Hi my name is Andrea Furlan and today we are going to talk about magnesium.
what is magnesium? why it's important for people with chronic pain? so stay here.
let's talk about it. so before we start talking about magnesium let's talk about
how the pain is transmitted in the central nervous system.
pain is transmitted by traveling through the neurons and then from one neuron it
has to be transmitted to another neuron. to transmit this information the first
neuron has to release some substances that is captured by a receptor in the
second neuron, and this space is called synapses. the second neuron has these
receptors for substances and it triggers an electrical reaction that travels to
the brain. in the transmission of pain these neurons communicate with each
other by releasing many substances, one of them is called glutamate and
glutamate activates the receptors called n-methyl D aspartate or the short
form is NMDA receptors. well under normal circumstances the NMDA receptors are
blocked by magnesium and this prevents calcium from entering the cells; however
when there is pain due to an injury or inflammation, the NMDA receptors is
activated and there is more buildup of calcium inside of the cell. these
receptors are overactive and they contribute to an increasing pain
transmission to the brain which leads to an increase intensity of pain; is like
the volume of pain is increased. this is called central sensitization and I
explained this in another video that I made; there are other substances that
block this NMDA receptors, they're called antagonists; one of
these antagonists is ketamine. the problem with ketamine is that it has to
be given by an we intravenous injection, and has many
serious adverse events, and also the person can become tolerant to the
ketamine. well magnesium is an element that has
the ability to block the NMDA receptor located in the pain synapses, especially
in the dorsal Horn of the spinal cord. well compared to the other types of
substances that blocked the NMDA, receptor magnesium is much safer,
very mild adverse effects. we're going to talk about those, and so they offer a big
advantage in the management of chronic pain. so if we give magnesium it can
block the influx of calcium in the NMDA receptors in the neurons that carry the
pain signals; therefore magnesium can attenuate
central sensitization, and results in less pain. magnesium is also a muscle
relaxant but it has to be administered in high doses especially intravenously
or intramuscularly. the muscle contraction
is highly dependent on the influx of calcium in the muscle fibers. so to
summarize magnesium has some benefits to our health,
one is to prevent central sensitization, the other one is to treat constipation,
and the other one is muscle relaxation, and all of those are excellent for our
patient population who have chronic pain. so I'm interested to know if there is
research from clinical trials, randomized trials of magnesium for treating pain,
and I'm happy to report that I found a systematic review published by a group
of researchers from Kingston Ontario here in Canada, published earlier this
year in 2020 that summarize and synthesize all the randomized trials
that exist of magnesium for pain, so this systematic review found nine randomized
control trials for a total of 418 participants. three randomized control
trials examine magnesium for neuropathic pain, three randomized trials
migraines, two randomised trials for complex regional pain syndrome or CRPS,
one for low back pain with neuropathic component. the only area that showed more
promising results was of magnesium for migraine, all three randomized trials of
oral magnesium showed that administration of magnesium supplements
of magnesium was associated with less intense, and also less episodes, less
attacks of migraines compared to placebo. in terms of side effects the most common
reported adverse effects in these randomized trials of oral magnesium were
soft stools, diarrhea, and gastric irritation. in this randomized trials the
dose of magnesium that they use in the supplements varied from 220 to 600
milligrams a day. so how much magnesium do we need per day? well it really varies
depending on if it's male or female, and also depends on the age group: for
children it's about 200 milligrams a day, for women it's about 300 a day, and for
men it's about 400 milligrams a day. that's easy to remember.
so where can we find magnesium in nature or in food? well if you look at this
picture behind me you will see that there are many things that contain
magnesium, and I look first at chocolate, I love chocolate, is it a good source of
magnesium? not so good because pure cocoa has magnesium yes but a little bit. one
tablespoon of cocoa has 25 milligrams of magnesium and one tablespoon is about 5
grams, so I usually put cocoa, pure cocoa on my banana, I mix a banana with oatmeal
and put 1 tablespoon of cocoa, so that's my source of magnesium. so what about
chocolate, and I love dark chocolate, so about 4 pieces of dark chocolate
91 milligrams of magnesium; however it also contains 240 calories, 15 grams of
fat, and 19 grams of carbohydrates of those 12 grams are sugars, so even though
it has four tablets four pieces has 91 milligrams of magnesium, it also contains
a lot of things that I don't need. so what about other sources of magnesium in
food? in things that we eat well? there are many other things like almonds,
spinach, cashews, peanuts, bananas, avocado, chicken breast, beef, broccoli ,apple, and
carrots. approximately 30 to 40 percent of magnesium that we ingest in food is
absorbed. we are going to talk about that. well another form of putting magnesium
into our body is by Epson Salts or bath salts, well this is a type of magnesia
it's called magnesium sulfate, it doesn't taste good so don't try to ingest it but
it can be absorbed by the skin. we don't know exactly how much is absorbed and
how much it increased the magnesium in the blood, but for hundreds and hundreds
of years this Epsom salts, they have been used to treat many different things like
constipation, insomnia, and pain all over the body.
unfortunately epsom salts have not been studied or researched it a lot. so let's
talk about supplements of magnesium. well there are many many different types of
supplements, there are many combinations of salts of magnesium combined to
something else, many, many different ones. well I'm going to talk to you about
three of them, okay? magnesium oxide or milk of magnesium, this is a liquid and
it's used mainly for constipation because the magnesium contains in the
milk of magnesium is not well absorbed, so it stays inside
the guts, and it pushes the water that we drink, and only maybe 4% of the
magnesium contained in the milk of magnesium or magnesium oxide is actually
absorbed. so the other one is magnesium citrate, and magnesium citrate is
relatively not expensive, this is a brand that you may recognize, but I
blocked the name of the brand, and magnesium citrate it's a big tablet, very
big, but it contains 150 milligrams in one big tablet like this one, and it's
considered one of the most absorbed forms of magnesium that we know, so it's
about, it's more than 40% of the magnesium that is included in this
tablet that is absorbed in the body, so if a person needs 300 milligrams of
magnesium a day that's the daily requirement they would need two tablets
of this a day magnesium citrate, it's also good for constipation but it's also
good for migraines, and it's also good for muscle relaxation. and the other form
of magnesium supplement is magnesium glycinate, so this is magnesium combined
with glycine. glycine is an amino acid and the advantage of this is that it's
also well short more probably than the magnesium citrate, so it doesn't stay in
the guts, therefore it doesn't cause diarrhea, or soft stools, and there are
advantages that glycine is an amino acid that helps with anxiety, stress and
insomnia. so many of my patients who have muscle pain or migraines, they also have
anxiety, insomnia. magnesium glycinate can be a good option for them, the only thing
is that it's more expensive, and can only be found in specialized health food
stores. please remember that this video is not intended to provide medical
advice, if you think that you have magnesium deficiency please consult your
physician, and the physician can measure your magnesium in your blood and
let you know if you need treatment, and give it a proper treatment. this video is
only for educational purposes. if you liked this video don't forget to like
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