A few years ago, I started working with a new client who was taking twelve different supplements from an alternative medicine doctor. Some were antimicrobial agents used for killing gut pathogens; some were herbs and nutrients meant 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 did not consider her bio-individuality, nor her unique root causes. Furthermore, the practitioner gave her every protocol at once, without paying attention to how the different herbs could interact with one another in a body that was compromised. Her practitioner gave her everything but the kitchen sink – she was spending thousands of dollars each month, and still couldn’t find relief from her symptoms!
Her top complaints were migraines, constipation, insomnia, sensitivity to loud noises, and anxiety. I went through my magnesium questionnaire with her, and she turned out to be at high risk for magnesium deficiency. I reviewed her list of supplements, had her stop all twelve of them, and recommended just one supplement – magnesium citrate – at bedtime. Constipation is a red flag for me for magnesium deficiency, and actually a contraindication for taking supplements intended for detox and/or killing pathogens. When we are constipated, we don’t clear out toxins, they just get reabsorbed.
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. 🙂
In this article, I’d like to dive a little deeper into the many benefits of magnesium for those with Hashimoto’s, including:
- How the body uses magnesium
- The magnesium and thyroid connection
- Causes and symptoms of magnesium deficiency
- Conventional and natural treatment options
What is Magnesium?
Magnesium is a mineral that is essential for human function. It is required for more than 300 biochemical reactions in the body, including: maintaining nerve and muscle function, supporting a healthy immune system, and keeping the heartbeat steady. Magnesium also helps create strong bones, steadies blood glucose levels, and aids in energy production.
The average adult body contains approximately 25 g of magnesium, with 50-60 percent in the bones, and most of the rest found in soft tissues.
Magnesium is naturally present in a variety of foods, is often added to food products, is readily available as a dietary supplement, and is found in some medicines (such as antacids and laxatives).
Magnesium and the Thyroid
While magnesium is critical to the healthy functioning of all individuals, I have found that it is one of the most important, and oftentimes deficient, nutrients for those with Hashimoto’s.
Most people with Hashimoto’s have numerous micronutrient deficiencies, which can occur as a result of eating nutrient-poor foods, having inflammation from infections or food sensitivities, taking certain medications, or having an imbalance of gut bacteria. Factors like low stomach acid, fat malabsorption, and a deficiency in digestive enzymes, which are common in those with Hashimoto’s, will result in many people not being able to break down and absorb the nutrients from the food they eat. A lack of sufficient thyroid hormones can also lead to nutrient deficiencies, as it makes nutrient extraction from food more difficult and less efficient.
Magnesium is crucial for liver health, and I include it as part of my liver detox protocol that I recommend as a key first step toward healing for those with Hashimoto’s. Furthermore, magnesium helps support adrenal function — another area that is often compromised for those with thyroid dysfunction.
Not only will a deficiency in magnesium lead to a whole host of symptoms, which I will explore in more detail below, but research has shown that it can also have a direct impact on thyroid function.
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 address this with supplementation. However, supplementing with only selenium did not lead to lasting results. They continued to dig deeper and found that magnesium deficiency correlated to many thyroid symptoms.
They reported that physical and psychological stress led to the depletion of magnesium, which is needed for iodine utilization by the thyroid gland.
Eleven patients with an elevated TSH (range of 2.3 – 21 mIU/L, average 7.67 mIU/L), received magnesium citrate for 6 weeks. Every patient had a drop in TSH (resulting range was 1.6 – 4 mIU/L). The average drop was by 5 points, resulting in an average TSH of 2.67 mIU/L after treatment! The highest drop was from a TSH of 21 mIU/L to a TSH of 4 mIU/L!
Patients reported feeling better, having more energy as well as better sleep, less anxiety and less constipation, after starting magnesium supplementation.
Additionally, the researchers 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 eight months of supplementation with magnesium is needed to see improvement on the thyroid gland. (However, I think it’s worth a try, especially since magnesium can help many symptoms that are common in Hashimoto’s.)
How Common Is Magnesium Deficiency?
There are two types of deficiencies that can occur with respect to nutrients. There are overt deficiencies, which can lead to low calcium or potassium levels, due to a 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 rhythms, and other types of serious reactions. This is relatively rare, as, in times of low intake, the kidneys kick in to prevent the excretion of magnesium, holding onto its current magnesium stores to prevent this.
There are also subclinical deficiencies, which will not be seen on standard blood tests but may, nonetheless, manifest with symptoms.
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
- 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
I’d like to add that joint pain, leg cramps, menstrual cramps, and thyroid disorders are always a reason to suspect magnesium deficiency, from my experience.
Testing for Magnesium Deficiency
I generally don’t test people for magnesium deficiency, as not all tests are reliable and my experience has shown that most people with Hashimoto’s are deficient in magnesium. Additionally, it is generally safe to take without testing. If any of the symptoms above apply to you, supplementing with magnesium is usually recommended.
