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Home , Chard, Magnesium glycinate, Magnesium malate

Fall 2017 | Vol. 3 No. 2 ND NOTES A Practical Resource for Naturopathic & Integrative Practice

Magnesium & Me

Mg Mg

Mg

Mg

In this issue

What is ’s fundamental role? P3 Magnesium absorption: what you need to know P7 Anxiety, depression & magnesium’s role P15 ND Notes | Vol. 3 No. 2

Message from the editor ND Notes We debated whether to release an entire edition of ND Notes featuring a single Fall 2017 | Vol. 3 No. 2 micronutrient. However, of all the micronutrients, magnesium and its versatile role in human and medicine, certainly warrants such discussion. Editor Norman Goh Magnesium cofactors over 600 human enzymes, and is needed to activate 200 more. For many Canadians trained to think of health products as a tight coupling of cause and effect, Copy Editor comprehending the broad scope of magnesium’s role as it pertains to the human body can Heidi Hoff be hard to wrap their minds around. Conversely, the scope of health issues a magnesium Contributors deficiency can wreak is large, long-lasting, and also difficult to wrap the mind around. Nadia Lamanna, ND Jenna Mangan CNP Truly, studying the correlations between magnesium levels and clinically observable symptoms is an exercise in systems biology. This issue provides a little context for that, incorporating Art Direction & Design Tina Amouzgar magnesium status as part of your regular differential diagnoses for certain ailments, as well Dorvan Davoudi as instigating more holistic thinking when it comes to supplementation of magnesium.

General Manager Norman Goh Yours naturally, Norman Goh Published by Editor CanPrev & Orange Naturals

We believe naturopathic medicine should be safe, effective and accessible to all Canadians. Q & A

Privacy Policy CanPrev & Orange Naturals respect your privacy. We do not rent, trade or sell our mailing lists. If you do not wish to receive Is there such a thing as a “best” have just one effect. Since magnesium this publication or wish to change your form of magnesium to take? works on such a fundamental level, the mailing address, please contact health benefits are hard to isolate. And [email protected] You would think so, but there actually isn’t. because we can’t identify just one effect, it’s or 905.881.6800 Like other areas of alternative medicine, easy to overlook its importance. choosing the ideal form for your clients Just as the body utilises , We welcome your letters, submissions, to take will depend on their particular and to stay healthy, vital organs like the news and comments. Please contact circumstances, needs and biological heart and brain use all forms of magnesium [email protected] individuality. Magnesium is a supplement, for the same reason. Hundreds of the body’s not a drug. While your patients might chemical processes fall apart without this All material is copyright © 2017 take an antacid to reduce heartburn or very important . So when you tell your ND Notes is intended for educational purposes an antibiotic to fight infection, taking clients that their bodies need magnesium in only and is not intended to serve as medical magnesium when they are deficient doesn’t order to stay alive, you’re not exaggerating! advice. The information provided is intended for the use of healthcare practitioners and should not be used for diagnosing or treatment of a health problem, or as a substitute for professional care. ISSN 2368-7908

Magnesium malate

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Do all types of magnesium increases the osmotic pressure that causes couple (magnesium+glycinate) can easily provide a laxative effect? water to be drawn into the intestine to dilute cross the intestinal membrane as an intact the ions and lower their concentration. The pair through gates designed specifically No, not at all. increased flow of water into the gut is what for their passing called dipeptide It all depends on the type of magnesium creates the laxative effect and can lead to channels. As a result, no magnesium you supplement with and if it needs to loose stools, bloating and diarrhea. ions are left behind to disrupt osmotic pressure, and therefore a laxative be broken down into its ionic form in the Magnesium chelates like magnesium effect is avoided. body before it can be absorbed. A high glycinate do not need to be broken down concentration of mineral ions in the gut into ionic form for absorption. The happy

Magnesium forms like citrate and oxide can cause a laxative effect in large doses and be driven straight out of the body through the colon. Other forms like and malate have higher absorptive properties that can travel happily to the small intestine where they are absorbed.

Magnesium citrate

Magnesium oxide

Magnesium glycinate

Magnesium malate

Osmotic diarrhea

Why does magnesium sometimes cause diarrhea and digestive upset? It’s all about osmosis. When there are more mineral ions unabsorbed in the intestinal tract than there are mineral ions in the surrounding intestinal cell wall, osmosis tries to equalize the concentration of ions.

This means water flows out of the mucosa cells into the intestine. Too much water in the intestinal tract could mean loose stools, bloating and diarrhea. That’s why having too much unabsorbed magnesium in your gut can have this laxative effect! Yuck!

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What is magnesium’s fundamental role? Hint: There isn’t just one

There is a host of scientific studies linking magnesium to many different health conditions, but reviewing these effects one by one is overwhelming and confusing. Instead, it’s more helpful to look at magnesium’s underlying physiological mechanisms. Understanding what magnesium does fundamentally will let us better understand how insufficient magnesium levels might affect our bodies and our daily lives. Magnesium’s hundreds of roles can be roughly categorized into four basic functions.

1. Magnesium activates furnace to speed up these reactions, not without causing a lot of damage anyway. enzymes That’s where enzymes come in. We are kept alive by trillions of chemical Enzymes are bits of that catalyze reactions that occur inside the body. and regulate almost all metabolic reactions. are broken up and harvested As catalysts, they reduce the energy needed Without enzymes to catalyze for energy. New tissue is created. Cellular to spark a chemical reaction and speed up reactions, hemoglobin synthesis waste products are removed. New strands reactions. Without enzymes, reactions that would be 30 times slower with a of DNA are synthesized. This collection of would normally take milliseconds to occur half-life of 2.3 billion years. That's chemical processes is called metabolism. might take hours or days. Some enzymes half the age of the earth! The speed a reaction occurs will depend on require additional ions or molecules called factors like temperature, pressure, solubility cofactors to function. Without a cofactor was a required cofactor for 300 enzymatic and concentration of molecules. We use bound to its structure, an enzyme may reactions. This figure is found in many these factors every day. You might notice float dormant and be unable to catalyze medical texts and quoted in many scientific that dissolves in hot water faster, or any reactions. Magnesium is a cofactor for papers. Since then, many more enzymes that refrigerating food will slow the rate of decay. several important enzymes in the body, like rely on magnesium have been identified. When you make a campfire, a hotter flame DNA/RNA polymerases used to transcribe A search of today’s enzymatic databases will burn wood faster. new DNA/RNA strands, and guanylate reveals over 600 enzymes that magnesium is Our metabolism needs to occur at a certain cyclase, used to regulate the movement a cofactor for and another 200 enzymes that rate to keep us alive. But we don’t have the of minerals across cell membranes. need magnesium to be activated. liberty of turning the body into a raging A 1968 estimate suggested that magnesium

A brief refresher: DNA, or deoxyribonucleic acid, is a long, twisting, double-stranded molecule found in the nucleus of every cell. These nucleic acids contain the sum of genetic information that makes us unique organisms. They’re also the blueprints for making all proteins in the body. DNA strands are made of sequences of nucleotide bases: adenine, thymine, cytosine, and guanine. Because of the way these nucleotides are attracted to one another, the opposite strand in a DNA molecule will have a mirror sequence of nucleotide bases. Adenine is always paired across thymine, and cytosine is always paired across guanine.

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Enzyme pathways

Mg2+

Glycolysis

Krebs cycle

Phosphorylation (breaking down)

Magnesium is involved in the enzymatic pathways (glycolysis, the Krebs cycle and oxidative phosphorylation) that are responsible for making (ATP).

2. Magnesium creates 3. Magnesium helps to synthesis is impaired. And since protein is used for most of the structural components cellular energy create, repair and protect and nearly all metabolic functions in the body, a lack of proteins can have Arguably the most important enzymes DNA and proteins widespread consequences. that magnesium is a cofactor for are the ones that produce cellular energy. Making proteins These enzymes form a series of pathways Creating DNA (glycolysis, Kreb’s cycle, phosphorylation) When a protein needs to be created, We mentioned earlier that magnesium is an that convert organic compounds like specific DNA nucleotide sequences are essential cofactor for an enzyme called DNA glucose sugars into smaller molecules read and copied (transcribed) onto another polymerase which repairs and replicates called adenosine triphosphate (ATP). ATP molecule called RNA. The RNA strand is strands of DNA using spare nucleotides acts as our main unit of cellular energy. then moved out of the nucleus where enzyme-like organelles called ribosomes floating around in the nucleus. Every one of our hundred trillion cells use it as a guide to synthesize chains of DNA polymerase is used all the time in manufactures ATP to store and shuttle amino acids that form the desired protein. DNA repair and DNA copying, creating intracellular energy. ATP stores a tremendous new strands at a speedy rate of 3,000 amount of potential energy in the bonds This protein synthesis relies on all sorts nucleotides per minute. Consider the of the second and third phosphate groups. of enzymes to work, from helicases that magnitude of the role this enzyme plays. When the cell wants to carry out a function open up the DNA strand to be read, to Hundreds of billions of cell divisions occur like cellular division or transport molecules RNA polymerases that create RNA based in the body daily, and each time a cell across the cell membrane, it breaks this bond on the original DNA sequence, to protein divides, it needs to replicate an identical and releases the energy. kinases. Magnesium is a cofactor for most of these critical enzymes. The ribosome, set of DNA, or approximately 3 billion We use a tremendous amount of ATP all the while not technically an enzyme, is the base pairs. time. The typical adult only stores about 50g most important catalyst for stitching DNA polymerase has two binding sites for of ATP in the body so each ATP molecule is together amino acids into proteins. Lots of magnesium. Without magnesium, it cannot recycled over a thousand times a day. magnesium is needed to keep this complex work. This is corroborated by studies that Since cellular pathways are magnesium riboprotein stable. show DNA synthesis visibly slowing in the dependent, we need quite a bit of Without enough magnesium, protein absence of enough magnesium. magnesium on hand to fuel a continuous production of ATP.

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their structure. Magnesium-powered ion pumps shunt , against its concentration gradient, This effect has been tested experimentally, out of the cell to maintain normal DNA showing that a higher concentration of concentrations of sodium and magnesium will measurably raise the in and out of the cell. Just like the water melting temperature of DNA molecules. pump in your basement, the ion pumps Transcription Many proteins and protein complexes in your body are necessary to restore incorporate magnesium into their structures. homeostasis and balance. In fact, there are about 3751 human proteins mRNA RNA with magnesium binding sites to date. Sodium and potassium Transcription 4. Magnesium in the conduct nerve signals cell membrane regulates Sodium and potassium gradients are key to how nerve cells transmit electrical concentrations of other signals. When a cell receives a stimulus, Protein minerals the cell opens gates that allow sodium ions to rush in cells and potassium ions Some of those 3751 proteins dot the to rush out. This action in one part of the surface of our cell membranes and perform cell membrane will cause nearby parts of a variety of roles, like receiving signals from the cell membrane to act as well, creating hormones (signal transduction), enzymatic Repairing DNA a travelling wave of depolarization. This activity and transporting things across wave is called the nerve impulse. DNA polymerase is a very accurate enzyme, the membrane. In particular, magnesium- making less than one mistake in a billion dependent proteins are used to facilitate Without enough magnesium, the active base pairs. But even if DNA is copied perfectly, the transport of different minerals into transporters are unable to restore the mistakes in the DNA sequences do happen. and out of cells, acting as gates for sodium original concentrations of sodium and Genetic damage can occur because of thermal (Na+), potassium (K+), and (Ca+). potassium in the cell. This, along with a changes, radiation, viruses or the presence of few other functions magnesium plays, can Many of these are active transporters, highly reactive chemicals. A lot can go wrong lead to an overactive nervous system which for instance pumping sodium out of when you’re maintaining 3 billion base pairs! is more sensitive to random stimuli. In cells even though it’s against the If left unchecked, these mutations will be real life, that might translate to increased concentration gradient. propagated with every cell division. sensitivity to noise, irritability, migraines, There is a whole other set of processes Imagine a flooding basement. Water twitching, irregular heartbeats and anxiety. naturally flows downhill, so you'll need dedicated to identifying and correcting If left unchecked, a a pump to move the water out of the damaged DNA. The involved enzymes cut can also lead to a potassium deficiency, basement, against the flow of gravity. away the damaged sections and repair the since potassium is released into the gap with fresh nucleotides. Unsurprisingly, bloodstream and flushed out in urine. magnesium is involved in almost every enzyme in this process.

