By: Dr. Izabella Wentz, Pharm D. \ June 6, 2016
The year was 2003, and I was in my second year of pharmacy school. A few years had passed since my undergraduate bout with the Epstein-Barr Virus (the virus that causes Mono and potential trigger for Hashimoto’s), but I was still very fatigued. In addition, I had horrible menstrual cramps and new onset irritable bowel syndrome (IBS).
One cloudy Sunday afternoon (I was living in Chicago at the time, after all), I was visiting my friend and his family, who were also Polish. I have to tell you something about my culture, whether it’s true for most Polish people or not, the Polish community I grew up in is very superstitious and belief in psychics is a cultural norm.
So it was no surprise to me that my friend’s mom had a psychic over at the house. The psychic was Russian and was able to communicate with my friend’s mom in broken Polish, while my friend’s mom responded in broken Russian (while both Polish and Russian are Slavic languages, contrary to popular belief, they are not mutually intelligible). The language barrier was overlooked, as there was an understanding that Russian psychics were the best kind.
At my friend’s mom’s insistence, the psychic stood over me and began to hum, almost vibrating… After a few minutes, she told me that I had the early signs of a thyroid problem and a heart problem (I had not been diagnosed with either at the time).
Her solution? To take magnesium! She even gave me a bottle of it to take… Being a skeptical scientist, I scoffed at her idea! I mean, after all, I learned that magnesium was used as a laxative during pharmacy school (my IBS predominantly manifested as diarrhea), and none of my doctors said anything about thyroid or heart problems…
I didn’t give her much thought until six years later, when I learned that I had a heart murmur (with a potential mitral valve prolapse) and Hashimoto’s thyroiditis during a physical with my doctor.
I sometimes wonder what would have happened if I had listened to the psychic instead of relying on my Western medical education… And I often wonder how she was able to tell that I had a heart and thyroid problem by just standing over me and humming. After all, I didn’t look sick at the time, like most people with autoimmune disease, I looked just fine.
While I’ll never be able to explain her powers, I can at least try to explain the power and miracle of magnesium with science.
According to the Institute of Functional Medicine, the following symptoms, family history and health conditions are reasons to suspect magnesium deficiency:
- Depression or poor mood
- Irritability or anxiety
- Difficulty focusing
- Family history of autism
- Frequent headaches or migraines
- Family or personal history of diabetes
- Trouble swallowing
- Acid reflux
- Sensitivity to loud noises
- Family history of asthma
- Constipation (fewer than two bowel movements a day)
- Excess stress
- Trouble falling and/or staying asleep
- Muscle twitching
- Premenstrual syndrome
- Leg or hand cramps
- Restless leg syndrome
- Heart flutters, skipped beats, or palpitations
- Family or personal history of kidney stones
- Family or personal history of heart disease or heart failure
- Family or personal history of mitral valve prolapse
- Low intake of kelp, wheat bran or germ, almonds, cashews, buckwheat, or dark-green leafy vegetables
How common is magnesium deficiency?
There are two types of deficiencies that can occur with respect to nutrients. There are overt deficiencies, that can lead to low serum calcium or potassium levels, due to disturbed balance of minerals in the body. This is a serious condition that can present with numbness, muscle contractions/cramps, seizures, personality changes, abnormal heart rhythm and other types of serious reaction. This is relatively rare, as in times of low intake, the kidneys kick in to prevent the excretion of magnesium, holding onto it to prevent this.
There are also subclinical deficiencies, which will not be seen on standard blood tests, but may manifest with the symptoms I listed above.
The recommended daily value of magnesium is 400 mg per day, and most adults eating the Standard American Diet are getting less than 300 mg per day. Populations at increased risk for deficiency include:
- People with Type 2 Diabetes
- People with a history of alcoholism – among other mechanisms, alcohol can double, even quadruple our excretion of magnesium
- People with diarrhea (such as in celiac disease, IBS, Crohn’s)
- People with Crohn’s disease
- Older adults, as their ability to absorb magnesium in the gut is reduced as they age, and their excretion of magnesium through the kidney increases
- People taking certain medications that can result in a magnesium depletion, the most common ones are proton pump inhibitors like Nexium, Prilosec, Omeprazole, Protonix
- People with hypothyroidism – yes, a lack of thyroid hormones can lead to low magnesium levels
- Americans! In 2009, the World Health Organization released a report that stated up to 75% of Americans were not receiving adequate amounts of magnesium!
