Is Magnesium safe for us or not? - Early CKD Support

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Is Magnesium safe for us or not?

“Stopping Kidney Disease” by Lee Hull was an extremely thought provoking read - but I am confused! He advocates supplementing Magnesium for its cardiovascular benefits: lower risk of vascular calcification and heart disease; antioxidant and anti-inflammatory properties; as well as its association with reduced risk of Type2 Diabetes. It all sounds good!

But warnings come from the National Kidney Foundation, webMD and very many others regarding the risks of taking Magnesium supplements. Can anyone tell me who is right, please?

Many thanks.

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HI HRWB,

This answer to a confusing question is easy. Ask your doctor. Although the book has a lot of good recommendations, every one is different with different needs. Your doctor knows the whole picture including medications. So before you pop anything, ask.

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Thank you, Bassetmommer, for your wise words. That is, of course, the only right answer.

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I too was under the impression the any magnesium was a huge "no no" for a person with CKD. However recently I underwent radiation for cancer of the spine. One of the side effects was severe constipation, causing vomiting, etc. I ended up in the emergency room. What was I given? Magnesium Citrate. I cautioned the doctor that I should not have magnesium due to CKD. He said that what should be avoided is long term use of "high levels" of magnesium. Well the treatment was too effective. I ended up the next day with severe dehydration. Back to the emergency room for 2 bags of saline. A different doctor. We got to discussing magnesium. His advice was the same. He said even a daily vitamin contains magnesium. Does this mean we should not take it because of CKD? No. Magnesium is okay with CKD, but he again stated, within "normal" limits. As was already said, your doctor knows your conditions. Simply ask him his opinion. Get his approval. If you have a cardiologist ask their opinion. Personally I believe to self "medicate" based upon the internet is folly. For every article, website, opinion you can easily find another which contradicts it. Especially for CKD. Articles say take this, take that, eat this, eat that, do this, while just as many will say don't take this, take that, eat this, eat that. Find a doctor(s) you trust. Follow his advice. See your own results with your blood and urine tests. Of course this does not mean to investigate your own health. For example, I have read on this forum different approaches which have been successful for some people. I always mention the positive ones to my doctor(s). Ask if we should try this or that. They are willing to listen. They are willing to say on occasion "try it, it can not hurt".

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Thank you, RickHow, for your response to my question and for your additional sound advice. I am sorry that you had to experience the less welcome effects of magnesium in order to prompt the opinion of two medical professionals. It was, no doubt, reassuring that they were in agreement on the safety of magnesium with CKD! However, we are all different and therein lies the problem with Lee Hull’s confident advocating of the supplement.

Best wishes with your ongoing health issues and many thanks. Helen

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You may have some considerate and communicative doctors, but doctors are people too with preferences, prejudices, and outside influences. They disagree among themselves. Some of them don't keep up with developments in their own fields, much less other specialties. Unfortunately, many of them limit their study of nutrition to the undergraduate course they were required to take in the subject. I like my doctor, but she was rather dismissive of my kidney concerns. I have a GFR of 53. So trust your doctor, but don't blindly trust your doctor. It's your health that's at stake. Research your condition. Lend more credence to peer reviewed articles in professional journals. As you learn more about your condition, you'll become better at sorting through the opinions and finding useful information.

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Thank you so much for your helpful comments. You raise some interesting points in respect of the medical profession. Our doctors have strengths and weaknesses in addition to the many pressures from within and beyond their profession. To find a GP with both the knowledge and the time to discuss a situation at length is unusual in the NHS of today. It makes our search for sound advice feel like a solo journey, which may have many false avenues along the way. That is one reason why this forum is so supportive. Many thanks.

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I am London based and specialise in kidneys - so don't lose heart that there are tools to help you. Nephrology is the UK is way too medicalised and has not evolved sufficiently.

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Yes I have a good medical team (primary care, kidney doctor, cardiologist, oncologist, urologist). It gives me the luxury of different opinions on my questions and health status. I find in general they all concur, without even knowing what the other has said. I am not blind to just following without a thought in my head. It is one reason I'm on this forum. To read what others do and have experienced. But when push comes to shove, the one reason I have faith in my doctors is they have something that all the opinions, theories, articles, websites, professional journals (which just publish without confirming accuracy of an article or publication). That is? They don't know what my doctors know about ME. My blood test (over time), urine tests (over time), other conditions I have (cancer), ultrasounds, MRI's, CT Scans that I have taken all within the past year.