Protecting nucleotide bindings and proteins Magnesium also has a stability effect on the structures of proteins and DNA. Each strand in a DNA double-helix is negatively Na+ charged. Without the hydrogen bonds of their nucleotide base pairs holding them together, they will repel and break apart (think opposites attract and likes repel). In situations where DNA is exposed to Pump higher temperatures or extreme pH, these hydrogen bonds can break. Magnesium + + ions have a strong positive charge. Na Na Concentrated in the nucleus of cells, these Na+ ions can help reduce the negative charges in the DNA strands, stabilizing

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even lead to cell death (apoptosis). Too much excitement in nerve or muscle cells might manifest as muscle spasms or twitching, and over time can cause neurodegenerative diseases.

Next time you do a high-intensity workout at the gym, see if you experience any muscle cramps. They may be an acute sign that Magnesium regulates needed for something specific like a nervous your muscle cells are not able to restore calcium in cells impulse or a muscle contraction. After such calcium balance. Try taking magnesium and an action occurs, magnesium helps active seeing what happens. Muscle contraction is Calcium is used in cells as a cofactor transporters pump calcium out of a cell. the classic example of how magnesium and for a variety of energetic functions calcium balance each other in the body and As with sodium and potassium pumps, including nerve impulses (like sodium is the most easily observable. and potassium), cell movement, and most insufficient magnesium may prevent notably muscle contractions. Because calcium pumps from working. Unable to And it’s not just contractions in your biceps. calcium is typically an excitatory cofactor, flush out calcium, the cell may become Magnesium to regulate calcium will affect the the mineral usually enters a cell only when overstimulated, damage the cells and strength of heart and arterial contractions too.

Mechanism: magnesium, headaches & migraines

Insufficient magnesium causes calcium to stay in muscle and nerve cells longer, resulting in over excitation of the muscles and nerves. This can lead to cramps, spasms and other muscle-related issues including muscle tension in both the neck and head. Tension headaches usually affect the base of the skull or forehead.

Magnesium also helps to convert tryptophan into the neurotransmitter, serotonin. Insufficient serotonin can result in migraines, as can small blood clots which reduce blood flow to the brain. Magnesium deficiencies can increase the risk of unnecessary platelet activation, forming more clots in blood vessels and creating a greater chance of decreased blood flow to the brain.

Chronic stress also triggers the pain producing substance P which dilates blood vessels and releases allergic compounds involved in migraines. For patients with stress-induced headaches, consider magnesium glycinate for added support and calming effects of the inhibitory amino acid, glycine.

If stress is leading to migraine headaches, more intense pain (moderate to severe) probably accompanies the unwanted condition. Migraines can last anywhere from four to seventy-two hours. Throbbing, sharp, unilateral pain is common for migraine sufferers. Although each patient will have an individualized protocol that addresses the root cause of the migraine, magnesium supplementation may be ideal in preventing the onset, or helping with the painful side effects caused by a wide variety of mechanisms involving receptors and neurotransmitters.

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How magnesium is absorbed!

MgGly chelate A magnesium

absorption primer MgGly b ered You likely know that magnesium supplements don’t contain just pure magnesium. Magnesium ions (Mg2+) are Mg Mg highly reactive and unstable on their own. Malate Citrate They are positively charged ions and like to form compounds with other substances. When they bind with negatively charged Mg Oxide molecules (anions) they form salts. When they bind specifically with amino acids,

we call them amino acid complexes. Mg The way our bodies absorb salts Citrate and complexes differs slightly. Here’s a quick review.

Absorbing magnesium salts Before magnesium from salts can be absorbed, they must first be dissolved back into ionic forms. Strong stomach acids deposits sometimes clog your showerhead. Absorbing amino acid complexes break apart the bonds that hold magnesium Calcium binds with carbonate, forming an Magnesium amino acid complexes, to other molecules. In this soluble, fluid insoluble complex that prevents the flow (or or chelates, behave differently from state, the free magnesium ions travel to absorption) of calcium through the shower magnesium salts. The strong and stable the duodenum where they are absorbed head. bonds between magnesium and amino through small mineral ion channels found acids keep the whole molecule intact in along your intestinal wall. The shell of water acidic environments. Pretty straightforward stuff, but magnesium Here’s another challenge. Even if a When complexes travel through the intestinal ions can encounter a few challenges magnesium ion remains dissolved, its tract, they bypass the ion channels and along the way. The ion channels are positive electrical charge will attract detour through other transport sites called small and can only transport magnesium water molecules. A shell of water, or dipeptide channels. From there, amino ions when they are unattached to other hydration shell, will start to form around acids and magnesium are carried across the molecules. That’s not a problem when it the magnesium ion and increase its size. intestinal membrane together. comes to the gastric acid that lives in your The hydrated radius grows about 400 times stomach - acidic environments are good at in size compared to the radius of a bare There are a couple of key advantages to this. breaking the bonds between magnesium magnesium atom. First, there are far more dipeptide channels than ion channels in the gut. Magnesium and other molecules. But the further you A sizeable challenge when it comes to complexes do not compete for the same ion travel from the stomach, the less acidic the absorption, but not insurmountable. The channels used by other minerals. A second environment becomes. The less acidic the proteins that make up the ion channels are advantage is that the stable bonds protect environment, the harder it is for magnesium capable of removing enough water for the magnesium from unfavourable chemical ions to remain soluble. So what happens magnesium ion to pass through. But take reactions that might lead to the creation of when pH levels rise? Magnesium ions start note, these proteins need a certain acidic unabsorbable precipitates. to bind with other nearby substances, pH to function properly. usually forming insoluble compounds. These Mineral amino acid complexes are common insoluble compounds precipitate out of Low pH is needed in certain foods and are a natural way to the liquid and pass through your body as get magnesium through our diet. Some waste. This process is much like how calcium Magnesium salts are a good source of of this magnesium is already bound to magnesium, provided you can keep your amino acids, but even when we consume pH low enough. 7 ND Notes | Vol. 3 No. 2

magnesium from salts, amino acids can relate to magnesium levels in their bones into the outer compartment. help. Peptides and amino acids can bind to and soft tissues. Scientists studying magnesium absorption magnesium ions and form complexes right All these things make it difficult to clinically have also used this method to predict how in your body. determine how much magnesium is well different kinds of magnesium can retained by the body through measuring pass through our intestinal lining. First, Experiments blood or urine. different kinds of magnesium are added to a solution that mimics the pH of the in magnesium However, we can investigate how well digestive tract. They are placed into the different magnesium types are absorbed absorption upper compartment of these plates. Some through the intestinal walls. As you may already know, studying of the magnesium will transport through the bioavailability of magnesium is a Many pharmaceutical scientists study drug this membrane layer into the bottom complicated subject. Unlike pharmaceutical absorption by cultivating intestinal cells compartment. The bottom compartments drugs that can be detected chemically in into a thin membrane layer that has all the are then measured for magnesium levels the body, magnesium is found everywhere features of a real intestinal wall, including using a mass spectrometer. various nutrient transport channels and a in the body in high concentrations. Direct These are fast and repeatable experiments brush border. This layer of cells is placed measurement is also complicated. that help us build a model for understanding into special plates called transwells. From how magnesium is absorbed in the body. You have probably discussed the these, scientists can measure how much complications and obstacles around of an agent permeates through this semi So what are the results? A 2016 study using the testing for magnesium levels with your permeable layer to the other side. above methodology resulted in the following. patients. Our blood contains less than one percent of our total magnesium levels, is Transwells have two compartments The chelated magnesium bis-glycinate and tightly regulated, and changes by up to six separated by a thin membrane of cultivated buffered magnesium bis-glycinate were percent depending on the time of day. intestinal cells. Researchers place different much better absorbed than other forms like Even if you test for magnesium in blood magnesium solutions into the inner magnesium citrate and magnesium oxide serum, you still end up unsure of how a compartment and measure how much on their own. patient’s magnesium levels in their blood magnesium passes through the membrane

pH rising

You absorb proteins and amino

amino acid like glycine, it can share a ride into the body this way .

Anions that magnesium might bind with. e.g. , Gly As pH rises magnesium ions form

Mg+ through the ion channel.

As pH rises magnesium binds with anions to form insoluble salts that cannot be absorbed

by pH. The strong bonds keep these Ion channels where complexes together and prevent them minerals are absorbed from binding with anions 8 ND Notes | Vol. 3 No. 2

Why does a magnesium deficiency exist?

It’s missing in our diets food in greater densities than ever before, Food processing they are drawing from the same dwindling Our diets are providing less magnesium than supply of magnesium. removes magnesium they used to. The composition of what we eat Food processing and refining remove large and the quality of our foods has drastically The end result? We’re overfed and swaths of magnesium. Whole grains, a staple changed over the past hundred years, and undernourished. Many fruits and in the modern diet, can lose over 80% of this has made it difficult for even the most have lost large amounts of their magnesium content simply through health-conscious Canadians to get enough minerals and nutrients in the past 50 years. milling. Seeds and nuts in their raw form magnesium. The Canadian Community For example, the intensive plowing are rich in magnesium, but the process of Health Survey, conducted in 2004, showed eliminates protective ground cover causing refining them into oils removes nearly all over 34% of Canadians consumed less high rates of erosion. Magnesium is lost in of their magnesium content. Even cooking than the estimated average requirement of the run-off. Instead of traditional fertilizers vegetables can leach magnesium. The typical magnesium. And those estimated average made of manure and compost, today’s Canadian diet, laced with refined grains, requirements are quite modest; around 350 fertilizers are synthetic. They are rich in oils and sugars, provides large amounts of mg/day for adults. Recent estimates show nitrogen, potassium and phosphorus, but calories with little to no magnesium. that before industrialization, dietary intakes low on essential minerals like magnesium. were closer to 475-500 mg/day! Higher yields and more crops grown in the Treated water same area of land means fewer minerals Magnesium from the soil go to each plant. This is In some parts of the world, magnesium known as the dilution effect. in drinking water accounts for 50% of the depleted soils recommended dietary intake. Treating McCance and Widdowson’s epic Foods like legumes, grains and greens and softening tap water removes minerals compilation, The Composition of Foods, that were once hailed for their magnesium like magnesium before you pour yourself has tracked the nutrient composition content no longer contain the same a single cup! of foods since 1940. Between 1940 and levels. Modern farming practices, meant 1991, there was an average magnesium to increase yields and resist pests, have decrease of 24% in vegetables and 16% Hard to Absorb left overworked farmlands depleted in fruits. Some foods have seen more Regardless of how much you consume, of essential nutrients like magnesium. drastic declines than others. Carrots have you will not get enough magnesium Soil compaction, surface irrigation, lost 75% of their magnesium content. without good absorption. Foods containing monoculture, pesticides and chemical You would have to eat four carrots today magnesium need to be broken down by fertilizers have all impacted the soil’s ability to get the same magnesium in one carrot enzymes and acids in our digestive tract to restore, retain and provide magnesium in 1940! before they can be absorbed in the small to crops. And while farmers are growing

9 ND Notes | Vol. 3 No. 2 intestine. A breakdown in the digestive absorption of key nutrients like ions, making them insoluble. Tetracycline process will seriously impede how much magnesium. Other conditions such antibiotics, corticosteroids and diuretics are magnesium can be absorbed. as irritable bowel syndrome (IBS) and just a few examples (see chart Drug-induced yeast overgrowth can have similar effects nutrient depletion on page 27). Weak stomach acid in inhibiting magnesium absorption or Even tap water, if treated with , flushing it out (through diarrhea) before Magnesium needs to be soluble to be can inhibit magnesium absorption. it can be absorbed. absorbed by the small intestine. The strong Fluoride binds with magnesium to form gastric acid in the stomach provides an an insoluble crystalline compound that environment that dissolves magnesium Foods, drugs and other the body can’t absorb. into this soluble form. If the environment substances that block Easy to lose is not acidic enough, magnesium will absorption remain insoluble and will simply be flushed Our magnesium requirements have Some foods not only lack magnesium but through the intestinal tract. increased. can also block its absorption. For example, While age is the primary culprit for low the phosphoric acid in many popular We’ve established that magnesium is stomach acid, chronic stress that is so sodas will impair absorption by forming involved in many processes throughout common in modern life will also reduce the body. Overstimulating these processes will result in an increase in our magnesium requirements. For instance, when we suffer from high stress, our body produces a 1940 Today hormone protein called cortisol. Producing and regulating this hormone means spending and excreting more magnesium. Magnesium is crucial for maintaining a functioning metabolism. Modern diets high in refined sugar cause more magnesium to be used for metabolizing glucose into cellular energy and activating the release of insulin. That’s why inadequate magnesium levels can lead to elevated insulin and glucose in the blood and contribute to insulin resistance.

