G3.6.1.8: If magnesium deficiency is cause of a diabetic patient’s pain, why give opioids instead?

Evidence based clinical research from 2009 could have helped save many lives lost to the opioid epidemic if patients were being told and treated with the discovery. (G3.101) Patients with diabetes and chronic pain often don’t experience much if any relief from the use of opioid medications, however that is the standard pain medication that is provided for chronic pain so it is often prescribed to diabetic patients anyway, just a prescription pad after all not a patient (not true). The research study provided magnesium to the diabetic patients as a pretreatment before providing the opioid or along with an IV drip of the medication, and not only was the pain reduced for patients who received magnesium, but the pain level was reduced for several days for the fortunate patients. And some trials of the experimental treatment didn’t provide the opioid medication and yet pain relief was felt by the diabetic patients.

Well that is exciting and it leads me to say – why even bother giving an opioid medication then, if it won’t help to relieve pain that is actually being caused by a magnesium deficiency? Because there is profit to be made by prescribing opioid medications but there isn’t profit to be made writing a magnesium prescription? Pondering is a waste of time for someone in pain.

The research discussion seemed to focus on using 30 mg of magnesium with IVs of morphine or other opioid medication for better pain control, but didn’t address or stress the fact that the 300 mg dose of magnesium had reduced pain levels for patients on its own, without any opioid medication having been given along with the nutrient. Pain control without needing an addictive drug that can cause death if overdosed?

Common sense can be inexpensive – consider the benefits of resolving a problem instead of treating symptoms and ignoring the underlying cause. (Magnesium can also be deadly in overdoses, but that really isn’t as common a cause of death as opioid overdoses.)

  • Read more: Magnesium ions and opioid agonists in vincristine-induced neuropathy, (G3.101).
  • A more recent study found a significant difference between magnesium levels between the patients with diabetes and the control group. Significantly lower levels of magnesium were also noted in association with insulin resistance factors although not with fasting blood sugar levels. Read more: Association of Serum Magnesium Deficiency with Insulin Resistance in Type 2 Diabetes Mellitus, (G3.122)

Trying to replace a natural function with a patented medication is using patient’s pain for the purposes of profit.

Calcium channel blocker medications (PPIs for example) are trying to close the gates and keep the calcium out – and magnesium would be delighted to do that as nature intended if enough of the mineral were being absorbed from the intestines. However many issues with our modern food supply and the contaminants it may contain, may be leading to poor absorption of magnesium and increased loss of magnesium by the kidneys, (too much active hormone D3 can cause increased calcium absorption and loss of magnesium). Note the frequent use of the word “may” – more research is needed, in the meantime an Epsom salt bath or foot soak or use of a topical magnesium chloride product could bypass poor intestinal absorption problems. The magnesium sulfate used in Epsom salt would also provide sulfate which may also be beneficial due to possible contaminants in our modern food supply.

Talking about doing things “traditionally” is nice but our children are not growing up in the same chemical environment that we did, and we didn’t get to experience the food supply that our grandparents enjoyed.

Calcium channel blocker medications make a large profit for the pharmaceutical company – magnesium cannot be patented.

Now that it is clear that emotions and environmental triggers can cause inflammation, which at the same time is a cause of feeling “pain,” it is easy to see why childhood trauma or severe traumatic experiences or ongoing trauma can lead to developing inflammatory conditions such as inflammatory bowel conditions or fibromyalgia and migraine pain. The next section moves into psychological conditions that can be due to emotional trauma but may cause physical symptoms as well as mental symptoms.

See a healthcare provider for medical advice, diagnosis or treatment.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)


Only one? – yes, it is an important one:

I found a more recent one that supports the premise that insulin resistance and Type 2 Diabetes may involve an underlying deficiency of magnesium.

G3.5: Negative stress chemicals may cause symptoms like itching, migraines, pain or IBS.

Our bodies don’t have specific receptors just for sensing “pain.” Pain is a sign that something is wrong in the body and is sensed in a variety of ways. In medical terminology there are two main types of “pain.”

