Diuretics, Heart Conditions and Magnesium]

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Diuretics, Heart Conditions and Magnesium

 

Magnesium deficiency is common and deadly.

Diuretics, heart conditions, exercise, and the ECA stack influence

magnesium status.

 

Contents

Page 1 A bunch of scary studies.

Page 2 Big brother to the rescue (sort of).

Dieters, athletes, and ECA.

Page 3 Diuretics and magnesium.

Page 4 The turf war.

Page 5 Safety & bioavailability.

 

The " processing " of food results in large losses of vital nutrients.

For example, white bread contains about 40% less magnesium than

organic whole grain bread.

 

In addition, since World War II, the amount of magnesium in our

food has steadily declined due to farming methods and the use of

fertilizers that only replenish nitrogen, phosphorus, and potassium

(9-BK).

 

Thus, there is reason to doubt whether even the best diet can

provide an optimum amount of magnesium.

 

In light of all this, it is amazing that Big Brother actually tells

people NOT to take supplements. Lets face it, Big Brother can tell

people to eat 3,000 servings of fresh vegetables a day till he's

blue in the face, but how many people are going to choose broccoli

over pizza?

Thus, most of the people who listen to the official party line about

supplements are left in the following predicament:

 

" In developed countries, the Mg [magnesium] intake [from food] is

often marginal and the Mg intake coming from drinking water

represents the critical factor through which the Mg intake is

deficient or satisfactory

 

.. . . all [Mg studies have] shown a reverse correlation between

cardiovascular mortality [death] and the Mg level " (1).

 

Isn't that amazing? Unless you take supplements or eat an

extraordinarily good diet, you are participating in the magnesium

lottery -- gambling your life on the quality of the WATER in your

town.

 

Yikes! When you hear some " expert " parroting the old line about how

we can get all the nutrients that we need from food, what they are

really saying -- to the vast majority of people -- is that instead

of taking

supplements (the dangerous practice of " self-medication " ), we should

just hope and/or pray that there is enough magnesium in the water.

 

If you listen to these clowns, you are playing the magnesium

lottery.

 

And if you get a losing ticket in THIS lottery, you die.

 

Written Aug 2000 Last Update Aug 2000

A Bunch Of Scary Studies

 

OK, now I know it's easy to criticize epidemiological studies.

Actually, there is also quite a bit of clinical and laboratory

research supporting the need for magnesium supplementation. However,

since the magnesium lottery is a global water quality game, we

really should dive in a little deeper (sorry):

 

" A consistent pattern has emerged, indicative of a global

phenomenon, which illustrates the importance of waterborne magnesium

in protecting against cardiovascular trauma and other ailments " (2).

 

Here are the lottery results from Sweden: " The odds ratios for death

from acute myocardial infarction in the groups were inversely

related to

 

the amount of magnesium in drinking water " (4). Scientists in Taiwan

studied over 17,000 cerebrovascular deaths and found that the

unlucky

people who lived in low magnesium areas were more likely to die of

strokes: " there is a significant protective effect of magnesium

intake from drinking water on the risk of cerebrovascular

disease " ).

The scientists in Taiwan have been quite busy. They also found that

low magnesium levels in drinking water are related to the risk of

death from

hypertension (6), diabetes mellitus ( , and an astonishing " 42%

excess risk of mortality from esophageal cancer " (7).

 

In light of the uncertainties of the magnesium lottery, it should

not be too big of a surprise to find that magnesium deficiency has

been found in a large percentage of hospital patients (I'll spare

you the joke about hospital food) -- and this has been linked

to " cardiovascular abnormalities,

ranging from cardiac arrhythmias

and atrial fibrillation

to hypertension " .

 

In addition, low serum magnesium levels are associated with

thickening of the carotid wall and high fasting insulin

levels (13). The elevated insulin levels reflect an attempt to

compensate for impaired insulin receptor function caused by

magnesium deficiency).

Proper insulin function requires a LOT more than popping a chromium

pill everyday.

