Free and total magnesium in lymphocytes of migraine patients - effect of magnesium-rich mineral water intake

Magnesium as an Important Factor in the Pathogenesis and Treatment of Migraine—From Theory to Practice

So far, no coherent and convincing theory has been developed to fully explain the pathogenesis of migraine, although many researchers and experts emphasize its association with spreading cortical depression, oxidative stress, vascular changes, nervous excitement, neurotransmitter release, and electrolyte disturbances. The contribution of magnesium deficiency to the induction of cortical depression or abnormal glutamatergic neurotransmission is a likely mechanism of the magnesium–migraine relationship. Hence, there is interest in various methods of assessing magnesium ion deficiency and attempts to study the relationship of its intra- and extracellular levels with the induction of migraine attacks. At the same time, many clinicians believe that magnesium supplementation in the right dose and form can be a treatment to prevent migraine attacks, especially in those patients who have identified contraindications to standard medications or their different preferences. However, there are no reliable publications confirming the role of magnesium deficiency in the diet as a factor causing migraine attacks. It also seems interesting to deepen the research on the administration of high doses of magnesium intravenously during migraine attacks. The aim of the study was to discuss the probable mechanisms of correlation of magnesium deficiency with migraine, as well as to present the current clinical proposals for the use of various magnesium preparations in complementary or substitute pharmacotherapy of migraine. The summary of the results of research and clinical observations to date gives hope of finding a trigger for migraine attacks (especially migraine with aura), which may turn out to be easy to diagnose and eliminate with pharmacological and dietary supplementation.

Nutritional composition and antinutrient content of Heteromorpha arborescens (Spreng.) Cham. & Schltdl. leaves: An underutilized wild vegetable

The nutritional and antinutrient composition of Heteromorpha arborescens (Spreng.) Cham. & Schltdl. leaves was reported in this study. Proximate analysis revealed the presence of 8.5% total ash, 4.92% crude fat, 8.41% moisture, 15.74% crude protein, 21.48% crude fiber, 40.95% carbohydrates, and 271.04 kcal/100 g energy value. Mineral analysis showed that H. arborescens leaves are very rich in K, Ca, and Fe. Considerable amounts of Mg, Mn, Na, P, Cu, and Zn were also present. Vitamin analysis showed that the plant has a high content of vitamins A, C, and E. The antinutrients evaluated were phytate, oxalate, saponin, and alkaloids, all of which were below toxic levels except for saponin which was observed at moderately high level. The results credibly indicate that H. arborescens leaves are nutrient-rich and can contribute effectively to the daily nutrient requirements alongside its therapeutic properties.

Headaches and Magnesium: Mechanisms, Bioavailability, Therapeutic Efficacy and Potential Advantage of Magnesium Pidolate

Magnesium deficiency may occur for several reasons, such as inadequate intake or increased gastrointestinal or renal loss. A large body of literature suggests a relationship between magnesium deficiency and mild and moderate tension-type headaches and migraines. A number of double-blind randomized placebo-controlled trials have shown that magnesium is efficacious in relieving headaches and have led to the recommendation of oral magnesium for headache relief in several national and international guidelines. Among several magnesium salts available to treat magnesium deficiency, magnesium pidolate may have high bioavailability and good penetration at the intracellular level. Here, we discuss the cellular and molecular effects of magnesium deficiency in the brain and the clinical evidence supporting the use of magnesium for the treatment of headaches and migraines.

Magnesium and Pain

In terms of antinociceptive action, the main mode of action of magnesium involves its antagonist action at the N-methyl-d-aspartate (NMDA) receptor, which prevents central sensitization and attenuates preexisting pain hypersensitivity. Given the pivotal function of NMDA receptors in pain transduction, magnesium has been investigated in a variety of pain conditions. The oral and parenteral administration of magnesium via the intravenous, intrathecal, or epidural route may alleviate pain and perioperative anesthetic and analgesic requirements. These beneficial effects of magnesium therapy have also been reported in patients with neuropathic pain, such as malignancy-related neurologic symptoms, diabetic neuropathy, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy. In addition, magnesium treatment is reportedly able to alleviate fibromyalgia, dysmenorrhea, headaches, and acute migraine attacks. Although magnesium plays an evolving role in pain management, better understanding of the mechanism underlying its antinociceptive action and additional clinical studies is required to clarify its role as an adjuvant analgesic.

