Magnesium & Me - Naturopathic NotesRNA polymerases that create RNA based on the original DNA...

ND NOTES A Practical Resource for Naturopathic & Integrative Practice

Fall 2017 | Vol. 3 No. 2

What is magnesium’s fundamental role? P3 Magnesium absorption: what you need to know P7Anxiety, depression & magnesium’s role P15

In this issue

Mg Mg

Mg

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Magnesium & Me

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ND Notes | Vol. 3 No. 2

ND Notes

Fall 2017 | Vol. 3 No. 2

Editor Norman Goh

Copy Editor Heidi Hoff

Contributors Nadia Lamanna, ND Jenna Mangan CNP

Art Direction & Design Tina Amouzgar

Dorvan Davoudi

General Manager Norman Goh

Published by CanPrev & Orange Naturals

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ISSN 2368-7908

Message from the editor

We debated whether to release an entire edition of ND Notes featuring a single micronutrient. However, of all the micronutrients, magnesium and its versatile role in human nutrition and medicine, certainly warrants such discussion.

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, comprehending the broad scope of magnesium’s role as it pertains to the human body can be hard to wrap their minds around. Conversely, the scope of health issues a magnesium deficiency can wreak is large, long-lasting, and also difficult to wrap the mind around.

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 magnesium status as part of your regular differential diagnoses for certain ailments, as well as instigating more holistic thinking when it comes to supplementation of magnesium.

Yours naturally,Norman GohEditor

Q & A

Is there such a thing as a “best” form of magnesium to take?

You would think so, but there actually isn’t.

Like other areas of alternative medicine, choosing the ideal form for your clients to take will depend on their particular circumstances, needs and biological individuality. Magnesium is a supplement, not a drug. While your patients might take an antacid to reduce heartburn or an antibiotic to fight infection, taking magnesium when they are deficient doesn’t

Magnesium citrateMagnesium glycinate

Magnesium malate

have just one effect. Since magnesium works on such a fundamental level, the health benefits are hard to isolate. And because we can’t identify just one effect, it’s easy to overlook its importance.

Just as the body utilises sugars, proteins and fats to stay healthy, vital organs like the heart and brain use all forms of magnesium for the same reason. Hundreds of the body’s chemical processes fall apart without this very important mineral. So when you tell your clients that their bodies need magnesium in order to stay alive, you’re not exaggerating!

Magnesium oxide

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Do all types of magnesium provide a laxative effect?

No, not at all.

It all depends on the type of magnesium you supplement with and if it needs to be broken down into its ionic form in the body before it can be absorbed. A high concentration of mineral ions in the gut

Magnesium citrate

Magnesium oxide

Magnesium glycinate

Magnesium malate

increases the osmotic pressure that causes water to be drawn into the intestine to dilute the ions and lower their concentration. The increased flow of water into the gut is what creates the laxative effect and can lead to loose stools, bloating and diarrhea.

Magnesium chelates like magnesium glycinate do not need to be broken down into ionic form for absorption. The happy

couple (magnesium+glycinate) can easily cross the intestinal membrane as an intact pair through gates designed specifically for their passing called dipeptide channels. As a result, no magnesium ions are left behind to disrupt osmotic pressure, and therefore a laxative effect is avoided.

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!

Osmotic diarrhea

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 glycine and malate have higher absorptive properties that can travel happily to the small intestine where they are absorbed.


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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 enzymesWe are kept alive by trillions of chemical reactions that occur inside the body. Carbohydrates are broken up and harvested for energy. New tissue is created. Cellular waste products are removed. New strands of DNA are synthesized. This collection of chemical processes is called metabolism. The speed a reaction occurs will depend on factors like temperature, pressure, solubility and concentration of molecules. We use these factors every day. You might notice that sugar dissolves in hot water faster, or refrigerating food will slow the rate of decay. When you make a campfire, a hotter flame will burn wood faster.

Our metabolism needs to occur at a certain rate to keep us alive. But we don’t have the liberty of turning the body into a raging

furnace to speed up these reactions, not without causing a lot of damage anyway. That’s where enzymes come in.

Enzymes are bits of protein that catalyze and regulate almost all metabolic reactions. As catalysts, they reduce the energy needed to spark a chemical reaction and speed up reactions. Without enzymes, reactions that would normally take milliseconds to occur might take hours or days. Some enzymes require additional ions or molecules called cofactors to function. Without a cofactor bound to its structure, an enzyme may float dormant and be unable to catalyze any reactions. Magnesium is a cofactor for several important enzymes in the body, like DNA/RNA polymerases used to transcribe new DNA/RNA strands, and guanylate cyclase, used to regulate the movement of minerals across cell membranes.

A 1968 estimate suggested that magnesium

was a required cofactor for 300 enzymatic reactions. This figure is found in many medical texts and quoted in many scientific papers. Since then, many more enzymes that rely on magnesium have been identified. A search of today’s enzymatic databases reveals over 600 enzymes that magnesium is a cofactor for and another 200 enzymes that need magnesium to be activated.

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.

Without enzymes to catalyze reactions, hemoglobin synthesis would be 30 times slower with a half-life of 2.3 billion years. That's half the age of the earth!

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2. Magnesium creates cellular energyArguably the most important enzymes that magnesium is a cofactor for are the ones that produce cellular energy. These enzymes form a series of pathways (glycolysis, Kreb’s cycle, phosphorylation) that convert organic compounds like glucose sugars into smaller molecules called adenosine triphosphate (ATP). ATP acts as our main unit of cellular energy.

Every one of our hundred trillion cells manufactures ATP to store and shuttle intracellular energy. ATP stores a tremendous amount of potential energy in the bonds of the second and third phosphate groups. When the cell wants to carry out a function like cellular division or transport molecules across the cell membrane, it breaks this bond and releases the energy.

We use a tremendous amount of ATP all the time. The typical adult only stores about 50g of ATP in the body so each ATP molecule is recycled over a thousand times a day.

Since cellular pathways are magnesium dependent, we need quite a bit of magnesium on hand to fuel a continuous production of ATP.

3. Magnesium helps to create, repair and protect DNA and proteins

Making proteinsWhen a protein needs to be created, specific DNA nucleotide sequences are read and copied (transcribed) onto another molecule called RNA. The RNA strand is then moved out of the nucleus where enzyme-like organelles called ribosomes use it as a guide to synthesize chains of amino acids that form the desired protein.

This protein synthesis relies on all sorts of enzymes to work, from helicases that open up the DNA strand to be read, to RNA polymerases that create RNA based on the original DNA sequence, to protein kinases. Magnesium is a cofactor for most of these critical enzymes. The ribosome, while not technically an enzyme, is the most important catalyst for stitching together amino acids into proteins. Lots of magnesium is needed to keep this complex riboprotein stable.

Without enough magnesium, protein

synthesis is impaired. And since protein is used for most of the structural components and nearly all metabolic functions in the body, a lack of proteins can have widespread consequences.

Creating DNAWe mentioned earlier that magnesium is an essential cofactor for an enzyme called DNA polymerase which repairs and replicates strands of DNA using spare nucleotides floating around in the nucleus.

DNA polymerase is used all the time in DNA repair and DNA copying, creating new strands at a speedy rate of 3,000 nucleotides per minute. Consider the magnitude of the role this enzyme plays. Hundreds of billions of cell divisions occur in the body daily, and each time a cell divides, it needs to replicate an identical set of DNA, or approximately 3 billion base pairs.

DNA polymerase has two binding sites for magnesium. Without magnesium, it cannot work. This is corroborated by studies that show DNA synthesis visibly slowing in the absence of enough magnesium.

Enzyme pathways

Mg2+

Phosphorylation (breaking down)

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

Krebs cycle

Glycolysis

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Repairing DNADNA polymerase is a very accurate enzyme, making less than one mistake in a billion base pairs. But even if DNA is copied perfectly, mistakes in the DNA sequences do happen. Genetic damage can occur because of thermal changes, radiation, viruses or the presence of highly reactive chemicals. A lot can go wrong when you’re maintaining 3 billion base pairs! If left unchecked, these mutations will be propagated with every cell division.

There is a whole other set of processes dedicated to identifying and correcting damaged DNA. The involved enzymes cut away the damaged sections and repair the gap with fresh nucleotides. Unsurprisingly, magnesium is involved in almost every enzyme in this process.

Protecting nucleotide bindings and proteinsMagnesium also has a stability effect on the structures of proteins and DNA. Each strand in a DNA double-helix is negatively 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 higher temperatures or extreme pH, these hydrogen bonds can break. Magnesium ions have a strong positive charge. Concentrated in the nucleus of cells, these ions can help reduce the negative charges in the DNA strands, stabilizing

DNA

RNA

Protein

Transcription

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mRNA

their structure.

This effect has been tested experimentally, showing that a higher concentration of magnesium will measurably raise the melting temperature of DNA molecules. Many proteins and protein complexes incorporate magnesium into their structures. In fact, there are about 3751 human proteins with magnesium binding sites to date.

