Common Name: Manganese

Overview:

Although human tissue contains only small amounts of the metal manganese, it is believed to be an essential trace mineral. Manganese is an important component of many enzymes, especially the antioxidant enzyme superoxide dismutase (MnSOD). Manganese is found primarily in the bones, liver, kidneys and pancreas. It plays an important role in the formation of connective tissue, bones, hormones, blood clotting factors as well as fat and carbohydrate metabolism. It also plays a role in calcium absorption and blood sugar regulation. Normal brain and nerve function also depend on manganese.

Manganese deficiency has been well documented in animals. Impaired growth, skeletal abnormalities, impaired glucose tolerance, altered carbohydrate and lipid metabolism as well as impaired reproduction were all demonstrated in animal manganese deficiency
Manganese deficiency has not been well studied in human nutrition. The symptoms of decreased serum cholesterol levels, slower than normal hair and nail growth, a skin rash, weight loss and impaired ability of the blood to clot were seen in a man taking large amounts of antacids while on a 4 month magnesium deficient diet. Another report of men fed a low manganese diet showed lower serum cholesterol and skin rash. In one instance of a child on long term parenteral nutrition that lacked manganese developed loss of minerals in the bones and impaired growth. When manganese was added to the diet these conditions were resolved.

Whole grains are a major source of dietary manganese. Because the American diet relies heavily on refined carbohydrates and processed foods, it is reported that 37% of the U.S. population is manganese deficient.

Benefits

Manganese has proven beneficial in:

1. Arthritis. Those who suffer from rheumatoid arthritis have low levels of MsSOD. This antioxidant protects joints from the damage casued by inflammation. In a recent randomized, double blind placebo controlled study, manganese in combination with glucosamine and chrondroitin sulfate was helpful in treating knee osteoarthritis.
2. Osteoporosis. Manganese along with other trace minerals are extremely important in bone health. Many experts believe that the appropriate balance and intake of manganese and these other trace minerals may play an important role in maintaining bone density and preventing osteoporosis.
3. Diabetes. People with diabetes have significantly lower manganese levels. It is not known however if this low manganese level is the cause or the effect of this condition. More studies are needed in this area to determine whether manganese supplements will help prevent or treat diabetes.
4. PMS (post menstrual syndrome). In one study, women who ate small amounts of manganese experience greater mood swings and cramping pain that women who ate sufficient amounts of manganese.
5. Epilepsy. It has been suggested in several studies that manganese levels are lower in people who have seizure disorders. As with diabetes, it it not known whether these lower than normal manganese levels are the cause of the seizures or the results of the seizures.
6. Several other disorders. Lower serum manganese levels have been associated with muscle disorders that involve lack of co ordination, in irregular menstrual cycles, ringing in the eye, as well as poor milk production in women who are breast feeding.

Dietary Sources

	Whole grains		Nuts
	Leafy vegetables		Tea
	Pineapples		Avocados
	Blueberries		Seaweed

Recommended Dosage

Typical supplemental intake of manganese usually ranges from 2-5mg per day.
Total dietary intake of manganese should not exceed 11mgs per day. This is because of the risk of neurological side effects. Supplementation from non food source in children should only be undertaken under the supervision of a qualified healthcare practioner.

Calcium, phosphorous and manganese work closely with each other. Because of this, the body’s requirement for manganese may increase as the consumption of calcium and phosphorous increases.

Contra-indications

1. People who are in liver failure should not take manganese supplements. It has been found that in end stage liver disease, manganese concentrates in nerve cells. This concentration of manganese can contribute to decreased mental abilities in those who are suffering from liver failure.
2. Under certain conditions manganese can be toxic. Mine workers who breathe in large amounts of manganese dust suffer from what is called “manganese madness. In later stages of this disease, symptoms similar to Parkinson’s disease develop.
3. Women who are pregnant or breastfeeding should avoid supplementing with manganese levels above 20.-5.0mg per day.

Drug interactions

1. Antacids that contain magnesium when taken with manganese may decrease the absorption of manganese.
2. Laxatives such as milk of magnesium that contain magnesium when taken with manganese may decrease the absorption of manganese.
3. Tetracycline when taken with manganese may decrease the absorption of manganese.
4. Calcium, iron and magnesium taken at the same time as magnesium may decrease the absorption of manganese.

