Magnesium - treating a deficiency
I have struggled for over twenty years to try to make sense of red cell magnesiums. It seems that they are almost invariably low in patients with chronic fatigue syndrome. Furthermore, so many patients with chronic fatigue syndrome do benefit from magnesium by injection. You could argue that I have been a bit naughty in the past by using a low intracellular magnesium as an excuse for trying magnesium injections! This is really to encourage GPs to use the injections because clinically they are so helpful, although often paradoxically when I repeat a red cell magnesium, it is only marginally better, but magnesium injections often afford marked improvement clinically.
I actually now believe that a low red cell magnesium is a symptom of mitochondrial failure. It is the job of mitochondria to produce ATP for cell metabolism and about 40% of all mitochondrial output goes into maintaining calcium/magnesium and sodium/potassium ion pumps. I suspect that when mitochondria fail, these pumps malfunction and therefore calcium leaks into cells and magnesium leaks out of cells. This, of course, compounds the underlying mitochondrial failure because calcium is toxic to mitochondria and magnesium necessary for normal mitochondrial function. This is just one of the many vicious cycles we see in patients with fatigue syndromes.
The reason for giving magnesium by injection is in order to reduce the work of the calcium/magnesium ion pump by reducing the concentration gradient across cell membranes.
So, a low red cell magnesium is an indication for giving magnesium by injection. Doing this makes the work of the ion pumps less and therefore helps mitochondria to work better.
This explains why it is a waste of time measuring serum magnesium. Serum levels are maintained at the expense of intracellular levels. If serum levels change this causes heart irregularities and so the body maintains serum levels at all cost. It will drain magnesium from inside cells and indeed from bone in order to achieve this.
Correcting a deficiency
Having said that, getting serum levels as high as possible will make the job of the calcium/magnesium ion pump much easier. Therefore intracellular levels can be improved by taking magnesium supplements. There are lots of different ways one can do this. The only way I can guarantee to get magnesium levels up is by using Magnesium by injection.
I have yet to see a red cell magnesium result which is too high. However, it is theoretically possible to overdose with magnesium in people with kidney failure.
Some people never manage to get their red cell magnesium levels into the normal range and one has to settle for low normal or levels just outside the normal range. Dr John McLaren Howard tells me that there is actually a biphasic normal distribution of magnesium. Because I see low magnesium almost routinely in patients with fatigue syndromes, I just wonder if this vicious cycle of low magnesium and fatigue has a genetic predisposition.
Magnesium by mouth
Are you taking enough magnesium in the diet? The recommended daily allowance is 300mgs for men, 350mgs for women. Magnesium is extremely safe by mouth – too much simply causes diarrhoea. Try increasing the amount of magnesium you take by mouth until it causes diarrhoea, then reduce the dose slightly so it does not. This is called taking magnesium to bowel tolerance (just like using vitamin C to bowel tolerance).
The richest source of magnesium in the diet is from chocolate (yippee, but care with the sugar!), nuts, green vegetables and seeds. Use a magnesium rich salt such as Solo. Use a bottled water rich in magnesium. Hard water also contains more magnesium than soft water. Most processed foods are low in magnesium.
As a routine I like all my patients to take my Mineral Mix, which is rich in magnesium in balance with all other essential trace elements that are permitted. If this does not do the trick, add in other magnesium salts such as Epsom salts (try between ¼ and 1 teaspoon daily dissolved in a little warm water and gulped down, followed by a nice drink – too much gives diarrhoea, but the right amount can help with constipation), magnesium citrate, chelated magnesium, magnesium EAP etc.
If there is also a problem with Acid-Alkali balance then magnesium carbonate would be a good option.
Is magnesium’s absorption blocked?
Calcium and magnesium compete for absorption and so too much calcium in the diet will block magnesium absorption. Our physiological requirement ratio for calcium to magnesium is about 2:1. In dairy products the ratio is 10:1. So, consuming a lot of dairy products will induce a magnesium deficiency.