Mg2+ This can lead to the flushing of excess Mg2+ glucose in urine, which has the unfortunate side effect of flushing serum magnesium along with it. Coffee, alcohol, diuretic drugs and birth control pills can cause our kidneys to acid production. The stress response phosphates with magnesium ions in the eliminate more magnesium than they should. diverts energy away from tasks like digestive tract. These phosphates are And here’s a good reason to hold off digestion. Overuse of antacids to reduce insoluble and cannot be absorbed through on that antacid. Low stomach acid can common symptoms like heartburn is the intestinal walls. Phytic acid, found in actually impair the absorption of nutrients, another contributor. soybeans, the hulls of seeds or bran of which leads to undigested food and a gassy grains can also form insoluble compounds. terrain. The intra-abdominal pressure Gastrointestinal Oxalic acids in raw greens and tannins in pushes the undigested food along with teas do the same. conditions gastric acid up the esophagus, where it Other minerals such as calcium or are irritates the delicate lining. Chronic functional disorders of the absorbed in the intestine the same way as gastrointestinal system are becoming Taking an antacid can provide temporary magnesium. When you consume minerals increasingly common. Inflammatory bowel relief but it will decrease an already low together, they often compete for the same diseases like Crohn’s and colitis result in amount of stomach acid making the issue limited channels of absorption. This is the inflammation in the intestine. worse, not to mention making it harder for reason why practitioners recommend taking us to breakdown magnesium! The inflammation destroys intestinal mineral supplements at different times. mucosal cells, which impede the Many drugs also bind to magnesium

References: 1 Wallach, J. Our Food is Deprived of minerals: the Proof. Longevity Institute Newsletter. 2006; Newsletter 16. Available at: http://www.longevinst.org/nlt/newsletter16.htm. Accessed November 11, 2009 10 ND Notes | Vol. 3 No. 2

From the competition stage to the oncology ward

How a top fitness competitor fought the biggest battle of her life and came out with a new approach to finding her best health.

The “C” word Being told you have cancer is something you don’t ever expect to hear at a routine check up, especially when you’re young and dedicate your life to staying fit. Fitness other ways to challenge herself physically levels, extreme fatigue and brain fog. The model Jill Bunny didn’t expect to hear it and mentally. She continued to train and fatigue and muscle pain associated with either. This Toronto native was one of the mentor others through her company, Fit MS was becoming a major obstacle in highest ranked IFBB bikini competitors in Bunnies Fitness, as she recovered from managing her business and training for the world. To her peers, she was the picture cancer. It was during this time that Jill an upcoming iron woman race. She chose of health physically and professionally. But found motivation to learn more about not to take prescription medication, but Jill’s inner strength would soon be tested. healing from the inside out. Through a team instead managed the disease through diet, Unusual symptoms Jill was experiencing of functional medicine practitioners and exercise and naturopathic medicine. Her told her that something wasn’t quite right. her Naturopathic Doctor (ND) she found chief concerns were low energy, neck pain A double diagnosis of multiple sclerosis more preventative ways to manage her MS and long recovery periods after work outs. and thyroid cancer catapulted Jill into the symptoms. Along the way, her own interest Dr. Lamanna ND, began treating Jill competition of her life. in how the body works expanded and she the next month with 200mg of CanPrev began to study functional medicine in her To many different degrees, we have all faced Magnesium Bis-Glycinate 200 Gentle before quest to find healing, and to make her body health challenges individually. This is the story bed, one sachet of CanPrev ElectroMag stronger than ever before. of a top fitness competitor who fought the to mix with water and to consume while biggest battle of her life and came out with training, two capsules of CanPrev Adrenal- a new approach to finding her best health. Case Study Pro twice daily, one capsule of CanPrev Jill approached Dr. Nadia Lamanna ND, Pro-Biotik 15B daily, and one capsule of Jill’s Story in April 2017 for a natural approach to CanPrev Thyroid-Pro twice daily. After two weeks the Magnesium Bis-Glycinate 200 Functional nutritionist, elite trainer, life managing her symptoms. Since having Gentle was increased to 400 mg per day coach and bikini model competitor, these a thyroidectomy in November 2016, Jill and ElectroMag to two pouches per day are only a few titles Jill Bunny goes by. struggled with fluctuating thyroid hormone Jill has always been fascinated by what

“When you’re the strongest and fittest you’ve ever been, the last thing you think you are is unhealthy and the last words you expect to hear are, you have cancer.”

the human body is capable of. When she was diagnosed with MS and thyroid cancer at age 30, her passion for health and fitness took a different turn. She retired from competition as the physical toll training took on her body would likely advance the progression of MS and slow recovery from a thyroidectomy to come. Instead, she found

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Words from Jill “The last thing that I felt was missing in my quest to heal, was the implementation of natural, quality supplements. Working with my Naturopath on an individual basis, with weekly check-ins was exactly what I needed to get the supplementation correct. Today, I can honestly say that I have not felt this much energy in at least a decade. Go with your gut and listen to your body. Take an individualized approach to your health and do what you feel is right and works best for you.”

Notes from Dr. Lamanna ND because Jill added a cycle class to her a significant improvement in energy levels (see evening fitness routine. Jill reported she Figure 1). She reported having bursts of energy After 16 weeks of therapy, Jill reported that her legs felt great and her energy was taking Synthroid 88 mcg per day when and diminished grogginess during the times levels were “night and day” compared to she first met with Dr. Lamanna, this was of day that she typically felt her worst. Her TSH how she felt in January. “I feel like my old later increased to 100 mcg per day in early in April was 4.79 and dropped to 0.59 in June, self again” she told Dr. Lamanna on the May as directed by her endocrinologist. after just seven weeks of therapy (see Figure phone as they wrapped up treatment. On 2). Jill’s endocrinologist was ecstatic with the their last follow-up appointment, Jill rated Results results and asked what she had been doing her energy level as 8.5 out of 10 and said, differently. Her TSH levelled out at 1.15 in July. Baseline scores were reported on April 10 and “I hate to give a 10 because I always feel I Jill was optimistic and motivated throughout after only a few weeks of therapy, Jill reported can do better.” Jill’s perseverance, ambition the duration of the study and overjoyed about improved symptoms like reduced neck pain, and optimism are the most noteworthy the progress she made along the way. improved ability to recover post workout and of her journey back to better health.

Mechanism: magnesium & osteoporosis

So how do you tackle a patient's long term health goals, like keeping bones healthy and avoiding silent and stealthy thieving conditions like osteoporosis? As a practitioner, you are likely well aware that magnesium regulates calcium in cells and that the two minerals work antagonistically with each other. Understanding that magnesium stimulates the production of calcitonin, the hormone responsible for inhibiting cells (osteoclasts) that break bone down, and knowing that it also activates alkaline phosphatase, responsible for forming new calcium crystals in bones, are key factors in connecting magnesium's role in preventing osteoporosis. If there is not enough magnesium around to regulate production of calcitonin, then bone loss can occur faster than bone renewal. This results in thin, porous and weak bones over time, which increases the risk for fractures. Osteoporosis is typically only discovered when a fracture occurs. The most common sites of osteoporotic fractures occur within the spine, wrist, shoulder and hip. But that’s not all. Magnesium also plays a role in synthesizing parathyroid hormone (PTH) which works to regulate cells responsible for bone renewal (osteoblasts), which are crucial for good bone density.

Parathyroid hormone (PTH) and calcitonin in many ways work as physiologic antagonists that contribute to proper mineral homeostasis and good bone density. Magnesium plays a deciding role in managing this homeostasis, helping to hinder bone break down and contribute to bone renewal. If magnesium deficiency exists, you can blame the failure of this homeostatic system at both ends. Truly a double edged sword, only the outcome of this scenario unfortunately won’t be seen nearly as quickly.

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Conditions associated with a magnesium deficiency

Below you will find the mechanisms behind the role magnesium plays in certain physiological processes and how a deficiency can contribute to pathology. You will also find a suggested therapeutic dose of magnesium for each condition.

Condition Mechanism Dose

Magnesium is involved in the production and storage of ATP (used for energy production) and mitochondrial Fatigue 200-300 mg per day function. A magnesium deficiency also reduces mitochondrial resistance to free radical damage.

Magnesium plays an important role in ATP energy production, and as a muscle relaxant and 300-600 mg magnesium analgesic. Due to the complex symptom picture of fibromyalgia, characterized by muscle soreness, Fibromyalgia per day and 1200-2400 mg cramping, headaches, pain, sleep disturbance and depression, a magnesium deficiency is thought to per day play an important role in the pathology of the disease.

Magnesium is involved in the regulation of neurotransmitters and serotonin receptor binding, as well as ATP energy production. Inadequate ATP can depolarize neurons affecting the transmission Anxiety and Depression of neurotransmitters, which plays an important role in the release of our “feel good” hormones. 450 mg per day Magnesium also plays an important role as a nervous system tonic and gets depleted with adrenergic stimulation during acute stress.

Magnesium plays a key role in the active transport of calcium and potassium ions across cell Muscle cramping membranes, a process that regulates muscle contraction and nerve conduction. These actions are 100 - 400 mg per day and tension responsible for the role magnesium has as a muscle relaxant.

Magnesium plays a key role in the active transport of calcium and potassium ions across cell membranes, a process that regulates muscle contraction and nerve conduction. These actions Hypertension 450 mg per day play an important role in vascular contractility and tone. Magnesium enhances dilation of vascular endothelium and a deficiency can result in vasoconstriction which causes hypertension.

Magnesium acts as a natural calcium channel blocker and plays a key role in the active transport of calcium and potassium ions across cell membranes, a process that regulates muscle contraction Coronary Artery Disease and nerve conduction. These actions play an important role in vascular contractility and tone. 450 mg per day Magnesium enhances vasodilation of arteries and regulates vascular smooth muscle tone. A deficiency can result in vasospasm of the coronary arteries and cardiac arrhythmias.

Magnesium is a key component to calcium homeostasis. It is a cofactor required in the metabolism Osteoporosis of D and it also stimulates the hormone calcitonin which prevents osteoclast activity and 400-800 mg per day bone break down.

Magnesium regulates calcium channels in bronchiole smooth muscle, decreasing calcium uptake and release, resulting in relaxation and dilation of bronchial airways. Magnesium also stabilizes T Asthma 250-300 mg per day cells and inhibits mast cell degranulation, thus exerting its effects as an excellent bronchodilating and anti-inflammatory agent.

