Low blood magnesium levels can pose multiple cardiometabolic and neurocognitive challenges and complications. Based on my decades of research and experience, I offer informed and nuanced perspectives.
This story does not include health advice. It is for information, inspiration, and awareness purposes.
Magnesium is not just another mineral. I see it as a joy and serenity-producing molecule. It gave me solace when I was a marathon runner and a gym rat, melting my bulging belly when I experienced abdominal obesity in my younger years. It helped me defeat prediabetes, empowering me to surpass my own limitations.
Thinking back, magnesium fills me with nostalgia and warmth. I discovered its significance through a simple family ritual in my tender childhood. Before bedtime, my parents would offer us tiny sweetened magnesium tablets each night. These little supplements became a cherished part of our nightly routine, ensuring restful sleep and rejuvenation upon waking.
I have always been mindful of my magnesium levels, especially after experiencing brain fog. Since then, I have made it a priority to ensure I get enough magnesium from my diet. When I switched to a keto diet, I supplemented my magnesium intake to maintain optimal levels and support my health and well-being.
However, I heard about hypomagnesemia for the first time in the early 1980s when learning about organic brain syndrome. In those years, organic brain syndrome was already documented in DSM III by the American Psychiatric Association. Later (DSM 5), these syndromes were described as delirium, dementia, amnestic, and other cognitive disorders, which are now referred to as neurocognitive disorders.
The biochemistry lecturer handed over a photocopied ten-year-old paper from JAMA (Journal of the American Medical Association), published in 1973. The title of the paper was Hypomagnesemia: Physical and Psychiatric Symptoms. The paper mentioned that hypomagnesemia, when not complicated by other factors, can lead to an organic brain syndrome. In a patient with a bleeding peptic ulcer, hypomagnesemia resulted from intravenous fluid replacement and suction losses.
The case study informed that hypomagnesemia led to various symptoms, like cramping, nystagmus, tremor, clonus, myoclonic jerks, hyperacusia, Chvostik sign, hypertension, tachycardia, and acute organic brain syndrome. Researchers concluded that the correlation between cerebrospinal fluid and serum magnesium concentrations can guide treatment and symptom management alongside monitoring electroencephalographic changes.
I highlighted this paper because we have known the adverse effects of hypomagnesemia since the early 1970s. However, hypomagnesemia is still a massive problem after five decades. I aim to emphasize the significance of hypomagnesemia, a condition that is sometimes overlooked and not fully comprehended by healthcare providers and the general public.
For example, this 2014 review paper published in the International Journal of Nephrology and Renovascular Disease mentions that despite being the second most abundant intracellular and fourth most abundant extracellular cation in the body, hypomagnesemia has received relatively poor attention in the medical literature compared with hyponatremia, hypokalemia, and hypocalcemia.
What is organic brain syndrome (neurocognitive disorders)?
OBS is an old term now replaced by neurocognitive disorders. According to this classic paper in the journal of Acta Neurologica Scandinavica, the main features of OBS include cognitive problems (memory loss and impaired thinking), altered emotions, and disrupted alertness. Various symptoms complicate the clinical picture.
The key causes are impaired brain function and how the illness affects the person subjectively. Industrial chemicals can also cause these syndromes, leading to various symptoms like fatigue and emotional disturbances resembling other conditions like depression.
The paper mentioned that organic brain syndromes are becoming more significant in public health, social, and economic terms. Diagnosis is challenging because no single symptom is specific. The DSM covers seven types of organic brain syndromes, including delirium and dementia.
This 2006 paper published in Geriatric Psychiatry mentioned that the Organic Brain Syndrome (OBS) Scale was created to assess awareness and orientation in elderly patients, as well as emotional and behavioral symptoms in conditions like delirium and dementia. The study aimed to review the scale’s usefulness using specific criteria.
Although still used in the literature, after 2008, OBS was replaced with neurocognitive disorders. The progress was documented in the American Journal of Geriatric Psychiatry in 2011.
As documented in Nature in 2014,
“Neurocognitive disorders — including delirium, mild cognitive impairment, and dementia — are characterized by a decline from a previously attained level of cognitive functioning. These disorders have diverse clinical characteristics and aetiologies, with Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal degeneration, traumatic brain injury, infections, and alcohol abuse representing common causes.”
