Tuesday, January 11, 2022

On January 10, 2022, the FDA announced a newly qualified health claim for magnesium and reduced risk of high blood pressure in a letter of enforcement discretion.

Both health claims and qualified health claims characterize the relationship between a substance and a reduction in risk of contracting a particular disease or health-related condition and are reviewed by the FDA through a petition process. Qualified health claims are supported by less evidence than the “significant scientific agreement” standard governing unqualified health claims. Therefore, eligible health claims require a disclaimer or other qualifying language to avoid misleading consumers regarding the strength of the scientific evidence supporting the claim.

In January, the FDA reviewed health claims related to magnesium. A review of multiple studies did show some benefits concerning hypertension, but the findings were varied. They did conclude that there was evidence of potential cardiovascular benefits from magnesium, especially for hypertension. Given this attention, we thought it would be an excellent time to review what we know about this vital mineral.

Magnesium is an essential mineral and is the fourth most abundant mineral used in the body. It is a necessary cofactor for over 300 enzymatic systems in the body that regulate biochemical reactions. These include protein synthesis, muscle and nerve function, blood pressure maintenance, bone structure, energy production, memory, and detoxification.

Magnesium is vital in cardiovascular function.

Low levels of magnesium are associated with an increased risk of heart disease. Recent studies suggest that magnesium should be the first-line drug therapy for hypertension.

In 2015 the Food and Drug Administration concluded that Americans were under-consuming magnesium and listed it as a “nutrient of concern.”

Over 60% of Americans are deficient in magnesium, and 75% of Americans do not get the recommended RDA intake of magnesium. The recommended RDA in men is 400 mg and in women is 310 mg. (older adults and athletes may need 20 – 50 mg more). In addition, there are certain lifestyle factors like stress and alcohol intake that can further deplete magnesium levels. Deficiency symptoms include anxiety and agitation, restless legs and muscle cramps, sleep disorders, abnormal heart rhythms, poor nail growth, osteopenia and osteoporosis, headaches, and in rare cases, seizures. Foods high in magnesium include pumpkin seeds, spinach, quinoa, nuts and beans, and chocolate.

Magnesium levels measured in the serum are not reliable as our bodies will maintain the magnesium level in the serum at the expense of other tissues. For example, when magnesium levels are low, our body will deplete stores in the bone to maintain serum levels. The best way to evaluate actual magnesium levels is to measure red blood cells. The normal range is 4.2 to 6.8 mg/dl, but optimal levels are over 5.5 mg/dl.

Given the high use of magnesium in the body, getting this mineral in foods or supplements is vital if needed.

Choosing the form of magnesium is important. The correct formulation is key to success. Always choose supplements free of fillers, gluten, dairy, soy, and artificial ingredients.

Magnesium Citrate has higher absorption than other forms of magnesium and is often used to support detoxification and regular bowel movements. It also helps prevent the crystallization of calcium in the kidney and avoids the formation of stones. This form of magnesium is excellent for individuals with constipation. It is important to titrate it until optimal results are achieved. Start at 100-150 mg doses and go up every three days until bowel movements are regular. For those with kidney stones, a daily dose of 100-200 mg may be enough to aid in prevention.

Magnesium Glycinate is the most highly bioavailable form of magnesium.

It is the most soluble, so it does not have a laxative effect like the citrate formulation and thus is not helpful for those with constipation and problems with evacuation. Magnesium glycinate is also very tolerant as it is chelated and less likely to cause GI symptoms. This formulation is optimal for treating or preventing headaches, sleep disturbances and restless legs, and muscle cramps. Doses can be divided twice a day and should never exceed 600 mg unless your physician recommends.

Magnesium L-Threonate is a unique form of magnesium as it can cross the blood-brain barrier. This formulation was found to augment synapse enhancing memory and learning in rodents. In humans, a clinical trial showed Magnesium L-threonate supported cognitive abilities in older adults. This formulation would be best for those struggling with brain fog, cognitive decline, anxiety, and agitation. Doses for these are variable but should start at 200 mg daily and increase to 200 mg twice a day if tolerated.