References: 1 Barbagallo, M., & Dominguez, L. J. (2015, August 25). Magnesium and type 2 diabetes. Retrieved September 13, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549665/ 2 Bichara, M. D., & Goldman, R. D. (2009, September). Magnesium for treatment of asthma in children. Retrieved September 13, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743582/ 3 Carpenter, T. O. (1988, December). Disturbances of vitamin D metabolism and action during clinical and experimental magnesium deficiency. Retrieved September 13, 2017, from https://www.ncbi. nlm.nih.gov/pubmed/3079418 4 Hechtman, L. (2014). Clinical naturopathic medicine. Chatswood, N.S.W.: Elsevier Australia. 5 Zofková, I., & Kancheva, R. L. (1995, March). The relationship between magnesium and calciotropic hormones. Retrieved September 13, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/7669510 ND Notes | Vol. 3 No. 2

14 ND Notes | Vol. 3 No. 2

Anxiety & Depression

The statistics are shocking: mental illness affects one in five Canadians and costs our healthcare system about fifty billion dollars a year. The cost of treating mental illness and addiction is 1.5 times that of all cancers, and seven times the cost of all infectious diseases. Patients are also forced to pay a high price (in more ways than one) when some conventional therapies end up being ineffective or result in a long list of extremely undesirable side effects and dependencies. It’s no wonder people suffering from mental illnesses can feel defeated and turn to alternative therapies.

Anxiety and depression are two of the most common mood disorders with anxiety holding the number one spot in Canada.

One in four Canadians experience at least one anxiety disorder in their lifetime.

It is not unlikely to find anxiety coexisting with depression. The two often occur together. Feeling anxious and sad are natural emotions and it can be difficult for practitioners to diagnose the severity, especially when first getting to know a patient. That’s why it’s important not be modest in your line of questioning especially when you suspect that a mood disorder might be present.

References: 1 Diana. on Sep 19, 2013 in Mental Health & Coping. stigma, research, prevention, awareness and stereotype. (2017, February 02). Statistics Canada releases mental health survey results. Retrieved September 13, 2017, from https://mindyourmind.ca/expression/blog/statistics-canada-releases-mental-health-survey-results 1 The Facts. (n.d.). Retrieved September 13, 2017, from http://strategy.mentalhealthcommission.ca/the-facts/ 1 R. P., M.D., M.P.H. (2017, January). What Is Depression? Retrieved June 13, 2017, from The American Psychiatric Association https://www.psychiatry.org/patients-families/depression/what-is-depression ND Notes | Vol. 3 No. 2

Diagnosis

Generalized anxiety disorder (GAD) need to delve deeper. Mental illness is the be extremely debilitating, which is why and major depressive disorder (MDD) leading cause of disability and accounts it is so important to acknowledge their interfere with daily activities such as for approximately 30 percent of all short existence early on and address them swiftly job performance, school work and and long-term disability claims. In fact, and accordingly. Refer to the Diagnostic relationships. The information your patient it is reported to be one of the top three and Statistical Manual of Mental Disorders relays to you when you ask about any of claims made by 80 percent of Canadian (DSM–5) in the charts below. these areas could be an indication that you employers. Depression and anxiety can

DSM-5 Criteria for Major Depressive Disorder

Five or more of the following symptoms have to be present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure

• Depressed mood most of the day, nearly every day (Note: in children can be irritable mood) (S/O) • Diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (S/O) • Significant unexpected weight loss or gain (more than 5% body weight/month) or increase or decrease in appetite nearly every day. (Note: in children, consider failure to make expected weight gain) • Insomnia or hypersomnia nearly every day • Psychomotor agitation or retardation nearly every day (O) • Fatigue or loss of energy nearly every day • Feelings of worthlessness or excessive or inappropriate guilt nearly every day • Diminished ability to think or concentrate, or indecisiveness, nearly every day (S/O) • Recurrent thoughts of death or suicide (with or without plan) or a suicide attempt

S = subjective report; O = objective report (observed by others)

DSM-5 Criteria for Generalized Anxiety Disorder

Excessive anxiety or worry occurs most days for at least 6 months and are associated with three (or more) of the following 6 symptoms (with at least some being present on most days in the past 6 months)

• Restlessness, feeling keyed up or on edge • Being easily fatigued • Difficulty concentrating • Irritability • Muscle tension • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

1 Lakhan, S. E., & Vieira, K. F. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition Journal,9(1). doi:10.1186/1475-2891-9-42 1 Freland, L., & Beaulieu, J. (2012). Inhibition of GSK3 by , from single molecules to signaling networks. Frontiers in Molecular Neuroscience,5. doi:10.3389/fnmol.2012.00014 1 Hechtman, L. (2014). Clinical naturopathic medicine. Chatswood, N.S.W.: Elsevier Australia. 1 Nechifor, M., & Vink, R. (2011). Magnesium in the Central Nervous System. S.l.: University of Adelaide Press. p.271 16 ND Notes | Vol. 3 No. 2

Comorbidity NMDA (N-Methyl-D-aspartate ) noradrenaline and dopamine receptors. receptor inhibition + glutamate The mechanism of how this works is not Anxiety has a remarkably high comorbidity fully understood, but several studies Glutamate is an excitatory neurotransmitter with depression, and vice versa. The reasons indicate that a relationship does exist. This that plays an important role in the may in part be due to a strong genetic pharmacokinetic relationship has been development of the brain and is a key correlation, and possibly partially due to the illustrated in studies that show an increase in player in neuroplasticity, learning, memory strong overlap in diagnostic criteria. Similar erythrocyte magnesium concentration with and locomotion. The amount of glutamate neuropeptides and pathways are shared in the administration of psychotropic drugs released in the brain is tightly regulated the pathophysiology of these disorders and such as antidepressants and antipsychotics. therefore they commonly occur together by the central nervous system. When this and can be thought of as the fraternal equilibrium is disrupted through some form Furthermore, magnesium supplementation twins of mood disorders. According to the of trauma, glutamate concentrations in the has been shown to enhance the activity of DSM-5, some GAD and MDD symptoms brain can increase. Contrary to its primitive antidepressants, demonstrating a synergistic that overlap include difficulty sleeping, function, in excess, this neuropeptide is action with these drugs. This last point is concentrating, being easily fatigued and toxic and destructive in the brain, leading important to consider when supplementing exhibiting psychomotor agitation. It is to neurotoxicity and cell death. Increased magnesium with a patient who is also important to make sure an anxiety diagnosis taking an antidepressant drug such as a does not mask that of depression and vice norepinephrine and dopamine reuptake versa, because the two often co-exist and Up to 80% of the brain uses GABA and inhibitor (NDRI) like Wellbutrin, a serotonin the clinical implications can be severe. glutamate for inhibitory and excitatory and norepinephrine reuptake inhibitor Increased risk of suicide, psychiatric responses, respectively. (SNRI) such as Pristiq, Cymbalta or Effexor; hospitalization, disability and decreased or a selective serotonin reuptake inhibitor compliance with treatment are all hazards (SSRI) such as Celexa, Prozac or Zoloft. of misdiagnosis. HPA Axis Magnesium and GABA Chronic stress leads to excess cortisol the brain levels which can negatively affect other GABA neuropeptides like serotonin and be a Magnesium plays an important role in a 80% GABA contributing factor to anxiety and depression. GABA multitude of biochemical reactions in the Magnesium has been shown to play a body, including the brain. Neurological GABA positive role in the stress response through functions of magnesium include its influence in the limbic-hypothalamic- cellular energy production, regulating pituitary-adrenocortical axis. Magnesium can neurotransmitters such as serotonin, reduce the release of adrenocorticotropic dopamine and gamma-Aminobutyric acid levels are found in the brains of patients hormone (ACTH) and affect adrenocortical (GABA), regulating ion gradients, and neuronal suffering from MDD, which may play a role in sensitivity to ACTH, which helps to modulate excitability. Dysregulation of these systems its pathophysiology. the amount of circulating cortisol in the plays an important role in the etiology of both body. High cortisol levels can also deplete depression and anxiety. Magnesium is a very potent inhibitor of NMDA receptors, which are a subtype of glutamate magnesium levels, which further supports the benefits of supplementation. Mechanism of action receptors. Magnesium is a natural antagonist to calcium and exerts its inhibitory effect Choosing the best GABA receptors in the nervous system by blocking the flow of calcium through the voltage-dependent magnesium for anxiety Magnesium has been shown to modulate NMDA receptors, preventing an excitatory GABA activity in the brain. Magnesium ions response in the brain. and depression can occupy GABA receptors acting as GABA Several forms of magnesium exist so it is receptor agonists to help facilitate GABA A magnesium deficiency coupled with high important to recognize the therapeutic neurotransmission. GABA is an inhibitory levels of calcium and glutamate is a recipe applications of each. Magnesium neurotransmitter in the brain that plays a for disaster in the brain. This combination bis-glycinate is an excellent choice role in motor control, vision and anxiety. can depolarize neuronal membranes and lead to altered synaptic function and the for treating anxiety and depression for GABA and magnesium bind to development of anxiety and depression. the following reasons: benzodiazepine receptors resulting in The NMDA/glutamate pathway is one an anxiolytic effect. These are the same • it is the optimal form for correcting way magnesium exerts its anxiolytic and a deficiency due to its superior receptors that are targeted with anxiolytic antidepressant effects in the brain. bioavailability to other forms prescription medications like Lorazepam (Ativan) or Diazepam (Valium). • glycine enhances its anxiolytic properties Monoamines • it is the optimal form to achieve therapeutic Magnesium exhibits anti-depressive effects doses without a laxation effect (minimum through its interaction with serotonin, 450 mg per day for depression and 300mg per day or anxiety) 17 ND Notes | Vol. 3 No. 2

Why Magnesium Bis-Glycinate? Glycine, like GABA, is a significant inhibitory neurotransmitter in the central nervous system. Glycine helps to regulate NMDA receptors and glutamate transmission, thereby creating a sense of calm in the nervous system. , another amino acid, plays a very similar calming role in the brain. Very interesting case studies presented by Eby and Eby (2006) demonstrated that 125-300 mg of magnesium glycinate and taurinate per day alleviated symptoms of major depression within seven days. In addition to its profound antidepressant effects, it also provided relief from headache, suicidal ideation, anxiety, irritability, insomnia, and short-term memory loss. What a collection of multi-beneficial side effects!