4. Magnesium in the cell membrane regulates concentrations of other mineralsSome of those 3751 proteins dot the surface of our cell membranes and perform a variety of roles, like receiving signals from hormones (signal transduction), enzymatic activity and transporting things across the membrane. In particular, magnesium-dependent proteins are used to facilitate the transport of different minerals into and out of cells, acting as gates for sodium (Na+), potassium (K+), and calcium (Ca+).

Many of these are active transporters, for instance pumping sodium out of cells even though it’s against the concentration gradient.

Imagine a flooding basement. Water naturally flows downhill, so you'll need a pump to move the water out of the basement, against the flow of gravity.

Magnesium-powered ion pumps shunt sodium, against its concentration gradient, out of the cell to maintain normal concentrations of sodium and potassium in and out of the cell. Just like the water pump in your basement, the ion pumps in your body are necessary to restore homeostasis and balance.

Sodium and potassium conduct nerve signalsSodium and potassium gradients are key to how nerve cells transmit electrical signals. When a cell receives a stimulus, the cell opens gates that allow sodium ions to rush in cells and potassium ions to rush out. This action in one part of the cell membrane will cause nearby parts of the cell membrane to act as well, creating a travelling wave of depolarization. This wave is called the nerve impulse.

Without enough magnesium, the active transporters are unable to restore the original concentrations of sodium and potassium in the cell. This, along with a few other functions magnesium plays, can lead to an overactive nervous system which is more sensitive to random stimuli. In real life, that might translate to increased sensitivity to noise, irritability, migraines, twitching, irregular heartbeats and anxiety.

If left unchecked, a magnesium deficiency can also lead to a potassium deficiency, since potassium is released into the bloodstream and flushed out in urine.

Pump

Na+

Na+

Na+

Na+

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Magnesium regulates calcium in cellsCalcium is used in cells as a cofactor for a variety of energetic functions including nerve impulses (like sodium and potassium), cell movement, and most notably muscle contractions. Because calcium is typically an excitatory cofactor, the mineral usually enters a cell only when

needed for something specific like a nervous impulse or a muscle contraction. After such an action occurs, magnesium helps active transporters pump calcium out of a cell.

As with sodium and potassium pumps, insufficient magnesium may prevent calcium pumps from working. Unable to flush out calcium, the cell may become overstimulated, damage the cells and

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 your muscle cells are not able to restore calcium balance. Try taking magnesium and seeing what happens. Muscle contraction is the classic example of how magnesium and calcium balance each other in the body and is the most easily observable.

And it’s not just contractions in your biceps. Magnesium to regulate calcium will affect the strength of heart and arterial contractions too.

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.

Mechanism: magnesium, headaches & migraines

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!

A magnesium absorption primerYou likely know that magnesium supplements don’t contain just pure magnesium. Magnesium ions (Mg2+) are highly reactive and unstable on their own. They are positively charged ions and like to form compounds with other substances. When they bind with negatively charged molecules (anions) they form salts. When they bind specifically with amino acids, we call them amino acid complexes.

The way our bodies absorb salts and complexes differs slightly. Here’s a quick review.

Absorbing magnesium saltsBefore magnesium from salts can be absorbed, they must first be dissolved back into ionic forms. Strong stomach acids break apart the bonds that hold magnesium to other molecules. In this soluble, fluid state, the free magnesium ions travel to the duodenum where they are absorbed through small mineral ion channels found along your intestinal wall.

Pretty straightforward stuff, but magnesium ions can encounter a few challenges along the way. The ion channels are small and can only transport magnesium ions when they are unattached to other molecules. That’s not a problem when it comes to the gastric acid that lives in your stomach - acidic environments are good at breaking the bonds between magnesium and other molecules. But the further you travel from the stomach, the less acidic the environment becomes. The less acidic the environment, the harder it is for magnesium ions to remain soluble. So what happens when pH levels rise? Magnesium ions start to bind with other nearby substances, usually forming insoluble compounds. These insoluble compounds precipitate out of the liquid and pass through your body as waste. This process is much like how calcium

deposits sometimes clog your showerhead. Calcium binds with carbonate, forming an insoluble complex that prevents the flow (or absorption) of calcium through the shower head.

The shell of waterHere’s another challenge. Even if a magnesium ion remains dissolved, its positive electrical charge will attract water molecules. A shell of water, or hydration shell, will start to form around the magnesium ion and increase its size. The hydrated radius grows about 400 times in size compared to the radius of a bare magnesium atom.

A sizeable challenge when it comes to absorption, but not insurmountable. The proteins that make up the ion channels are capable of removing enough water for the magnesium ion to pass through. But take note, these proteins need a certain acidic pH to function properly.

Low pH is neededMagnesium salts are a good source of magnesium, provided you can keep your pH low enough.

Absorbing amino acid complexesMagnesium amino acid complexes, or chelates, behave differently from magnesium salts. The strong and stable bonds between magnesium and amino acids keep the whole molecule intact in acidic environments.

When complexes travel through the intestinal tract, they bypass the ion channels and detour through other transport sites called dipeptide channels. From there, amino acids and magnesium are carried across the intestinal membrane together.

There are a couple of key advantages to this. First, there are far more dipeptide channels than ion channels in the gut. Magnesium complexes do not compete for the same ion channels used by other minerals. A second advantage is that the stable bonds protect magnesium from unfavourable chemical reactions that might lead to the creation of unabsorbable precipitates.

Mineral amino acid complexes are common in certain foods and are a natural way to get magnesium through our diet. Some of this magnesium is already bound to amino acids, but even when we consume

MgCitrate

MgGly chelate

MMMgGlyb ered

Mg Malate

MgOxide

MgCitrate

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magnesium from salts, amino acids can help. Peptides and amino acids can bind to magnesium ions and form complexes right in your body.

Experiments in magnesium absorption

As you may already know, studying the bioavailability of magnesium is a complicated subject. Unlike pharmaceutical drugs that can be detected chemically in the body, magnesium is found everywhere in the body in high concentrations. Direct measurement is also complicated.

You have probably discussed the complications and obstacles around testing for magnesium levels with your patients. Our blood contains less than one percent of our total magnesium levels, is tightly regulated, and changes by up to six percent depending on the time of day. Even if you test for magnesium in blood serum, you still end up unsure of how a patient’s magnesium levels in their blood

relate to magnesium levels in their bones and soft tissues.

All these things make it difficult to clinically determine how much magnesium is retained by the body through measuring blood or urine.

However, we can investigate how well different magnesium types are absorbed through the intestinal walls.

Many pharmaceutical scientists study drug absorption by cultivating intestinal cells into a thin membrane layer that has all the features of a real intestinal wall, including various nutrient transport channels and a brush border. This layer of cells is placed into special plates called transwells. From these, scientists can measure how much of an agent permeates through this semi permeable layer to the other side.

Transwells have two compartments separated by a thin membrane of cultivated intestinal cells. Researchers place different magnesium solutions into the inner compartment and measure how much magnesium passes through the membrane

into the outer compartment.

Scientists studying magnesium absorption have also used this method to predict how well different kinds of magnesium can pass through our intestinal lining. First, different kinds of magnesium are added to a solution that mimics the pH of the digestive tract. They are placed into the upper compartment of these plates. Some of the magnesium will transport through this membrane layer into the bottom compartment. The bottom compartments are then measured for magnesium levels using a mass spectrometer.

These are fast and repeatable experiments that help us build a model for understanding how magnesium is absorbed in the body.

So what are the results? A 2016 study using the above methodology resulted in the following.

The chelated magnesium bis-glycinate and buffered magnesium bis-glycinate were much better absorbed than other forms like magnesium citrate and magnesium oxide on their own.

Ion channels where minerals are absorbed

Anions that magnesium might bind with. e.g. Phosphorus,

pH rising

Mg+

Gly

You absorb proteins and amino

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

by pH. The strong bonds keep these complexes together and prevent them from binding with anions

As pH rises magnesium ions form

through the ion channel.

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

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Why does a magnesium deficiency exist?

It’s missing in our dietsOur diets are providing less magnesium than they used to. The composition of what we eat and the quality of our foods has drastically changed over the past hundred years, and this has made it difficult for even the most health-conscious Canadians to get enough magnesium. The Canadian Community Health Survey, conducted in 2004, showed over 34% of Canadians consumed less than the estimated average requirement of magnesium. And those estimated average requirements are quite modest; around 350 mg/day for adults. Recent estimates show that before industrialization, dietary intakes were closer to 475-500 mg/day!

Magnesium depleted soilsFoods like legumes, grains and greens that were once hailed for their magnesium content no longer contain the same levels. Modern farming practices, meant to increase yields and resist pests, have left overworked farmlands depleted of essential nutrients like magnesium. Soil compaction, surface irrigation, monoculture, pesticides and chemical fertilizers have all impacted the soil’s ability to restore, retain and provide magnesium to crops. And while farmers are growing

food in greater densities than ever before, they are drawing from the same dwindling supply of magnesium.

The end result? We’re overfed and undernourished. Many fruits and vegetables have lost large amounts of minerals and nutrients in the past 50 years.

For example, the intensive plowing eliminates protective ground cover causing high rates of erosion. Magnesium is lost in the run-off. Instead of traditional fertilizers made of manure and compost, today’s fertilizers are synthetic. They are rich in nitrogen, potassium and phosphorus, but low on essential minerals like magnesium. Higher yields and more crops grown in the same area of land means fewer minerals from the soil go to each plant. This is known as the dilution effect.