Web References

1. http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21802
2. http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/man_0171.shtml
3. http://www.umm.edu
   

Printed Reference Material

1. Baly DL, Schneiderman JS, Garcia-Welsh AL. Effect of manganese deficiency on insulin binding, glucose transport and metabolism in rat adipocytes. J Nutr. 1990; 120:1075-1079.
2. Fell JME, Reynolds AP, Meadows N, et al. Manganese toxicity in children receiving long-term parenteral nutrition. Lancet. 1996; 347:1218-1221.
3. Gong H, Amemiya T. Optic nerve changes in manganese-deficient rats. Exp Eye Res. 1999; 68:313-320.
4. Hussain S, Ali SF. Manganese scavenges superoxide and hydroxyl radicals: an in vitro study in rats. Neuroscience Letters. 1999; 261:21-24.
5. Keen CL, Ensunsa JL, Watson MH, et al. Nutritional aspects of manganese from experimental studies. Neurotoxicol. 1999; 20:213-223.
6. Komaki H, Maisawa S, Sugai K, Kobayashi Y, Hashimoto T. Tremor and seizures associated with chronic manganese intoxication. Brain Dev. 1999;21(2):122-124.
7. Krieger D, Krieger S, Jansen O, et al. Manganese and chronic hepatic encephalopathy. Lancet. 1995; 346:270-274.
8. Leffler CT, Philippi AF, Leffler SG, Mosure JC, Kim PD. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Military Medicine. 1999:164(2):85-91.
9. Leonhartdt W, Hanefeld M, Muller G, et al. Impact of concentrations of glycated hemoglobin, alpha-tocopherol, copper, and manganese on oxidation of low-density lipoproteins in patients with type I diabetes, type II diabetes, and control subjects. Clin Chim Acta. 1996;254(2):173-186.
10. Mehta R, Reilly JJ. Manganese levels in a jaundiced long-term total parenteral nutrition patient: Potentiation of haloperidol toxicity?: Case report and literature review. J Parenter Enter Nutr. 1990;14(4):428-430.
11. Morselli B, Neuenschwander B, Perrelet R, Lippunter K. Osteoporosis diet [in German]. Ther Umsch. 2000;57(3):152-160.
12. Nagatomo S, Umehara F, Hanada K, et al. Manganese intoxication during total parenteral nutrition: report of two cases and review of the literature. J Neurol Sci. 1999; 162:102-105.
13. Nielsen FH. Ultratrace minerals. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease, 9th ed. Baltimore, MD: Williams and Wilkins; 1999:283-303.
14. Nielsen FH. Ultratrace minerals: manganese. In: Shils ME, Olson JA, Shihe M, Ross RC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Williams & Wilkins; 1999:289-291.
15. Pasquier C, Mach PS, Raichvarg D, Sarfati G, Amor B, Delbarre F. Manganese-containing superoxide-dismutase deficiency in polymorphonuclear leukocytes of adults with rheumatoid arthritis. Inflammation. 1984;8:27–32.
16. Penland JG, Johnson PE. Dietary calcium and manganese effects on menstrual cycle symptoms. Am J Obstet Gynecol. 1993;168(5):1417-1423.
17. Saltman PD, Strause LG. The role of trace minerals in osteoporosis. J Am Coll Nutr. 1993;12:384–389.
18. Strause L, Saltman P, Glowacki J. The effect of deficiencies of manganese and copper on osteo-induction and on resorption of bone particles in rats. Calcif Tissue Int. 1987; 41:145-150
19. Strause L, Saltman P, Smith KT, et al. Spinal bone loss in postmenopausal women supplemented with calcium and trace minerals. J Nutr. 1994; 124:1060-1064.
20. Strause LG, Hegenauer J, Saltman P, et al. Effects of long-term dietary manganese and copper deficiency on rat skeleton. J Nutr. 1986; 116:135-141.
21. Walter RM Jr, Uriu-Hare JY, Olin KL, Oster MH, Anawalt BD, Critchfield JW, Keen CL. Copper, zinc, manganese, and magnesium status and complications of diabetes mellitus. Diabetes Care. 1991;14(11):1050-1056.