Tea contains tannin, which binds up and chelates all minerals including magnesium. If tea is to be drunk, don’t have it with food. Incidentally, tea drinking is a common cause of iron deficiency anaemia in the UK for this same reason.
Vitamin D is necessary for the body to utilise magnesium. The only significant source of vitamin D is direct sunshine on the skin (no effect through glass). Only a small amount is required to make a difference – 10 minutes a day on the face and hands has an effect. One hour of whole body sunshine in summer can produce 10.000iu! The RDA for vit D is set ridiculously low at 400iu – in America it has just been raised further, but I like people to have at least 2,000iu and many people I recommend 10,000iu daily. At this level of dosing there are no side effects and no toxicity. In winter in our climate we should all be taking vitamin D.
Hypochlorhydria – magnesium requires an acid environment for its absorption and hypochlorhydria will result in poor magnesium absorption. See Heartburn - at last I have sussed out why this is such a common problem!. Actually I see this problem very commonly in CFS!
Are you a magnesium loser?
- All diuretics will make you pee out magnesium. By this I do not just mean drugs, but also tea, coffee and alcohol. Even some herbal teas are mildly diuretic.
- Hyperventilation makes you pee out magnesium. This is because hyperventilation induces a respiratory alkalosis, the body pees out bicarbonate to compensate, but each bicarbonate is negatively charged and carries a positively charged cation with it – in this case magnesium.
- Heavy exercise makes you pee out magnesium. This should not be a problem for CFS patients (although many are ex-athletes!) but does explain why long distance runners may suddenly drop dead with heart dysrhythmias.
- Magnesium is lost at times of stress. This also includes hypoglycaemia, food allergy reactions and detoxification.
Can you hang on to magnesium?
- For magnesium to be retained inside cells you need good cell membranes. The two important facets of cell membranes are:
- Have good antioxidant status - see Antioxidants.
- Have good levels of fats and Essential Fatty Acids in the diet. See GOOD FATS AND BAD FATS.
- Boron is necessary for normal calcium and magnesium metabolism. Calcium and magnesium metabolism is of critical importance in livestock. Indeed all vets will tell you the dramatic effects injecting these minerals have on cows which go down at calving time. What is interesting is that they don’t just inject calcium and magnesium, they actually inject calcium, magnesium boroglucanate - ie it seems that the boron is also important in calcium/magnesium metabolism. Boron is of proven benefit in arthritis, it is in the Mineral Mix but additional amounts are present in my Joint Mix. See Arthritis - Nutritional treatments.
Magnesium absorption through the skin
A recent paper by Rosemary Waring from Birmingham has been very helpful. She did experiments with people looking at the absorption of Epsom Salts in the bath. A 15 minute bath at 40ºC with a 1% solution of Epsom Salts caused significant rises in plasma magnesium and sulphate levels together with an increase in magnesium excretion in the urine. To achieve a 1% solution, a standard UK bath of 15 gallons requires 600grams, (just over a 1lb) of Epson Salts. The water should feel slightly soapy. In this experiment there were no adverse effects, indeed 2 of the volunteers who were over 60 years of age commented without prompting that their rheumatic pains had disappeared. See Report on Absorption of magnesium sulfate (Epsom salts) across the skin
Magnesium chloride could also be given through the skin. Again there is good scientific work showing that magnesium chloride is well absorbed through the skin. The recipe for this is a 33% solution of magnesium chloride. So if you take 333grams of magnesium chloride (I can supply) into a jug and make this up to a litre this will give you the correct solution. You may have to warm this up for it to be completely dissolved. Or you could add a bit more water - it really doesn’t matter. The daily dose is then 10mls (or more) rubbed onto skin. Use soft skin such as in the tummy or in the armpits or inside the thighs, don’t wash it off subsequently but every day add to magnesium on site – as the levels build up the absorption will be improved. Se also Minerals and vitamins in creams
Epsom salts available from Just a Soap - they will deliver a sack to your door!
