The relevance of magnesium homeostasis in COVID-19

Abstract

Purpose: In less than one and a half year, the COVID-19 pandemic has nearly brought to a collapse our health care and economic systems. The scientific research community has concentrated all possible efforts to understand the pathogenesis of this complex disease, and several groups have recently emphasized recommendations for nutritional support in COVID-19 patients. In this scoping review, we aim at encouraging a deeper appreciation of magnesium in clinical nutrition, in view of the vital role of magnesium and the numerous links between the pathophysiology of SARS-CoV-2 infection and magnesium-dependent functions.

Methods: By searching PubMed and Google Scholar from 1990 to date, we review existing evidence from experimental and clinical studies on the role of magnesium in chronic non-communicable diseases and infectious diseases, and we focus on recent reports of alterations of magnesium homeostasis in COVID-19 patients and their association with disease outcomes. Importantly, we conduct a census on ongoing clinical trials specifically dedicated to disclosing the role of magnesium in COVID-19.

Results: Despite many methodological limitations, existing data seem to corroborate an association between deranged magnesium homeostasis and COVID-19, and call for further and better studies to explore the prophylactic or therapeutic potential of magnesium supplementation.

Conclusion: We propose to reconsider the relevance of magnesium, frequently overlooked in clinical practice. Therefore, magnesemia should be monitored and, in case of imbalanced magnesium homeostasis, an appropriate nutritional regimen or supplementation might contribute to protect against SARS-CoV-2 infection, reduce severity of COVID-19 symptoms and facilitate the recovery after the acute phase.

Keywords: Aging; Chronic non-communicable diseases; Immune response; Long COVID; Magnesemia; SARS-CoV-2.

Fig. 1

How magnesium might contribute to protecting against COVID-19. Magnesium modulates innate and adaptive immunity and gut microbiota composition, and is essential for Vitamin D activation and its consequent anti-inflammatory activity. Crucial steps of SARS-CoV-2 infection might be directly affected by magnesium

Fig. 2

How magnesium deficiency might contribute to the long COVID-19 syndrome. Among the symptoms of post-acute COVID-19 syndrome summarized in the figure, many are often associated to hypomagnesaemia, i.e., muscular-related symptoms, pulmonary distress, neurologic and behavioral disorders, some arrhytmias, hypercoagulation disorders. These symptoms may benefit from a magnesium-rich diet or, if necessary, magnesium supplementation. PTSD Post Traumatic Stress Disorders, including physical, cognitive, and psychiatric symptoms