McCance and Widdowson’s epic compilation, The Composition of Foods, has tracked the nutrient composition of foods since 1940. Between 1940 and 1991, there was an average magnesium decrease of 24% in vegetables and 16% in fruits. Some foods have seen more drastic declines than others. Carrots have lost 75% of their magnesium content. You would have to eat four carrots today to get the same magnesium in one carrot in 1940!

Food processing removes magnesiumFood processing and refining remove large swaths of magnesium. Whole grains, a staple in the modern diet, can lose over 80% of their magnesium content simply through milling. Seeds and nuts in their raw form are rich in magnesium, but the process of refining them into oils removes nearly all of their magnesium content. Even cooking vegetables can leach magnesium. The typical Canadian diet, laced with refined grains, oils and sugars, provides large amounts of calories with little to no magnesium.

Treated water In some parts of the world, magnesium in drinking water accounts for 50% of the recommended dietary intake. Treating and softening tap water removes minerals like magnesium before you pour yourself a single cup!

Hard to Absorb Regardless of how much you consume, you will not get enough magnesium without good absorption. Foods containing magnesium need to be broken down by enzymes and acids in our digestive tract before they can be absorbed in the small

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intestine. A breakdown in the digestive process will seriously impede how much magnesium can be absorbed.

Weak stomach acid Magnesium needs to be soluble to be absorbed by the small intestine. The strong gastric acid in the stomach provides an environment that dissolves magnesium into this soluble form. If the environment is not acidic enough, magnesium will remain insoluble and will simply be flushed through the intestinal tract.

While age is the primary culprit for low stomach acid, chronic stress that is so common in modern life will also reduce

acid production. The stress response diverts energy away from tasks like digestion. Overuse of antacids to reduce common symptoms like heartburn is another contributor.

Gastrointestinal conditionsChronic functional disorders of the gastrointestinal system are becoming increasingly common. Inflammatory bowel diseases like Crohn’s and colitis result in inflammation in the intestine.

The inflammation destroys intestinal mucosal cells, which impede the

absorption of key nutrients like magnesium. Other conditions such as irritable bowel syndrome (IBS) and yeast overgrowth can have similar effects in inhibiting magnesium absorption or flushing it out (through diarrhea) before it can be absorbed.

Foods, drugs and other substances that block absorption Some foods not only lack magnesium but can also block its absorption. For example, the phosphoric acid in many popular sodas will impair absorption by forming

phosphates with magnesium ions in the digestive tract. These phosphates are insoluble and cannot be absorbed through the intestinal walls. Phytic acid, found in soybeans, the hulls of seeds or bran of grains can also form insoluble compounds. Oxalic acids in raw greens and tannins in teas do the same.

Other minerals such as calcium or iron are absorbed in the intestine the same way as magnesium. When you consume minerals together, they often compete for the same limited channels of absorption. This is the reason why practitioners recommend taking mineral supplements at different times.

Many drugs also bind to magnesium

ions, making them insoluble. Tetracycline antibiotics, corticosteroids and diuretics are just a few examples (see chart Drug-induced nutrient depletion on page 27).

Even tap water, if treated with fluorine, can inhibit magnesium absorption. Fluoride binds with magnesium to form an insoluble crystalline compound that the body can’t absorb.

Easy to lose Our magnesium requirements have increased.

We’ve established that magnesium is involved in many processes throughout 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 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.

This can lead to the flushing of excess 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 eliminate more magnesium than they should.

And here’s a good reason to hold off on that antacid. Low stomach acid can actually impair the absorption of nutrients, which leads to undigested food and a gassy terrain. The intra-abdominal pressure pushes the undigested food along with gastric acid up the esophagus, where it irritates the delicate lining.

Taking an antacid can provide temporary relief but it will decrease an already low amount of stomach acid making the issue worse, not to mention making it harder for us to breakdown magnesium!

1940 Today

Mg2+

Mg2+

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

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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” wordBeing 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 model Jill Bunny didn’t expect to hear it either. This Toronto native was one of the highest ranked IFBB bikini competitors in the world. To her peers, she was the picture of health physically and professionally. But Jill’s inner strength would soon be tested. Unusual symptoms Jill was experiencing told her that something wasn’t quite right. A double diagnosis of multiple sclerosis and thyroid cancer catapulted Jill into the competition of her life.

To many different degrees, we have all faced health challenges individually. This is the story of a top fitness competitor who fought the biggest battle of her life and came out with a new approach to finding her best health.

Jill’s StoryFunctional nutritionist, elite trainer, life coach and bikini model competitor, these are only a few titles Jill Bunny goes by. Jill has always been fascinated by what

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

other ways to challenge herself physically and mentally. She continued to train and mentor others through her company, Fit Bunnies Fitness, as she recovered from cancer. It was during this time that Jill found motivation to learn more about healing from the inside out. Through a team of functional medicine practitioners and her Naturopathic Doctor (ND) she found more preventative ways to manage her MS symptoms. Along the way, her own interest in how the body works expanded and she began to study functional medicine in her quest to find healing, and to make her body stronger than ever before.

Case StudyJill approached Dr. Nadia Lamanna ND, in April 2017 for a natural approach to managing her symptoms. Since having a thyroidectomy in November 2016, Jill struggled with fluctuating thyroid hormone

“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.”

levels, extreme fatigue and brain fog. The fatigue and muscle pain associated with MS was becoming a major obstacle in managing her business and training for an upcoming iron woman race. She chose not to take prescription medication, but instead managed the disease through diet, exercise and naturopathic medicine. Her chief concerns were low energy, neck pain and long recovery periods after work outs.

Dr. Lamanna ND, began treating Jill the next month with 200mg of CanPrev Magnesium Bis-Glycinate 200 Gentle before bed, one sachet of CanPrev ElectroMag to mix with water and to consume while training, two capsules of CanPrev Adrenal-Pro twice daily, one capsule of CanPrev Pro-Biotik 15B daily, and one capsule of CanPrev Thyroid-Pro twice daily. After two weeks the Magnesium Bis-Glycinate 200 Gentle was increased to 400 mg per day and ElectroMag to two pouches per day

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Notes from Dr. Lamanna NDAfter 16 weeks of therapy, Jill reported that her legs felt great and her energy levels were “night and day” compared to how she felt in January. “I feel like my old self again” she told Dr. Lamanna on the phone as they wrapped up treatment. On their last follow-up appointment, Jill rated her energy level as 8.5 out of 10 and said, “I hate to give a 10 because I always feel I can do better.” Jill’s perseverance, ambition and optimism are the most noteworthy of her journey back to better health.

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.

Mechanism: magnesium & osteoporosis

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.

because Jill added a cycle class to her evening fitness routine. Jill reported she was taking Synthroid 88 mcg per day when she first met with Dr. Lamanna, this was later increased to 100 mcg per day in early May as directed by her endocrinologist.

ResultsBaseline scores were reported on April 10 and after only a few weeks of therapy, Jill reported improved symptoms like reduced neck pain, improved ability to recover post workout and

a significant improvement in energy levels (see Figure 1). She reported having bursts of energy and diminished grogginess during the times of day that she typically felt her worst. Her TSH in April was 4.79 and dropped to 0.59 in June, after just seven weeks of therapy (see Figure 2). Jill’s endocrinologist was ecstatic with the results and asked what she had been doing differently. Her TSH levelled out at 1.15 in July. Jill was optimistic and motivated throughout the duration of the study and overjoyed about the progress she made along the way.

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.”


Condition Mechanism Dose

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

200-300 mg per day

Fibromyalgia

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

300-600 mg magnesium per day and 1200-2400 mg malic acid per day

Anxiety and Depression

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 of neurotransmitters, which plays an important role in the release of our “feel good” hormones. Magnesium also plays an important role as a nervous system tonic and gets depleted with adrenergic stimulation during acute stress.

450 mg per day

Muscle cramping and tension

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 are responsible for the role magnesium has as a muscle relaxant.

100 - 400 mg per day

Hypertension

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 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.

450 mg per day

Coronary Artery Disease

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 and nerve conduction. These actions play an important role in vascular contractility and tone. Magnesium enhances vasodilation of arteries and regulates vascular smooth muscle tone. A deficiency can result in vasospasm of the coronary arteries and cardiac arrhythmias.

450 mg per day

OsteoporosisMagnesium is a key component to calcium homeostasis. It is a cofactor required in the metabolism of Vitamin D and it also stimulates the hormone calcitonin which prevents osteoclast activity and bone break down.

400-800 mg per day

Asthma

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 cells and inhibits mast cell degranulation, thus exerting its effects as an excellent bronchodilating and anti-inflammatory agent.

250-300 mg per day

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.

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/30794184 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

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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.

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.

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

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-results1 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

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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 Major Depressive 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).

