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By Dr. Lee Wang Loong, Chief Medical Officer, BP Healthcare Group

If I asked you to name the most important minerals for your health, you’d probably say calcium or iron. Maybe vitamin D, if you’ve had a blood test recently. But there is one mineral that quietly powers over 300 chemical reactions in your body, and most people have never once thought about whether they’re getting enough of it.

That mineral is magnesium.

As a doctor, I see the effects of magnesium deficiency almost every day in my clinic, often hiding behind complaints that seem unrelated: poor sleep, stubborn muscle cramps, blood sugar that just won’t cooperate. The tricky part? Most people don’t connect the dots, because magnesium deficiency doesn’t show up the way you’d expect.

Let me walk you through what you need to know.

Why Is Magnesium So Important?

Think of magnesium as the behind-the-scenes manager of your body. It doesn’t get the spotlight like calcium or vitamin C, but without it, things start falling apart.

Magnesium is involved in more than 300 enzymatic reactions in your body (Source: Harvard T.H. Chan School of Public Health). That includes some pretty critical jobs:

• Energy production – Every cell in your body needs magnesium to produce energy. Without it, you feel tired for no clear reason.
• Muscle and nerve function – Magnesium helps your muscles contract and relax properly. Too little of it, and your muscles cramp, twitch, or feel constantly tight.
• Blood sugar regulation – Magnesium plays a direct role in how your body handles insulin. It is required for insulin receptors on your cells to function properly. When magnesium is low, insulin doesn’t work as efficiently, which means higher blood sugar levels (Source: Xu L et al., Frontiers in Nutrition, 2023).
• Sleep and relaxation – Magnesium helps regulate neurotransmitters that calm the brain. Specifically, it blocks excitatory NMDA receptors while supporting calming GABA receptors. This is why people with low magnesium often struggle with poor sleep quality.
• Heart rhythm and blood pressure – Your heart is a muscle, and it depends on magnesium to beat steadily and maintain healthy blood pressure.
• Bone health – About 60% of the magnesium in your body is stored in your bones. It works alongside calcium and vitamin D to keep your skeleton strong.

In short, magnesium is not a “nice to have.” It is fundamental to how your body functions on a daily basis.

What Happens When You Don’t Get Enough?

Magnesium deficiency doesn’t usually announce itself with one dramatic symptom. Instead, it tends to show up as a collection of nagging issues that people learn to live with or attribute to stress, aging, or “just getting older.”

Here are the most common signs to watch for:

Poor sleep quality is one of the earliest and most common complaints. You might find it hard to fall asleep, or you wake up frequently during the night and never feel truly rested. A 2025 randomized controlled trial by Schuster J et al. in Nature and Science of Sleep found that magnesium supplementation at 250mg elemental magnesium significantly reduced insomnia severity compared to placebo over four weeks.

Muscle cramps and spasms are another classic sign, especially in the calves or feet. If you’re getting cramps that seem out of proportion to your activity level, low magnesium could be a factor.

Fatigue and low energy that persists even after a full night’s sleep. Since magnesium is essential for cellular energy production, running low leaves you feeling drained.

Migraines and headaches have been associated with magnesium deficiency in multiple studies. Research suggests that magnesium supplementation may help reduce the frequency and severity of migraines (Source: Marek Saric et al., Nutrients, 2025).

Difficulty controlling blood sugar is particularly relevant if you have Type 2 diabetes. A pooled analysis of 24 clinical trials involving 1,325 T2DM patients showed that magnesium supplementation reduced HbA1c by 0.22% and fasting glucose by 0.20 mmol/L (Source: Xu L et al., Frontiers in Nutrition, 2023). These are modest but meaningful improvements, especially as an add-on to existing treatment.

Mood changes such as increased anxiety, irritability, or low mood can also be linked to magnesium levels, though the evidence here is still evolving.

The frustrating reality is that many of these symptoms overlap with other conditions, which is why magnesium deficiency often goes unrecognized.

Why Are So Many People Deficient?

This is where things get interesting, and a little alarming. Global data suggests that roughly 2.4 billion people, or about 31% of the world’s population, fail to meet the recommended magnesium intake levels (Source: International Journal of Vitamin and Nutrition Research, 2025).

There are several converging reasons for this.

Modern Diets Have Changed

Our food supply isn’t what it used to be. Processed and refined foods, which make up an increasing proportion of modern diets, are significantly lower in magnesium compared to whole foods. When grains are refined (white rice instead of brown rice, white bread instead of wholegrain), most of the magnesium is removed along with the bran and germ.

On top of that, modern farming practices and soil depletion mean that even whole foods may contain less magnesium than they did decades ago.

Certain Medications Actively Deplete Magnesium

This is an important point that many patients are not aware of. Several commonly prescribed medications can lower your magnesium levels over time:

• Proton pump inhibitors (PPIs) like omeprazole and esomeprazole, commonly prescribed for gastric reflux and ulcers, reduce magnesium absorption from the gut. Long-term use can lead to progressive, silent depletion. This was significant enough that the FDA issued a safety advisory in 2011 specifically warning about the risk of hypomagnesemia with prolonged PPI use.
• Diuretics (water pills) used for blood pressure management increase magnesium loss through urine.
• Metformin, the most commonly prescribed diabetes medication, has also been associated with lower magnesium levels.

