Magnesium: Diagnostic Significance and Clinical Insights

Authors: Dr. Payal Bhandari, M.D., Hailey Chin 

Contributors: Tejal, Vivi Chador

 

 

 

 

Magnesium 

 

Magnesium is a critical nutrient involved in 300+ biochemical reactions, including maintaining normal muscle and nerve function, blood sugar levels, steady heartbeat, and blood pressure. It helps to produce energy, protein, bone, and DNA while supporting a healthy immune system. Abnormally low magnesium levels are associated with neuromuscular disorders, cardiac arrhythmias, diabetes, and kidney or gut dysfunction. Abnormally high magnesium levels can indicate chronic kidney disease, with insufficient magnesium excreted via urine. Please note that because 99% of magnesium is inside the cells, blood magnesium levels are not an accurate assessment of magnesium in the body.

Typical Adult Range

 

Ranges and thresholds can vary due to: 

(1) Lab-specific equipment, techniques, and chemicals, and 

(2) Patient demographics, including age, sex, and ethnicity.

 

Key Insights

Magnesium (Mg2+) tests are important for diagnosing and managing conditions related to magnesium imbalances. These tests can help identify magnesium deficiencies or excesses, which may cause symptoms like muscle cramps, fatigue, and irregular heart rhythms. Magnesium tests also help monitor chronic conditions like heart and kidney diseases, as abnormal levels can harm organs and muscles. Keeping magnesium levels balanced is crucial for energy, muscle function, and the health of organs like the kidneys, bones, and blood vessels.

 

What is Magnesium?

The adult human body contains about 25 grams of magnesium, mostly stored in bones and soft tissues. Magnesium is involved in over 300 body processes, including energy production and electrolyte regulation. It helps produce ATP, which fuels essential body functions.

Magnesium is crucial for regulating calcium, sodium, and potassium levels in the body. It helps control muscle contractions, heart rhythms, and nerve function. It also plays a key role in making DNA, RNA, and the antioxidant glutathione, which protects cells from damage.

Magnesium supports bone health by working with calcium, vitamin D, and parathyroid hormones. It also helps control muscle function by balancing calcium levels. In the brain, magnesium regulates neurotransmitter release, preventing overstimulation and supporting healthy nerve function.

Magnesium helps the pancreas release insulin and other hormones, and it prevents excessive glucose production by the liver. It also aids in fat metabolism, producing more energy than glucose. Low magnesium levels are linked to problems with metabolism, inflammation, and organ damage.

 

Figure 1: Magnesium is key for many body functions, including enzyme activity, blood clotting, muscle control, insulin regulation, bone health, and brain function. It helps with mood, thinking, and memory, and controls blood clotting and immune response. Magnesium also supports strong bones by managing calcium levels and helps muscles relax. Low magnesium can cause cramps and fatigue. It’s also important for heart health, regulating heart rhythm and blood pressure.

 

Regulation of Magnesium Levels in the Body

Magnesium levels in the body are controlled by the small intestine, bones, kidneys, and calcium levels. Keeping these levels balanced is important for health.

Magnesium is found in plant foods like vegetables, nuts, seeds, and fruits. When you eat magnesium, 24-76% is absorbed in the small intestine and enters the bloodstream. The rest is stored in bones and muscles, helping control muscle movement. The kidneys filter magnesium, reabsorbing 95% and excreting 100 mg in urine daily.

 

Figure 2: Magnesium absorption primarily occurs in the small intestine. It is then released into the bloodstream, filtered by the kidneys, and reabsorbed. Most unused magnesium is stored in the bones and skeletal muscles, with a small percentage excreted in the urine. By regulating various electrolyte levels, such as calcium, sodium, and potassium; magnesium released in the bloodstream and delivered to various tissues plays an integral role in harvesting energy, muscle contraction, maintaining blood vessel integrity, neurotransmitter release, and keeping inflammation under control. 

 

 

 

Magnesium and calcium compete for absorption, meaning too much of one can reduce the absorption of the other. Calcium and magnesium levels are controlled by parathyroid hormone (PTH). Low calcium levels trigger the release of PTH and magnesium from bones. High calcium levels reduce magnesium absorption and increase magnesium loss in urine.

 

 

Figure 3:  Calcium and magnesium are absorbed in the small intestine, mainly in the duodenum and ileum. Calcium is actively transported with help from vitamin D and proteins, while magnesium is mostly absorbed passively or through specific channels. High calcium can reduce magnesium absorption, and magnesium can affect calcium absorption.

 

Balanced magnesium, calcium, and PTH levels are important for energy production, muscle and nerve function, and vitamin D synthesis. Disruptions in these minerals can cause oxidative stress, leading to cell damage and increasing the risk of cancers, infections, heart disease, and other health issues. High calcium-to-magnesium ratios can raise the risk of death and cardiovascular disease by 24-66% . 

Figure 4: Vitamin D, PTH, phosphate, and calcium help balance minerals in the body. When calcium is low, PTH is released, which releases calcium from bones, helps the kidneys reabsorb calcium, and activates vitamin D to increase calcium and phosphate absorption. When calcium is high, PTH decreases, reducing calcium release from bones and its absorption.

