2018: Comorbidity in US patients with multiple sclerosis

[jimmylegs]

Comorbidity in US patients with multiple sclerosis (2018)
fft: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815483/

The most common comorbidities from 2006 to 2014 were hyperlipidemia and hypertension (25.9%–29.7% of patients within an individual year), followed by gastrointestinal disease (18.4%–21.2% of patients) and thyroid disease (12.9%–17.1% of patients).
...
Diagnoses of high cholesterol, high blood pressure, gastrointestinal disorders, thyroid disease, and anxiety were common with MS. The percentage of patients with MS with gastrointestinal disorders, thyroid disease, and anxiety increased over the 9 years. The percentage with high cholesterol increased from 2006–2009, was stable from 2009–2011, then declined from 2011–2014. The percentage with hypertension increased from 2006–2013, then declined from 2013–2014. Comorbidities were more common among older patients, except for anxiety, depression, and alcohol abuse. Diagnoses of gastrointestinal disease, lung disease, arthritis, anxiety, and depression were more common among women. High cholesterol, high blood pressure, diabetes, and alcohol abuse were more common among men. More patients in the Northeast and South had comorbidities compared with patients in the Midwest and West. A better understanding of comorbidities in MS may improve patient support, health care services, and quality of life.

[1eye]

I have very high blood pressure. My gut is fine since three years ago I started biotin 300mg+rice bran 300 mg.

Lately I have been having kidney problems. I get an exacerbation in my kidneys if I take too much calcium (watch out for TUMS).

But worst lately is pain and stiffness in my calf muscles, specially when I wake up. My PSW said she used to have that same symptom until she was on magnesium for a while: it went away. So I'm going to try magnesium. Anybody else have that?

[jimmylegs]

hey there, high as in what over what, normally?

i personally can't supplement much calcium. i've never been a fan or user of tums either! i used to try to take more calcium based i think on best bet recommendations if memory serves, but my back hurt. i assumed it was my kidneys, so gave them a break and nowadays, whatever calcium comes in my diet and my multi is it.

is your psw aware of the kidney problem? what are the details there? is the issue secondary to the HBP? any renin info? i wouldn't automatically expect the kidney concern to be a barrier while you are experiencing mag deficiency symptoms, but i'm no pro. as long as you have the okay from your doc re adding magnesium in conjunction with a kidney issue, you could absolutely expect extra mag to help address pain and stiffness in your calf muscles, and possibly lower high blood pressure into the bargain (maybe even helping the kidney in passing, depending on the origins of the problem).

i recall a study in which this poor man with stubborn hiccups was given double doses of i think it was gabapentin, and meanwhile his magnesium status was in the dumper. i assume they were monitoring it bc he was on dialysis. i suspect they could have addressed his very low serum magnesium to correct the hiccup issue, without causing a problem.

my friend recently had lower leg and foot pain due to mag depletion while undergoing chemo. replacement magnesium kept things tolerable, but she also had heartburn so we took it easy on oral mag in case it relaxed the esophagus and contributed to the problem. to work around the gi tract, epsom salt baths were a solution while at home. while in hospital, when her mag levels dropped below normal they bumped it back up via iv.

if you decide to try oral mag, if you are not already aware some forms are highly laxative, others less so. i have no idea what the implications of transdermal mag might be when kidney issues are in the mix!

hope something in there helps.

ps more research needed, but:

Magnesium and Blood Pressure: A Physiology-Based Approach (2018)
https://www.sciencedirect.com/science/a ... 9517302161
Hypertension is an important public health challenge because of its high prevalence and strong association with cardiovascular disease and premature death. Hypertension is a major cause of CKD, is present in more than 80% of CKD patients, and contributes to CKD progression. Risk factors for hypertension include, but are not limited to, age, race, family history, obesity, physical inactivity, tobacco use, and inadequate intake of minerals such as calcium, potassium, and magnesium. Magnesium is the second most abundant intracellular cation in the human body and plays an important role in insulin and adenosine triphosphate metabolism. Low dietary magnesium intake has been associated with an increased risk of developing hypertension in prospective cohort studies. Moreover, clinical trials suggest that magnesium supplementation has blood pressure–lowering effects. In addition, emerging data reveal potential mechanisms by which magnesium may influence blood pressure. Here, we will review these mechanisms, using a physiology-based approach, focusing on the effects of magnesium on total peripheral resistance and cardiac output.

