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Thursday 5 February 2015

Magnesium Deficiency May Be Caused By Prescription Pills


Life Extension Magazine

Life Extension Magazine February 2015

ASK THE PHARMACIST

Magnesium Deficiency May Be Caused By Prescription Pills

By Kimmi Stultz, PharmD, CPH

Magnesium Deficiency May Be Caused By Prescription Pills  
Q: Recent studies have come out stating magnesium deficiency is running rampant among Americans and that it’s a serious problem. I take quite a few medications for different health conditions. Do medications drive magnesium levels even lower?
A: The literature suggests magnesium deficiency is common among Americans. Studies published by the National Institute of Health and World Health Organization estimate that up to 68% of people in the United States are magnesium deficient.1
To maintain health, the current Reference Daily Intake (RDI) of magnesium for adults is 310 to 420 mg a day.2,3 Keep in mind, this value is not the optimal amount required to prevent deficiency. Even if we meet the RDI, this level is not satisfactory to nurture one’s health by correcting existing deficiencies or preventing the development of disease.4,5
Magnesium is a critical co-factor involved in over 300 diverse enzyme-driven biochemical reactions in the body. It plays a crucial role in maintaining cellular physiological function.6 Multiple health benefits of magnesium include energy metabolism and transport, muscle contractility, nerve function, DNA and RNA synthesis, stabilization of mitochondrial membranes, glucose utilization, insulin metabolism, neurotransmission, bone density development, regulation of detoxification pathways, a healthy nervous and cardiovascular system, and much more.7-9

Magnesium’s Key Roles

Magnesium’s Key Roles  
Magnesium is an essential mineral that the body cannot manufacture, yet every single fundamental cell in the body requires it to perform properly. Because of its many functions, magnesium plays a key role in disease prevention and overall health.10 Continual low intake and absorption produces changes in biochemical pathways, which can increase the development of a wide array of disease and illness.11
Though frequently overlooked, magnesium deficiency is strongly linked to many diseases and disorders of the human body including diabetes, cardiovascular disease, osteoporosis, neuromuscular manifestations, metabolic syndrome, and increased levels of both inflammatory mediators and free radicals.7,12-15
Even though the exact mechanism is not clearly understood, magnesium deficiency is believed to be involved in processes that lead to tumor formation and development.16-18 Emerging research shows low magnesium levels are associated with cardiovascular and high all-cause mortality.19 Numerous studies recognize the value of magnesium in the presentation of lifestyle-related diseases such as heart disease, diabetes, and metabolic syndrome.20-22 These pathological conditions are characterized as having a chronic inflammatory stress component exacerbating the occurrence of chronic diseases. Research shows that the recommended level of dietary magnesium is not able to prevent the negative consequences on health associated with cellular magnesium deficiency.23 Research priorities include refining the magnesium requirement and understanding how a magnesium deficiency influences the incidence of inflammatory-related disorders.24

Magnesium, Medication, And Health Care Providers

Since magnesium is critical for the function of multiple enzyme systems, deficiency results vary from minor to extremely debilitating clinical manifestations.25,26 Health care providers should adopt practices that recognize early disordered magnesium metabolism and implement therapy quickly to avoid further complications.27
The lack of transparency and awareness in diagnosing potential magnesium deficiency may cause health care practitioners to overlook the possibility of natural magnesium supplementation and implement prescription-drug treatment instead.28-30
Medications, including over-the-counter drugs, deplete your body of critical nutrients. This exacerbates the existing problem most Americans suffer from—a nutrient deficiency.31 While medications are effective at relieving symptoms, they deplete viable nutrients our bodies need in order to heal. Even worse, they may generate unintended consequences from these nutrient losses, which leads to more prescriptive medications being prescribed, creating a vicious cycle.32,33
There are a number of ways that medications can negatively affect the nutrient status of magnesium in the body. Some pharmaceuticals alter the mechanics of how magnesium gets utilized in your body by inhibiting nutrient absorption, synthesis, transport, metabolism, and excretion.34,35 There is no direct relationship regarding how the depletion occurs, especially when you take into account a patient’s varied health status and biochemical individuality.36

