 by Ashley Jordan Ferira, PhD, RDN
Recent research from three well-known cohorts, The Nurses’ Health Study (NHS), NHS2 and Health Professionals’ Follow-Up Study (HPFS), reveals that higher magnesium intake is associated with lower risk of type 2 diabetes (T2D), particularly in diets with poor carbohydrate quality.1 Green leafy vegetables, unrefined whole grains, and nuts are richest in magnesium, while meats and milk contain a moderate amount.2 Refined foods, like carbohydrates (carb), are poor sources of magnesium. Diets with poor carb quality are characterized by higher glycemic index (GI), higher glycemic load (GL), and lower fiber intake. These poor carbs require a higher insulin demand. The typical American diet is low in vegetables and whole grains, resulting in reduced magnesium intake. The Recommended Daily Allowance (RDA) for magnesium is 310-320 mg/day for adult women and 400-420 mg/day for adult men.3 Half of the US population fails to meet their daily magnesium needs, and hypomagnesemia exists in 1/3 of adults.4-5 Magnesium is needed for normal insulin signaling; current research has linked insufficient magnesium intake to prediabetes, insulin resistance and T2D.4 Increased magnesium intake has been inversely associated with T2D risk in observational studies.6 Collaborators from Tufts University, Harvard University, and Brigham and Women’s Hospital, sought to investigate the impact of magnesium intake, from both dietary and supplemental sources, on the risk of developing T2D in subjects who had diets with poor carb quality and raised GI, GL, or low fiber intake.1 They followed three large prospective cohorts, NHS, NHS2 and HPFS (totaling over 202,700 participants). Dietary intake was quantified by validated food frequency questionnaires (FFQ) every 4 years, and T2D cases were captured via questionnaires. Over 28 years of follow-up, there were 17,130 cases of T2D. Major study findings included:1
Similar to the US population estimates, 40-50% of study participants had inadequate magnesium intake. A healthful, varied diet and supplemental magnesium (especially in diets that restrict or exclude carbohydrates, dairy or meat) are essential to ensure sufficient daily magnesium intake. Why is this Clinically Relevant?
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 Did you know that getting just 10 minutes of sunshine (ultraviolet B, or UVB) per day helps the body create approximately 10,000 IU of vitamin D?1 This nutrient is necessary for the health of your bones, as well as overall health.2 However, during the months of November through February, and if you live north of Atlanta, there won’t be enough UVB rays to penetrate through the atmosphere and help your skin generate this vital nutrient. So is there something you can do? Sometimes you just have to create your own sunshine. And considering that three-quarters of teens and adults in the United States are deficient in vitamin D,3 as well as 1 billion people worldwide,4 this is where supplemental vitamin D can really help. Natural dietary sources of vitamin D are few (e.g. fatty fish, eggs), and fortified dietary sources such as milk, orange juice and cereal provide minimal amounts of vitamin D. This is why vitamin D is one of the most common nutrient gaps and also one of the easiest to address via supplementation. Why is vitamin D important? Vitamin D is a fat-soluble vitamin that regulates bone growth and mineralization and plays an important role in ensuring the muscles, heart, lungs, and brain function properly.2 Vitamin D has also been shown to support immune function. Vitamin D is not only an essential vitamin but also acts as a hormone in the body. Vitamin D that you obtain from the sun, food, beverage, or supplements must be first activated by the liver which converts the vitamin D to 25-hydroxyvitamin D (25(OH)D), also known as calcidiol.2 It is then converted by the kidneys and target tissues in the body to the biologically active form 1,25-dihydroxyvitamin D (1,25(OH)2D), also known as calcitriol.2 Calcitriol is the active, hormone form, which supports a variety of physiological functions, including helping the body regulate levels of calcium and phosphorus, as well as mineralize bone.5 Vitamin D deficiency What does it mean to be deficient in vitamin D? Measuring serum concentrations of 25(OH)D rather than 1,25(OH)2D is a better indicator of vitamin D status in the body due to its longer half life. Certain groups define vitamin D deficiency as 25(OH)D level less than 20 ng/mL (50 nmol/L).6 Vitamin D deficiency can be an issue for many people, including:7
