Magnesium For Long COVID

Overview

In the aftermath of the COVID-19 pandemic, we have been left with the immense task of recovery. Recovery has taken various  forms, with both patients and clinicians reckoning with a loss of agency. The disparity between the immune response to COVID-19 was stark, as some patients recovered quickly or remained  asymptomatic, while others suffered fatalities or required hospitalisation. Approximately 10% of patients, ranging from mild to severe, are still experiencing what is unofficially called ‘Long COVID’or Post Acute Coronavirus Syndrome (PACS).¹

PACS is characterised by a wide range of symptoms. The most commonly reported symptoms 6 months after exposure toCOVID-19 include pain, respiratory difficulties, hyperlipidemia, malaise,fatigue, hypertension, and cognitive dysfunction. More severe reactions to PACS can result in conditions such as pulmonary fibrosis, myocarditis, newly diagnosed diabetes, stroke and other cerebrovascular events, cardiac arrhythmia, hypercoagulability, encephalopathy, peripheral neuropathy, and liver and renal function abnormalities.²

Unlike COVID-19, which was more severe in men, the syndrome appears to be more prevalent in premenopausal/perimenopausal women.³

However, due to the broad range of symptoms, determining a specific cause for PACS has been challenging. 

Possible causes for PACS are:

• Damage to organs due to the body’s immune response to SARS-CoV-2 infection
• Abnormal antibodies leading to blood clotting and destabilising the immune response
• Residual virus particles in one or more organs continueing to trigger an immune response
• ersistent low-level brain/heart/muscle/nerve inflammation
• An autoimmune response in which the body’s antibodies attack the brain
• Dysfunction of receptors in the heart and lungs⁴

Digital public awareness of the syndrome has meant that those suffering from PACS have readily shared their home treatments and techniques to combat PACS. Online suggestions such as exercise therapy and healthy eating to reduce symptoms like fatigue and brain fog are commonplace in syndromes like chronic fatigue syndrome and long-term COVID that affect multiple organs, but they lackspecificity and do not provide targeted support.⁵ Now, we are turning to minerals like magnesium, which are essential for overall health and finding that they may be even more important than previously known.

How does magnesium affect long-term COVID?

Magnesium is a crucial mineral in the human body involved in all metabolic and biochemical pathways. It is required for vital functions, such as bone formation, neuromuscular activity, signalling pathways, bioenergetics, glucose, lipid and protein metabolism, DNA/RNA stability, as well as cell proliferation.⁶

Researchers noticed similarities between the risk factors for experiencing a severe response to COVID-19 and conditions linked to low serum magnesium levels, (hypomagnesemia), such as age, diabetes, obesity, high blood pressure, arrhythmias, thrombosis and cardiovascular diseases.⁷ Data indicates that 10%–30%, of a given population in a developed country, may have a subclinical magnesium deficiency based on serum magnesium levels <0.80 mmol/L.⁸ Magnesium deficiency is now believed to be associated with brain fog, fatigue, post-exertional malaise, headache, dizziness, myalgia and asthma of PACS.⁹ It is worth mentioning that magnesium is necessary for Vitamin D absorption, as a deficiency in Vitamin D was also noted in over 80% of patients with severe cases of the coronavirus.¹⁰

In PACS, the immune system is hypothesised to trigger a lethal inflammatory response coupled with oxidative stress, in which inflammatory cytokines are released in abnormally large quantities in response to infection. This cytokine storm, which is often observed in patients requiring intensive care unit (ICU) admission, can lead to cell death in various cell types, leading to pathological conditions.¹¹ There is also a possibility that COVID-19 causes myocardial cell injury by interacting with the angiotensin-converting enzyme-2 (ACE2) receptors, which attack organs expressing these ACE2 receptors in the heart, brain, vessels, liver, kidney, and lung.¹² Additionally, low levels of magnesium serum have been discovered to worsen a cytokine storm and oxidative stress, with Vitamin D  affecting the metabolism of phosphate and Mg. Thus, maintaining the homeostasis of key vitamins and minerals may be crucial in monitoring and controlling PACS.¹³

Conversely, magnesium supplementation has been shown to have prophylactic use for a variety of disorders or diseases related to the respiratory system, nervous system, and cardiovascular system, as well as diabetes. Magnesium has also been shown to improve the white blood cells' ability to seek out and destroy germs.¹⁰

Which magnesium is best for long-term COVID?

In general, a well-balanced diet should provide the required magnesium levels, but sometimes the body is unable to get the necessary amount. Some causes of this can be poor diet, alcoholism, diarrhoea, vomiting, absorption problems, diabetes, and other medical problems.¹⁴

Natural dietary sources of magnesium include green leafy vegetables, nuts, legumes, soy, whole grain cereals, and fish such as herring or turbot. 

There are many different supplemental forms of magnesium available as well, such as:

• Magnesium chloride, a salt with the highest absorption rate, although it only contains approximately 12% of elemental magnesium. With a stability constant of 0, it is best for the detoxification of cells and tissues
• Magnesium citrate has a lower concentration, but a bioavailability of 16%, due to the magnesium-citric acid bond. Due to citrate being a large molecule, there is less magnesium per weight than in any other form. As citric acid is a mild laxative, magnesium citrate can also help with constipation and the prevention of kidney stones. These qualities mean it is not suitable for those with diarrhoea or loose stools. It is recommended to be taken on an empty stomach with water to aid absorption
• Chelated magnesium glycinate,  a magnesium-glycine formulation. This formulation is one of the most bioavailable and absorbable forms of magnesium and is least likely to cause gastrointestinal problems. This chelation with a non-essential amino acid is considered a safe choice to fix a long-term deficiency
• Magnesium ascorbate is a source of vitamin C and magnesium with higher gastrointestinal tolerance than the other forms and contains 6.4% of the mineral. This is considered the most natural and bioavailable form to combat stress and can help with the detoxification of heavy metals¹⁵
• Due to previously noted complementary roles, the supplementation of phosphate and Mg combined with vitamin D has also been suggested as a preventative strategy in populations at risk of PACS¹⁶

How much magnesium should I take for long-term COVID?

The recommended daily magnesium intake for females aged 14-18 years is 360mg, and 410 mg for males. For patients aged 19-30 years, the dose is 310 mg for females and 400 mg for males.  For patients 31 years of age and older, the RDI is 320 mg for females and 420 mg for males.¹⁴

Side effects and other concerns

Magnesium in supplements can interact with certain antibiotics and other medicines. Please check with a doctor or pharmacist before taking magnesium supplements, especially if you take magnesium-containing antacids or laxatives, as high doses of magnesium in supplements or medications may cause nausea, abdominal cramping and diarrhoea.¹⁷

Summary

Though there is continuing debate over the nature of long COVID, it is important to consider options available to improve the quality of life for those with PACS. Magnesium has been shown to have strong links to the pathogenesis of SARS-CoV-2 and is aided by key micronutrients like zinc, phosphate, and Vitamin D, which may all play an important role in stabilising the immune reaction to COVID. As we learn more about the syndrome, we can build on this knowledge and aid in the recovery of patients and communities.