 

I could go on and on, but Altura et al. did a good job of summing up

the overwhelming evidence of the health problems that are related to

magnesium deficiency:

 

" It is now becoming clear that a lower than normal dietary intake of

Mg [magnesium] can be a strong risk factor for hypertension, cardiac

arrhythmias, ischemic heart disease, atherogenesis and sudden

cardiac

death. Deficits in serum Mg appear often to be associated with

arrhythmias, coronary vasospasm and high blood pressure " (15).

 

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The processing of food results in large losses of vital nutrients.

For example, white bread contains about 40% less magnesium than

whole wheat bread. In addition, since World War II, the amount of

magnesium in our food has steadily declined due to farming methods

and the use of fertilizers that only replenish nitrogen, phosphorus,

and potassium (9-BK). Thus, there is reason to doubt whether even

the best diet can provide an optimum amount of magnesium.

 

In light of all this, it is amazing that Big Brother actually tells

people NOT to take supplements. Lets face it, Big Brother can tell

people to eat 3,000 servings of fresh vegetables a day till he's

blue in the face, but how many people are going to choose broccoli

over pizza?

Thus, most of the people who listen to the official party line about

supplements are left in the following predicament:

 

" In developed countries, the Mg [magnesium] intake [from food] is

often marginal and the Mg intake coming from drinking water

represents the critical factor through which the Mg intake is

deficient or satisfactory

.. . . all [Mg studies have] shown a reverse correlation between

cardiovascular mortality [death] and the Mg level " (1).

 

Isn't that amazing? Unless you take supplements or eat an

extraordinarily good diet, you are participating in the magnesium

lottery -- gambling your life on the quality of the WATER in your

town.

Yikes! When you hear some " expert " parroting the old line about how

we can get all the nutrients that we need from food, what they are

really saying -- to the vast majority of people -- is that instead

of taking

supplements (the dangerous practice of " self-medication " ), we should

just hope and/or pray that there is enough magnesium in the water.

If you listen to these clowns, you are playing the magnesium

lottery. And if you get a losing ticket in THIS lottery, you die.

 

Written

Aug 2000

Last Update

Aug 2000

A Bunch Of Scary Studies

OK, now I know it's easy to criticize epidemiological studies.

Actually, there is also quite a bit of clinical and laboratory

research

supporting the need for magnesium supplementation. However, since

the magnesium lottery is a global water quality game, we really

should dive in a little deeper (sorry):

 

" A consistent pattern has emerged, indicative of a global

phenomenon,

which illustrates the importance of waterborne magnesium in

protecting

against cardiovascular trauma and other ailments " (2).

 

Here are the lottery results from Sweden: " The odds ratios for death

from acute myocardial infarction in the groups were inversely

related to

the amount of magnesium in drinking water " (4). Scientists in Taiwan

studied over 17,000 cerebrovascular deaths and found that the

unlucky

people who lived in low magnesium areas were more likely to die of

strokes: " there is a significant protective effect of magnesium

intake

from drinking water on the risk of cerebrovascular disease " (5). The

scientists in Taiwan have been quite busy. They also found that low

magnesium levels in drinking water are related to the risk of death

from

hypertension (6), diabetes mellitus (8), and an astonishing " 42%

excess

risk of mortality from esophageal cancer " (7).

 

In light of the uncertainties of the magnesium lottery, it should

not be

too big of a surprise to find that magnesium deficiency has been

found

in a large percentage of hospital patients (I'll spare you the joke

about hospital food) -- and this has been linked to " cardiovascular

abnormalities, ranging from cardiac arrhythmias and atrial

fibrillation

to hypertension " (12). In addition, low serum magnesium levels are

associated with thickening of the carotid wall and high fasting

insulin

levels (13). The elevated insulin levels reflect an attempt to

compensate for impaired insulin receptor function caused by

magnesium

deficiency (14). Proper insulin function requires a LOT more than

popping a chromium pill everyday.

 

I could go on and on, but Altura et al. did a good job of summing up

the

overwhelming evidence of the health problems that are related to

magnesium deficiency:

 

" It is now becoming clear that a lower than normal dietary intake of

Mg

[magnesium] can be a strong risk factor for hypertension, cardiac

arrhythmias, ischemic heart disease, atherogenesis and sudden

cardiac

death. Deficits in serum Mg appear often to be associated with

arrhythmias, coronary vasospasm and high blood pressure " (15).