Finding out if you need more vitamin D Measuring your vitamin D levels via a blood test is the only way to definitively know if you’re getting enough of this nutrient. With a 25(OH)D blood test from your healthcare practitioner, you will know your vitamin D levels and whether you need to take a supplement. Optimal levels of vitamin D vary according to different scientific organizations. For example, for adults the Vitamin D Council recommends daily supplementation with 5,000 IU of vitamin D3 when you cannot get enough sun to achieve a status between 40-60 ng/ml; whereas, the Endocrine Society recommends 1500-2000 IU/day.7-8 Higher levels are recommended to address deficiency.8 It is also important to recheck vitamin D levels two months after beginning a supplement regimen, and adjust as needed based on your practitioner’s recommendations. Which D is right for me? It’s important to get the form of vitamin D that is most bioavailable to the body. There are two kinds of vitamin D—D2 and D3. Vitamin D2 (ergocalciferol), is found in plants such as lichens and mushrooms, which are often irradiated by growers to boost nutritional value. Some soy and almond milks are also fortified with vitamin D2. Vitamin D3 (cholecalciferol) is the natural form of this nutrient that is created by the body with sun exposure, and research has shown that the D3 form increases the total circulating level of 25(OH)D significantly more effectively than D2.9-10 Vitamin D3 is found in small amounts in oily fish such as cod and salmon, egg yolks, as well as fortified cereals and milk, and some commercial mushrooms. Additionally, vitamin D3 has been shown to maintain adequate amounts of serum vitamin D levels during the winter months.11 There are also special sunlamps to help the skin generate vitamin D, but because of the risk for skin damage from ultraviolet rays, many healthcare practitioners don’t recommend using them.  Make D your favourite letter for better health Whether you’re lucky enough to get the vitamin D you need from the sun all year around, or taking a vitamin D supplement, you’re wise to ensure you get enough of this vital nutrient. If you’re wondering whether you need more vitamin D, ask your healthcare practitioner. References:
 Glyphosate, first registered for use in the United States in 1974, is an herbicide widely used to kill broadleaf weeds and grasses and regulate the growth of certain plants.1,2 It is employed in agriculture, forestry, in lawn and garden maintenance, and for weed control in industrial areas.1
The use of glyphosate has skyrocketed since 1997, after crops genetically modified to tolerate glyphosate were first introduced.3 The broad usage has led to questions of whether glyphosate remains present in the food we eat and water we drink, as well as whether it is safe for humans to consume. Because glyphosate binds so tightly to soil particles after use, it is believed to be prevented from entering groundwater.4 However, this may not be the case. During a 2002 study of waterways in nine Midwestern states, glyphosate was detected in 36% of the 154 samples taken, although the highest measured concentration was still well below the maximum contaminant level (set by the Environmental Protection Agency) of 700 micrograms per liter.3 And in one study of an agricultural community in Mexico, glyphosate was detected in both groundwater and bottled water.5 Due to its lack of quick degradation in plants, glyphosate residue could be present in the food supply.4 In tests performed by researchers and consumer watch groups, glyphosate has been detected in a number of foods, including bread, honey, oat-based cereals, granolas, and snack bars.6,7 Common means of glyphosate exposure Pure glyphosate is said to be low in toxicity, but it is often mixed with other ingredients that can make the resulting product more toxic.1 Directions for applying glyphosate usually caution users to wear gloves and eye protection to avoid skin and eye irritation and to be careful not to breathe the compound to protect against nose and throat irritation.1 Although it isn’t easy for glyphosate to pass through the skin into the body, it is possible to ingest glyphosate by breathing it in while spraying or by eating or smoking after applying, without first washing your hands.1 When absorbed or ingested, most glyphosate tends to remain unchanged and leaves the body pretty quickly in urine or excrement.1 Despite that, swallowing glyphosate-containing products can result in nausea, vomiting, diarrhea, and burns in the mouth and throat.1 Intentional ingestion has resulted in fatalities in some cases.1 Because glyphosate products often contain additional chemicals, it can be hard to determine whether glyphosate alone is responsible for the adverse symptoms observed when humans come into contact with it.8 For instance, some studies suggest that the surfactant polyoxyethyleneamine used with glyphosate is more toxic than glyphosate alone.8 Agency opinions and glyphosate research Consensus on risks associated with glyphosate exposure has been tough to pin down. In April 2019, the US Environmental Protection Agency stated it “continues to find [glyphosate] poses no risk to public health when used as labeled and that it is not a carcinogen.”2 This follows a similar declaration by the European