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Magnesium: Not to Be Overlooked
ometimes one can overlook simple things, such as the importance of magnesium (Mg)—not only for maintaining good health in our patients by supplementation but also in various conditions where low Mg contributes to the symptoms that trigger our patients’ complaints. We are all taught about Mg sometime during our training in health care. Low Mg levels have been implicated in diabetes, metabolic syndrome, osteoporosis, and asthma. Supplementation with Mg can help patients with fibromyalgia and can help prevent myocardial infarctions and stroke. It is used in patients with cardiac arrhythmias.1 Though many health care professionals rely on serum levels of Mg and red blood cell Mg, the most accurate method for measuring Mg in a patient is via intravenous loading dose.2 Mg is the fourth most abundant mineral in the body. About one half is found in bone and the rest inside all cell types. Mg is an essential mineral trace element. More than 300 enzymes need Mg for catalysis, including those for the synthesis of DNA and RNA. Adenosine triphosphate (ATP), the principal source of energy for all cells, can only be biologically active when bound to Mg. Mg helps maintain normal nerve and muscle function, promotes normal blood pressure, and is essential for normal heart rhythm and for normal function of the immune system.3 MAGNESIUM DEFICIENCY Humans obtain Mg from their diet. Natural sources of Mg include spinach, mustard greens, Swiss chard, turnip greens, figs, black beans and navy beans, seeds from sunflowers, pumpkins and flax, and mineralized hard water. Mg is absorbed in the small intestine and excreted via the kidneys. The Recommended Daily Allowance (RDA) of Mg is 320 mg/day in women and 420 mg/day in men. However, data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) showed that a substantial population in the United States failed to get the RDA from their diet.4 For example, only 16% of the Mg found in whole wheat is found in refined flour, and most of Mg has been removed from the water supply, resulting in a general deficiency.5 Mg deficiency can also be caused by a high carbohydrate diet as a result of mineral flushing.6 Hypomagnesemia can be found in the premenstrual period in women. During pregnancy, low Mg may play a role in premature delivery, hypertension and eclampsia, and vasospasm.
Certain medications are prone to cause Mg deficiency, particularly diuretics, gentamycin, amphotericin, and cisplastin.7,8,9 Patients with poorly controlled diabetes have increased loss of Mg in their urine and need Mg supplementation.10 In alcoholism, hypomagnesemia is found in 30% to 60% of patients and 90% in those who are undergoing alcohol withdrawal.11,12 Patients with intestinal malabsorption such as Crohn’s disease, gluten enteropathy, enteritis, and intestinal surgery are at risk for low Mg due to loss from diarrhea and fat malabsorption.13 People with chronic hypocalcemia and hypokalemia may have insufficient levels of Mg and correction of the Mg deficiency may resolve the calcium and potassium deficiencies.9 The geriatric population is particularly prone to Mg loss due to less absorption and more renal excretion, poorer diets, and taking drugs that interact with Mg.14 Mg deficiency is found in 80% of patients with depression.15,16 Though this is an important finding, it is little known. Women in the premenstrual period and in the geriatric population are prone to hypomagnesemia. It is important to note that in these two groups, depression is a common finding. Another study found low levels of Mg in the cerebral spinal fluid of suicidal patients.17 MAGNESIUM IN TREATMENT AND REPLENISHMENT Severe hypocalcemia often presents as a neurological disorder with seizures, tetany, and arrhythmias. In the asymptomatic form, when it is accompanied with low Mg levels, usually by giving Mg alone, the hypocalcemia will correct itself.18 Mg can help patients suffering from multiple sclerosis (MS). It can reduce some of the muscle spasticity and tends to give loose stools to counter the more commonly found constipation in patients with MS. In patients with acute migraine, 1 g of intravenous magnesium sulfate eliminated the pain along with the nausea and vomiting in 87% of cases.19 For migraine prophylaxis, a study found that trimagnesium dicitrate at a daily dose of 600 mg reduced migraine frequency by 42%.20 An example of severe nervous system involvement is the seizures that define eclampsia. Treatment to stop these seizures is an intravenous bolus of magnesium sulfate; once the seizures stop, the intravenous Mg is then continued into the postpartum period for up to a week.21 Mg also has a role in preterm labor, which is defined as labor beginning before the
ALTERNATIVE THERAPIES, may/june 2013, VOL. 19, NO.3