Serotonin Dopamine GABA GABA receptor receptor

Glutamate

GABA NMDA receptor receptor

1 Anderssen, E. (2017, June 26). The case for publicly funded therapy. Retrieved July 8, 2017, from https://beta.theglobeandmail.com/life/the-case-for-publicly-funded-therapy/article24567332/?ref=h ttp%3A%2F%2Fwww.theglobeandmail.com& 1 Poleszak, E. Benzodiazapene/GABA(A) receptors are involved in magnesium-induced anxiolytic-like behaviour in mice. Pharmacological Reports 2008 (4):483-89. 1 Iadarola, N. D., Niciu, M. J., Richards, E. M., et al. (2015). Ketamine and other N-methyl-D-aspartate receptor antagonists in the treatment of depression: a perspective review. Therapeutic Advances in Chronic Disease,6(3), 97-114. doi:10.1177/2040622315579059 1 Wiese, Kristen, et al. Do glutameatergic drugs have a role in treating depression? Current Psychiatry 2015 (2):14-16. 1 Serefko, A., Szopa, A., & Poleszak, E. (2016, March 01). Magnesium and depression. Magnesium Research; 29(3):112-9 1 Zbozinek, T. D., Rose, R. D., Wolitzky-Taylor, K. B., et al. (2012). Diagnostic Overlap Of Generalized Anxiety Disorder And Major Depressive Disorder In A Primary Care Sample. Depression and 18 Anxiety,29(12), 1065-1071. doi:10.1002/da.22026

ND Notes | Vol. 3 No. 2

Magnesium deficiency DDX

The following is a list of differentials to consider when making a diagnosis of magnesium deficiency

DDX Signs/Symptoms Tests & Diagnosis

fatigue, dizziness, weight loss, caloric restricted diet, history of an CBC, RBC magnesium, potassium, calcium, albumin, lipids, Malnutrition eating disorder ferritin, leptin, total protein, A, D, B12

Dietary consumes a diet low in magnesium RBC magnesium

use of diuretics, PPI’s, digitalis, cyclosporine, cisplatin, cetuximab, discontinue medication to find out if this resolves Drug-Induced aminoglycosides, gentamicin, tobramycin and insulin hypomagnesaemia

increased superficial cutaneous veins, peripheral neuropathy, Alcohol abuse fatty liver, ascites, jaundice, depression, anxiety, restlessness, AST, ALT, GGT, RBC magnesium, case history, DSM-5 criteria violent behaviour

abdominal distention and tenderness, hypotension, decreased skin Laxative abuse RBC magnesium, potassium turgor, dry mucous membranes

abdominal pain and cramping, diarrhea, fever, fatigue, bloody CBC, WBC, ESR, RBC magnesium, potassium, colonoscopy, Crohn’s Disease stool, mouth sores, reduced appetite, weight loss, perianal disease, endoscopy, CT scan or MRI, stool for occult blood, faecal inflammation of skin, eyes and joints leukocytes

watery diarrhea, abdominal pain and cramping, nausea, vomiting, CBC, WBC, RBC magnesium, potassium, physical exam, Gastroenteritis muscle ache, headache, low grade fever rapid stool test, stool culture

diarrhea (with blood or pus), abdominal pain and cramping, rectal CBC, WBC, B12, ESR, RBC magnesium, potassium, faecal Ulcerative Colitis pain and bleeding, weight loss, fatigue, fever leukocytes, colonoscopy, stool for occult blood, CT scan

HLA-DQ2, HLA-DQ8, IgA-tTG, anti endomysial Ab,anti- anemia, osteomalacia, skin rash, mouth ulcers, headache, fatigue, joint Celiac Disease gliadin Ab, RBC magnesium, potassium, folic acid, B12, pain, heartburn, diarrhea, constipation, bloating, vomiting/nausea vitamin D, small bowel biopsy CBC, albumin, RBC magnesium, potassium, calcium, B12, Short Gut diarrhea, fatigue, bloating, pale, greasy, foul smelling stool, edema, vitamins A, D, INR, fecal , small intestine X-ray, upper GI Syndrome weight loss, dehydration series, CT scan

Diabetic excessive thirst, frequent urination, nausea, vomiting, abdominal pain, CBC, glucose, CRP, urea, creatinine, RBC magnesium, Ketoacidosis SOB, fatigue, confusion, blurred vision, fruity breath odour potassium, sodium, calcium, urine ketones

upper abdominal pain that radiates to your back, pain worse after Pancreatitis eating, fever, rapid pulse, nausea, vomiting, weight loss, oily smelly CBC, WBC, amylase, lipase, AST, ALT, CT scan, MRI stool (steatorrhea)

weight loss, tachycardia, increased appetite, anxiety, tremor, sweating, TSH, T3, T4, radioactive intake, TSH-R Ab, TSI, RBC Hyperthyroidism heat sensitivity, insomnia, fatigue, muscle weakness magnesium, potassium

AST, ALT, GGT, alkaline phosphatase, bilirubin, GFR, fatigue, jaundice, easy bruising and bleeding, ascites, loss of appetite, Cirrhosis creatinine, BUN, hepatitis antibodies, INR, ESR CT scan, nausea, edema, weight loss MRI, RBC magnesium, 24-hr urine

a pregnant woman > 20 weeks gestation who presents with protein in 24-hr urine, CBC, platelet count, AST, ALT, GFR, creatinine, Pre-eclampsia urine (proteinuria), hypertension, headaches, change in vision abdominal BUN, RBC magnesium, fetal ultrasound pain, nausea, vomiting, decreased urine output, shortness of breath

Pregnancy third trimester RBC magnesium Excessive IV history of IV fluids RBC magnesium fluids

References: 1 © 1998-2017 Mayo Foundation for Medical Education and Research (MFMER) 2 Hypomagnesemia - Endocrine and Metabolic Disorders. (n.d.). Retrieved September 13, 2017, from http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte- disorders/hypomagnesemia ND Notes | Vol. 3 No. 2

When is it common 0.70 mmol/L (< 1.8 mg/dL). Clinical renal function and electrolyte balance. features often accompany a deficiency Malabsorption from gastrointestinal disease practice to check in other electrolytes such as calcium and is also where you will commonly find magnesium levels? potassium and include lethargy, tremor, deficient magnesium stores. seizures and arrhythmias. It can result in Magnesium levels are typically checked Keep in mind that a dietary deficiency of complications with every organ system and to evaluate kidney function, to aid in magnesium is extremely common (see cause potentially fatal complications such diagnosis of gastrointestinal disorders Why does a magnesium deficiency exist? as ventricular arrhythmia, coronary artery and to determine the severity of on page 9). Since magnesium plays such a vasospasm and sudden death. uncontrolled diabetes. critical role in the body, there are several clinical manifestations that can arise from What is How common is it? a dietary deficiency and a magnesium hypomagnesemia? In the general population, a clinical deficiency can be present without deficiency in magnesium (hypomagnesemia) hypomagnesemia (see chart Conditions This is the medical term for magnesium is rare. Hypomagnesemia is commonly associated with a magnesium deficiency deficiency and is defined as a serum associated with more complicated chronic on page 13). magnesium concentration of less than disease processes that eventually affect

Mechanism: magnesium & cardiovascular conditions

High Blood Pressure Besides preventing blood clots, magnesium also acts as a natural vasodilator. Magnesium, as a calcium antagonist, allows the heart muscles and the smooth muscles of the arteries to rest and relax, reducing blood pressure. If there is insufficient magnesium, these blood vessels constrict, raising blood pressure. Magnesium’s role in maintaining healthy blood pressure has a lot to do with its ability to activate the sodium-potassium pump. Even if a magnesium deficiency occurred and a sufficient supply of potassium was available, it would likely not make it into the cell to allow for proper sodium regulation.

Blood clotting (intravascular thrombosis, heart attacks and strokes) Clotting is a normal response to blood vessel damage. When a blood vessel wall is damaged, tiny blood cells called platelets activate. These platelets adhere to a damaged surface and release sealing agents like fibrin. Magnesium regulates the activation of these platelets by controlling calcium levels and maintaining cell receptors. That’s why magnesium is sometimes called an anticoagulant.

Magnesium deficiencies increase the risk of unnecessary platelet activation, forming more clots in blood vessels. These clots may block blood flow to the brain or heart, increasing the risk of strokes and heart attacks.

Arrhythmia Like elsewhere in the body, magnesium regulates concentrations of potassium and calcium in the heart as well. These concentrations control and coordinate the rhythm of electrical signal and muscle contractions. The Canadian Cardiovascular Society recommends that hospitals administer magnesium intravenously in order to reduce the risks of atrial fibrillation.

3 Hypomagnesemia. (2017, August 30). Retrieved September 13, 2017, from http://emedicine.medscape.com/article/2038394-overview#a6 4 Magnesium in diet. MedlinePlus. Health Topics. 2016. Retrieved June 12 2017, from https://medlineplus.gov/ency/article/002423.htm 5 Magnesium. (n.d.). Retrieved September 13, 2017, from https://labtestsonline.org/understanding/analytes/magnesium/tab/test 22 ND Notes | Vol. 3 No. 2

Here are 12 magnesium products you might Featured products find helpful to stock in your dispensary, along with their suggested uses.

ElectroMag Magnesium Bis-glycinate Magnesium Bis-glycinate 200 ElectroMag delivers a shocking 150 mg of Gentle Powder Gentle* elemental magnesium with and This perfect fusion of magnesium (essential This unique magnesium-glycine complex electrolytes, all in a refreshing effervescent mineral) and glycine (amino acid) is essential provides a therapeutic 200 mg dose of pure drink. It’s an easy way to get your for energy production, maintaining normal elemental magnesium in every recommended daily amount of magnesium muscle and nerve function, regulating heart capsule. Designed to maximize magnesium whether you’re training for a triathlon or rhythm, supporting immune system health, intake while maintaining gentleness and simply enjoying an active life. and keeping bones strong. The glycinate form absorption, Magnesium Bis-Glycinate 200 helps to ensure optimal magnesium absorption. was designed for the general population Directions: Empty contents into a glass and Available in capsule and powder form. add 150 to 250ml of water, or to taste. in mind. Adults – Take 1 capsule per day or Each packet contains: Directions: Dissolve powder in liquid, or take as Directions: as directed by a healthcare practitioner. Magnesium bis-glycinate blend ...... 150mg directed by a health care practitioner. Children: Ages 1-3 years: ¼ scoop per day; ages 4-8 years: (magnesium oxide, magnesium Each vegetable capsule contains: bis-glycinate chelate, glycine) ½ scoop per day. Adolescents: ages 9-18 years: Magnesium bis-glycinate blend ...... 200mg Vitamin C (ascorbic acid) ...... 375mg 1 rounded scoop per day. Adults: 1-2 rounded (glycine, magnesium oxide, Non-medicinal ingredients: Citric acid, scoops per day magnesium bis-glycinate chelate) tartaric acid, sodium bicarbonate*, calcium 1 rounded scoop contains: Non-medicinal ingredients: Vegetable-grade carbonate*, potassium carbonate*, stevia, Magnesium bis-glycinate blend ...... 200mg magnesium stearate, vegetable capsule. xylitol, maltodextrin, natural lemon-lime (magnesium oxide, magnesium Available in: 120 & 240 Vegetable Capsules flavour, natural lemon flavour, natural lime bis-glycinate chelate, glycine) flavour. *Provides electrolytes. Non-medicinal ingredients: Citric acid (1%). ND’s Note: This is my go-to for patients who 30 Sachets per box: Lime flavour are generally healthy but require a good 120 Grams quality, high dose magnesium supplement to support prescription drug or stress-induced ND’s Note: Recommended during and after ND’s Note: Many North Americans are deficiencies. I also prescribe this particular workouts to replenish magnesium and other deficient in this crucial mineral. Older adults formula to treat conditions like diabetes, important electrolytes that keep muscles might even be more vulnerable due to hypertension, insomnia, anxiety, and PMS. pumping. Vitamin C not only supports lower dietary intake and higher nutritional immune system function, it also plays an requirements that come along with aging. The *formerly Magnesium Bis-glycinate 200 important role in collagen synthesis and senior population tremendously benefits from capsule form wound healing. Patients can throw it in their magnesium bis-glycinate which is essential gym bag or add it to water and enjoy the fizz. for cardiovascular health, preventing muscle cramping and maintaining bone strength.