DSM-5 Criteria for Generalized Anxiety Disorder

Diagnosis

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) interfere with daily activities such as job performance, school work and relationships. The information your patient relays to you when you ask about any of these areas could be an indication that you

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 lithium, from single molecules to signaling networks. Frontiers in Molecular Neuroscience,5. doi:10.3389/fnmol.2012.000141 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

need to delve deeper. Mental illness is the leading cause of disability and accounts for approximately 30 percent of all short and long-term disability claims. In fact, it is reported to be one of the top three claims made by 80 percent of Canadian employers. Depression and anxiety can

be extremely debilitating, which is why it is so important to acknowledge their existence early on and address them swiftly and accordingly. Refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) in the charts below.

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ComorbidityAnxiety has a remarkably high comorbidity with depression, and vice versa. The reasons may in part be due to a strong genetic correlation, and possibly partially due to the strong overlap in diagnostic criteria. Similar neuropeptides and pathways are shared in the pathophysiology of these disorders and therefore they commonly occur together and can be thought of as the fraternal twins of mood disorders. According to the DSM-5, some GAD and MDD symptoms that overlap include difficulty sleeping, concentrating, being easily fatigued and exhibiting psychomotor agitation. It is important to make sure an anxiety diagnosis does not mask that of depression and vice versa, because the two often co-exist and the clinical implications can be severe. Increased risk of suicide, psychiatric hospitalization, disability and decreased compliance with treatment are all hazards of misdiagnosis.

Magnesium and the brainMagnesium plays an important role in a multitude of biochemical reactions in the body, including the brain. Neurological functions of magnesium include cellular energy production, regulating neurotransmitters such as serotonin, dopamine and gamma-Aminobutyric acid (GABA), regulating ion gradients, and neuronal excitability. Dysregulation of these systems plays an important role in the etiology of both depression and anxiety.

Mechanism of action

GABA receptorsMagnesium has been shown to modulate GABA activity in the brain. Magnesium ions can occupy GABA receptors acting as GABA receptor agonists to help facilitate GABA neurotransmission. GABA is an inhibitory neurotransmitter in the brain that plays a role in motor control, vision and anxiety.

GABA and magnesium bind to benzodiazepine receptors resulting in an anxiolytic effect. These are the same receptors that are targeted with anxiolytic prescription medications like Lorazepam (Ativan) or Diazepam (Valium).

NMDA (N-Methyl-D-aspartate )receptor inhibition + glutamateGlutamate is an excitatory neurotransmitter that plays an important role in the development of the brain and is a key player in neuroplasticity, learning, memory and locomotion. The amount of glutamate released in the brain is tightly regulated by the central nervous system. When this equilibrium is disrupted through some form of trauma, glutamate concentrations in the brain can increase. Contrary to its primitive function, in excess, this neuropeptide is toxic and destructive in the brain, leading to neurotoxicity and cell death. Increased

levels are found in the brains of patients suffering from MDD, which may play a role in its pathophysiology.

Magnesium is a very potent inhibitor of NMDA receptors, which are a subtype of glutamate receptors. Magnesium is a natural antagonist to calcium and exerts its inhibitory effect in the nervous system by blocking the flow of calcium through the voltage-dependent NMDA receptors, preventing an excitatory response in the brain.

A magnesium deficiency coupled with high levels of calcium and glutamate is a recipe for disaster in the brain. This combination can depolarize neuronal membranes and lead to altered synaptic function and the development of anxiety and depression. The NMDA/glutamate pathway is one way magnesium exerts its anxiolytic and antidepressant effects in the brain.

MonoaminesMagnesium exhibits anti-depressive effects through its interaction with serotonin,

Up to 80% of the brain uses GABA and glutamate for inhibitory and excitatory responses, respectively.

80%GABA

GABA

GABA

GABAGABA

noradrenaline and dopamine receptors. The mechanism of how this works is not fully understood, but several studies indicate that a relationship does exist. This pharmacokinetic relationship has been illustrated in studies that show an increase in erythrocyte magnesium concentration with the administration of psychotropic drugs such as antidepressants and antipsychotics.

Furthermore, magnesium supplementation has been shown to enhance the activity of antidepressants, demonstrating a synergistic action with these drugs. This last point is important to consider when supplementing magnesium with a patient who is also taking an antidepressant drug such as a norepinephrine and dopamine reuptake inhibitor (NDRI) like Wellbutrin, a serotonin and norepinephrine reuptake inhibitor (SNRI) such as Pristiq, Cymbalta or Effexor; or a selective serotonin reuptake inhibitor (SSRI) such as Celexa, Prozac or Zoloft.

HPA AxisChronic stress leads to excess cortisol levels which can negatively affect other neuropeptides like serotonin and be a contributing factor to anxiety and depression. Magnesium has been shown to play a positive role in the stress response through its influence in the limbic-hypothalamic-pituitary-adrenocortical axis. Magnesium can reduce the release of adrenocorticotropic hormone (ACTH) and affect adrenocortical sensitivity to ACTH, which helps to modulate the amount of circulating cortisol in the body. High cortisol levels can also deplete magnesium levels, which further supports the benefits of supplementation.

Choosing the best magnesium for anxiety and depressionSeveral forms of magnesium exist so it is important to recognize the therapeutic applications of each. Magnesium bis-glycinate is an excellent choice for treating anxiety and depression for the following reasons:

• it is the optimal form for correcting a deficiency due to its superior bioavailability to other forms

• glycine enhances its anxiolytic properties

• it is the optimal form to achieve therapeutic doses without a laxation effect (minimum 450 mg per day for depression and 300mg per day or anxiety)

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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. Taurine, 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!

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=http%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:10.1177/20406223155790591 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):112-91 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 Anxiety,29(12), 1065-1071. doi:10.1002/da.22026

GABASerotonin receptor

GABA receptor

Dopamine receptor

NMDA receptor

GABA

Glutamate


DDX Signs/Symptoms Tests & Diagnosis

Malnutrition fatigue, dizziness, weight loss, caloric restricted diet, history of an eating disorder

CBC, RBC magnesium, potassium, calcium, albumin, lipids, ferritin, leptin, total protein, vitamins A, D, B12

Dietary consumes a diet low in magnesium RBC magnesium

Drug-Induceduse of diuretics, PPI’s, digitalis, cyclosporine, cisplatin, cetuximab, aminoglycosides, gentamicin, tobramycin and insulin

discontinue medication to find out if this resolves hypomagnesaemia

Alcohol abuseincreased superficial cutaneous veins, peripheral neuropathy, fatty liver, ascites, jaundice, depression, anxiety, restlessness, violent behaviour

AST, ALT, GGT, RBC magnesium, case history, DSM-5 criteria

Laxative abuseabdominal distention and tenderness, hypotension, decreased skin turgor, dry mucous membranes

RBC magnesium, potassium

Crohn’s Diseaseabdominal pain and cramping, diarrhea, fever, fatigue, bloody stool, mouth sores, reduced appetite, weight loss, perianal disease, inflammation of skin, eyes and joints

CBC, WBC, ESR, RBC magnesium, potassium, colonoscopy, endoscopy, CT scan or MRI, stool for occult blood, faecal leukocytes

Gastroenteritiswatery diarrhea, abdominal pain and cramping, nausea, vomiting, muscle ache, headache, low grade fever

CBC, WBC, RBC magnesium, potassium, physical exam, rapid stool test, stool culture

Ulcerative Colitisdiarrhea (with blood or pus), abdominal pain and cramping, rectal pain and bleeding, weight loss, fatigue, fever

CBC, WBC, B12, ESR, RBC magnesium, potassium, faecal leukocytes, colonoscopy, stool for occult blood, CT scan

Celiac Diseaseanemia, osteomalacia, skin rash, mouth ulcers, headache, fatigue, joint pain, heartburn, diarrhea, constipation, bloating, vomiting/nausea

HLA-DQ2, HLA-DQ8, IgA-tTG, anti endomysial Ab,anti-gliadin Ab, RBC magnesium, potassium, folic acid, B12, vitamin D, small bowel biopsy

Short Gut Syndrome

diarrhea, fatigue, bloating, pale, greasy, foul smelling stool, edema, weight loss, dehydration

CBC, albumin, RBC magnesium, potassium, calcium, B12, vitamins A, D, INR, fecal fat, small intestine X-ray, upper GI series, CT scan

Diabetic Ketoacidosis

excessive thirst, frequent urination, nausea, vomiting, abdominal pain, SOB, fatigue, confusion, blurred vision, fruity breath odour

CBC, glucose, CRP, urea, creatinine, RBC magnesium, potassium, sodium, calcium, urine ketones

Pancreatitisupper abdominal pain that radiates to your back, pain worse after eating, fever, rapid pulse, nausea, vomiting, weight loss, oily smelly stool (steatorrhea)

CBC, WBC, amylase, lipase, AST, ALT, CT scan, MRI

Hyperthyroidismweight loss, tachycardia, increased appetite, anxiety, tremor, sweating, heat sensitivity, insomnia, fatigue, muscle weakness

TSH, T3, T4, radioactive iodine intake, TSH-R Ab, TSI, RBC magnesium, potassium

Cirrhosisfatigue, jaundice, easy bruising and bleeding, ascites, loss of appetite, nausea, edema, weight loss

AST, ALT, GGT, alkaline phosphatase, bilirubin, GFR, creatinine, BUN, hepatitis antibodies, INR, ESR CT scan, MRI, RBC magnesium, 24-hr urine

Pre-eclampsiaa pregnant woman > 20 weeks gestation who presents with protein in urine (proteinuria), hypertension, headaches, change in vision abdominal pain, nausea, vomiting, decreased urine output, shortness of breath

24-hr urine, CBC, platelet count, AST, ALT, GFR, creatinine, BUN, RBC magnesium, fetal ultrasound

Pregnancy third trimester RBC magnesium

Excessive IV fluids

history of IV fluids RBC magnesium

Magnesium deficiency DDX

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

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

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When is it common practice to check magnesium levels?Magnesium levels are typically checked to evaluate kidney function, to aid in diagnosis of gastrointestinal disorders and to determine the severity of uncontrolled diabetes.

