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Magnesium Deficiency Questionnaire


Circle each yes answer which is given a numerical value.

When you finish, total your score.



2 Under excessive emotional stress

3 Irritable, or easily provoked to anger

2 Restless, or hyperactive

4 Easily startled by sounds or lights

2 Difficulty sleeping

3 Chronic headaches or migraines

2 Convulsions

3 Fine tremor or shakiness in your hands

3 Fine, barely noticeable muscle twitching around your eyes, facial muscles, or

other muscles of your body

3 Muscle cramps

3 Muscle spasms in hands or feet

4 Gag or choke from spasms in your oesophagus

3 Have asthma or wheezing

2 Suffer from emphysema, chronic bronchitis, or shortness breath

5 Have osteoporosis

3 Have you ever had a kidney stone

2 Suffer from chronic kidney disease

4 Have diabetes

3 Have an overactive thyroid, or parathyroid gland

3 Have high blood pressure

4 Have mitral valve prolapse (“floppy heart valve”)

3 Have very fast heart beats, irregular heart beats, or arrhythmia

3 Take Digitalis (Digoxin)

5 Take any kind of diuretic

5 Recent radiation therapy or exposure

4 Have more than 7 alcohol drinks weekly

3 Have you ever had a drinking problem?

2 Have more than 3 servings of caffeine daily

2 Eat sugar containing food daily

2 Crave carbohydrates &/or chocolate

2 Crave salt

2 Eat a high processed food/ junk food diet

2 Eat a diet low in green, leafy vegetables, seeds, & fresh fruit

2 Eat a low protein diet

2 Pass undigested food or fat in your stools

3 Suffer from chronic intestinal disease, ulcerative colitis, Crohn’s, irritable bowel syndrome

3 Frequent diarrhea or constipation

3 Suffer from PMS or menstrual cramps

2 Pregnant or recently pregnant

4 In previous pregnancy had high blood pressure or pre-eclampsia

2 Chronic fatigue

2 Muscle weakness

2 Cold hands &/or feet

2 Numbness in face, hands, or feet

2 Persistent tingling in body

2 Chronic lack of interest, indifference, or apathy

2 Poor memory

2 Loss of concentration

3 Anxiety

2 Chronic depression for no apparent reason

2 Feelings of disorientation as to time or place

2 Feel your personality is stiff or mechanical

2 Hallucinations

2 Feel that people are trying to harm or persecute you

2 Face pale, puffy, or lacking in color

2 Loss of considerable sexual energy or vitality

2 Been told by your Dr. that your blood calcium is low

3 Been told by your Dr. that your blood potassium is low

2 Take Calcium supplements regularly without magnesium

2 Take iron or zinc supplements regularly without magnesium

2 Know chronic exposure to fluorides

3 Frequently use antibiotics, steroids or oral contraceptives

<— TOTAL …

–With 30-50, you likely have low magnesium.

–Over 50 & you most certainly have low magnesium.


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  • CHERYL OATES says:


    • Emed Sales and Support says:

      The choice of magnesium would depend on your symptoms. Magnesium as amino acid chelate, orotate and citrate forms are best absorbed and less irritating for the gut. It is always better to take it as a powder. Please book in for a consultation with us if you would like more comprehensive treatment advice.


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