TL;DR
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A Sixty and Me report highlights guidance from the NIH and FDA that long-term use of certain proton pump inhibitors and diuretics can lower magnesium. The sources say patients should discuss medication history and whether testing is appropriate with a health professional; they should not stop prescribed medicines or start supplements on their own.
A Sixty and Me report highlights guidance from the National Institutes of Health (NIH) and U.S. Food and Drug Administration (FDA) that long-term use of some heartburn medicines and diuretics can lower magnesium. The report urges people taking these medicines to review their medication list with a health professional and ask whether magnesium testing is appropriate, rather than changing treatment on their own.
The NIH says prescription proton pump inhibitors (PPIs), a class of drugs used for conditions including reflux and ulcers, can cause low magnesium when taken for long periods, typically more than a year. Examples include omeprazole, esomeprazole, lansoprazole and pantoprazole. The supplied report says the FDA advises doctors to consider checking magnesium before long-term PPI treatment and periodically during use.
Some loop and thiazide diuretics, commonly called water pills, can increase magnesium loss through urine with prolonged use. The NIH examples include furosemide and hydrochlorothiazide. The report distinguishes these from potassium-sparing diuretics such as spironolactone, which reduce magnesium loss. It does not say every medicine in these classes will cause deficiency in every person.
The FDA-reviewed cases cited in the report found that supplements often raised low magnesium, but did not do so in one-quarter of those reported cases; patients in those cases had to stop the PPI. That proportion describes the cases reviewed, not the likelihood for an individual patient. The report advises people not to stop a prescribed drug without first speaking with their clinician.
Medication Reviews Can Flag Magnesium Risk
The issue matters because people may take a PPI or diuretic for years, while magnesium may not be part of the routine blood work they receive. The NIH identifies older adults as a group at risk of low magnesium, citing factors that can include lower dietary intake, reduced absorption, greater urinary loss, chronic illness and medicines that affect levels.
Symptoms listed by the NIH can include fatigue, weakness, nausea and muscle cramps; more serious deficiency can involve numbness, seizures or an abnormal heart rhythm. These symptoms can have many causes, so they do not establish a magnesium deficiency by themselves. Reviewing medicines and health history with a clinician can help determine whether testing or other evaluation is warranted.
People with kidney disease should take particular care before using magnesium supplements, the report says, because impaired kidneys may not clear excess magnesium well. Food sources listed by the NIH include pumpkin seeds, almonds, spinach and black beans. Whether a person needs a supplement or a medication change is a decision for a qualified health professional.
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What Magnesium Tests Can Show
Magnesium is mostly found in bones and soft tissues; less than one percent is in the blood, according to the source report’s account of NIH material. The NIH says the body tightly regulates blood magnesium and that the blood level has limited correlation with total body stores. A routine chemistry panel may not include a magnesium measurement.
Even so, a blood test remains the most commonly used and readily available way to assess magnesium, according to the NIH. The report says no single test is considered satisfactory, so clinicians may interpret a result alongside symptoms and medical history. A normal result does not establish that a person’s overall magnesium stores are full, while a low result can give a clinician information to act on.
The report recommends bringing a complete list of medicines—including over-the-counter heartburn products—and noting how long each has been used. Patients can ask whether any could affect magnesium and whether testing is appropriate. The NIH also advises people who regularly use these medicines to discuss magnesium intake with their health care providers.
“The FDA advises doctors to consider checking magnesium before starting long-term PPI treatment and to check it periodically after that.”
— U.S. Food and Drug Administration, as described in the Sixty and Me report
Individual Risk Depends on Medical History
The supplied material does not give an individual’s risk of developing low magnesium while taking a PPI or diuretic, nor does it provide a date for the report. The FDA case review’s one-quarter figure applies only to the reported cases described, and cannot be used to predict what will happen to a particular patient.
It is also unclear from symptoms alone whether a person has low magnesium: the signs cited by the NIH can result from other conditions. A blood test is commonly used, but the NIH says no single test fully assesses magnesium status. Decisions about testing, supplements or medication changes require an individual clinical review.
Review Medicines With a Clinician
People taking a prescribed heartburn medicine or water pill should keep taking it unless their prescriber advises otherwise. They can bring a list of prescription and over-the-counter medicines to a doctor or pharmacist and ask whether any may affect magnesium, whether it has been checked and whether a test is suitable for them.
Anyone considering a magnesium supplement should ask a health professional first, particularly if they have kidney disease. The report identifies a seizure or a racing or irregular heartbeat as reasons to seek medical care right away. The supplied material does not announce a new policy or a scheduled follow-up; the practical next step is a medication review and individualized discussion with a clinician.
Key Questions
Which heartburn medicines are associated with low magnesium?
The report names proton pump inhibitors, including omeprazole, esomeprazole, lansoprazole and pantoprazole. The NIH guidance described in the report concerns prescription PPIs taken for long periods, typically more than a year. People using an over-the-counter product regularly can tell their clinician how long they have taken it.
Which water pills may increase magnesium loss?
The report says long-term use of some loop and thiazide diuretics can increase magnesium loss in urine. Examples are furosemide and hydrochlorothiazide. It says potassium-sparing diuretics such as spironolactone reduce magnesium loss; patients should ask a clinician about their own medicine rather than infer risk from the drug category alone.
Does a normal blood test rule out low magnesium?
No. A blood magnesium test is commonly used, but the NIH says blood levels have limited correlation with the body’s total magnesium stores and no single test is considered satisfactory. A clinician may interpret the result with symptoms and medical history.
Should I stop my medicine or take a supplement?
The report advises people to keep taking prescribed medicines until they have spoken with their doctor. Ask a health professional before starting a supplement, especially if you have kidney disease, because the kidneys clear excess magnesium.
Source: sixtyandme.com
