Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis
Open Heart 2018;5:e000668. doi:10.1136/ openhrt-2017-000668n 13 January 2018.
James J DiNicolantonio,firstname.lastname@example.org James H O’Keefe,1 William Wilson2
’Department of Preventive Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA 2Hospital Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
Overview Magnesium and vitamin D Has venn diagram of relationship of Mg to Vit D
|Vitamin D|| Magnesium or Vitamin D|
Aging, Amytrophic Lateral Sclerosis, Alzheimer's Disease;
Asthma, Attention Deficit Disorder; Autism, Cancer, Cerebrovascular,
Chronic Fatigue, Diabetes, Hearing Loss, Heart Disease, Heart Attack, Atherosclerosis,
Cardiovascular Disease, HIV, AIDS; Hypertension; Kidney Stones,
Migraine Headache, Multiple Sclerosis, Obesity, Osteoporosis; Peripheral vascular disease;
Pregnancy-related problems,Rheumatoid Arthritis; Sports-related problems,
| Vitamin D only|
Acne, Allergy, Autoimmune, Bone, Breathing,
Celiac, Cognition, Colds and Flu, Cystic Fibrosis,
Dental, Fertility, Hyperparathyroid, Immunity, Kidney,
Liver, Lupus, Osteoarthritis, Pain - chronic, Parkinson,
Psoriasis, Rickets, Strokes, Sarcoidosis, Thyroid, Parathyroid,
Tuberculosis, Vision, Hair, Skin, Sports
|Not Vitamin D|| Magnesium only|
Aggressive Behavior, Alcoholism, Arrhythmia, Cerebral Palsy,
Chemical Sensitivity, Cluster Headaches; Cocaine-related Stroke; Constipation,
Cramps, Fluoride Toxicity; Head Injuries, Central Nervous System Injuries,
Magnesium Deficiency; Menopause, Mitral Valve Prolapse,
Nystagmus, Psychiatric Disorders; Repetitive Strain Injury, Sickle Cell Disease, SIDS,
Stress, Stuttering, Tetanus; Tinnitis, Sound Sensitivity; TMJ; Toxic Shock; Violence
ALL OTHER DISEASES
Magnesium and Vitamin D contains the following summary
- Overview Magnesium and vitamin D
- Vitamin D Cofactors in a nutshell
- Magnesium and Vitamin D - similar, different and synergistic
- Magnesium deficiency – causes and symptoms – May 2016
- Magnesium is vital to Vitamin D in 4 places (maybe 8) – March 2018
- Magnesium and Vitamin D – recent deficiencies, needed, synergistic - good overview 2017
- The Importance of Magnesium in Clinical Healthcare (with level of evidence) – Sept 2017
- Some Podcasts by Dr. C Dean – Magnesium, Vitamin D, Iodine, etc.
- Why Vitamin D is Useless without This Critical Nutrient (Magnesium) - Jan 2019
- Magnesium supplementation raises Vitamin D if initially less than 30 ng – RCT Dec 2018
Because serum magnesium does not reflect intracellular magnesium, the latter making up more than 99% of total body magnesium, most cases of magnesium deficiency are undiagnosed. Furthermore, because of chronic diseases, medications, decreases in food crop magnesium contents, and the availability of refined and processed foods, the vast majority of people in modern societies are at risk for magnesium deficiency. Certain individuals will need to supplement with magnesium in order to prevent suboptimal magnesium deficiency, especially if trying to obtain an optimal magnesium status to prevent chronic disease. Subclinical magnesium deficiency increases the risk of numerous types of cardiovascular disease, costs nations around the world an incalculable amount of healthcare costs and suffering, and should be considered a public health crisis. That an easy, cost-effective strategy exists to prevent and treat subclinical magnesium deficiency should provide an urgent call to action.
- ...magnesium balance decreases when calcium intake is over 10mg/kg/day. 21
- patients with diabetes appear to be magnesium-deficient and magnesium deficiency likely increases the risk of diabetes.
- Dietary aluminium may lead to magnesium deficit by reducing the absorption of magnesium by approximately fivefold
- Just 42–64 days on a diet low in magnesium (~101 mg/day) produced atrial fibrillation and flutter in three of five postmenopausal women (ages 47–75 years). Moreover, the arrhythmias responded quickly to magnesium supplementation.