What is hypomagnesemia? This is the medical term for magnesium deficiency and is defined as a serum magnesium concentration of less than

0.70 mmol/L (< 1.8 mg/dL). Clinical features often accompany a deficiency in other electrolytes such as calcium and potassium and include lethargy, tremor, seizures and arrhythmias. It can result in complications with every organ system and cause potentially fatal complications such as ventricular arrhythmia, coronary artery vasospasm and sudden death.

How common is it?In the general population, a clinical deficiency in magnesium (hypomagnesemia) is rare. Hypomagnesemia is commonly associated with more complicated chronic disease processes that eventually affect

renal function and electrolyte balance. Malabsorption from gastrointestinal disease is also where you will commonly find deficient magnesium stores.

Keep in mind that a dietary deficiency of magnesium is extremely common (see Why does a magnesium deficiency exist? on page 9). Since magnesium plays such a critical role in the body, there are several clinical manifestations that can arise from a dietary deficiency and a magnesium deficiency can be present without hypomagnesemia (see chart Conditions associated with a magnesium deficiency on page 13).

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.

Mechanism: magnesium & cardiovascular conditions

3 Hypomagnesemia. (2017, August 30). Retrieved September 13, 2017, from http://emedicine.medscape.com/article/2038394-overview#a64 Magnesium in diet. MedlinePlus. Health Topics. 2016. Retrieved June 12 2017, from https://medlineplus.gov/ency/article/002423.htm5 Magnesium. (n.d.). Retrieved September 13, 2017, from https://labtestsonline.org/understanding/analytes/magnesium/tab/test

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

ElectroMag ElectroMag delivers a shocking 150 mg of elemental magnesium with vitamin C and electrolytes, all in a refreshing effervescent drink. It’s an easy way to get your recommended daily amount of magnesium whether you’re training for a triathlon or simply enjoying an active life.

Directions: Empty contents into a glass and add 150 to 250ml of water, or to taste.

Each packet contains:Magnesium bis-glycinate blend ......................................... 150mg (magnesium oxide, magnesium bis-glycinate chelate, glycine)Vitamin C (ascorbic acid) ..................................................... 375mg

Non-medicinal ingredients: Citric acid, tartaric acid, sodium bicarbonate*, calcium carbonate*, potassium carbonate*, stevia, xylitol, maltodextrin, natural lemon-lime flavour, natural lemon flavour, natural lime flavour. *Provides electrolytes.

30 Sachets per box: Lime flavour

ND’s Note: Recommended during and after workouts to replenish magnesium and other important electrolytes that keep muscles pumping. Vitamin C not only supports immune system function, it also plays an important role in collagen synthesis and wound healing. Patients can throw it in their gym bag or add it to water and enjoy the fizz.

Magnesium Bis-glycinate Gentle PowderThis perfect fusion of magnesium (essential mineral) and glycine (amino acid) is essential for energy production, maintaining normal muscle and nerve function, regulating heart rhythm, supporting immune system health, and keeping bones strong. The glycinate form helps to ensure optimal magnesium absorption. Available in capsule and powder form.

Directions: Dissolve powder in liquid, or take as directed by a health care practitioner. Children: Ages 1-3 years: ¼ scoop per day; ages 4-8 years: ½ scoop per day. Adolescents: ages 9-18 years: 1 rounded scoop per day. Adults: 1-2 rounded scoops per day

1 rounded scoop contains:Magnesium bis-glycinate blend ......................................... 200mg (magnesium oxide, magnesium bis-glycinate chelate, glycine)

Non-medicinal ingredients: Citric acid (1%).

120 Grams

ND’s Note: Many North Americans are deficient in this crucial mineral. Older adults might even be more vulnerable due to lower dietary intake and higher nutritional requirements that come along with aging. The senior population tremendously benefits from magnesium bis-glycinate which is essential for cardiovascular health, preventing muscle cramping and maintaining bone strength.

Magnesium Bis-glycinate 200 Gentle*

This unique magnesium-glycine complex provides a therapeutic 200 mg dose of pure elemental magnesium in every vegetable capsule. Designed to maximize magnesium intake while maintaining gentleness and absorption, Magnesium Bis-Glycinate 200 was designed for the general population in mind.

Directions: Adults – Take 1 capsule per day or as directed by a healthcare practitioner.

Each vegetable capsule contains:Magnesium bis-glycinate blend . . . . . . . . . . . . . . . . . . . . . . . . 200mg (glycine, magnesium oxide, magnesium bis-glycinate chelate)

Non-medicinal ingredients: Vegetable-grade magnesium stearate, vegetable capsule.

Available in: 120 & 240 Vegetable Capsules

ND’s Note: This is my go-to for patients who are generally healthy but require a good quality, high dose magnesium supplement to support prescription drug or stress-induced deficiencies. I also prescribe this particular formula to treat conditions like diabetes, hypertension, insomnia, anxiety, and PMS.

*formerly Magnesium Bis-glycinate 200 capsule form

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Magnesium + Taurine, B6 & Zinc for CardioExtra gentle magnesium combined with therapeutic levels of taurine, vitamin B6, and zinc. This formulation was designed for those looking for a magnesium supplement that provides strong cardiovascular support.

Directions: Adults – Take 1 capsule 4 times daily or as directed by a healthcare practitioner.

Each vegetable capsule contains:Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75mg TRAACS® magnesium bis-glycinate chelate buffered (magnesium bis-glycinate chelate, magnesium oxide)Taurine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550mgVitamin B6 (pyridoxal-5-phosphate) . . . . . . . . . . . . . . . . . . . 25mgZinc (TRAACS® zinc bisglycinate chelate) . . . . . . . . . . . . . 2.5mg


120 Vegetable Capsules

ND’s Note: Taurine has antihypertensive, antiatherogenic, and antioxidant effects. When combined with zinc and magnesium, it is especially beneficial for treating a variety of cardiovascular conditions including ischemia, coronary artery diseases, congestive heart failure, and hypertension. Vitamin B6 is used in taurine synthesis, making it a necessary

Magnesium Bis-glycinate 80 Ultra GentleDesigned for those who require a magnesium supplement with maximum gentleness. This form provides the most glycine to ensure gentle absorption and resistance to insoluble substances. Recommended for those who take multiple prescriptions or who suffer from digestive conditions like Crohn’s and colitis.

Directions: Adults - Take 1 to 3 capsules per day or as directed by health care practitioner.

Each vegetable capsule contains:Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80mg (TRAACS® magnesium bis-glycinate chelate)

Non-Medicinal Ingredients: Vegetable-grade magnesium stearate, vegetable capsule.


ND’s Note: When I treat patients with a long list of health problems and who take multiple prescription drugs, I want to make sure that what I’m prescribing will be easily tolerated and properly absorbed. This formula is fully chelated and won’t bind with any other drugs, so it’s perfect for people in these circumstances. I also know that this product doesn’t cause gut irritation and that I can recommend it to even my most sensitive patients.

Magnesium Bis-glycinate 140 Extra Gentle Made for those seeking potency with enhanced gentleness, this Magnesium Bis-Glycinate delivers more glycine to ensure optimum magnesium absorption despite digestive issues. Recommended for those with sensitive digestion, Irritable Bowel Syndrome or weak stomach acid.

Directions: Adults - Take 1 to 2 capsules per day or as directed by health care practitioner.

Each vegetable capsule contains:TRAACS® magnesium bis-glycinate . . . . . . . . . . . . . . . . . 140mg chelate buffered (magnesium bis-glycinate chelate, magnesium oxide)



ND’s Note: I recommend this formula to patients who have chronic stress that leads to digestive problems. It’s gentle on the gut and doesn’t irritate sensitive gastrointestinal tracts.

No, it hasn’t. It’s the very same formulation you’ve come to rely upon and enjoy. What has changed is our understanding of magnesium bis-glycinate. Since the release of Magnesium Bis-Glycinate 200, we’ve improved our understanding of what magnesium bisglycinate is and how it works. And as our understanding improves, so do our offerings.

Not all magnesium bis-glycinates are alike. We want to make sure

you understand the differences and options they provide so that you and your customers can continue to make informed decisions.

We’re making sure our labels are accurate and easy to understand. And we’re striving to create a magnesium bisglycinate that suits every person’s needs. While our understanding of an ingredient might change, the understanding we share has not. That’s our commitment to you.

Has the original 200 mg formulation changed?

