IV/IM magnesium - EP-Cardiologists refuse to give it to me

Hi,

I asked my EP-cardiologist, if she would consider to use Magnesium IV as an adjunctive to the normal treatment protocol, in case I was admitted to the hospital again for AF. She knows, that I'm taking 500-750 mg magnesium supplements per day, and that it helped to keep me in NSR since July. I talked to her about the fact, that most people with PAF have intracellular magnesium deficiencies and gave her some relevant abstracts and studies such as the following:

Magnesium Effective and Safe for Acute Treatment of Rapid Atrial Fibrillation (2007) [www.medscape.com]

Magnesium for the Treatment and Prevention of Atrial Tachyarrhythmias (2004)
[www.medscape.com]
"magnesium may inhibit substrate formation and the development of reentrant circuits within the atria that are responsible for the development and propagation of atrial tachyarrhythmias, such as atrial fibrillation and flutter." ... "Given the limited relationship between serum and tissue concentrations of magnesium, in addition to the potential correlation between intracellular magnesium concentrations and arrhythmia risk, measurement of serum magnesium concentrations for evaluation of atrial tachyarrhythmia risk may have limited use and correction of intracellular hypomagnesemia may explain some of the antiarrhythmic effect of magnesium."

Impact of magnesium sulfate on serum magnesium concentrations and intracellular electrolyte concentrations (2008) [www.ncbi.nlm.nih.gov]
"CONCLUSION: intracellular Mg deficiencies exist despite normal serum Mg concentrations ... Intravenous magnesium sulfate corrects iMg deficiencies immediately postinfusion."

Those studies show, that magnesium works well by itself and as an adjunctive in increasing the success rate of conversion to NSR.

I was very disappointed, that my EP would not even consider it. She did not believe, that the studies were sufficient. She said, if I would insist, that I would have to look for another doctor. I do not have much of a choice though, as she is one of the best cardiologists I have had, and she is certainly the only EP in this city of two million people. In Germany, I got similar answers from cardiologists I had asked, who said, that magnesium is only used for ventricular arrhythmias.

Subsequently I asked another doctor, if he would consider prescribing me IM injections, so that I could replete my intracellular magnesium stores. He likewise refused.

I am always amazed, that experienced doctors, who have no problem in prescribing potentially dangerous and largely untested combinations of Flecainide and Verapamil, or highly toxic agents like Amiodarone will refuse to give a mineral, which has been proven to be safe in dozens of clinical trials over more than 40 years.

Maybe it has something to do with the fact, that magnesium has no patent, is incredibly cheap and has no med-reps pushing it. When I see the 15 med-reps (I am not exaggerating - I counted them!) from Big-Pharma companies waiting in front of the doctor's clinic each evening to push their latest, badly tested, and expensive products, I really question how these doctors get their information.

I still found a solution on how to up my intracellular magnesium. Additional to a a magnesium rich diet, epsom salt baths and chelated magnesium supplements, I have started to get IM injections of 500 mg magnesium sulfate /day. My wife was instructed by a nurse friend of ours on how to do it, and is growing in confidence ;-)

My kidneys are fine and my serum magnesium tested within safe limits after the first few shots, so the risks I'm taking are minimal. My heart is calm and I experience no side effects. Certainly, I would rather have more support from a doctor practicing 'integrative medicine', who I'm still searching for.

I know, that some of you on this board have received IV or IM magnesium to restore their intracellular levels, and I would like to find out some more details on how it went. What dosages did you receive? For how many days/weeks? How did your magnesium levels rise as determined by a whole blood cell Mg or by an exatest? How did it correlate with your frequency of AF episodes?


Christof

My story: <[www.afibbers.org];

Christof, i really do look forward to the answers you receive. What an interesting thread this will be.
PeggyM

Christof,

You should be able to find a physician who will give you magnesium injections/infusions at

[www.acam.org]

Hans

Hans Larsen wrote:
> You should be able to find a physician who will give you
> magnesium injections/infusions at
>
> [www.acam.org]

Thanks, Hans, I found three 'Integrative Medicine Physicians' listed in the Philippines and will give them a call.

Christof,

A suggestion is that you might try transdermal magnesium to get more into your system. You could use either epsom salt (MgSO4) or magnesium chloride (MgCl2). A source of MgCl2 where you are could be bulk food grade Nigari - (MgCl2) used by the Japanese to coagulate tofu. If you search on nigari and me as author you will see some of my posts here.

This post <[www.afibbers.org]; talks about applying epsom salt in a bath & otherwise. You can do the same with mag chloride.

Here is a post by Jackie on how fats can be involved in absorption of magnesium: <[www.afibbers.org];

George

Christof - I hope you have some success thru the ACAM links provided by Hans. It's really too bad your physicians remain unenlightened. There is a saying... 'What you're not up on, you're down on' and this seems to fit when we discuss the advantages of nutritional interventions with mainstream medicine. They didn't get into much nutrition in medical school and unless they go on to study it in depth after that, they remain uninformed.

You certainly are correct that nutritional supplements aren't revenue producers for Big Pharma and of course, they don't educate doctors about therapies that don't bring them income.