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Common Name: Magnesium
Synonyms: Mg++, Magnesium chloride, magnesium citrate, magnesium fumarate, magnesium gluconate, magnesium malate, magnesium oxide, magnesium sulfate

Overview:

Magnesium is an earth metal that exists in the human body in its divalent state. It is an essential mineral involved in over 300 metabolic functions and in every organ in the body. Magnesium is involved in the production of cellular energy and the synthesis of nucleic acids (the building blocks of DNA) and proteins. It also has an important role in the electrical stability of cells, the maintenance of cell membrane integrity, muscle contractions, nerve impulse conduction and the regulation of vascular tone. Magnesium is essential for ion transport across cell membranes. Magnesium is intimately connected to the regulation of calcium and potassium levels as well the levels of copper, zinc, and vitamin D. Without sufficient magnesium, cellular energy production would stop and so would life.

Although magnesium is found in sufficient amounts in unprocessed whole foods, most Americans, especially the elderly, do not get enough magnesium in their diet. This is because the highly refined American diet has lost a large amount of the naturally occurring magnesium found in whole, unprocessed foods. Despite the low magnesium levels in the American diet, severe magnesium deficiency is rare. But certain medications and diseases as well as poor dietary choices can lead to low magnesium levels. These include but are not limited to:

1. intestinal flu with vomiting and diarrhea as can
2. stomach and bowel diseases such as IBS, celiac, sprue
3. diabetes,
4. Pancreatitis,
5. Hyperthyroidism
6. Kidney disease and use of diuretics
7. Excessive sweating
8. Too much soda pop, salt or alcohol

Signs of magnesium deficiency include agitation, anxiety, irritability, nausea and vomiting, abnormal heart rhythms, muscle spasm and weakness, hyperventilation, insomnia, poor nail growth, seizures. Ultimately, severe magnesium defiance leads to coma and death.

Benefits

As already stated, magnesium is essential for health. Numerous studies are confirming the use of magnesium supplementation in a number of diseases and conditions that are exacerbated by low magnesium levels. These studies have shown magnesium to be of benefit in:

1. People who suffer from recurrent migraine headaches have a lowere intracellular (inside the cell) level of magnesium than do those who do not suffer from these debilitating headaches. In two placebo controlled trials, the use magnesium supplements of 600mg showed modest decreases in the frequency of migraine headaches. One trial took place over a twelve week period with 81 people given either 600mg of magnesium or a placebo. By the time the study reached the last 3 weeks of testing, those who received the magnesium supplements had 41.6% fewer migraines compared to 15.8% who received no magnesium supplements. A smaller studied reached a similar conclusion. The only side effects of supplementing with this level of magnesium were diarrhea and in a few cases gastrointestinal irritation.
2. Preventing the development of asthma. In a population based study of 2,500 children from 11 to 19 years of age, low dietary intake of magnesium might be associated with a higher risk of developing asthma. A similar study in over 2,600 adults from 18 to 70 showed a similar correlation.
3. The treatment of acute asthma attacks. In one double blind placebo controlled study of 38 adults, that were non responsive to initial emergency treatment, found improved lung function and a decreased likelihood of hospital admission after an infusion of magnesium sulfate. In one meta- analysis, intravenous magnesium was found to significantly reduce the rate of hospital admissions and to improve pulmonary function of patients treated in emergency rooms. This benefit was seen only in those suffering from severe asthma attacks and no benefits were seen in those with mild to moderate symptoms. Epidemiological data has also shown that higher dietary intakes of magnesium are associated with a lower incidence of airway reactivity and respiratory symptoms associated with asthma. This may also be true for those who suffer from emphysema or COPD (chronic obstructive pulmonary disease).
4. Helping to control high blood pressure. Studies have shown that eating low fat diary along with lots of fruits and vegetables helps to moderate blood pressure. Since all of these foods are high not only in magnesium but calcium and potassium. As similar studies with magnesium supplements have shown the same benefits, it is surmised that a combination of the these three nutrients accounts for this effect.
5. Treatment of Attention Deficit/Hyperactivity Disorder (ADHD). Some experts have concluded that children with ADHD are showing the effects of mild magnesium deficiency such as irritability, decreased attention span and mental confusion. In a study of 116 children with ADHD, 95% were magnesium deficient. In another study, 75 magnesium deficient children with ADHD were randomly assigned to receive magnesium supplements in addition to standard treatment or just standard treatment for 6 months. Those who received magnesium and standard treatment demonstrated a significant improvement in behavior while those who received only standard treatment showed an increase in unacceptable behavior.
6. Increasing insulin resistance. Depletion of magnesium is commonly associated with both insulin dependant and non-insulin dependant diabetes. Between 25 and 38% of diabetics have decreased serum magnesium levels. This maybe because of the increased loss as a result of the increased excretion of glucose which accompanies poorly controlled blood sugar levels. Supplementation with magnesium may increase insulin resistance, this especially true in the elderly.
7. The treatment of osteoporosis. In osteoporosis and bone density, calcium has been the main focus. A change in the collagenous matrix that holds the calcium may result in bones that are brittle and more susceptible to braking. Magnesium compromises about 1% of bone mineral and influences both the bone matrix and the bone mineral metablolism. As the magnesium content of bone mineral decreases, the bone crystals become larger and more brittle. This low magnesium level has cascading effect. Low blood magnesium levels lead to low blood calcium levels which inturns leads to resistance to parathyroid hormone and to some of the effects of vitamin D which all lead to increased bone loss. A study of 900 elderly men and women found that higher dietary intake of magnesium correlated with increased bone density at the hip.
8. Preeclampsia and eclampsia (toxemia of pregnancy). This is a disease that is unique to pregnancy and occurs anytime after the 20th week of pregnancy till 6 weeks after birth. Preeclampsia is defined as the presence of elevated blood pressure, the appearance of protein in the urine and severe edema (swelling) during pregnancy. Eclampsia occurs when seizures are present along with the other symptoms. Eclampsia is a significant cause of maternal death. High doses of intravenous magnesium have been the treatment of choice for both of these conditions. Magnesium is believed to relieve the cerebral blood vessel spasm and increase blood flow to the brain.
9. Relieving the symptoms of PMS (Premenstrual Syndrome). Scientific evidence as well as clinical experience suggests that magnesium supplements may help relieve the bloating, leg swelling, weight gain and breast tenderness as well as mood swings that are common in PMS. A double blind placebo controlled study of 32 women showed that taking magnesium supplements starting on day 15 of the menstrual cycle to the onset of menstrual flow could significantly improve PMS symptoms, especially mood changes. Another study showed that taking regular magnesium supplements reduced fluid retention. Magnesium supplements were also found to be helpful in relieving dysmenorrheal or painful menstruation.
10. The treatment of stroke and transient ischemic attack or TIA (a temporary disturbance in the blood supply to an area of the brain). Preliminary studies suggest that people with low magnesium levels are at a greater risk of stroke. Preliminary scientific evidence hints that magnesium sulfate may be helpful in the treatment of both stroke and TIA.

Dietary Sources

	Legumes such as beans		Legumes such as peas
	green leafy vegetables		almonds
	wheat bran		cashews
	brazil nuts		blackstrap molasses as well as peanuts
	whole wheat and oat flour		beet greens
	chocolate		cocoa powder
	many herbs and spices		seaweeds

Recommended Dosage:

Pediatric

1. Infants birth to 6 months: 30 mg-this should be in the form of formula, breast milk or food
2. Infants 6 months to 1 year: 75 mg -this should be in the form of food not supplements
3. 1 to 3 years: 80 mg
4. Children 4 to 8 years: 130 mg
5. Children 9 to 13 years: 240 mg
6. Adolescent males 14 to 18 years: 410 mg
7. Adolescent females 14 to 18 years: 360 mg

Adult

1. Males 19 to 30 years: 400 mg
2. Females 19 to 30 years: 310 mg
3. Males 31 years and older: 420 mg
4. Females 31 years and older: 320 mg
5. Pregnant females under 18 years: 400 mg
6. Pregnant females 19 to 30 years: 350 mg
7. Pregnant females 31 to 50 years: 360 mg
8. Breastfeeding females under 18 years: 360 mg
9. Breastfeeding females 19 to 30 years: 310 mg
10. Breastfeeding females 31 to 50 years: 320 mg

Magnesium needs increase during times of protein synthesis, such as pregnancy, recovering from certain illnesses, and athletic training.

