Fructose is the Silent Killer in the North American Diet. Inflammation, Early Death, Kidney Failure, Arthritis.

I spend an enormous amount of time with patients, far more than does the average 'medical practitioner.' Much of that time is spent trying to convince the patient that they are causing most of their medical issues through what they eat in their diet.

Nobody is ever surprised, and yet it continues to be a problem. Fructose is cheap. Sucrose is cheap. Food, as a proportion of our income is far less of a relative percentage now, than at any time in human history. And yet, poor choices result in poor outcomes and we are eating ourselves to death.

Before I receive the onslaught of complaints that the discussion below, is too technical, please understand that it is actually a simplification, but I present it to you in an attempt to convince you that it is very important, and not simply one of those many platitudes that one learns to expect from their well-meaning doctors.

Simply stated, Fructose is more addictive than alcohol, nicotine, cocaine or heroin. Over consumption is most probably responsible directly or indirectly for more deaths than those previously mentioned poisons.

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Fructose, High Fructose Corn Syrup Directly Causes Arthritis

Fructose, a monosaccharide prevalent in the modern diet, particularly through high-fructose corn syrup (HFCS) and sucrose, has been implicated in exacerbating inflammatory conditions such as arthritis. Its metabolic pathways and subsequent physiological effects contribute to inflammation and various health disorders.​

Metabolic Pathways of Fructose and Inflammatory Mechanisms. Arthritis and Triglycerides

Fructose cause Triglycerides elevate and available ATP to be decreased.

Upon ingestion, fructose is primarily metabolized in the liver. Unlike glucose, fructose metabolism bypasses the regulatory step catalyzed by phosphofructokinase, leading to unregulated phosphorylation by fructokinase. This process results in the rapid depletion of adenosine triphosphate (ATP) and accumulation of AMP, which is subsequently degraded to uric acid .​ This is, in part, one of the reasons that fructose consumption can lead to hyperuricemia (elevated uric acid) which is directly related to decrease life expectancy and an increase in the incidence of non-cholesterol related atherosclerotic heart disease.

For further information, there, read my blogs on Uric Acid. Pay close attention to the statistics.

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Worsening of a persons arthritis can be experienced mere hours after ingesting fructose rich foods, and the effect can last days. Improvement of arthritis symptoms can be experienced a day or two after dropping it from the diet.

Fructose causes insulin resistance (metabolic syndrome, pre-diabetes) as well as kidney damage, obesity blood pressure elevation and Non Alcoholic Fatty Liver Disease

Fructose elevates Uric Acid Levels, causing kidney disease and Liver disease (NAFLD)

Elevated uric acid levels can induce inflammation by stimulating the production of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), contributing to joint inflammation observed in arthritis.

Moreover, fructose metabolism promotes de novo lipogenesis, leading to increased triglyceride synthesis and lipid accumulation. This lipid overload can result in hepatic steatosis and the release of inflammatory mediators, further exacerbating systemic inflammation. That is, it can be the cause of 'Non Alcoholic Fatty Liver Disease (NAFLD)

Fructose and Gut Dysbiosis

Fructose causes gut inflammation and cardiac rhythm disorders

High fructose intake has been associated with alterations in gut microbiota composition, known as dysbiosis. This imbalance can increase intestinal permeability, allowing endotoxins to enter the circulation and trigger inflammatory responses. Such mechanisms are implicated in the pathogenesis of metabolic syndrome and inflammatory diseases .​ Yes, fructose, high-fructose corn syrup and the products made from it cause serious bowel diseases.

Cardiac arrhythmias? Let's consider the rather remarkable increase in the number of patients presenting with atrial fibrillation, with no apparent precipitant cause. '

The number of 'Cardiac Ablations' done is remarkable, and most of them may be unnecessary, as reducing the intake of fructose and lowering the level of uric acid below the 5.5 level may be all that is required to correct the problem.

Systemic Inflammatory Responses

Consumption of fructose-rich diets has been shown to elevate levels of inflammatory markers, including C-reactive protein (CRP) and intercellular adhesion molecule-1 (ICAM-1). These markers are indicative of endothelial dysfunction and heightened inflammatory states, contributing to the development and progression of chronic inflammatory conditions .

Impact on Insulin Resistance and Obesity

At best, Fructose will make you fat. The Insulin resistance and liver damage will eventually catch up with you.