In 2023, the American Psychiatric Association updated DSM 5 regarding definitions of neurocognitive and mental health conditions. Here’s a sample video showing a psychiatric interview conducted by a professional to assess this complex condition.
Magnesium is now researched intensely to address neuroinflammation and neurodegeneration, as documented in this 2023 paper published in the International Journal of Molecular Sciences.
What is Hypomagnesemia?
Hypomagnesemia indicates a serum magnesium level of less than 1.8 mg/dL (< 0.74 mmol/L). It may result from inadequate magnesium intake, increased gastrointestinal or renal losses, or redistribution from extracellular to intracellular space.
This paper informs that increased renal magnesium loss can result from genetic or acquired renal disorders. Most patients with hypomagnesemia are asymptomatic, and symptoms usually do not arise until the serum magnesium concentration falls below 1.2 mg/dL. One of the most life-threatening effects of hypomagnesemia is ventricular arrhythmia.
According to this NIH Book Chapter, hypomagnesemia, a condition in which magnesium levels in the body are low, poses risks across various healthcare settings. The prevalence ranges from 2.5% to 15% in the general population, while hospitalized patients can experience it at 12% to 20%.
Critically ill patients face even higher risks, with estimates suggesting around 65% prevalence. Certain groups, like critically ill children and individuals with chronic alcohol use disorder, are particularly vulnerable.
The book chapter states that the human body contains about 25 grams of magnesium, primarily found in bones and soft tissues, which play crucial roles in enzymatic reactions, muscle function, insulin regulation, and more. Hypomagnesemia can disrupt electrolyte balance, affecting sodium, calcium, and potassium levels, and may stem from kidney or gastrointestinal issues.
Hypomagnesemia can lead to complications like hypocalcemia, cardiac arrhythmias, and electrolyte imbalances. Inherited forms of hypomagnesemia, like Gitelman syndrome and EAST syndrome, result from genetic mutations affecting magnesium reabsorption in the kidneys, leading to various complications such as fluid loss, hypokalemia, and metabolic alkalosis.
What are the symptoms and signs of hypomagnesemia?
As documented in a paper on Clinical Endocrinology, signs and symptoms of hypomagnesemia often go unnoticed until the blood magnesium concentration drops below a certain level, typically <0.50 mm.
Patients may initially be asymptomatic, but when symptoms do appear, they are often accompanied by other biochemical abnormalities like hypokalemia, hypocalcemia, and metabolic acidosis, making it challenging to pinpoint specific clinical features solely to hypomagnesemia.
Common manifestations involve neuromuscular, cardiovascular, and metabolic aspects. Neuromuscular symptoms include weakness, tremors, tingling sensations, muscle spasms, and abnormal eye movements.
Cardiovascular effects may manifest as changes in the heart’s electrical activity, leading to arrhythmias and potentially life-threatening ventricular arrhythmias.
Metabolic effects include hypokalemia, occurring in about 60% of cases, and hypocalcemia, which persists until the magnesium deficit is corrected due to suppressed parathyroid hormone release and end-organ resistance to it.
How is hypomagnesemia diagnosed?
First, we need to understand the mechanisms and causes as documented in the Journal of Nephrology and Hypertension. I’d like to summarize the key points for diagnosis from the paper on Clinical Endocrinology.
The preferred method for diagnosing magnesium deficiency is for healthcare providers to measure the total blood magnesium concentration. This is usually done using automated spectrophotometer techniques, with atomic absorption spectrophotometry considered the reference method.
However, interpreting blood magnesium results requires caution due to potential factors like contamination from anticoagulants in sample tubes and the fact that blood magnesium levels may not always accurately reflect total body magnesium status. Another consideration is that some blood magnesium is bound to albumin and may not be active, but conventional testing methods do not adjust for this.
24-hour urinary magnesium excretion can provide valuable insights into renal magnesium avidity. Levels below or above certain thresholds can indicate intact renal response or abnormal renal wasting, respectively. Fractional excretion of magnesium (FEMg) is sometimes used to differentiate between gastrointestinal and renal magnesium loss.