Cady RK. To subscribe. 22. Ryder KM.307(suppl 1):S60-S65. National Institutes of Health. Peikert A. 16. 1995. 12. 17. Siamopoulos KC.gov.28 In case of Mg overdose. Borggrefe M. increase in bone mineral density and reduced fracture rate can occur with more intake of Mg. 18. 2006.37(1):59-65. Updated July 13. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Sojka JE. Bassett JH. Wilimzig C. 11. Obstet Gynecol. Arató M. Cisplatin and hypomagnesemia. Papp Z. Magnesium intake from food and supplements is associated with bone mineral density in healthy older white subjects. Magnesium.67(2):362-367. 2006. Topçuoğlu MA. DC: National Academy Press. 9th ed. 2004. Thomson Micromedex.53(11):1875-1880.com Campbell—Magnesium . et al. J Am Geriatr Soc. Veehoff D. et al. Prophylaxis of migraine with oral magnesium: results from a prospective. 9. 1994. Dietary magnesium intake in a national sample of US adults. 1999. Call 1-877-647-0322 today for world class testing with 95% of results available online in less than 3 days. Abbott L. Standing Committee on the Scientific Evaluation of Dietary References Intakes. Mokdad AH. Dietary Reference Intakes: Calcium. Greenwood Village. 2008. Headache. Magnes Res. Am J Med Sci. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Care must be taken because some patients may develop loose stools. In those patients whose Mg levels are low. 1994.20(2):163-171. 2006. Update on the assessment of magnesium status.250(1686):4-6. Song Y. 4. Klasco RK (Ed): USP DI. you’re guessing. 1999:169-192. 1999. visit alternative-therapies. Jackson PR. LLC.nih. 1994.99(suppl 3):S24–S36. Vojnick M. Daugaard G. Arnaud MJ. and suicide attempts. 2001. The role of glucose in diabetic hypertension: effects on intracellular cation metabolism. Resnick LM. 6. 2005. 13. Barbagallo M. Seeling MS. Spong CY. NY: Plenum Publishing Corporation. 1980. LABORATORY TESTING MADE SIMPLE ©2013 ZRT Laboratory. To share or copy this article. the treatment is calcium gluconate intravenously.16(4):257-263.133(9):2879-2882. Murphy E. Food and Nutrition Board. Diabetes Care. 28. Elisaf M. Olerich M. New York. Köhne-Volland R. Office of Dietary Supplements. 5. Washington. 2000. Asthma exacerbations 5: assessment and management of severe asthma in adults in hospital. eds. doi:10. Studies have shown that magnesium lactate and chloride have higher bioavailability than magnesium oxide. a carefully chosen supplement can be given once good kidney function is established. Rapid recovery from major depression using magnesium treatment. Cousins RJ. Eby KL. The neurochemistry of depression. 2013. Disorders of calcium metabolism. et al. Ford ES. 1996. Dora B. 10.14(4):257-262. Caballero B. 2005. Shorr RI. 2009. 1992.23(suppl 1):S43-S46. placebo-controlled and double-blind randomized study. Sibai BM. and management of eclampsia. In: Shils ME. Bairaktari E. Alcohol Clin Exp Res.24 In Harvard’s Nurses’ Health Study. Nadler J.od. 23. Use ISSN#1078-6791. ` ZRT Laboratory www. Cerebrospinal fluid magnesium and calcium related to amine metabolites. 21. Yeo WW.This article is protected by copyright.zrtlab. Alcohol Clin Exp Res. Nutrition recommendations and principles for people with diabetes mellitus. Liu S. Thorax.factsheets/Magnesium-HeathProfessional. 2007. 2. Cardiology. Williams GR. American Diabetes Association. 1996. 184.108.40.206(1):134. 24. If you’re not testing. Shike M. 19. Ramsay LE.25(1):47-58. Dietary supplement fact sheet. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/ American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. 1998. Zipes DP. Firoz M.22 In women with osteoporosis. MD Editor in Chief REFERENCES 1. Graber M. Circulation. which causes an improvement in airflow and can reduce hospitalization rates. New York. prevention. 14. Weaver CM. Vural O. Institute of Medicine. 2003. Prediction and prevention of recurrent spontaneous preterm birth. 25. ALl rights reserved. Bioavailability of US commercial magnesium preparations. 8. diagnosis. J Nutr. Practitioner.84(suppl 2):48-56. Camm AJ. 20. Biol Psychiatry. Bush AJ. and magnesium sulfate is given as a bolus followed by a drip until contractions cease. Eby GA. Preterm labor is responsible for 85% of all neonatal illnesses and deaths. Lajer H. multi-center. 27. Magnesium. 2001.53(3):71-74. Modern Nutrition in Health and Disease. Magnesium Deficiency in the Pathogenesis of Disease.26 MAGNESIUM REPLENISHMENT The most effective and efficient way to replenish very low levels of Mg is intravenously. Nutr Rev.1017/S000711450800682X. Metabolic effects of diuretics. Ross AC.110(2):405-415.6(6):453-461. Colorado 2003. please visit copyright.com. 1985.25 Mg is used in acute severe asthma in the form of intravenous magnesium sulfate. Phosphorus. 2007.18(5):1076-1082. Am J Pain Manag. Cancer Treat Rev . 15. Br J Nutr . Manson JE.com 37th week of pregnancy. Med Hypotheses. Hypermagnesemia is almost always as a result of advanced chronic renal disease and the inability to excrete the Mg from diet and medications such as antacids and laxatives. Rude RK. Beasley R. Cephalalgia. Magnesium deficiency in alcoholism: possible contribution to osteoporosis and cardiovascular disease in alcoholics. Andrew W. Drug Information for the Health Care Professional. Hypomagnesemia in alcoholic patients.62(5):447-458. Vitamin D and Fluoride. Shealy NC.41(2):171177. Accessed March 29. Campbell. The bioavailability of a Mg supplement influences its effectiveness. Banki CM. Balla KZ. Diagnosis. Rude RK. http://ods. 3. women with higher levels of Mg had a significantly lower risk of developing type 2 diabetes by increasing insulin sensitivity and increasing insulin secretion from the pancreas. Shils ME.114(10):e385-e484. Magnesium supplementation and osteoporosis. Aldington S.2(1):13-16. NY: Lippincott Williams and Wilkins. 7. Obstet Gynecol. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Osteoporos Int.105(2):402-410. Kalaitzidis R. Demirkaya S. Buring JE. Diabetes Care.
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