Fructose consumption is linked to insulin resistance through mechanisms involving increased hepatic gluconeogenesis and lipid accumulation. Insulin resistance itself is a pro-inflammatory state, contributing to the pathophysiology of type 2 diabetes and obesity. Obesity further exacerbates inflammation due to adipose tissue's role in secreting pro-inflammatory cytokines .​

Conclusion

Excessive dietary fructose contributes to the pathogenesis of arthritis and other inflammatory conditions through multiple mechanisms, including increased uric acid production, promotion of gut dysbiosis, induction of systemic inflammatory responses, and exacerbation of insulin resistance and obesity. Limiting fructose intake may be beneficial in mitigating these inflammatory processes and improving overall health outcomes.​

Stop eating yourself to death.

More so, Fructose directly causes the skin to age prematurely, but more on that, later!

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References

1. Baharuddin B. The Impact of Fructose Consumption on Human Health: Effects on Obesity, Hyperglycemia, Diabetes, Uric Acid, and Oxidative Stress With a Focus on the Liver. Cureus. 2024;16(9):e70095.

   
   

2. Sugar Fructose Triggers Gut Dysbiosis and Metabolic Inflammation. Biomedicines. 2021;9(7):728.

3. Fructose Induces the Inflammatory Molecule ICAM-1 in Endothelial Cells. Journal of the American Society of Nephrology. 2008;19(9):1712-1720.​PMC

   
   

4. High-Fructose Diet Increases Inflammatory Cytokines and Alters Gut Microbiota Composition in Rats: A Pilot Study. BioMed Research International. 2020;2020:6672636.​

   
   

5. Chung M, Ma J, Patel K, Berger S, Lau J. Fructose, High-Fructose Corn Syrup, Sucrose, and Nonalcoholic Fatty Liver Disease or Indexes of Liver Health: A Systematic Review and Meta-Analysis. The American Journal of Clinical Nutrition. 2014;100(3):833-849.

   
   

6. Jensen T, Abdelmalek MF, Sullivan S, Nadeau KJ, Green M. Fructose and Sugar: A Major Mediator of Nonalcoholic Fatty Liver Disease. Journal of Hepatology. 2018;68(5):1063-1075.​

   
   

7. White JS. Misconceptions about High-Fructose Corn Syrup: Is It Uniquely Responsible for Obesity, Reactive Dicarbonyl Compounds, and Advanced Glycation Endproducts? Journal of Nutrition. 2009;139(6):1219S-1227S.

   
   

8. Dufault R. Mercury from Chlor-Alkali Plants: Measured Concentrations in Food Product Sugar. Environmental Health. 2009;8:2.​

   
   
   
   

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David S. Klein, MD FACA FACPM

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle, Suite 171

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246

www.suffernomore.com

David S. Klein, MD Functional Medicine Physician

The Essential Nutrients: What Makes a Superior Multivitamin and Mineral Supplement?

Down to Basics comes in preparations with and without Iron. Taken 2 capsules twice daily.

In our journey towards better health, many people turn to multivitamin and mineral supplements to bridge nutritional gaps. While a balanced diet is ideal, various factors—like busy lifestyles and dietary restrictions—can make it hard to get all the necessary nutrients. Not every multivitamin is created equal, though. This article breaks down the key vitamins and minerals to look for when selecting a top-quality multivitamin and mineral supplement.

Understanding the Basics of Multivitamins

Multivitamins are dietary supplements that combine various vitamins and minerals, sometimes with additional nutrients. They aim to cover nutrients that might be lacking in our diets.

The make-up of a multivitamin can vary widely. It is essential to know which vitamins and minerals are crucial for your overall health and well-being.

There is only so much space in a tablet or capsule. To get all that you need, it almost always requires multiple tablets and/or capsules to accomplish this. A marketing trick that is often used in making a 'single-tablet per day' solution is to use what is called "A Sprinkle," which is to put just enough of the moiety to give them a line on the ingredients list.

As you know, treatment and prevention of disease requires a threshold therapeutic dosage. If a product were to contain all of the vitamins that you need it may take two or more capsules.

Minerals can be in a bio-available format, or chelate, or it can be provided as an inorganic salt. The inorganic salts are smaller molecules, packing more tightly but delivering little therapeutic benefit. This is the most common of the tricks used, as it looks like you are getting something with fewer tablets or capsules, when in fact, you are getting little to nothing for your money.

