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?
Link to Abstract
by Bianca Garilli, ND
Magnesium is the 4th most abundant mineral in the human body following calcium, sodium, and potassium. Intracellularly, magnesium is the 2nd most abundant cation behind only potassium.1 The number of essential roles magnesium plays in the body is extraordinary, with over 300 enzymes requiring magnesium as a co-factor for proper functioning.1
This essential element is involved in numerous critical physiological processes such as energy production (ATP metabolism, oxidative phosphorylation, and glycolysis), protein synthesis, muscle contraction, nerve function, blood glucose control, hormone receptor binding, blood pressure regulation, trans membrane ion flux, gating of calcium channels, cardiac excitability, and synthesis of nucleic acids (RNA and DNA).1
Unfortunately, magnesium is one of the most prevalent nutrient gaps in the US. The 2015 Dietary Guidelines Advisory Committee noted a substandard intake of magnesium as compared to the Estimated Average Requirement (EAR), which is the Dietary Reference Intake (DRI) used to assess population sufficiency vs. insufficiency for nutrients.2-3 A 2016 publication in Advanced Nutrition concluded, “Approximately 50% of Americans consume less than the EAR for magnesium, and some age groups consume substantially less”.4 This is especially concerning when one considers the critical implications of long-term, frequently unrecognized magnesium deficiencies.
Deficiencies in magnesium can present with overt clinical manifestations such as nausea, vomiting, lethargy, weakness, personality changes, tetany and tremor, seizures, arrhythmia, and muscle fasciculations.5 In other cases, sub clinical deficiencies may be more difficult to recognize yet have equally serious effects if left untreated. Health concerns and disease processes resulting from an underlying, subclinical magnesium deficiency may contribute to low bone mineral density and cardio-metabolic implications such as metabolic syndrome, hypertension, arrhythmia, arterial calcification, atherosclerosis, heart failure, and increased risk for thrombosis.6
A sub clinical magnesium deficiency can also disrupt sleep and cause muscle cramping, two common symptoms often glossed over but which can be signs of a bigger problem if left untreated. The impact of magnesium on these two clinical manifestations will be explored further:
Magnesium and sleep
A double-blind randomized clinical trial composed of 43 elderly participants between 60-75 years of age with diagnosed insomnia was conducted.7 The experimental group was given 500 mg/day of elemental magnesium for 8 weeks (250 mg elemental magnesium from 414 mg of Mg oxide, twice daily), while the control group received a placebo for the same length of time.7 A statistically significant increase was seen in sleep time, sleep efficiency, and concentration of serum renin and melatonin, as well as a significant decrease in insomnia severity index (ISI) score, sleep onset latency, and serum cortisol level.7
For many individuals, sleep is disrupted by restless leg syndrome (RLS) or periodic limb movements (PLMS).8 A study supplementing 12.4mmol of oral magnesium in the evenings for 4-6 weeks found that the overall sleep efficiency improved from 75 to 85%.9 The Mg-supplemented group also experienced a significant reduction in PLMS associated with arousal (7 PLMS/hr vs. 17 PLMS/hr at baseline).9
Magnesium and muscle cramps
Muscle cramping is a common occurrence among women during pregnancy, in athletes, and in the elderly, for which magnesium is often recommended.10 There are only a few studies, however, that have reviewed the efficacy of magnesium for muscle cramping.10 In a Cochrane review, 7 trials (5 parallel, 2 cross-over design) were included, with 3 of these trials studying pregnancy-associated leg cramps in 202 females and 4 trials looking at idiopathic leg cramps in 322 participants.10 Results from the studies noted no significant improvement of muscle cramping in older adults, while results in pregnancy were mixed leading the authors to recommend further studies in this population.10 The authors of a review article in Scientifica note that the mixed findings may be explained by the potential that, “deficiencies of other elemental nutrients including calcium and potassium have also been implicated in muscle cramps and spasms. It may be that magnesium is potentially helpful in situations of magnesium deficiency but is not of use if the problem is related to deficiency of another nutrient.”1
Magnesium: Daily needs and sources
Magnesium is an essential macro-mineral required by the human body. The prevalence of deficiency from serum measurements ranges from 12.5-20% of the population.11 Due to the necessity of this cation for over 300 reactions in the human body and the high risk of deficiency, magnesium levels should be routinely monitored either through blood testing and/or a diet diary review. If found to be low, magnesium stores can be replaced through increasing daily intake of the mineral through nutrition as well as routine supplementation.
