There have been longstanding discussions as whether vitamin and mineral supplementation is needed to prevent mineral deficiency and the role they should play in health. This short article, written by a pharmacist, addresses the issue.
By Chad Campbell, Director of Pharmacy, PharmD, Rehabilitation Hospital of Northern Arizona
Vitamins and minerals have been utilized for improvement of general health and wellbeing as well as directly used in the treatment of some disease states. The Department of Health and Human Services has combined with the United States Department of Agriculture to develop recommended dietary guidelines for daily intake of vitamins, minerals, and macronutrients . Diets vary widely between individuals making nutritional adequacy sometimes difficult to measure on an individual basis. High levels of processed foods tend to have lower levels of nutritional completeness.
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Soil depletion and loss of nutritional value in food
There has been some additional discussion about the progressive loss of nutritional value of fruits and vegetables over time due to soil depletion. While it is true that perpetual use of soil will necessarily deplete soil of important nutrients; fertilizers are able to replete most of the loss of minerals over time to the point that nutritional loss is largely negligible. However, fertilizers are not uniformly effective and despite widespread use copper, sodium, and magnesium have seen statistical losses over time .
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Is the American diet adequate to prevent mineral deficiency?
The nutritional adequacy of the American diet is a matter of debate and disagreement. Some reports demonstrate that the American diet is largely nutritionally sufficient. This is likely due to the relative high levels of total consumption of Americans; thereby making nutritional inadequacies less common in healthy adults. However, this doesn’t equally apply to the economically disadvantaged who may have a more difficult time consuming a more nutritionally complete diet . The majority of reports, however, demonstrate that reasons such as vitamin D deficiency, certain medication use, and advancing age have been implicated in widespread magnesium deficiency with a majority of Americans consuming magnesium deficient diets.
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Magnesium deficiency – The most noteworthy
Of these minerals, the loss of magnesium is perhaps the most noteworthy. Magnesium is the fourth most abundant mineral in the human body; the majority of which is located within bone(4). Magnesium is used in a variety of ways in the human body including serving as an essential cofactor in hundreds of enzymatic reactions. Furthermore, DNA, RNA, and protein synthesis all require magnesium and it is one of the essential elements that regulate nerve impulse and muscle contraction. Due to the deposition of magnesium in the bone low magnesium levels are often not seen acutely. Due to the importance of magnesium in so many essential biologic functions, serum magnesium levels are tightly regulated. Blood magnesium levels are maintained at the expense of magnesium stores in other locations, namely bone. However, since early signs of hypomagnesemia are non-specific and typically non-fatal, it is frequently undiagnosed in the absence of blood monitoring (4).
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Too much vs. Too little magnesium
While hypermagnesemia (too much) is possible it is far less common than hypomagnesemia (too little). Why is this? Serum magnesium levels are moderated by kidney excretion making it difficult to reach toxic levels in those with adequate renal function. 
Magnesium as a medical treatment
Magnesium has been utilized in the treatment of several medical conditions including; osteoporosis, muscle cramps (in lay terms, a “charley horse), hypertension, coronary heart disease, preeclampsia/eclampsia, migraines, and various metabolic disorders such as diabetes .
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Muscle cramps and magnesium
In the case of muscle spasms and cramping, what is known is that cationic minerals, namely calcium and magnesium, are components of the contraction and relaxation of muscles. However, the pathogenesis of muscle spasms/cramping is not completely understood and occur for a variety of reasons. Because of the multifactorial nature of muscle action and the bevy of pathologies that could contribute to muscle spasms/cramping treatment with single agents has yielded mixed results. As such, depending on the etiology of muscle cramps, minerals may or may not necessarily be efficacious.
 Huang KS, Huang SW. Changes in the nutrient content of American diets. Health Econ Rev. 2011; 1:19.
 Marles, RJ. Mineral nutrient composition of vegetables, fruits and grains: The context of reports of apparent historical declines. Journal of Food and Composition and Analysis. 56 (2017) 93-103.
 Grober U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015; 7, 8199-8226.
 Schwalfenberg GK, Genuis SJ. The Importance of Magnesium in Clinical Healthcare. Hindawi Scientifica. Vol 2017. ID 4179326.
 de Baaij J, Hoenderop J, Bindels R. Magnesium in Man: Implications for Health and Disease. Physiol Rev. 2015. 95: 1-46.