar regulation and reduction of diabetes risk . Higher magnesium diets have been tied to lower risk of type 2 diabetes in observational studies , and in people with diabetes , magnesium deficiency can worsen their insulin resistance , so some trials suggest supplementation can improve insulin sensitivity .

So for those who are borderline diabetic or who do have type 2 diabetes , especially if you have low magnesium levels , supplementation might be helpful . So what about magnesium for brain health , including mood and sleep

? One of the reasons why magnesium is one of the hottest supplements right now is because it's termed the relaxation mineral , with its possible effects on the nervous system . There has been newer evidence that magnesium might have mild benefits for mood and sleep .

A 2023 review found an association between magnesium supplementation and improved depression symptoms , and a review from last year concluded that magnesium supplements might actually help people with mild anxiety and insomnia , helping them feel calmer and sleep better .

Now I certainly have as much anxiety as anyone else out there , and the literature does make sense , since magnesium is involved in neurotransmitter regulation and stress responses . So I might up my magnesium dose , which I will talk about in a little bit . Many people also anecdotally report better sleep quality when they take their magnesium at night .

The science isn't complete , but it is relatively low risk to try magnesium if you have occasional sleeplessness , as long as you don't overdo it . Magnesium is also sometimes recommended for migraine headache prevention .

Some clinical guidelines suggest magnesium , usually around 400 milligrams a day , as a preventative for migraines , based on studies showing it might reduce headache frequency for some sufferers . It's not effective for everyone but again , given its low risk , migraine specialists often consider it worth a try .

So in summary , maintaining adequate magnesium levels is clearly important for overall health . It can affect your muscles , heart , metabolic and nervous system function . But if you have a decent diet with sufficient magnesium , taking extra supplements might only help you in specific ways , possibly better sleep or fewer migraines .

It probably won't overwhelm you with results , but there are definitely situations where evidence does support magnesium use . So if you do choose to supplement with magnesium , here are a few guidelines

to do it smartly . For adults , around 200 to 400 milligrams of magnesium a day is a common supplemental dose and the recommended daily allowance in total is 400 milligrams for men , about 320 for women . That includes the magnesium that you consume in your diet . More magnesium is not necessarily better .

In fact , if you take more than about 350 milligrams at once , it might cause diarrhea , because magnesium does draw water into the intestines and high doses of magnesium are used in laxatives or for colonoscopy prep . So make sure you start on the lower end of the dose and then first see how you feel .

Choose the well-absorbed forms , forms that dissolve well in liquid , which tend to be absorbed better in your gut . Magnesium citrate , glycinate and chloride are examples that are more bioavailable . In contrast , magnesium oxide , which is found in many cheaper supplements or multivitamins , is less absorbed and is more likely to cause GI upset .

Read the label for the form , and I personally use magnesium glycinate capsules , which seem to work for me . In terms of timing , magnesium can be taken in the evening if it helps you relax or sleep . If you take it for workout recovery , you might take it after exercise or before bed as well . There's no strict rule , and do what fits your routine .

Some people will split the dose morning and night to avoid any stomach issues . For me personally , I currently take about 120 mg of magnesium glycidate a day , usually every morning as soon as I wake up . I won't count my daily multivitamin , which has 100 milligrams of magnesium oxide , because of the terrible absorption rate .

But anyway , I must be used to taking it in the morning because I don't feel drowsy in the morning , or maybe I'm already drowsy enough so I don't notice the effect . I've been taking it for years so I'm very used to it .

But as I mentioned , I am now considering adding another 120 milligrams at night before I go to bed to help me sleep , based on this research . But since right now I'm doing a couple other things to try to help my sleep routine , I'll probably wait and see how those maneuvers work first before I start on more magnesium .

In terms of quality and purity , look for reputable brands and third-party testing . Since supplements aren't tightly regulated , it's better to choose products that have been verified by an independent group . For example , a USP verified or NSF certified indicates that the product has been tested for quality and is free from contaminants .

You can check if the company uses third-party labs to check their magnesium for heavy metals or impurities . I personally take the Pure Encapsulations Magnesium Glycinate , which is third-party tested .

Probably the most rigorously tested product I've seen out there is Thorne's Magnesium by Glycinate , which is NSF certified for sport , which means the product undergoes rigorous independent testing and is certified free from 200 banned substances for sport competition , but since I'm not going to the CrossFit Games anytime soon , I'm okay with the formulation I'm taking right

now . Also , know when to consult your medical specialist . If you have kidney issues , you should be careful with magnesium , since kidneys clear excess magnesium . And magnesium can interact with certain medications like antibiotics or blood pressure medications . So when in doubt , ask your medical provider or pharmacist , especially if you plan on taking higher doses

. So , in conclusion , is magnesium worth taking ? Yes , but it does depend on your individual needs and expectations . For someone like me , who probably has low magnesium levels , to start taking it for muscle cramps can be helpful If you have migraines , anxiety or poor sleep . It might also be helpful For those with high blood pressure or type 2 diabetes .

This might be something to discuss with your medical provider about as well . Fortunately , magnesium is low risk and low cost . I plan on continuing my magnesium . Might increase my dose at night . Most of these studies showed that a magnesium-rich diet was the most helpful in terms of the beneficial effects .

So supplements may or may not have those same effects that a magnesium-rich diet has , but if your blood work shows low magnesium , then starting with a supplement might be beneficial . Remember to talk to your healthcare provider if you have conditions or take other medications before you start any of these new supplements .

If you are considering magnesium , what is the reason why you're planning on taking it ? I'd be interested in knowing , and if you're already taking magnesium , what has been your experience with these supplements and what other supplements would you want me to deep dive on next ?

Please DM me on Instagram at Botox and Burpees Podcast , or leave a comment on our YouTube channel , wwwyoutubecom . Slash at Botox and Burpees If you already hit the like and subscribe buttons . I really appreciate it and , as always , thank you for listening .