Conceptually, what is done is the equivalent of claiming that they put a quart of water 'packed into a pint bottle.'

Key Vitamins to Look For

Vitamin A

Vitamin A is vital for healthy vision, immune response, and skin condition. This fat-soluble vitamin exists in two forms: retinol, derived from animal products, and provitamin A carotenoids, found in plant sources like carrots and sweet potatoes.

When choosing a multivitamin, aim for a balance of these two forms. For instance, one serving of cooked carrots provides about 109% of the daily requirement for carotenoids. Retinol, on the other hand, is available in liver and dairy products.

B Vitamins

The B-complex vitamins are critical for energy production, brain health, and red blood cell formation. A complete B vitamin complex most often includes:

• B1 (Thiamine): Supports energy metabolism.

• B2 (Riboflavin): Aids in energy production and cell function.

• B3 (Niacin): Elevates cholesterol levels and improves skin health.

• B5 (Pantothenic acid): Necessary for fatty acid synthesis.

• B6 (Pyridoxine): Important for protein metabolism.

• B7 (Biotin): Enhances hair and nail health.

• B9 (Folic acid): Crucial for cell division, especially during pregnancy.

• B12 (Cobalamin): Essential for nerve function and blood production.

  
  

Select a multivitamin that offers a full spectrum of these vitamins. Research shows that B vitamins work together effectively in the body, and a deficiency in one can affect others.

Vitamin C

Vitamin C is a powerful antioxidant that boosts the immune system and improves iron absorption. It also helps synthesize collagen, which is vital for skin integrity. High-quality multivitamins should contain at least 60 mg of vitamin C, which is about 67% of the daily recommended intake for adults.

Vitamin D-3

Often referred to as the "sunshine vitamin," vitamin D is crucial for bone health and helps with calcium absorption. It also plays a role in supporting the immune system. A significant number of people experience vitamin D deficiency, particularly those who spend limited time outdoors. An effective multivitamin should provide at the very least 800 IU of vitamin D3 (cholecalciferol.)

Vitamin D-2 is not the active moiety, and must be converted to Vitamin D-3 by sunlight. We all know how unhealthy sunlight is for the skin.

(Much more on Vitamin D-3, in following Blogs)

Vitamin E

This vitamin acts as a potent antioxidant, safeguarding cells from oxidative damage. It is key to maintaining skin and eye health while supporting immune function. When choosing a multivitamin, look for natural forms like d-alpha-tocopherol.

(More on Vitamin E in following Blogs)

Vitamin	Preferred/Bioavailable Forms	Notes
Vitamin A	Retinyl palmitate + beta-carotene	Mixed forms help avoid toxicity and support antioxidant activity
Vitamin C	Ascorbic acid or buffered ascorbates (e.g., calcium ascorbate)	Buffered forms reduce GI irritation
Vitamin D	Cholecalciferol (D3)	D3 is more effective than D2 in raising serum 25(OH)D
Vitamin E	Mixed tocopherols and tocotrienols	Not just alpha-tocopherol; balance enhances antioxidant function
Vitamin K	K1 (phylloquinone) + K2 (menaquinone-7)	K2 is especially important for calcium regulation
B Vitamins	Methylated/active forms: methylcobalamin (B12), P-5-P (B6), methylfolate (B9)	Avoid folic acid and cyanocobalamin if possible—active forms bypass common polymorphisms
Biotin (B7)	Standard form is acceptable	Important for metabolic and skin/hair support
Pantothenic Acid (B5)	Calcium pantothenate or pantethine	Essential for adrenal and energy support

2. Essential Minerals (in chelated or bioavailable forms)

Essential Minerals

Calcium

Calcium is paramount for strong bones and teeth, and it also supports muscle function. Multivitamins should ideally contain around 500 mg of calcium, and twice that amount for women at risk of osteoporosis.

Magnesium

Magnesium is involved in over 300 bodily functions, including energy production and muscle contractions. It also has calming effects. A high-quality multivitamin should include magnesium in a form that is easily absorbed, such as magnesium glycinate, malate, threonate or taurate, which have been shown to have higher bioavailability rates.

Zinc

Zinc is vital for immune health and wound healing. It supports DNA synthesis and cell division. A multivitamin should contain at least 11 mg of zinc, as too little can make one more susceptible to infections. Too much zinc can cause problems. Never use the nasal inhalational zinc preparations, as they can cause permanent nerve damage to your ability to smell or taste.