Contra-indications

Women who are pregnant or breastfeeding should consult a health care provider before using supplements of magnesium that exceed the recommended amount. Individuals with heart or kidney disease should not take magnesium supplements except under the guidance of their healthcare practitioner.

People who suffer from myasthenia gravis (Lou Gehrig’s disease) should avoid magnesium supplements. Magnesium supplements could cause an increase in weakness and trigger a myasthenic crisis.

Overdosing with magnesium is hard to do with food alone. Those who take large amounts of milk of magnesia or Epson salts may overdose. Too much magnesium can cause serious health problems including:

1. nausea
2. vomiting
3. severely low blood pressure
4. slowed heart rate
5. deficiencies of other minerals, especially calcium
6. confusion
7. coma
8. and even death
   

Magnesium competes with calcium absorption. If calcium intake is already low, this can lead to a calcium deficiency.

Drug interactions

If you are taking any of the medications listed below consult yo9ur healthcare practitioner before starting a magnesium supplement.

1. Antibiotics such as the Quinolones (a class of antibiotics that include ciprofloxacin and moxofloxacin), tetracycline, doxycycline, minocycline as well as nitrofurantoin. Magnesium supplements can decrease the absorption of these antibiotics. Magnesium supplements should be taken tow to four hours before or after taking these antibiotics to avoid interfering with them.
2. Blood pressure medications, calcium channel blockers. Magnesium may increase the likelihood of negative side effects of calcium channel blockers in pregnant women.
3. Diabetic medication. Magnesium hydroxide, often found in antacids has been known to increase the absorption of oral diabetic medications such as glipizide and glyburide. Magnesium supplementation may allow for a decrease in the amount of medication needed to control blood sugar but should be closely monitored by a health care practioner.
4. Digoxin. Magnesium levels must be monitored while on digoxin. Low blood levels of magnesium may increase the negative side effects of this medication. If you are taking digoxin, your healthcare practioner will monitor the magnesium levels to determine of supplementation is needed.
5. Certain diuretics known as loop diuretics (such as furosemide) and thiazide diuretics (including hydrochlorothiazide) can deplete magnesium levels. Because of this healthcare practitioner prescribing these diuretics may recommend magnesium supplements.
6. Those people who are taking penicillamine for the treatment of Wilson’s disease ( a condition characterized by high coppr levels) and rheumatoid arthritis may want to use a magnesium supplement. This medication when taken over a long period of time has been shown inactivate magnesium. A healthcare practitioner will need to determine if supplementation is necessary.
7. Magnesium may interfere with the absorption of tiludronate used to treat osteoporosis. Magnesium supplements or magnesium antacids should be taken at lest tow hours before or two hours after these medications to minimize magnesium interfering in their absorption.

Web References

1. http://lpi.oregonstate.edu/infocenter/minerals/magnesium/
2. http://www.umm.edu/altmed/ConsSupplements/Magnesiumcs.html
3. http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21795
4. http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/mag_0167.shtml

