This scenario occurs often in American health care:
A doctor takes the blood pressure of a patient with no known health problems and finds it elevated. A diuretic is prescribed to reduce body fluids and return blood pressure to normal.
But during a follow-up appointment, the person's blood pressure is even higher, leading to more blood-pressure medications such as a calcium channel blocker and perhaps an ACE inhibitor.
Blood pressure finally begins to come down but then the next round of blood work reveals high cholesterol, leading to a prescription for statin drugs. Now on three, even four, prescribed drugs, the patient is eventually diagnosed with type 2 diabetes, with more prescriptions added to the mix.
Healthy one moment, now-embattled with a variety of diseases the next. What went wrong?
Researchers are recognizing that such a domino effect of health problems can result from a magnesium deficiency, with each prescribed drug further depleting the important mineral and raising health risks.
From the very start, the person might have needed nothing more than a magnesium supplement.
"I really believe this happens," said Betsy Blazek-O'Neill, a physician with the Allegheny General Hospital Integrative Medicine Program. "The literature is out there about nutrient deficiencies caused by medications but doctors are not paying attention to it. They are not bad doctors but just overloaded and aren't always paying attention to the effects of drugs on certain nutrients."
Carolyn Dean, an M.D. and naturopathic physician based in Maui, Hawaii, who this year updated her 2006 book, "The Magnesium Miracle," also said the scenario described "is a very common one," based on emails and accounts from her patients whom she says she's helped overcome certain health problems solely with magnesium supplements.
The World Health Organization said, "Low magnesium status has been implicated in hypertension, coronary heart disease, type 2 diabetes mellitus and the metabolic syndrome," while noting that up to 80 percent of Americans are deficient in the mineral.
The National Institutes of Health recommend daily consumption of 420 milligrams for men and 320 milligrams for adult woman, with slightly more for pregnant women. Dr. Dean goes further, suggesting 700 milligrams of elemental magnesium daily, a level difficult nowadays to get through diet alone — through leafy green vegetables, squash, broccoli, legumes, seeds, nuts, whole grains and some meats and saltwater fish — because of soil that is depleted of magnesium.
In fact, magnesium levels in food have been declining for the past 60 years because of intensive, high-yield farming practices and synthetic fertilizers that can dilute concentrations of nutrients, including magnesium, according to a study published in Nutrition and Health in 2007, as well as others.
Prescribed drugs further deplete the stores of magnesium in the body. Among these are proton pump inhibitors for acid reflux, including Prilosec, Zantac or Nexium; statins; and blood pressure medications, Dr. Dean said. The biggest magnesium busters are drugs containing fluoride, she said, which also is added to public water systems to prevent cavities.
Magnesium provides so many benefits that doctors might be unable to pinpoint the problem. "They can't define the one thing it does," Dr. Dean said.
But the literature is clear, she said. Magnesium may be our most important and most necessary nutrient.
Neurosurgeon and pain expert C. Norman Shealy, and a noted holistic medicine proponent, has said that "every known illness is associated with a magnesium deficiency," adding that magnesium is necessary for "electrical stability of every cell in the body."
Magnesium is involved in 700 to 800 enzyme systems bodywide and necessary for proper nerve, bone, muscle and heart function, while playing an important role in energy and digestion. It also is a building block for RNA, DNA and neurotransmitters, Dr. Dean said.
The most immediate symptoms of deficiency include heart palpitations, leg and muscle cramps, constipation, insomnia, migraines and fatigue.
Although Americans are used to being told they need calcium, excess intake is now linked to heart problems, and osteoporosis rates continue to rise in the United States. The National Osteoporosis Foundation in April 2013 said about 9 million Americans have osteoporosis and 48 million adults 50 and older have low bone mass, representing the rising toll of problems involving bone health.
For most people, in addition to good nutrition, healthy bones are maintained by regular exercise, not smoking and sensible consumption of alcohol.
But Dr. Dean said too much calcium, coupled with magnesium deficiency, will leave bones brittle. With sufficient magnesium, she said, the bone latticework becomes more flexible, less likely to break.
Calcium and magnesium should be at a 1-to-1 ratio in the body, Dr. Dean said, with the need for adequate levels of vitamin D and K2 that help with mineral absorption for optimum bone health. She said people should strive for the right ratio of calcium, magnesium and vitamins K2 and D, noting the proper ratio of those nutrients to be found in a combination of cod liver oil and butter oil.
Typical serum blood tests don't usually reflect deficiency because the body tends to keep a steady supply of magnesium circulating in the blood to assure enough is available to sustain heart function, with the left ventricle having the highest concentration of magnesium in the body. Deficiencies are more readily gauged with the Magnesium RBC test — a test of magnesium levels inside red blood cells, Dr. Dean said.
Treating magnesium deficiencies also can be challenging. Most supplements include magnesium oxide, which has a 4 percent absorption rate. Dr. Dean recommends supplements using magnesium citrate or picometer-sized magnesium, which have higher absorption rates. She sells a supplement on her website, http://drcarolyndean.com. She warns that magnesium supplements can cause loose stools and even diarrhea.
Ronald M. Glick, medical director for the Center for Integrative Medicine at University of Pittsburgh Medical Center Shadyside, said he recommends magnesium to patients who have migraine headaches and fibromyalgia, but the benefits don't stop there.
"The one thing magnesium is reported to do is to help with blood pressure," he said. "People with high blood pressure, with magnesium on the low side, have beneficial effects from magnesium. Studies show that it lowers blood pressure by a few points."
Scott R. Drab, associate professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy and director of University Diabetes Care Associates in Greensburg, said he recommends magnesium supplements to those with diabetes to smooth out blood-glucose levels.
"We've used it in patients with diabetes, where it actually improved glucose control, as well. It's not uncommon that 400 milligrams of magnesium oxide helps them to gain better control by smoothing out blood sugar levels with less fluctuation."
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