Intractable Mg Deficiency
by The Magnesium Web Site Librarian
Contents:
I have written to a number of researchers as follows:
Dear Mg Researchers:
I have received numerous queries from patients and doctors
about intractable Mg deficiency — cases where intravenous
and oral supplementation has simply failed to replenish Mg
levels, even though these patients are pushing the upper limits
of intake to the point of loose bowels.
Can anyone please give me guidance on what I should tell these
people who can't replenish their Mg?
Pasted in below are two typical messages from victims of
recalcitrant Mg deficiency, and one of my typical, inadequate
replies.
Paul Mason, Mg librarian
www.MgWater.com
Examples of patient
letters:
Paul,
I had written to you before. I have low magnesium - I didn't
need a test to tell me this - I don't sleep at night and further,
my digestion is poor.
However, an intracellular test showed very low magnesium - so
the test confirmed my symptoms. I was tested in Sept-October of
2001.
I've been taking 800-1000 mg of chelated (Mg glycinate) per
day since late October. Back in October and November, my doctor
gave me a series of SIX magnesium IV. Each IV contained 5 grams
of Mg Sulfate and I got an IV once each week for SIX weeks.
At this point - 8 months or so later - I don't feel like I
made any progress. I still sleep poorly and continue to have
muscle tics (twitches).
Every few days, I have loose stools and need to cut back on
the magnesium. I think that I can only take a total of 600-700 mg
of magnesium per day - otherwise, I get loose stools. I don't
digest most high magnesium foods - like nuts, avocados, etc. I do
NOT take calcium supplements - but I do eat dairy products -
mostly homemade yogurt.
Am I doing something wrong???? Should it be taking THIS long
to make ANY notable progress??? Must I cut out ALL calcium -
including the dairy products in order to restore my magnesium? By
the way, I don't eat salt either - I've read that salt can
depress magnesium stores.
I hope that you have some insight for me!! I'm really, really
disgusted. I've tried liquid magnesium chloride, mag. oxide, mag.
glycinate (which I'm currently using), mag. gluconate, and of
course, the $800 worth of magnesium IVs.
Thanks,
M.
Paul,
I am HIV positive and my body isn't holding mag. I continue to
have infusions but nothing seems to help. My Dr., I'm sure, is
getting quite baffled and frustrated, as am I. At first we
thought it was going through me because of diarrhea, but that
stopped and I still can't keep mag in my body. Went in on a Mon.
had infusions thru Wed. had blood checked Thurs, and I was still
at 1.1 I have been at a very dangerous level for some time and I
am starting to get worried.......for what I don't know???? Now I
am instructed to go back on oral mag (400mg) once per day, along
with 5 infusions starting next week Monday. A blood test is being
ordered before my 5th treatment so we can see if anything is
holding. If you have any suggestions, please let me know. I am
getting weak, dizzy, and something is going on with my eyes now
too, don't know if it has anything to do with mag but I hope
something gets figured out soon.
Thanks,
J.
Paul,
I have CFIDS, and in 1992 started getting weekly IM injections
of magnesium sulfate. They hurt, but gradually, very slowly and
with much bed rest, the magnesium began to slowly build up. I can
now go more than a week without an injection, and I no longer
have to stay in bed. If I am not careful, it all comes back. It
has taken ten years to build up my magnesium status to this point
and that has included injection plus supplements all that time. I
am very careful about taking magnesium by mouth every day and
getting an injection at least every 3 weeks. I read in one
article that a patient took over 3 years with i.v. magnesium to
build up some magnesium health.
A.
Hello,
I am writing with a thought on how to help people with
intractable magnesium deficiency. I am not a doctor or expert per
se. I am a medical social worker who after 6 months am finally
returning to my normal self after a serious magnesium deficiency.
I was told by all my regular, allopathic doctors that I had
nothing wrong. Long story short I figured it out on my own -
stumbling across a lady's response on a neurology forum. The
symptoms for magnesium deficiency she listed matched mine &
so started the saga.
I have since found a great integrative medicine MD &
utilized my children's ND to test & treat.
I talked my integrative med doc into testing my adrenal
function thinking that my adrenaline & or cortisol would be
high as a possibility for my magnesium deficiency. (I had
significant stress in my life for the past few years with a life
threatening car accident on 12-2-03 which preceded my symptoms by
exactly one week). Well, my test shocked both me & my doctor.