Printed Reference Material

1. Abbott L, Nadler J, Rude RK. Magnesium deficiency in alcoholism: possible contribution to osteoporosis and cardiovascular disease in alcoholics. Alcohol Clin Exp Res. 1994; 18:1076-1082.
2. Alaimo K, McDowell MA, Briefel RR, et al. Dietary intake of vitamins, minerals and fiber of persons age 2 months and over in the United States: Third National Health and Nutrition Examination Survey, phase 1, 1988–91. Advance Data from Vital and Health Statistics. 1994;258:1-26.
3. Altura BM, Altura BT. Role of magnesium and calcium in alcohol-induced hypertension and strokes as probed by in vivo television microscopy, digital image microscopy, optical spectroscopy, 31P-NMR, spectroscopy and a unique magnesium ion-selective electrode. Alcohol Clin Exp Res. 1994; 18:1057-1068.
4. Andon MB, Ilich JZ, Tzagournis MA, et al. Magnesium balance in adolescent females consuming a low- or high-calcium diet. Am J Clin Nutr. 1996;63:950–953.
5. Attias J, Weisz G, Almog S, et al. Oral magnesium intake reduces permanent hearing loss induced by noise exposure. Am J Otolaryngol. 1994;15:26–32.
6. Baxter GF, Sumeray MS, Walker JM. Infant size and magnesium: insights into LIMIT-2 and ISIS-4 from experimental studies. Lancet. 1996; 348:1424-1426.
7. Britton J, Pavord I, Richards K, et al. Dietary magnesium, lung function, wheezing, and airway hyper-reactivity in a random adult population sample. Lancet. 1994; 344:357-362.
8. Casscells W. Magnesium and myocardial infarction. Lancet. 1994; 343:807-809.
9. Christiansen CW, Rieder MA, Silverstein EL, Gencheff NE. Magnesium sulfate reduces myocardial infarct size when administered before but not after coronary reperfusion in a canine model. Circulation. 1995; 92:2617-2621.
10. de Lourdes Lima M, Cruz T, Carreiro Pousada J, et al. The effect of magnesium supplementation in increasing doses on the control of type 2 diabetes. Diabetes Care. 1998; 21:682-686.
11. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press; 1997.
12. Durlach J, Durlach V, Bac P, et al. Magnesium and therapeutics. Magnes Res. 1994; 7:313-328.
13. Dyckner T, Wester PO. Effect of magnesium on blood pressure. Br Med J (Clin Res Ed). 1983;286:1847–1849.
14. Elisaf M, Merkouropoulos M, Tsianos EV. Siamopoulos KC. Pathogenetic mechanisms of hypomagnesemia in alcoholic patients. J Trace Elem Med Biol. 1995; 9:210-214.
15. Facchinetti F, Borella P, Sances G, et al. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991; 78:177-181.
16. Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991;31:298–301.

