Could Low Macrominerals Be Causing Your Symptoms? - Dr. Michael Ruscio, DC

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Could Low Macrominerals Be Causing Your Symptoms?

Healthy Macromineral Levels Support Important Day-to-Day Functions

Key Takeaways:

  • Macrominerals are essential dietary minerals that are required by our body in fairly large amounts in order for us to function well on a daily basis.
  • The most common macromineral deficiencies in adults and kids are calcium, potassium, and magnesium, as they are lacking in the standard American diet.
  • The most common symptoms of macromineral deficiencies are dizziness, fatigue, shakiness, and muscle cramping in relation to low potassium and magnesium, and low bone density and frequent bone fractures due to low calcium. 
  • Removing inflammatory foods such as gluten and dairy, while increasing nutrient-dense whole foods like colorful vegetables can help support proper macromineral levels.
  • Long-distance running, living in hot climates, pregnancy and lactation, or a poor diet can all create a need for supplemental macrominerals.

There are some essential minerals that we need to function well on a daily basis such as (but not limited to) magnesium, calcium, and sodium. If you are low in these major minerals, you may experience symptoms or illnesses such as dizziness, fatigue, and osteoporosis. 

Fortunately, there are some simple ways to improve macromineral levels through daily lifestyle changes such as decreasing processed foods, increasing whole foods of meats and veggies, and improving your gut health. Some groups of people may need additional supplementation, such as people with POTS (postural orthostatic tachycardia syndrome) or athletes with a heavy training load.     



In this article, we will take a look at which macrominerals are most often too low, what problems they might cause, and how to make sure you are getting enough of them so you can start feeling better. 

What are Macrominerals?

Macrominerals, according to the National Institutes of Health, are any essential dietary minerals we require in fairly large amounts relative to trace minerals (microminerals). The main dietary minerals we need in large amounts are calcium, phosphorus, magnesium, sodium, potassium, and chloride. These are needed in larger amounts than microminerals and trace elements such as fluoride, selenium, chromium, molybdenum, and manganese.

Why are these macrominerals so important? They are needed to support many essential functions of the body on a daily basis. 

In fact, you will recognize these macrominerals as you have probably heard of them in relation to either bone strength, heart health, or electrolyte balance. 

MacromineralsRequired for [1]
CalciumHealthy teeth and bones, nerve impulses, nerve function, muscle contractions, blood clotting, energy production, immune system health
PhosphorusBone strength, cell functions and membranes 
MagnesiumMost bodily processes, glucose use, DNA and protein synthesis, cell energy
SodiumWater balance in tissues
PotassiumMajor bodily processes, muscle contractions, nerve impulses, nerve function, DNA and protein synthesis, cell energy
ChlorideBalancing body fluids and electrolytes, component of digestive juices

The most common macrominerals adults and children are deficient in are [2, 3, 3]:

  • Calcium
  • Potassium
  • Magnesium
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The standard American diet, which is high in processed foods and sugar and low in fruits and vegetables, is especially low in calcium, potassium, and magnesium [2, 3]. This makes these the most common macromineral deficiencies. Conversely, we tend to take in macrominerals like phosphorus in excess, due to its presence in baked goods, soda beverages, and red meat [4]. 

A quick note: Because the term “macros” has been everywhere in the health space recently, It is easy to confuse the terms macrominerals with macronutrients. Macronutrients are essential nutrients that we need in large amounts in order to function, rather than essential minerals. The three macronutrients are carbohydrates, protein, and fat. 

In the next section, we will talk about the symptoms you may experience in your daily life if your macromineral levels are too low. 

Symptoms of Macromineral Deficiency

Without macrominerals Young Woman Feels Like She Is Going To Faint Stock Photo – Download Image Now – Dizzy, Vertigo, Out of Breath – iStockwe simply cannot function, and low levels can greatly hinder your health. 

Probably the most common manifestation of a macromineral deficiency people know about is having an electrolyte imbalance. Electrolytes not only reflect and regulate proper hydration levels in your body but also maintain muscle and nervous system function [5]. 

The most likely reason for low electrolytes is dehydration. Dehydration occurs when you have water loss and some combination of altered potassium, chloride, magnesium, and/or sodium levels. Some common symptoms of dehydration/ an electrolyte imbalance are dizziness, fainting, shakiness, muscle fatigue, and nausea [6].