Foods groups high in magnesium content include green leafy vegetables, legumes, nuts, seeds, and whole grains.12 Specific foods with high magnesium levels include spinach, Swiss chard, beet greens, turnip greens, pumpkin seeds, summer squash, soybeans, sesame seeds, quinoa, black beans, cashews, sunflower seeds, brown rice and pinto beans.12
The Recommended Dietary Allowance (RDA) for magnesium varies by age, sex, and whether pregnant or lactating:13
*RDA not able to be determined; Adequate Intake (AI) reported
Supplementation with high-quality magnesium is another, targeted way to reach optimal levels and fill dietary gaps. Supplementation dosing and form can be personalized and taken orally via capsules, tablets, liquid, and even powder. Some of the different forms available in the market include Mg oxide, gluconate, chloride, citrate, sulfate, glycinate, and L-threonate.
Bianca Garilli, ND
Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.
Targeted probiotic in personalized therapeutic plan for patients with diabetes shows promise
by Bianca Garilli, ND and Ashley Jordan Ferira, PhD, RDN
Type 2 diabetes (T2D) is no longer a Western world phenomena, but rather a global epidemic, with research revealing an association between higher T2D rates and a country’s wealth or economic growth.1 As a clear example, in a publication titled “Prevalence of type 2 diabetes in the Arab world: impact of GDP and energy consumption”, it was observed that the higher a country’s gross domestic product (GDP), the higher the T2D prevalence.1 T2D rates in these regions include Kingdom of Saudi Arabia- 31.6%, Oman- 29%, Kuwait- 25.4%, Bahrain- 25%, and United Arab Emirates- 25%.1
Recognizing the worldwide impact of T2D, it is critical to identify underlying causes and practical, implementable tools for prevention and treatment. It is well documented that T2D is a chronic, inflammatory condition. Higher levels of lipopolysaccharides (LPS) have been observed in diabetic vs. non-diabetic individuals.2 LPS are Gram-negative bacterial fragments that are considered endotoxins, and can, if left untreated, overgrow in the gastrointestinal tract leading to increased gut permeability.3 A “leaky gut” environment increases the opportunity for these endotoxins to migrate out of the gut and into the circulation, ultimately contributing to systemic inflammation.3
Probiotics have been studied in various models to determine their effects on LPS growth and proliferation and whether targeted probiotic administration aimed at mitigating LPS effects can reduce systemic inflammation, in particular in the T2D population.4-5 The limitations of previous research included short-term duration (≤3 months) and the utilization of mono-strain supplementation.3
To augment the current literature on this topic, a longer study (6 months) was conducted in a randomized, double-blind, placebo-controlled fashion to examine the impact of probiotics on endotoxemia, inflammation, and cardiometabolic disease risk in Arab patients with T2D.3 In this study, 61 Saudi adults (35 females) aged 30-60 years completed the 6-month trial: 30 in the placebo group and 31 in the probiotic group.3 The placebo and probiotic groups were randomly allocated to powder sachets, to be dissolved in a glass of water twice daily, before breakfast and bedtime. The probiotic intervention provided 2.5 billion CFU/g BID and included the following strains: Bifidobacterium bifidum W23, Bifidobacterium lactis W52, Lactobacillus acidophilus W37, Lactobacillus brevis W63, Lactobacillus casei W56, Lactobacillus salivarius W24, Lactococcus lactis W19, and L. lactis W58.3
No additional therapeutics such as exercise or dietary recommendations were included during the course of the study in either group.3
In the probiotic group, significant changes in glycemic indices, lipid profile, inflammatory markers, endotoxin levels, and adipocytokine profile were observed at 6 months vs. baseline:3
The improvements in endotoxin load, inflammation, and cardiometabolic profile over time in the probiotics group are noteworthy, but they were not clinically significant when compared to the placebo group.3 Comparing the probiotic intervention to the placebo group: There was a significant and clinically relevant decrease in HOMA-IR (↓64.2%) in the probiotic group.3 HOMA-IR is correlated with most other cardiometabolic indices measured, so one could posit a potentially broader cardiometabolic benefit from the probiotic intervention, but this and other hypotheses should be explored in a future study with an adequately powered sample size.
