Thoughts at Large Controversies in Clinical utrition an unctional eicine
Issue 3
Chronic Low-Grade Metabolic Acidosis - Part III
by: Jeffrey Moss, DDS, CNS, DACBN
The Essentiality of Magnesium in Potassium Metabo- lism
Given the emphasis on potassium in parts one and two of this series, you may be wondering when the discussion in magnesium will occur. As you will see, that discussion will be prominently featured in this report. However, I deliberately wanted to postpone my discussion on magnesium so that I could review literature that emphasizes the immense importance potassium plays in the optimization of acid/alkaline balance. Why Because this discussion is going to head in a different direction from the typical review of the literature on magnesium which usually examines magnesium in iso- lation. As you will see from the papers I am about to present, even though potassium is incredibly important for acid/alkaline optimization, it simply cannot perform all the tasks necessary for this optimization without the presence of optimal levels of magnesium. Therefore, this review will focus not on magnesium in isolation but on its important and multifaceted interaction with potassium. It will be divided into two sections. The rst will focus on papers that highlight how often potassium and mag- nesium are found together in many important human physiological functions. The second will focus on papers that demonstrate how each mineral is dependent on the other for optimal function.
Potassium and magnesium are often found together in human physiology
An excellent paper that highlights this interrelationship is “Potassium, magnesium, and electrolyte imbalance and complications in disease management” by Weglicki et al (Weglicki W et al. Clin Exp Hypertension, Vol. 1, pp. 95-112, 2005). The paper begins with an observation of how often potassium and magnesium deciencies are found concurrently: “Patients with congestive heart failure…frequently show hyponatremia, hypokalemia, and hypomagnesemia.”
THE ORIGINAL INTERNIST MARCH 2017
Furthermore:“…very early observations indicated that electrolyte disorders are often coincident with, for example, hypokalemia and hypomagnesemia often occurring together.”
This association is also seen with certain cardiovascular irregularities as well as diabetes:“Subclinical magnesium increased ventricular ectopy and arrhythmias.”
In addition:“Hypokalemia and hypomagnesemia are often seen in patients with hypertension, diabetes, and congestive heart failure, which also may be associated with high levels of calcium.”
Of course, this relationship is not only seen on a gross level based on clinical diagnosis but in the intracellular milieu also: “The higher the intracellular potassium, the higher the intracellular magnesium and the lower the intracellular calcium”
What about bone metabolism
“While calcium and vitamin D have been the focus of much attention, potassium and magnesium are emerging as important ions in preserving bone structure in the aging population. Magnesium and potassium depletion is common in elderly subjects and is due to inadequate dietary intake, impairment of renal or gut absorption, hypercalcemia, diabetic acidosis, or diuretic therapy.”
Then, of course, there is the issue of diuretic use: “Indeed, volume depletion, hypokalemia, hyperkalemia, metabolic acidosis, metabolic alkalosis, hypomagnesemia, hypo- natremia, and hypernatremia are complications that may occur from diuretic use.”
Furthermore:“Treating hypertension is a common clinical practice. However, the onset of hypokalemia and hypomagnesemia with thiazides or loop diuretics may lead to increased ventricular ectopy and an increased incidence of sudden death.”
Next Weglicki et al comment on diagnostic and treatment aspects of this relationship between potassium and magnesium: coexist in several disease conditions including congestive heart failure. And because serum magnesium testing is seldom done in the clinical setting, hypomagnesemia and hypermagnesemia go unrecognized.
Weglicki et al conclude their review of the literature with a statement that emphasizes how important it is in the clinical setting to always consider potassium and magnesium jointly: “Several metabolic disorders (e.g., diabetes and obesity, hypertension, and congestive heart related to hypokalemia and hypomagnesemia. Indeed, the must consider this when recommending treatments for conditions that essentially arise from ion imbalances. Reinstitution of electrolyte balance may go a long way in addressing complications in disease management.”
(Continued on next page) 41
Thus, treating
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