Magnesium per rectum
This is another route of getting magnesium into the body. Details in Magnesium per rectum.
Magnesium by nebuliser
A nebuliser bubbles air through a solution and turns it into a mist which can be inhaled. The lungs have a large absorptive surface (about the size of a tennis court) and so magnesium can easily be absorbed in this way. I now have patients whose levels I have checked before and after nebulisation and so far results consistently show increased levels.
I am using the same magnesium sulphate preparation for nebulisation as for injections. It is a 50% solution, which some people find slightly irritant because it may make them sneeze or cough but after a few breaths this settles down (I found it best just to inhale through the mouth and not the nose). There are no theoretical or practical reasons why anyone should get problems such as wheezing while nebulising - indeed, magnesium works well for asthma. Some patients respond clinically as well as if they'd had an injection. In fact, a study in New Zealand of magnesium by nebuliser for the treatment of acute asthma showed this to be a very effective treatment, over and above the effect of standard bronchodilators. If you feel you are getting short of breath during the nebulisation, stop the treatment.
Initially I suggest using 1gm daily of magnesium sulphate (approx 100mgs of elemental magnesium). Because magnesium sulphate is a salty solution, you may see white crystals appearing in the nebuliser and the tubing but these can be easily washed away. They may block the small hole through which the solution bubbles in the nebuliser, in which case rinse it out.
How to use the nebuliser
The idea is to convert the liquid magnesium sulphate into a vapour which can be inhaled and absorbed by the lungs. This is achieved by bubbling air through a solution of magnesium. Most of the nebuliser is a simple pump which pumps air. Plug it in and start. You can feel the air coming out of the nozzle. There is a length of plastic tubing - push one end over this nozzle, the other end goes into the base of the nebulisation chamber. From the top of the nebulisation chamber the mask fits on via a connecting piece. The nebulisation chamber divides in two when the top half is unscrewed from the bottom. Magnesium needs to go into the bottom half of the chamber - you can see there is a little plastic float which directs the air from the pump down through the liquid magnesium. This float needs to be positioned squarely over the air flow otherwise the nebulisation chamber won't screw back together snugly again. You can see when the nebuliser is working because air bubbles through the magnesium and a white mist comes up out of the mask. Nebulisation is complete when the pool of magnesium is almost gone and no more white mist comes out of the mask - it should take 10-15 minutes.
How to obtain a nebuliser
These are the arrangements I have come up with to speed up the process and to reduce the cost. You can purchase a nebuliser direct from "intermedical" - freephone 0800 028 2194, the cost is approx £60.00, plus carriage. You simply ring them, they send you an order form and a form to fill in so they do not charge you VAT, you return the form to them with payment, and they will post it directly to you. It has a two year warranty and appears to be very good value for money. When you receive your nebuliser, phone the office to order some magnesium sulphate crystals (60g) and instructions on how to use them. I recommend using analar grade magnesium which is highly purified. One pot should be sufficient for two months of daily nebulisation.
Instructions for use of magnesium sulphate crystals
The crystals are hygroscopic – this means that they will absorb water from the atmosphere if exposed to air. It does not matter much of they do - the crystals simply go a bit hard! Therefore, keep the pot sealed and only open it very briefly when you are measuring your dose of magnesium sulphate. One gram of magnesium sulphate is contained in approximately a third of a teaspoon. The actual dose is not critical at all – it will be obvious within a week or two if you are using a little bit too much or a bit too little as, of course, you can expect the whole pot to last two months. 1gm of magnesium dissolves easily in a small teaspoon of water. I recommend you use spring water, put the crystals of magnesium sulphate and water straight into the nebulisation chamber and the air bubbling through will quickly mix and dissolve these crystals. After a while it may go a bit foggy, but this does not matter – it will still work just as well.
I am very happy for people to experiment with stronger or weaker solutions. Sometimes the stronger solutions give a metallic taste in the mouth and throat – but on the other hand the weaker solutions take longer to nebulise. It is up to everybody to find the right balance for themselves.
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