Another diagnostic approach is the magnesium infusion test, measuring magnesium retention after acute magnesium loading. This method can assess intracellular magnesium levels, but its utility is limited to cases where clinical suspicion of magnesium deficiency is high despite normal blood magnesium levels.
How is hypomagnesemia treated?
This paper in Nederlands Tijdschrift voor Geneeskunde, a Dutch medical journal, states that hypomagnesemia can be treated by parenteral or oral administration of magnesium, guided by the serum magnesium level. Parenteral magnesium suppletion is indicated if the concentration is below 0.5 mmol/l or in the presence of symptoms of hypomagnesemia.
This paper on Clinical Endocrinology states that patients with symptomatic hypomagnesemia are usually treated with intravenous magnesium, while an oral replacement is reserved for asymptomatic patients. The commonly used intravenous formulation is magnesium sulfate (MgSO4), which contains elemental magnesium. It’s typically diluted with sodium chloride or glucose for intravenous use.
The recommended initial dose is around 8–12 grams over the first 24 hours, followed by 4–6 grams per day for 3 or 4 days to replenish body stores. The maximum infusion rate should not exceed 2 grams per hour, and blood magnesium levels should be above 0.4 mmol/L.
For patients with renal insufficiency, the initial dose should be reduced, and close monitoring, especially with ECG, is recommended, particularly for high doses and in the elderly. Intramuscular administration is an option but is usually avoided due to its painful nature.
Oral magnesium salts can also be used, although they are not well absorbed, and various preparations are available, providing different amounts of magnesium per tablet. The choice of preparation and dosage depends on the severity of the deficiency and individual patient response.
This 10-minute educational video, which Dr. Andras Fazakas clearly explains on YouTube, can help you learn more about treatment approaches and empower you to discuss your situation with your family physicians.
What is the function of magnesium briefly, and why is it so critical for the body, particularly the brain?
Magnesium is indispensable for numerous bodily functions. Acting as a cofactor for hundreds of enzymes, it facilitates energy metabolism, protein synthesis, and muscle and nerve activity. It regulates calcium function and is vital for muscle and nerve function.
For example, as pointed out in this study, “magnesium has been recognized as a co-factor for more than 300 enzymatic reactions, where it is crucial for adenosine triphosphate metabolism.
The body needs magnesium for reproduction, protein synthesis, the regulation of muscular contraction, blood pressure, insulin metabolism, cardiac excitability, energy production, metabolism, DNA repair, neuromuscular conduction, vasomotor tone, and nerve transmission.
Magnesium affects neurotransmitter synthesis and neurotransmission, affecting mood regulation and mental well-being. Low magnesium levels have been associated with symptoms of depression, anxiety, and mood disorders. Supplementation with magnesium may benefit mood and mental health, although further research is needed to understand its mechanisms fully.
Magnesium is a cofactor in producing ATP (adenosine triphosphate), the primary energy source for cells. Without sufficient magnesium, the production of ATP can be impaired, leading to reduced energy levels and fatigue. Magnesium is crucial in energy production, specifically in ATP synthesis. ATP is produced through a complex process called cellular respiration. It occurs in the mitochondria of cells.
Magnesium is required as a co-factor for several enzymes producing ATP, including those in the citric acid cycle and the electron transport chain. When magnesium levels are low, these enzymes cannot function properly, decreasing ATP production. This can result in reduced energy levels and feelings of lethargy, as the body cannot produce enough ATP to meet its energy demands.
Additionally, magnesium deficiency can impair glucose metabolism and degrade insulin signaling, reducing energy production. Therefore, it is critical for diabetes, as I explained in the previous article.
Furthermore, magnesium contributes to bone health by supporting bone density and formation with calcium and vitamin D. Magnesium also aids in maintaining heart health by regulating heart rhythm and electrical activity, which is essential for blood pressure control.
In the brain, magnesium is particularly critical because it regulates the activity of neurotransmitters and is involved in synaptic plasticity, which is the ability of synapses (connections between nerve cells) to adapt and change in response to experience and learning.