17. Fontana-Klaiber H, Hogg B. Therapeutic effects of magnesium in dysmenorrhea [in German; English abstract]. Schweiz Rundsch Med Prax. 1990;79:491–494
18. Gullestad L, Dolva LO, Soyland E, et al. Oral magnesium supplementation improves metabolic variables and muscle strength in alcoholics. Alcohol Clin Exp Res. 1992; 16:986-990.
19. Herzog WR, Schlossberg ML, MacMurdy KS, et al. Timing of magnesium therapy affects experimental infarct size. Circulation. 1995; 92:2622-2626.
20. Iseri LT, French JH. Magnesium: nature's physiologic calcium blocker. Am Heart J. 1984; 108:188-193.
21. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulfate in 58,050 patients with suspected acute myocardial infarction. Lancet. 1995; 345:669-685.
22. Jermain DM, Crisman ML, Nisbet RB. Controversies over the use of magnesium sulfate in delirium tremens. Ann Pharmacother. 1992; 26:650-652.
23. Johansson G, Backman U, Danielson BG, et al. Biochemical and clinical effects of the prophylactic treatment of renal calcium stones with magnesium hydroxide. J Urol. 1980;124:770–774.
24. Kao WHL, Folsom AR, Nieto J, et al. Serum and dietary magnesium and the risk for type 2 diabetes mellitus (editorial). Arch. Int Med. 1999; 159:2151-2159.
25. Kummerow FA, Zhou Q, Mafouz MM. Effects of trans fatty acids on calcium influx into arterial endothelial cells. Am J Clin Nutr. 1999;70:832–838.
26. Lewis NM, Marcus MS, Behling AR, et al. Calcium supplements and milk: effects on acid-base balance and on retention of calcium, magnesium, and phosphorus. Am J Clin Nutr. 1989;49:527–533.
27. Lim R, Herzog WR. Magnesium for cardiac patients: is it a valuable treatment supplement? Contemp Int Med. 1998; 10:6-9.
28. Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med. 1995; 333:201-205.
29. Martin BJ, Milligan K. Diuretic-associated hypomagnesemia in the elderly. Arch Intern Med. 1987;147:1768–1771.
30. Martini LA. Magnesium supplementation and bone turnover. Nutr Rev. 1999; 57:227-229.
31. Mauskop A, Altura BM. Role of magnesium in the pathogenesis and treatment of migraines. Clin Neurosci. 1998; 5:24-27.
32. Orchard TJ. Magnesium and type 2 diabetes mellitus (editorial). Arch Int Med. 1999; 159:2119-2120.
33. Paolisso G, Sgamabato S, Pizza G, et al. Improved insulin response and action by chronic magnesium administration in aged NIDDM. Diabetes Care. 1989; 12:265-269.
34. Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996; 16:257-263.
35. Rivlin RS. Magnesium deficiency and alcohol intake: mechanisms, clinical significance and possible relation to cancer development (a review). J Am Coll Nutr. 1994; 13:416-423.
36. Roberts JM. Magnesium for preeclampsia and eclampsia. N Engl J Med. 1995; 333:250-251.
37. Roffe C, Fletcher S, Woods KL. Investigation of the effects of intravenous magnesium sulphate on cardiac rhythm in acute myocardial infarction. Br Heart J. 1994; 71:141-145.
38. Sanjuliani AF, de Abreu Fagundes VG, Francischetti EA. Effects of magnesium on blood pressure and intracellular ion levels of Brazilian hypertensive patients. Int J Cardiol. 1996;56:177–183.
39. Saris N-EL, Mervaala E, Karppanen H, et al. Magnesium. An update on physiological, clinical and analytical aspects (review). Clinica Chimica Acta. 2000; 294:1-26.
40. Schendel DE, Berg CJ, Yeargin-Allsopp M, et al. Prenatal magnesium sulfate exposure and the risk for cerebral palsy or mental retardation among very low-birth-weight children aged 3 to 5 years. JAMA. 1996; 276:1805-1810.
41. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. J Am Coll Nutr. 1993;12:442–458.
42. Shechter M, Merz CN, Paul-Labrador M, et al. Beneficial antithrombotic effects of the association of pharmacological oral magnesium therapy with aspirin in coronary heart disease patients. Magnes Res. 2000;13:275–284.
43. Shechter M, Sharir M, Labrador MJ, et al. Oral magnesium therapy improves endothelial function in patients with coronary artery disease. Circulation. 2000;102:2353–2358.
44. Shils ME. Magnesium. In: Shils M, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams and Wilkins; 1999:169-192.
45. Sibai BM. Prevention of preeclampsia: a big dissapointment. Am J Obstet Gynecol. 1998;179:1275–1278.
46. Sojka JE. Magnesium supplementation and osteoporosis. Nutr Rev. 1995; 53:71-80.
47. Spatling L, Spatling G. Magnesium supplementation in pregnancy. A double-blind study. Br J Obstet Gynaecol. 1988;95:120–125.
48. Spencer H, Norris C, Williams D. Inhibitory effects of zinc on magnesium balance and magnesium absorption in man. J Am Coll Nutr. 1994;13:479–484.
49. Taubert K. Magnesium in migraine. Results of a multicenter pilot study [in German; English abstract]. Fortschr Med. 1994;112:328–330.
50. Terblanche S, Noakes TD, Dennis SC, et al. Failure of magnesium supplementation to influence marathon running performance or recovery in magnesium-replete subjects. Int J Sports Nutr. 1992; 2:154-164.
51. Toba Y, Kajita Y, Masuyama R, et al. Dietary magnesium supplementation affects bone metabolism and dynamic strength of bone in ovariectomized rats. J Nutr. 2000; 130:216-220.
52. Tosiello L. Hypomagnesemia and diabetes mellitus. A review of clinical implications. Arch Intern Med. 1998; 156:1143-1148.
53. Wester PO. Magnesium. Am J Clin Nutr. 1987;45(suppl):1305–1312.
54. Witteman JC, Grobbee DE, Derkx FH, et al. Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension. Am J Clin Nutr. 1994;60:129–135.

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An all-natural nightcap and powerful antioxidant. It's secreted by the pineal gland and helps defends against toxic free radicals in the central nervous system.

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Used by the Chinese for over 1,000 years to ward off colds and keep the lungs moist and clear. Used to eliminate constipation and gastrointestinal disorders. Sweeter than refined sugar but with zero calories.