23 ND Notes | Vol. 3 No. 2

Magnesium Bis-glycinate 140 Magnesium Bis-glycinate 80 Magnesium + Taurine, B6 & Extra Gentle Ultra Gentle for Cardio Made for those seeking potency with Designed for those who require a magnesium Extra gentle magnesium combined with enhanced gentleness, this Magnesium Bis- supplement with maximum gentleness. This therapeutic levels of taurine, vitamin B6, and Glycinate delivers more glycine to ensure form provides the most glycine to ensure zinc. This formulation was designed for those optimum magnesium absorption despite gentle absorption and resistance to insoluble looking for a magnesium supplement that digestive issues. Recommended for those substances. Recommended for those who provides strong cardiovascular support. with sensitive digestion, Irritable Bowel take multiple prescriptions or who suffer from Directions: Adults – Take 1 capsule 4 times Syndrome or weak stomach acid. digestive conditions like Crohn’s and colitis. daily or as directed by a healthcare practitioner. Directions: Adults - Take 1 to 2 capsules per Directions: Adults - Take 1 to 3 capsules per Each vegetable capsule contains: day or as directed by health care practitioner. day or as directed by health care practitioner. Magnesium ...... 75mg Each vegetable capsule contains: Each vegetable capsule contains: TRAACS® magnesium bis-glycinate chelate buffered ­(magnesium bis-glycinate TRAACS® magnesium bis-glycinate ...... 140mg Magnesium ...... 80mg chelate buffered ­(magnesium bis-glycinate (TRAACS® magnesium bis-glycinate chelate) chelate, magnesium oxide) chelate, magnesium oxide) Taurine ...... Non-Medicinal Ingredients: Vegetable-grade 550mg Non-medicinal ingredients: Vegetable-grade magnesium stearate, vegetable capsule. Vitamin B6 (pyridoxal-5-phosphate) ...... 25mg magnesium stearate, vegetable capsule. Available in: 120 & 240 Vegetable Capsules Zinc (TRAACS® zinc bisglycinate chelate) ...... 2.5mg Available in: 120 & 240 Vegetable Capsules Non-medicinal ingredients: Vegetable-grade ND’s Note: When I treat patients with a long magnesium stearate, vegetable capsule. ND’s Note: I recommend this formula to list of health problems and who take multiple patients who have chronic stress that leads to prescription drugs, I want to make sure that 120 Vegetable Capsules digestive problems. It’s gentle on the gut and what I’m prescribing will be easily tolerated ND’s Note: Taurine has antihypertensive, doesn’t irritate sensitive gastrointestinal tracts. and properly absorbed. This formula is fully antiatherogenic, and antioxidant effects. chelated and won’t bind with any other drugs, When combined with zinc and magnesium, it so it’s perfect for people in these circumstances. is especially beneficial for treating a variety of I also know that this product doesn’t cause gut cardiovascular conditions including ischemia, irritation and that I can recommend it to even coronary artery diseases, congestive heart my most sensitive patients. failure, and hypertension. Vitamin B6 is used in taurine synthesis, making it a necessary

Has the original 200 mg formulation changed?

No, it hasn’t. It’s the very same formulation you’ve come to you understand the differences and options they provide so that rely upon and enjoy. What has changed is our understanding you and your customers can continue to make informed decisions. of magnesium bis-glycinate. Since the release of Magnesium We’re making sure our labels are accurate and easy to understand. Bis-Glycinate 200, we’ve improved our understanding of what And we’re striving to create a magnesium bisglycinate that suits magnesium bisglycinate is and how it works. And as our every person’s needs. While our understanding of an ingredient understanding improves, so do our offerings. might change, the understanding we share has not. That’s our Not all magnesium bis-glycinates are alike. We want to make sure commitment to you.

24 ND Notes | Vol. 3 No. 2

What conditions Magnesium plays various roles in my practice. I encourage my patients to use have you treated magnesium to promote relaxation, reduce muscle tension and improve quality of sleep. with magnesium Also, I have found it very helpful to regulate in your practice? hormones and blood sugar. Last but not least, I like to use magnesium to help lower Second opinion blood pressure for cases of hypertension. Katie Weststrate, ND

Magnesium + GABA & Melatonin Magnesium Malate MagPop! for Sleep Another amino acid containing complex, this Quench your thirst with this highly absorbable We’ve augmented our extra gentle magnesium particular magnesium formulation is often magnesium glycinate supplement enhanced formula with melatonin and GABA to help recommended by naturopathic doctors for with vitamin C and electrolytes. It contains no people relax, reset their circadian biological improved metabolic and energetic function. added sugar, preservatives, artificial flavours, or colours. clocks, and get a better night’s sleep. Directions: Adults - Adults – Take 1 to 3 Directions: Adults – Take 1 to 2 capsules capsules per day or as directed by a Directions: Empty contents into a glass and before bedtime or as directed by a healthcare healthcare practitioner. add 150 to 250ml of water, or to taste. practitioner. Do not drive or use machinery for Each vegetable capsule contains: Each packet contains: 5 hours after taking melatonin. Magnesium �������������������������������������������������������������������������� 110mg Magnesium bis-glycinate blend ...... 100mg Each vegetable capsule contains: Albion® Di-Magnesium Malate (magnesium oxide, magnesium glycinate chelate, glycine) Vitamin C (ascorbic acid) ...... 325mg Magnesium ...... 125mg Non-Medicinal Ingredients: Vegetable-grade TRAACS® magnesium bis-glycinate magnesium stearate, vegetable capsule. Non-medicinal ingredients: Citric acid, chelate buffered ­(magnesium bis-glycinate microcrystalline cellulose. tartaric acid, sodium bicarbonate,* calcium chelate, magnesium oxide) carbonate,* potassium carbonate,* stevia, GABA (gamma-aminobutyric acid) 120 Vegetable Capsules ...... xylitol, maltodextrin, quercetin, -carotene, 100mg TRAACS® magnesium bis-glycinate ND’s Note: Magnesium and malic acid are orange juice powder, natural orange flavour. Melatonin ...... involved in the production of adenosine *Provides electrolytes. . 2.5mg triphosphate (ATP) which generates cellular 35 Sachets per box: Orange flavour Non-Medicinal Ingredients: Vegetable-grade energy. This formula makes a great addition to magnesium stearate, vegetable capsule. a comprehensive protocol for fibromyalgia and ND’s Note: We lead busy lives and can often chronic fatigue. You can also recommend this skip meals and go for long periods without 120 Vegetable Capsules formula to athletes as a post training remedy drinking water. Using this easy-to-make and to enhance muscle recovery. take drink makes getting our key nutrients, ND’s Note: I recommend using this product like magnesium and vitamin C, a cinch. It also in conjunction with good sleep habits, like helps decrease stress! sleeping in a completely dark room, eliminating screen time an hour before turning in, and using

25 ND Notes | Vol. 3 No. 2

Magnesium deficiency is quite common in Magnesium is one of the supplements I use Prescribing magnesium supplements can my practice. Given its critical role in many most often in my practice. I often prescribe help your patients feel better quickly and biochemical reactions, I commonly prescribe magnesium to my Lyme patients as it quickly commit to your practice for the duration magnesium bisglycinate for hypertonic takes a foothold on the disease. Magnesium of their treatment. muscles, tension headaches, muscle strains, deficiency symptoms like irregular heartbeat, chronic pain and for all athletes. This form is anxiety, insomnia, muscle cramps and easily absorbed and patients often report a spasms can mimic those of Lyme disease. difference soon after starting. Tina Rogers, ND Marie Matheson, ND

Magnesium Glycinate Powder Magnesium Glycinate 200 mg Magnesium Glycinate 180 mg Magnesium is a natural stress-reducing Magnesium is a multi-functioning mineral that A lower dose magnesium designed for mineral that comes in handy on days when also promotes relaxation and sleep. individuals who desire to create specific our stress levels ramp up. self dosages. Directions: Adults: take 1 capsule per day, Directions: Dissolve powder in liquid, or take as or as directed by a healthcare practitioner. Directions: Adults: take 1 capsule per day, directed by a health care practitioner. Children: or as directed by a healthcare practitioner. Each vegetable capsule contains: Ages 1-3 years: ¼ scoop per day; ages 4-8 years: Magnesium ...... 200mg Each vegetable capsule contains: ½ scoop per day; Adolescents: ages 9-18 years; Magnesium glycinate blend Magnesium ...... 180mg 1 rounded scoop per day; Adults: 1-2 rounded (magnesium oxide, magnesium Magnesium glycinate blend scoops per day. glycinate chelate, glycine) (magnesium oxide, magnesium glycinate chelate, glycine) 1 rounded scoop contains: Non-Medicinal Ingredients: vegetable-grade Magnesium ...... 200mg magnesium stearate, vegetable capsule. Non-Medicinal Ingredients: vegetable-grade Magnesium glycinate blend 90 Vegetable Capsules magnesium stearate, vegetable capsule. (magnesium oxide, magnesium 60 Vegetable Capsules glycinate chelate, glycine) ND’s Note: It’s important for active patients Non-medicinal ingredients: citric acid (1%). to replenish their electrolyte levels, especially ND’s Note: Parents like to make sure their 90 Grams magnesium. The majority of the North teens stay physically active. One way to American population is already depleted in support sustained activity is to supplement ND’s Note: In addition to recommending this essential mineral and living an active with a reliable magnesium source. Popping a supplements like magnesium and B vitamins, lifestyle compromises levels even more. low-dose magnesium capsule keeps energy why not create a stress reduction library I recommend taking it after a workout to levels steady and makes for an easy on-the-go filled with tools your patients can borrow? support muscle recovery and prevent option for busy kids with busy parents! Books, electronic devices, and hand-outs muscle cramps. that help them practice stress reduction techniques at home would surely be welcomed and appreciated.

26 ND Notes | Vol. 3 No. 2

Drug-induced nutrient depletion

Despite being effective and even life-saving, of water soluble vitamins and electrolytes five or more prescription medications to feel both over-the-counter and prescription such as potassium and magnesium. the effects of nutrient deficiencies. These medications can have potential side effects. So who might be the most at risk? The can happen whether you are taking one or What your clients might not realize is that answer is seniors. In 2009, The Canadian more prescription medications. there can be side effects that do not come Institute for Health Information (CIHI) from the drugs themselves, but rather show reported that about two-thirds, or 63 percent From a Practitioner's up as a result of nutritional deficiencies of seniors on public drug programs in six Point of View from prolonged use. provinces were taking five or more drugs You’re undoubtedly aware of which Medications can deplete nutrients like belonging to different drug classes. Nearly a prescription medications your clients are magnesium through various mechanisms, quarter were taking prescription drugs from taking. As an extra precaution, you might like altering the way a nutrient is absorbed, ten or more drug classes. Polypharmacy, or familiarize yourself with how those particular converted, stored or excreted. Some, like the act of taking five or more prescription medications might alter nutrient absorption acid blockers, can impair the digestion of medications, is especially common among and cause deficiencies. Helping your clients nutrients by altering the acidity in one’s seniors. It’s further compounded by the fact understand how these deficiencies can occur gastrointestinal tract. Others may bind that seniors metabolize and eliminate drugs might encourage them to take preventative with nutrients, preventing absorption more slowly than other age groups because measures to maintain good health, especially completely. Others, like diuretics, can of aging organs like the liver and kidneys. when prescription medications are necessary increase urinary output, causing a loss Not surprisingly, one doesn’t need to take and taken daily.

Drug Classification Common Name Nutrient Depletion Effects

Ranitidine • Alter the acidity of the GI tract which can affect gut health by inhibiting proper digestive Cimetidine Acid blockers • function and interfere with nutrient absorption. Stomach acid is an important factor in Nizatidine • the absorption of minerals. • Famotidine

Calcium carbonate Create weak stomach acid which impacts the solubility of magnesium and contributes towards Antacids • • Sodium bicarbonate minerals getting flushed out through the colon.

• Tetracycline Amoxicillin Can alter gut flora where B vitamins are manufactured. B vitamins together with their cofactors Antibiotics • • Doxycycline and magnesium, help to metabolize carbohydrates and synthesize energy production. • Cephalexin

Diuretics lower blood pressure by lowering the amount of and water in the body. This loss of Thiazide diuretics fluids can lead to the loss of precious minerals, such as potassium, magnesium, calcium and zinc. Anti-Hypertensives • • Loop diuretics Of the minerals that are lost, magnesium and potassium are of the most concern, as a deficiency may be a risk factor for cardiovascular disease, hypertension and arrhythmias.

Cardiac glycosides • Digoxin Digoxin decreases intracellular magnesium, causing more magnesium to be lost via urine.

