Magnesium: A Much-Overlooked Mineral

A Quick Guide

Understanding Testing Limitations and Treatment Options

Why Magnesium Matters

Magnesium is involved in over 300 enzymatic reactions in your body. It affects everything from energy production to heart rhythm, as well as muscle function and mood regulation.^1,2 Despite its critical importance, magnesium deficiency is surprisingly common—affecting anywhere from 10% to 60% of people depending on the population studied—yet it often goes undetected.^3,4

I (PMJ Magovern) was educated about magnesium-related problems by Sid Baker MD who is based in Sag Harbor, New York. Sid, who was Yale Medical School educated, more than once quoted one of his medical teachers, Dr. Edgar Millar: In 1959 when Sid was then working with the Peace Corps in Nepal, Dr. Millar would ask Dr. Baker: “Have we done everything we can for this patient?” Dr. Baker is the most inspiring medical teacher I have encountered in fifty-one years as student and doctor.

I was living in North America at the time. Sid, who is board-certified in both obstetrics and pediatrics, educated and enthused a whole generation of MDs about functional medicine over decades and, in addition, was a total delight as a human.

This guide explains why standard laboratory tests frequently miss magnesium deficiency and explores treatment options that may be more effective for certain individuals.

Signs You Might Be Low in Magnesium

Magnesium deficiency manifests in remarkably diverse ways, affecting multiple body systems.^5,6 Common signs include:

• Muscle-related: Cramps, twitches, spasms, weakness, restless sensations, morning muscle stiffness, the need to sigh frequently, Matchbox chest (a sensation that the person’s chest is too small for their lungs). Tight chest and shoulders, tightness between the shoulder blades. Muscle cramps, particularly at night. There also may be abdominal pain. Particularly over my long career I have met patients who have severe upper abdominal pain below the ribs – because of tight muscles ‘pulling’ on the lower border of the ribs. Also, I can recall a middle-aged gent who described severe, “burning” pain between the shoulder blades which he had taken from doctor to doctor including at least one neurologist. An intravenous infusion containing magnesium provided dramatic relief.^6,7
• Energy and mood: Fatigue, difficulty concentrating, low mood, anxiety, sleep difficulties.^8,9
• Cardiovascular: Heart palpitations, irregular heartbeat, elevated blood pressure.^10,11
• Neurological: Headaches, migraines, tingling or numbness in extremities.¹²
• Metabolic: Blood sugar regulation challenges, especially in those with diabetes.^13,14

The challenge is that these symptoms are often subtle and nonspecific. Magnesium deficiency is very easy to overlook, especially when laboratory testing appears normal and may take patients anywhere in the medical ‘silo’ system.¹⁵

The Critical Problem with Standard Lab Testing

Where Magnesium Actually Lives in Your Body

99% of your body’s magnesium is inside your cells—stored in bones, muscles, and soft tissues. Less than 1% circulates in your bloodstream.¹⁶ Yet standard blood tests only measure that tiny 1% in your serum. I have met hundreds of patients who benefited from magnesium supplementation who said, “the doctor in the hospital told me my magnesium levels were fine.”

Why This Creates a False Sense of Security

Your body is remarkably efficient at maintaining serum magnesium levels within a narrow range. When magnesium stores become depleted, your body will pull magnesium from cells, bones, and tissues to keep blood levels appearing normal.^5,15 This means:

• You can have severely depleted cellular magnesium while your blood test shows ‘normal’ levels.¹⁴
• Symptoms typically don’t appear until the deficiency is quite advanced.¹⁵
• The conventional cutoff of 0.75 mmol/L may be too low—some researchers now suggest 0.85 mmol/L as optimal.^13,14

Studies have consistently shown that people with normal serum magnesium can still be magnesium deficient at the tissue level. This is particularly common in individuals with hypertension, metabolic syndrome, or diabetes.^13,14

Better Assessment Approaches

• Ionized magnesium testing measures the active form of magnesium rather than total magnesium.⁴
• Red blood cell magnesium may better reflect intracellular status than serum testing.
• Magnesium Depletion Score considers multiple risk factors beyond blood levels alone.¹⁷
• Clinical assessment evaluating symptoms, risk factors, and response to supplementation.

Why Oral Supplementation May Not Be Enough

Think about an individual’s magnesium status as being affected by three factors: 1. magnesium absorption (magnesium in), 2. the amount of magnesium used up in the body in biochemical processes, and 3. any underlying tendency the individual may have to ‘lose’ magnesium. Some people are ‘magnesium-losers’.

