Inulin significantly improves serum magnesium levels in proton pump inhibitor-induced hypomagnesaemia

Background Proton pump inhibitors (PPI) are among the most widely prescribed drugs to treat gastric acid-related disorders. PPI-induced hypomagnesaemia, a defect in intestinal absorption of Mg2+, can be a severe side effect of chronic PPI use. Aim To restore serum Mg2+ concentrations in PPI-induced hypomagnesaemia patients by dietary supplementation with inulin fibres. Methods Eleven patients with PPI-induced hypomagnesaemia and 10 controls were treated with inulin (20 g/day). Each trial consisted of two cycles of 14-day inulin treatment followed by a washout period of 14 days. Patients continued to use their PPI. Serum Mg2+ levels served as the primary endpoint. Results Inulin significantly enhanced serum Mg2+ levels from 0.60 to 0.68 mmol/L in PPI-induced hypomagnesaemia patients, and from 0.84 to 0.93 mmol/L in controls. As a consequence 24 h urinary Mg2+ excretion was significantly increased in patients with PPI-induced hypomagnesaemia (0.3-2.2 mmol/day). Symptoms related to hypomagnesaemia, including muscle cramps and paraesthesia, were reduced during intervention with inulin. Conclusion Inulin increases serum Mg2+ concentrations under PPI maintenance in patients with PPI-induced hypomagnesaemia.