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An article based on NIH and FDA information warns that long-term use of some proton pump inhibitors and diuretics can lower magnesium. It advises patients to review their medicines with a clinician rather than stopping prescribed treatment or starting supplements on their own.
A Sixty and Me report highlights guidance from the National Institutes of Health and the U.S. Food and Drug Administration: long-term use of some heartburn medicines and diuretics can lower magnesium, and patients can ask their health care providers whether testing is appropriate. The report advises people not to stop prescribed medicines or begin supplements without discussing them with a clinician.
The medicines of concern include proton pump inhibitors (PPIs), which reduce stomach acid and are prescribed for conditions including reflux and ulcers. Examples include omeprazole, esomeprazole, lansoprazole and pantoprazole. The NIH Office of Dietary Supplements says prescription PPIs can cause low magnesium when taken for a long time, typically more than a year. People taking a daily over-the-counter PPI are also advised by the report to tell their clinician how long they have used it.
Among diuretics, or medicines sometimes called water pills, loop diuretics such as furosemide and thiazide diuretics such as hydrochlorothiazide can increase magnesium loss in urine with long-term use. Potassium-sparing diuretics, including spironolactone, have the opposite effect and reduce magnesium loss, according to the NIH information cited by the report.
The FDA advises clinicians to consider checking magnesium before starting long-term PPI treatment and periodically during treatment. The report says magnesium supplements raised low levels in many cases reviewed by the FDA, but in about one-quarter of those reported cases, supplementation did not correct the problem and the patient had to stop the PPI. That proportion describes the cases the FDA reviewed; it is not an estimate of an individual patient’s risk.
Medication Reviews Can Flag Magnesium Risk
The issue may matter to people who have taken the same prescriptions or over-the-counter medicines for years without a recent medication review. Older adults are listed by the NIH as at risk of low magnesium, in part because intake and absorption can decline with age and the kidneys may pass more magnesium into urine. Chronic conditions and medicines can also affect levels.
Symptoms such as fatigue, weakness, nausea, muscle cramps, numbness or tingling can have many possible causes, so they do not establish magnesium deficiency. The NIH also lists seizures and abnormal heart rhythms among signs associated with more severe deficiency. The report says those symptoms warrant medical attention, and that seizures or a racing or irregular heartbeat require care right away.
The practical point is a review with a qualified health care professional, not a change in treatment based on an article. Patients can bring a complete list of prescriptions and nonprescription medicines and ask whether any may affect magnesium, whether testing is suitable, and whether diet or other steps should be discussed.
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Why a Routine Blood Panel May Miss It
Magnesium is present mainly in bones and soft tissues; less than 1% of the body’s magnesium is in blood. The NIH says the body tightly regulates blood magnesium and that blood levels have limited correlation with total magnesium in the body. It also says magnesium is not routinely included in standard electrolyte testing, so a basic chemistry panel may not measure it.
A blood magnesium test remains the most commonly used and readily available way to assess magnesium, according to the NIH. A low result can give a clinician a finding to act on, but no single test is considered satisfactory, the NIH says. A clinician may consider a patient’s health history and symptoms alongside the result. A normal result does not, by itself, establish how much magnesium is held in the body overall.
The report also notes that a low-magnesium diet alone seldom causes symptoms in otherwise healthy people because the kidneys conserve magnesium when intake is low. Risk can involve low intake over time, health conditions, heavy alcohol use or medicines. The NIH recommended daily amount cited for women over 50 is 320 milligrams; the report lists pumpkin seeds, almonds, spinach and black beans as food sources.
What Testing Can and Cannot Show
The source does not give a publication date, identify a new study or policy announcement, or provide estimates of how often magnesium deficiency occurs among people taking these medicines. The FDA figure cited concerns reported cases it reviewed, not the chances for every PPI user. The risk for any individual depends on factors that require clinical assessment.
Testing also has limits. A blood result is commonly used, but it may not fully reflect magnesium held in other tissues, and the NIH says there is no single satisfactory test. Symptoms are nonspecific, too. Whether a person should be tested, and what a result means, remains a decision for their health care provider based on their medicines and health history.
Bring a Medicine List to Your Clinician
People concerned about long-term PPI or diuretic use can write down every prescription and over-the-counter medicine, including how long each has been taken, and review the list with a doctor or pharmacist. Useful questions include whether any medicine affects magnesium and whether a magnesium test or follow-up is appropriate. The report stresses that patients should keep taking prescribed medicines until they have spoken with their clinician.
Patients should ask before taking a magnesium supplement, particularly if they have kidney disease, because impaired kidney function can make it harder to clear excess magnesium. A clinician can also discuss food sources and whether other checks are needed. The source provides no new testing schedule beyond the FDA advice for clinicians to consider baseline and periodic checks during long-term PPI use.
Key Questions
Which heartburn medicines are linked to low magnesium?
The NIH information cited by the report says long-term use of prescription proton pump inhibitors can cause low magnesium. Examples include omeprazole, esomeprazole, lansoprazole and pantoprazole. Tell your clinician about daily over-the-counter use as well.
Which water pills can affect magnesium?
Long-term use of loop diuretics such as furosemide and thiazide diuretics such as hydrochlorothiazide can increase magnesium loss in urine, according to the NIH information cited. Potassium-sparing diuretics such as spironolactone reduce magnesium loss.
Does a normal blood test rule out low magnesium?
Not necessarily. Blood testing is the most commonly used and readily available assessment, but the NIH says blood levels have limited correlation with total body magnesium and that no single test is satisfactory. A clinician may consider the result alongside symptoms and medical history.
Should I stop my medicine or start a magnesium supplement?
No change should be made based on this report alone. Do not stop prescribed medicine or start a supplement without discussing it with a health care professional. This is particularly relevant for people with kidney disease, who may have difficulty clearing excess magnesium.
Source: sixtyandme.com