Dose-response relationship between dietary magnesium intake, serum magnesium concentration and risk of hypertension: a systematic review and meta-analysis of prospective cohort studies (2017)
fft: https://nutritionj.biomedcentral.com/ar ... 017-0247-4

Results
Nine articles (six on dietary magnesium intake, two on serum magnesium concentration and one on both) of ten cohort studies, including 20,119 cases of hypertension and 180,566 participates, were eligible for inclusion in the meta-analysis. We found an inverse association between dietary magnesium intake and the risk of hypertension [relative risk (RR) = 0.92; 95% CI: 0.86, 0.98] comparing the highest intake group with the lowest. A 100 mg/day increment in magnesium intake was associated with a 5% reduction in the risk of hypertension (RR = 0.95; 95% CI: 0.90, 1.00). The association of serum magnesium concentration with the risk of hypertension was marginally significant (RR = 0.91; 95% CI: 0.80, 1.02).

Conclusions
Current evidence supports the inverse dose-response relationship between dietary magnesium intake and the risk of hypertension. However, the evidence about the relationship between serum magnesium concentration and hypertension is limited.

Results from the Atherosclerosis Risk in Communities study suggest that low serum magnesium is associated with incident kidney disease (2015)
https://www.sciencedirect.com/science/a ... 3815302027

Magnesium and Vascular Changes in Hypertension (2012)
fft: https://www.hindawi.com/journals/ijhy/2012/754250/

[1eye]

Hi.

Well my bp was 175 over 95 i think but I'll find out for sure. in fact i have the bp machine sitting next to me. i'll be monitoring it and taking a water pill to add on to my bp medication (15 mg ramipril). Would love to just get enough dietary magnesium.

We've been discussing vagus nerve issues. Well, a while back I had a very serious (including hospitalization) attack of hiccups. I had them for three weeks! Solid, no letup, even when I was asleep! In hosp. they gave me iv chlorpromazine, and that helped (I think by paralyzing my vagus) but it was very temporary. My gp gave me a bottle of chlorpromazine tablets, and that worked. Got a really sore stomach muscle from the hiccups. I still have some, just in case, but haven't had any more attacks.

I definitely have sedentary issues. I hardly ever get up from my chair.

My wife has just gone out to get me: 1. a vitamin tablet that has some magnesium in it, and 2. a bottle of milk of magnesia that I will take when constipated. I'll let you know what happens to my bp. Have to start a twice a day reading.

I am not at all sure my heart is going to last much longer. I'll have to see. If you don't hear from me in a year or so, you know why.

Have a routine not very rigorous for pain and sleep management. I alternate between 3 or 4 pain pills (tylenol, advil, occasional codeine, aspirin and naproxen) and 3 or 4 sleep meds (gravol, tylenol and advil night-time, benadryl, occasionally lorazepam, all those get me to sleep, fairly regularly 1/4 tablet of quetiapine keeps me asleep). I often do without anything, and never take the same thing 2 days running.

For depression I am on welbutrin.

I feel like a human drugstore.

For spasticity (restless legs keep me awake) occasional baclofen and fairly regular sativex.

Wish I could do all that with food.

[jimmylegs]

wow that's a lot of great info

checking out possible drug nutrient interactions

• Ramipril decreases chlorthalidone-induced loss of magnesium and potassium in hypertensive patients.
  https://www.ncbi.nlm.nih.gov/pubmed/8750365

ok so ramipril makes mag status better (only after using chlorthalidone? no idea).. but so does mag - and it does many other essential jobs that ramipril likely does not...

amazing (and all kinds of no fun) that you also had chronic hiccups. do you happen to have a serum magnesium level on file? if not, could be worth looking into. (everyone has potassium levels on file, if they're a problem you likely already know it).

found this in passing just now:

• Chronic hiccups following chemotherapy
  https://www.jpsmjournal.com/article/S08 ... 0112-8/pdf
  
  "Biochemistry results from the previous day indicated a serum magnesium of 0.6 mmol/L (0.70–0.95) and phosphate of 0.78 mmol/L (0.80–1.60)"

my friend's serum mag had dropped to .50 when they added it thru the iv, and now even with daily supplementation (400-600 mg because she is also taking vit d3) she can barely keep it above 0.60 mmol/l.

re chlopromazine:

• https://www.drugbank.ca/drugs/DB00477
  "Chlorpromazine may decrease the excretion rate of Magnesium chloride which could result in a higher serum level."

i can find very little so far, linking magnesium and the vagus nerve specifically:

• THE INFLUENCE OF CALCIUM, POTASSIUM AND MAGNESIUM IONS IN CEREBROSPINAL FLUID ON VASOMOTOR SYSTEM
  https://physoc.onlinelibrary.wiley.com/ ... 9.sp004441
  
  Influence of the magnesium ion concentration
  In eight experiments the arterial blood pressure fell when the ventricles were perfused with a solution of increased MgCl2 concentration (solution VI). Also the carotid sinus reflexes and the hypertension caused by faradic stimulation of the proximal end of the vagus were depressed (Fig. 7).

• Effect of Excess Magnesium on Vagal Inhibition and Acetylcholine Sensitivity of the Mammalian Heart in situ and in vitro
  https://www.nature.com/articles/217679a0
  
  To determine whether the same dose of magnesium that paralyses skeletal muscle will also block vagal inhibition of the heart in situ, we carried out experiments with twelve unanaesthetized high spinal cats. ... With the plasma magnesium elevated, high frequency stimulation of the vagus caused a partial block in atrio-ventricular conduction. Because of this, the ventricular beat was suppressed and the drop of blood pressure was almost as severe as in the control period

a note re mag intake and supplements.
according to current RDAs, (which some researchers suggest may be too low) your daily magnesium intake should be about 400 mg from food and supplements combined.
health canada suggests no more than 350mg per day from supplements.
a multi with some mag is likely to contain much less. perhaps not enough to be effective.
the more laxative the form (eg mag oxide, often used in multis), the less readily absorbed into tissue. that doesn't mean it's not absorbed at all, just that it's harder to take higher amounts without it getting away on you.
the small amount in most multis is not usually going to be enough to cause a laxative issue.
i personally find magnesium glycinate is a good one. in my area, rexall carries a brand i like at the moment (orange naturals). the powder caps are 200 mg. the bottle says take one a day but that supposes the user is getting the rest from food and also is not deficient to begin with.

magnesium is a great pain killer. so much so that it's been suggested as an alternative to opioids. i think the last time i touched an actual pain killer was more than five yrs ago, when i was recovering from knee reconstruction.

magnesium helps with sleep, depression and spasticity too (even tetany). fun fact, researchers use magnesium deficiency as a mouse model of depression, to test anti depressant drugs.

• Role of magnesium supplementation in the treatment of depression: A randomized clinical trial
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487054/
  
  The intervention was 6 weeks of active treatment (248 mg of elemental magnesium -as four 500 mg tablets of magnesium chloride- per day) compared to 6 weeks of control (no treatment). ...
  Measurement of serum magnesium was outside the scope of the study. ...
  Consumption of magnesium chloride for 6 weeks resulted in a clinically significant net improvement... Similar effects were observed regardless of age, gender, baseline severity of depression, baseline magnesium level, or use of antidepressant treatments. Effects were observed within two weeks. Magnesium is effective for mild-to-moderate depression in adults. It works quickly and is well tolerated without the need for close monitoring for toxicity.

i'm pretty curious about your own serum mag level. hope you are too!