He didn't think I looked like, acted like or carried on the life
of someone in adrenal exhaustion and I though my levels would be
high. The test showed my adrenals were in an addison's like
exhaustion state (stage 7). My cortisol & DHEA were
critically low. He called the lab to verify the findings because,
again, he didn't think I had the symptoms one would expect. The
medical director at Meridian Valley Labs said it was actually
quite common to see what he called "adrenal overflow" with
magnesium deficiency. He said that I was basically running on
adrenaline (which of course was flushing my magnesium as fast as
I could down it).
I wasn't asymptotic before my car accident (I had suffered
with papillophlebitis/CRVO, heart palpitations, hyperactive
deep-tendon reflexes, panic attacks, borderline HTN with no risk
factors etc). But after the car accident I believe my adrenaline
overflow kicked in & I became 'very symptomatic'.
I started taking DHEA prepared by a compounding pharmacist
& licorice root extract (again pharmaceutically provided -
not store-bought). I opted to try the licorice vs the cortisone
as it was the more natural route.
In a month my adrenal function was back to normal & my
DHEA & cortisol levels were normal. I took physiologic doses
of both. I am still on the DHEA and tapering. I ran out of the
second Licorice Extract & am staying off until I test again.
I feel like my old self just this month! (8/04)
I just finished a wonderfully informative book called: "The
Miracle of Natural Hormones" by David Brownstein. I think
everyone with unexplained (or even explained) medical symptoms
should read it. But for some of us who are having a hard time
'holding' our magnesium it may be the ticket. I would suggest
others have their adrenals tested as well. Perhaps they will need
to plug the adrenal holes as it were before they fix the
magnesium leakage problem. (You can't hold mag if you don't plug
the leak & as all the studies show, if you have high
adrenaline you waste magnesium in urine. And of course if you
have low mag your adrenaline levels don't subside as they should
- leading into a 'which-came-first-the-chicken-or-the-egg'
magnesium deficiency/adrenal exhaustion). I also believe the need
to take natural hormones may be temporary to give your adrenals a
boost/jump-start so to speak. I also meditate for at least 15min
each day and do many other relaxation promoting things throughout
the day to take the stress off my adrenals, a whole food
(whenever possible) and completely organic diet and of course
taking magnesium (as well as a list of other supplements) and
exercise.
Here is a
link to the book on Amazon.com
A different hypomagnesemic (coined: a person with
hypomagnesemia) may have different hormonal imbalances as
well....
This is just a thought - something I put together from my
experience & from my extensive reading (my library is huge
now!).
Thanks for all the info I obtained on your website through my
struggles. I have put a link to it on my webpage in hopes of
reaching others who may be scared to death like I was.
Sincerely
EM
Patients must be under the direct supervision of
their own physician to implement any of these researchers'
recommendations
Advice from
researchers:
(in order received)
( a )
Along with the suggestions, noted above, for correction of
intractable Mg. deficiency, there are 2 other
considerations:
1. Unrecognized malabsorption syndrome which would require
parenteral Mg.and brings up the necessity of developing a
suitable subcutaneous product ,which Prof. H.G. Classen has
informed me is feasible
2. Enhancing the storage sites for Mg. in bone and
skeletal muscle by a regular and aggressive isometric and
endurance exercise program. Both of these problems exist on
space flights www.femsinspace.com
William J. Rowe M.D.
( b )
Regarding the letter by J., she should take smaller doses of
mag every few hours throughout the day. She probably needs
800-1000 mg/day (she should run this by her doc), divided into
doses every 2 to 4 hours and when she awakens during the
night.
Jay S. Cohen, M.D.
Associate Professor
Department of Family and Preventive Medicine
University of California, San Diego
( c )
I will preface my answer to your question by stating I am a
scientist, not a physician. Any thoughts I have are purely
scientific opinion and not medical opinion.
Clearly, these seem to be examples of an inadequate
magnesium uptake system. The alternative approach may therefore
be to minimize magnesium loss. I have used amiloride (inhibitor
of magnesium transport) in place of magnesium administration in
experimental brain injury studies with great success. I would
therefore suggest that the individuals in question approach
their physician and ask about the potential use of amiloride to
attenuate their magnesium loss. It is a weak
antidiuretic/hypertensive agent usually prescribed as an
adjunct to other diuretics so as prevent potassium/magnesium
depletion. It is marketed in the USA as Midamor (Merck).