 

Clinical Significance of High Blood Magnesium Levels

Hypermagnesemia means having too much magnesium in the blood, which is rare but serious. It often happens due to kidney problems or excessive magnesium supplements.

Magnesium affects muscles and nerves by competing with calcium. While it can prevent muscle cramps, too much magnesium can weaken muscles, the heart, and blood vessels. This may cause low blood pressure, slow heart rate, or even heart and lung failure.

High magnesium levels also reduce active vitamin D, which is needed for strong bones and to regulate calcium, magnesium, and phosphorus. Low vitamin D leads to lower calcium levels, causing magnesium to leave the bones and enter the blood. The parathyroid gland works harder to make up for this imbalance.

Magnesium helps balance insulin and other hormones that control blood sugar and energy. Chronic hypermagnesemia can lead to insulin resistance, high blood sugar, and excess fat. It also increases cell damage and affects gut bacteria. Reduced nitric oxide levels—essential for keeping arteries flexible and improving blood flow—can lead to vascular inflammation and a higher risk of heart disease.

 

Figure 5: Atherosclerosis happens when fat and plaque build up in arteries, causing them to harden and narrow. This blocks blood flow, raises blood pressure, and reduces oxygen to tissues. When cells die, they release harmful substances like cholesterol and iron into the blood.

 

 

 

Atherosclerosis is a long-term inflammatory disease that causes organs like the kidneys, thyroid, and liver to release hormones. These hormones increase the production of red blood cells, white blood cells (WBCs), and platelets in the bone marrow. While this helps with clotting and wound healing, overactive WBCs can attack the body’s own tissues, leading to autoimmune diseases.

Conditions like rheumatoid arthritis (RA), lupus (SLE), inflammatory bowel disease (IBD), multiple sclerosis, and HIV/AIDS are linked to high magnesium levels, which can worsen immune system imbalances. RA patients, for example, have a higher risk of heart disease, similar to people with diabetes. Managing high magnesium levels involves treating the underlying causes, such as organ issues or excessive magnesium intake.

 

 

 

Figure 6: High magnesium levels can harm the body, affecting the brain, muscles, digestion, and heart. In the brain, it can cause memory problems and muscle issues. In digestion, it leads to symptoms like vomiting, cramps, and diarrhea. Muscles may weaken or become paralyzed. High magnesium also damages blood vessels, increasing the risk of heart disease, irregular heartbeats, low blood pressure, and organ failure.

 

Clinical Significance of Low Blood Magnesium Levels

Magnesium is important for muscle function, insulin regulation, bone health, nerve function, and blood vessels. Low magnesium levels (hypomagnesemia) can also indicate low calcium or potassium levels, often linked to kidney problems, parathyroid or pancreas disorders, and heart disease.

Low magnesium affects fat storage and energy production, raising blood sugar and reactive oxygen species (ROS), which generate heat and inflammation. Symptoms of hypomagnesemia vary depending on which organs are affected. Lifestyle, medications, genetics, and environment can make these conditions worse.

 

Figure 7: Low magnesium can raise blood sugar, slow fat metabolism, and lower energy, causing cell damage and brain function issues. It may lead to weak bones, memory loss, headaches, fatigue, high blood pressure, and digestive problems. Conditions like diabetes and osteoporosis are also linked to low magnesium. Diet, genetics, lifestyle, and environment can affect severity. 

 

Prevalence and Statistics of Abnormal Blood Magnesium Levels

Very high or low magnesium levels can harm the body by slowing digestion and upsetting the balance of healthy gut bacteria (dysbiosis). Gut bacteria help digest food, absorb nutrients, and remove waste, so an imbalance can lead to nutrient deficiencies and health problems.

Dysbiosis also disrupts energy and electrolyte balance, causing harmful reactive oxygen species (ROS) that damage cells, slow healing, and increase the risk of infections and tumors. For example, a 2021 COVID-19 study showed lower survival rates in patients with high magnesium levels, partly due to cell damage and severe illness.

 

 

 

Figure 8: A healthy gut microbiota is important for balancing metabolism and energy. It helps digest food, absorb nutrients, and remove waste. Dysbiosis, or an imbalance in gut bacteria, can disrupt these processes. This imbalance lowers energy production and causes inflammation, increasing harmful pathogens, proteins, and unhealthy cholesterol in the blood.

 

Low magnesium is common, affecting 2.5–15% of people, especially those with Type 2 diabetes, heavy alcohol use, or severe illness. In hospitalized patients, up to 20% have low magnesium, rising to 65% in critically ill patients, who also face higher death rates.

 

Conclusion

 

Magnesium is important for energy, muscle, nerve function, and organ health. Too little or too much magnesium can cause muscle cramps, fatigue, heart problems, and affect organs. To balance magnesium, eat a plant-based diet with leafy greens and whole grains, and reduce animal products. Supplements like magnesium, vitamin D, and calcium may help. Reducing stress, alcohol, tobacco, and certain medications can improve magnesium use. Maintaining healthy magnesium levels supports overall well-being.

 

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