 

 

 

 

Diuretics And Magnesium

My mother has congestive heart failure. Although I told her (many

times)

about the benefits of supplements, she did not want to take them: " I

have to take a handful of drugs everyday and I don't want to take

ANY

more pills " was her usual response. Trips to the emergency room

occurred

frequently. And, as if that wasn't bad enough, the diuretics (water

pills) that she was getting from her doctor were depleting her

potassium

and endangering her life.

 

The best that several doctors and a heart specialist could do was to

give her potassium-sparing diuretics and higher doses of potassium.

This

did no good because she was not retaining the potassium. Eventually,

her

potassium got so low that she almost died -- I found her on the

floor

unable to move. Another trip to the emergency room.

 

This traumatic experience convinced my mother that the doctors were

unable to get a handle on this potassium problem. She didn't want to

end

up paralyzed again, so she agreed to take whatever I thought would

help

this potassium problem -- as long as it involved a " reasonable "

amount

of pills (I take a LOT of supplements).

 

That night I did a MEDLINE computer search of the medical

literature.

For the life of me, I can't imagine why the doctors and the

specialist

(expensivist?) couldn't figure the problem out -- the reason why my

mother was unable to retain potassium was easy to find. In fact,

there

is so much research on this that it's hard not to trip over it. You

do

NOT have to be Sherlock Holmes, dig? Here are a few clues:

 

Written

Aug 2000

Last Update

Aug 2000

A medical article titled " Refractory potassium repletion. A

consequence

of magnesium deficiency " explains how diuretics flush a lot more

than

potassium out of your system -- and if (when) you get low in

magnesium,

you will be unable to retain potassium:

 

" Patients with hypertension and with congestive heart failure appear

to

be at special risk for magnesium depletion because diuretics are

commonly prescribed in treatment . . . Experimental and clinical

observations support the view that uncorrected magnesium deficiency

impairs repletion of cellular potassium . . . consideration should

be

given to treating hypokalemic [low potassium] patients with both

magnesium as well as potassium to avoid the problem of refractory

potassium repletion due to coexisting magnesium deficiency " (19).

[emphasis added]

 

Consideration??? I nominate that for the understatement of the year

award. Lets see . . . hmm . . . If the patient doesn't take

magnesium

supplements, she will die. Hmm . . . Maybe we should give them thar

suppulments some " consideration. " What do you think, Jethro?

 

 

I realize that medical professionals are busy and abstracts contain

up

to 250 words, but just the TITLE of this article should have given

the

doctors and the highly paid specialist a clue: " Potassium/magnesium

depletion in patients with cardiovascular disease " explains how 43%

of

heart patients are at risk of dying (sudden death) from magnesium

deficiency:

 

" below normal muscle magnesium levels have been found in 43 percent

of

congestive heart failure patients receiving diuretics. Magnesium is

important for maintenance of cell potassium . . . an increased risk

of

sudden death demands that potassium and magnesium deficiencies be

treated promptly and that repletion of both electrolytes be

considered "

(21). [emphasis added]

 

They said " demands. " Right on! Oops, just as I was about to say that

it's nice to see scientists with the guts to say it straight, they

wimp

out and use the word " considered. " Hey guys, get real -- it's death

or

magnesium. What's to consider?

 

 

" Introduction: magnesium -- coming of age " discusses how the

patients

serum magnesium level can be misleading. Do the research scientists

have

to hit doctors over the head with sledgehammers? Every heart patient

with sound kidneys should be taking magnesium supplements:

 

" Clinical and research evidence continues to accumulate that

magnesium

deficiency likewise contributes to triggering ventricular ectopic

activity and sudden cardiac death ... magnesium depletion can

coexist

with a low-normal to normal serum magnesium level ... The most

frequent

causes of magnesium depletion in cardiovascular medicine are

diuretic

drugs " (22-NA).

 

So, obviously, I gave my mother magnesium supplements and (SURPRISE,

SURPRISE) her potassium level went up and the problem was solved.

This

has over a decade of documentation in the medical literature. Why is

magnesium STILL underutilized? If I were not self-educated, my

mother

probably would not have survived. In addition to fixing her

potassium

problem, the magnesium supplements also made my mother feel better --

 

which is not too surprising since magnesium also improves left

ventricular function and exercise tolerance (28).

