The skeptical cardiologist first mentioned magnesium in a post on the treatment of premature ventricular contractions (PVCs). I wrote that some individuals find relief from this troubling arrhythmia with the use of magnesium supplements.
I noted then that:
Most of the internet’s top quacks, however, greedily market and glowingly swear by magnesium for all manner of common ailments. A Google search for magnesium cardiovascular disease yields 833,000 entries and the first page is a Who’s Who of quackery, including Dr Mercola (strong candidate for America’s greatest quack), Dr. Sinatra (see here), NaturalNews and Life Extension (see here).
This Weston Price Foundation blurb on magnesium is typical of the inaccurate and dangerous misinformation found widely on the internet:
(M agnesium) deficiency is related to atherosclerosis, hypertension, strokes and heart attacks. But magnesium shines brightest in cardiovascular health. It alone can fulfill the role of many common cardiac medications: magnesium inhibits blood clots (like aspirin), thins the blood (like Coumadin), blocks calcium uptake (like calcium channel-blocking durgs such as Procardia) and relaxes blood vessels (like ACE inhibitors such as Vasotec)
Weston Price Foundation
Today the Google search for magnesium cardiovascular yields 27,220,000 entries. The potential cures for magnesium supplementation according to many pseudoscientific websites are legion and extend well beyond PVCs and cardiovascular disease.
You can be assured that a sales pitch accompanies these claims and that the magnesium-containing snake oil being promoted has not been proven effective or safe. Because symptomatic PVCs like most benign, common and troubling conditions (lower back pain, fatigue, insomnia and nonspecific GI troubles come to mind), are closely related to mood and wax and wain spontaneously; the placebo effect proves powerful. In such conditions, snake oil and charlatans thrive.
To be clear, magnesium plays a crucial role in multiple crucial enzymatic processes in the body. Magnesium levels are very important to monitor in hospitalized and critically ill patients, especially those receiving diuretics and medications that can affect cardiac electrical activity.
However, the evidence that magnesium supplementation is beneficial for the majority of the population who suffer from common chronic diseases is lacking.
Although observational studies have shown a weak association of low magnesium levels (hypomagnesemia) with cardiovascular disease, magnesium supplementation has not been proven beneficial for the prevention or treatment of any chronic cardiovascular disease.
The Best Magnesium Supplement: The Candidates are Legion
Those who promote and sell magnesium supplements for all manner of ailments have to promote the idea that hypomagnesemia is rampant, causing widespread symptoms and underdiagnosed by the medical profession.
Once establishing this concept they then will try to distinguish their product from the magnesium that doctors typically prescribe (magnesium oxide) and those supplements which are cheaper and available through other sources. This aggressive marketing of useless supplements is, of course, the #1 red flag of quackery.
Thus if we look at the bestselling magnesium supplements on Amazon we see in addition to magnesium oxide, an inorganic salt, multiple organic magnesium salts:
- Magnesium glycinate lysinate
- Magnesium L-threonate
- Magnesium citrate
- Magnesium malate
Depending on the marketing goals of the supplement maker, differing magnesium preparations are promoted to “support bone and muscle health”, or “support stress relief, sleep, heart health, nerves, muscles” with no scientific basis for the claims.
In fact, magnesium pushers have invented specific niches for different magnesium preparations with absolutely no solid scientific support.
An article in Healthline.com entitled “10 Interesting Types of Magnesium (and What to Use Each For)” helps propagate this magnesium propaganda. Despite its appearance as a reliable and referenced source of nutritional information, the article aids supplement manufacturers by suggesting these products “may” have benefits for varying conditions.
Healthline’s article starts with Magnesium citrate, which doctors have traditionally used to treat constipation and induce diarrhea in order to clean out colons prior to procedures:
it’s occasionally marketed as a calming agent to help relieve symptoms associated with depression and anxiety, but more research is needed on these uses
The Healthline article also mentions multiple times that these alternative forms of magnesium when available as a salt with an organic compound are better absorbed or more bioavailable. The implication here and in multiple magnesium snake oil sites across the internet is that you are far better off buying a more expensive niche brand of magnesium than the cheaper magnesium oxide your physician might recommend.
Intestinal Absorption and Bioavailability of Different Magnesium Salts
Those who promote and sell magnesium supplements for all manner of ailments have to promote the idea that hypomagnesemia is rampant, causing widespread symptoms and underdiagnosed by the medical profession..