If you’re on any of these medications long-term, you may be losing magnesium faster than your diet can replace it.

Chronic Diseases Create a Vicious Cycle

Type 2 diabetes is a prime example. High blood sugar forces the kidneys to excrete more magnesium in urine. But low magnesium, in turn, impairs insulin receptor function, which makes blood sugar harder to control. It becomes a self-reinforcing cycle. Research shows that low magnesium levels are found in 14 to 48% of patients with Type 2 diabetes, compared with about 2.5 to 15% in the general population (Source: Marek Saric et al., Nutrients, 2025).

Age Matters

As we get older, our bodies naturally absorb less magnesium from food. Combined with the fact that older adults are more likely to be on multiple medications (PPIs, diuretics, diabetes drugs), the risk of deficiency compounds significantly.

The Testing Problem

Here is perhaps the most important thing to understand: routine blood tests are not a reliable way to detect magnesium deficiency.

Only about 1% of your body’s total magnesium is found in the blood. The other 99% is stored inside cells and in bone. This means your blood test can read perfectly “normal” even while your cells are significantly depleted. It is like checking the water level in a bucket by only looking at the surface, while the bottom is nearly empty.

What Can You Do About It?

The good news is that magnesium deficiency is very manageable once you’re aware of it. There are two main approaches, and ideally you’d use both.

1. Eat More Magnesium-Rich Foods

Building your diet around magnesium-rich foods is always a good foundation. Some of the best sources include:

• Dark leafy greens like spinach and kangkung (water spinach) – a single cup of cooked spinach provides roughly 150mg of magnesium
• Nuts and seeds, particularly pumpkin seeds (168mg per 28g serving), almonds, and cashews
• Legumes like black beans, chickpeas, and edamame
• Whole grains such as brown rice, oats, and wholegrain bread
• Dark chocolate (70% cocoa or higher) – yes, this counts!
• Avocados, bananas, and tofu are also good contributors

The recommended daily intake for adults is roughly 310-320mg for women and 400-420mg for men (Source: NIH Office of Dietary Supplements).

The challenge, of course, is consistency. In practice, many people find it difficult to reliably hit these targets through diet alone, especially if they have a busy lifestyle, dietary restrictions, or are already on medications that deplete magnesium faster than normal.

2. Consider Magnesium Supplementation

For patients who are at higher risk of deficiency, or who have symptoms suggestive of low magnesium, supplementation is a practical and effective option.

Not all magnesium supplements are created equal, though. The form matters:

• Magnesium glycinate (bisglycinate) is one of the most well-absorbed forms and is notably gentle on the stomach. The glycine component is itself a calming neurotransmitter, which makes this form particularly well-suited for patients with sleep issues. It is also less likely to cause the diarrhea that some other forms (like magnesium oxide) are known for.
• Magnesium citrate is also well-absorbed but can have a mild laxative effect at higher doses.
• Magnesium oxide contains more elemental magnesium per capsule but has lower bioavailability, meaning your body absorbs less of it.

When choosing a supplement, pay attention to the elemental magnesium content, not just the total compound weight. For example, a capsule labelled “Magnesium Glycinate 400mg” provides approximately 80mg of actual elemental magnesium. This distinction matters when matching your dose to clinical recommendations.

A few practical tips for supplementation:

• Take it with food to maximize absorption and minimize any stomach discomfort
• Separate from certain medications by 2 to 4 hours, including thyroid medications (levothyroxine), antibiotics (quinolones, tetracyclines), bisphosphonates (alendronate), and iron supplements, as magnesium can reduce their absorption
• Be patient – benefits for sleep and muscle function typically become noticeable within 1 to 2 weeks, with full effects assessed at around 4 weeks
• Check with your doctor if you have kidney disease (especially if eGFR is below 30), as impaired kidneys may not be able to clear excess magnesium effectively

Who Should Consider Supplementation?

Based on the current evidence, the following groups stand to benefit most from proactive magnesium supplementation:

• Adults over 60, due to reduced absorption and higher medication use
• Anyone on long-term PPI therapy (omeprazole, esomeprazole, pantoprazole)
• Patients on diuretics for blood pressure management
• People with Type 2 diabetes, particularly those on metformin
• Those experiencing chronic poor sleep, muscle cramps, or recurrent migraines

For most of these individuals, the decision to supplement doesn’t need to wait for a blood test. The clinical risk profile alone is sufficient justification.

The Bottom Line

Magnesium is one of the most important minerals in your body, yet it is one of the most commonly overlooked. Modern diets, common medications, and the limitations of routine blood testing all contribute to a situation where millions of people are quietly deficient without knowing it.

The good news? It is easy to address. Eat more whole foods, be aware of your risk factors, and talk to your doctor or pharmacist about whether magnesium supplementation makes sense for you.

Your body is already telling you what it needs. Sometimes, you just have to listen.

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