Cholestyramine Cholesterol agents • Deplete most minerals including magnesium. • Colestipol

Prednisone use can deplete vital nutrients involved in keeping the immune system healthy. Corticosteroids • Prednisone (Deltasone) Magnesium plays a huge role in synthesizing glutathione, a powerful antioxidant that strengthens the immune system.

• Stimulant laxatives Stimulant laxatives exert their primary effects through alteration of electrolyte transport in the Laxatives • Bisacodyl (Dulcolax) intestinal mucosa. They are the most powerful class of drug for constipation and generally not used for prolonged periods of time. Can cause electrolyte imbalances.

This list is by no means conclusive, but meant to give you an idea of which medication classes to watch out for and provide a brief outline of the mechanisms involved.

References: 1 Cohen, S. (2011). Drug muggers: which medications are robbing your body of essential nutrients--and natural ways to restore them. Emmaus, PA: Rodale. ND Notes | Vol. 3 No. 2

Continuing education course listings

Keep up-to-date and current with ongoing continuing education. See below for some upcoming courses.

Course CE Name/ Organizers Location Date Registration Info Description Info Theme

Not to be mistaken with the annual conference the same organizers hold in New York every February, but a great way to gather Integrative Integrative and exchange knowledge without having Healthcare Healthcare Richmond http://www.ihsymposium. to travel too far, for those of us living in the Oct 13 - 14, 2017 TBD Symposium Symposium Hill, Ontario com/canada/ Greater Toronto Area. (Canada) This conference inspires integrative healthcare providers to engage with one another to promote education and practical advice on integrative therapies.

The OAND annual convention! Reconnect Clinical OAND 2017 Blue 19.5 https://oand.org/2017- with colleagues, get your CE credits and Innovations in Annual Nov 10-12, 2017 Mountain, Cat A convention-tradeshow- explore clinical innovations in Naturopathic Naturopathic Convention ON TBC registration/ Medicine in a picturesque setting at Blue Medicine & Tradeshow Mountain resort, Collingwood!

Participants will learn how to uniquely design https://education. treatment regimens that include customized Functional and lp3network.com/live- dosage strengths, dosage forms, delivery Personalized Toronto, 15.5 training/functional- systems, and combinations. This program will Hormone LP3 Network Dec 2-3, 2017 Ontario Cat A personalized-hormone- allow healthcare providers with the unique Restoration restoration-therapy/toronto/ opportunity to collaborate together to produce Therapy december-2-3-2017 a patient-centered treatment regimen that is tailored to the individual patient.

This online seminar is designed to provide theoretical research, practical applications and clinical pearls integrating nutrition, Epigenetics lifestyle, exercise, supplementation and the and IV therapies, with the goal of easily 2 https://oand.org/non- Mitochondria OAND Live Webinar Dec 4, 2017 implementing these protocols into daily Cat A certificate-ce-courses/ in the Context practice. You will leave with a greater of Fertility understanding of the role of mitochondrial function in fertility success, and suggested treatment protocols that enhance this function in male and female fertility patients.

Dr. Eric Marsden ND will review compliance standards critical for CONO’s upcoming IVIT 2017 IVIT Center of http:// inspection training program. Topics include: Regulatory Excellence in integrativemedicinecme. Online only Ongoing TBC a review of Physical standards, Compliance Integrative com/sales-page/ref/ Infection control, Sterile Compounding, Course Medicine OANDCE/ Documentation, Risk Assessment, Infection control planning and Compounding.

To have a course listed in an upcoming issue of ND Notes, please submit course details to [email protected]. Please remember to double check the amount of credits and the category in which these courses will be placed, according to your province’s regulatory body. 28 ND Notes | Vol. 3 No. 2

Dietary magnesium: what you need to know

Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board at the Institute of Medicine of The National Academies, recommend that males and females ages 19-30 take in 400 mg and 310 mg of magnesium a day respectively. Males 31 and older should up their intake to 420 mg a day, and females 31 and older should increase their daily amounts to 320 mg.

The DRI also encourages pregnant or will offer you a relatively high amount of True or False: Organic lactating women to boost their magnesium magnesium as well. But the real winners intake even higher and to consult their when it comes to the most nutrient dense, Foods Contain More doctors for suggested amounts. magnesium-rich foods are fresh vegetables Magnesium and dark leafy greens like chard, collards Sea vegetables (kelp), nuts and seeds, It’s no surprise that choosing to buy organic and spinach. Nuts and seeds also pack beans, soybeans and some seafood dark leafy greens and vegetables can cost a big punch for their size when it comes generally contain higher levels of you. But if you choose to not purchase to magnesium density. Refer to the magnesium compared to other organic produce will you pay in different Magnesium Content in Foods chart on foods. Grains and pseudocereals like ways? Does buying organic make a difference page 31, to see which nuts and seeds are quinoa, buckwheat and brown rice in terms of mineral (magnesium) content highest in magnesium! compared to conventionally grown crops?

References: 1 Nutrient Recommendations: Dietary Reference Intakes (DRI). (n.d.). Retrieved September 15, 2017, from https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx 2 Magnesium. (n.d.). Retrieved September 15, 2017, from https://www.nal.usda.gov/fnic/magnesium 3 (n.d.). Retrieved September 13, 2017, from http://whfoods.org/genpage.php?tname=nutrient&dbid=75 ND Notes | Vol. 3 No. 2

Heartburn

Like other muscles, the esophageal sphincter that separates the stomach from the esophagus, needs magnesium to function properly. Without enough magnesium, the sphincter may spasm, allowing the acid to travel up and irritate the sensitive esophageal lining. Contrary to common belief, acid reflux or heartburn is not a symptom of too much acid in the stomach, According to the Environmental Working Absorption of dietary magnesium isn’t but too little. Low stomach acid Group, conventionally grown spinach guaranteed, though. Enzymatic function, can contribute to malabsorption of carbohydrates, which in turn leads to ranks second when it comes to produce stomach and bowel health are key factors in a buildup of gasses in the stomach. containing pesticide residue. the absorption process. From the beginning This intra-abdominal pressure pushes of the digestive system (oral cavity) to the While some studies conclude that organic the stomach contents, including very end (the anus), all parts need to be food may or may not be more nutritious gastric acid, up to the esophagus working efficiently (especially the small than conventionally grown, it is safe to say which creates a burning sensation. intestine) for optimum breakdown of dietary that buying organic can protect you from Taking an antacid can provide magnesium. Even if our digestive process is detrimental pesticides and herbicides that temporary relief but it will decrease working perfectly, mineral content in food an already low amount of stomach generally act as antagonists when it comes likely won’t be high enough to offer our cells acid making the issue worse, not to magnesium absorption. Eventually optimum protection. to mention making it harder for us leading to mineral deficiency. to breakdown foods and absorb Cooking methods and refined foods can minerals like magnesium. Is Dietary Intake also account for magnesium loss. If we Enough? choose to fry that one cup of swiss chard instead of bake or lightly sauté it, we Swiss chard contains a whopping 150 can cheat ourselves out of getting the mg of magnesium per cup. But does that magnesium we need. mean you are covered when it comes to Between mineral-depleted plant foods, adequate dietary magnesium intake? Not compromised digestive systems and necessarily. Lifestyle, physiological and popular denaturing cooking methods, agricultural factors all play roles in how optimizing our magnesium intake via much dietary magnesium is available and food can become quite a challenge. how it is absorbed. A disappointing reality, but a reality nonetheless! The Kicker Let’s Explore Why Ironically, magnesium needs magnesium to facilitate the absorption Mineral-rich foods are becoming an anomaly process. It’s imperative for helping to these days. High rates of soil erosion account synthesize enzymes, repair tissue in our for less magnesium in the soil which results in intestinal lining, and contribute to our low mineral content in plant foods including parasympathetic nervous system health, magnesium. And that’s only one reason. The for starters. In order for these processes health of our digestive system is also a factor to function properly in the first place, we in whether or not we can adequately break need to have enough magnesium in our down food to get the good stuff. Optimum bodies to provide energy to get these absorption is key in making sure magnesium physiological jobs done and done well. actually enters our cells!

4 The 2017 Dirty Dozen: Strawberries, Spinach Top EWG's List of Pesticides in Produce. (n.d.). Retrieved September 15, 2017, from http://www.ewg.org/release/2017-dirty-dozen-strawberries- spinach- top-ewgs-list-pesticides-produce#.Wbvyw9OGNUM 5 Office of Dietary Supplements - Magnesium. (n.d.). Retrieved September 13, 2017, from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#h5 30 ND Notes | Vol. 3 No. 2

Magnesium content in foods

Magnesium deficiency is common and many people seek to boost levels the easy way by taking a supplement. But what about getting the magnesium we need through our food?

Here’s a comprehensive tool to help you and your patients get more magnesium into your meals. This is a great guideline for people who are most at risk for having a magnesium deficiency such as older adults, people with type 2 diabetes, and people with gastrointestinal conditions who can’t absorb enough magnesium from their diets.

mg of Magnesium mg of Magnesium Food Serving Size Food Serving Size per Serving per Serving

Nuts and Seeds Brussels Sprouts 1 cup 31

Pumpkin Seeds ¼ cup 190 Turnip Greens 1 cup 31

Sesame Seeds ¼ cup 126 Winter Squash 1 cup 26

Cashews ¼ cup 116 Cabbage 1 cup 25

Sunflower Seeds ¼ cup 113 Asparagus 1 cup 25

Cashews, dry roasted 1 ounce 74 1 cup 23

Almonds ¼ cup 61 Bok Choy 1 cup 18

Flaxseeds 2 tablespoons 54 Mustard Greens 1 cup 18

Mustard Seeds 2 tsp 14 Leeks 1 cup 14

Vegetables Cucumber 1 cup 13

Spinach, boiled 1 cup 156 Romaine Lettuce 2 cups 13

Broccoli, chopped and Swiss Chard 1 cup 150 ½ cup 12 cooked

Beet Greens 1 cup 97 Cauliflower 1 cup 11

Avocado, cubed 1 cup 44 Celery 1 cup 11

Potato, baked with skin 3.5 ounces 43 Bell Peppers 1 cup 11

Summer Squash 1 cup 43 Carrot, raw 1 medium 7

Collard Greens 1 cup 39 Fruits

Beets 1 cup 39 Papaya 1 medium 57

Broccoli 1 cup 32 Banana 1 medium 32

31 ND Notes | Vol. 3 No. 2

mg of Magnesium mg of Magnesium Food Serving Size Food Serving Size per Serving per Serving

Raspberries 1 cup 27 Wheat 1 cup 58

Raisins ½ cup 23 Bread, whole wheat 2 slices 46

Tomatoes 1 cup 19 Rice, brown, cooked ½ cup 42

Cantaloupe 1 cup 19 Rice, white, cooked ½ cup 10

Strawberries 1 cup 18 Dairy and Dairy Alternatives

Watermelon 1 cup 15 Soymilk, plain or vanilla 1 cup 61

Apple 1 medium 9 Yogurt, plain, low fat 8 ounces 42

Legumes Milk 1 cup 24

Soybeans 1 cup 147 Meat and Meat Alternatives

Black beans, cooked 1 cup 120 Tempeh 4 ounces 87

Navy Beans 1 cup 96 Tofu 4 ounces 65

Pinto Beans 1 cup 85 Tuna 4 ounces 47

Lima Beans 1 cup 80 Scallops 4 ounces 41

Salmon, Atlantic, farmed, Kidney Beans 1 cup 74 3 ounces 26 cooked

Green Peas 1 cup 53 Halibut, cooked 3 ounces 24

Edamame, shelled, cooked ½ cup 50 Chicken breast, roasted 3 ounces 22

Kidney beans, canned ½ cup 35 Beef, ground, 90% lean, 3 ounces 20 pan broiled Green Beans 1 cup 22 Herbs and Spices Grains Cumin 2 teaspoons 15 Quinoa ¾ cup 118 Parsley ½ cup 15 Buckwheat 1 cup 85 Fennel 1 cup 14 Brown Rice 1 cup 83 Basil ½ cup 13 Barley cup 81 Cloves 2 tsp 10 Millet 1 cup 76

Oats ¼ cup 69

Cereal, shredded wheat 2 large biscuits 61

Rye cup 61

References: 1 (n.d.). Retrieved September 13, 2017, from http://whfoods.org/genpage.php?tname=nutrient&dbid=75 2 Office of Dietary Supplements - Magnesium. (n.d.). Retrieved September 13, 2017, from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#h5 32 ND Notes | Vol. 3 No. 2

Can I test for a magnesium deficiency?