Food sources of magnesium include: green leafy veggies (like spinach and kale), whole grains, nuts, beans, legumes and seeds. Some processed foods like breakfast cereals may also be fortified with magnesium. As we know, excluding grains and processed foods is often beneficial for people with Hashimoto’s, some people with Hashimoto’s may inadvertently become deficient. If they are following a diet like the autoimmune Paleo diet, which excludes nuts, seeds, beans and legumes, their risk of deficiency will go up even more.
Of course green leafy vegetables are an appropriate option for most people with Hashimoto’s. (If you are concerned about goitrogens, please read my Thyroid Food Myth Post.) However, it’s not always realistic to eat enough of them… One-half cup of boiled spinach will provide us with just 20% of the recommended daily allowance of magnesium.
Caffeine, stress, and toxins like fluoride and alcohol, are everyday things that can deplete us of magnesium…
A Client Story
A few years ago, I started working with a new client who was taking 12 different supplements from an alternative medicine doctor. Some were antimicrobial agents used for killing gut pathogens, some were herbs and nutrients to support her liver and adrenals… In theory, the protocol she was on was aligned with my teachings…supporting the gut, liver and adrenals…
However, the protocol and practitioner didn’t consider her bio-individuality or her unique root causes. Furthermore, the practitioner gave her every protocol at once, not paying attention to how the different herbs could interact with one another within a body that was compromised. Her practitioner gave her everything but the kitchen sink – she was spending thousands of dollars each month and still feeling like crap!
When we had our consult, her biggest complaints/priorities were: migraines, constipation, and insomnia. I always ask people what their top 3 priorities are so we can address them right away.
She also complained about sensitivity to loud noises and anxiety. To me, this was a clear case of magnesium deficiency, potentially exacerbated by all of the supplements she was on…
I went through my magnesium questionnaire with her and she turned out high risk for magnesium deficiency.
I reviewed her list of supplements and had her stop all twelve of them and recommended just one supplement….
Magnesium citrate; 1-2 at bedtime…
At our follow up appointment, she reported that her migraines, constipation and insomnia were GONE! She no longer needed to take NSAIDs, laxatives or sleep medications and was able to tolerate her teenager’s music (music had previously aggravated her).
My Own Magnesium Story, continued…
This past winter, I had first-hand experience with my own bout of magnesium deficiency. After a period of stress – I relapse on caffeine when I’m stressed – and a few rounds of chelation (I thought that it would be a good idea for preparing my body for pregnancy – more about why this wasn’t the best idea some other time…), my husband and I decided to take a vacation in the Dominican Republic.
My stress was exacerbated by a couple of delayed flights and a long drive to our hotel from the airport. A day or so after we landed, I ended up with horrible menstrual cramps with diarrhea! The prostaglandins that are responsible for period cramps due to uterine contractions also cause contractions of the bowels, leading to stomach cramps and diarrhea – not pleasant.
I had to spend almost a half day in bed, feeling weak, pale and tired! I hadn’t experienced this issue for many years and ended up having to take Ibuprofen as a rescue remedy…
Ibuprofen at 200-400mg every 6-8 hours starting 24 hours before the anticipated menstrual period is a recommendation I commonly made to my patients to prevent menstrual cramps, and 200-400mg every 6-8 hours during acute cramps to treat them, when I was working as a community & consulting pharmacist.
Ibuprofen can be very helpful in relieving menstrual cramps because it reduces pain and prostaglandin activity. This can make life with painful periods manageable and has saved me in the past many times!
While Ibuprofen is fine for most people at small doses for occasional situations, long term and high doses can lead to ulcers and leaky gut, and I try to only use it when I feel it is necessary and there are no safer alternatives. As you guys know, I’m a big proponent of self-care and self-kindness, and so if the need arises, I will take it to make myself feel better, but I’m always looking for safer alternatives that could work as well.
I wasn’t sure if the episode I had in the Dominican Republic was food poisoning or menstrual cramps, because I hadn’t had them for a long time, and I took some food poisoning protocols to be safe. But when I got back into town in January, the menstrual cramps happened once more and I decided it was time to do something about them!
I didn’t have any other symptoms of magnesium deficiency, but decided to take some magnesium anyway, as I realized that the stress + chelation combination likely depleted more magnesium than I thought. Magnesium deficiency can increase prostaglandin production, and I thought it was worth a try.
I began to take the magnesium at bedtime a few weeks before my next period (prevention works best). Lo and behold, my cramps went from a 10/10 on a pain scale to barely there on my next period. I’d give them a 1/10! Taking an additional 2 doses of magnesium throughout the day made that a 0.1/10. No more Ibuprofen – I can now save it for other occasions. 🙂
MORE GOOD NEWS about Magnesium and the THYROID
Roy and Helga Moncayo, two Austrian researchers, have been working with people with autoimmune thyroid disease since 2007. In their initial interventions, they noticed that thyroid patients had low selenium and began to supplement them that way. Selenium, did not lead to lasting results. They continued to dig deeper and found that Magnesium deficiency correlated to many thyroid symptoms.
They report that physical and psychological stress led to the depletion of magnesium, which is needed for iodine utilization by the thyroid gland.
They tracked thyroid function, thyroid appearance on ultrasound and thyroid symptoms.
Eleven patients with an elevated TSH (range of 2.3 – 21, average 7.67), received magnesium citrate for 6 weeks. Every patient had a drop in TSH (resulting range was 1.6 – 4). The average drop was by 5 points, resulting in an average TSH of 2.67 after the treatment! The highest drop was from a TSH of 21 to a TSH of 4!
In addition to the magnesium citrate, these clinicians also use Selenium (Pure Encapsulations 200 mcg) and Coenzyme Q10 (Pure Encapsulations 120 mg) with their patients, as well as manage their psychological stress and physical alignment.
You may also be interested in my post on Selenium.
Patients reported feeling better, having more energy, better sleep, less anxiety and less constipation.
Additionally, the researchers also reported a normalization on some of the patients’ thyroid ultrasounds (patients with Hashimoto’s initially presented increased appearance of veins and damage to the thyroid on their initial ultrasound). They cautioned that not everyone’s thyroid tissue will normalize, and that at least 8 months of supplementation with magnesium is needed to see improvement on thyroid gland. However I think it’s worth a try, especially if magnesium will help people with symptoms.
Uses of Magnesium
Earlier in this article, I alluded to the fact that magnesium is used as a laxative. This is only true for certain salts of magnesium. Specifically, for people with Hashimoto’s and constipation, I recommendMagnesium Citrate.
For people with normal bowel function or who tend towards diarrhea, I recommend Magnesium Glycinate. This type of magnesium has been shown to relieve magnesium deficiency on blood tests.
How to Use Magnesium
While I always recommend the Root Cause approach – figuring out the main reason your body is out of balance and leading you to experience symptoms (such as, why is your magnesium deficient in the first place? Do you lead a life that is too stressful? Are you taking on too many responsibilities, because your childhood traumas have led you to believe that you are not enough? Do you not eat enough leafy greens?), I am also a fan of Orthomolecular medicine. I was first exposed to Orthomolecular medicine during my 4th year in pharmacy school, during my clinical rotations. I was an intern at the Pfeiffer Treatment Center led by Dr. William Walsh. The center often used high doses of vitamins and minerals to address symptoms of biochemical imbalances that manifested as mood disorders. This was a fascinating experience for me and I learned so much, getting to see how the right nutrients could help people feel better. While I’m always looking for root causes, I love to utilize Orthomolecular principles in combination to help people meet their health goals and feel better fast!
Magnesium is one of the tools in my toolbox to address my client’s symptoms:
- For constipation: Take 1-2 capsules of magnesium citrate at bedtime. The magnesium citrate salt acts as a gentle laxative. If you are still constipated, increase your dose. If your bowel movements become too loose, cut back on your dose. You should also explore gut issues, including SIBO, parasites, and food sensitivities.
- For insomnia: I like to recommend Epson salt baths at bedtime (1 cup of salts per tub – follow package instructions, don’t overdo it!), and either magnesium citrate or magnesium glycinate.
- For period cramps: Prevention is key for period cramps, so if you tend towards period cramps, start magnesium ASAP. You can do either magnesium citrate or magnesium glycinate. This should help your cramps right away! If you are having acute cramps, you can also take magnesium as needed, 1-4 per day – this will relieve your pain as quickly as Ibuprofen, without the side effects… If you find that your periods are still painful, that may be a sign that you will need more time on magnesium to replete your stores and that you should work on your adrenals, which can lead to menstrual issues when impaired..You can combine magnesium with Ibuprofen for period cramps in that case. Your ultimate goal, of course, is to get off the Ibuprofen and save it for emergencies only. 🙂 I’ve also found hot water bottles or socks filled with rice, microwaved for 2 minutes and placed over the stomach, to be really helpful in acute situations. If you are a techy-nerdy-biohacker like me, you can also pre-order a new gadget called “Livia” for period cramps! It is a device worn under your clothes and uses low power frequencies on your tummy to reduce cramping.
- For body cramps: Increasing your magnesium stores will prevent cramps, so if you have intermittent cramps now, you should start magnesium preventatively. You can do either magnesium citrate or magnesium glycinate. If you are having acute cramps, you can also take magnesium as needed, 1-4 per day (magnesium glycinate is less likely to cause diarrhea, as well as soak in Epson salt baths – they are so soothing and a wonderful tool for your self-care routine 🙂 ).If you find that you are still cramping, that may be a sign that you will need more time on magnesium to replete your stores, or that you have other nutrient deficiencies or food sensitivities. You can combine magnesium with pain medications as you work your way off them. In most cases, taking magnesium with pain medications at the same time should be fine, though I’d recommend checking with your pharmacist first, as magnesium can prevent the absorption of some medications.
- For anxiety: Anxiety is not fun. I’ve been there and done it! Magnesium deficiency can contribute to anxiety, and I recommend replenishing your magnesium stores to reduce anxiety. The citrate salt of magnesium (as in magnesium citrate) is the most common ingredient in formulations of “calming” supplements that feature magnesium, though I’m not 100% convinced that it is the required salt. For acute bouts of anxiety, a faster acting magnesium in liquid form may work best. Other reasons for anxiety that should be explored include blood sugar imbalances, Selenium deficiency, adrenal dysfunction and gut issues.
- For headaches: Prevention is key for migraines and headaches as well, so start magnesium ASAP. You can do either magnesium citrate or magnesium glycinate. If you are having acute headaches, you can also take magnesium as needed, 1-4 per day (magnesium glycinate is less likely to cause diarrhea) as this will reduce your headaches without the side effects… If you find that you are still getting headaches/migraines, that may be a sign that you will need more time on magnesium to replete your stores, or that you may have reactive foods, or infections like H. Pylori, that can contribute. You can combine magnesium with pain medications in most cases, though I’d recommend checking with your pharmacist first, as magnesium can prevent the absorption of some medications.
Magnesium and Thyroid Meds
Magnesium can impair the absorption of thyroid medications, so please space out magnesium by 4 hours from your thyroid medications. For most conditions, I generally recommend taking magnesium at bedtime.
I’d like to share some additional resources for you to help you overcome your health challenges. I know that some people prefer book learning, while others enjoy courses, so I am including both options here for you. I spent over $100,000 to get my PharmD degree. I learned so much and now have wonderful credentials from my formal education, but I’ve also learned so much since then that is NOT taught at universities!
I feel so blessed to be a part of the digital age where we can learn from the experience of others on how to recover our health for a fraction of the cost of a basic class at a community college!