Limited Absorption

Even in healthy individuals, only 30-40% of oral magnesium is typically absorbed through the digestive tract.¹⁸ Absorption can be significantly further reduced by:

• Gastrointestinal disorders (Crohn’s disease, celiac disease, chronic diarrhea).¹⁵
• Long-term use of proton pump inhibitors (common heartburn medications).¹⁹
• Certain antibiotics and other medications.¹⁹
• Age-related changes in absorption efficiency.²⁰
• Low stomach acid.

Increased Losses

• Diuretics (water pills for blood pressure) increase urinary magnesium loss.¹⁵
• Alcohol consumption affects both absorption and increases excretion.⁵
• Some chemotherapy drugs and immunosuppressants deplete magnesium.¹⁹
• Diabetes and insulin resistance can increase urinary magnesium loss.¹³

Digestive Side Effects

Many forms of oral magnesium cause digestive upset, diarrhea, or laxative effects, limiting the dose that can be tolerated and further reducing effective absorption.²¹

The Advantages of Intravenous Magnesium Therapy

Direct Delivery, Complete Absorption

IV administration bypasses the digestive system entirely, allowing magnesium to go directly into your bloodstream and then into your cells. This means 100% bioavailability compared to the 30-40% (or less) from oral supplementation.

Rapid Replenishment

IV magnesium can restore cellular levels much more quickly than oral supplementation. Clinical experience shows that some individuals usually experience relief from acute symptoms—such as severe migraines or muscle spasms—within minutes to hours rather than days or weeks.^12,22

No Digestive Side Effects

Since IV magnesium doesn’t pass through the digestive system, it avoids the laxative effects and digestive discomfort that limit oral supplementation for many people.

The Myers’ Cocktail Approach

What’s in the Myers’ Cocktail?

• Magnesium (usually magnesium chloride) as the cornerstone
• Vitamin C for immune support and antioxidant effects
• B-complex vitamins (B12, B6, B5) for energy production and metabolism
• Calcium to support multiple physiological functions
• Other nutrients tailored to individual needs

The Synergistic Rationale

Rather than addressing single nutrient deficiencies, the Myers’ Cocktail recognizes that many health concerns involve multiple nutritional factors. The combination is considered to work synergistically—meaning nutrients work together more effectively than they would individually.²³

Reported Clinical Applications

• Chronic fatigue and low energy states
• Acute migraine attacks¹²
• Fibromyalgia symptoms (muscle pain, fatigue)²⁵
• Seasonal allergy symptoms
• Muscle spasms and tension²⁴
• Recovery support during high-stress periods
• General nutritional optimization

Research on the Myers’ Cocktail remains limited compared to studies of individual nutrients. A pilot study on fibromyalgia suggested that much of the benefit may come from the magnesium component, which is known to be deficient in many people with this condition.²⁵ While clinical observations have been positive, larger controlled studies are needed to definitively establish efficacy for specific conditions.²⁶

Safety and Considerations

When administered by qualified healthcare professionals, IV nutrient therapy is usually well-tolerated. Common experiences include a warm or flushing sensation (from the magnesium), typically not unpleasant—it’s very similar to the sensation of having contrast dye for a CT scan. Anxious individuals frequently report that their body has “all loosened up and it feels as though I have had one drink of alcohol”—just feeling slightly relaxed, they may report that their tight chest is looser and that their anxiety has improved.²⁴ If administered too quickly, temporary blood pressure drops can occur, which is why proper administration is important.²⁶

Individuals with kidney disease, heart conditions, or electrolyte imbalances require careful evaluation before receiving IV therapy. A thorough health assessment should always precede treatment and at Drummartin Clinic we always ask patients to attend for a pre-procedure consultation.²⁶

Who Might Benefit from IV Magnesium Therapy?

• Have symptoms of magnesium deficiency despite ‘normal’ blood test results.^13,14
• Experience poor absorption due to digestive disorders.¹⁵
• Cannot tolerate oral magnesium due to digestive side effects.
• Take medications that deplete magnesium or interfere with absorption.^15,19
• Need rapid replenishment for acute symptoms (severe migraines, muscle spasms).¹²
• Have chronic conditions associated with magnesium deficiency (diabetes, hypertension, fibromyalgia).^13,25
• Experience chronic fatigue unresponsive to other interventions.
• Seek comprehensive nutritional support during periods of high stress or demand.

Making Informed Decisions About Magnesium Support

Understanding that standard laboratory testing can miss magnesium deficiency is crucial for anyone experiencing unexplained symptoms that might be related to this essential mineral. If you have muscle cramps, fatigue, mood changes, headaches, or cardiovascular concerns—particularly if standard blood tests show ‘normal’ magnesium—it may be worth exploring more comprehensive assessment approaches.