  • Nociceptive pain is associated with physical damage to the body or by sensations of pressure or heat or extreme cold. It might be due to pressure from a cancer tumor. Nociceptive pain might be described as “sharp, aching or throbbing.”
  • Neuropathic pain is caused by physical damage or pressure on nerves. It might also be due to a cancer tumor but one that is pressing on a nerve. Nerve damage can also be due to some nutrient deficiencies such as vitamin B12,  (G3.13), or other “Nutritional imbalance, alcoholism, toxins, infections or auto-immunity.” Neuropathic pain often is described as “a burning or heavy sensation, or numbness along the path of the affected nerve.” (G3.14)

Some types of pain such as migraine headaches may involve both nociceptive pain due to the pressure of inflammation or dilation of blood vessels an neuropathic pain from pressure on nerves by dilated or inflamed blood vessels.

    The next part gets complicated, some background information:

  • Calcitonin is a hormone released by the thyroid that promotes lower blood calcium levels by reducing bone resorption, (G3.15) (Bone resorption: breakdown of the bone and release of minerals, (G3.16)).
  • Calcitonin Gene-Related Peptide 1 and 2 (CGRP 1: (G3.17) and CGRP 2: (G3.18)) cause dilation of blood vessels in the heart and brain and throughout the body. Its prevalence in the Central Nervous System (CNS) also suggests that it may also have a neurotransmitter or neuromodulator role.

CGRP is produced by nerve cells in the brain and throughout the body. The protein has a role in sensations of pain. It is a member of the calcitonin family of proteins and exerts its effects at receptors that are formed from two other types of receptors.

The CGRP protein has two commonly found forms, one helps reduce pain and one helps increase it – luck of the draw. The alpha form of the protein may help reduce pain while the beta form is associated with migraine, temporomandibular joint (TMJ) pain, psoriasis and irritable bowel syndrome (IBS). The beta form is largely produced in keratinocytes found in the epidermis layer of skin. The alpha form is the type produced more within sensory nerves. (G3.19) (Psoriasis is an eczema-like condition believed to be autoimmune in nature.)

After a physical injury like a bump on the shin, inflammation causes an increased output of the Calcitonin Gene-Related Peptide (CGRP) and an inflammatory protein that is called Substance P, possibly for peptide, which is another word for protein. The release of the peptides follows shortly after an inflammatory event and shortly the chemicals are released there is  edema and plasma leakage in the surrounding area. (G3.20) The inflammatory peptides are also released in increased amounts during migraine headaches. (G3.21) The peptides increase the dilation of blood vessels and cause increased leakage from blood vessels (edema) and “degranulation of mast cells.” (G3.19) (G3.21)

Levels of CGRP increase in people who suffer from migraines and a type of prescription medication, called sumatriptan, which has been found helpful to stop migraine pain, has also been found to inhibit the release of CGRP in migraine patients. The medication may be inhibiting the release of CGRP by increasing intracellular levels of calcium. The “cytokine TNF-α” may be involved in migraine pain. (G3.21)

That was the background – the bottom line – magnesium deficiency can make the body more susceptible to the negative effects of CGRP, Substance P and chronic stress. And a chronic stress situation combined with chronic magnesium deficiency may lead to the development of inflammatory conditions like migraines, fibromyalgia, PTSD, or Irritable Bowel Syndrome. The magnesium deficiency associated with the inflammatory peptides CRGP and Substance P may be causing an increase in the level of the cytokine TNF as early as two days after a deficient diet was begun in a research study with lab animals. (G3.22)

So an Epsom salt bath or foot soak may relieve itch by providing the body with a form of magnesium that can be absorbed through the skin bypassing any GI problems that might underlie a chronic magnesium deficiency. It isn’t uncommon to have a diet low in magnesium but it is also not uncommon in the food supply. Problems with poor absorption or increased kidney or bowel loss are common causes of chronic magnesium deficiency.

