From the Guidelines
Chronically low magnesium levels are primarily caused by inadequate dietary intake, increased gastrointestinal losses, and enhanced renal excretion, with the most significant contributors being malnutrition, chronic diarrhea, and certain medications such as proton pump inhibitors and diuretics, as reported in the most recent study 1. The causes of chronically low magnesium levels can be multifaceted, involving various factors that affect the body's ability to maintain adequate magnesium stores.
Common Causes
- Inadequate dietary intake: Malnutrition, alcoholism, and diets high in processed foods but low in magnesium-rich foods like nuts, seeds, and green leafy vegetables can lead to chronically low magnesium levels.
- Increased gastrointestinal losses: Chronic diarrhea, malabsorption syndromes, inflammatory bowel disease, celiac disease, and bariatric surgery can result in excessive magnesium loss through the gastrointestinal tract.
- Enhanced renal excretion: Certain medications, such as diuretics, particularly loop and thiazide diuretics, can increase magnesium excretion through the kidneys, while endocrine disorders like diabetes, hyperaldosteronism, and hyperparathyroidism can also contribute to increased renal magnesium loss.
Medications and Medical Conditions
- Medications: Proton pump inhibitors (like omeprazole), certain antibiotics (gentamicin, amphotericin B), and some chemotherapy agents can significantly contribute to magnesium depletion.
- Chronic kidney disease: This condition can affect magnesium regulation, leading to chronically low magnesium levels.
- Genetic disorders: Conditions like Gitelman syndrome can cause inherent magnesium wasting.
Other Contributors
- Chronic stress, excessive sweating, pregnancy, lactation, and chronic alcoholism can also damage magnesium absorption and increase excretion. According to the most recent study 1, hypomagnesemia has been reported in up to 12% of hospitalized patients, with an incidence around 60-65% among critically ill patients, highlighting the importance of addressing underlying causes and supplementing with magnesium to prevent or treat chronically low magnesium levels.
Treatment
Treatment involves addressing the underlying cause while supplementing with magnesium, typically 300-400mg elemental magnesium daily through oral supplements like magnesium oxide, citrate, or glycinate, with citrate and glycinate generally being better absorbed and causing less gastrointestinal distress, as supported by the study 1.
From the Research
Causes of Chronically Low Magnesium
- Several factors can contribute to chronically low magnesium levels, including:
- Medications: Certain drugs, such as diuretics and proton-pump inhibitors, can cause magnesium loss and hypomagnesemia 2, 3, 4
- Dietary intake: Low dietary intake of magnesium can lead to subclinical magnesium deficiency, which is a predisposing factor for chronic inflammatory stress and chronic diseases such as cardiovascular disease and diabetes 5, 6
- Underlying medical conditions: Conditions like obesity, metabolic syndrome, and type 2 diabetes can increase the risk of magnesium deficiency 5, 6
- Interactions with other nutrients: Magnesium can interact with other nutrients, such as calcium and zinc, which can affect its absorption and utilization in the body 2
Medications that Can Cause Magnesium Deficiency
- The following medications have been linked to magnesium deficiency:
- Diuretics: Can induce renal magnesium loss 2, 3, 4
- Proton-pump inhibitors: Can decrease intestinal absorption of magnesium 2, 3, 4
- Antibiotics: Certain antibiotics, such as aminoglycosides and amphotericin B, can cause hypomagnesemia 3
- Antineoplastic drugs: Certain chemotherapy drugs, such as cisplatin and cetuximab, can cause hypomagnesemia 3
- Calcineurin inhibitors: Can cause hypomagnesemia 3
Dietary Factors that Contribute to Magnesium Deficiency
- A low dietary intake of magnesium can contribute to magnesium deficiency, particularly in individuals who: