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How a Magnesium Deficiency May Contribute to Crohns

Magnesium deficiency is one of the commonly diagnosed nutritional deficiencies in Crohn’s disease. The identified cause of this deficiency is diarrhea. Because diarrhea is a common symptom of Crohn’s disease, close monitoring of magnesium levels is recommended in order to avoid serious complications such as seizures, mental confusion and irregular heartbeat. Unfortunately, magnesium supplements can also cause diarrhea. So, how is magnesium properly given in Crohn’s disease? Read on to find out.
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Magnesium and Crohn’s Disease

Crohn’s disease is caused by impaired innate immunity. The inflammation that damages the gastrointestinal tract is really an unchecked immune reaction to increased bacterial growth in the gut.

Because of the inflammation and damage to the gastrointestinal mucosal surface, people with Crohn’s disease usually suffer from nutritional deficiencies. For example, folate deficiency and vitamin B12 deficiency quickly result from damage to the small intestine.

Besides these two examples, other nutritional deficiencies may also result from Crohn’s disease.

With regards to magnesium, the kind of diarrhea commonly experienced in Crohn’s disease can severely reduce the absorption of the mineral.

Diarrhea leads to electrolyte imbalance and low levels of essential minerals such as magnesium.

The absorption of magnesium is furthered reduced by the inflammation and damage to the gastrointestinal mucosa. The raw, exposed mucosal surface often bleeds. Therefore, diarrhea in Crohn’s disease is also characterized by blood and pus in stool.

Relieving diarrhea among Crohn’s disease sufferers may help reverse magnesium deficiency. However, the increased bowel movement associated with diarrhea reduces the absorption of magnesium from foods.

The absorption of oral magnesium supplements may also be affected. Therefore, alternate routes of administration are often considered for magnesium supplementation in Crohn’s disease.

Intravenous magnesium is recommended for Crohn’s disease patients with severe diarrhea because it bypasses the oral route and the gastrointestinal tract.

Health Benefits of Magnesium

Magnesium is one of the essential minerals needed for the normal functioning of the body. Over 300 enzymes need magnesium to function properly. The many roles of magnesium in the body include

  • the generation of ATP (adenosine triphosphate), the energy molecules required for cellular metabolism
  • the optimal working of the muscles of the heart
  • nerve conduction
  • calcium balance and optimal bone health
  • regulation of blood sugar levels
  • dilation of blood vessels and blood pressure regulation

With such central roles, experts agree that maintaining normal magnesium levels can help in the prevention and treatment of fibromyalgia, type 2 diabetes, cardiovascular disease and premenstrual syndrome.

Magnesium deficiency is one of the most underreported nutritional deficiencies. It is estimated that as many as 80% of Americans do not meet the daily nutritional requirement (300 – 400 mg) for magnesium.

Extended low-magnesium intake can result in acute magnesium deficiency or hypomagnesemia.

When hypomagnesemia is left untreated, it can lead to overt, chronic magnesium deficiency.

Signs of Magnesium Deficiency
  • Weakness, lethargy and muscle cramps
  • Heart palpitations
  • Irritability
  • Involuntary muscle movements such as twitching, jerk reflex reactions, restless leg syndrome and epilepsy
  • Mental confusion, anxiety and hallucination
  • Depression

Studies on Magnesium and Crohn’s Disease

Magnesium Deficiency in Crohn’s Disease Patients

In a 2012 study published in the South African Journal of Clinical Nutrition, the author discussed nutrition management in adult patients with Crohn’s disease.

In that review, she identified chronic diarrhea as one of the common symptoms of Crohn’s disease.

In addition, she noted that magnesium is one of the important nutrients needed to manage active Crohn’s disease.

The author recommended that patients suffering from this disease should receive 300 mg/day of magnesium in the form of supplements with high bioavailability such as magnesium chloride and magnesium lactate.

The study put the prevalence of magnesium deficiency among Crohn’s disease patients at 14 – 33% and identified the causes of this deficiency as

  • chronic diarrhea
  • high-output stoma or fistulae
  • short bowel syndrome
  • bacterial overgrowth
  • malabsorption

Magnesium Supplementation in Patients with Crohn’s Disease

A 2002 study published in the Canadian Medical Association Journal provided additional insights into the nature and treatment of magnesium deficiency among patients with Crohn’s disease.

The researchers also noted that magnesium deficiency is common (prevalence of 50%) among Crohn’s disease sufferers especially in those who have had sections of their ileum removed.

Regarding treatment, the researchers mentioned that magnesium salts can cause diarrhea too. Therefore, the magnesium supplements recommended for Crohn’s disease patients should be those with the least potential to cause diarrhea.

For oral magnesium therapy, the researchers of this study recommended magnesium heptogluconate and magnesium pyroglutamate.

To further reduce the odds of diarrhea caused by these supplements, the authors of the study recommended mixing these supplements with ORS (oral rehydration salts) and sipping the solution slowly throughout the day.

The researchers maintained that the goal of magnesium supplementation was to get serum magnesium levels into normal range by supplying between 5 and 20 mmol/day of elemental magnesium.

This study is important because it identified an often-overlooked side effect of magnesium salts.

Because magnesium supplements can cause diarrhea when taken in high doses, care should be taken not to perpetuate the root cause of magnesium loss in patients with Crohn’s disease.

Evaluating Magnesium Status in Crohn’s Disease Patients

A 1988 study published in the Scandinavian Journal of Gastroenterology provided useful insights into the differences between the balance and distribution of magnesium in people with Crohn’s disease and healthy controls.