It’s important to note that if you are currently using other medications, such as those used to regulate blood pressure, you should check with your pharmacist before supplementing with magnesium, as it can interfere with the absorption of some medications.
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, or even quadruple, our excretion of magnesium
- People with diarrhea
- People with gut conditions such as celiac disease, IBS, and Crohn’s
- Older adults (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 being proton pump inhibitors (Nexium, Prilosec, Omeprazole, Protonix), female hormones (oral contraceptives and hormone replacement therapy), and antibiotics
- People with hypothyroidism – a lack of thyroid hormones can lead to low magnesium levels
- Americans (in 2009, the World Health Organization released a report stating that up to 75 percent of Americans were not receiving adequate amounts of magnesium!)
- People on certain diets, such as Paleo (or Autoimmune Paleo) diets, that eliminate food sources of magnesium (grains, processed foods, nuts, seeds, beans, and legumes)
Food Sources 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.
Ideally, we would obtain all of the magnesium we need from our diet. However, this might not be realistic for most people. Not only are many of our food sources deficient in nutrients, due to modern farming practices, but many people with Hashimoto’s may exclude a number of these foods if they are following a Paleo diet (or other type of elimination diet).
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 percent of the recommended daily allowance of magnesium.
For this reason, I recommend that most people supplement with magnesium.
How to Supplement with Magnesium
I always recommend starting with the Root Cause approach – figuring out the main reason your body is out of balance and leading you to experience symptoms. Ask yourself:
- 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?
- Do you not eat enough leafy greens?
However, I am also a fan of Orthomolecular medicine – using nutritional supplementation to maintain health. I was first exposed to Orthomolecular medicine during the clinical rotations of my fourth year in pharmacy school. 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 with other interventions, to help people meet their health goals and feel better fast!
For this reason, magnesium is one of the tools in my toolbox to address my client’s symptoms:
- For constipation: Constipation is a red flag for magnesium deficiency. I recommend taking 1-2 capsules of magnesium citrate at bedtime. The magnesium citrate salt works like a gentle laxative. If you are still constipated, increase your dose gradually by one capsule per evening. If your bowel movements become too loose, cut back on your dose. You may also want to explore gut issues that may be a trigger, including SIBO, parasites, and food sensitivities.
- For insomnia: I like to recommend Epsom salt baths at bedtime (1 cup of salts per tub – follow package instructions, and don’t overdo it!), and either magnesium citrate or magnesium glycinate. Please watch how the magnesium makes you feel. Some people report much better sleep with the citrate version of magnesium, while others report worse sleep. Same goes with the glycinate version. You may have to try a few different kinds to see which works best for sleep, but generally, I would recommend starting with the citrate version.
- For period cramps: Did you know? Magnesium deficiency can increase prostaglandin production, which is associated with painful menstrual cramps. Prevention is key for period cramps, so if this is an issue for you, I recommend starting a magnesium supplement immediately. Either magnesium citrate or magnesium glycinate can work to relieve your cramps right away! If you are having acute cramps, you can also take magnesium as needed, 1-4 times per day – this will relieve your pain as quickly as ibuprofen, without the side effects. Generally, women who take magnesium for one month will say their cramps are reduced by 80-90 percent the first period after starting magnesium, and almost completely gone within two months. If you find that your periods are still painful, that may be a sign that you will need more time with magnesium to replete your stores, and that you should work on your adrenals, which can lead to menstrual issues when impaired. In such cases, you can combine magnesium with ibuprofen for period cramps. However, your ultimate goal, of course, is to get off the ibuprofen and save it for emergencies only.
- For body cramps: Increasing your magnesium stores will prevent cramps, so if you have intermittent cramps now, you should start taking magnesium preventatively. You can take either magnesium citrate or magnesium glycinate. Again, if you are having acute cramps, you can also take magnesium as needed, 1-4 times per day (magnesium glycinate is less likely to cause diarrhea), as well as soak in Epsom salt baths – they are so soothing and are 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, though I do recommend checking with your pharmacist first, as magnesium can prevent the absorption of some medications.
- For anxiety: Magnesium deficiency can contribute to anxiety, and I recommend replenishing your magnesium stores to reduce symptoms. The citrate salt of magnesium (magnesium citrate) is the most common ingredient in formulations of “calming” supplements – though, 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 I recommend starting magnesium immediately if you suffer from either. You can take either magnesium citrate or magnesium glycinate. If you are having acute headaches, you can also take magnesium as needed, 1-4 times per day. If you find that you are still getting headaches/migraines, it may be a sign that you need more time on magnesium to replete your stores, or that you are reacting to foods. You may also have infections, like H. pylori, that can contribute to such food sensitivities. 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.
Forms of Magnesium
There is a long list of different forms of supplemental magnesium, and they each have their own benefits and potential drawbacks.
As mentioned above, certain types of magnesium can be used as a laxative. Specifically, for people with Hashimoto’s and constipation, I recommend Magnesium Citrate Powder by Rootcology. This is also the form that was studied specifically for Hashimoto’s.