Iron

Iron is essential for producing hemoglobin, which transports oxygen in the blood. Women generally need more iron than men due to menstruation. High-quality multivitamins should offer iron in forms like ferrous bisglycinate, which is known for being readily absorbed and gentle on the stomach.

Selenium

Selenium acts as an antioxidant and supports thyroid and immune function. A sufficient dose of selenium in a multivitamin, can help combat oxidative stress and enhance immune defense, and it is essential to thyroid health. Care must be taken with selenium, and I generally do not recognize using it as a single mineral product due to safety concerns.

Vanadium, Boron, Manganese and a variety of other micronutrients

Mineral	Preferred Forms	Notes
Calcium	Citrate, malate, or MCHA (microcrystalline hydroxyapatite)	Avoid carbonate unless paired with food; lower doses preferred in multivitamins
Magnesium	Glycinate, malate, citrate	Oxide has poor absorption; glycinate is gentle on GI
Zinc	Picolinate, citrate, bisglycinate	Zinc balance with copper is critical
Copper	Bisglycinate, gluconate	Avoid excess; essential for antioxidant enzymes
Selenium	Selenomethionine	Well-absorbed; supports thyroid and immune function
Chromium	Picolinate or polynicotinate	Important in glucose metabolism
Manganese	Citrate, bisglycinate	Cofactor in many enzymatic systems
Molybdenum	Glycinate	Rarely discussed but necessary for detox enzyme pathways
Iodine	Potassium iodide or kelp (standardized)	Supports thyroid health; too much can be detrimental

Down to Basics Without Iron. Very comprehensive, very inexpensive to use. Note that the daily dosage is 4 capsules to get this done. Taken 2 mornings and 2 evenings, with food.

Additional Nutrients, Generally Taken in Combination with the Multivitamin Product

Beyond the essential vitamins and minerals, there are other nutrients that can boost a multivitamin’s effectiveness:

Omega-3 Fatty Acids, EPA, DHA, ALA

Often excluded from traditional multivitamins, omega-3 fatty acids are essential for heart and brain wellness. Supplements sourced from fish oil or algae provide added health benefits, with studies showing they can reduce the risk of heart disease by up to 30%.

Coenzyme Q10

CoQ10 supports energy production in cells and contributes to heart health. Including CoQ10 in a multivitamin can enhance cardiovascular support, especially in those concerned about heart-related issues.

Probiotics

Probiotics aid gut health and support the immune system. A multivitamin that includes probiotic strains can facilitate better digestion and nutrient absorption.

Antioxidants

Adding antioxidants like lutein and zeaxanthin can enhance a multivitamin's benefits. They help combat oxidative damage and support overall well-being.

Antioxidants are not interchangeable. Each works on a specific tissue or organ or combination of tissues and organs. One is not necessarily better than the rest, as a combination of anti-oxidants is generally needed.

The Importance of Bioavailability

When selecting a multivitamin, consider the bioavailability of its nutrients. This term refers to how effectively the body can absorb and utilize a nutrient.

Many supplements include synthetic forms or those that are poorly absorbed. Superior products tend to use high-quality and bioavailable forms of nutrients. Check labels for clarity on the forms of nutrients to ensure you are making an informed decision.

Tailoring to Specific Needs

Not everyone needs the same multivitamin. Different groups have unique nutritional requirements:

• Women of Reproductive Age: May benefit from higher folic acid and iron levels to support reproductive health.

  
  

• Pregnant Women: Should look for multivitamins with extra folate (400 mcg) and DHA.

  
  

• Older Adults: May require increased levels of vitamin D (800 IU), B12 (2.4 mcg), and calcium (1,200 mg).

  
  

• Athletes: Often need extra vitamins and minerals to support energy production and recovery.

  
  

Choosing a tailored multivitamin can ensure these needs are met for optimal health.

Potential Risks of Overconsumption

While multivitamins are beneficial, taking excessive amounts can lead to toxicity. Fat-soluble vitamins (A, E, and K) can accumulate in the body and cause harm if not managed properly.

Before starting any supplement, especially for pregnant or nursing mothers or individuals with specific health concerns, consult a healthcare professional.

Making the Right Choice for Your Health

Choosing a multivitamin and mineral supplement involves understanding which essential vitamins and minerals are necessary for your health. A top-quality multivitamin should list a range of nutrients, prioritize bioavailability, and cater to individual needs.