Complementary and Integrative Health Treatments for Migraine

BACKGROUND

Migraine is a chronic disabling neurologic condition that can be treated with a combination of both pharmacologic and complementary and integrative health options.

EVIDENCE ACQUISITION

With the growing interest in the US population in the use of nonpharmacologic treatments, we reviewed the evidence for supplements and behavioral interventions used for migraine prevention.

RESULTS

Supplements reviewed included vitamins, minerals, and certain herbal preparations. Behavioral interventions reviewed included cognitive behavioral therapy, biofeedback, relaxation, the third-wave therapies, acupuncture, hypnosis, and aerobic exercise.

CONCLUSIONS

This article should provide an appreciation for the wide range of nonpharmacologic therapies that might be offered to patients in place of or in addition to migraine-preventive medications.

Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis

Because serum magnesium does not reflect intracellular magnesium, the latter making up more than 99% of total body magnesium, most cases of magnesium deficiency are undiagnosed. Furthermore, because of chronic diseases, medications, decreases in food crop magnesium contents, and the availability of refined and processed foods, the vast majority of people in modern societies are at risk for magnesium deficiency. Certain individuals will need to supplement with magnesium in order to prevent suboptimal magnesium deficiency, especially if trying to obtain an optimal magnesium status to prevent chronic disease. Subclinical magnesium deficiency increases the risk of numerous types of cardiovascular disease, costs nations around the world an incalculable amount of healthcare costs and suffering, and should be considered a public health crisis. That an easy, cost-effective strategy exists to prevent and treat subclinical magnesium deficiency should provide an urgent call to action.

Increased vitamin plasma levels in Swedish military personnel treated with nutrients prior to automatic weapon training

Noise-induced hearing loss (NIHL) is a significant clinical, social, and economic issue. The development of novel therapeutic agents to reduce NIHL will potentially benefit multiple very large noise-exposed populations. Oxidative stress has been identified as a significant contributor to noise-induced sensory cell death and NIHL, and several antioxidant strategies have now been suggested for potential translation to human subjects. One such strategy is a combination of beta-carotene, vitamins C and E, and magnesium, which has shown promise for protection against NIHL in rodent models, and is being evaluated in a series of international human clinical trials using temporary (military gunfire, audio player use) and permanent (stamping factory, military airbase) threshold shift models (NCT00808470). The noise exposures used in the recently completed Swedish military gunfire study described in this report did not, on average, result in measurable changes in auditory function using conventional pure-tone thresholds and distortion product otoacoustic emission (DPOAE) amplitudes as metrics. However, analysis of the plasma samples confirmed significant elevations in the bloodstream 2 hours after oral consumption of active clinical supplies, indicating the dose is realistic. The plasma outcomes are encouraging, but clinical acceptance of any novel therapeutic critically depends on demonstration that the agent reduces noise-induced threshold shift in randomized, placebo-controlled, prospective human clinical trials. Although this noise insult did not induce hearing loss, the trial design and study protocol can be applied to other populations exposed to different noise insults.

Nutrient plasma levels achieved during treatment that reduces noise-induced hearing loss

Hearing loss encompasses both temporary and permanent deficits. If temporary threshold shift (TTS) and permanent threshold shift (PTS) share common pathological mechanisms, then agents that reduce PTS also should reduce TTS. Several antioxidant agents have reduced PTS in rodent models; however, reductions in TTS have been inconsistent. This study first determined whether dietary antioxidants (beta-carotene and vitamins C and E) delivered in combination with magnesium (Mg) reliably increase plasma concentrations of the active agents. Then, additional manipulations tested the hypothesis that these nutrients reduce acute TTS insult in the first 24 h after loud sound as well as longer lasting changes in hearing measured up to 7 days postnoise. Saline or nutrients were administered to guinea pigs prior to and after noise exposure. Sound-evoked electrophysiological responses were measured before noise, with tests repeated 1-h postnoise, as well as 1-day, 3-days, 5-days, and 7-days postnoise. All subjects showed significant functional recovery; subjects treated with nutrients recovered more rapidly and had better hearing outcomes at early postnoise times as well as the final test time. Thus, this combination of nutrients, which produced significant increases in plasma concentrations of vitamins C and E and Mg, effectively reduced hearing loss at multiple postnoise times. These data suggest that free radical formation contributes to TTS as well as PTS insults and suggest a potential opportunity to prevent TTS in human populations.