I'm really glad you are doing so well with the steps you have taken so far.
It takes some time, but you are certainly well on your way.

I'll be looking forward to more good reports on your progress.

Good luck. Jackie

Christof,

I would be extremely carefull of any dealings in the Philippines.

I have lived in S.E. Asia since 1995 and the general feeling from most ex-pats I know is the the place is one big scam center for fleecing dumb westerners.

The girls are lovely though.

Barry

Hi Christof,
I am in a rush but wanted to reply to you.
After two Natale ablations, I still had lots of ectopics mainly PVCs of various ilk. I had an exatest and my intracellular level of magnesium was low. To remedy this situation, I first tried the magnesium chloride foot soaks from global light and as I recall they helped a bit. Then I found a doctor who was willing to do IM magnesium sulfate injections. I started with 500 mg and worked up to 1.5 grams. The doctor combines the magnesium with B6 to help absorption. Long story short, I seem to need weekly injections and have been having them for about 3 years now. The PVCs are gone but skipping injections for a few weeks will reinstate them. I believe that others here have been able to "load" with magnesium and then discontinue IM injections. This is not the case for me and I have an objective measure of that fact.
I also take magnesium glycinte now and occasionally try the Epsom salt baths that Fran said had helped her. I think that the baths may be a good option.
Lynn

Hi Christof,

I have a large (180 page) site concerning magnesium and depression where I also address some cardiovascular issues related to magnesium deficiency. That page also shows that serum magnesium will ALWAYS register as "Normal", which is very deceptive. Google "magnesium" and "depression" to find the page. It is the first one of millions.

Two causes of arrhythmias are imbalances between calcium and magnesium and separately imbalances between sodium and potassium. In both cases the first metal is primarily external to the plasma cell membrane which is "balanced" by the second metal which is primarily internal to the cell membrane.

It is imbalances of these mineral relationships that cause heart problems. When they measure plasma metals, the intracellular metals are not properly observed. This failure of medicine hurts us and one has to find alternative means to discover the intracellular mineral levels. There are various ways of doing that and the simplest is to measure red blood cell magnesium and potassium.

Often doctors will address calcium and sodium, telling us to modify or diets or to restrict sodium. Yet, they do not consider magnesium or potassium until we arrive at an emergency room with heart problems! What is the first thing the ER docs do? PUMP US FULL OF INTRACELLULAR MAGNESIUM AND/OR POTASSIUM!

I guest what I am getting around to is that General Practice doctors are flying blind using serum measures for these intracellular minerals, defering those decisions to ER docs. Please remember that too much magnesium or calcium will have an adverse effect on the heart, similarly for sodium and potassium. The converse, too little, is also problematic.

In general, people are more likely to be lacking in magnesium and potassium, than to have them in excess, but it can run both ways.

Pretty sick system.

George,

I am really curious about your statement:

"What is the first thing the ER docs do? PUMP US FULL OF INTRACELLULAR MAGNESIUM AND/OR POTASSIUM!"

I know of many afibbers who would love to have a magnesium infusion when they arrive in emergency with an afib episode. But as far as I know very few are lucky enough to encounter a physician who is knowledgeable enough to do this. Also, I would think that potassium infusions would be a No-No in today's error-prone medical system - this is also unfortunate. I had one in Bordeaux and it immediately took care of a very heavy run of PVCs.

Hans

PS. You may find the following abstract from Volume 5 of "Lone Atrial Fibrillation: Toward a Cure" of interest:

"Magnesium infusions in AF control
TORONTO, CANADA. Magnesium is effective in prolonging the atrial and atrioventricular nodal refractory periods. As afib cannot be initiated during refractory periods, this is clearly a good thing and may explain why many afibbers have experienced substantial benefit from magnesium supplementation. Unfortunately, several studies have shown that 50% or more of patients with atrial fibrillation suffer from hypomagnesemia – that is, a lower than normal blood serum magnesium concentration (less than about 0.8 mmol/L). Serum magnesium concentration is a fairly poor indicator of magnesium status since only about 2% of the body’s total magnesium stores are found in the blood. It is thus likely that substantially more than 50% of afibbers are magnesium deficient if intracellular levels are measured.
Researchers at the University of Toronto have just released the results of a meta-analysis of 8 clinical trials involving patients presenting with rapid atrial fibrillation. The trials compared the effect of magnesium infusions with placebo controls and patients given intravenous diltiazem or amiodarone. In the trials 1,200 to 10,000 mg of magnesium (as magnesium sulfate) was infused over a period of 1 to 30 minutes. In four of the studies magnesium infusion was continued for an additional 2 to 6 hours. Adequate rate control (ventricular rate below 100 bpm) was achieved in 61% of patients with magnesium as compared to 35% among controls. Magnesium was found to be as effective as diltiazem and amiodarone in achieving adequate rate control during the first hour. Magnesium was also found to be twice as effective as diltiazem or placebo in restoring sinus rhythm. Overall, the average time to conversion to sinus rhythm was 4 hours for magnesium as compared to 15 hours for placebo. The researchers conclude that magnesium infusions are safe and effective in achieving both rate and rhythm control in patients presenting with rapid atrial fibrillation.