- In a randomised, double-blind, placebo controlled study on 350 patients with acute myocardial infarction, intravenous magnesium sulfate given immediately after completion of thrombolytic therapy significantly reduced all-cause mortality (3.5% vs 9.9%, P<0.01) and ventricular arrhythmias (13% vs 48.6%, P=0.00001).135
- "One study found that 10 out of 11 apparently healthy women were magnesium-deficient based on the oral magnesium load test. "
Since 1940 there has been a tremendous decline in the micronutrient density of foods.
In the UK for example, there has been loss of magnesium in
- beef (−4 to −8%),
- bacon (−18%),
- chicken (−4%),
- cheddar cheese (−38%),
- parmesan cheese (−70%),
- whole milk (−21%) and
- vegetables (−24%).61
- The loss of magnesium during food refining/processing is significant:
- white flour (−82%),
- polished rice (−83%),
- starch (−97%) and
- white sugar (−99%).12
Since 1968 the magnesium content in wheat has dropped almost 20%,
Principal Clinical signs of Magnesium Deficiency
(coeliac disease, non-tropical sprue, bowel resection,Crohn's disease, ulcerative colitis, steatorrhoea),
prolonged diarrhoea or vomiting.
Liver disease 191 (acute or chronic liver disease, including cirrhosis).
Metabolic acidosis167 192 193 (latent or clinical).
Pancreatitis194-197 (acute and chronic).
Porphyria with inappropriate secretion of antidiuretic hormone.
Proton pump inhibitors.199 200
Vitamin B6 (pyridoxine) deficiency.71 202
Vitamin D excess or deficiency 85 152 184 203
(chronic kidney disease and liver disease can prevent the activation of vitamin D).2 Causes of magnesium deficiency
Aluminium 8 (environmental and dietary).
Ageing149 (hypochlorhydria, ie, decreased acid in the stomach).
Antacids149 150 (including ranitidine and famotidine).
Bariatric surgery (small intestinal bypass surgery).151
Calcium supplements (or a high calcium to magnesium diet).
Type 1 and type 2 diabetes 83 167 (uncontrolled glucose levels).
Diet high in fat or sugar.152 168
Diuretics170-172—non-potassium-sparing diuretics (thiazide and loop diuretics).
Excessive ingestion of poorly absorbable magnesium 173 (such as magnesium oxide), leading to diarrhoea and magnesium loss.
Emotional and/or psychological stress174 (overactivation of the sympathetic nervous system).
Enzymatic dysfunction175 (impaired magnesium distribution).
Oestrogen therapy176 (shifts magnesium to soft and hard tissues lowering serum levels).
Excessive or prolonged lactation.177
Fasting178 (or low magnesium intake).
Gentamicin180 and tobramycin.181
Hyperparathyroidism and hypoparathyroidism.
Kidney diseases182-184 (glomerulonephritis, pyelonephritis, hydronephrosis, nephrosclerosis and renal tubular acidosis).
High phosphorus in the diet152 (soda, inorganic phosphates contained in many inactive ingredients in processed foods).
Hyperinsulinaemia187 (and insulin therapy).179
Insulin resistance188 (intracellular magnesium depletion).
Low salt intake.189
Low selenium intake.152
Less severe signs
Chvostek sign80 (twitching of the facial muscles in response to tapping over the area of the facial nerve).
Cramps (spontaneous carpopedal spasm or painful cramps of the muscles in your hands and feet).
Fasciculations (‘a brief, spontaneous contraction affecting a small number of muscle fibres, often causing a flicker of movement under the skin.
It can be a symptom of disease of the motor neurons)'.91
Pain or hyperalgesia206 (decreases the nociceptive threshold).
Tetany204 (involuntary muscle spasms).
Tinnitus208 (ringing in the ears).
Vitamin D resistance.
Arrhythmias (caused by overexcitation of the heart due to enhanced depolarisation susceptibility,
especially torsades de pointes or ventricular tachycardia with a prolonged QT interval).
Calcifications (soft tissue).
Coronary artery disease.
Depressed immune response.210
Hearing loss.152 212
Mitral valve prolapse.213
Parathyroid hormone resistance and impaired parathyroid hormone release/function.214
Seizures 215 (overexcitation of the nervous system (nerve cells),
which are more likely to fire due to a reduced electric potential difference between the outer and inner surfaces of the membrane).
Sudden cardiac death.
Prolonged QTc. ST segment depression 115 (in animals).