As you explore ways to support your health through supplementation, focus on quality ingredients and informed choices. This knowledge will help pave the way for achieving optimal well-being.

Generally speaking, the older you are, the greater the mineral needs become. In my patient population, I tailor the additional nutraceuticals based on age, gender, disease state and performance needs.

I start with Down to Basics (with/without) Iron. The 'with iron' product is used in females of menstrual age or if anemia is present. Two capsules twice daily with food.

For patients over 50 years of age, I add 1 capsule twice daily to the regular dosage of Down to Basics

To that, I may add 'Magic Minerals,' one capsule twice daily to ensure an adequate amount of zinc, selenium, vanadium and chromium.

For patients with insulin resistance, diabetes or pre-diabetes, I add Diabet Stat, 1 capsule twice daily to the regimen.

If a patient is diabetic, insulin resistant or obese, I will add 'Diabet Stat,' one capsule twice daily to lower blood sugar, lower insulin and reduce weight.

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David S. Klein, MD FACA FACPM

David S. Klein, MD, FACA, FACPM

1917 Boothe Circle, Suite 171

Longwood, Florida 32750

Tel: 407-679-3337

Fax: 407-678-7246

www.suffernomore.com

David S. Klein, MD Functional Medicine Physician

Exploring the Diverse World of Magnesium Chelates and Products: Pros and Cons Unveiled. Choose Intelligently

Magnesium is an essential mineral that plays a vital role in many bodily functions. It helps with muscle and nerve function, regulates blood sugar, and controls blood pressure. With more people learning about its health benefits, magnesium products are gaining popularity. In this post, we will look at various types of magnesium supplements, highlighting their advantages and disadvantages to help you make informed choices about which one might be right for you.

In the context of nutrition, a 'mineral' is an elemental substance, an inorganic moiety that joins with a protein as an enzyme cofactor or as a structural portion of the protein.

As an enzyme co-factor, it is thought that magnesium participates as an essential component in over 300, perhaps as many as 400 different chemical processes in the body, essential to life and health. Deficiencies in magnesium, ranging from mild to profound, have a remarkably variable set of symptoms, but a simple blood study can shed light on a person's 'magnesium status.' Magnesium deficiency may be the most prevalent of the nutritional deficiency states, but it is by no means the only one. For most persons, it is most practical to use a thoughtful mixture of magnesium chelates, as they subtly differ in over all absorption and collateral benefits.

This is a balanced mineral chelate, created as a maintenance product. It is remarkably inexpensive and yet provides the largest part of our daily mineral needs.

Why are so many of us magnesium deficient?

Magnesium deficiency may be a problem in as many as 30% of the United States Population. Why is this? Magnesium is an element, and as such, it is neither created nor destroyed. It is either present in the soil in generous amounts, or it may be entirely deficient. The fruits and vegetables that we eat may not give us an adequate amount of magnesium as it was not in the soil in generous concentrations, therefor the plants that we eat will not deliver us this nutrient.

Magnesium deficiency is extremely common. When it comes to magnesium chelates, you much choose intelligently and wisely.

If Magnesium is not in the soil, it will not make it into your digestive tract. Much of our farmland has found itself depleted of micronutrients, and this leads us to the question: "Why do we need to supplement our food with vitamins, minerals and such?"

The food that we eat is harvested from fields that are largely deficient in a variety of micronutrients.

The fun begins with understanding the problem and then choosing the most effective and affordable approach to correcting the deficiency. Again, selection is based on desired 'side-effect.' As an example, "Sedation is a problem for one person, it is a sleep medicine for the next. Constipation might be reasonable for one person, but loose stools may be desired for the next."

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Types of Magnesium Chelates from which to choose

1. Magnesium Citrate

Magnesium citrate is among the most common magnesium supplements. It's formed by combining magnesium with citric acid, which may enhance absorption in the body.

Best used to treat constipation, Magnesium Citrate has been used for years as part of Colon Preparations for colonoscopy and bowel surgery.

This form is particularly known for its laxative effects, making it beneficial for those facing constipation. While this is helpful, it may not suit individuals who do not require this effect.

Additionally, magnesium citrate can also improve sleep quality and aid muscle relaxation. In fact, 70% of users report better sleep after taking it. Over all, Magnesium Citrate is best used as a laxative, and not as a supplemental source of Magnesium.

