Dr Durrant-Peatfield has had a special interest in thyroid problems for over 20 years, which culminated in his recent book The Great Thyroid Scandal and How to Survive it (see: Reviews). He lectures widely and is about to return to private practice after retiring some years ago. For details of his lectures and publications, see www.baronsdownpublishing.com .

When most people think of magnesium they probably think of fireworks, but in fact the element is quite extraordinary and crucially important for the proper working of the body. Even so, the average person may have no more than 1 or 2 oz of it at best in their entire body. Half of this amount is within the bones (magnesium supports bone mineralization); much of the remainder is in the soft tissues and only one percent in the blood itself. As with calcium, magnesium in the bones acts as a reservoir for use in times of need. It is widely available in our food resources, such as nuts, legumes, whole grains, green vegetables, seafood and chocolate (although no one food contains very much).

In 1977 the National Academy of Sciences (NAS) stated that 80 percent of people in the USA were deficient in magnesium and predicted a death rate of over 3 million in the next 21 years from this cause alone. (As a result, the FDA was charged, in a Californian lawsuit, with ‘genocide’ in 1998 for failing to prevent this epidemic of deficiency.) In 1997 the NAS, in a follow-up study, confirmed that most Americans are magnesium-deficient.

The problem is likely to be over-processing of foodstuffs and the excessive consumption of fizzy drinks that contain phosphates, which compete with magnesium for absorption. Another cause of deficiency is an excess fitness regime. Quite simply, too much can be lost in body sweat and unreasonable exhaustion should ring a warning bell, as the British Olympic Paula Radcliffe discovered when she was forced to take magnesium injections (Times, January 21).

Malabsorption will also occur as a result of bowel surgery and excessive kidney loss from diuretics or alcohol are further causes. Diabetes mellitus, with its increased kidney excretion, may also prove a source of loss, which is worsened by the transport of magnesium into the tissues by insulin.

It is generally reckoned that we need 300 - 400 mg per day, although 450 mg per day is a better target. The fundamental activity of magnesium resides in the way it is needed for hundreds of enzyme systems. In the production of energy from glucose, through the tricarboxylic cycle, adenosine diphosphate (ADP) is uprated to adenosine triphosphate (ATP) and magnesium catalyses this crucial energy reaction. Magnesium also catalyses synthesis of protein, fat and nucleic acids, together with cellular membrane transport systems.

Its manifold tasks in keeping us alive don’t end there. Together with calcium, magnesium gets involved with muscle contraction – calcium promoting contraction and magnesium inhibiting it. And the two minerals partner blood-clotting in the same way. As an extension of this, both calcium and magnesium have a role to play in the maintenance of blood pressure and the mechanics of breathing. It is also one of the many nutrients supporting the immune system.

This is all pretty important, so that it should come as no surprise that magnesium deficiency does us no good at all. This is particularly true of blood pressure and heart disease; a deficiency is found to be associated with hypertension and an increased risk of heart attack. Its interaction with calcium is thought to play a role in the formation of coronary heart disease and thrombus formation due to increased platelet stickiness.

To become deficient in magnesium requires a chronic lack of input because the kidney is very good at maintaining blood levels by shutting down excretion. So it becomes a matter of concern to osteopaths and naturopaths treating chronic fatigue.

Illnesses will cause magnesium deficiency in their own right. As noted before, one cause of deficiency is alcoholism. It is also associated with diabetes mellitus due to the increased urinary excretion and, as nutritionists at the Harvard School of Public Health drew attention to in a study (1), a significant increase in the risk of type II diabetes where there was an initial low intake of magnesium. It also impairs the secretion of parathyroid hormone and causes impairment of liver function as it progresses on to cirrhosis.

Problems to be expected from deficiency include a general fatigue and muscle weakness, with consequent aching in muscles and joints. The effect may be to cause muscle cramps and spasm, and this may be seen in hypertension particularly; and by the same token will affect heart muscle relaxation, causing arrhythmias. Other effects will be personality change, effects on the central nervous system, especially lack of coordination and an effect on gut motility. It has also been linked to diabetic retinopathy.

A study in 1994 (2) suggested that magnesium deficiency was associated with fibromyalgia, especially combined with selenium and thiamine deficiency. This was supported by a Belgian study in 1997 (3), which showed half of their chronic fatigue patients were magnesium-deficient.

Magnesium toxicity is not to be expected and is likely only as a result of very excessive intake of magnesium-containing supplements; but the effect on the heart, causing arrhythmias, may be fatal.

The clinical use of magnesium supplements is quite widespread and injections have been used in the treatment of ME/CFS disorders, although reports of its usefulness have been conflicting. A history of excessive exercise and possible dietary insufficiency, together with symptoms of fatigue and muscle weakness, may engender suspicion.

In general, estimation of serum magnesium may be unhelpful. Since it is very inexpensive and really very safe, there is a lot to be said for a trial of treatment. Oral salts are, of course, the easiest, although not very well absorbed. Magnesium chloride, the citrate, the gluconate and the sulphate are most commonly used. Injections weekly for 10 weeks have been used with some benefit being claimed. Since its main indication is in the relief of fatigue disorders it should certainly be thought of – but only in the context of any present thyroid and adrenal insufficiency being reliably treated first.

As a matter of interest, Laylander (4), writing about chronic fatigue, underlined the double effect of fluoride excess and magnesium deficiency on enzyme systems. When we learn that fizz-drinking, poorly fed children in Birmingham, fluoridated 40 years (5), are now developing Type II Diabetes, our anxieties become sharply focused; perhaps we can understand the thinking that led the FDA in America to being accused, through their own negligence, of causing millions of needless deaths. If an informed public anger, mindful of this, would challenge the Medicines and Healthcare Products Regulatory Agency (who claim that fluoride, whether medicine or poison, does not fall within their brief), perhaps the disgraceful science that backs fluoride could be shown up for the fraud that it is.

1. Lopez-Ridaura R, et al. Magnesium Intake and Risk of Type 2 Diabetes in Men and Women. Diabetes Care 2004:27:134-40.
2. Eisinger J, et al. Selenium and magnesium status in fibromyalgia. Magnes Res 1994 Dec; 7(3-4):285-8.
3. Moorkens G, Manuel Y, Keenoy B, et al. Magnesium deficit in a sample of the Belgian population presenting with chronic fatigue. Magnes Res 1997;10:329-37.
4. Laylander JA. A Nutrient/Toxin Interaction Theory of the Etiology and Pathogenesis of Chronic Pain-Fatigue Syndromes, Parts I & II. Journal of Chronic Fatigue Syndrome 1999; 5:67-126.
5. Etisham S, et al. Prevalence of Type II Diabetes in Children in Birmingham. Letter to Ed. BMJ 2001; 322:1428.