This is a long shot based on my animal research. Obviously a
careful evaluation of possible contraindications and
side-effects needs to be taken by the physician.
Robert Vink, PhD
Department of Pathology
University of Adelaide
Adelaide, South Australia 5005
Australia
( d )
Advice about clinical treatment should be
cautious...patients with renal insufficiency need to be
followed closely for increased K and Mg if they take Mg/K
retaining drugs,eg ACE inhibitors like captopril. Some AIDS
related drugs (pentamidine,foscarnet,amphotericin )may cause
renal loss of Mg.Also, another supplement is Maginex (Mg l
aspartate) from Geist Pharmaceuticals in Indianapolis.
Dr. Bill Weglicki
( e )
One possibility suggested by work in Norway about 10 years
ago is to also increase potassium in the diet (or by
supplement) along with magnesium. This dual therapy may
overcome a renal "leakage" problem of magnesium, more typically
found in elderly subjects. Very little investigation has been
conducted on this issue, to the best of my knowledge.
John Anderson
( f )
A taurine supplement is worth considering. Taurine
transports magnesium (and potassium) into cells (both these
minerals should reside primarily inside rather than outside the
cell). Taurine seems to be very safe, is best taken apart from
food (unlike other amino acids) partly because large doses
sometimes upset the stomach. Sometimes 2000-3000 mg per day is
needed (1000 mg at 2-3 meals), and high urinary taurine usually
indicates high loss of taurine rather than excess intake (blood
and urine taurine levels can be tested to check this out).
Dr. Russ Jaffe recommends using choline with magnesium
supplements to enhance assimilation. It is available in
capsules or from Perque Labs in liquid form.
James Heffley
Nutrition Counseling Service
Austin, TX
( g )
Here are some possible answers to your questions...Also...Mg
is best given with Calcium...if not...there might be MORE
spasms due to calcium blocking effect of magnesium doses.
If the intracellular magnesium were tested within 48 hours
using the EXAtest one would find a rise in cellular Mg. If
after 10 days the test was repeated Mg may be lost in chronic
magnesium wasters. This is the only test that can show that
relationship since it measures what is happening on the day of
the test in Tissues!
Use of a spectrum of antioxidants and B complex vitamins
help replenish lost Mg stores.
Exercise also helps transport magnesium. However some people
may have a genetic predisposition to loss of magnesium with no
regard to their intake.
Entrez-PubMed See this article:
J Am Soc Nephrol 2000 Oct;11(10):1937-47 Related Articles,
Books, LinkOut. Inherited disorders of renal magnesium
handling. Cole DE, Quamme GA. Department of Laboratory
Medicine & Pathobiology, University of Toronto, Ontario,
Canada.
The genetic basis and cellular defects of a number of
primary magnesium wasting diseases have been elucidated over
the past decade. This review correlates the clinical
pathophysiology with the primary defect and secondary changes
in cellular electrolyte transport. The described disorders
include (1) hypomagnesemia with secondary hypocalcemia, an
earlyonset, autosomal-recessive disease segregating with
chromosome 9q12-22.2; (2) autosomal-dominant hypomagnesemia
caused by isolated renal magnesium wasting, mapped to
chromosome 11q23; (3) hypomagnesemia with hypercalciuria and
nephrocalcinosis, a recessive condition caused by a mutation
of the claudin 16 gene (3q27) coding for a tight junctional
protein that regulates paracellular Mg(2+) transport in the
loop of Henle; (4) autosomal-dominant hypoparathyroidism, a
variably hypomagnesemic disorder caused by inactivating
mutations of the extracellular Ca(2+)/Mg(2+)-sensing
receptor, CASR: gene, at 3q13.3-21 (a significant association
between common polymorphisms of the CASR: and extracellular
Mg(2+) concentration has been demonstrated in a healthy adult
population); and (5) Gitelman syndrome, a recessive form of
hypomagnesemia caused by mutations in the distal tubular NaCl
cotransporter gene, SLC12A3, at 16q13. The basis for renal
magnesium wasting in this disease is not known. These
inherited conditions affect different nephron segments and
different cell types and lead to variable but increasingly
distinguishable phenotypic presentations. No doubt, there are
in the general population other disorders that have not yet
been identified or characterized. The continued use of
molecular techniques to probe the constitutive and congenital
disturbances of magnesium metabolism will increase the
understanding of cellular magnesium transport and provide new
insights into the way these diseases are diagnosed and
managed.