Why is this Clinically Relevant?
Inflammation is a popular buzzword these days. But what causes it exactly? How can you know you have it, and if it’s something your body does naturally to help you heal, then what’s the big deal?
We’ve all been there: It’s late, you’re tired, and you don’t feel like turning the lights on just to cross a room…then bam! Shin finds coffee table. The resulting egg-shaped lump is formed when blood flow increases to the area, bringing with it neutrophils and macrophages as part of the immune response.
Symptoms of this acute inflammation are typical: redness, swelling, heat, and pain. The swelling that occurs as fluid collects in the area is also called “edema.” The symptoms last for a limited period of time—minutes to days—as the body heals itself.
Acute inflammation vs. chronic inflammation
When the body isn’t given enough time, or if the body is unable to resolve the immune response due to deficiency of certain nutrients, it can lead to chronic inflammation. This can also be caused by untreated infectious pathogens such as bacteria or viruses, as well as the adverse effects of long-term exposure to pollutants or chemicals, including smoking.1,2 Stress and obesity are also known factors that lead to chronic inflammation.3,4
Common symptoms of chronic inflammation include:
What can we do?While acute inflammation is one way your body can heal itself, chronic inflammation should be avoided, as a prolonged inflammatory response can cause damage to healthy cells and tissue.
Consider adopting a few simple ways to decrease inflammation. If you have been experiencing the symptoms described herein and are concerned you may have chronic inflammation, make an appointment with your healthcare practitioner.
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
Eat a healthy breakfast. It sounds simple enough. But what exactly does that mean?
While there is no definition of the “perfect breakfast,” it makes sense that there are ideal and less than ideal ways to energize your body. So let’s compare typical breakfast options to various types of fires and ways to fuel your morning right!
The Cooking Fire:
This fire is the equivalent of a stove range. It burns slowly, evenly and can literally last all day.
The breakfast equivalent? A breakfast that will keep you energized all day with stable blood sugar levels should always have lean protein as its base. Like seasoned firewood, lean protein is a slow burn fuel. It improves glycemic response, inhibits the secretion of the hunger hormone ghrelin and stimulates the secretion of the satiety hormones peptide YY (PYY), glucagonlike peptide 1 (GLP-1) and cholecystokinin (CKK). 11 The net effect? You feel more satisfied and have fewer food cravings, which may also help maintain a healthy body weight.
In addition to protein, some minimally processed fats, such as avocado, olive or coconut oil, not only add flavor but also further increase satiety. Carbohydrates should ideally be limited to whole food sources (fruits, vegetables, legumes, and whole grains)—as close to their natural form as possible. Think steel cut oats, rather than instant oatmeal.
Here are some examples of slow burn breakfasts and tips to get you started.
The Kindling Fire:
This fire burns hot and fast. It ignites quickly, then extinguishes once it has consumed its fuel: paper, leaves, etc. It’s all kindling, no logs.
Think of the typical bagel and juice breakfast as a kindling fire. The more processed, more sugar-laden your breakfast, the faster your body burns it. In the big picture of long-term health effects, within reason, any breakfast is better than no breakfast at all. True, it gives you some fast energy. But keep in mind, it may leave you hungry and needing energy by mid-morning.
