Magnesium plays a crucial role in alcohol withdrawal — functions, deficiency, bioavailability of different compounds. Magnesium is essential for the heart, muscles, and nerves. Learn why people with alcohol dependence often have magnesium deficiency, what role magnesium plays during withdrawal, and which supplements work best.
Magnesium is a vital mineral found mainly in bones, muscles, and the nervous system. It is involved in more than 300 enzymatic reactions, including energy production (ATP), electrolyte balance, nerve conduction, and muscle contraction.
Functions in the Body #
Magnesium is indispensable for:
- • Bone and tooth stability
- • Regulation of heart rhythm and blood pressure
- • Muscle and nerve function
- • Synthesis of DNA, RNA, and proteins
- • Energy metabolism in mitochondria
Deficiency can cause fatigue, cramps, cardiac arrhythmias, and neurological symptoms.
Magnesium and Alcoholism #
Chronic alcohol consumption very frequently leads to magnesium deficiency. Causes include:
- • Increased renal excretion (alcohol-induced diuresis)
- • Reduced intestinal absorption
- • Poor diet low in magnesium
- • Concurrent electrolyte disturbances (e.g., potassium, calcium, phosphate) worsened by alcohol
Magnesium deficiency intensifies typical symptoms in alcohol-dependent individuals:
- • Cardiac arrhythmias and circulatory problems
- • Neuromuscular hyperexcitability (tremor, cramps, muscle twitching)
- • Psychological symptoms such as irritability, anxiety, or low mood
Magnesium in Alcohol Withdrawal #
Magnesium is particularly important in acute alcohol withdrawal:
- • Cardiovascular protection: Magnesium stabilises cardiac conduction and reduces the risk of arrhythmias.
- • Neurological stabilisation: Withdrawal causes overactivation of glutamatergic NMDA receptors. Magnesium blocks the NMDA channel at rest, acting as a natural calcium blocker and promoting calm. Without this protection, tremor, anxiety, and seizures worsen.
- • Synergy with thiamine: Magnesium is a cofactor for thiamine activation. Without sufficient magnesium, thiamine supplementation is less effective.
- Clinical practice:
- • In severe withdrawal, especially delirium tremens, magnesium is often given intravenously, usually with thiamine and other electrolytes.
- • Even moderate deficiency can prolong withdrawal symptoms.
- • Magnesium administration may help prevent seizures and reduce the required benzodiazepine dose (clinical observations).
Bioavailability of Different Magnesium Compounds #
Magnesium absorption strongly depends on the compound. Organic salts (e.g., citrate, aspartate, glycinate) are generally better absorbed than inorganic ones (e.g., oxide, hydroxide). Quality is reflected in price — cheap products often provide little benefit and frequently cause diarrhoea.
Brief comparison of bioavailability, characteristics, and clinical relevance
| Compound | Bioavailability | Characteristics | Clinical Use |
|---|---|---|---|
| Magnesium citrate | High (~30–40 %) | Highly soluble, fast absorption, mildly laxative | Supplements, standard for deficiency |
| Magnesium aspartate | High | Organic salt, well tolerated | Supplements, studies in heart and muscle conditions |
| Magnesium lactate | High | Gentle on stomach, good absorption | Supplements, clinical preparations |
| Magnesium glycinate | High | Chelated, very well tolerated | Popular for sensitive stomachs |
| Magnesium orotate | Medium | Possible positive effect on cardiac metabolism | Cardiological specialty products |
| Magnesium chloride | Medium–high | Highly soluble, bitter taste | Supplements, infusions, transdermal |
| Magnesium oxide | Low (~4 %) | High Mg content, poorly soluble | Cheap products, strongly laxative |
| Magnesium hydroxide | Low | Also antacid | Antacids, laxatives |
| Magnesium sulfate | Low (oral) | Strongly laxative, highly effective IV | IV for eclampsia, delirium tremens, seizure prophylaxis; Epsom salt as laxative |
Intake and Supplementation #
Daily requirement for healthy adults is approximately 300–400 mg. Good sources include whole grains, nuts, seeds, legumes, and green vegetables.
In people with alcohol dependence, supplementation is almost always necessary and sometimes higher doses are required short-term — always considering the risk of diarrhoea. Long-term higher-than-needed doses should be discussed with and monitored by a doctor.
Key References #
- Romani A. Cellular magnesium homeostasis. Arch Biochem Biophys. 2011;512(1):1-23.
- Sullivan JF et al. Magnesium metabolism in chronic alcoholism. Ann NY Acad Sci. 1969;162(2):949–962.
- Spies CD et al. Therapy of alcohol withdrawal syndrome in intensive care unit patients. Alcohol Clin Exp Res. 1996;20(3):573–579.
- Rösner S et al. Behandlung des Alkoholentzugs. Nervenarzt. 2010;81:1157–1165.
- Schuchardt JP, Hahn A. Intestinal absorption and factors influencing bioavailability of magnesium—an update. Curr Nutr Food Sci. 2017;13(4):260–278.
Frequently Asked Questions (FAQ) #
Why do people with alcoholism often have magnesium deficiency?
Alcohol increases renal excretion and impairs intestinal absorption.
Poor nutrition is usually also a factor.
This depletes magnesium stores, leading to more frequent arrhythmias, muscle cramps, and neurological symptoms.
What role does magnesium play in alcohol withdrawal?
Magnesium stabilises cardiac conduction and dampens NMDA receptor overactivation.
This can reduce tremor, seizures, and agitation.
In severe cases, magnesium is given intravenously under medical supervision, often combined with thiamine.
Which magnesium compounds have good bioavailability?
Organic compounds are generally better absorbed, e.g., magnesium citrate, aspartate, lactate, and glycinate.
Inorganic forms like oxide or hydroxide provide high elemental magnesium but are poorly absorbed and often cause diarrhoea.
Is there an interaction between magnesium and thiamine in withdrawal?
Yes. Magnesium is a cofactor for converting thiamine into its active form (thiamine pyrophosphate).
Without sufficient magnesium, thiamine supplementation may be less effective.
Clinicians therefore monitor both nutrients during withdrawal.
What should be considered when taking magnesium?
Normal daily intake for adults is about 300–400 mg.
For sensitive digestion, split doses and well-tolerated forms are advisable.
In impaired kidney function, medical supervision is essential.
If diarrhoea occurs, the dose should be adjusted.
Bernd Guzek, MD, PhD #
Physician, author & co-founder of Bye-Bye-Booze
Specialized in biochemical mechanisms of addiction and brain metabolism.