When mentioning low electrolytes, it’s helpful to say here that some people have a condition called POTS (postural orthostatic tachycardia syndrome) which often comes with chronically low sodium and other electrolytes. [7] These persistent electrolyte imbalances disrupt the fluid balance in the body causing low blood pressure, headaches, shakiness, and fatigue.

Calcium is another macromineral that is also often low, and you may not find out until you’re diagnosed with osteoporosis or low bone density. Although, many people also experience bone pain, bone fractures, muscle cramps, reduced cognition, and/or numbness and tingling.

If concerned about your macromineral levels, you can check them at home:

  1. Keep track of your food and beverage intake over a typical 24-hour period [8]. (There are apps that can help with this like MyFitnessPal or ViCa Vitamin Tracker.) 
  2. Once you have a list of what and how much you consumed, you can look up each item and quantity in a reliable food composition database [9], such as the USDA’s FoodData Central [10]. 
  3. Then add up your macrominerals. (Or the apps will do this for you.) 
  4. Lastly, compare your macromineral amounts to the recommended daily amounts in the table below.

All of your macrominerals can also be checked with a simple blood draw, and if you have any of the symptoms above, this will probably be the first thing your doctor will check. Below is a comprehensive table that covers many of the symptoms of a macromineral deficiency.

Macromineral [11]Required Dietary Allowance (RDA) or Adequate Intake (AI) per day for adults [11]Signs of chronic inadequate macromineral intakeWhole foods rich in macromineral [11]
Calcium1,000 mgOsteoporosis, rickets, and bone pain or fractures with muscle weakness [12]Milk products, legumes, shellfish, sardines with bones, and vegetables
Magnesium400 mgLoss of appetite, nausea, vomiting, fatigue, weakness, numbness, tingling, muscle cramps, seizures, personality shifts, abnormal heartbeat [13]Fruits, veggies, whole grains, legumes, nuts, dairy products, and meat
Potassium4,700 mgHigh blood pressure, kidney stones, low bone mass [14]Fruits and veggies 
Chloride1,500 mgSymptoms are unlikely, but may include:recurrent vomiting, diarrhea, fatigue, weakness, dehydration, trouble breathing [15]Foods with table salt 
Phosphorus (phosphates)700 mgSymptoms are unlikely, but may include:loss of appetite, anemia, muscle weakness, rickets, bone pain or fractures [16]Dairy products, meat, and poultry
Sodium1,500 mgNausea, vomiting, headache, confusion, fatigue, restlessness, irritability, muscle weakness, seizures [17]Salt, meat, milk, eggs, and veggies 

Natural Ways to Increase Macrominerals

Optimizing your macromineral status all starts with changing your diet and healing your gut. Fortunately, there is an easy way to improve your levels of these major minerals — with whole foods, particularly dairy products, fruits, and vegetables.   

As you can see from the list above, of foods rich in different macrominerals, eating a whole-food diet of a variety of foods is a good way to support your macromineral levels. While some processed foods and cereals have added minerals, eating a variety of fresh, whole foods is a more desirable option. 

At the clinic, we often start with a Paleo diet which removes inflammatory foods such as grains, gluten, and processed foods, and encourages a variety of meat, vegetables, and healthy fats.

We also look at gut health when improving macromineral levels. In particular, making sure you are not low in stomach acid is helpful because low stomach acid can impair the absorption of calcium and magnesium [18]. A common reason for low stomach acid is gastritis (inflammation of the gut) and acid-blocking medications. 
Better gut health through an improved diet and often probiotics will decrease gut inflammation and, in turn, support better absorption of macrominerals.

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Should You Take Supplemental Macrominerals?

But what if diet is not enough? 

Fortunately, for most people, diet will be enough to improve macromineral levels. However, there are some times when it may not be enough to boost the amount of minerals in your body. 

In general, if you have found that your diet has a low mineral content and/or you have an increased nutrient requirement (like during pregnancy), you can also increase your macromineral levels by taking a multivitamin-multimineral supplement that contains the full spectrum of micronutrients [19, 20, 21]. 