Do you skip breakfast? If so, you’re in good company. In fact, according to a national survey, “breaking the fast” is not on the morning agenda of 31 million American adults. How might skipping the most important meal of the day affect you? Research supports the importance of breakfast for better energy and healthier food choices throughout the day, wins for everyone. But if you fit the following criteria, you may have even more to gain from breakfast 1,2.
What’s your excuse for skipping breakfast?
About Maribeth EvezichMaribeth Evezich, MS, RD is a functional nutrition and therapeutic lifestyle consultant. Maribeth is also a graduate of Bastyr University and the Natural Gourmet Institute. Whether she is in her kitchen experimenting, at her computer researching, or behind the lens of her camera, she is on a mission to inspire others to love whole foods. as much as she does. She lives in Seattle and is the founder of Lifestyle Medicine Consulting, LLC and the culinary nutrition blog, Whole Foods Explorer. Maribeth Evezich is a paid consultant and guest writer for Metagenics.
View all posts by Maribeth Evezich →
What’s Eating You?
Feeling overly tired, bloated, or achy? When dealing with these often stress-related concerns, there are a few questions you should ask yourself: Am I eating well? Am I getting enough sleep? Do I drink enough water and get enough exercise?
A healthy body handles daily stress better while an unhealthy lifestyle and daily stress can contribute to a deeper issue—chronic inflammation.
Inflammation is the body’s natural response to fighting off potential health threats, but unhealthy lifestyle choices can stunt the resolution of your immune response. In fact, chronic low-grade inflammation is often related to common chronic illnesses. But here’s the good news: There are a few ways you can help resolve your body’s inflammation response—starting today!
1. Ditch That Diet
Unfortunately, many of us do not receive our fair share of nutrients from food. You may feel tired and overworked, and rather than taking the time to prepare a healthy, well-balanced meal, you may often resort to convenient inflammatory trigger foods that are lacking in nutrients: refined starches, high-fat and processed red meats, fried foods, dairy, etc. These may cause an activation of the innate immune system and lead to excessive production of pro-inflammatory cytokines.
It’s time to break the cycle by incorporating anti-inflammatory foods into your day. A Mediterranean-style diet, for example, typically has a high ratio of monounsaturated fatty acids as compared to saturated fats, and more omega-3 to omega-6 polyunsaturated fatty acids. It’s also rich in fresh fruits, vegetables, legumes, and whole grains, which have shown anti-inflammatory effects in observational and intervention studies.
2. Stay Hydrated
This one is obvious. It’s always important to drink enough water throughout the day and ensure you are properly hydrated. Water makes up a large percentage of our bodies to keep all our physiological systems working together smoothly, and it helps flush out toxins and unwanted chemicals we may pick up from the environment.
Tip: Bored with plain water? Add in fresh fruit slices to liven up your H2O. Antioxidant-packed green tea is also great for afternoon sipping.
3. Put Stress to Rest
In our fast-paced modern culture, you may find yourself working too much and not getting enough rest. The initial stress response can be positive, but when left unchecked, it can lead to chronic stress and become pro-inflammatory. This is when getting extra sleep, practising yoga, or taking on leisurely activities you love can make a world of difference.
Catching those Zs at night is especially important because it’s your body’s time to rest and recharge. Lack of sleep can make you feel sluggish, unmotivated, and irritable, which only compounds a stress problem; and increased stress disturbs the quality of your sleep. Research has also linked higher levels of inflammatory proteins to getting fewer hours of sleep at night.
In addition to getting proper rest, taking time to move and exercising are helpful stress relievers, as they release “feel-good” endorphins and can reduce your body’s levels of adrenaline and cortisol (stress hormones).
It’s never too late to make positive life changes!Eating a nutrient-rich diet, ensuring proper hydration, and taking time for relaxation, exercise, and healthy sleep habits are some simple ways you can support your body’s best health today.
If you’re trying to maintain a healthy weight, counting sheep may be as important as counting the carbs on your plate or weight repetitions at the gym. Because, while physical activity and a balanced diet are key factors, sleep may be the most overlooked aspect of your weight management plan.