 

Fortunately, this experience changed her attitude about pill taking

and

supplements and she asked me what else she should take. I showed her

TWO

DECADES of research in medical journals about supplements that are

extremely safe and effective for her heart problems. Based on the

medical literature, in addition to her prescription drugs, she began

taking Coenzyme Q10, Carnitine, Taurine, etc. (I will discuss these

supplements in a separate post.) Before this she was in the

emergency

room several times a year.

 

Since the addition of the supplements more than FIVE YEARS AGO, she

has

never had to go to the emergency room.

 

 

 

The Turf War

Despite this irrational reluctance to tell people to take

supplements,

the medical industry routinely prescribes drugs that increase

magnesium

and potassium levels. For example, AFTER you develop deficiency-

related

heart problems, they are likely to prescribe drugs like Captopril,

which

increases intracellular magnesium and potassium (29). It is well

known

that ACE inhibitors " have an important magnesium conserving action "

(31). In fact, the improvement in insulin sensitivity caused by ACE

inhibitor drugs is related to their ability to increase magnesium

levels

and improve the calcium/magnesium ratio (32). Magnesium supplements

have

been recommended as an adjunct to prescription calcium channel

blockers

in treating hypertensive patients (30).

 

However, from what I have seen with my mother, all this research

doesn't

seem to have much effect on what doctors tell their patients. This

is

ridiculous! My mother has congestive heart failure and NOT ONE

DOCTOR

HAS TOLD HER TO TAKE MAGNESIUM SUPPLEMENTS despite the fact that

research shows that " patients with a low serum magnesium

concentration

had a significantly worse prognosis during long-term follow-up (45%

versus 71% 1 year survival, p less than 0.05) " (33). This sort of

insanity is the reason why I study medicine. There really seems to

be no

alternative. It's funny, musicians are generally not very reliable,

but

it's not all that difficult to find a musician that can play ALL

styles

of music. Why are doctors not equally versatile?

 

This reluctance to use (or ignorance of) alternative medicine is

most

baffling. I keep hearing people say that the situation is improving,

but

I don't see it. My mother has seen quite a few doctors, but they

routinely neglect to tell her that she should take magnesium,

coenzyme

Q10, carnitine, taurine, etc. Since I simply cannot understand this

situation, the best that I can do is post referenced information and

make it easy for people to get copies of the medical studies.

Hopefully,

if enough people go to their doctors waving a bunch of medical

studies,

things will HAVE to change.

 

Written

Aug 2000

Last Update

Aug 2000

Why didn't you tell me about magnesium,

coenzyme Q10, carnitine, and taurine?

 

 

 

 

There is a ton of research showing that these nutrients are safe and

that they can improve the QUALITY and the LENGTH of life of people

with

heart failure. There is no rational medical reason why so many

doctors

do not tell their patients about them. I would really like to hear

from

medical students and doctors who think they have some insight into

this.

Send me an e-mail.

 

There seems to be an irrational opposition to acknowledging the fact

that the scientific data shows that -- no matter how good your diet

is

-- you cannot achieve optimum nutrition (i.e., optimum disease

prevention/treatment) without taking supplements. One of the most

knowledgeable people in alternative medicine, Brian Leibovitz, has

written about this situation:

 

" I have observed an incredible resistance to the " Journal of Optimal

Nutrition " (JON) at the very top of the academic community. Both the

" American Journal of Clinical Nutrition " and the " Journal of

Nutrition "

refused to run my " calls for papers " notice . . . several members of

JON's Editorial Board have related instances where they have been

warned

NOT to publish positive results on supplemental nutrients, for by

doing

so their careers would suffer. The fear of having ones career ruined

is,

in my estimation, one of the methods whereby the system has survived

for

so many years . . . I believe that as nutritionists we can no longer

hide behind the veil of academia; we must stand up for what we know

to

be the truth. " (24-BK).

 

 

 

Safety & Bioavailability

Although the focus of this post has been on magnesium, I want to

take a

moment to discuss potassium.

