What is Magnesium?
Magnesium is a naturally occurring element (Mg), that is essential to not only all human life, but all cellular life. Magnesium can be found in green leafy vegetables, nuts, beans, and whole grains. Several conditions can predispose someone to low levels of magnesium, including kidney disease, digestive problems (such as Ulcerative Colitis and Crohn’s Disease), alcohol abuse, older age (above 65), and even certain medications that treat gastric reflux or heart conditions.
What does Magnesium Do?
Magnesium is involved in a wide range of bodily functions. These include keeping a healthy heart rhythm, regulating blood pressure, decreasing inflammation, maintaining a healthy bone structure, and more. It’s used as treatments by physicians for seizures, heart arrhythmias, restless leg syndrome (albeit evidence is not robust), and even as a natural laxative.
Does Magnesium Help with Anxiety, Sleep or Mood?
While the decision to take any supplement should be discussed with a medical provider, many tout magnesium supplements as a natural treatment for anxiety and insomnia. Magnesium may help to reduce anxiety by several mechanisms. Magnesium has a role in lowering blood pressure, via it’s involvement in the release of chemicals (such as nitric oxide) which dilate (or enlarge) blood vessels. Maintaining a healthy blood pressure can improve anxiety. Healthy levels of magnesium also promote healthy (and less tense) muscle tissue. With muscle tension and soreness being a manifestation of anxiety for many, reducing this tension can result in an improved level of anxiety, and allow individuals to feel more relaxed. Magnesium has been implicated as a natural supplement to promote healthy sleep, which can also help individuals to feel less anxious, and improve mood and energy as well. It is thought to help regulate sleep via the neurotransmitter GABA (which is your body’s main inhibitory [or calming] neurotransmitter). Magnesium has anti-seizure qualities and may help to promote healthy function of all neurotransmitters (think serotonin, norepinephrine, and dopamine – many of the same healthy brain chemicals that are targeted by psychiatric medications that treat depression and anxiety).
When Should Someone Consider Magnesium Supplementation?
If someone is struggling with their mood, anxiety or insomnia, discussing magnesium supplementation with their medical provider may be warranted. If someone has digestive issues, kidney problems, an unhealthy diet, takes medications for gastric reflux or their heart, or is over the age of 65, it may be even more important.
Any Concerns with Someone Starting Magnesium?
As magnesium is an element essential for healthy cellular activity, maintaining a healthy level of magnesium is important. High levels of magnesium (even caused by over-the-counter supplements), can result in heart arrhythmias, breathing problems, kidney failure and even death. High levels of magnesium can also cause abnormal levels of other healthy elements and minerals in the body (such as potassium and calcium), which can also cause severe and/or deadly effects. As a licensed physician, surgeon and mental health professional in several states, I always recommend having a provider check one’s magnesium level (with a simple blood test) before, starting magnesium supplementation.
Additionally, for moderate to severe levels of anxiety, I will always recommend a full evaluation by a mental health professional, to discuss all options. Magnesium supplementation may be part of a patient’s treatment plan (particularly if their blood levels of magnesium are low), however, the treatment of more significant illness may require more traditional medication management – either with, or without, over-the-counter supplements such as magnesium.
Magnesium supplements may interact with various medications including antibiotics, heart medications, diuretics and others. This is an additional reason why it is important to discuss supplementation with your medical provider.
How do You Take Magnesium Supplements?
Magnesium supplements can be taken at anytime during the day, and with, or without food. However, as magnesium may increase GABA activity (promoting calmness and sleep), many individuals choose to take it in the evening, or before bed. Magnesium is also a natural laxative, and taking it at bedtime may promote healthy regular morning bowel movements. If magnesium causes upset stomach or diarrhea, then taking it with food may be prudent. Taking any supplement long-term, may have additional risks. For both short-term and long-term use, I always recommend having your medical provider test your magnesium level, as elevated levels of magnesium may be dangerous. If taken long-term, your provider may want to check your magnesium level on a regular basis, to make sure that your levels are not becoming elevated. For example, a baseline level, then a level 3-6 months later, and then every 6-12 months, depending on results. If a patient has certain heart, kidney or other conditions, their provider may want to check levels more regularly.
Any Specific Recommendations on Types or Brands?
Magnesium citrate is a common form, which is generally well tolerated, well-absorbed and economical. There are other versions available (such as Magnesium Glycinate), which may have slightly improved absorption and less GI side effects, but may not be worth the additional cost.
Over-the-couter supplements are less regulated than medications, and it is not unheard of that routine auditing will find that the labels on supplements (even those sold at reputable vitamin stores) aren’t completely accurate regarding their contents and dosages. Vitamins and supplements are actually often taken off of the market, for this very reason. If someone is going to buy a supplement of any kind, I always recommend using a well-known and established large company, that holds itself to rigorous third-party certifications, such as Nature Made or Nature’s Way.
Side Effects?
Side effects include nausea, low blood pressure, diarrhea and upset stomach, irregular heart rhythms, breathing problems, kidney problems and others. Magnesium can be fatal in over-dose. This is why I recommend discussing magnesium supplementation with a medical provider, prior to initiating treatment. Lab work (including a magnesium level) may be part of not only your work-up, but routine monitoring for those starting with magnesium supplementation.
What are Some Other Ways to Treat Anxiety?
Regular exercise and physical activity is incredibly important for the treatment of both anxiety and insomnia. I recommend 30-40 minutes of cardiovascular activity (enough to break a slight sweat) 3-4 times per week. 10,000 steps a day (which can be easily monitored by most cellphones) is also a great starting point. Many do not realize the effect that caffeine has on both anxiety and insomnia. I recommend no more than one cup of coffee or energy drink per day, and never having it after 1 or 2PM. Be mindful of the number of espresso shots in those lattes! I am frequently reminding patients that any more than one shot of espresso in a drink, may be too much caffeine, and may be worsening their symptoms. Please keep in mind, that for moderate or severe symptoms, while trialing psychotherapy, exercise, dietary changes, and even supplements (under the supervision of a medical professional) may be reasonable, medication management may be necessary to fully treat your illness.
Final Thoughts?
The majority of individuals can achieve healthy magnesium levels by maintaining a well-balanced diet; magnesium supplementation is generally not necessary. However, if you are struggling with anxiety, insomnia or other difficulties, discussing all options with your medical provider is recommended, and a quick magnesium level may be prudent. Who knows? Magnesium supplementation may be the missing piece in your treatment plan.
– Chris Pagnani, MD