A variety of tips for reducing Substance P levels are included in the article Trichodynia, Pain, and Substance P. Exercise, hobbies that use repetitive motions of the hands such as knitting, and stretching exercises may help reduce excess levels of the inflammatory chemical according to the article on the website drwardbond.com, see the article for more details: (G3.23)

See a healthcare provider for medical advice, diagnosis or treatment.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)


Chronic itch, ion channels, magnesium and calcium

Genetic differences in more than 70 genes have been associated with increased itchiness. [1] Calcium and serotonin levels may be involved in increased itch or arthritis pain signals being sent/perceived. [2] See the excerpts below:

Summary: Too much or too little calcium and magnesium can affect pain, itching, and mood. The minerals are both electrically active, and provide energy for ion channels which control the transport of messenger chemicals like serotonin across cell membranes – such as nerve cell membranes.

“For neurons to become excited, you need a receptor to communicate with an ion channel,” said Dr. Bautista. “We tried a variety of experiments and found that HTR7 communicates with the TRPA1 ion channel. Both receptors seem to be working together to mediate chronic itch.” “The researchers found more than 70 genes whose expression was higher in the more itch-sensitive mice. Of these, the gene for the HTR7 receptor was the most closely linked to itch. In fact, the HTR7 gene was twice as active in the itchiest mice compared to the least sensitive mice. ”  [1]

  1. An Itch You Just Can’t Scratch; NIH-funded study identifies proteins that may cause chronic itch (Oct. 27, 2015) http://www.ninds.nih.gov/news_and_events/news_articles/pressrelease_chronic_itch_10272015.htm
  2. Adam Horvath, et al., Transient receptor potential ankyrin 1 (TRPA1) receptor is involved in chronic arthritis: in vivo study using TRPA1-deficient mice, Arthritis Res Ther. 2016; 18: 6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718022/          

    Excerpt: “TRPA1 is also directly stimulated by intracellular calcium [24] and a broad range of noxious endogenous oxidative products, such as 4-hydroxy-2-nonenal, hydrogen peroxide, hypochloride, hydrogen sulphide, 15-delta prostaglandin J2 [2528]. Furthermore, there are several exogenous irritants like mustard oil (allyl isothiocyanate: AITC) [29], cinnamaldehyde [30, 31], allicin [32, 33] and formalin [34] that are known to be potent agonists of TRPA1. Inflammatory mediators, such as bradykinin and serotonin, can sensitize this receptor and increase the responsiveness of the nerve endings [19, 35]. These findings suggest that TRPA1 may be involved in the development and maintenance of arthritic pain, but the precise mechanisms are still unknown.”

  3. Rs6295: The “Single” and “Self-Transcendent” Gene (5-HT1A Receptor) https://selfhacked.com/2015/07/23/rs6295-the-single-and-self-transcendent-gene-5-ht1a-receptor/Magnesium and Calcium increase the binding of serotonin to the 5HT1A receptors in the cortex (purkinje cells). (R)

  4. Bujalska M., et. al., Magnesium ions and opioid agonist activity in streptozotocin-induced hyperalgesia. Pharmacology. 2008;82(3):180-6.http://www.ncbi.nlm.nih.gov/pubmed/18701828

  5. That Really Does Make It Worse

    Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

nErD does not stand for nearest Emergency room Department

I ran across the term nErD yesterday and I wasn’t sure what it might mean. My first thought as a health professional trained in medical acronyms was that it might have something to do with the ER or Emergency Room Department. In addition to the adult ICU (Intensive Care Unit) there is also a Neonatal Intensive Care Unit (NICU) but there isn’t a neonatal emergency room department to my knowledge.

To my chagrin after a few seconds of puzzlement I noticed another reference to the term — “nerd” — and I felt like I should probably go see the movie “Revenge of the Nerds” again just as a refresher course.

Emergency Rooms have been on my mind for a while so that might explain my jumping to that idea first. At some point in the past I’ve shared this idea but I’ll reshare it because it could help provide safe and effective health care at an inexpensive price.

A patient can spend a lot of time waiting in an Emergency Department, to be seen or to be treated or for the test results to be ready or for the specialist to stop by. Some of that waiting time could be spent in a relaxing and potentially healing Epsom salt foot soak or bath.