 

I often read posts on the newsgroups from people who are worried

about

getting too much potassium -- probably because the FDA restricts the

amount of potassium in supplements.

 

The fact of the matter is that most people do not get enough

potassium

-- in fact, one study showed that " A 10-mmol increase in daily

potassium

intake (approximately one serving of fresh fruit or vegetables) was

associated with a 40 percent reduction in risk [of stroke] " (23).

 

Lets put this in perspective: one medium sized banana contains 451

mg of

potassium, yet the FDA limits potassium supplements to 99 mg.

 

How many strokes could be prevented if multivitamins contained 500

mg of potassium?

 

Interestingly, anyone can go to a grocery store and buy salt

substitutes and " low salt " foods that can easily add several GRAMS of

potassium to ones daily intake. People who take certain medications, or

have

kidney problems or other conditions, should not use these products without

consulting their doctors. However, for most people, this is a good

way to consume adequate potassium.

 

Serum magnesium balance is controlled by urinary magnesium

excretion. In

the case of deficiency, the body tries to retain magnesium; if you

consume too much magnesium, the excess is excreted in the urine.

 

If your kidneys are functioning properly, there is little danger in

any

rational supplementation program. Personally, I think the research

strongly suggests that supplements should contain approximately a

1:1 ratio (equal amounts) of calcium and magnesium, instead of the

common 2:1 ratio.

 

A reasonable dose for most people is 500-1,000 mg of magnesium a

day.

People with heart conditions or hypertension (who are working with a

doctor) might take up to 2,000 mg a day.

 

Written

Aug 2000

Last Update

Aug 2000

 

Most multivitamins contain magnesium oxide, which is not well

absorbed. The supplement manufacturers use magnesium oxide because they can

list big numbers (see the green box) without telling people to take a lot

of pills.

 

People want big numbers and very few pills to take. Well . . . they

get

it, but they aren't told that they will absorb VERY little of the

elemental magnesium in magnesium oxide. If you really want to

improve your magnesium status, you need a form of magnesium that is highly

bioavailable (e.g., aspartate, malate, citrate) For example,

magnesium oxide is only one-tenth as bioavailable as magnesium aspartate (9-

BK).

 

Magnesium oxide contains 60.3 % elemental magnesium. Thus, if a

supplement maker puts 500 mg of magnesium oxide in a product, the

labels will read:

 

Magnesium . . . 301 mg (from magnesium oxide).

Magnesium citrate contains 16.2% elemental magnesium. Thus, if a

supplement maker puts 500 mg of magnesium citrate in a product, the

labels will read:

 

Magnesium . . . 81 mg (from magnesium citrate).

 

 

Many people think that a good diet and one multivitamin pill a day

is all they need. However, when you look at what is actually

assimilated, you can see that it is not even possible to fit sufficient

magnesium in a single pill.

 

That should tell you something about the quality of most

multivitamins.

However, we cannot lay all the blame on the supplement companies:

how many people would buy a multivitamin that said " take ten capsules

with each meal " on the label?

 

Unfortunately, no matter how good ones diet is, optimum nutrition

involves taking a LOT of pills. There's just no way around it. Durk

Pearson and Sandy Shaw were candid about this reality:

 

" Get your vitamins and minerals from a bottle, rather than relying

on diet. It is difficult to get large amounts of vitamins in even the

best of unsupplemented diets. For example, you are unlikely to be getting

as much as 25 I.U. of vitamin E from your diet, even if you are devoted

to unprocessed whole-grain foods " (34-BK).

 

It is comforting to think that mother nature wants to provide us

with everything we need to live long and healthy lives. However, a huge

amount of scientific evidence documents the fact that optimum

disease prevention requires MANY TIMES the level of nutrients found in

food -

-even if it were grown under ideal conditions.

 

The Darwinian view is probably closer to reality: we are designed to

reproduce and die. Modern man lives longer because of improved

sanitation and medicine, but our health gives out because the

nutrient content of food is not designed for much more than the fulfillment

of our purpose -- to reproduce and die.

 

Personally, I have other plans. Taking a lot of pills costs money,

but it's cheaper than a heart attack or a stroke. Taking a lot of pills

is a hassle, but it's one hell of a lot safer than playing the magnesium

lottery.

 

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