[ElliotB]

"I am not at all sure my heart is going to last much longer. I'll have to see. "

Sorry to hear that. I suggest you immediately read a book that was recommended to me by someone here on TIMS (I don't remember who recommended it to me but I am extremely grateful to him), "The Sinatra Solution: Metabolic Cardiology " by Stephen T. Sinatra M.D. F.A.C.C. F.A.C.N. C.N.S (Author). Sinatra, who is a cardiologist offers some tremendous insight into heart health and his recommendations have helped me tremendously. He recommends several heart healthy and energy enhancing supplements, one of which is Ribose and another is L-carnitine. He also recommends CoQ10 and magnesium.

His conclusion on page 403 of the paperback edition is that the heart is highly susceptible to many common issues that can effect heart health and that the heart also responds very, very well to the targeted nutritional supplements he suggests. And since those with MS may be more susceptible than 'normal' people to heart issues, it makes sense to be proactive in every way.

IMHO, this book is a must read for anyone with heart issues. AND for those with MS who do not presently have any issues. As the old saying goes, an ounce of prevention is worth a pound of cure! I wish I had been given this advise when I was first diagnosed. BUT, better late then never!


With regard to the linked article, the rates of the various diseases suffered by those with MS is really not all that different from the general population. Those with MS are not protected from those illnesses. For example, the article states "gastrointestinal disease (18.4%–21.2% of patients)" yet in the rate is basically the same in the general population, gastrointestinal diseases affects an estimated 60 to 70 million Americans annually (according to Dr. Google). I checked a couple of the other illnesses listed and again the rates were about the same for those with MS as compared to the general population.

[jimmylegs]

if sinatra's words lend any weight to what we've covered above, he recommends 400-800mg of supplemental mag per day, above and beyond food sources. i wouldn't personally deliver that as a blanket recommendation for all, but what do i know.

Health Risks from Excessive Magnesium
https://ods.od.nih.gov/factsheets/Magne ... sional/#h8
"Too much magnesium from food does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine [31]. "

i don't know who generates the content provided below but fwiw:

What Are the Prevailing Opinions on Whether Dr. Stephen Sinatra Is Legitimate?
https://www.reference.com/health/prevai ... 54173ef0b7

and speaking of 'as of 2015', i also don't know what the good doctor's contribution might have been to this publication:

Recent Science and Clinical Application of Nutrition to Coronary Heart Disease
https://www.tandfonline.com/doi/abs/10. ... 17.1381053

as for the op article making the case for improved quality of life amongst ms patients, i don't see any value in trying to poke holes in that... why risk lifestyle behaviours leading to even more challenges than ms has to throw at us already. bring on the pursuit of health!

[1eye]

Thanks very much for the link to https://www.tandfonline.com/doi/full/10 ... src=recsys

Was just discussing how Canada Food Guide had been retrieved from the jaws of Commercialism. This is pretty definitive, and ready for a digest (!) version...

I am now on that magnesium you talked about (a bit expensive) and have started a vitamin supplement. I feel healthier already, but my legs are a bit worse. When I stretch them after being curled up asleep, one or both if them will shake uncontrollably for a few seconds. Scary. And in certain positions, when walk(er)ing about the house, I will get a painful twinge that stops me in my tracks, just below my knee, at the back. I may still be feeling my 1/2 hour of exercise on the Nustep machine five days ago...

I'm waiting for changes in nutrition to settle and get constant. But I guess that's the thing about MS. Nothing is constant.

Kidneys are feeling better. Whatever it is in my vitamin that makes my pee bright yellow may be improving them.

[jimmylegs]

hi i don't yet see where the research available via that particular link has been previously shared here at tims, but the content does look interesting. if there's a different link you meant to post, please do!
it is definitely nice that food guides in the americas and elsewhere are doing a better job at relying on the evidence base.

very glad to hear you are feeling better.

if it's any consolation, the new but less pleasant experiences may be things 'coming back'. back when i was severely mag depleted (in my case the functionality of my throat was really suffering), the early response to magnesium was a noticeable spasm in my throat which happened reliably for i would say months if not years while my background tissue stores recovered. i would feel it within an hour of taking a magnesium supplement, and i called it 'the magnesium knock'. over time, it stopped happening. it's a distant memory these days.

i've also felt the leg spasm after stretching before, but it has happened when i'm not diligent enough with magnesium and nutrient intake in general. for me at this point that symptom would indicate that things are headed downhill. for you, it might represent change in a more positive direction.