Magnesium modulates the function of NMDA receptors, which play a crucial role in synaptic plasticity and learning and memory processes in the brain. Additionally, magnesium has been shown to have neuroprotective effects, helping to protect brain cells from damage and oxidative stress.
What can we do to prevent hypomagnesemia?
Low magnesium levels have been associated with neurological and psychiatric disorders, including depression, anxiety, migraine, and cognitive decline. Therefore, maintaining adequate magnesium levels is essential for optimal brain health and function.
This paper states, “Certain individuals must supplement with magnesium to prevent suboptimal magnesium deficiency, especially if trying to obtain an optimal magnesium status to prevent chronic disease.”
Magnesium is one of the safest minerals to supplement in the proper doses. I have been supplementing successfully for decades with no side effects in the correct dose. When I consumed more than one gram, it caused digestive issues. Therefore, finding the sweet spot was important.
Therefore, besides the 600 mg daily dose recommended by Dr Stephen Phinney when I started a keto diet, I also take magnesium dermally to relax my muscles, such as from Epsom Salts or sprays sold in pharmacies. However, the efficiency of dermal supplements for the overall magnesium profile is yet to be researched.
As I covered oral supplementation in a previous article, I will not repeat them here. You may check this story titled six types of magnesium, making different effects on the body from a bioavailability perspective. I also summarized my extensive literature review covering Magnesium’s criticality in a previous article.
According to NIH, men, women, and children need different amounts of magnesium. Men need at least 400 mg, and women need 310 mg. Here are granular details documented by NIH. Here is a summary of foods, including magnesium, as documented by NIH.
If you have symptoms such as muscle weakness, cramps, fatigue, headaches, numbness, tingling, loss of appetite, irregular heart rhythms, and seizures, you may need to get it checked via a referral from your family doctor. It can be checked via blood and urine.
The test can indicate a deficiency, which is called hypomagnesemia. However, some people rarely might have excessive amounts due to a condition called hypermagnesemia.
If you are on certain medications, you must be extra careful for magnesium deficiency. For example, this 2021 paper published in the Journal of British Pharmacology Society informs that:
“Hypomagnesemia due to drug therapy is common, with the list of drugs inducing low magnesium levels. Culprit medications are antibiotics (aminoglycosides, amphotericin B), diuretics, antineoplastic drugs (cisplatin and cetuximab), calcineurin inhibitors, and proton pump inhibitors.”
Conclusions and Takeaways
My journey through studying the vital role of hypomagnesemia in organic brain syndrome presented a profound revelation into the complex relationship between a humble mineral and the complex workings of the human body.
Magnesium is not just a mineral but a guardian of health and well-being, a silent protagonist in the story of our physiological and psychological balance. From my fond memories of ensuring peaceful sleep to the nuanced understanding of its biochemical impact on our cells, magnesium’s significance transcended generations and scientific inquiry.
Unveiling the hidden and subtle veils of organic brain syndrome, a complex neurological, cognitive, and mental health issue, I offered a glimpse into the intricacies of cognitive function, emotional regulation, and alertness by magnesium, often overshadowed by its more illustrious mineral counterparts.
Magnesium is a linchpin in cognitive function and neurological health, its absence casting shadows of confusion and cognitive fog. Through meticulous research spanning decades, the medical community has unearthed the subtle yet profound impact of hypomagnesemia on brain health, urging us to heed its call for attention and understanding.
Chronic magnesium deficiency can trigger various health problems and aggravate conditions such as cardiovascular disease, diabetes, osteoporosis, neurodegenerative diseases, and mental health disorders.
The key takeaway of this story is the recognition that hypomagnesemia refers to an abnormally low level of magnesium in the blood, typically defined as a blood magnesium concentration below 0.8 mmol/L. As we navigate the pathways of timely diagnosis and treatment guided by scientific and clinical knowledge, we are reminded of the exploration of holistic health.
Thank you for reading my perspectives. I wish you a healthy and happy life.
If you found this story helpful, you may also check out my other articles on NewsBreak. As a postdoctoral researcher and executive consultant, I write about important life lessons based on my decades of research and experience in cognitive, metabolic, and mental health.