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Not sure where you live, Rick, but here in the United States, most doctors don't even own their practices any more. They were forced by the insurance industry many years ago into forming medical "groups" in order to protect themselves. Now these groups have been bought out by the hospitals in order for the hospitals to protect themselves against the insurance industry which pays the bills. My last pcp, who I absolutely loved, was booted from her practice due to not bringing in enough revenue. And my pcp before her, who I went to for nearly 20 years, chose to retire early as he saw the writing on the wall. Doctors make money by providing services, period. That's how our system is set up. And there's no financial incentive to finding cures. The incentive is to find "treatments". As the comedian Chris Rock so aptly put it; "There ain't no money in a cure. The money's in the come-back!" Our system is a for-profit system and profits ALWAYS come first. This is why the insurance companies want to give the boot to people with pre-existing conditions who are unprofitable as they did in the old days. You seem like a smart guy. Please don't tell me you believe otherwise. And as somebody mentioned above, most doctors have never taken a nutrition course in their entire lives, not to mention having kept up with the latest research. Why? Because they're either set in their ways or just don't have the time at the end of a busy day.

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You write very clearly. I like it! This is an issue I am particularly passionate about with much of my clinical focus now turned to doctors.

Fasting and breathing properly are the two cornerstones to health - both free....it is an irony that we now need people to tell us to fast and breathe when we evolved by doing both these things. Summary - there are always tools to help you heal. Always explore and always listen to your instinct. Part of my mission is to get these messages into our NHS here in the UK. There are small geysers of hope but given how medics have been revered at great consequence to both public health and themselves - the small geysers need to become massive waterfalls - we are each a part of that change in how we show up, question and challenge. I now work with doctors on these issues because some of them care and can no longer stay blind to the truth. The system doesn't work and many are opening their eyes to that. As the Lakota tribe saying goes - 'If you're not part of the solution, you're part of the problem.'

I have done this questing and challenging all my life as a kidney patient in the NHS for 30 years and it has been my saviour to question and to trust my own instincts. I have said No to many drugs because I know the true research and I will always trust the messages from my body. Doctors are not super human and being treated as such has lead to massive physician burnout and alarming rates of suicide in the medical population.

We all must take responsibility for our own health and discern clearly what feels right for us from a place of knowledge and honest inquiry. It's certainly not always easy as challenge can be difficult especially when someone is not aware of nutritional medicine but we must be informed and continue to question.

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Your comments regarding opinions, theories, articles, and websites are valid. However, the editors and staff of professional journals in the fields of medicine and the scientific disciplines are diligent in insuring that only studies meeting exacting standards are published. The preface and conclusion of articles that meet those standards point out the strengths and weaknesses of each study. The authors include references to support their findings and conclusions. Articles that make the cut are peer reviewed by a critical professional audience with advanced degrees and experience in associated disciplines.

Many of the studies submitted for publication are challenging and rigorous involving large groups and vast expenditures of time and resources. Some stretch on for years, and many are ongoing. Though seeing their work published may be a motivating factor, the doctors and scientists involved are primarily motivated by professional curiosity, the search for answers to perplexing questions, and an interest in advancing their field of knowledge. In the medical field, many are also driven by a fervent desire to alleviate needless suffering and death.

Our personal physicians do, of course, know more about our condition that all these outside voices. However, our doctors also have many other patients. I only have one. The one who knows my body and my condition best, and is most interested in my health is me.

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Hi there - I am a nutritionist specialising in kidneys - also myself being a kidney patient.

In response to your question, magnesium is only really an issue when the kidneys are severely compromised - say 15% and under. Otherwise it is fine. Dr Carolyn Dean has done a lot of work in this area. What I would counsel is including magnesium rich foods and taking regular Epsom salts baths as it is better to recruit natural lifestyle modifications rather than over supplement. Magnesium is important for muscle health (hence the cardiovascular benefits given the heart is a specialised muscle). I personally did supplement at about 800 mg daily a number of years ago when I had a working transplant and was suffering with regular migraines - that helped a lot along with reducing alcohol and taking time to rest more as well as regular yoga.

What is your current GFR and consider too why you are wishing to supplement? Getting enough activity, spending time in nature, hugging loved ones, swimming in the sea - this is all medicine too for the heart!

Best,

Ciara

whollyaligned.com

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What do you recommend for a person whose numbers are normal and a "decreased egfr with no kidney damage" of 70. My doctor told me to up the water, limit sodium, no caffeine, no NSAIDs and lose weight. Your thoughts?