When it comes to testing your magnesium Status Checkist on page 36). be supplementing. levels, the process can be a bit complicated. Because magnesium flows between blood, When supplementing, you’ll want to aim for Magnesium is kept mostly in bones and the bones, and inside cells, testing magnesium a test result in the higher end of the range, in soft tissues. The amount that travels in just the blood can be inaccurate. say around 2.4 to 2.52mmol/L. through our bloodstream is less than one percent and those levels are tightly If you decide to requisition a magnesium One last thing: if you take the RBC test, you regulated by your body. red blood cell test, try taking one might see a reference range between 1.65 baseline test before supplementing with and 2.52 mmol/L. That’s a very wide interval Magnesium levels in blood or urine might magnesium and again three to four months and you may still experience deficiency not relate to magnesium levels in the after supplementation. Steady, consistent symptoms at the lower end of this range. body as a whole. There are a few other supplementation will help build up the tests that are more accurate (for example reserve stores in your bones and tissues. testing magnesium inside red blood cells), Repeating this test every three to four but we recommend, as a first defence, to months will provide a guideline for become familiar with magnesium deficiency how much magnesium you should Diet symptoms and risk factors (see Magnesium 12.5 mmol/day m

Plasma 2.5 mmo l

Bone 600-700 mmol of magnesium

Inside cells Waste Urine 7.5 mmol/day 5 mmol/day

Muscle pain, spasms, twitches, cramps

Insufficient magnesium causes calcium to stay in muscle and nerve cells longer, causing over excitation of the muscles and nerves. This can lead to cramps, spasms and other muscle related issues.

33 ND Notes | Vol. 3 No. 2

Mechanism: PMS and magnesium

Prostaglandins, the powerful inflammatory of hormone proteins progesterone modulators and important chemical-like and estrogen. During times of elevated messengers, play a crucial role in keeping progesterone and estrogen (when PgE1 PMS symptoms in check. But keeping conversion isn’t happening the way it should) prostaglandins (PgE1 and PgE2) balanced even more magnesium is used in order to can be tough - especially if the right make up for imbalanced hormonal levels. amount of nutrients aren’t present. PgE1 Not every woman who suffers from PMS deficiency is a known PMS trigger. will have the same symptoms. But it is Magnesium plays a role in the synthesis possible that every woman can find some of PgE1 and is also involved in essential relief by supplementing with magnesium fatty acid metabolism. Prostaglandins are (see chart below). PMS symptoms at once, to help identify why an individual is experiencing synthesized in cells from essential fatty acids. Be sure to get optimum amounts of B6 and premenstrual syndrome, it might be helpful If not enough magnesium is present, other B vitamins as well as magnesium. to categorize symptoms. This might help then hormonal issues can arise from a These specific vitamins play a key role in identify what specific hormonal issues and prostaglandin production imbalance. guiding magnesium into the cell. deficiencies your female patients may be Magnesium also aids in the manufacturing Although women can suffer from multiple suffering from.

PMS Symptoms your patients Possible Hormonal Magnesium’s Role Categorized may be experiencing behaviour

• Manufactures both estrogen and progesterone ↑ estrogen • Calms the nervous system A Anxiety, irritability, mood swings ↓ progesterone Reduces hyperexcitability Anxiety • Chronic Stress • ↑ magnesium = ↓ estrogen • ↑ magnesium = ↓ cortisol

Increases blood flow to the brain ↑ insulin • C Cravings, increased appetite, fatigue, • ↓ magnesium = potassium loss = irregular heartbeat Cravings headache, irregular heartbeat Hypoglycemic • Promotes regular heartbeat via proper nerve impulse symptoms • Needed for proper absorption of carbohydrates and fats

Regulates mineral concentration Hyperhydration, swelling, • ↑ aldosterone Excess salt = magnesium loss dehydration, sodium retention, high • H ↓ magnesium = potassium loss = dehydration blood pressure, breast tenderness, ↑ estrogen • Hyperhydration Promotes proper bowel movement (peristalsis) bloating, weight gain, inflammatory • Decreased Immunity Required for estrogen detox pathway in the liver (sulfation and stress response, adrenal fatigue • methylation pathway)

• Helps convert tryptophan to serotonin (our feel good neurotransmitter) ↓ estrogen Depression, confusion, forgetfulness, • ↑ magnesium levels = ↓ cortisol D crying spells, adrenal fatigue, ↑ progesterone Supports energy production Depression • impaired neurological function Hypothyroidism • ↓ magnesium = HPA axis dysfunction • ↓ magnesium = impaired function of parathyroid gland = improper magnesium absorption

Dysmenorrhea, nausea, acne, pains, body temperature changes, and other symptoms may also be present during PMS.

References: 1 Premenstrual Syndrome, Part 1. (2011, November 14). Retrieved September 25, 2017, from http://www.physicianspractice.com/pmspmdd/premenstrual-syndrome-part-1 2 P. (2011, January 25). PMS - How to Balance your Hormones. Retrieved September 25, 2017, from https://www.patrickholford.com/advice/pms-how-to-balance-your-hormones 3 3)Walker, A. F., De, M. C., Vickers, M. F., Abeyasekera, S., Collins, M. L., & Trinca, L. A. (1998, November). Magnesium supplementation alleviates premenstrual symptoms of fluid retention. 34 Retrieved September 25, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/9861593 ND Notes | Vol. 3 No. 2

Can you take too much magnesium?

The body is very smart at regulating magnesium will not be able to be cleared magnesium levels. If too much dietary from the body. magnesium is consumed, it can flush Patients with low blood pressure and the excess through the digestive tract as conditions related to muscle tone and diarrhea. Too much magnesium in the electrolyte imbalances should be cautious bloodstream is flushed out through the when supplementing with magnesium and kidneys in urine. As long as these safety consult with a natural healthcare practitioner mechanisms are functioning, it is very to find out what is best for them. difficult to take in too much magnesium. Supplementation protocols should In the case where safety mechanisms address the patient's unique healthcare are not functioning, then taking oral needs and take into consideration any magnesium supplements may not be health concerns and/or contraindications suitable or should be closely monitored. that might be present based on a proper If your patient suffers from kidney (renal) health assessment. failure or bowel obstructions for example,

Here are some conditions that can benefit from magnesium supplementation:

Acid reflux Blood clotting Fibromyalgia Muscle cramping and pain

Hypertension, angina and coronary Adrenal fatigue Chronic fatigue syndrome Osteoporosis and bone health artery disease

Alzheimer’s disease and dementia Constipation Infertility PMS and dysmenorrhea

Anxiety stress, and panic attacks COPD and lung function Inflammation Preeclampsia and eclampsia

Arrhythmia Depression Insomnia Seizures

Asthma Dysglycemia and diabetes Migraines and headaches Sports endurance

Attention Deficit Hyperactive Fatigue Disorder (ADHD)

Recommended Use Magnesium Bis-Glycinate is a versatile mineral that is involved in over 800 bodily biochemical functions. Vital organs like the heart and brain simply can’t work without it.

Contraindications As with any natural health product, it is advisable to consult a healthcare practitioner prior to use.

35 Magnesium Status Checklist

The following are symptoms and risk factors of a magnesium deficiency. Tick off the corresponding box for any statements that apply to you. Check this list again every four months to track progress with treatment.

Baseline Month 4 Month 8 Month 12 Baseline Month 4 Month 8 Month 12

RISK FACTORS: DIET & LIFESTYLE Lack of appetite

Drinking more than 3 cups of coffee or tea per day Confusion or difficulty concentrating

Drinking over 7 alcoholic drinks per week Poor memory or confusion

Eating junk foods with high sugar, fats or salt Mood swings

Consuming less than one serving of greens per day Feeling irritable

Limited consumption of seeds, nuts or fruits Muscle cramps or spasms

Intense exercise or training more than 3 times per week Hand tremors

Excessive sweating Muscle weakness or soreness Currently pregnant or have been pregnant in the past 12 Muscle, neck or back pain months

RISK FACTORS: CONDITIONS Twitching, tics or restlessness

Regularly having undigested foods in stools Restless leg syndrome

Chronic kidney disease Reynaud’s syndrome

Diarrhea Fibromyalgia

Heavy menstrual periods Shortness of breath

RISK FACTORS: SUPPLEMENTS & DRUGS Chest tightness

If you are taking... Startled easily

Acid blockers Sensitivity to loud noises or lights

Antacids Tingling or other unusual sensations in the hands or feet

Antibiotics Poor circulation leading to cold hands and feet Tear this out, make copies and use with your patients. and use with your copies this out, make Tear Antihypertensives Osteoporosis or low bone density

Calcium or iron supplements Irregular periods

Corticosteroids or anti-inflammatories Preeclampsia and eclampsia

Diuretics Severe PMS

Hormone replacements Difficulties conceiving

Oral contraceptives (birth control) Loss of libido

Vitamin D Hyper or hypothyroidism

Hyperparathyroidism SIGNS & SYMPTOMS

Chronic fatigue, lethargy or low energy Trouble sleeping

Chronic headaches or migraines History of seizures

History of strokes High blood pressure Low blood potassium Rapid or irregular heart rate Vitamin D deficiency Anxiety or panic attacks Strong cravings for carbohydrates, salt or chocolate Hyperventilation or frequent sighing

Nausea or vomiting Recommendations Lifestyle &Dietary • • • • • • • • Here are somesuggestions andtips to improve your magnesium status. to track your progress. Once you've started to make thesechanges, go through the“MagnesiumStatus” checklistagain compared to otherplant-based foods, andare easy to snackon. Add more raw nutsandseedsinto Nutsandseedscan yourdiet. beeaten raw, havelowphyticacid Joining acommunity-sponsored agriculture program isagreat way to access locally-grown greens. Increase yourconsumption oforganic greens. Look for organic greens grown withnatural, organic fertilizer. wastage. You can measure ofthestress hormonecortisol levels through anon-invasive saliva test. anxiety willhelpimprove magnesiumdigestion (IBS isoften stress-induced) and reduce magnesium Try to remove stressors inyourlife. Easier saidthandone,butdealing withtheroot causes ofstress and with magnesiumabsorption. Steam raw greens like spinachandchard to remove theoxalic acidcontent. Oxalic acidalsointerferes beans andgrains. Phyticacidinterferes withmagnesiumabsorptioninthegut. Soak beans andgrains before cooking. Soaking can reduce phyticacidfound inhighconcentrations in Reduce sodiumconsumption. Sodiumcompetes withmagnesiumfor ionchannels. Cut back onprocessed andjunkfoods. Heavy processing willremove manyminerals found infood. wastage andreduce magnesiumabsorption. Cut back ontheconsumption ofcoffee, alcohol andsoftdrinks.Thesedrinks canincrease magnesium

This tear-out can be copied for use with your patients. CanPrev guide to Magnesium natural medicine is here! A complete primer.

Our new 2017 guide is now available. It’s a Download or request a copy of our comprehensive comprehensive 148-page guide of CanPrev's natural Magnesium Primer. In it you’ll learn more about: products, complete with detailed descriptions and practical health advice. A great resource for your • How magnesium works • Magnesium deficiency patients - or as a handy reference for your practice. • Why take magnesium • Magnesium absorption

To request or download your copy, To request or download your copy, visit canprev.ca/guide visit magnesium.ca

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