Can you sleep your way to your dream body? Perhaps not. But if you are sleep deprived, more sleep may help you reach your weight goals. Here’s what you need to know about the sleep-weight connection.
Are you sleep deprived? The National Sleep Foundation recommends seven to nine hours of sleep per night for adults 24-64, slightly more for younger adults and a bit less for those older.1 But due to electronic gadget lights, chronic stress, habitual caffeine, shift-work, and many other reasons, few folks get their target rack time. In fact, according to the Centers for Disease Control, insufficient sleep is a public health problem2 with serious concerns for our productivity, safety, and health—including your waistline.
It’s not just when you’re sleep deprived and find yourself battling the bulge, you’re in good company. Studies have found consistency in the sleep-weight connection; sleep deficiency is linked to weight gain. The largest study of its kind involved over 200 participants and simulated a sleep-restricted workweek. It compared the effects of restricting sleep to only four hours per night compared to unrestricted sleep, up to ten hours per night.3 After only five days, the sleep-restricted subjects had gained about 2 pounds. In contrast, the control group, allowed to sleep for up to 10 hours a night, gained virtually no weight.
If sleep restriction can cause you to gain two pounds in just five days, what can happen on the scale long-term?A lot, according to women tracked for 16 years in The Nurses’ Health Study. Women reporting six hours of sleep per night were 12% more likely to gain at least 30 pounds during the study compared to the women who slept seven hours per night. But those women who were even more sleep deprived, reporting no more than five hours per night, were 28% more likely to gain at least 30 pounds during that same period!4 Apparently, with the sleep-weight connection, every hour counts.
How does less sleep = less svelte? There are several underlying factors behind the sleep-weight connection. But a common thread is our own chemistry, which almost seems to revolt when restorative sleep is intentionally or unintentionally withheld. It’s you against them—and it’s not a fair fight.
Getting to know your hunger chemistry. There’s more than your sensation of fullness and stomach-brain communication involved. Rather, when it comes to hunger regulation and sleep, we have several chemical messengers at play. And when it gets complicated between you and the sandman, those messengers are not on your side. So get to know them:
As you can see, proper balance of ghrelin and leptin is very sleep-dependent. And for the caveman, perhaps these hormones were key to survival during the shorter, sleep-heavy but food-poor days of winter. They also played a part in the ability to capitalise on the longer, lighter sleep and more food-abundant days the rest of the year.
Today, our sleep-deprived bodies are prone to having too much ghrelin and not enough leptin. The result is that the body doesn’t feel satiated, thinks it’s hungry, and needs more calories—and squirrels away those calories for the long winter. In short, ghrelin and leptin kept the caveman alive, but they may be making you heavy.
What to do?
That depends. There are two main reasons behind sleep deprivation. Either you have a sleep hygiene issue (trouble falling asleep or staying asleep), or you have a scheduling issue, in that your lifestyle is interfering with adequate sleep.
For sleep hygiene issues, the typical recommendations always merit consideration: limiting caffeine, avoiding blue light before bed, creating a cool and dark environment, etc. But, when you have a scheduling challenge, getting adequate sleep requires some lifestyle restructuring. It’s worth the time to re-engineer your schedule to slowly go to bed earlier or rise later to increase your sleep time. But in the meantime, can you catch up on sleep on the weekends?
Weekend catch-up sleep: Is it a real thing?Of course, you can get extra sleep on the weekend. But can it potentially reverse your Monday-Friday sleep deprivation? Perhaps. In a study of over 2,000 people participants, those who slept longer on the weekends, nearly two hours longer on average, had a significantly lower body mass index (BMI) than those who didn’t. Further, it appears that the sleep:BMI relationship was dose-dependent in that every extra hour of weekend catch-up sleep was associated with a significantly lower body mass.8 So catch-up sleep can indeed be a good strategy. That is, if your overall average sleep for the week puts you out of the red and into the black, as in you’ve paid back your sleep debt.
Sleep more. Weigh less. Not convinced? Sleep on it…