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Magnesium plays various roles in my practice. I encourage my patients to use magnesium to promote relaxation, reduce muscle tension and improve quality of sleep. Also, I have found it very helpful to regulate hormones and blood sugar. Last but not least, I like to use magnesium to help lower blood pressure for cases of hypertension.

Katie Weststrate, ND

What conditions have you treated with magnesium in your practice?

Second opinion

Magnesium MalateAnother amino acid containing complex, this particular magnesium formulation is often recommended by naturopathic doctors for improved metabolic and energetic function.

Directions: Adults - Adults – Take 1 to 3 capsules per day or as directed by a healthcare practitioner.

Each vegetable capsule contains:Magnesium .......................................................................... 110mg Albion® Di-Magnesium Malate

Non-Medicinal Ingredients: Vegetable-grade magnesium stearate, vegetable capsule. microcrystalline cellulose.


ND’s Note: Magnesium and malic acid are involved in the production of adenosine triphosphate (ATP) which generates cellular energy. This formula makes a great addition to a comprehensive protocol for fibromyalgia and chronic fatigue. You can also recommend this formula to athletes as a post training remedy to enhance muscle recovery.

MagPop!Quench your thirst with this highly absorbable magnesium glycinate supplement enhanced with vitamin C and electrolytes. It contains no added sugar, preservatives, artificial flavours, or colours.

Directions: Empty contents into a glass and add 150 to 250ml of water, or to taste.

Each packet contains:Magnesium bis-glycinate blend .......................................... 100mg (magnesium oxide, magnesium glycinate chelate, glycine)Vitamin C (ascorbic acid) ..................................................... 325mg

Non-medicinal ingredients: Citric acid, tartaric acid, sodium bicarbonate,* calcium carbonate,* potassium carbonate,* stevia, xylitol, maltodextrin, quercetin, beta-carotene, orange juice powder, natural orange flavour. *Provides electrolytes.

35 Sachets per box: Orange flavour

ND’s Note: We lead busy lives and can often skip meals and go for long periods without drinking water. Using this easy-to-make and take drink makes getting our key nutrients, like magnesium and vitamin C, a cinch. It also helps decrease stress!

Magnesium + GABA & Melatonin for SleepWe’ve augmented our extra gentle magnesium formula with melatonin and GABA to help people relax, reset their circadian biological clocks, and get a better night’s sleep.

Directions: Adults – Take 1 to 2 capsules before bedtime or as directed by a healthcare practitioner. Do not drive or use machinery for 5 hours after taking melatonin.

Each vegetable capsule contains:Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125mg TRAACS® magnesium bis-glycinate chelate buffered (magnesium bis-glycinate chelate, magnesium oxide)GABA (gamma-aminobutyric acid) . . . . . . . . . . . . . . . . . . . 100mg TRAACS® magnesium bis-glycinateMelatonin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.5mg

Non-Medicinal Ingredients: Vegetable-grade magnesium stearate, vegetable capsule.


ND’s Note: I recommend using this product in conjunction with good sleep habits, like sleeping in a completely dark room, eliminating screen time an hour before turning in, and using

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Magnesium Glycinate 200 mgMagnesium is a multi-functioning mineral that also promotes relaxation and sleep.

Directions: Adults: take 1 capsule per day, or as directed by a healthcare practitioner.

Each vegetable capsule contains:Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200mg Magnesium glycinate blend (magnesium oxide, magnesium glycinate chelate, glycine)

Non-Medicinal Ingredients: vegetable-grade magnesium stearate, vegetable capsule.


ND’s Note: It’s important for active patients to replenish their electrolyte levels, especially magnesium. The majority of the North American population is already depleted in this essential mineral and living an active lifestyle compromises levels even more. I recommend taking it after a workout to support muscle recovery and prevent muscle cramps.

Magnesium Glycinate PowderMagnesium is a natural stress-reducing mineral that comes in handy on days when our stress levels ramp up.

Directions: Dissolve powder in liquid, or take as directed by a health care practitioner. Children: Ages 1-3 years: ¼ scoop per day; ages 4-8 years: ½ scoop per day; Adolescents: ages 9-18 years; 1 rounded scoop per day; Adults: 1-2 rounded scoops per day.

1 rounded scoop contains:Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200mg Magnesium glycinate blend (magnesium oxide, magnesium glycinate chelate, glycine)

Non-medicinal ingredients: citric acid (1%).

90 Grams

ND’s Note: In addition to recommending supplements like magnesium and B vitamins, why not create a stress reduction library filled with tools your patients can borrow? Books, electronic devices, and hand-outs that help them practice stress reduction techniques at home would surely be welcomed and appreciated.

Magnesium deficiency is quite common in my practice. Given its critical role in many biochemical reactions, I commonly prescribe magnesium bisglycinate for hypertonic muscles, tension headaches, muscle strains, chronic pain and for all athletes. This form is easily absorbed and patients often report a difference soon after starting.

Tina Rogers, ND

Magnesium is one of the supplements I use most often in my practice. I often prescribe magnesium to my Lyme patients as it quickly takes a foothold on the disease. Magnesium deficiency symptoms like irregular heartbeat, anxiety, insomnia, muscle cramps and spasms can mimic those of Lyme disease.

Prescribing magnesium supplements can help your patients feel better quickly and commit to your practice for the duration of their treatment.

Marie Matheson, ND

Magnesium Glycinate 180 mgA lower dose magnesium designed for individuals who desire to create specific self dosages.

Directions: Adults: take 1 capsule per day, or as directed by a healthcare practitioner.

Each vegetable capsule contains:Magnesium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180mg Magnesium glycinate blend (magnesium oxide, magnesium glycinate chelate, glycine)

Non-Medicinal Ingredients: vegetable-grade magnesium stearate, vegetable capsule.


ND’s Note: Parents like to make sure their teens stay physically active. One way to support sustained activity is to supplement with a reliable magnesium source. Popping a low-dose magnesium capsule keeps energy levels steady and makes for an easy on-the-go option for busy kids with busy parents!


Drug-induced nutrient depletion

Despite being effective and even life-saving, both over-the-counter and prescription medications can have potential side effects. What your clients might not realize is that there can be side effects that do not come from the drugs themselves, but rather show up as a result of nutritional deficiencies from prolonged use.

Medications can deplete nutrients like magnesium through various mechanisms, like altering the way a nutrient is absorbed, converted, stored or excreted. Some, like acid blockers, can impair the digestion of nutrients by altering the acidity in one’s gastrointestinal tract. Others may bind with nutrients, preventing absorption completely. Others, like diuretics, can increase urinary output, causing a loss

of water soluble vitamins and electrolytes such as potassium and magnesium.

So who might be the most at risk? The answer is seniors. In 2009, The Canadian Institute for Health Information (CIHI) reported that about two-thirds, or 63 percent of seniors on public drug programs in six provinces were taking five or more drugs belonging to different drug classes. Nearly a quarter were taking prescription drugs from ten or more drug classes. Polypharmacy, or the act of taking five or more prescription medications, is especially common among seniors. It’s further compounded by the fact that seniors metabolize and eliminate drugs more slowly than other age groups because of aging organs like the liver and kidneys.

Not surprisingly, one doesn’t need to take

Drug Classification Common Name Nutrient Depletion Effects

Acid blockers

• Ranitidine• Cimetidine• Nizatidine• Famotidine

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

Antacids • Calcium carbonate• Sodium bicarbonate

Create weak stomach acid which impacts the solubility of magnesium and contributes towards minerals getting flushed out through the colon.

Antibiotics

• Tetracycline• Amoxicillin• Doxycycline• Cephalexin

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

Anti-Hypertensives • Thiazide diuretics • Loop diuretics

Diuretics lower blood pressure by lowering the amount of salt and water in the body. This loss of fluids can lead to the loss of precious minerals, such as potassium, magnesium, calcium and zinc. 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.

Cholesterol agents • Cholestyramine • Colestipol

Deplete most minerals including magnesium.

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

Laxatives• Stimulant laxatives• Bisacodyl (Dulcolax)

Stimulant laxatives exert their primary effects through alteration of electrolyte transport in the 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.

five or more prescription medications to feel the effects of nutrient deficiencies. These can happen whether you are taking one or more prescription medications.

From a Practitioner's Point of View

You’re undoubtedly aware of which prescription medications your clients are taking. As an extra precaution, you might familiarize yourself with how those particular medications might alter nutrient absorption and cause deficiencies. Helping your clients understand how these deficiencies can occur might encourage them to take preventative measures to maintain good health, especially when prescription medications are necessary and taken daily.

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.

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Course Name/Theme

Organizers Location Date CE Info Registration Info Description

Integrative Healthcare Symposium (Canada)

Integrative Healthcare Symposium

Richmond Hill, Ontario

Oct 13 - 14, 2017 TBDhttp://www.ihsymposium.com/canada/

Not to be mistaken with the annual conference the same organizers hold in New York every February, but a great way to gather and exchange knowledge without having to travel too far, for those of us living in the Greater Toronto Area.

This conference inspires integrative healthcare providers to engage with one another to promote education and practical advice on integrative therapies.