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All sounds like good advice. NSAIDS are absolutely contra-indicated for kidney issues and I don't recommend them to anyone I work with (I don't just work with kidneys!). Caffeine is a personal choice. I have one black coffee in the morning (my situation is different as currently on PD but have had coffee for years and it's no issue for me including when I had a working transplant) and really enjoy it. Limit is the operative word there regards sodium. It is a key electrolyte and very much needed by the body, meaning not no sodium! If you home cook you'll be fine - it's commercial and packet food that tend to be loaded with salt. Consider the Mediterranean diet that shows good longevity and health result and that contains cheese and olives and some other salty foods so some sodium is fine and indeed important, especially if you sweat and are drinking a lot of water - both will have a bearing on your electrolyte status.

Lose weight is a very broad one - fasting windows (intermittent fasting) is the most effective and safest and comes with all sorts of wonderful benefits. Check out Dr Jason Fung (Toronto based nephrologist) who I totally love for the sense he speaks. Of course sugar is a huge one so no soda pop including anything 'diet' that will be full of artificial sweeteners. Drink water at room temperature as it is less stress on the body.

I am also a yoga teacher so always emphasise a spiritual practise, whatever resonates with you. Sitting with our stuff so the mind is not running the show. Find a yoga class if it's something already in your life. Explore.

Hope this helps,

Best,

Ciara

whollyaligned.com

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I appreciate your advice, Ciara, given from both professional knowledge and a ‘patient’ point of view. I am a 73 year-old female with eGFR at around 54. My interest in supplementing magnesium arises from concerns about cardiovascular health. I have high total cholesterol - currently 8.4 - diagnosed familial hypercholesterolaemia. HDL level is good at 1.7. BP is 127/71. Having refused statins for over thirty years, I relented last year and took atorvastatin for a period of six months. After experiencing many unwelcome side effects I discontinued, despite the fact that during those six months my eGFR did show improvement. Currently taking no prescribed medication at all - my preferred option! For that reason, I particularly welcome your ‘alternative ‘ recommendations. Nature does indeed nurture! Many thanks. - Helen

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Hi Helen - thank you for your lovely message. Wow that's a beautiful blood pressure. Your heart must be very happy indeed! So that's a big positive. In terms of the familial cholesterol issue, this is an interesting one. I am the same in that I refuse statins and I'm sorry to hear you had side effects after taking them - it seems common. GFR of 54 is super. you can absolutely thrive at that level as I'm sure you know. It might be that a high cholesterol is simply what is right in your DNA pool. In isolation, high cholesterol is not a cardiovascular risk. Especially if HDL ratio is good. If it presents together with hypertension, being overweight and emotionally frustrated, then one might see a higher risk profile. What's interesting is that people who have heart attacks - in most cases they all had 'normal' cholesterol profiles. In terms of advising you on magnesium, it's tricky without taking a full case and discerning what is appropriate for you. I would definitely include Epsom salts baths if you enjoy taking a bath - you can pick a big bag up at a local chemist. Make sure it is just pure magnesium sulphate and not a strange combo of fragranced salts. It's pretty reasonable. Maybe £7 for a big bag. Add three generous cupfuls into the bath and soak for at least 10-15 minutes say 2 to 3 times a week. You can also look at this also in terms of patterns that might be depleting your tissue magnesium (note blood serum magnesium doesn't tell us much as the magnesium tends to be in the deeper muscular tissue) - caffeine, high sugar, alcohol, stress - all deplete magnesium status. So I advise just 1-2 caffeine drinks being organic coffee and tea and green tea, no soda pop of course! That's if you enjoy coffee and tea otherwise don't worry. Green tea actually has a protective effect on the heart and is a great option for kidney patients as it is also good for bones and mental focus. Deep breathing is also an amazing and profound tool for the cardiovascular system. Coherent breath is when you breathe in smoothly for the count of 6 seconds, through the nose, letting the belly rise up so the diaphragm moves down and then breathe out for 6 seconds through the nose, feeling the belly gently fall. You might need to build up to 6 if it's too much at first. This doubles your circulatory capacity which is the same effect as exercise. It also oxygenates the blood and a common issue in modern life with all the chaos and stress is shallow breathing! Ill health defiantly comes from too much shallow breathing as the brain and muscles and whole complex body/mind system are not getting enough oxygen. This impacts muscle health, mood, energy levels, lung capacity. Do the coherent breathing for 20 minutes a day and see how you feel. Over 6 months and longer with this consistent practise, it will change and influence a lot for the better. Walking in nature is also great heart medicine. Did you know in Japan they actually have a practise called 'forest bathing' where they lie in a forest and just soak it all up. Makes sense they have the most centurions! Lifestyle and beliefs and culture matter. Thoughts and actions matter - they all make up our life experience. I know you know this as you are in your 70s and I can see you have an open mind which serves you so well. I hope this is helpful. Very best Helen, Ciara