Update on the assessment of magnesium status

Magnesium (Mg) is the fourth most abundant mineral in the body and the most abundant intracellular divalent cation, with essential roles in many physiological functions. Consequently, the assessment of Mg status is important for the study of diseases associated with chronic deficiency. In spite of intense research activities there is still no simple, rapid, and accurate laboratory test to determine total body Mg status in humans. However, serum Mg < 0.75 mmol/l is a useful measurement for severe deficiency, and for values between 0.75 and 0.85 mmol/l a loading test can identify deficient subjects. The loading test seems to be the gold standard for Mg status, but is unsuitable in patients with disturbed kidney and intestinal functions when administered orally. There is also a need to reach a consensus on a standardized protocol in order to compare results obtained in different clinical units. Other cellular Mg measurements, such as total or ionized Mg, frequently disagree and more research and systematic evaluations are needed. Muscle Mg appears to be a good marker, but biopsies limit its usefulness, as is the case with bone Mg, the most important but heterogeneous Mg compartment. The development of new and non invasive techniques such as nuclear magnetic resonance (NMR) may provide valuable tools for routinely analysing ionized Mg in tissues. With the development of molecular genetics techniques, the recent discovery of Transient Receptor Potential Melastatin channels offers new possibilities for the sensitive and rapid evaluation of Mg status in humans.

Magnesium absorption from mineral waters of different magnesium content in healthy subjects

OBJECTIVE

To assess the absorption of magnesium (Mg) from mineral waters of different Mg content in comparison to low mineralized water and a Mg capsule.

MATERIALS AND METHODS

DESIGN

Randomized, controlled, double- blind trial in a crossover design with an additional control with a Mg capsule.

SETTING

Institute of Balneology and Medical Climatology, Medical School of Hanover, Germany.

SUBJECTS

22 healthy male volunteers aged between 23-46 years.

INTERVENTION

After a standardized breakfast, each participant received, in Latin square order, 500 ml of either of two Mg-rich mineral waters (281 or 120 mg/l). As a control condition, a mineral water of low Mg content (8 mg/l) was used. A Mg capsule (Magnesium-Diasporal 150, Protina, Ismaning, Germany) was used for further comparisons.

RESULTS

Changes in serum Mg levels in the first 4 hours after intake differed significantly between the groups (p = 0.030; ANOVA). Mean values differed between the Mg-rich mineral water conditions and the control conditions though did not reach statistical significance (p = 0.055), however, mean values did not differ between the test waters and the capsule (p = 0.338).

CONCLUSION

Magnesium from mineral waters can easily be absorbed and its absorption rate is similar to that from a pharmaceutical Mg preparation.

Small bowel absorption of magnesium and calcium sulphate from a natural mineral water in subjects with ileostomy

BACKGROUND

In many developed countries, magnesium and calcium intakes do not reach recommendations for a large part of the population. Mineral water may be a useful alternative source of dietary minerals, especially in groups of people at risk for developing deficiency due to low intakes.

AIM

To assess if the addition of a natural and mineral-rich water increased small bowel mineral absorption in people with ileostomy.

METHODS

A controlled randomised crossover study with two periods of two days each and a minimum 5 days of washout was performed in six ileostomy subjects. Apparent mineral absorption from 0.5 L of natural mineral water with either a high or a low mineral content consumed in the fasting state was compared. The daily addition of minerals corresponded to 2.3mmol magnesium, 6.9 mmol calcium and 7.7mmol sulphate. Ileostomy effluents were sampled and analysed for magnesium, calcium and total sulphate.

RESULTS

When compared with the control, the median absorbed amount of magnesium increased from 0.8 (0-1.34) mmol/d to 1.2 (0.8-1.9) mmol/d,which corresponded to a 30% increase (P = 0.028). Median amount of calcium absorbed increased from 8.3 (6.7-13.6) mmol/d to 14.8 (8.3-20.4) mmol/d, i. e. a 45% increase (P = 0.027). The sulphate absorption increased from 1.9 (1.3-2.2) mmol/d to 5.1 (4.2-6.8) mmol/d,which corresponded to 197 % increase (P = 0.028).

CONCLUSIONS

The mineral-rich water increased absorption of both magnesium and calcium and can therefore be used as an additional source of minerals. However, consumption with meals may be preferred.