Two Food Nutrition scientists from the Institute of Food Science and Human Nutrition, Leibniz University in Hannover, Germany surveyed what is known about magnesium absorption and bioavailability in 2017.
They noted that multiple factors influence magnesium (Mg2+) absorption and that “the bioavailability of Mg2+ varies within a broad range, depending on the dose, the food matrix, and enhancing and inhibiting factors.”
Jan Philipp Schuchardt and Andreas Hahn (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652077/)
Dietary factors play a huge role with some impairing magnesium up-take including “high doses of other minerals, partly fermentable fibres (e.g., hemicellulose), non-fermentable fibres (e.g., cellulose, lignin), phytate and oxalate.”
And some dietary factors enhancing magnesium uptake including proteins, medium-chain-triglycerides, and low- or indigestible carbohydrates (e.g., resistant starch, oligosaccharides, inulin, mannitol and lactulose)
They also noted that there is no widely accepted, standardized method of assessing magnesium bioavailability therefore it is not clear which form of magnesium supplement has the highest bioavailability.
Although animal studies have suggested a slightly higher bioavailability of organic Mg2+ compounds it is not clear that this finding is relevant to any human condition.
Due to the lack of standardized tests to assess Mg2+ status and intestinal absorption, it remains unclear which Mg2+ binding form shows the highest bioavailability.
Animal studies showed that organic and inorganic Mg2+ salts were equally efficient at restoring depleted Mg2+ levels in plasma and red blood cells, despite a slightly higher bioavailability of organic Mg2+ compounds.
Despite what nutraceutical and supplement marketing hype claims and what seemingly reliable health websites like Healthline parrot there is no evidence to support taking one magnesium supplement over another for any particular condition.
Therefore, if you want to try magnesium for PVCs (or insomnia, muscle cramps, depression, etc.) you should choose the cheapest preparation that you are able to tolerate without side effects.
Magnesium Dietary Sources
Rather than focusing on taking a magnesium supplement and thereby adding to the coffers of the nutraceutical industry, I advise following a healthy, balanced diet.
The NIH summarizes magnesium food sources as follows:
Magnesium is widely distributed in plant and animal foods and in beverages. Green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains, are good sources. In general, foods containing dietary fiber provide magnesium. Magnesium is also added to some breakfast cereals and other fortified foods. Some types of food processing, such as refining grains in ways that remove the nutrient-rich germ and bran, lower magnesium content substantially. Tap, mineral, and bottled waters can also be sources of magnesium, but the amount of magnesium in water varies by source and brand (ranging from 1 mg/L to more than 120 mg/L) Approximately 30% to 40% of the dietary magnesium consumed is typically absorbed by the body [2,9].
Eumagnesemically Yours
-ACP
N.B. Mg2+ sources from the NIH
| Food | Milligrams (mg) per serving | Percent DV* |
|---|---|---|
| Pumpkin seeds, roasted, 1 ounce | 156 | 37 |
| Chia seeds, 1 ounce | 111 | 26 |
| Almonds, dry roasted, 1 ounce | 80 | 19 |
| Spinach, boiled, ½ cup | 78 | 19 |
| Cashews, dry roasted, 1 ounce | 74 | 18 |
| Peanuts, oil roasted, ¼ cup | 63 | 15 |
| Cereal, shredded wheat, 2 large biscuits | 61 | 15 |
| Soymilk, plain or vanilla, 1 cup | 61 | 15 |
| Black beans, cooked, ½ cup | 60 | 14 |
| Edamame, shelled, cooked, ½ cup | 50 | 12 |
| Peanut butter, smooth, 2 tablespoons | 49 | 12 |
| Potato, baked with skin, 3.5 ounces | 43 | 10 |
| Rice, brown, cooked, ½ cup | 42 | 10 |
| Yogurt, plain, low fat, 8 ounces | 42 | 10 |
| Breakfast cereals, fortified with 10% of the DV for magnesium, 1 serving | 42 | 10 |
| Oatmeal, instant, 1 packet | 36 | 9 |
| Kidney beans, canned, ½ cup | 35 | 8 |
| Banana, 1 medium | 32 | 8 |
| Salmon, Atlantic, farmed, cooked, 3 ounces | 26 | 6 |
| Milk, 1 cup | 24–27 | 6 |
| Halibut, cooked, 3 ounces | 24 | 6 |
| Raisins, ½ cup | 23 | 5 |
| Bread, whole wheat, 1 slice | 23 | 5 |
| Avocado, cubed, ½ cup | 22 | 5 |
| Chicken breast, roasted, 3 ounces | 22 | 5 |
| Beef, ground, 90% lean, pan broiled, 3 ounces | 20 | 5 |
| Broccoli, chopped and cooked, ½ cup | 12 | 3 |
| Rice, white, cooked, ½ cup | 10 | 2 |
| Apple, 1 medium | 9 | 2 |
| Carrot, raw, 1 medium | 7 | 2 |
24 thoughts on “What Kind of Magnesium Supplement Should You Take For___?”
