Monday, January 7, 2013

Factors in improving magnesium status

In my last blog found here I went over the importance of magnesium in the metabolic syndrome.  In this blog I will go over some of the things I feel are important in maintaining an adequate magnesium status.  While digging through the research I found a lot more than what I originally bargained for so it appears we may have a part 3, but more on that later.

To recap, when your intestine becomes permeable, an endotoxin known as LPS enters your blood circulation. This sepsis leads to your cells not responding to insulin, leading to high blood glucose levels which cause an even greater secretion of insulin which leads to conversion of glucose to fat and storage in your fat tissue.  In addition, the release of histamine in response to this sepsis increases your need for DAO, an enzyme used to decrease histamine levels.  Since all of the above require magnesium in order to perform these processes, magnesium deficiency appears to be a central player in the metabolic syndrome.  The question now becomes how can we manage our magnesium levels to prevent these issues?

Judging by the way this country operates, my guess is that most of the people who read part 1 came to the conclusion that they need to start supplementing with magnesium.  While magnesium supplementation is a good idea given the mineral depleted status of our soil and de-mineralized status of most water sources, just shoving magnesium supplements in to your mouth is probably not sufficient.  We need to pay attention to multiple factors here including whether or not the magnesium we ingest makes it's way in to cells, if it stays there, as well as how much magnesium we use on a daily basis.

The RDA for magnesium is set at 320mg for women and 420mg for men while actual intake in North America is 228mg and 323mg, respectively(1).  According to Carolyn Dean, MD, author of The Magnesium Miracle, research over the past 20 years shows that 300mg is required per day just to offset daily losses under ideal conditions(2).  When you add in stress, lack of sleep, a high sugar diet, diuretics such as caffeine and alcohol, and other things known to affect magnesium status, this number increases dramatically.  Let's take a look at each one and see what the research shows.

Stress and sleep deprivation are so intertwined that it is difficult to separate the two.  If there is any relationship that underscores the fact that you cannot separate the mental state from the physical it's the relationship between sleep and stress.  Magnesium appears to be a huge player here.  In a study performed on students during finals week, students who were under stress and had 80% of the sleep they were accustomed to saw a decrease in erythrocyte magnesium levels(3).  This study confirmed the results of a previous study by the same principal investigator that showed 4 weeks of sleep deprivation increased catecholamine levels (Stress hormones) and decreased intracellular magnesium levels and heart rate variability (HRV)(4).  Heart rate variability is a measure of autonomic function/stress where lower heart rate variability indicates increased stress load.

One of the problems one experiences with magnesium deficiency and sleep is that reduction in the quality and quantity of sleep increases magnesium wasting while a magnesium deficiency reduces the quality and quantity of sleep, making the problem worse.  One of the primary roles of magnesium in the body is to calm down the nervous system.  In a small study with people who experience restless leg syndrome, 10 subjects were given an oral magnesium supplement in the evenings.  The number of arousals per hour experienced by the subjects due to leg movements was reduced from 17 to 7, sleep efficiency improved from 75% to 85%, and 7 of the subjects stated that their sleep had improved on oral magnesium supplementation(5).  In another study on rats, 9 weeks of a magnesium restricted diet increased wakefulness by 50%, with a reduction of slow wave sleep by week 7.  When magnesium was reintroduced back in to the diet, the rats' sleep patterns returned to baseline(6).  Because of it's ability to improve sleep quality, it is probably a good idea to dose any magnesium supplementation just prior to bed in people who have poor sleep quality that may be caused by magnesium deficiency.  This will help end the vicious cycle of low magnesium decreasing sleep quality which in turn decreases magnesium levels.

One form of stress that people expect to see positive benefits from is exercise.  The results of exercise on magnesium balance have been mixed with most studies showing a shift from the plasma to erythrocytes (intracellular space) with an increase in urinary output on the same day based on the intensity of the exercise(7,8).  In 1 study, the amount of magnesium lost in the urine was positively correlated to post-exercise blood lactate levels and oxygen consumption indicating that exercise modalities that rely more on the anaerobic energy pathways are likely to induce greater losses of magnesium than aerobic activities(7).  This information should be of practical use to people pounding themselves in to the ground with 5 times a week crossfit and p90x style workouts as well as overweight people who begin with exercise that is too intense for their needs on January 1st.

As stated in part 1, magnesium is required to not only secrete insulin but also for cells to take in glucose once insulin has attached to the receptor on the cell membrane.  It makes sense that as you increase the amount of carbohydrate you eat you would also need to increase the amount of magnesium you get in order to process the higher amount of glucose being manufactured from that carbohydrate.  It would seem that this is a problem of relying on insulin as the primary modality of increasing glucose transport in to cells.  While a person who uses physical activity as their primary method of transporting glucose in to cells may not need to worry about magnesium needs via insulin action, the fact that ATP must be bound to magnesium in order to be active shows that there is really no way of getting around the greater need for magnesium in a higher carbohydrate diet, whether you exercise or sit on your keister.

As far as diuretics go, caffeine and alcohol are by far the most frequently used diuretics given their ease of availability.  Since both increase water loss, they can both have an impact on magnesium status.  Alcoholics tend to have lower levels of magnesium and some of the clinical symptoms of alcoholism such as hypertension, sleep problems, and the withdrawal symptoms after ceasing alcohol use appear to be from low magnesium levels(9,10).  Alcohol negatively impacts magnesium by drastically increasing urinary losses(9).  Interestingly enough, this appears to be dose dependent as a study looking at the effects of light beer consumption (330mL/day for 30 days)showed an increase in plasma magnesium status with the ingestion of beer when compared to a control drink containing mineral water with similar mineral content(11).  (Mmmm, beer)  However, we do not know if this is a shift out of cells and in to the plasma or a result of a response to the alcohol and magnesium combination.