Onalan, O, et al. Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. American Journal of Cardiology, Vol. 99, June 15, 2007, pp. 1726-32

Editor’s comment: It is hoped that emergency departments will take note of these findings and begin to treat acute cases of afib with magnesium infusions rather than with ineffective infusions of digoxin, verapamil, or diltiazem. It would be tempting to speculate that oral supplementation with magnesium might be effective in slowing heart rate and restoring sinus rhythm during an acute afib episode. However, I have not come across anything in the medical literature indicating that this would be so. Besides, achieving an intake of 1,200 to 10,000 mg via oral ingestion would be pretty well impossible and likely to lead to massive diarrhea. Using magnesium infusions to help prevent afib episodes and ectopic beats would, however, make sense since it is very difficult to correct hypomagnesemia just by oral supplementation."

Thanks for all your helpful comments.

GeorgeN wrote:
> A suggestion is that you might try transdermal magnesium to get
> more into your system. You could use either epsom salt (MgSO4)
> or magnesium chloride (MgCl2).

Yes, I'm using Epsom Salt baths and footbaths, which seem to work fine. The question I have with that is, how do I determine, how much magnesium do I actually absorb from the Epsom Salt baths? There do not seem to be (m)any studies, which compare bioavailability and pharmakokinetics of transdermal Mg with IV/IM or oral Mg. This makes it very difficult to figure out proper dosing and the amount of magnesium in mg, which I would likely absorb from the skin.

Barry wrote:
> I would be extremely carefull of any dealings in the Philippines.
> > I have lived in S.E. Asia since 1995 and the general feeling
> from most ex-pats I know is the the place is one big scam
> center for fleecing dumb westerners.

When it comes to alternative medicine, I believe, that there are some scammers in every country; so you'd have to be discerning wherever you are, when choosing a practitioner in 'integrative medicine'. I think the ACAM accredited MD's are pretty safe, and the costs for a doctor's appointment here are low (in the US$6.00 range). I've lived here for more than 10 years and I think medical care in the major cities here is no worse, than it would be in Hong Kong or Macao for you. Many westerners are coming to the Philippines to get cheaper laser eye treatments or dentures.

Lynn wrote:
> I had an exatest and my intracellular
> level of magnesium was low. ... Then I found a doctor who was
> willing to do IM magnesium sulfate injections. I started with
> 500 mg and worked up to 1.5 grams. ... Long story short, I seem
> to need weekly injections and have been having them for about 3
> years now. The PVCs are gone but skipping injections for a few
> weeks will reinstate them. I believe that others here have
> been able to "load" with magnesium and then discontinue IM
> injections. This is not the case for me and I have an objective
> measure of that fact.

Thank you Lynn for sharing your experience. It encourages me to continue with the IM injections. I will try to test, if the 'loading' is enough to restore normal magnesium absorption after a month or so.

George Eby wrote:
> I have a large (180 page) site concerning magnesium and
> depression where I also address some cardiovascular issues
> related to magnesium deficiency. That page also shows that
> serum magnesium will ALWAYS register as "Normal", which is very
> deceptive.

Thanks for pointing out your site, which I had visited previously for the Mg/Arginine/Taurine proposal. I'm really blessed by your studies regarding Zinc supplements for preventing/treating common colds, as virus infections are for me the main trigger of severe Afib episodes.

Hans Larsen wrote:
> George,
> I am really curious about your statement:
> "What is the first thing the ER docs do? PUMP US FULL OF
> INTRACELLULAR MAGNESIUM AND/OR POTASSIUM!"
>
> I know of many afibbers who would love to have a magnesium
> infusion when they arrive in emergency with an afib episode.
> But as far as I know very few are lucky enough to encounter a
> physician who is knowledgeable enough to do this.

This has been exactly my experience in the last 15 years. In Germany and in the Philippine, the doctors refused to give me IV magnesium in the ER, even when I asked for it. They reason, that it is only permitted for ventricular arrhythmias.

> PS. You may find the following abstract from Volume 5 of "Lone
> Atrial Fibrillation: Toward a Cure" of interest:
...
> The researchers
> conclude that magnesium infusions are safe and effective in
> achieving both rate and rhythm control in patients presenting
> with rapid atrial fibrillation.

I pointed out similar studies with the same conclusions to my EP, and asked her, if she would agree on an ER protocol to use magnesium IV as an adjunctive to the standard treatment for AF. The protocol she unsuccessfully used last time included Amiodarone, being the only anti-arrhythmic drug available by IV in this country, and Verapamil for rate control. - She told me I would have to look for another cardiologist, if I insist on IV magnesium!

Until I find a local doctor more favorable to Mg, my plan is for now, that I would ask my wife to give me 1500 mg magnesium IM, before proceeding to the ER, if I have a severe Afib episode. I do not think my EP would be very pleased, once I would tell her about it in the ER. I hope though, that this will not happen, as my AF is better controlled with the current supplemental and Flec protocol.