I have found the #5 magnesium supplement above to be a very effective osmotic laxative. I much prefer it to milk of magnesia. Why is this important to heart health? My doctor recently raised my Pravastatin from 40 mg to 80 and I immediately developed the worst constipation of my life. Yes, I have tried every remedy in the book but nothing works as well. You may say it was coincidental that I developed constipation at the same time as raising statin but I have tried starting and reducing dosage and yup, it’s the statin. So if your patients say they developed C after starting or increasing statin, this supplement might just help them to take the statin. I have heard doctors say constipation is preferable to heart disease or stroke but they obviously never had the type I have which is dibilitating and excruciatingly painful. Think a crumbly stick of chalk.
Weston Price also has a book out claiming that viruses don’t even exist, which makes mere anti-vaxxism seem mild in comparison. They are the last place I’d look for anything accurate and whatever bit of reality they recognize are found elsewhere.
Thankyou.
Thank you Dr. Pearson for another excellent blog entry that clarified considerable long standing confusion on Mg supplements. My husband began using 400 mg Magnesium Triple Complex after a STEMI (Proximal LAD) in 2019. Immediately afterward his LVEF was 35%, with three areas of apical akinesis that four months later recovered to 55%. Whether or not the Mg assisted the meds / lifestyle changes in his fortunate return to health, I suppose I will never know, but your article makes it pretty clear that almost three years later, he no longer needs to use it.
I have taken magnesium supplements for several years. Why? I think it was to decrease the discomfort of PVCs (but not sure). Ah, Weston Price–in his day probably wouldn’t have been considered a quack, though his followers (particularly George Meinig) tend to raise my dental colleagues’ blood pressure. Probably not as much as Paul Gosar, though.
I was having excruciating leg cramps and magnesium was recommended. Placebo or not, it’s a relief that they have stopped.
Robert I’ve had the exact same experience I take magnesium taurate and malate
I apply a magnesium chloride “oil” topically a few times a week to my legs. Leg and foot cramp frequency and severity is greatly reduced since starting about 5 months ago.
And, I am very open to the possibility that it is a placebo effect. If that’s the case, I expect my brain won’t be fooled for long! For now, I am happy with the result.
I appreciate this post and comments today.
Are you familiar with Dr. Gundryls unusual dietary plan. He apparently is or was a noted cardiologist.
Richard,
Yes. Gundry’s aggressive marketing plan prompted me to write my original post on red flags of quackery.
See https://theskepticalcardiologist.com/2018/07/14/why-you-should-ignore-the-plant-paradox-by-steven-gundry/
Ddr. P
Gundry shows up when I am watching youtube with these lengthy informercials. In one of those, he was pushing his olive oil as being superior to others and I had to look him up. He is/was a bonafide doctor but looks like he’s now merchandising all sorts of weird things that he loses all credibility in my eyes. I am glad to see doctors like yourself educating people on quackery and huge thanks.
Magnesium oxide will block absorption of some medications, so if you take that one you have to take it two hours before or after certain medications. For some reason I’ve had an allergic reaction to magnesium glycinate the two times I took it, which is odd because I’ve read that glycine is an amino acid in almost everything we eat. I use magnesium citrate to avoid medication interactions when I take magnesium, but I think I get enough from peanut butter.
On another matter. I recently read a book called The Clot Thickens by Dr. Malcolm Kendrick. It addresses what he believes are the real causes of Heart Disease. I would love for you to critique it sometime in the future if you feel so inclined to read it. Your opinion on it the would be interesting.
A very interesting book in my opinion. I would also suggest the book Prevention Myths by Ford Brewer.
Bart,
Another viewer asked me about Brewer.
My response was
His video on reversing arterial disease has some fundamental inaccuracies .
I noted that he is using a report from Bale-Doneen and I looked at their website. This appears to be a quack center which gives individuals the idea that only Bale-doneen has the secret to identifying and reversing arterial inflammation.