Clinical Innovations in Naturopathic Medicine

OAND 2017 Annual Convention & Tradeshow

Blue Mountain, ON

Nov 10-12, 201719.5 Cat A TBC

https://oand.org/2017-convention-tradeshow-registration/

The OAND annual convention! Reconnect with colleagues, get your CE credits and explore clinical innovations in Naturopathic Medicine in a picturesque setting at Blue Mountain resort, Collingwood!

Functional and Personalized Hormone Restoration Therapy

LP3 NetworkToronto, Ontario

Dec 2-3, 201715.5 Cat A

https://education.lp3network.com/live-training/functional-personalized-hormone-restoration-therapy/toronto/december-2-3-2017

Participants will learn how to uniquely design treatment regimens that include customized dosage strengths, dosage forms, delivery systems, and combinations. This program will allow healthcare providers with the unique opportunity to collaborate together to produce a patient-centered treatment regimen that is tailored to the individual patient.

Epigenetics and the Mitochondria in the Context of Fertility

OAND Live Webinar Dec 4, 20172 Cat A

https://oand.org/non-certificate-ce-courses/

This online seminar is designed to provide theoretical research, practical applications and clinical pearls integrating nutrition, lifestyle, exercise, supplementation and IV therapies, with the goal of easily implementing these protocols into daily practice. You will leave with a greater understanding of the role of mitochondrial function in fertility success, and suggested treatment protocols that enhance this function in male and female fertility patients.

2017 IVIT Regulatory Compliance Course

Center of Excellence in Integrative Medicine

Online only Ongoing TBC

http://integrativemedicinecme.com/sales-page/ref/OANDCE/

Dr. Eric Marsden ND will review compliance standards critical for CONO’s upcoming IVIT inspection training program. Topics include: a review of Physical standards, Infection control, Sterile Compounding, Documentation, Risk Assessment, Infection control planning and Compounding.

Continuing education course listings

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

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.


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 lactating women to boost their magnesium intake even higher and to consult their doctors for suggested amounts.

Sea vegetables (kelp), nuts and seeds, beans, soybeans and some seafood generally contain higher levels of magnesium compared to other foods. Grains and pseudocereals like quinoa, buckwheat and brown rice

will offer you a relatively high amount of magnesium as well. But the real winners when it comes to the most nutrient dense, magnesium-rich foods are fresh vegetables and dark leafy greens like chard, collards and spinach. Nuts and seeds also pack a big punch for their size when it comes to magnesium density. Refer to the Magnesium Content in Foods chart on page 31, to see which nuts and seeds are highest in magnesium!

True or False: Organic Foods Contain More MagnesiumIt’s no surprise that choosing to buy organic dark leafy greens and vegetables can cost you. But if you choose to not purchase organic produce will you pay in different ways? Does buying organic make a difference in terms of mineral (magnesium) content 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.aspx2 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

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According to the Environmental Working Group, conventionally grown spinach ranks second when it comes to produce containing pesticide residue.

While some studies conclude that organic food may or may not be more nutritious than conventionally grown, it is safe to say that buying organic can protect you from detrimental pesticides and herbicides that generally act as antagonists when it comes to magnesium absorption. Eventually leading to mineral deficiency.

Is Dietary Intake Enough? Swiss chard contains a whopping 150 mg of magnesium per cup. But does that mean you are covered when it comes to adequate dietary magnesium intake? Not necessarily. Lifestyle, physiological and agricultural factors all play roles in how much dietary magnesium is available and how it is absorbed. A disappointing reality, but a reality nonetheless!

Let’s Explore Why Mineral-rich foods are becoming an anomaly these days. High rates of soil erosion account for less magnesium in the soil which results in low mineral content in plant foods including magnesium. And that’s only one reason. The health of our digestive system is also a factor in whether or not we can adequately break down food to get the good stuff. Optimum absorption is key in making sure magnesium actually enters our cells!

Absorption of dietary magnesium isn’t guaranteed, though. Enzymatic function, stomach and bowel health are key factors in the absorption process. From the beginning of the digestive system (oral cavity) to the very end (the anus), all parts need to be working efficiently (especially the small intestine) for optimum breakdown of dietary magnesium. Even if our digestive process is working perfectly, mineral content in food likely won’t be high enough to offer our cells optimum protection.

Cooking methods and refined foods can also account for magnesium loss. If we choose to fry that one cup of swiss chard instead of bake or lightly sauté it, we can cheat ourselves out of getting the magnesium we need.

Between mineral-depleted plant foods, compromised digestive systems and popular denaturing cooking methods, optimizing our magnesium intake via food can become quite a challenge.

The KickerIronically, magnesium needs magnesium to facilitate the absorption process. It’s imperative for helping to synthesize enzymes, repair tissue in our intestinal lining, and contribute to our parasympathetic nervous system health, for starters. In order for these processes to function properly in the first place, we need to have enough magnesium in our bodies to provide energy to get these physiological jobs done and done well.

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

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, but too little. Low stomach acid can contribute to malabsorption of carbohydrates, which in turn leads to a buildup of gasses in the stomach.

This intra-abdominal pressure pushes the stomach contents, including gastric acid, up to the esophagus which creates a burning sensation.

Taking an antacid can provide temporary relief but it will decrease an already low amount of stomach acid making the issue worse, not to mention making it harder for us to breakdown foods and absorb minerals like magnesium.

Heartburn

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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.

Food Serving Size mg of Magnesium per Serving

Nuts and Seeds

Pumpkin Seeds ¼ cup 190

Sesame Seeds ¼ cup 126

Cashews ¼ cup 116

Sunflower Seeds ¼ cup 113

Cashews, dry roasted 1 ounce 74

Almonds ¼ cup 61

Flaxseeds 2 tablespoons 54

Mustard Seeds 2 tsp 14

Vegetables

Spinach, boiled 1 cup 156

Swiss Chard 1 cup 150

Beet Greens 1 cup 97

Avocado, cubed 1 cup 44

Potato, baked with skin 3.5 ounces 43

Summer Squash 1 cup 43

Collard Greens 1 cup 39

Beets 1 cup 39

Broccoli 1 cup 32


Brussels Sprouts 1 cup 31

Turnip Greens 1 cup 31

Winter Squash 1 cup 26

Cabbage 1 cup 25

Asparagus 1 cup 25

Kale 1 cup 23

Bok Choy 1 cup 18

Mustard Greens 1 cup 18

Leeks 1 cup 14

Cucumber 1 cup 13

Romaine Lettuce 2 cups 13

Broccoli, chopped and cooked

½ cup 12

Cauliflower 1 cup 11

Celery 1 cup 11

Bell Peppers 1 cup 11

Carrot, raw 1 medium 7

Fruits

Papaya 1 medium 57

Banana 1 medium 32

32



Raspberries 1 cup 27

Raisins ½ cup 23

Tomatoes 1 cup 19

Cantaloupe 1 cup 19

Strawberries 1 cup 18

Watermelon 1 cup 15

Apple 1 medium 9

Legumes

Soybeans 1 cup 147

Black beans, cooked 1 cup 120

Navy Beans 1 cup 96

Pinto Beans 1 cup 85

Lima Beans 1 cup 80

Kidney Beans 1 cup 74

Green Peas 1 cup 53

Edamame, shelled, cooked ½ cup 50

Kidney beans, canned ½ cup 35

Green Beans 1 cup 22

Grains

Quinoa ¾ cup 118

Buckwheat 1 cup 85

Brown Rice 1 cup 83

Barley cup 81

Millet 1 cup 76

Oats ¼ cup 69

Cereal, shredded wheat 2 large biscuits 61

Rye cup 61


Wheat 1 cup 58

Bread, whole wheat 2 slices 46

Rice, brown, cooked ½ cup 42

Rice, white, cooked ½ cup 10

Dairy and Dairy Alternatives

Soymilk, plain or vanilla 1 cup 61

Yogurt, plain, low fat 8 ounces 42

Milk 1 cup 24

Meat and Meat Alternatives

Tempeh 4 ounces 87

Tofu 4 ounces 65

Tuna 4 ounces 47

Scallops 4 ounces 41

Salmon, Atlantic, farmed, cooked

3 ounces 26

Halibut, cooked 3 ounces 24

Chicken breast, roasted 3 ounces 22

Beef, ground, 90% lean, pan broiled

3 ounces 20

Herbs and Spices

Cumin 2 teaspoons 15

Parsley ½ cup 15

Fennel 1 cup 14

Basil ½ cup 13

Cloves 2 tsp 10

References: 1 (n.d.). Retrieved September 13, 2017, from http://whfoods.org/genpage.php?tname=nutrient&dbid=752 Office of Dietary Supplements - Magnesium. (n.d.). Retrieved September 13, 2017, from https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/#h5

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When it comes to testing your magnesium levels, the process can be a bit complicated. Magnesium is kept mostly in bones and in soft tissues. The amount that travels through our bloodstream is less than one percent and those levels are tightly regulated by your body.

Magnesium levels in blood or urine might not relate to magnesium levels in the body as a whole. There are a few other tests that are more accurate (for example testing magnesium inside red blood cells), but we recommend, as a first defence, to become familiar with magnesium deficiency symptoms and risk factors (see Magnesium

Status Checkist on page 36).

Because magnesium flows between blood, the bones, and inside cells, testing magnesium in just the blood can be inaccurate.