Dr. Burton Silver
IntraCellular Diagnostics Inc.
( h )
The body is extremely complex and there can be many
different causes of what seems to be the same problem. With
that caveat here are some possible issues to consider.
If someone has low stomach acid, this can cause difficulty
in breaking down various nutrients to an absorbable form.
Chloride deficiency can cause low stomach acid. If someone had
low stomach acid and they were taking magnesium oxide they
could have difficulty in converting it to magnesium chloride
for absorption.
Osmolality is another issue that can affect absorption of
various nutrients including magnesium. The high osmolality of
Magnesium chloride when taken in liquid or tablet form can
hinder absorption and also increase the laxative effect of the
product. What happens is that the substance once it enters the
gut can have a more powerful pull than the stomach and can draw
water out and then flush through the system rather than being
pulled into
the system, absorbed and utilized. Although it seems
counterintuitive when someone is experiencing diarrhea, if
people will drink larger amounts of water with the product it
will have the tendency to drop the osmolality
down through dilution and decrease this effect. Some people
have also reported that if they experience the laxative affect
when they first start taking a magnesium chloride product they
can overcome this by starting out with small doses and then
steadily increasing the dose over a two-week period so that the
body can adjust.
Many people can have better absorption of they will have
smaller doses of the nutrient spread out throughout the day in
their food or water rather than in one large dose. This is due
to the issue described above but also because there are only so
many active receptor cites available at any given time. There
is also some research that suggests even the taste, smell and
presentation of a food will affect nutrient absorption
rates.
We have done a great disservice to the human race when we
started to process all of our food and water to be "pure." Our
salt is not a balanced electrolyte but "pure" NaCl. Our water
no longer provides an array of minerals including magnesium but
is "pure" H2O. The modern processing of our food
supply for shelf life and "purity" is an experiment where the
human race is the lab animal and it has only lasted about a
hundred years with serious negative consequences that have not
been recognized.
Magnesium sulfate is the common form of magnesium used in
medicine but they are not considering the issue of balance.
Magnesium is a macro mineral requiring large doses on a daily
basis. Sulfate is a micro mineral which is used in small
amounts. Even though they have the pairing of anion and cation
the ratios can cause problems. In the case of magnesium
chloride, both anion and cation are macro minerals, making it a
better balance over all.
The magnesium deficiency problems in these cases could be
either absorption or wasting disorders and could be caused by
nutritional imbalances or deficiencies, hereditary problems,
stress, illness or even other problems. Some of the problems
might not have a good answer. Others are rare and will require
unique problem solving such as experimenting and learning from
trial and error but this can be greatly aided if the individual
and/or the physician are aware of the different issues and ask
the right questions.
If it is a serious wasting disorder, my guess is that the
best way to handle it would be to increase consumption of the
most easily absorbable forms of Mg throughout the day,
especially by adding it to all food and water.
Val Anderson
President, Mineral Resources International
( i )
Please try magnesium+potassium+coenzyme Q10+aldactone thrice
daily with meals for a week in patients with normal renal
function for desired benefit. The later two would be able to
retain intracellular and blood Mg.
This treatment may cause hypermagnesemia, hyperpotassemia if
renal functions are not maintained. Addition of insulin in the
glucose solution with Mg and K would provide further
benefit.
Let me know what did you get.
Prof. R.B. Singh, M.D.
icn@mickyonline.com
( j )
Since there have been already stated most of the more or
less known sources of idiopathic mg deficiency one or two more
possibilities:
- 1. mg is lost from cells under participation of
catecholamine β receptors. β blocking may be at
least worth trying.
- 2. check HGH levels, since mg usually builds up in blood
during the night
- 3. Hypoproteinemia? check total serum proteins and
albumine
- 4. (related) mg turnover is regulated by mg serum levels.
check ionized mg in serum.