Most people will find that the citrate version induces relaxation and can aid in achieving a restful night of sleep. However, a small percentage of people will find that the opposite is true for them, while others may have diarrhea and further “movement” of the bowels that may not be desirable. In such cases, I recommend trying a different form of magnesium.
For people who tend towards diarrhea, I recommend Magnesium Glycinate by Pure Encapsulations. This type of magnesium has been shown to relieve magnesium deficiency on blood tests, but does not loosen stool. However, for some people, magnesium glycinate can worsen anxiety symptoms.
There is a group of people who can’t tolerate magnesium glycinate due to the GAD1 gene variation. While most people convert this form of magnesium into GABA (a relaxing neurotransmitter), those with the gene variation will convert the glycinate to glutamate (an excitatory neurotransmitter that causes anxiety/irritability in excess) and may need to look for a different form of magnesium.
Please note: an inability to break down glutamate can be an indication of B6 deficiency. If you are finding yourself anxious after taking magnesium glycinate, glycine, GABA, glutamate, glutamine and/or bone broth, you may benefit from taking B6 (I prefer the activated, P5P version at 50-100 mg per day, as the pyridoxine B6 version can be toxic above 300 mg). B6 has been shown to help process glutamate in humans and rats. 😉
Other forms of magnesium that may be helpful include:
- Magnesium malate – This form promotes energy and may be effective for those experiencing chronic fatigue or fibromyalgia. For others, it may be too stimulating and cause sleep disruptions, especially if taken late in the day.
- Magnesium taurate – This form reduces cortisol and may lead to stress reduction.
- Magnesium threonate – This form may improve learning and memory functions, as well as be beneficial for those experiencing age-related cognitive decline.
- Magnesium chloride – This form can lower anxiety, reduce pain, and help promote restful sleep. It is also sometimes used topically as an antimicrobial treatment, or to deliver magnesium directly into the bloodstream, which can be beneficial for those with malabsorption issues.
Note: It is important to be aware that magnesium can impair the absorption of thyroid medications, so please space out magnesium from your thyroid medications by four hours. For most conditions, I generally recommend taking magnesium at bedtime. However, you should consult with your practitioner before beginning supplementation.
My Own Magnesium Story
My own introduction to magnesium is a little bit quirky. 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 is a 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. The Polish community I grew up in is very superstitious, and a 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.
At the insistence of my friend’s mom, 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? Take magnesium! She even gave me a bottle of it to take.
Being a skeptical scientist, I scoffed at her idea. After all, I learned that magnesium was used as a laxative during pharmacy school, and none of my doctors said anything about its use for 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.
As part of the protocol to heal myself, I did end up using magnesium… Of course, I ended up using many additional things to recover my health as I share in my book Hashimoto’s: The Root Cause.
Then, a few short years ago, I decided to stop taking magnesium, and was reminded of just how important magnesium really is. After a period of stress, my husband and I decided to take a vacation in the Dominican Republic.
I tend to relapse on caffeine when I’m stressed, and I’d undergone a few rounds of chelation to detox my body (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 stress was further 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, along 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 half a 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.
I didn’t have any other symptoms of magnesium deficiency, but decided to take some magnesium anyway, as I realized that the stress and chelation combination likely depleted more magnesium than I had thought. I knew that magnesium deficiency can increase prostaglandin production (as I mentioned earlier on in this article), so I thought taking a magnesium supplement 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 would’ve rated them a 1/10. Taking an additional two doses of magnesium throughout the day made that a 0.1/10 the next time my menstrual cycle came around. No more ibuprofen was needed after that!
While I’ll never be able to explain the powers of the psychic who “diagnosed” my magnesium deficiency those many years ago, I can at least attest to the power of magnesium!
If you have been suffering from headaches, menstrual cramps, anxiety, muscle aches, constipation, insomnia, or other symptoms that may be linked to magnesium deficiency, I highly recommend trying a quality magnesium supplement. Most Americans, and certainly those with Hashimoto’s, are deficient in this important nutrient, and can benefit greatly from magnesium supplementation.
For more information on my liver and adrenal protocols – both of which use magnesium as a key nutrient – I encourage you to pick up a copy of Hashimoto’s Protocol. The information inside will help guide you through your healing journey, and offer you practical tips on how to use supplements to address your own root causes.
My cookbook, Hashimoto’s Food Pharmacology dives even deeper into nutrition protocols and healing recipes to help you take charge of your thyroid health!
Have you tried magnesium? How has it helped? What are some additional things you’ve tried for the above-listed conditions?
As always, I wish you the very best of health!
P.S. You can also download a free Thyroid Diet Guide, 10 thyroid-friendly recipes, and the Nutrient Depletions and Digestion chapter of my first book for free by subscribing to my weekly newsletter. You will also receive occasional updates about new research, resources, giveaways and helpful information.
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Please Note: Originally Published in May 2016, this article has been updated for accuracy and thoroughness.