If you decide to requisition a magnesium red blood cell test, try taking one baseline test before supplementing with magnesium and again three to four months after supplementation. Steady, consistent supplementation will help build up the reserve stores in your bones and tissues. Repeating this test every three to four months will provide a guideline for how much magnesium you should

be supplementing.

When supplementing, you’ll want to aim for a test result in the higher end of the range, say around 2.4 to 2.52mmol/L.

One last thing: if you take the RBC test, you might see a reference range between 1.65 and 2.52 mmol/L. That’s a very wide interval and you may still experience deficiency symptoms at the lower end of this range.

Can I test for a magnesium deficiency?

m

Diet12.5 mmol/day

Waste7.5 mmol/day

Inside cells

Urine5 mmol/day

Bone600-700 mmolof magnesium

Plasma 2.5 mmo l

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.

Muscle pain, spasms, twitches, cramps

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Mechanism: PMS and magnesium

Prostaglandins, the powerful inflammatory modulators and important chemical-like messengers, play a crucial role in keeping PMS symptoms in check. But keeping prostaglandins (PgE1 and PgE2) balanced can be tough - especially if the right amount of nutrients aren’t present. PgE1 deficiency is a known PMS trigger.

Magnesium plays a role in the synthesis of PgE1 and is also involved in essential fatty acid metabolism. Prostaglandins are synthesized in cells from essential fatty acids.

If not enough magnesium is present, then hormonal issues can arise from a prostaglandin production imbalance.

Magnesium also aids in the manufacturing

of hormone proteins progesterone and estrogen. During times of elevated progesterone and estrogen (when PgE1 conversion isn’t happening the way it should) even more magnesium is used in order to make up for imbalanced hormonal levels.

Not every woman who suffers from PMS will have the same symptoms. But it is possible that every woman can find some relief by supplementing with magnesium (see chart below).

Be sure to get optimum amounts of B6 and other B vitamins as well as magnesium. These specific vitamins play a key role in guiding magnesium into the cell.

Although women can suffer from multiple

PMS Categorized

Symptoms your patients may be experiencing

Possible Hormonal behaviour Magnesium’s Role

AAnxiety Anxiety, irritability, mood swings

↑ estrogen

↓ progesterone

Chronic Stress

• Manufactures both estrogen and progesterone• Calms the nervous system• Reduces hyperexcitability • ↑ magnesium = ↓ estrogen• ↑ magnesium = ↓ cortisol

CCravings

Cravings, increased appetite, fatigue, headache, irregular heartbeat

↑ insulin

Hypoglycemic symptoms

• Increases blood flow to the brain • ↓ magnesium = potassium loss = irregular heartbeat• Promotes regular heartbeat via proper nerve impulse• Needed for proper absorption of carbohydrates and fats

HHyperhydration

Hyperhydration, swelling, dehydration, sodium retention, high blood pressure, breast tenderness, bloating, weight gain, inflammatory stress response, adrenal fatigue

↑ aldosterone

↑ estrogen

Decreased Immunity

• Regulates mineral concentration• Excess salt = magnesium loss• ↓ magnesium = potassium loss = dehydration • Promotes proper bowel movement (peristalsis) • Required for estrogen detox pathway in the liver (sulfation and

methylation pathway)

D Depression

Depression, confusion, forgetfulness, crying spells, adrenal fatigue, impaired neurological function

↓ estrogen

↑ progesterone

Hypothyroidism

• Helps convert tryptophan to serotonin (our feel good neurotransmitter)

• ↑ magnesium levels = ↓ cortisol• Supports energy production • ↓ magnesium = HPA axis dysfunction • ↓ magnesium = impaired function of parathyroid gland = improper

magnesium absorption

References: 1 Premenstrual Syndrome, Part 1. (2011, November 14). Retrieved September 25, 2017, from http://www.physicianspractice.com/pmspmdd/premenstrual-syndrome-part-12 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-hormones3 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. Retrieved September 25, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/9861593

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

PMS symptoms at once, to help identify why an individual is experiencing premenstrual syndrome, it might be helpful to categorize symptoms. This might help identify what specific hormonal issues and deficiencies your female patients may be suffering from.

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Can you take too much magnesium?

The body is very smart at regulating magnesium levels. If too much dietary magnesium is consumed, it can flush the excess through the digestive tract as diarrhea. Too much magnesium in the bloodstream is flushed out through the kidneys in urine. As long as these safety mechanisms are functioning, it is very difficult to take in too much magnesium.

In the case where safety mechanisms are not functioning, then taking oral magnesium supplements may not be suitable or should be closely monitored. If your patient suffers from kidney (renal) failure or bowel obstructions for example,

magnesium will not be able to be cleared from the body.

Patients with low blood pressure and conditions related to muscle tone and electrolyte imbalances should be cautious when supplementing with magnesium and consult with a natural healthcare practitioner to find out what is best for them.

Supplementation protocols should address the patient's unique healthcare needs and take into consideration any health concerns and/or contraindications that might be present based on a proper health assessment.

Here are some conditions that can benefit from magnesium supplementation:

Acid reflux Blood clotting Fibromyalgia Muscle cramping and pain

Adrenal fatigue Chronic fatigue syndromeHypertension, angina and coronary artery disease

Osteoporosis and bone health

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 Disorder (ADHD)

Fatigue

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.

Magnesium Status ChecklistTe

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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.

RISK FACTORS: DIET & LIFESTYLE

Drinking more than 3 cups of coffee or tea per day

Drinking over 7 alcoholic drinks per week

Eating junk foods with high sugar, fats or salt

Consuming less than one serving of greens per day

Limited consumption of seeds, nuts or fruits

Intense exercise or training more than 3 times per week

Excessive sweating

Currently pregnant or have been pregnant in the past 12 months

RISK FACTORS: CONDITIONS

Regularly having undigested foods in stools

Chronic kidney disease

Diarrhea

Heavy menstrual periods

RISK FACTORS: SUPPLEMENTS & DRUGS

If you are taking...

Acid blockers

Antacids

Antibiotics

Antihypertensives

Calcium or iron supplements

Corticosteroids or anti-inflammatories

Diuretics

Hormone replacements

Oral contraceptives (birth control)

Vitamin D

SIGNS & SYMPTOMS

Chronic fatigue, lethargy or low energy

Chronic headaches or migraines

High blood pressure

Rapid or irregular heart rate

Anxiety or panic attacks

Hyperventilation or frequent sighing

Nausea or vomiting

Lack of appetite

Confusion or difficulty concentrating

Poor memory or confusion

Mood swings

Feeling irritable

Muscle cramps or spasms

Hand tremors

Muscle weakness or soreness

Muscle, neck or back pain

Twitching, tics or restlessness

Restless leg syndrome

Reynaud’s syndrome

Fibromyalgia

Shortness of breath

Chest tightness

Startled easily

Sensitivity to loud noises or lights

Tingling or other unusual sensations in the hands or feet

Poor circulation leading to cold hands and feet

Osteoporosis or low bone density

Irregular periods

Preeclampsia and eclampsia

Severe PMS

Difficulties conceiving

Loss of libido

Hyper or hypothyroidism

Hyperparathyroidism

Trouble sleeping

History of seizures

History of strokes

Low blood potassium

Vitamin D deficiency

Strong cravings for carbohydrates, salt or chocolate

Mon

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Mon

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Mon

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Mon

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Lifestyle & Dietary Recommendations

Here are some suggestions and tips to improve your magnesium status.

• Cut back on the consumption of coffee, alcohol and soft drinks. These drinks can increase magnesium wastage and reduce magnesium absorption.

• Cut back on processed and junk foods. Heavy processing will remove many minerals found in food.

• Reduce sodium consumption. Sodium competes with magnesium for ion channels.

• Soak beans and grains before cooking. Soaking can reduce phytic acid found in high concentrations in beans and grains. Phytic acid interferes with magnesium absorption in the gut.

• Steam raw greens like spinach and chard to remove the oxalic acid content. Oxalic acid also interferes with magnesium absorption.

• Try to remove stressors in your life. Easier said than done, but dealing with the root causes of stress and anxiety will help improve magnesium digestion (IBS is often stress-induced) and reduce magnesium wastage. You can measure levels of the stress hormone cortisol through a non-invasive saliva test.

• Increase your consumption of organic greens. Look for organic greens grown with natural, organic fertilizer. Joining a community-sponsored agriculture program is a great way to access locally-grown greens.

• Add more raw nuts and seeds into your diet. Nuts and seeds can be eaten raw, have low phytic acid compared to other plant-based foods, and are easy to snack on.

Once you've started to make these changes, go through the “Magnesium Status” checklist again to track your progress.

CanPrev guide to natural medicine is here!

Our new 2017 guide is now available. It’s a comprehensive 148-page guide of CanPrev's natural products, complete with detailed descriptions and practical health advice. A great resource for your patients - or as a handy reference for your practice.

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

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ND NOTESFall 2017 | VOL. 3 NO. 2

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Serotonin receptor

GABA receptor

GABA GABA

GlutamateDopamine receptor

NMDA receptor

Magnesium & Me - Naturopathic NotesRNA polymerases that create RNA based on the original DNA...

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