If I could have been of any help, please feed back
Sepp Porta
stesscenter@netway.at
( k )
I would guess that these individuals have an impaired
ability to have a normal reabsorption in the renal nephron.
They just excrete it. This suggests some kidney damage. How to
correct it? I don't know, since I am not a clinician.
If any of these patients have insulin resistance, it would
also be difficult for the insulin-requiring cells to take up
Mg. Insulin is necessary for Mg uptake in those tissues that
require insulin.
Many years ago, I worked with a woman who had severe
hypertension. I measured some minerals in 24 hour urines. Mg
was very low, as was zinc. When she was hospitalized with a
hypertensive crisis, her physician gave her a modest Mg load
test. She excreted nearly 100% of the load. This woman's diet
had been poor for many months. She had been eating a vegetarian
diet, which she interpreted to be salads. Her protein intake
was negligible, as were many other nutrients. She now started a
regimen of a better diet and took supplements that included
fluid meal replacers, Mg, zinc, and other nutrients. After
about 6 weeks, she was again hospitalized with another
hypertensive crisis. She was given another Mg load test. This
time she retained 100% of the load. What was the difference? I
think that the cells in her body were damaged somewhat by the
poor nutrition she had been taken previously. After building up
her total nutrition, including Mg, her cell membranes had begun
to be repaired. Now the transport mechanisms for Mg uptake were
working so she was able to retain the Mg from the load. And the
kidney was able to retain the Mg it filtered.
Whether something similar can be operating among the people
who e-mailed you, I have no idea.
Kay Franz
( l )
Mg Aspartate Hydrochloride (marketed as Maginex) is good for
people who need large doses because it doesn't
generally cause diarrhea, according to Dr. Mildred
Seelig's book, The Magnesium Factor.
( m )
Coconut oil is antifungal and three heaping tablespoons
though the day seems more effective than anything else in
preventing diarrhea from excess (therapeutic) doses of
magnesium. Yet, we are told that magnesium, not the yeast +
magnesium, is the cause of diarrhea. We are told that coconut
oil is bad for us (too much lipids) when eminent researchers
like Dr. Mercola say different, that in fact some of the
healthiest people on earth, pacific islanders, eat tons of
coconuts and its oil and never have heart problems. George
Eby
Quotes from magnesium
researchers:
Quotes supplied by Erling Waller
1) From the booklet Magnesium by Alan R. Gaby M.D. (also M.S.
bio-chemistry), Keats Publishing, Inc., 1994, ISBN 0-87983-602-4,
$3.95:
"As disease progresses, cells lose their ability to
function properly. Most of the cells of the body maintain a
very high magnesium concentration relative to that in the blood
serum. For example, there is about ten times as much magnesium
inside the cells of a healthy heart as there is in the serum.
This high concentration of magnesium is necessary for cells to
perform their various biochemical tasks. However, maintaining
this steep concentration gradient between cells and blood
requires a great deal of energy. The laws of random motion
cause magnesium ions to leak continually out of the cells and
into the bloodstream. Each time a magnesium ion leaks out,
another one must be pulled back in by special pumps that reside
on the cell membrane. Pulling against a concentration gradient
is analogous to swimming upstream or to carrying bowling balls
up a hill, only to see them roll right back down. As
inefficient as that sounds, that is how the body works. Indeed,
a substantial proportion of the calories you burn each day are
used to maintain higher concentrations of some nutrients inside
cells than in the bloodstream. When you become ill, some of the
cells in your body may become less efficient in holding on to
magnesium. The cell membranes may break down, allowing more
magnesium to leak out. In addition, the cell membrane pumps
that pull magnesium back in may also be weakened by disease.
The end result is that disease itself can be a cause of
magnesium deficiency. Since magnesium deficiency may have been
one of the original causes of the disease, a vicious cycle of
greater deficiency and increasingly severe disease may
result."
Dr. Gaby goes on to say:
"... a substantial minority of patients ... fail to
improve after taking oral magnesium for months or even years.
In these cases, administering magnesium by injection is
necessary to overcome their medical problems."
