Science Update

Antacid medications cause an increased risk of hospitalization for low blood magnesium

Proton pump inhibitors (PPI) are associated with hospitalization for hypomagnesemia specifically among patients also receiving diuretics according to research recently published in PLOS Medicine. The study suggests that doctors should reconsider long-term PPI therapy for patients with a diagnosis of hypomagnesemia or the concurrent use of diuretics.

More than 50% of Americans are magnesium deficient and this applies to half the population on proton pump inhibitors. Magnesium plays a key role in more than 350 enzymes and is involved in virtually every metabolic process occurring in the body. 

How do you determine if a patient is magnesium deficient? Serum magnesium is not the answer. Serum magnesium represents only 1% of magnesium stores. Magnesium is homeostatically controlled in the serum so measuring serum magnesium levels provides many false negatives. By the time serum magnesium tests low a person is already very deficient as the body is in a state where it cannot maintain normal serum levels. RBC magnesium is definitely a better indicator and the most accurate test we have. This test can be done by most labs and all functional medicine labs.

There are approximately 145 million prescriptions for PPI dispensed in the US each year for acid-related disorders such as dyspepsia and GERD. These medications are widely regarded as safe yet many adverse effects have been noted. Since 2006 there have been thirty case studies linking the long-term use of PPIs to hypomagnesemia and the theory is that this is caused by impaired intestinal absorption of magnesium. When severe hypomagnesemia is dangerous and can be associated with arrhythmias muscle dysfunction and seizures.

Proton pump inhibitors may not be the solution. Natural treatments offer a more effective approach than what is provided by proton pump inhibitors.

Some nutritional options to consider that improve digestive function are probiotics and glutamine. In addition deglycyrrhiizinated licorice (DGL) helps relax the esophageal sphincter; it is soothing and protecting to the gastric mucosa and mucous membranes lining the digestive tract.

These natural solutions offer a more effective approach than what is provided by proton pump inhibitors. Proton pump inhibitors can induce several nutrient deficiencies in calcium potassium and magnesium. In addition they can cause serious neuromuscular and cardiovascular problems and may increase the chance of hip fracture in people over 50 years of age.


Medicine PLOS. "Patients prescribed proton pump inhibitors in combination with diuretics face increased risk of hospitalization for low blood magnesium."