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 Overview:

Milk thistle is a hardy annual plant native to southern Europe and the Middle East but is now found world wide.   It prefers warm, dry soil and is often found growing in locations inhospitable to other plants.  These hardy plants grow from 4-10 feet in height.  The leaves are wide with white blotches and are at the top of a single branched stem.  The red-purple flowers appear from May through September.  The flower of the milk thistle produces a small, brown hard skinned fruit from July to October.

The history of Milk Thistle’s use in traditional healing dates back to the ancient Greeks and Romans.  They used it to treat a variety of ailments with milk thistle, particularly  those connected with liver.  In fact, Pliny, a first century naturalist, said that it was “excellent for carrying away bile”. 

Active Ingredients:

Milk thistle main constituents are:

• Silymarin a flavonoligand that is responsible for the liver healing and detoxifying properties of milk thistle.
• Flavonoids
• Volatile oils

Traditional uses:

Milk thistle has been used in traditional medicine treat liver and gallbladder disease.  Many of these traditional uses for milk thistle are being confirmed by research.  Some of its many uses are:

• To treat alcoholism and related disorders
• An effective antidote for  Amanita or death-cap mushroom poisoning
• As an anti inflammatory
• To stimulate the appetite
• Antioxidant
• Gastrointestinal upsets
• Hormone imbalances
• Bile defiency
• Fatty congestion of the digestive system
• Virally induced organ damage

Clinical uses:

Milk thistle is well known for its proven ability to counteract the effects of death-cap mushroom poisoning.  All across Europe, poison control centers keep milk thistle extract on hand.  It reduces the death rate from death-cap mushroom poisoning from 30-50% to 10% and significantly reduces the risk of liver damage.

Studies are confirming milk thistle’s ability to reverse the toxic effects on the liver from alcohol abuse, industrial toxins (especially carbon tetrachloride), and drugs like acetaminophen (this drug can cause liver damage when taken in large amounts).  In five out of 7 studies involving milk thistle and liver disease caused by alcohol abuse, there was marked improvement in liver function.  Those with the mildest forms improved the most wile those suffering from end stage liver disease, cirrhosis showed the least.

Its anti-inflammatory properties are showing promise in the treatment of viral hepatitis, especially hepatitis C, while in vitro (test conducted in a test tube) have shown the active ingredient in milk thistle to inhibit the growth of human prostate, breast, and cervical cancer cells.  Further studies are needed to see if theses anti-tumor and anti hepatitis activities happen inside the human body.

Recommended Dosage:

As the active ingredient in milk thistle is hard to absorb, standardized extracts in capsule form is considered the optimum way to take this herb.  Treatment for liver damage is long term. Improvement should be seen in 8 to 12 weeks.

Pediatric

Pediatric dosages are calculated by a child’s body weight.  Since adult dosages are calculated using a body weight of 150 lbs to calculate a pediatric dose simply take the child’s weight and divide by 150 lbs.  For example, if a child weights 50 lbs and the adult dose for a supplement is 150mg:

50lbs/150lbs=.33 or 1/3 of adult dose so take the 150mg adult dose and divide by 3 to obtain the child’s dose of 50mg.

Adult

• 12 to 15 grams of dried herb per day
• 100 to 200mg of silymarin-phosphatidycholine complex twice a day
• For the treatment of liver damage 120mg of the silymarin complex should be taken 3 times/day.

Contra-indications:

Side effects from taking milk thistle are rare but may include stomach pain, nausea, vomiting and diarrhea.  It can also cause headaches joint pain, impotence allergic skin reactions and in extremely rare cases anaphylaxis. Although milk thistle in considered safe, women who are pregnant or breastfeeding should consult a health care provider before using milk thistle.

Drug interactions

If you are using any of the following drugs, consult your health care practitioner before taking milk thistle.

1. Antipsychotic such as butyrophenes (haldol) and phenothiazines.
2. Phenytoin
3. Halothane used during general anesthesia

 Milk thistle may enhance the effectiveness of aspirin.

 Preliminary research has shown that silybin may enhance the tumor fighting effects of cisplatin and doxorubicin when tested against breast and ovarian cancer cells.

Web References

1. Holistic Online
2. Flora Health
3. UMM.edu

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