Yesterday BfR released a new opinion stating that the maximum daily level for magnesium in food supplements should not exceed 250 mg. We’d not waste our or your time considering this opinion or writing about it, if the BfR didn’t hold a fair amount of sway in Europe, with the European Commission (EC), the European Food Safety Authority (EFSA) and with many EU Member States that view Germany as the micronutrient expert country. Germany has after all spawned pharmaceutical giants like Merck, Bayer and BASF. Interestingly, the latter were among the post-WWII spin-offs from IG Farben, the company that made Zycklon-B used in the gas chambers during the holocaust.
Why is magnesium so essential?
Magnesium is a cofactor in more than 300 enzyme systems that are needed to maintain life and health, from protein synthesis, to muscle and nerve function, blood glucose control, and blood pressure regulation. Magnesium is also needed to produce energy. It contributes to the structural development of bone and is required to make DNA, RNA and the antioxidant, glutathione, key for phase II detoxification. Magnesium is involved in nerve impulse conduction, muscle contraction, and crucially, maintaining normal heart rhythm.
An adult body contains stores of around 25 g magnesium, with about half of this in the bones and almost all the rest in soft tissues including muscles. Whilst magnesium levels are usually measured in blood, there’s actually less than 1% of total magnesium in blood serum. A recent paper highlights the fact that serum magnesium levels do not accurately reflect body magnesium stores, and chronic magnesium deficiency is not widely recognised.
BfR’s beef with magnesium
According to BfR President Prof Dr Andreas Hensel, "Food supplements are in vogue, and many people believe that they can provide health benefits. But the consumption of food supplements may also be associated with health risks. The best nutritional strategy basically involves a balanced and varied diet with plenty of fruit and vegetables. Such a diet supplies a healthy body with all essential substances. In most cases, therefore, food supplements are superfluous."
One senses that the BfR would prefer people to rely on licensed drugs, despite these being the third leading cause of death after heart disease and cancer. Ironically, increasing magnesium status to well above standard reference levels is one of the most reliable ways of reducing death from heart disease (see below).
The health risk that BfR references with regard supplemental magnesium is loose bowels – mild diarrhoea. Its answer to this perceived problem is that food supplements are not necessary because a balanced and varied diet with plenty of fruit and vegetables supplies a healthy body with sufficient magnesium. In its view, this is the same for athletes and the active.
Table 1 provides examples of magnesium-rich foods and Table 2 considers risks and benefits of magnesium, as well as ANH-Intl's view on the optimal therapeutic intake range for the mineral.
Table 2. ANH-Intl’s suggested optimal intake range for magnesium from all sources (food and supplements).
How much is enough?
The current commonly-used clinical reference range in conventional medicine for circulating magnesium in serum (blood) is 0.75 – 1.25 mmol/L, yet levels as low as 0.66 mmol/L are generally accepted as normal. Integrative and functional medicine practitioners are more focused on optimal amounts for health, rather than just adequacy to prevent life-threatening deficiency. As such, optimal ranges are typically significantly higher, such as 1.00 – 1.25 mmol/L (Table 3).
Table 3. Laboratory reference ranges for circulating magnesium (serum).
We spoke to Jonathan Cohen, Director of the FunctionalDX blood chemistry screen, who told us, “After seeing hundreds of tests, I recall no more than 1 to 1.5% of all tests I have seen ever showing a plasma level over 1.0 mmol/L. The vast majority tend on average to fall between 0.75 and 0.85 mmol/L”.
Cohen, himself an integrative medicine practitioner of many years standing, went on to say, “If I was to go out on a limb I would suggest that one would have 2 standards; for the healthy and the unwell, who definitely will need additional magnesium. Any standardisation lower than what we have now is a potential health risk in itself”.
It should also be noted that while athletes, especially endurance athletes, will typically be viewed as healthy, in order to maintain 'normal' or 'optimal' ranges in serum, their intake might need to be much higher than a normal person. That is because magnesium use in muscle fibres and, hence, its removal from body stores, will tend to greatly exceed that of a non-athlete.