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Thank you, Ciara, for again sharing your thoughts so generously. Your reply was very reassuring and gave me a positive lift. The Japanese ‘forest bathing’ sounds blissful - and I certainly do feel the benefit of being among trees when the opportunity arises. Maybe that would be a great place to try out the coherent breathing that you recommend! Thank you also for your guidance on the use of magnesium, which was the subject of my original question. All your helpful suggestions offer a means of increased relaxation, which must surely lead to better health outcomes. Very many thanks. Helen

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You are so welcome Helen. I'm so pleased you found it reassuring and uplifting. I love your perceptiveness around the increased relaxation. It really is exactly that - reminding the body/mind system of the powerful relaxation response which has profound physiological benefits. Another practise I incorporate regularly is gratitude. Each night as I get into bed I bring to mind three things from the day I am grateful for. Having been practising this for a few years now, it has had such a positive impact on seeing life through the lens of joy and abundance. Very best, Ciara

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Yes, indeed, gratitude for even the smallest of things sets feelings onto a more positive track. Thank you for your wise words.

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Returning to your original question regarding supplementing magnesium, Lee Hull, in his book, also points out that hypermagnesium can be dangerous, and the magnesium supplementation he suggests is moderate. The chapter dedicated to magnesium cites thirty articles published in such prestigious journals as The American Journal of Nephrology, , the Journal of Renal Nutrition, and International Urology and Nephrology, to name a few. However, as I don't make consequential changes without, as my wife says, researching it to death, I have delved into the matter further. I won't try to include all my findings here, but this review, published after Mr. Hull's book, pulls together information from numerous studies on the subject, and might interest you

ncbi.nlm.nih.gov/pmc/articl...

I will quote from the conclusion

"Serum magnesium concentration consistently is inversely associated with all-cause and cardiovascular mortality in patients treated with hemodialysis or peritoneal dialysis and patients with CKD not treated with dialysis. This association persists even above the “normal” reference range of magnesium concentrations. This suggests that the reference concentrations for serum magnesium do not necessarily represent the optimal concentrations, but should be higher in CKD."

They do not suggest what levels would be optimal for persons at various levels of ckd, but state that

"Prospective clinical trials are needed to determine the effect of magnesium supplementation on clinically relevant outcome and to determine how to optimize plasma magnesium concentrations in individual patients with CKD before individualized target ranges for serum magnesium concentrations can be adopted in clinical practice."

Though everything published is subject to review and opposing viewpoints should be entertained and considered, when sufficient evidence accumulates, we are beginning to approach the level of scientific certainty. I, personally, am persuaded as to the value of supplemental magnesium and intend to introduce it into my diet. I will probably be taking a low dose of time-release magnesium similar to that suggested by Lee Hull. However, the Epsom salts baths described by WhollyAligned are intriguing. I believe that the medical profession may reach the same conclusion that I have, but I can't afford to wait. Regards, Ron

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Thank you for sharing the link to the review of research into magnesium and CKD. I have only skimmed the report so far, but was interested to note the mention of a connection between low serum magnesium and type 2 diabetes and, possibly, hypercholesterolaemia. I look forward to an in-depth read.

You may have discovered that by tapping on the website’s MDPI logo, you will find a menu of other articles and reviews relating to CKD.

mdpi.com/journal/nutrients/...

Topics include: low protein diet; lipids; gut microbiota; folic acid and vitamin B12. There is always more to learn! Thank you for your own research guidance.

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I hadn't looked at the other articles - some interesting information. There is certainly always more to learn, and I hesitate to make any changes without thoroughly researching the possible consequences both positive and negative.

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Regarding the Epsom salts baths suggested by WhollyAligned, the sulphate part of magnesium sulphate gives me pause. I have doubts regarding the efficacy of absorbing magnesium in this manner, and, in any case, introducing more sulphates to be processed might have a negative impact on already compromised kidneys. You might find this article of interest.

ncbi.nlm.nih.gov/pmc/articl...

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The article is certainly of interest - thank you. Transdermal absorption appears to be an area for further investigation. My concern would be the lack of any control over the level of absorption - if this does occur. Personally, I am happy to eat measurable quantities of almonds and pumpkin seeds to boost my magnesium intake.

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