Post-cholecystectomy syndrome and magnesium deficiency

BACKGROUND AND OBJECTIVE

In 20%-30% of cholecystectomised patients a biliary syndrome (called Post-Cholecystectomy Syndrome: PCES) reappears after some weeks or months. Its etiology, in certain cases, is an anatomic one: (choledochal lithiasis or stricture, obstructive papillitis, pancreatic duct stenosis), but there are many cases in which all organic causes are excluded.

METHODS

The aim of this study was to analyze the correlation between these functional disturbances and magnesium (Mg) deficiency (MD). We analysed 52 patients with PCES and MD, in which organic lesions of the remaining bile ducts were excluded by imaging and endoscopic methods.

RESULTS

MD was confirmed by serum and erythrocytic low Mg levels. 82% of patients were women. Supplemental therapy was provided with Tiomag (Mg gluconate and methionine), vitamin B6 and Ca lactate for 6 weeks or more. In 50 patients, PCES symptomatology disappeared after this treatment. In 14 cases some symptoms reappeared after a few weeks-months, but after repetition of the same therapy they completely disappeared.

CONCLUSIONS

Our results demonstrate the dependence of PCES functional manifestations on MD, especially the recurrence of symptoms, which again subsided after Tiomag therapy was reinstituted.

Mineral water intake reduces blood pressure among subjects with low urinary magnesium and calcium levels

Background

Several previous epidemiological studies have shown a relation between drinking water quality and death in cardiovascular disease whereas others have not found such a relationship. An intervention study was undertaken to evaluate the effect of water with added magnesium and natural mineral water on blood pressure.

Methods

A group of 70 subjects with borderline hypertension was recruited and consumed 1) a water low in minerals, 2) magnesium enriched water or 3) natural mineral water, in a random, double blind fashion during four weeks.

Results

Among persons with an initial low excretion of magnesium or calcium in the urine, the urinary excretion of magnesium was increased in the groups consuming the two waters containing magnesium after 4 weeks. A significant decrease in blood pressure was found in the group consuming mineral water at 2 and 4 weeks.

Conclusion

The results suggest that minerals taken in water are significant for the body burden and that an intake of mineral water among persons with a low urinary excretion of magnesium or calcium may decrease the blood pressure. Further studies should investigate the extent of mineral deficiency in different populations and the efficiency of different vehicles for supplying minerals, particularly magnesium and calcium.

Oral magnesium oxide prophylaxis of frequent migrainous headache in children: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

To assess whether, in children, oral magnesium oxide reduces migrainous headache frequency, severity, and associated features compared to placebo.

BACKGROUND

There is no single, safe, widely well-tolerated, and effective prophylactic treatment for all children and adolescents with frequent migrainous headache.

DESIGN

Randomized, double-blind, placebo-controlled, parallel-group trial.

METHODS

This study was conducted between June 1997 and January 2000 using 7 selected Northern California Kaiser Permanente sites. We recruited children of ages 3 to 17 years who reported a 4-week history of at least weekly, moderate-to-severe headache with a throbbing or pulsatile quality, associated anorexia/nausea, vomiting, photophobia, sonophobia, or relief with sleep, but no fever or evidence of infection. Subjects were randomly assigned to receive either magnesium oxide (9 mg/kg per day by mouth divided 3 times a day with food) (n = 58) or matching placebo (n = 60) for 16 weeks. The number of headache days (days with at least one headache) during each of eight 2-week intervals was chosen to be the primary outcome variable.

RESULTS

Of those enrolled, 86 (73%) completed the study (42 received magnesium oxide and 44 placebo); 74 of 192 eligible subjects declined to participate. Baseline information on demographic factors, health status, and headache history was similar comparing the 2 groups. By intention-to-treat analysis, we found a statistically significant decrease over time in headache frequency in the magnesium oxide group (P =.0037) but not in the placebo group (P =.086), although the slopes of these 2 lines were not statistically significantly different from each other (P =.88). The group treated with magnesium oxide had significantly lower headache severity (P =.0029) relative to the placebo group.

CONCLUSIONS

This study does not unequivocally determine whether oral magnesium oxide is or is not superior to placebo in preventing frequent migrainous headache in children, but treatment with the active agent did lead to a significant reduction in headache days. Larger trials involving this safe, appealing complementary therapy are needed.