i'm afraid i can't commiserate on the pain below the back of the knee. maybe it does have something to do with your exercise regimen. time will tell i guess.

glad to hear the kidneys are feeling better!

the yellow pee deal is from the b2 in the multi. don't fall for observer bias - there are things in there that you can't see, all pitching in to improvements together

this is interesting, a bit of vit b2 shows up (along with other essentials) in the (lower quality) recommendations for stage 4 chronic kidney disease:

• Evidence based practice guidelines for the nutritional management of chronic kidney disease
  Nutrition Prescription/Intervention
  https://onlinelibrary.wiley.com/doi/ful ... 06.00100.x
  
  "Supplementation. Patients on a restricted protein diet (<0.75g/kg IBW/day) should receive thiamine (>1mg/day), riboflavin (1–2mg/day) and vitamin B6 (1.5–2mg/day)."

level IV evidence, ie not awesome. looks like some researchers need to get busy!

i hope you continue to experience improvements could be in for a long haul - don't give up!

[1eye]

Well I would have thought I would never need a B supplement, because I take 300 mg /day of rice bran, which I thought was all the b vitamin part of rice that is removed, and you don't get, unless you eat brown rice. I'm only using it as filler but I would have thought I got lots of B2! Guess not.

[jimmylegs]

i'm sure your b2 intake has been fine. as i understand things, the excreted amount you are seeing is what's not being retained, because you're topped up for this water soluble vitamin.

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015041/
  
  Deficiencies
  Dietary intake information derived originally from the NHANES and the second NHANES 2003–2006 indicated little-to-no concern for inadequate riboflavin consumption (4). Later studies corroborated these findings, showing that 0% of 2- to 8-y-old children, 5% of 14- to 18-y-old girls, and 2% of adults ≥19 y had dietary intakes of riboflavin marginally below their estimated average requirement.
  
  Interference with intestinal transport that includes digestive and absorptive disorders and bowel resection can lead to the development of suboptimal status or frank deficiency and eventual clinical abnormalities. Persistent riboflavin deficiency is observed in patients with Brown-Vialetto-Van Laere (BVVL) and Fazio-Londe syndromes. The phenotype of BVVL syndrome is characterized by hearing loss and sensory ataxia followed by progressive upper limb weakness, optic atrophy, bulbar weakness, and respiratory failure. Both BVVL and Fazio-Londe syndromes are rare congenital defects of the riboflavin transporter gene and exhibit overlapping clinical features except that sensorineural hearing loss is not observed in Fazio-Londe syndrome.
  
  Aside from these rare genetic defects and malabsorptive conditions, isolated deficiencies of riboflavin are not widely prevalent in the general population. Although textbooks label the physical and clinical symptoms as unique features of riboflavin deficiency, in actuality none is pathognomonic of riboflavin deprivation. The classic glossitis, angular stomatitis, cheilosis, and dermatitis observed in advanced cases of riboflavin deficiency may be due to other vitamin deficiencies as well. In fact, when a deficiency of riboflavin does occur, it is almost invariably in association with multiple nutrient deficits.

[1eye]

Thanks for keeping on top of this. This morning I had scarily painful legs so today I stayed away from the NuStep. The other thing I've been doing is trying to walk every day. But today being a snow day I didn't. If I don't have the same scare in the morning that'll be it. I'll have to take every other day off. Makes sense at my age.

Not worried at all about B2 now.

[jimmylegs]

hmm scarily painful sounds counterintuitive. is it general post-exercise pain, ie hurts when you move muscles a certain way, but is okay at rest? or is it something different?

[1eye]

That was it. I took some codeine last night. OK at rest. How did you know? No NuStep, OK this morning. Yay. Happy Valentine.

[jimmylegs]

well, i guess i just know what muscles feel like after exertion, vs other. eg i recently overdid some deep squats, recovering from that was fun hehe :S
glad things are better today. going forward, sounds like baby steps might be in order.
happy valentine's day! you've reminded me to post a fave joke in the humour section