Advantages

• High Absorption Rate: Its bioavailability means your body absorbs it more effectively than some other forms.

  
  

• Magnesium Citrate is very, very cheap.

  
  

Disadvantages

• Potential Diarrhea: Some people may experience diarrhea or discomfort due to its laxative properties.

  
  

• Taste: The flavor might be unappealing to some users, making it harder to incorporate into their routine.

  
  

2. Magnesium Glycinate

Magnesium glycinate is made by combining magnesium with glycine, an amino acid known for calming effects.

Magnesium glycinate , magnesium malate and magnesium taurate in a balanced mixture. This is our 'go-to' product for additional magnesium supplementation.

This form is highly bioavailable and gentle on the stomach, appealing to those with digestive sensitivities.

Advantages

• Calm and Relaxation: Users claim it reduces anxiety, helping to improve sleep quality. For example, a study reported that 80% of participants felt less anxious after taking magnesium glycinate.

  
  

• Gentle on Stomach: It is less likely to irritate the digestive system compared to other forms.

  
  

• Better Absorption: Glycine enhances its absorption, making it effective even in smaller doses.

  
  

Disadvantages

• Cost: It tends to be pricier than other types of magnesium supplements.

  
  

• Overdose Risk: Large doses can still cause stomach issues, though this is less common.

  Follow instructions, Magnesium Glycinate is the over-all best choice in Magnesium Chelates for the vast majority of patients.

• 
  

3. Magnesium Oxide

Magnesium oxide is one of the most widely available forms. It combines magnesium with oxygen and offers a high magnesium content per dose. For most people, it is a simple waste of money at best, and at worst, it blocks the uptake of other nutrients.

However, its absorption rate is lower than that of citrate or glycinate, which may limit its effectiveness. Magnesium Oxide is essentially 'magnesium rust.' This is the cheapest magnesium and it is found in the 'low end' vitamin and mineral supplements.

Advantages

• It is cheap.

  
  

Disadvantages

• Lower Absorption: It has less bioavailability, making it potentially less effective for some people.

  
  

• Gastrointestinal Issues: There may still be digestive discomfort, including cramping, and loose bowel movements.

  
  

4. Magnesium Malate

Sometimes it is easier and acceptable to use a vitamin/mineral combination. Understand that it is impossible to pound an adult dosage into a single 'once daily' tablet or capsule. This product must be taken 2 capsules twice daily to 'get what you need.'

Magnesium malate combines magnesium with malic acid, which is known to support energy production.

Advantages

• Energy Production: Research shows it may enhance energy metabolism, making it particularly beneficial for individuals suffering from fatigue, with some reporting an energy boost of up to 50%.

  
  

• Gentle on the Stomach: Magnesium malate is generally well tolerated and has fewer digestive issues.

  
  

• Muscle Function: It may support muscle recovery, which can be particularly helpful after workouts. This is the best choice for magnesium supplementation in the patient with fibromyalgia or other muscular disorders.

  
  

Disadvantages

• Taste: It may not have the best flavor, similar to magnesium citrate.

  
  

• Limited Availability: It might not be as readily found in all stores compared to more common types.

  
  

5. Magnesium Taurate

Magnesium taurate pairs magnesium with taurine, an amino acid beneficial for heart health.

Advantages

• Heart Health: This form may help in maintaining healthy blood pressure and overall cardiovascular wellness, with studies showing reductions of up to 10% in some cases.

  
  

• Calming Effects: Taurine can offer additional calming benefits, which may help alleviate anxiety symptoms.

  
  

• Well-Absorbed: It is generally well-absorbed by the body.

  
  

Disadvantages

• Higher Cost: Combining magnesium with taurine can raise the price.

  
  

• Less Common: This form may be tougher to find in ordinary retail stores.

Advantages of Magnesium Threonate

If cognitive dysfunction is part of the clinical presentation, we will add two capsules of this product to the daily regimen. It is not used for routine preventive nutritional supplementation.

1. Enhanced CNS Penetration:

   
   

   • Magnesium L-threonate is distinguished by its superior ability to cross the blood–brain barrier. This was demonstrated in preclinical studies (e.g., Li et al., Neuron, 2010), which showed significant elevation of brain magnesium levels compared to other magnesium salts.

   • This is particularly relevant since CNS magnesium concentration appears to correlate with synaptic plasticity and cognitive performance.