A new in vitro blood load test using a magnesium stable isotope for assessment of magnesium status

Magnesium (Mg) status is currently assessed by various biochemical biomarkers, most of which, however, have some limitations. We developed an in vitro blood load test as a new Mg biomarker using a Mg stable isotope. This test is based on the hypothesis that cellular Mg uptake is increased in Mg deficiency. For this purpose, Wister male rats were fed either Mg-deficient or Mg-adequate diets for 1 mo and blood was sampled and incubated with the (25)Mg isotope (10 mg/L) for 2 h at 37 degrees C. Erythrocytes, lymphocytes and platelets were isolated and (25)Mg concentrations were determined by inductively coupled plasma/mass spectrometry. The feasibility of this approach was then tested on human blood. (25)Mg enrichments in erythrocytes, lymphocytes and platelets from Mg-deficient rats were greater than those from controls. (25)Mg enrichment was low in human erythrocytes (3%) compared with rat erythrocytes (38%), whereas high (25)Mg enrichments were obtained in human lymphocytes and platelets, suggesting that lymphocytes and platelets may be more appropriate cells than erythrocytes for examining Mg status in humans with this approach. More studies are required to validate the utilization of this test as a Mg status biomarker in humans.

Contribution of mineral waters to dietary calcium and magnesium intake in a French adult population

OBJECTIVE

To assess the contribution of mineral water containing different amounts of calcium and magnesium to the total dietary intakes of these minerals

DESIGN

Matched case control study using data issued from the Supplementation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort.

SUBJECTS

Subjects were water consumers-240 men and 424 women-divided into the following 4 groups (n=166 per group): regular drinkers of a calcium-rich and magnesium-rich mineral water (calcium, 486 mg/L; magnesium, 84 mg/ L), drinkers of a water classified as a moderately mineralized content (calcium, 202 mg/L; magnesium, 36 mg/L), drinkers of 2 low-mineralized waters (calcium, 9.9 to 67.6 mg/L and magnesium, 1.6 to 2 mg/L, respectively), and drinkers of tap waters.

STATISTICAL ANALYSES

Quantitative data were compared using student's t test. Mean comparisons were performed in multivariate analysis by analysis of variance.

RESULTS

Dietary calcium intake provided by the various food groups did not differ between the 4 consumer groups, except for calcium provided by mineral water. According to its calcium concentration, mineral water may contribute to one fourth of the total daily calcium intake. Subjects who regularly drink mineral-rich water have a calcium intake that is significantly higher (P< 10(-3)) than those drinking either low-mineral-content water or tap water. Dietary magnesium intake provided by the various food groups did not differ between the 4 consumer groups, except for magnesium provided by mineral water. Depending on the magnesium concentration of the mineral water, it contributed 6% to 17% of total daily magnesium intake. Drinkers of magnesium-rich mineral water and water with a moderate mineral content had magnesium intakes significantly (P< 10(-3)) higher than those of drinkers on low-mineralized or tap water.

APPLICATIONS

Mineral-rich water may provide an important supplementary contribution to total calcium and magnesium intake. For dietetics professionals, it may provide-in place of the usual recommendations concerning the consumption of dairy products-a good way to improve calcium and magnesium intakes, particularly in subjects who don't like dairy products.

Oral magnesium load test in patients with migraine

OBJECTIVE

To determine whether migraineurs may have a systemic deficiency of magnesium.

BACKGROUND

Magnesium deficiency has been shown to play a potential role in the pathogenesis of migraine, but there are no data on total body magnesium status in migraineurs.

METHODS

An oral magnesium load test was performed by giving 3000 mg of magnesium lactate during a 24-hour interictal period to 20 patients with migraine (15 women and 5 men; mean age, 37.9 years) and 20 healthy volunteers (16 women and 4 men; mean age, 39.6 years). Baseline and postload magnesium concentrations were determined from serum and 24-hour urine specimens.

RESULTS

There was no significant difference between the groups in the baseline serum and urine magnesium concentrations, although the latter tended to be lower (P = .064) in the migraine group. The postload magnesium concentrations were significantly higher within both the migraine (P < .0001 and P < .0001) and the control (P = .0009 and P < .0001) groups compared to the baseline values. After loading, the 24-hour urinary magnesium excretions were significantly lower (P = .0007) in the patients with migraine than in the controls, but serum values did not differ.

CONCLUSIONS

Magnesium retention occurs in patients with migraine after oral loading, suggesting a systemic magnesium deficiency.