Food Safety Authority in 2015 that glyphosate is unlikely to be a carcinogen in humans.9 By contrast, the World Health Organization’s International Agency for Research on Cancer (IARC) stated in March 2015 that it had analyzed the results of over 1,000 studies and determined that glyphosate was possibly carcinogenic to humans.10 In an updated monograph released one year later, the IARC attributed the difference between its statement and the findings of other agencies to the source material, noting that most regulatory agencies reviewed nonpublic industry data from toxicological studies.10 Still, research into glyphosate’s possible carcinogenic effects continues. A recent analysis of human epidemiological studies confirmed a link between glyphosate exposure and an increased risk for non-Hodgkin’s lymphoma.11 And in another lab study, glyphosate was shown to stimulate the growth of a certain type of hormone-dependent breast cancer in cells by acting on estrogen receptors, indicating it may be an endocrine disruptor.12 Researchers are also investigating glyphosate’s impact on the human reproductive system. In one study, exposure to glyphosate-based herbicides below the toxicity threshold decreased the activity of aromatase, a key enzyme in balancing sex hormones.13 Another study in prepubertal male rats showed a decrease in testosterone levels in those given soy milk supplemented with glyphosate.14 And results of a study in pregnant mice indicate that glyphosate can cause the ovaries to fail and interfere with secretion of hormones.15 There have been cases of accidental exposure to concentrated glyphosate solutions causing neurological lesions, suggesting glyphosate could be neurotoxic in high doses.16 In a model of the blood-brain barrier, researchers observed that a high dose of glyphosate resulted in neurological damage and altered metabolism of glucose.16 Glyphosate and antibiotic resistance Recent research has uncovered a worrisome link between glyphosate use and the growing problem of antibiotic resistance.17,18 It is believed the use of glyphosate is leading to changes in microbiome composition and, as a result, increases in resistance to critical antibiotics.17 Researchers note that when bacteria are exposed to non-antibiotic chemicals such as herbicides, they can be inclined to develop resistance to antibiotics more rapidly: in some cases, 100,000 times faster.18 Looking to avoid glyphosate? The Detox Project offers Glyphosate Residue Free and Gold Standard Detox certification to bring a new era of transparency to the food and supplement industries. References:
 By Michael Stanclift, ND You’re feeling that rush as you catch your stride on your morning run. The air is perfect. Suddenly a cramp or muscle ache stops you dead in your tracks. You try to shake it off, but it just grabs more. Ah! We still don’t completely understand why muscles tighten up involuntarily. Exercise, pregnancy, electrolyte imbalances, nerve compression, and diminished blood supply to the muscle all may contribute.1,2 So what can we do to combat these harmless but pesky discomforts? In this article we’ll look at what the research says. Surprisingly, some popular natural remedies don’t shine through in the current medical evidence. What might not help with cramping Magnesium and Epsom salts: A Cochrane Review found that oral magnesium wasn’t likely to help with muscle cramps in older people, and the findings were inconsistent in pregnant women.3 A recent randomized, placebo-controlled trial in pregnant women found no difference in leg cramps with magnesium compared to placebo.4 Epsom salt (magnesium sulfate) baths have long been a go-to for muscle relaxation, and “float” centers with sensory deprivation tanks full of the magnesium-rich water have popped up as an urban refuge from the constant stimulation of modern life. A study in nonathletic healthy men found a one-hour float (in magnesium sulfate) after exercise reduced pain perception compared to one hour of passive recovery.5 However, these findings are tough to attribute to magnesium, as the study’s control didn’t match other potentially therapeutic factors, such as body positioning and sensory deprivation.5 So a relaxing bath may help with cramping and muscles, but it’s unclear if adding Epsom salt makes a significant difference. Active cool-down and static stretching: Many believe after exercising intensely a period of low-to-moderate intensity will prevent muscle soreness and injuries, but this doesn’t appear to be true.6 A 2018 review found evidence on active cool-downs shows it doesn’t significantly reduce soreness, stiffness, or range of motion and may inhibit muscular glycogen resynthesis (energy storage).6 This same review found that static stretching before or after exercise didn’t reduce muscle soreness.6 What might help with muscle cramping: Foam rolling: This surprisingly simple tool can be valuable if you suffer from muscle soreness and cramps. Using