2009 case study review: GERD, PPIs, magnesium & D3

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2009 case study review: GERD, PPIs, magnesium & D3

Postby jimmylegs » Sat Sep 02, 2017 11:08 am

i found this article by searching the literature for magnesium and d3 interactions. although it only looks at one older female patient, the data is still interesting.
the play by play:

Hypomagnesaemia due to use of proton pump inhibitors – a review
https://www.njmonline.nl/getpdf.php?id=788
Abstract
"Magnesium homeostasis is essential for many intracellular processes and depends on the balance of intestinal absorption and renal excretion. Hypomagnesaemia may arise from various disorders. We review the literature on hypomagnesaemia due to the use of proton pump inhibitors, as illustrated by a case of a 76-year-old woman with muscle cramps and lethargy caused by hypomagnesaemia and hypocalcaemia with a low parathyroid hormone level while using esomeprazole, a proton pump inhibitor (PPI). After oral magnesium repletion both abnormalities resolved. Fractional magnesium excretion was low, excluding excessive renal loss. A causal relation with PPI use was supported by the recurrence of hypomagnesaemia after rechallenge..."

ok interesting. will be good to see where the d3 enters the picture here.

Intro excerpt
"On admission the laboratory findings showed hypocalcaemia (1.26 mmol/l), hypomagnesaemia (0.18 mmol/l), hypokalaemia (3.2 mmol/l) and a low parathyroid hormone (0.9 pmol/l). Her serum vitamin D3 level was normal."

good old normal. what will the actual number be??!! let's find out...

"We started intravenous calcium and magnesium suppletion. In three days the calcium, potassium, magnesium and parathyroid hormone (PTH) level normalised and her
symptoms slowly resolved..."

sounds good, continue...

"After 11 days she was discharged with oral magnesium supplements (magnesium oxide 500 mg three times daily). Two months later the magnesium was discontinued."

holy *actual* $#!+ that poor poor woman. what a couple of months that must have been.

"Within four weeks a dramatic drop in the serum magnesium and calcium followed."

hmm whaddaya reckon that was at least in part because it wasn't taken in a form that would be readily absorbed?

"We discontinued the magnesium supplements and the esomeprazole. The serum magnesium and calcium level did not change in four weeks."

i notice the serum magnesium was circling the drain in terms of being *just* within our familiar and (not) most excellent 'normal' range.

"Because of increasing symptoms of gastro-oesophageal reflux we let her resume the esomeprazole."

hmm wonder what optimizing that serum mag level might have done for that... if someone had bothered... okay i'm still looking for that d3 connection...

"Table 1. Electrolyte balance and other biochemical data at admittance, during and after magnesium supplements and esomeprazole

................................Normal value..........Day 1........6 months
Serum magnesium.....0.65-1.05 mmol/l.....0.18..........0.67
Serum vitamin D3.........30-130 nmol/l......39.............58"

and that is literally the beginning and then end re mention of d3. no connections made in the text.

so the 'normal' serum d3 was just 39 nmol/l to begin, which is atrocious of course.
perhaps unsurprising that using mag oxide, in the context of intermittent PPI use, only allowed this patient to achieve 0.67 mmol/l magnesium in serum (which is clearly suboptimal and would be considered outright deficient at some labs i've frequented)

however, it is interesting to note that
without any apparent d3 supplementation *and* with PPI medication in the picture which actively depletes magnesium levels, that a simple (if less than perfect) magnesium supplementation regimen was still associated here with a ~20nmol/L increase in serum d3 levels
. fascinating, and consistent with other studies in which folks with low magnesium status have impaired d3 dose response whether from diet, sun or supplements.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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