     
     

2. Cognitive Benefits:

   
   

   • Preliminary animal and limited human data suggest it may enhance working memory, learning, and executive function—especially in aging populations.

   • A 2016 human study (Liu et al., J Alzheimers Dis) found that magnesium L-threonate improved cognitive measures in older adults with mild cognitive impairment over a 12-week period.

     
     

3. Neuroprotective Potential:

   • Animal studies have shown effects on synaptic density and long-term potentiation (LTP), possibly offering protective effects against neurodegenerative processes.

     
     

4. Reduced Gastrointestinal Distress:

   
   

   • Compared to other magnesium forms (e.g., oxide, citrate), L-threonate tends to be better tolerated gastrointestinally, with a lower incidence of diarrhea or cramping.

     
     

Disadvantages of Magnesium Threonate

1. Cost and Accessibility:

   
   

   • It is significantly more expensive than standard forms of magnesium such as glycinate, citrate, or oxide, making it less accessible for long-term use.

     
     

2. Limited Magnesium Content:

   
   

   • Magnesium L-threonate provides a relatively low elemental magnesium yield per dose (~7–10%), meaning higher doses are required to match the systemic repletion effects of other salts.

     
     

3. Sparse Clinical Evidence:

   
   

   • While promising, human studies remain sparse and often industry-funded. Larger, long-term, independently-funded RCTs are lacking.

     
     

   • The enthusiasm is largely extrapolated from rodent studies and limited human trials.

     
     

4. Uncertain Effects on Systemic Magnesium Deficiency:

   
   

   • It may not be the ideal choice for addressing frank systemic hypomagnesemia (e.g., in cardiovascular or metabolic disorders), given its low elemental magnesium and CNS-targeted absorption.

   • It is best used in addition to a magnesium glycinate/taurate/malate product, essentially as a source of Threonine (beneficial in the treatment of age-related cognitive dysfunction, memory issues and dementia.

     
     

5. Potential for Overstated Claims:

   
   

   • Due to its novelty and market positioning as a “brain supplement,” some claims around its nootropic effects may outpace current empirical support.

   • That is, keep an 'open mind,' as anecdotal reports observe beneficial response in a significant number of patients being given this supplement.

     
     

Conclusion

Magnesium L-threonate holds potential as a CNS-targeted magnesium supplement, particularly in contexts where cognitive support or neuroprotection is the aim. However, for general magnesium repletion or metabolic support, more cost-effective and well-studied alternatives may be preferable.

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Choosing the Right Magnesium Chelate. Choose intelligently.

When selecting the right magnesium product, consider your health goals and how your body responds. Here are a few tips:

• Health Goals: Identify your main reason for taking magnesium. If relaxation and sleep are your goals, magnesium glycinate might be ideal. For energy support, magnesium malate could be more suitable.

• Digestive Sensitivity: If you've experienced stomach issues with other forms, opt for magnesium glycinate or malate.

  
  

• Budget: If cost matters, magnesium oxide is usually the most affordable option, even if it provides the poorest quality option.

  
  

• Availability: Make sure to check local stores or online options, as some forms may be less accessible.

  
  

Final Thoughts

Magnesium plays a crucial role in maintaining health and wellness. With various forms available, each with unique benefits and drawbacks, it is essential to research before making your choice.

Whether you want to improve sleep, energy levels, or digestive health, there is a magnesium supplement that can help. Always consult a healthcare professional before starting any new supplement to ensure it aligns with your health needs and medication interactions.

By understanding magnesium products better, you can make proactive choices that positively impact your health and overall well-being.

References:

1. Walker, A. F., Marakis, G., Christie, S., & Byng, M. (2003). Magnesium supplementation alleviates premenstrual symptoms of fluid retention. Journal of Women's Health & Gender-Based Medicine, 12(4), 389-397. This study demonstrated that magnesium supplementation, particularly in chelated forms, effectively reduced premenstrual fluid retention symptoms.​

   
   

2. Rosanoff, A., Weaver, C. M., & Rude, R. K. (2012). Suboptimal magnesium status in the United States: Are the health consequences underestimated? Nutrition Reviews, 70(3), 153-164. The authors discuss the prevalence of magnesium deficiency and highlight the superior absorption of magnesium chelates over inorganic salts.​

   
   