Caffeine appears to have the same effect on magnesium as alcohol in that it increases urinary loss of magnesium.  The urinary loss of magnesium appears to be dose related and tends to occur around the time of caffeine consumption, tapering off as time from ingestion increases(12,13,14).  The average intake of magnesium is nowhere near sufficient in people who drink alcohol or coffee/caffeinated beverages, get poor sleep, are chronically stressed, exercise intensely, and eat high sugar diets.  I would even make the argument that the RDA is insufficient for people who do more than one of these things on a regular basis. 

Up until this point we have discussed lifestyle factors that increase the need for magnesium.  The next logical step is to increase magnesium intake via supplementation or foods high in magnesium.  The problem is, this simplistic way of looking at it can be problematic.  Many gastrointestinal issues can prevent magnesium from being absorbed.  Since magnesium requires stomach acid to separate the elemental magnesium from whatever it is bound to, people with low stomach acid tend to have a problem absorbing magnesium(2).  In addition, those with a leaky gut will also have a problem absorbing magnesium because some of the magnesium channels are located in the tight junctions between enterocytes.  In fact, 80-90% of the magnesium absorbed from the intestine uses these tight junction channels, illustrating why a healthy gut is critical in making sure magnesium is getting in to the blood so it can make it's way to cells(15).

In 2 studies performed on rats, animals that were induced with intestinal permeability to either 5 or 10 fold greater than baseline levels saw permeability return to baseline upon rinsing the lumen with magnesium or calcium at lower permeability and only magnesium at higher permeability(16,17).  In this instance ingesting oral magnesium may prove beneficial to healing your leaky gut, but if you continue to enjoy weekly gluten and alcohol bombs on Friday through Sunday very little magnesium will ever make it in to your cells so you wouldn't really be fixing the problem.  It would be like trying to heal a cut on your hand that has 5 stitches by popping the stitches every few days, it's never going to heal that way.  Take a couple of months to fix the problem and then return to enjoying your life, it will be worth it in the end.  Obviously a couple of rat studies proves nothing but they certainly make you think, especially with so much other evidence pointing to a positive effect of magnesium on health.

Let's say you are doing everything you can to heal your leaky gut and you would like to speed up the process.  You like the idea of taking oral magnesium and you are doing everything in your power to avoid things that may perforate your intestinal lining.  Is there something we can do to also get magnesium directly to cells?  In his book transdermal magnesium therapy, Dr. Mark Sircus goes over, in detail, the benefits of transdermal magnesium therapy.  There appears to be multiple ways to use magnesium transdermally, and while there is not a lot of studies supporting the use of it that way, there are thousands of anecdotal reports of success on the internet.  In my opinion, the best way would be to enjoy dips in sea water as often as possible, but since a lot of us are landlocked, I will go over the other routes of administration.

Magnesium sulfate (Epsom salt) baths-Putting magnesium sulfate in to a bath or a foot soak is one potential way of getting magnesium transdermally.  I find this way to be less than ideal from a cost perspective because you have to use a ton of epsom salts.  However, I've done the baths with just 2 cups of epsom salts and when you are finished I cannot think of ever being in a more relaxed state.  I also add in an equal amount of baking soda as a sort of detox bath.  Foot baths are also a good option and require less epsom salts.

Magnesium chloride oil-A few companies make a magnesium preparation from sea brine that can be effective for delivering magnesium while bypassing the gut.  It's not really an oil, but it kind of feels that way.  This was how I did it when I was having problems sleeping and oral magnesium glycinate didn't seem to help.  I was out like a light on the first night and my wife commented I was not my normal tossing and turning self.  Obviously I cannot rule out placebo effect but when you can't sleep any effect is welcome.

Personally, I use magnesium oil transdermally and it was initially my preferred modality because even high oral doses of magnesium glycinate did nothing.  It turns out this was because I had a leaky gut and the magnesium wasn't making it's way in to my cells.  As the leaky gut improved I no longer needed to take it in this manner so now I just take periodic baths and a small oral dose.  It took a while for me to fix the issue because I initially went at it alone and didn't completely fix my diet.  I eventually contacted a functional medicine doctor to help address the issue, something I will be discussing in an upcoming blog series.  I do continue to use the oil  as a deodorant/anti-perspirant because it works better than anything else I have ever tried.  I will not go over how much I took to resolve my issue because it is higher than the RDA and I'm not a doctor, I will only say that I did a lot of digging on this site and followed his instructions:

FYI, at high doses the oil burns.  As far as oral magnesium goes, I like dimagnesium malate and magnesium oxide.  If you search around the internet enough you will find plenty of evidence that magnesium oxide isn't absorbed well from the intestine.  This may not be a bad thing if you have significant issues in your gut and are taking transdermal magnesium with it.  The functional medicine doctor I use told me that in his clinical experience the magnesium oxide he prescribes seems to work better than anything else.  My guess is that since it doesn't get absorbed well from the gut it probably works better for fixing issues in the gut.  As for dosage, this will be specific to the individual and requires a bit of tinkering.  You'll know if you take too much orally because your stools will become loose. As an example, I took about 4x times the RDA and still didn't experience diarrhea.  As long as you have properly functioning kidneys you don't really need to worry about overdoing it, but consult your doctor just to make sure.

So where do we go from here?  In researching for this second part I actually came upon something very interesting with regard to the histamine part of the magnesium picture but it would have made this blog too long.  In the final part of this blog series on magnesium I will explore the interplay between histamine and magnesium and how you may be unknowingly botching your efforts to improve magnesium status by eating those leftovers.

If you have any questions about magnesium feel free to post them in the comments.