Magnesium deficiency is estimated to be a problem for as many as 70-80% of the U.S. population. It can be an underlying factor in many chronic illnesses and chronic pain conditions and can be involved in acute substance abuse or mental health situations. A foot soak in Epsom salts can take slightly longer than a soak in an Epsom salt bath to achieve results but both can be helpful for relieving muscle cramps and some other types of pain such as migraines. Mental upset due to alcohol or other substance abuse or mental health conditions can also be soothed by soaking in Epsom salts. The amount of time to soak would vary depending on how deficient the person was in magnesium and might even be helpful as a diagnostic screening for magnesium deficiency (the mineral is largely stored within the interior of cells or within the bones so blood tests for magnesium only catch extremely severe cases of magnesium deficiency).

Excessive magnesium absorption can relax the muscles too much and may cause slowing of the heart rate and smooth muscle relaxation can also cause watery bowel movements. A hospital protocol might involve having an attendant start a patient with a non-open wound pain situation or upset mood in an Epsom salt foot soak or bath. The patient would be instructed on the early symptoms of excessive magnesium absorption and to let the attendant know if/when the first fluttery heart beats or relaxation of sphincter muscles was occurring. Typically a 20 minute Epsom salt bath is a good length of time while a forty minute bath might cause excess relaxation. Research suggested the ideal routine for a patient with difficulty absorbing magnesium from dietary sources would be approximately twenty minutes in a bath with one cup of Epsom salts every other day or three to four times per week. Taking the baths more often though can lead to symptoms of excess magnesium occurring sooner than twenty minutes, based on my personal experience with Epsom salt baths.

Alcohol and some other substances that are used excessively can cause magnesium deficiency which can cause irritability and even increase the risk for violence.

So if you or a loved one is upset or in pain that is not due to an open wound then it is possible that a trip to your bathroom for a Epsom salt bath might be soothing enough to skip a trip to the nearest Emergency room Department (you know, the nErD).

Excerpt from a previous post with more info about safely taking Epsom salt baths:

Time for an Epsom bath perhaps.

Epsom salt baths can be a well absorbed source of magnesium because skin absorption will bypass a problem of poor intestinal absorption of magnesium. Calcium tends to be preferentially absorbed by the intestines, especially when there is an imbalance in vitamin and hormone D levels and poor intestinal absorption of magnesium over time can easily lead to symptoms of magnesium deficiency. Symptoms of magnesium deficiency are usually labeled something else by the medical profession because the problem is not obvious on lab tests until it is quite severe because the body takes more magnesium from the bones as needed up until the point where osteoporosis is severe  enough to cause a shortage of stored magnesium.

Soaking in a bathtub for twenty minutes that has one cup of Epsom salt to a half full bathtub, and one teaspoon of a cooking vinegar such as apple cider vinegar to balance the alkalinity of the Epsom salt, can be a cure for a bad mood as well as various achy muscle cramps if magnesium deficiency is an underlying problem. Negative symptoms can occur if you stay in the bath too long. Excess magnesium absorption can cause loose watery stools for an entire day, not just once. Falling asleep in the bath can also lead to more life threatening symptoms of a weak, and fluttery heart rate, or even lead to coma and/or death — so twenty minutes to forty minutes is probably safe for a deficient person while someone who isn’t deficient might notice a weak slowing heart rate sooner than the twenty minute average that a person deficient in magnesium might find only as calming and soothing to  their mood and muscles. A person who was deficient but who then started taking the baths regularly might start noticing the weak heart rate sooner — get out of the tub then, even if its not been twenty minutes — shower and rinse time. Research on the therapeutic use of Epsom salt baths recommended one cup Epsom salt to the half full/full bath and use up to three to four times per week, but not daily.

I can’t find the actual research study {here it is: http://george-eby-research.com/html/absorption_of_magnesium_sulfate.pdf } among the following posts of mine (see below) but Dr. Oz has an article on the baths also and recommends the twenty minutes a few times a week also: [http://blog.doctoroz.com/oz-experts/restoring-magnesium-levels-with-epsom-salt-baths]

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.