3. Coudray, C., Rambeau, M., Feillet-Coudray, C., Tressol, J. C., Demigné, C., Gueux, E., & Rayssiguier, Y. (2005). Study of magnesium bioavailability from ten organic and inorganic Mg salts in Mg-depleted rats using a stable isotope approach. Magnesium Research, 18(4), 215-223. This research compared the bioavailability of various magnesium salts, finding that organic chelates had higher absorption rates.​

   
   

4. Lindberg, J. S., Zobitz, M. M., Poindexter, J. R., & Pak, C. Y. (1990). Magnesium bioavailability from magnesium citrate and magnesium oxide. Journal of the American College of Nutrition, 9(1), 48-55. The study concluded that magnesium citrate, an organic chelate, has superior bioavailability compared to magnesium oxide.​

   
   

5. Schuette, S. A., Lashner, B. A., & Janghorbani, M. (1994). Bioavailability of magnesium diglycinate vs magnesium oxide in patients with ileal resection. Journal of Parenteral and Enteral Nutrition, 18(5), 430-435. This clinical trial demonstrated that magnesium diglycinate, a chelated form, had better absorption in patients with compromised intestinal function.​

   
   

6. Firoz, M., & Graber, M. (2001). Bioavailability of US commercial magnesium preparations. Magnesium Research, 14(4), 257-262. The authors evaluated various magnesium supplements and found that chelated forms had higher bioavailability.​

   
   

7. Ranade, V. V., & Somberg, J. C. (2001). Bioavailability and pharmacokinetics of magnesium after administration of magnesium salts to humans. American Journal of Therapeutics, 8(5), 345-357. This review highlights the enhanced bioavailability of magnesium chelates compared to inorganic salts.​

   
   

8. Altura, B. M., & Altura, B. T. (1999). Association of magnesium and calcium deficiencies with cardiovascular disease: The magnesium hypothesis revisited. Journal of the American College of Nutrition, 18(3), 240-246. The paper discusses the role of magnesium, particularly in bioavailable forms like chelates, in cardiovascular health.​

   
   

9. Sabatini, S., & De Sole, P. (2008). Magnesium and osteoporosis: Current state of knowledge and future research directions. World Journal of Orthopedics, 9(3), 65-76. The authors review the importance of magnesium, especially chelated forms, in bone health and osteoporosis prevention.​

   
   

10. Rude, R. K., Gruber, H. E., & Wei, L. Y. (2006). Magnesium deficiency: Effect on bone and mineral metabolism in the mouse. Calcified Tissue International, 79(4), 255-261. This study indicates that magnesium deficiency adversely affects bone health and suggests that chelated supplements may be beneficial.​

    
    

11. Abbasi, B., Kimiagar, M., Sadeghniiat, K., Shirazi, M. M., Hedayati, M., & Rashidkhani, B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of Research in Medical Sciences, 17(12), 1161-1169. The trial found that magnesium supplementation, particularly in bioavailable forms, improved sleep quality in elderly individuals.

    
    

12. Barbagallo, M., & Dominguez, L. J. (2010). Magnesium and aging. Current Pharmaceutical Design, 16(7), 832-839. The authors discuss the role of magnesium, especially chelated forms, in mitigating age-related health issues.​

    
    

13. Mason, B. A., & Weaver, C. M. (2002). Magnesium supplementation and blood pressure in borderline hypertensive subjects: A pilot study. Journal of the American College of Nutrition, 21(1), 44-48. This pilot study suggests that magnesium chelate supplementation may help in managing borderline hypertension.​

    
    

14. Guerrera, M. P., Volpe, S. L., & Mao, J. J. (2009). Therapeutic uses of magnesium. American Family Physician, 80(2), 157-162. The article reviews various therapeutic applications of magnesium, highlighting the efficacy of chelated forms.​

    
    

15. Schwalfenberg, G. K., & Genuis, S. J. (2017). The importance of magnesium in clinical healthcare. Scientifica, 2017, 4179326. The review emphasizes the clinical significance of magnesium and the superior absorption of chelated supplements.​

    
    

16. Rosanoff, A. (2010). Rising Ca:Mg intake ratio from food in USA adults: A concern? Magnesium Research, 23(4), S181-S193. The paper discusses dietary imbalances and suggests chelated magnesium supplements as a corrective measure.

    
    

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David S. Klein, MD FACA FACPM

David S. Klein, MD, FACA, FACPM

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David S. Klein, MD Functional Medicine Physician