I’ve come to the conclusion that there should be a separate chapter dedicated just to this issue. For many people on the forum, therapy fails. Having textbook symptoms of magnesium deficiency, supplementation does little for them. Let’s take a look at what the researchers on the subject are writing about:
https://academic.oup.com/qjmed/article-abstract/111/11/759/4209351?redirectedFrom=fulltext
First of all, they point out that in people who have low intracellular levels, the blood test gives good results. You can have a very severe deficiency giving strong symptoms and yet have good test results.
The second point. Strong doses of the supplement will cause the body to trigger a defense response against poisoning by increasing secretion by the kidneys, which in turn will lead to even greater loss of the element from the body than if we had not tried to supplement at all.
Third, and most important: supplementation takes 5-10 months before the results normalize. And this is pretty obvious if you think about it for a moment. There are 20,000 mg of magnesium in the body of a healthy person. From supplements we assimilate no more than 100 mg per day, the rest we either do not assimilate in the intestines, or simply pee. If we also have for some reason impaired absorption, it will be closer to 30 mg, if we assimilate anything at all, because it may turn out that thanks to the tablets we will simply lose it more slowly.
If someone is deficient by 10,000 mg, and they store 100 mg per day, then the therapy will have to last 100 days. With more serious deficiencies and problems with absorption or storage, it will take longer. In some cases it will simply never work, as more will be lost than absorbed.
In summary, to supplement magnesium, you should:
- eliminate all factors that impede absorption and assimilation
- avoid very large doses
- be patient
There is a whole group of diseases in which the level of magnesium decreases or it is not stored, mainly these are various genetic disorders. It is not possible to list and describe them on such a site, I just point out the fact that they exist.
Using the study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786912/
Of the factors that impede both absorption and assimilation at the cellular level, probably the most important would be vitamin D3. This is where the problem arises, because firstly magnesium deficiency hinders the absorption of the vitamin itself, and secondly its supplementation in people with deficiencies gives very unpleasant symptoms. Which means that it will be necessary to take it in small doses, alternating with magnesium. Note: excess vitamin D3 also leads to problems with magnesium absorption.
Second thing, selenium. With selenium deficiency in rats it was possible to detect elevated plasma magnesium levels, but lower levels in internal organs:
https://www.ncbi.nlm.nih.gov/pubmed/7766029
If a similar mechanism occurs in humans, this would partly explain why some people have deficiency symptoms despite good blood results. Suggested doses are high to start, on the order of 200-300 mcg and after a month go down to 50-100 mcg.
Both vitamin A and vitamin E are at least partially responsible for some problems with absorption, there is a separate subpage on this site where you can read about it.
Vitamin B6 is heavily involved in magnesium metabolism, people with anxiety and panic attacks often have lowered levels, so it would be advisable to raise it with higher doses of supplements, on the order of even 200 mg per day for several days.
Diarrhea causes a very severe drop in levels and makes it basically impossible to quickly correct the deficiency. It is often impossible to get rid of the problem completely (e.g. if it is ulcerative colitis), but in healthy people, zinc supplementation and vitamin D3 supplementation often helps.
Diseases like celiac disease or pancreatic insufficiency also make absorption very difficult, but here too it is hard to get any advice other than curing the disease.
Very low salt intake hinders the absorption of both magnesium and calcium.
High calcium intake, both from supplements and from diet (mostly cheese and milk) hinders magnesium absorption.
One study showed a link between glutathione and intracellular magnesium, which means it’s probably a good idea to raise glutathione levels, it’s important for many other reasons anyway.
https://www.ncbi.nlm.nih.gov/pubmed/10406827
The authors of this study recommend another method of supplementation: for a month 600 mg of magnesium ions per day, then for a long period (many months, even up to a year) lower doses, of the order of 200 mg per day.
Of the supplements, lactate, citrate or aspartate will be completely sufficient. It is also advisable to supplement potassium with small doses in parallel.
Note that magnesium is the same as magnesium ions, but not the same as, for example, magnesium lactate. 500 mg of magnesium lactate contains 50 mg of magnesium or, in other words, magnesium ions.
If diarrhea occurs during supplementation, it means that the single dose of the supplement is too high and you are actually losing magnesium instead of replenishing it.
Supplementing magnesium with high doses can lead to lower calcium levels, which paradoxically will make the condition worse instead of better. If the symptoms worsen, especially the onset of symptoms such as eyelid twitching or lip tingling, magnesium should be discontinued for a while and calcium supplementation should be taken. Note: such symptoms, indicating a disruption of the ratio of magnesium and calcium in the diet does not indicate anything in the long term, you can have a very low supply of magnesium in the body, and at the same time poisoning because of excessive supplementation. There is more on the relationship of calcium and magnesium in the chapter on tetany.