However, if you know or suspect that you are low in only one macromineral, such as magnesium or potassium, supplementing with just that nutrient may make more sense. You are more likely to get a therapeutic dose and, especially if you eat a nutrient-dense diet, taking a multivitamin could put you over the levels needed for other vitamins and minerals. 

While this typically isn’t a problem, if you overdo it by too much for too long, you can start to experience unwanted side effects or toxicity.

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If you are unable to eat foods high in calcium such as milk products (often due to lactose intolerance) or fish, and/or if you are low in vitamin D, you may want to consider supplementation that can help with calcium levels. 

In general, calcium supplementation alone is not as effective at improving bone density and reducing fractures as we think it is [22]. If you cannot eat calcium-containing foods, you may want to talk to your doctor before taking a calcium supplement. However, when truly indicated, calcium is best absorbed when combined with vitamins D and K, so a combination of supplements is probably your best option to support the calcium levels your body needs.  

Vitamin D is important in bone health because it promotes calcium absorption from the gut [23]. A large study of 10,000 older adults showed that vitamin D and calcium supplementation resulted in a 16% reduction in bone fractures [24]. When possible, the best way to support Vitamin D levels is with 15-20 minutes of sun exposure daily.

Do We Need Extra Electrolytes?

There are a few reasons why someone might use an electrolyte supplement mix. 

Athletes or those who lose a lot of electrolytes through sweating and muscle use may need additional electrolytes on heavy workout days. Regular runners, sauna users, and those who live in hot climates also fall into this category and may benefit from supplemental electrolytes. In these cases, a good electrolyte mix such as LMNT can be a great way to start to feel better. 

As previously discussed, people with POTS often need supplemental electrolytes because they tend to have low sodium levels. They too can use an electrolyte mix, but some people, with severe symptoms of POTS may have a port or PICC line (which provides direct access to larger veins) put in so they can get intravenous saline (sodium). 

For supplementation of macrominerals, especially if you are having severe symptoms, work with your doctor to get your levels checked so you know what supplementation will be best for you. 

Supporting Macromineral Levels for Better Health

Macrominerals support the daily functioning of our brain and body. When we do not have enough of them, we may struggle to get through the day with fatigue, headaches, and shakiness, or we could have more severe symptoms over time.

Because the standard American diet is low in some of our essential macrominerals like calcium and magnesium, it is important to improve the quality of your food as your first step to restoring nutrient levels.   

A varied, whole-food diet including meat, fish, and a variety of colorful vegetables is the best way to support your macromineral levels and improve any gut health issues that may be leading to poor nutrient absorption. Consider adding in some dairy (if you can tolerate it) and fish with the bone in, such as canned sardines, for calcium. Be sure to fill at least half of your plate at each meal with veggies for your other macrominerals. 

You can check the levels of macrominerals in your diet by recording what you eat and drink to get an estimated daily level. If your levels appear to be low, you can add in a multivitamin or individual supplement, which is generally safe to take long-term. To be safe, do not exceed the recommended daily limits of all nutrients, including macrominerals for an extended period of time [21].

If you have severe or chronic symptoms of low macrominerals, you should want to get your levels checked by your doctor. If you have been having a variety of symptoms and you are not sure if your macrominerals are balanced and you would like some support, we would be happy to help you at our functional medicine clinic.  