2) From the Forum and Bulletin Board for magnesium headed by
Walt Stoll, M.D. at
http://askwaltstollmd.com/archives/mg.html
"Magnesium metabolism has one quirk in that, if the
level is low enough (in that person) to cause symptoms, it is
low enough that the body loses its ability to absorb it
efficiently orally. Since it is almost impossible to hurt
someone by giving them too much magnesium, doing a therapeutic
trial of an easily absorbed (orally) form of chelated magnesium
(orotate, aspartate or glycinate) might be tried by
anyone."
"This paragraph is just to warn those who try it that
way--and get no results--not to throw out the baby with the
bathwater. They may just be not absorbing it orally. For those,
they will need intravenous infusions of at least 2 grams of
elemental magnesium/IV about 3 times a week for 2 weeks. This
can be injected over a period of about 5 minutes with no risk
or negative side effects. By then, they should be able to
absorb it orally for maintenance. By then, they will also know
if their bodymind laboratory says they needed it (Did they get
better?)"
Patients must be under the direct supervision of
their own physician to implement any of these researchers'
recommendations
Three women have been struggling with Intractable Mg
Deficiency, and each has some thoughts about intravenous
infusions compared with shots and oral supplementation. Here is
what they have to say:
Paul,
I do give myself Mg shots. Have been for several years. It
takes time to build up. My doctor first showed my husband how
to do it, and when I travel I do it myself. Even so, I am,
after 10 years of this, beginning to hold my magnesium. What a
strange thing.
----Andrea
Paul,
I am receiving infusions of mg, not shots. I didn't know
there was such a thing as a mg shot???? I always said...
wouldn't it be easier to give myself injections like I did when
I was anemic? And they respond with.... they don't have such a
thing ... yet. ... I do agree $400 is a lot for 1/2 hr of time
and as of now if I didn't have insurance, I would have paid
over $12,000 this year alone in mg infusions... yes it's
ridiculous, but what do you do?
---- Joli
Paul,
I have given shots to MANY, MANY animals. Giving myself a
shot would be uneventful. EXCEPT for the fact that I have heard
from folks who have received mag. shots that they are
INCREDIBLY PAINFUL - to the point that people wondered whether
the pain was worth the short lived benefit. From what others
have told me, you cannot tolerate more than 1/2 cc of mag.
sulfate per day - which equates to a minuscule amount of
elemental mag. This is why at least one other doctor has
experimented with some special mag. sulfate suppository. This
one hasn't made much sense to me, personally, because I
normally have loose stool problems from dietary mag.
-----Marj
Paul's comments:
A Mg suppository might make some sense, if there is such a
thing as "transdermal uptake". Many cultures have found benefit
in soaking in mineral baths (hence the term "bath salts", for
which there are 70,000 pages on the web). Apparently, soaking in
bath salts gives perceived benefits over and above soaking in
normal tap water. (See Absorption of
magnesium sulfate and MgSO4 Less Effective) Epsom Salts
(MgSO4) is very cheap, about $2 for a half-gallon carton at Longs
Drug Stores. You might try soaking in a hot tub of Mg-enriched
warm water. I take a book or magazine to read in the tub, when I
am tense and need to unwind.
In an article I wrote for
the Water Quality Association, I suggested the Association
fund research by Prof. Judith Turnlund at University of
California at Davis re transdermal uptake of Mg. Water-softening
has been removing Mg, but the industry could switch and add Mg to
drinking water and bath water. A new
study has shown that transdermal uptake of Mg does indeed
happen through soaking in water enriched with Epsom Salts
(MgSO4).
What else a sufferer can do, without prescriptions, is to
prevent deficiency in any of the inexpensive nutrients that can
prevent uptake of Mg: Copper, Boron, and Vitamin B-6. Common
levels of supplementation are:
Copper 1 mg/day
Boron 3 mg/day
Vitamin B-6 38 mg/day
And, take oral Mg supplementation at each meal and at bedtime.
And, drink Mg-enriched water between meals (either naturally
Mg-rich water, or fortified with Mg sulphate (Epsom Salts) or Mg
chloride --- both are inexpensive.
If anybody finds a regimen or treatment that works, please
feed back the news.
--- Paul, Email:
paulmason@mgwater.com
Paul,
It's remarkable......my mg went up to 1.2 so it's climbing.
Thanks for all the feedback...I guess it will take some time to
get back on track.
----Joli
This page was first uploaded to The Magnesium Web Site on
April 26, 2002
http://www.mgwater.com/
Healthy Water
Association--USA