For the study, the researchers recruited 30 controls and 30 patients with active Crohn’s disease.

Magnesium levels in the muscle, mononuclear cells and urine samples were measured for all 60 participants. The results clearly showed that magnesium levels for Crohn’s disease patients were lower than for healthy controls at all 3 collection points.

Thereafter, the researchers gave a subset of the participants (including 17 patients with Crohn’s disease) intravenous infusions of 60 mmol of magnesium and 80 mmol of potassium.

The results showed that magnesium levels significantly rose in the muscle, cells and plasma.

The increase was higher in subjects with Crohn’s disease than in healthy controls. In addition, the researchers noted that participants with the highest jump in muscle magnesium levels were also the ones with the lowest muscle magnesium levels before the intravenous infusion of magnesium supplement.

This study showed that magnesium level was closely regulated in the body by a feedback mechanism. This feedback mechanism was responsible for the slow rise in magnesium levels after the intravenous infusion in healthy controls with normal magnesium levels.

Furthermore, the study proved that intravenous magnesium supplementation can quickly raise magnesium levels in different parts of the body including important sites such as immune cells and the muscles.

Lastly, the researchers demonstrated that magnesium deficiency can be diagnosed in Crohn’s disease patients simply by giving intravenous infusion of the mineral and measuring its retention through analysis of magnesium level in the muscles.

Magnesium Absorption in the Gastrointestinal Tract

In a study published in the journal, Acta Medica Scandinavica in 1982, a group of researchers investigated the relationship between magnesium deficiency and damage to parts of the small intestine.

The study involved 19 patients with Crohn’s disease. These patients had varying presentations of the disease.

The results showed that serum and muscle magnesium levels were lower in patients with severe diarrhea characterized by loose stools as compared to those with firm stools.

This is quite expected as diarrhea removes nutrients from the gastrointestinal tract and severely reduces the absorption of electrolyte minerals such as magnesium.

More importantly, the study found out that the severity of magnesium deficiency was related to the part of the gastrointestinal tract most affected by inflammation and damage caused by Crohn’s disease.

The results showed that patients with lesions in the terminal ileum (end of the small intestine) had the highest magnesium concentrations in the muscles and serum. On the other hand, patients with widespread damage in the small intestine had lower magnesium levels.

However, the least magnesium concentrations were observed in patients in which inflamed lesions were found in the small intestine and colon.

This study shows that the small intestine is not the major site of magnesium absorption in the gastrointestinal tract. Rather, it suggests that most of the magnesium derived from diet and oral supplements are absorbed in the colon.

Magnesium Deficiency and Ileum Resection

A 1983 study published in the same journal investigated the link between magnesium deficiency and the surgical removal of the ileum in Crohn’s disease patients.

The researchers determined the magnesium status of 87 patients who have had varying lengths of ileum removed. They found out that the amount of magnesium excreted in the urine and the concentration of magnesium in muscle decreased with increasing length of ileum removed.

In some cases of magnesium deficiency, the severity of muscle fatigue was found to be a good indicator of undetected chronic magnesium deficiency and a good predictor of the length of ileum removed.

The researchers concluded that patients who have had more than 75 cm of the ileum removed usually have low magnesium levels even when the measurement of serum magnesium returned normal results.

This study showed that although the ileum is not a major site of magnesium absorption, it is still an important one. This means that while small lesions in the ileum may not significantly affect the absorption of magnesium, the surgical removal of significant lengths of the ileum will affect the amount of magnesium reaching systemic circulation.

Lastly, this study suggests that symptoms of magnesium deficiency (such as muscle fatigue) are more accurate predictors of low magnesium levels than laboratory tests measuring serum magnesium concentrations.

Therefore, magnesium supplements should be given to patients with Crohn’s disease if they experience signs of magnesium deficiency or after having considerable lengths of their ileum removed.

The Dangers of Hypomagnesemia in Crohn’s Disease

A case study published in the Spanish journal, Hospital Nutrition, described the occurrence and treatment of seizures triggered by low magnesium levels in a patient with Crohn’s disease.

The paper described a male patient admitted to the University of Santiago Hospital who suffered several generalized convulsions even though scans and neurophysiologic tests showed no permanent abnormalities in the brain.

The treatment team confirmed that the patient had chronic low magnesium levels by blood test and then initiated treatment by giving magnesium through intravenous transfusion.

The team reported that soon after the start of magnesium therapy the convulsions disappeared.

The authors of the paper cautioned that doctors treating Crohn’s disease patients should be on the alert for severe nutritional deficiencies such as this.

Magnesium deficiency can easily trigger convulsions in patients with Crohn’s disease because the mineral is essential for nerve conduction and muscle functions. In the continued absence of magnesium ions, neurons may misfire and muscles lose their co-ordination.

Besides convulsion, chronic hypomagnesemia and overt magnesium deficiency can cause depression, and fibromyalgia as well as increase the risks of cardiovascular disease and type 2 diabetes.

Other commonly reported complications of electrolyte imbalance in patients with Crohn’s disease are arthritis and bone disease.

Magnesium is quite important to bone health. In fact, 53% of the body’s store of magnesium is found in the bone. In addition, magnesium is closely linked to calcium and, by extension, bone mineral density. For example, low levels of magnesium block the release of parathyroid hormone which then results in low calcium levels.

Sources


http://www.ajol.info/index.php/sajcn/article/view/83531/73564

http://www.ncbi.nlm.nih.gov/pubmed/3399827

http://onlinelibrary.wiley.com/doi/10.1111/j.0954-6820.1982.tb00388.x/abstract

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