Dr. P
Sorry that you feel that way about Dr Brewer but I respect your opinion and enjoy your content.
I’ve been following Kendrick’s blog for almost as long as I’ve been writing mine. He’s an English GP who is bright and contrarian. He does not accept the theory of atherogenesis accepted by >95% of scientists working in this field. I have looked at the accumulating data linking LDL-C (which is a close but not perfect measure of apo B) to heart attacks and strokes ad feel it has gain much strong in the last 8 years. Consequently, I consider apolipoprotein B levels to be the primary initiator of the atherosclerotic process not thrombosis. I think he’s wrong. This becomes dangerous when his work convinces people to stop taking their very effective and safe statin drugs.
Dr. P
I’ve been supplementing with magnesiun taurate for a number for years to settle down some infrequent short runs of SVT (also have an implanted defibrillator, just in case). Some studies seem to validate this. Also, I’ve added some magnesium glysinate (in addition to the bit of magnesium, probably oxide, that I get in my multivitamin) to get up to my max gut-tolerability without potty issues… about 400 mg/day from all supplement sources.
I think the truth is somewhere in the middle on supplements. No question many manufacturers make extraordinary claims and tend to glamorize their particular formulation for profit.The FDA does not oversee the supplement industry so the sky is the limit with claims they often make.You have to take those claims with a grain of salt but some supplements do work for the claim cited. Consumer lab .com does a good job of sorting through all the research on the efficacy of supplements and they are medical doctors. However , Americans have left themselves open to this supplement puffery by embracing an unhealthy diet and always expecting a pill to solve their problems. I will say this though, more people have had more ill effects from pharmaceutical drugs than from taking a supplement. Have you ever seen the listed side effects on most prescription drugs? Anyway, yes, magnesium is critical stuff but not a cure all. It is extremely important for health, especially heart health. It is required for the correct functioning of the electrical system in your heart, and a low level increases the risk of atrial fibrillation. Unless you are eating a great diet full of the foods you mention a mag supplement would be a good idea. I take a Mag supplement. My doctor recommended it for headaches and insomnia. It helps. Don’t get me started on Vitamin D. I know folks taking 10,000 IU’s a day. Can’t be a good thing unless they are diagnosed as very deficient. I stick to a much lower dose(2,000IU’s) and try and get some sunshine daily. There is so much info on the net these days that it gets very confusing.I don’t want to make the supplement industry richer than they already are but I feel the same way about Big Pharma. Another thought provoking article Doc. thank-you
Tony I agree 100% with all your comments
Tony, interesting you mention Vitamin D. There are quite a few papers you should read on Pubmed regarding dose, relating to factors such as age and BMI, as well as current Vitamin D level. 2000 IU will maintain the level, and 4000~5000 IU daily is required to increase it.
I live in Australia, and believe it or not, we have widespread Vit D deficiency in the South Eastern region of the country where the vast bulk of the population live. We also have some of the highest rates of skin cancer in the world, so there is a delicate balancing act between supplementation & sun exposure. Measuring blood Vit D level is the only real way to assess deficiency, or excess supplementation.
Bilinski K, Talbot P. Vitamin d supplementation in australia: implications for the development of supplementation guidelines. J Nutr Metab. 2014;2014:374208. doi: 10.1155/2014/374208. Epub 2014 Aug 19. PMID: 25210624; PMCID: PMC4152924. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152924/ )
Singh G, Bonham AJ. A predictive equation to guide vitamin D replacement dose in patients. J Am Board Fam Med. 2014 Jul-Aug;27(4):495-509. doi: 10.3122/jabfm.2014.04.130306. PMID: 25002004. ( https://pubmed.ncbi.nlm.nih.gov/25002004/ )
Veugelers PJ, Ekwaru JP. A statistical error in the estimation of the recommended dietary allowance for vitamin D. Nutrients. 2014 Oct 20;6(10):4472-5. doi: 10.3390/nu6104472. PMID: 25333201; PMCID: PMC4210929. ( https://pubmed.ncbi.nlm.nih.gov/25333201/ )
Those papers will show you other papers that are related. Lots of good stuff in the literature, rather some random internet page.
Thanks for the links
I don’t know if you heard but Dr. Sinatra just passed away after a brief battle with Pancreatic Cancer. Not sure how that will effect his company, products, legacy, etc…
Tom,
I hadn’t heard that. Quite sad.
Dr. P