For some individuals, oral magnesium supplementation (choosing the right form for your needs) may be sufficient. For others—particularly those with absorption challenges, medication interactions, or more significant deficiency—intravenous delivery through focused magnesium infusions or comprehensive formulations like the Myers’ Cocktail may offer advantages.

The key is personalization. Your health history, symptoms, medications, risk factors, and response to initial interventions should all guide the approach that’s right for you.

• ✓ Standard blood tests measure less than 1% of your body’s magnesium and frequently miss deficiency.¹⁶
• ✓ You can have normal blood levels while being significantly deficient at the cellular level.^13,14
• ✓ Oral magnesium absorption is limited (30-40%) and further reduced by many common factors.¹⁸
• ✓ IV magnesium therapy provides 100% bioavailability and bypasses absorption challenges.
• ✓ Myers’ Cocktail combines magnesium with other nutrients for comprehensive support.²³
• ✓ Personalized assessment—not just lab values—should guide treatment decisions.

References

1. Kothari M, Wanjari A, Parepalli A, et al. A Comprehensive Review on Understanding Magnesium Disorders: Pathophysiology, Clinical Manifestations, and Management Strategies. Cureus. 2024;16(9):e68385.
2. Schwalfenberg GK, Genuis SJ. The Importance of Magnesium in Clinical Healthcare. Scientifica (Cairo). 2017;2017:4179326.
3. Healthline. Magnesium Deficiency: Symptoms, Recommendations, and More. Updated December 4, 2024.
4. Radboudumc. Magnesium: forgotten mineral in the spotlight. June 6, 2024.
5. Rude RK. Clinical manifestations of magnesium deficiency. Min Electrolyte Metab. 1998.
6. Gragossian A, Bashir K, Bhutta BS, Friede R. Hypomagnesemia. StatPearls. Updated November 30, 2023.
7. Kothari M, et al. Neuromuscular hyperexcitability in magnesium deficiency. Cureus. 2024;16(9):e68385.
8. Healthline. Association between magnesium supplementation and improved depression. December 4, 2024.
9. Luo X, Tang M, Wei X, Peng Y. Association between magnesium deficiency score and sleep quality in adults. J Affect Disord. 2024;358:105-112.
10. Kothari M, et al. Cardiovascular manifestations of magnesium deficiency. Cureus. 2024;16(9):e68385.
11. Tan MY, Mo CY, Zhao Q. The association between magnesium depletion score and hypertension in US adults. Biol Trace Elem Res. 2024;202:4418-4430.
12. Integrative Medicine Center of Western Colorado. Migraine headaches respond well to IV magnesium infusions. May 10, 2024.
13. Sun Y, Zhang H, et al. Hypomagnesemia: exploring its multifaceted health impacts and associations with blood pressure regulation and metabolic syndrome. Diabetology & Metabolic Syndrome. 2025.
14. Yang J, Cao Y, Zhang H, et al. Association of plasma magnesium with metabolic syndrome. Front Nutr. 2024;11:1346825.
15. Gragossian A, et al. Clinical manifestations and diagnosis of hypomagnesemia. StatPearls. 2023.
16. Musso CG. Magnesium metabolism in health and disease. Int Urol Nephrol. 2009;41(2):357-62.
17. Fan L, Zhu X, Rosanoff A, et al. Magnesium depletion score predicts risk of systemic inflammation. J Nutr. 2021;151(8):2226-35.
18. Sun Y, et al. Magnesium absorption through paracellular pathway. Diabetology & Metabolic Syndrome. 2025.
19. Kothari M, et al. Medications affecting magnesium balance. Cureus. 2024;16(9):e68385.
20. Kothari M, et al. Age-related changes in magnesium metabolism. Cureus. 2024;16(9):e68385.
21. Healthline. Types of Magnesium and Their Benefits. May 11, 2023.
22. Gaby AR. Rapid symptom improvement with IV magnesium. Altern Med Rev. 2002;7(5):389-403.
23. Gaby AR. Intravenous nutrient therapy: the ‘Myers’ cocktail’. Altern Med Rev. 2002;7(5):389-403.
24. Empower Pharmacy. What Is a Myers’ Cocktail IV? April 18, 2024.
25. Katz DL, et al. Intravenous Micronutrient Therapy (Myers’ Cocktail) for Fibromyalgia: A Placebo-Controlled Pilot Study. PMC. 2009.
26. Merck Manual Professional Edition. Intravenous Vitamin Therapy (Myers’ Cocktail). July 8, 2025.