Testing For Deficiency

Magnesium is found primarily inside the cells. Conventional tests that measure serum magnesium only show what is in the bloodstream and not what is inside the cells. Because magnesium is primarily an intracellular ion, blood contains less than 1% of the body’s magnesium stores.37,38 Most routine laboratory evaluations only measure serum magnesium in the blood, which is why these results are often misleading and can lead to a false sense of security.39 To comprehensively evaluate magnesium status, both an RBC (Red Blood Cell) magnesium test and a clinical assessment are necessary, especially if long-term prescription therapy is required.
EXAMPLES OF DRUGS THAT ROB THE BODY OF MAGNESIUM40
Examples Of Drugs That Rob The Body Of Magnesium

Acid Blockers

  • Cimetidine (Tagamet®)
  • Famotidine (Pepcid®)
  • Omeprazole (Prilosec®)
  • Pantoprazole (Protonix®)
  • Ranitidine (Zantac®)

Antacids

  • Calcium Carbonate 
    (Tums®)
  • Sodium Bicarbonate 
    (Alka-Seltzer®)

Antibiotics

  • Amoxicillin (Amoxil®)
  • Azithromycin (Z-Pak®)
  • Cephalexin (Keflex®)
  • Ciprofloxacin (Cipro®)
  • Minocycline (Minocin®)
  • Sulfamethoxazole and 
    Trimethoprim (Bactrim®)
  • Tetracycline (Sumycin®)

Antivirals

  • Foscarnet (Foscavir®)
  • Lamivudine (Epivir®)
  • Nevirapine (Viramune®)
  • Zidovudine (Retrovir®)

Cardiac Glycoside

  • Digoxin (Digitek®)

Central Nervous System Stimulants

  • Methylphenidate (Ritalin®)

Corticosteroids

  • Betamethasone Dipropionate 
    (Diprolene®)
  • Dexamethasone (Decadron®)
  • Hydrocortisone (Cortef®)
  • Prednisone (Sterapred®)
  • Fluticasone (Flonase®)

Diuretics

  • Hydrochlorothiazide (Hydrodiuril®)
  • Bumetanide (Bumex®)
  • Furosemide (Lasix®)
  • Indapamide (Lozol®)

Hormone Replacement Therapy

  • Estradiol (Estrace®, Menostar®, 
    and many more)
  • Estrogen-containing drugs 
    (birth control)
  • Conjugated Estrogens (Prempro®)
  • Levonorgestrel (birth control)

Kimmi Stultz, PharmD, CPH is a member of the American Pharmacists Association Foundation, American Academy of Anti-Aging Medicine, and a clinical pharmacy educator for the Life Extension Foundation®.
If you have any questions on the scientific content of this article, please call a Life Extension® Health Advisor at 1-866-864-3027.

References

  1. Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012 Mar;70(3):153-64.
  2. US Dept of Health and Human Services and US Dept. of Agriculture. Dietary Guidelines for Magnesium. 2005.
  3. King DE, Mainous AG 3rd, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels.J Am Coll Nutr. 2005 Jun;24(3):166-71.
  4. Witkowski M, Hubert J, Mazur A. Methods of assessment of magnesium status in humans: A systematic review. Magnesium Res. 2011;24:168-80.
  5. Johnson S. The multifaceted and widespread pathology of magnesium deficiency. Med Hypothesis. 2001 Feb;56(2):163-70.
  6. Gums JG. Magnesium in cardiovascular and other disorders. Am J Health Syst Pharm. 2004 Aug 1;61(15):1569-76.
  7. Champagne CM. Magnesium in hypertension, cardiovascular disease, metabolic syndrome, and other conditions: A Review. Nutr Clin Pract. 2008 Apr-May;23(2):142-51.
  8. Bo S, Pisu E. Role of dietary magnesium in cardiovascular disease prevention, insulin sensitivity and diabetes. Curr Opin Lipidol. 2008 Feb;19(1):50-6.
  9. Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev. May 2003;24(2):47-66.
  10. Killilea DW, Maier JA. A connection between magnesium deficiency and aging: new insights from cellular studies. Magnes Res. 2008 June:21(2):77-82.
  11. Martin KJ, Gonzalez EA, Slatopolsky E. Clinical consequences and management of hypomagnesemia. J Am Soc Nephrol. Nov 2009:20(11):2291-5.
  12. Guerrera MP, Volpe SL, Mao JJ. Therapeutic uses of magnesium. Am Fam Physician. 2009;80(2):157-62.
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  14. Guasch-Ferre M, Bullo M, Estruch R, et al. Dietary magnesium intake is inversely associated with mortality in adults at high cardiovascular disease risk. J Nutr. 2014 Jan;144(1):55-60.
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  19. Reffelmann T, Ittermann M, Dorr H, et al. Low serum magnesium concentrations predict cardiovascular and all-cause mortality. Atherosclerosis. 2011 Nov;219(1):280-4.
  20. Hruby A, Meigs JB, O’Donnell CJ,Jacques PF, McKeown NM. Higher magnesium intake reduces risk of impaired glucose and insulin metabolism, and progression from prediabetes in middle-aged Americans. Diabetes Care. 2014 Feb;37(2):419-27.
  21. Khan AM, Lubitz SA, Sullivan LM, Sun JX. Low serum magnesium and the development of atrial fibrillation in the community: the Framingham heart study. Circulation. 2013 Jan 1;127(1):33-8.
  22. Dacey MJ. Hypomagnesemia disorders. Crit Care Clin. 2001;17(1):155-73.
  23. Mathers TW, Beckstrand RL. Oral magnesium supplementation in adults with coronary heart disease or coronary heart disease risk . J Am Acad Nurse Prac. 2009;21(12):651-7.
  24. Guerrero-Romero F, Rodriguez-Moran M. Hypomagnesemia, oxidative stress, inflammation, and metabolic syndrome. Diabetes Metab Res Rev. 2006 Nov-Dec;22(6):471-6.
  25. He K, Song Y, Belin RJ, Chen Y. Magnesium intake and metabolic syndrome: epidemiologic evidence to date. J Cardiometab Syndr. 2006;1(5):351-5.
  26. Blanchard A, Vargas-Poussou R. Magnesium disorders. Nephrol Ther. 2012 Nov 8;(6):482-91.
  27. Gonzalez W, Altieri PI, Alvarado S, et al. Magnesium: the forgotten electrolyte. Bol Asoc Med PR. 2013;105(3):17-20.
  28. Corica F, Corsonello A, Lentile R, et al. Serum ionized magnesium levels in relation to metabolic syndrome in type 2 diabetic patients. J Am Coll Nutr 2006 June;25(3):210-5.
  29. Bagis S, Karabiber M. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. 2013 Jan;33(1):167-72.
  30. Lima ML, Cruz T, Rodriguez LE, et al. Serum and intracellular magnesium deficiency in patients with metabolic syndrome-evidences for its relation to insulin resistance. Diabetes Res Clin Pract. 2009 Feb;83(2):257-62.
  31. Therapeutic Research Faculty. Drug influences on nutrient levels and depletion. Nat Med Comp Database. 2010.
  32. Kalyan S, Huebbe P, Esatbeyoglu T, et al. Nitrogen-bisphosphonate therapy is linked to compromised coenzyme Q10 and vitamin E status in postmenopausal women. J Clin Endocrinol Metab. 2014 Apr;99(4):1307-13.
  33. Lazarou J , Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200-5.
  34. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors.Clin Endocrinol (Oxf). 2008 Aug;69(2):338-41.
  35. Kuipers MT, Thang HD, Arntzenius AB. Hypomagnesaemia due to use of proton pump inhibitors-a review. Neth J Med. 2009 May;67(5):169-72.
  36. Ross Pelton. Drug-Induced Nutrient Depletion Handbook. 2nd ed. Lexi-Comp Inc; 2001.
  37. Centeno C, Lopez Saca JM. An update on the importance of monitoring serum magnesium in advanced disease patients. Curr Opin Support Palliat Care. 2013 Dec;7(4):396-405.
  38. Liebscher DH, Liebscher DE. Misdiagnosis of magnesium deficiency. J Am Coll Nutr. 2004 Dec;23(6):S730-1.
  39. Elin RJ. Assessment of magnesium status for diagnosis and therapy. Magnes Res. 2010 Dec;23(4):S194-8.
  40. Cohen S. Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients and Natural Ways to Restore Them. Rodale; 2011.

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