High Dose Magnesium: The truths

Magnesium is known as a mineral that is normally present in the human body. Although it is in fact a type of soft, very chemically reactive metal. It has a variety of physiological roles and properties that are often necessary for life.

• Magnesium can contribute to nervous system function and regulation.
   
• It is a co-factor, or important component, of many enzymatic reactions which drive and regulate many types of processes in digestive, vascular, endocrine and other biological systems.
   
• Magnesium is also necessary for red blood cell and kidney function. A reduced intake of this mineral through diet may be associated with a wide range of symptoms, and may increase the risk of some conditions such as renal disorders.
   
• Magnesium deficiency may also be associated with inflammation, a contributing factor in many chronic diseases and disorders, including arthritis, diabetes, neuropathy, Crohn's disease and ulcerative colitis. It is also associated with the increased expression of C-reactive protein, a risk factor in cardiovascular disorders such as heart failure and atherosclerosis.

Intravenous or high dose magnesium supplementation has been associated with an expansive and diverse range of therapeutic and disease-reversing applications. These include:

Treatment for Asthma Attack 

Intravenous magnesium compounds are a standard of care for severe (i.e. near-fatal) attacks of asthma, particularly in paediatric patients. A trial in which 31 patients aged 6 to 18 experiencing severe attacks were randomised to intravenous magnesium (25mg/kg, equivalent to a maximum of 2000mg per patient) or a placebo for 20 minutes found that short-term lung volume and function were significantly improved in the magnesium group, in comparison to the placebo group.

Treatment of Chemotherapy-Induced Kidney Damage

Nephrotoxicity, or severe toxic damage to kidney tissue, is associated with the use of cisplatin, a chemotherapy agent used in the treatment of many types of cancer. This damage often results in the impairment of the organ's ability to re-absorb magnesium, which may lead to other symptoms including possible further kidney damage. In a review of 401 patients to whom cisplatin was prescribed, 127 developed this renal toxicity. However, intravenous magnesium administration was significantly associated with a reduced risk of kidney damage. It was also associated with the significant reduction of toxicity if present.

Erythromelalgia Treatment

Erythromelalgia, also known as acromelalgia or Mitchell's disease, is a condition affecting small blood vessels and sensory nerve fibres. These are usually located in the legs or hands. This disorder is characterised by inflammation, swelling, redness and often chronic burning pain in the affected areas. It is associated with dysfunctional neural impulses, which may be regulated by magnesium. In 2002, a physician released communications claiming that his debilitating erythromelalgia had been treated to remission by self-medicating with a course of intravenous high-dose magnesium (equivalent to over 1000mg per day). He set out to replicate his findings by administering oral high dose magnesium tablets to twelve other patients (with their consent) in an informal study. Eight of these patients responded to this, with one also achieving remission, two showing major improvement, two exhibiting moderate improvement and two others minor improvement. However, two patients experienced the adverse effect of diarrhoea and one patient exhibited a worsening of symptoms. This procedure to treat erythromelalgia has been submitted as a patent application by the same physician.

Prevention of Pre-term Labour

Premature labour (the early onset of childbirth) is associated with reduced newborn size, infant mortality and morbidity. Intravenous magnesium sulphate may be used as a tocolytic, or drug that inhibits premature labour. A trial comparing this to two other drugs, indomethacin and nifedipine, allocated these randomly to 301 women experiencing premature labour. All three drugs were equally effective, although high dose magnesium treatment resulted in significantly less side-effects and risks to the foetus.

An analysis of four trials including over 400 patients indicated that prophylaxis against pre-term labour through magnesium supplementation was not significantly associated with severe adverse effects compared to placebo or other tocolytics.

There was an association with the increased risk of diarrhoea.
 

Tetanus Treatment

Tetanus is a disease (caused by bacterial infection) still prevalent worldwide, particularly in developing countries. In severe cases, it results in neuromuscular symptoms such as uncontrollable spasms, which may require intervention to prevent respiratory failure. Some case reports and observational studies indicate that infusions of magnesium may reverse these adverse effects. However, further analysis of clinical trials on this treatment indicates the results are inconsistent, but show no significant improvement on survival or hospital stay duration.

Magnesium Supplementation

Regular high dose magnesium supplementation health benefits:

As can be seen above, magnesium supplementation may treat or reduce the risk of many medical conditions, and is often beneficial in a healthcare setting. However, it is less clear if more general, everyday magnesium supplementation may be associated with equally positive results. There are some situations in which daily magnesium may be warranted; for example, an analysis of data from over 2000 participants taking daily supplements of magnesium (in addition to vitamins A, C and E) was associated with the reduced risk of hearing loss, in comparison to controls on a placebo or with a low intake of these substances.

On the other hand, high doses of magnesium taken by a healthy individual may disrupt the many cellular and metabolic processes that depend on a delicate balance and/or specific concentrations of this mineral. Therefore, increased magnesium intake may be associated with adverse effects, most notably diarrhoea and hypotension (a dangerous drop in blood pressure).

Supplementary magnesium may offer benefits to other common conditions in theory, but has been associated with minimal effect in practice. For example, magnesium plays a role in the regulation of insulin signalling and glucose metabolism; therefore, it is possible that conditions such as insulin resistance (the precursor of type 2 diabetes) may be addressed through supplementation. S

everal studies have also observed an association between low dietary magnesium and obesity. A 2-week trial of 72 obese women (at a high risk of insulin resistance and cardiovascular disease) randomised to 400mg magnesium a day or a placebo found that physiological markers of glucose metabolism or cardiovascular risk were not significantly different between these groups. However, blood and cellular magnesium levels in the treatment group were not significantly increased at the end of the trial. This indicates that obesity may have a component of extremely impaired magnesium absorption and/or cellular intake, or that much higher doses are required to elicit an appreciable effect in this condition.

References

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Kidera Y, Kawakami H, Sakiyama T, et al. Risk factors for cisplatin-induced nephrotoxicity and potential of magnesium supplementation for renal protection. PLoS One. 2014;9(7):e101902. Accessed 2014.

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Wangmo KP, Teng M, Henker R, Kinnear S, Tshering J, Wang NE. Survival of a patient with tetanus in Bhutan using a magnesium infusion managed only by clinical signs. Wilderness Environ Med.2014;25(2):194-197.

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