a foam roller after exercise can reduce muscle soreness and improve athletic performance the following day.6 Physical therapists from Harvard agree that 30-120 seconds per area can be helpful in relieving sore muscles and preventing cramps.7 Muscle soreness: Tart cherry or pomegranate juice: A small randomized, double-blind, placebo-controlled trial found 355 ml (~12 oz.) of tart cherry juice drunk twice a day for a week before a 26 km (16-mile) run reduced the amount of pain reported from participants.8 A research review found similar effects from drinking tart cherry juice twice a day, and one study found pomegranate juice reduced soreness.9 But the research on these two drinks in relation to muscle soreness has shown mixed results.9 A recent study compared tart cherry, pomegranate, and placebo drinks to analyze the impact on muscle soreness in nonresistance trained men.10 In this study, the researchers were surprised to find that neither of the fruit drinks appeared to help with muscle soreness when compared to placebo.10 Ginger: In a small double-blind, randomized, placebo-controlled trial in experienced runners, 5 days of powdered ginger supplementation (1.4 g/day) moderately reduced muscle soreness from a run (on day 3) during the supplement period.11 A review of randomized clinical trials found that consuming up to 4 g of ginger postintense exercise can reduce muscle soreness and improve muscle recovery.12 Lower single dosages of 2 g ginger did not help with muscle soreness when compared to placebo.12 This suggests it may take multiple days or higher doses to get the effect. Curcumin: It’s no surprise that curcumin, a bright orange compound from the spice turmeric is making news again. A research review found curcumin in a wide range of doses (150 mg-5,000 mg) can reduce muscle soreness after exercise.13 Curcumin can work when used on an “as needed” basis, with even a single dose (150-200 mg) showing effectiveness for muscle soreness following exercise.13 Interestingly, in this review they found small doses (90 mg twice a day) of curcumin taken for 7 days before exercise had no effect on postexercise soreness, while the same dosage taken after exercise for 4 days was effective.13 Other studies in the review at similar doses did not find curcumin improved muscle soreness compared to placebo, so differences in the trial participants and types of exercise may influence the effects.13 Conclusion:Cramping and muscle soreness can ruin a good exercise session, but they don’t have to. When it comes to combatting these annoying aches, you have numerous options—but beware that some popular natural treatments might be more hype than help.
References: 1. Young G. Leg cramps. BMJ Clin Evid. 2015;2015:1113. 2. Mayo Clinic Staff. Muscle cramps. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/muscle-cramp/symptoms-causes/syc-20350820#:~:text=Overuse%20of%20a%20muscle%2C%20dehydration,Inadequate%20blood%20supply. Accessed February 11, 2021. 3. Garrison SR et al. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2012;2012(9):CD009402. 4. Araújo CAL et al. Oral magnesium supplementation for leg cramps in pregnancy-An observational controlled trial. PLoS One. 2020;15(1):e0227497. 5. Morgan PM et al. The acute effects of flotation restricted environmental stimulation technique on recovery from maximal eccentric exercise. J Strength Cond Res. 2013;27(12):3467-3474. 6. Van Hooren B et al. Do we need a cool-down after exercise? A narrative review of the psychophysiological effects and the effects on performance, injuries and the long-term adaptive response. Sports Med. 2018;48(7):1575-1595. 7. Harvard Health Staff. Roll away muscle pain. Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/roll-away-muscle-pain#:~:text=Foam%20rollers%20are%20easy%2Dto,from%20exercise%2C%20and%20reduce%20injury.&text=As%20you%20age%2C%20occasional%20muscle,lightweight%20cylinder%20of%20compressed%20foam. Accessed February 11, 2021. 8. Kuehl KS et al. Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial. J Int Soc Sports Nutr. 2010;7:17. 9. Bowtell J et al. Fruit-derived polyphenol supplementation for athlete recovery and performance. Sports Med. 2019;49(Suppl 1):3-23. 10. Lamb KL et al. No effect of tart cherry juice or pomegranate juice on recovery from exercise-induced muscle damage in non-resistance trained men. Nutrients. 2019;11(7):1593. 11. Wilson PB. A randomized double-blind trial of ginger root for reducing muscle soreness and improving physical performance recovery among experienced recreational distance runners. J Diet Suppl. 2020;17(2):121-132. 12. Rondanelli M et al. Clinical trials on pain lowering effect of ginger: A narrative review. Phytother Res. 2020;34(11):2843-2856. 13. Yoon WY et al. Curcumin supplementation and delayed onset muscle soreness (DOMS): effects, mechanisms, and practical considerations. Phys Act Nutr. 2020;24(3):39-43. |
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