- My book, Hashimoto’s the Root Cause is a guide you can use. My Hacking Hashimoto’s program has assessments for 16 different root causes, (like the one for magnesium deficiency above), to help you determine your root cause triggers and learn about the most helpful interventions for the many symptoms related to autoimmune thyroid disease, based on your unique symptoms and history.
- The Period Repair Manual: If you’re looking for a book on getting your period on track, this book is a wonderful tool. I don’t know the author, but hope I can meet her one day to shake her hand and thank her for her work!
- No Grain No Pain: My friend Dr. Peter Osborne’s brilliant book on pain.
- The Food Anxiety Solution: My good friend and phenomenal nutritionist Trudy Scott wrote this excellent book.
- Headache Free: My fellow pharmacist and friend Suzy Cohen wrote this groundbreaking book.
Have you tried magnesium? How has it helped? What are some additional things you’ve tried for the above listed conditions?
PJFL Recomends Your Thyroid Pharmacist, Dr. Izabella Wentz, Pharm D.
- Lundberg, MD, G. Magnesium Deficiency: The Real Emperor of All Maladies?. Medscape. 2015. Available at: http://www.medscape.com/viewarticle/844214.
- Abbas A, Sakr H. Effect of magnesium sulfate and thyroxine on inflammatory markers in a rat model of hypothyroidism. Can J Physiol Pharmacol. 2016;94(4):426-32. doi:10.1139/cjpp-2015-0247.
- Moncayo R, Moncayo H. The WOMED model of benign thyroid disease: Acquired magnesium deficiency due to physical and psychological stressors relates to dysfunction of oxidative phosphorylation. BBA Clin. 2014;12(3):44-64. doi:10.1016/j.bbacli.2014.11.002.
- Cinar V. The effects of magnesium supplementation on thyroid hormones of sedentars and Tae-Kwon-Do sportsperson at resting and exhaustion. Neuro Endocrinol Lett. 2007;28(5):708-12. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17984925.
- Baydas B, Karagos S, Meral I. Effects of oral zinc and magnesium supplementation on serum thyroid hormone and lipid levels in experimentally induced diabetic rats. Biol Trace Elem Res. 2002;88(3):247-53. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12350134.
- Kawicka A, Regulska-Ilow B, Regulska-Ilow B. Metabolic disorders and nutritional status in autoimmune thyroid diseases. Postepy Hig Med Dosw (Online). 2015;69(2):80-90. doi:10.5604/17322693.1136383.
- Magnesium: Fact Sheet for Professionals. National Institutes of Health: Office of Dietary Supplements. 2016. Available at: https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/.
- Calcium And Magnesium In Drinking Water: Public Health Significance. Geneva: World Health Organization Press; 2009. Available at: http://apps.who.int/iris/bitstream/10665/43836/1/9789241563550_eng.pdf.
- Soma M. Effects of low magnesium diet on the vascular prostaglandin and fatty acid metabolism in rats. Prostaglandins. 1988;36(4):431-41. Available at: http://www.ncbi.nlm.nih.gov/pubmed/3238000.
- Moncayo R, Moncayo H. Exploring the aspect of psychosomatics in hypothyroidism: The WOMED model of body–mind interactions based on musculoskeletal changes, psychological stressors, and low levels of magnesium. Woman – Psychosomatic Gynaecology and Obstetrics. 2014;1:1-11. doi:10.1016/j.woman.2014.02.001.
- Moncayo R, Moncayo H. The WOMED model of benign thyroid disease: Acquired magnesium deficiency due to physical and psychological stressors relates to dysfunction of oxidative phosphorylation. BBA Clin. 2015;3:44-64. doi:10.1016/j.bbacli.2014.11.002.
- Moncayo R, Moncayo H. Proof of concept of the WOMED model of benign thyroid disease: Restitution of thyroid morphology after correction of physical and psychological stressors and magnesium supplementation. BBA Clin. 2015;3:113-122. doi:10.1016/j.bbacli.2014.12.005.
PJFL Recommends Dr.Izebella Wentz