ANH-Intl’s concerns over BfR’s opinion
We have a number of major concerns over BfR's opinion:
BfR has delivered its opinion to limit magnesium from supplements to 250 mg of elemental magnesium per day using, as its basis, data from the forms most likely to yield this effect (e.g. magnesium sulphate or oxide) and the amount based on a single serving from supplements. The opinion ignores the effects of divided doses during a day from other forms, this being the common way in which magnesium status is improved among those with higher requirements and/or low status.
There is no mention of the different forms of magnesium that exert very different effects, e.g. magnesium sulphate (Epsom salts) or oxide, the least preferred forms, versus magnesium bisglycinate, taurate, malate or chloride, all of which have different benefits and usages and are greatly preferred in supplemental form. There are currently 21 different forms of magnesium authorised for use in Europe under the EU Food Supplements Directive. Magnesium oxide, the form typically used in supermarket and pharmacy multis, and along with Epsom salts (magnesium sulphate), are the forms with the most potential to cause diarrhoea (through osmotic dysregulation in the gut). Many of the forms used or recommended by nutritional and integrative medicine practitioners are much gentler on the gut and in divided doses, yield zero risk and multiple benefits.
BfR does not appear to acknowledge that risks and benefits overlap, and therefore by using regulation to eliminate risk from the most risky form among the most sensitive population groups, benefit to the majority would also be eliminated. This principle of overlapping risks and benefits for micronutrients, and its implication for regulation, was first elucidated by ANH’s founder, Robert Verkerk PhD, in a peer-reviewed journal article published in Toxicology in 2010.
Sports enthusiasts and elite athletes, particularly those involved in endurance exercise, have a much greater requirement for magnesium than non-athletes owing to the mineral's key role in muscle contraction. To perform optimally, these individuals are often dependent on supplementary (and dermally applied) magnesium to maintain levels and avoid cramps. In contrast to the inappropriate remarks made by Prof Dr Dr Alfonso Lampen, Head of Food Safety for the BfR, in the BfR video on magnesium, endurance athletes cannot consume the necessary amounts of fruits and vegetables to maintain optimal status, and certainly not during competition.
Most of the therapeutically valuable forms of magnesium (e.g. citrate, taurate, malate, biglycinate) are bulky ingredients in their supplemental forms, with magnesium levels generally comprising between 12% and 17% of the magnesium salt or chelate. Therefore cheap multivitamin/mineral products available in supermarkets and pharmacies e.g. Centrum, Sanatogen and Seven Seas, typically contain magnesium oxide, nutritionally, one of the least useful forms for delivering magnesium (and one of the forms with the greatest likelihood of causing diarrhoea).
Lowered levels of magnesium creates an increased risk that calcium won’t be adequately buffered, which in turn creates the potential for calcium influx into cells and with it the increase risk of cell death and inflammatory ‘cell danger’ responses. Low grade chronic inflammation is at the heart of all chronic disease.
Circulating magnesium levels are not a good guide for levels of magnesium in body stores. This means a lot of the research that BfR has used to study intake and serum levels is unreliable, with clinicians often having a very different view of magnesium requirements for different individuals as compared with researchers with no clinical experience.
Magnesium deficiency is a major source of preventable disease, especially coronary heart disease. A recently published meta-analysis from China confirms the well-known inverse association between incidence of coronary heart disease, hypertension and even type 2 diabetes and magnesium status.
Table 4. Magnesium levels in common supermarket/pharmacy multis, manufactured and distributed by Pharma companies
The key take-homes?
Don’t be frightened off taking supplemental magnesium, especially if your diet isn’t chock full of plant foods, which include plenty of dark green leafy vegetables
Do take your magnesium supplements alongside food and if you want to take more than 250 mg, do so in divided doses (at least 3 hours apart)