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Minerals: What They Do, Where to Get Them | Texas Heart Institute [Internet]. [cited 2022 Sep 7]. Available from: https://www.texasheart.org/heart-health/heart-information-center/topics/minerals-what-they-do-where-to-get-them/
  2. Home | Dietary Guidelines for Americans [Internet]. [cited 2022 Jan 7]. Available from: https://dietaryguidelines.gov/
  3. Blumberg JB, Frei BB, Fulgoni VL, Weaver CM, Zeisel SH. Impact of Frequency of Multi-Vitamin/Multi-Mineral Supplement Intake on Nutritional Adequacy and Nutrient Deficiencies in U.S. Adults. Nutrients. 2017 Aug 9;9(8). DOI: 10.3390/nu9080849. PMID: 28792457. PMCID: PMC5579642.
  4. Uribarri J, Calvo MS. Hidden sources of phosphorus in the typical American diet: does it matter in nephrology? Semin Dial. 2003 Jun;16(3):186–8. DOI: 10.1046/j.1525-139x.2003.16037.x. PMID: 12753675.
  5. What are Electrolytes? | Cedars-Sinai [Internet]. [cited 2021 Aug 19]. Available from: https://www.cedars-sinai.org/blog/electrolytes.html
  6. El-Sharkawy AM, Sahota O, Lobo DN. Acute and chronic effects of hydration status on health. Nutr Rev. 2015 Sep;73 Suppl 2:97–109. DOI: 10.1093/nutrit/nuv038. PMID: 26290295.
  7. Benarroch EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc. 2012 Dec;87(12):1214–25. DOI: 10.1016/j.mayocp.2012.08.013. PMID: 23122672. PMCID: PMC3547546.
  8. 24-hour Dietary Recall (24HR) | INDDEX Project [Internet]. [cited 2022 Sep 9]. Available from: https://inddex.nutrition.tufts.edu/data4diets/data-source/24-hour-dietary-recall-24hr
  9. Food Composition Databases | INDDEX Project [Internet]. [cited 2022 Sep 9]. Available from: https://inddex.nutrition.tufts.edu/node/204
  10. FoodData Central [Internet]. [cited 2021 Oct 14]. Available from: https://fdc.nal.usda.gov/ndb/nutrients/report?nutsort=608&max=25&offset=0&nutrient1=610&nutrient2=609&nutrient3=608&measureby=g&subset=0&sort=c&totCount=6323
  11. Morris AL, Mohiuddin SS. Biochemistry, Nutrients. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 32119432.
  12. Calcium – Consumer [Internet]. [cited 2022 Feb 2]. Available from: https://ods.od.nih.gov/factsheets/Calcium-Consumer/
  13. Magnesium – Consumer [Internet]. [cited 2021 Jun 28]. Available from: https://ods.od.nih.gov/factsheets/Magnesium-Consumer/
  14. Potassium – Consumer [Internet]. [cited 2021 Jun 28]. Available from: https://ods.od.nih.gov/factsheets/Potassium-Consumer/
  15. Chloride Blood Test: MedlinePlus Medical Test [Internet]. [cited 2022 Sep 9]. Available from: https://medlineplus.gov/lab-tests/chloride-blood-test/
  16. Phosphorus – Consumer [Internet]. [cited 2022 Sep 9]. Available from: https://ods.od.nih.gov/factsheets/Phosphorus-Consumer/
  17. Hyponatremia – Symptoms and causes – Mayo Clinic [Internet]. [cited 2022 Sep 9]. Available from: https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711
  18. Chubineh S, Birk J. Proton pump inhibitors:  the good, the bad, and the unwanted. South Med J. 2012 Nov;105(11):613–8. DOI: 10.1097/SMJ.0b013e31826efbea. PMID: 23128806.
  19. Blumberg JB, Cena H, Barr SI, Biesalski HK, Dagach RU, Delaney B, et al. The use of multivitamin/multimineral supplements: A modified delphi consensus panel report. Clin Ther. 2018 Apr;40(4):640–57. DOI: 10.1016/j.clinthera.2018.02.014. PMID: 29573851.
  20. Zhang FF, Barr SI, McNulty H, Li D, Blumberg JB. Health effects of vitamin and mineral supplements. BMJ. 2020 Jun 29;369:m2511. DOI: 10.1136/bmj.m2511. PMID: 32601065. PMCID: PMC7322674.
  21. Blumberg JB, Bailey RL, Sesso HD, Ulrich CM. The Evolving Role of Multivitamin/Multimineral Supplement Use among Adults in the Age of Personalized Nutrition. Nutrients. 2018 Feb 22;10(2). DOI: 10.3390/nu10020248. PMID: 29470410. PMCID: PMC5852824.
  22. Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Burckhardt P, Li R, Spiegelman D, et al. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007 Dec;86(6):1780–90. DOI: 10.1093/ajcn/86.5.1780. PMID: 18065599.
  23. Fischer V, Haffner-Luntzer M, Amling M, Ignatius A. Calcium and vitamin D in bone fracture healing and post-traumatic bone turnover. Eur Cell Mater. 2018 Jun 22;35:365–85. DOI: 10.22203/eCM.v035a25. PMID: 29931664.
  24. Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res. 2004 Mar;19(3):370–8. DOI: 10.1359/JBMR.0301240. PMID: 15040824.

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