Qs for Hans re Exatest

Hans,

I'm assuming here that you would agree that the Exatest IS the gold standard for magnesium testing right? I'm just a bit thrown with Jim W's assertion in my other thread about my own Exatest results that his own Exatest results were when repeated several times extremely inconsistent to the point where he decided that the test was a bit of a waste of time....

Assuming that you don't concur with Jim W and that you accordingly DO consider that the Exatest is a very worthwhile and highly indicative test, then it would be really useful for me to know how low my mag reading of 30.7 is compared to others who have had the test and for whom you have or have at least seen the results. On the basis that you have such info to hand, what were other folks from the forum's Mag results like and just how low is my Mag reading relative to other results you've seen? What I'm trying to ascertain here just how bad being 10% below bottom of range is. If all other results you've ever seen have been over 30, then it is. If you've seen a few in the mid-to-high 20s, then maybe it isn't all THAT low.. ??

Mike F.

Mike - I spent a considerable amount of time this afternoon talking with Alexandra of IntraCellular Diagnostics because I wanted to confirm once again my thoughts on the reliability of Exatest as an accurate and reliable source for the intracellular tests.

Possibly by now, you have responded to her email requesting that you and your physician respond to the important and relevant questions that should have accompanied your test sample. Without that, they are at a disadvantage in helping to interpret the results and typically, results are never released directly to a patient but rather through the physician for the very reasons that patients can become alarmed over deviations from the typical ranges. If you have not responded, then it is imperative that you do so since it could well be that something skewed your sample. As explained, it could have been a medication, or failure to fast, and other influences such as inadequate collection sample or sample contamination.

Also, it is definitely not appropriate to speculate on your results without the input of your physician who can discuss your results direction with Dr. Burton Silver if he has interpretation questions.

IntraCellulara Diagnostics is bound by our US HIPPA laws and although you have published your data online, it is still against the law (here) to discuss a patient's medical history or records so we didn't get into anything about your specific levels. (HIPPA= Health Information Portability Accountability Act)

IntraCellular Diagnostics, Inc. is a CLIA approved and Oregon State Licensed laboratory and is subject to all of the mandatory guidelines set forth for laboratories in this country. <[www.cms.hhs.gov];

I will be sending you an email on this topic as well so watch for it.

Jackie

Jackie,

I never received a submittal form either with the kit or seperately, and today emailed Alex informing her of the same and asking that she send me one out at her earliest convenience. I did have a bit of trouble actually getting the test kit sent through to the UK. Took me quite a few weeks. Apparently the first kit sent was confiscated by customs as it contained distilled water..... (I took my own distilled water to the test, but my doc already had some ready too). Then there were software/Internet issues/problems and illness-related absences at Exatest's end that held things up further. The delays were such that Exatest actually (kindly) offered to do the test for free by way of apology for all the hassle I'd had. That the submittal form was omitted somewhere along the way that I/my doc should have filled in and returned with the test is perhaps not all that surprising in the aforementioned circumstances.

As regards how the sample was taken/test was done, I had both received emailed instructions seperately in this regard from Alex's assistant Chelsea and read the guidance on the Exatest website, and I followed everything to the T as regards the required fasting, no brushing of teeth on the morning of the test, no supplements the evening/night before the test etc etc. The test was done VERY carefully by my doc at 9am in the morning in his surgery, and I didn't even take my am Flec until after the test was done. As such, I am unaware of any factor that could have skewed my sample. After all the messing about trying to get this test, believe me, I would not be such a dummy as to compromise the upshot by messing up how the sample was taken or trying to do it myself.

As regards whether or not it is appropriate for me to try to interpret my results myself, two things. First, I have thus far been left with little choice and am not unreasonably a bit anxious about how and where to go from here. Secondly, as I've already stated, the test protocol was followed correctly by my doc and me, and the results to no little extent ARE what they ARE.

As regards my posting (not publishing as such, surely) my results on the discussion forum, I was never at any stage made aware that the results were anything other than my own to do with as I thought fit - including posting them on the forum for everyone's information - much like many others had done previously (such as Andrew and Ivan most recently).

Forgive me Jackie if I sound a tiny bit 'testy' here, but I've gone to what I consider to be quite a bit of time and trouble to really try to get all of this right, only to find that I'm flapping about a bit as a result of seeing how out of range most of my readings are and wondering how best to both interpret and act upon the results without, as yet, any assistance from Exatest.

Thanks again for all of your kind assistance with this Jackie: I really do appreciate it.

Mike F.

Mike - sounds as if you followed everything to a "T" and I do hope you get the questionnaire thing straightened out. I'd be frustrated too after all this. No problem here for me...I just hope we can learn what we need to about your results one way or the other.

Hang in there and keep us posted. Best to you, Jackie

Mike,

Hopefully this excerpt from the March 2009 issue of The AFIB Report will help answer your question. I have no doubt that most lone afibbers are deficient in intracellular magnesium when first tested.

"Afibbers are magnesium-deficient
HARTFORD, CONNECTICUT. Magnesium (Mg) is an enormously important mineral being a cofactor in over 300 enzymatic reactions continuously taking place in the body. Magnesium is also a vital component of the skeletal structure and about 65% of the body’s magnesium stores are found in bone, another 34% is found in transcellular fluids, and the remaining 1% is found in extracellular fluids such as blood. It is thus clear that measuring magnesium in blood serum is not likely to be a very accurate measure of the body’s overall magnesium status.

There is increasing evidence that magnesium plays a crucial role in preventing and terminating cardiac arrhythmias. A group of cardiologists and pharmacologists at the Hartford Hospital reasoned that a pre-procedure infusion of magnesium might help prevent the acute development of atrial fibrillation following a radiofrequency ablation for this disorder. As a first step in proving or disproving this hypothesis, they decided to do a trial in which half the participants would have saline solution (0.9% sodium chloride) with 4 grams of magnesium sulfate (800 mg elemental magnesium) infused over a 15-minute period just prior to accessing the left atrium in a standard PVI procedure, while the other half would just have a saline solution infusion.

The trial involved 22 patients with paroxysmal or persistent afib. Samples of venous blood (for determination of extracellular Mg concentration) and buccal scrapings (scrapings from inside the cheek) were collected before the start of the procedure, 15 minutes after the completion of the infusion, at the end of the ablation procedure, and at 6 hours after the infusion. The blood samples (serum) were analyzed for extracellular magnesium concentration and the buccal scrapings were analyzed (using the EXAtest) for intracellular magnesium concentration as well as for concentrations of calcium, potassium, sodium, chloride, and phosphate. At least one study has shown that there is an excellent correlation between the magnesium (intracellular) content of buccal scrapings and that of myocytes (heart cells). The major findings are as follows:

• None of the study participants were deficient in Mg at baseline when considering blood serum values only. The average serum Mg concentration was 2.08 mg/dL versus the normal lower limit of 1.6 mg/dL.

• The majority (89%) of participants were magnesium-deficient at baseline when considering intracellular (EXAtest) values only. The average intracellular Mg concentration was 32.2 mEq/IU versus a normal lower limit of 33.9 mEq/IU. NOTE: The unit is defined as x-ray intensity (peak divided by background) divided by unit cell volume.

• There was no correlation whatsoever between serum magnesium and intracellular magnesium concentrations.

• Serum levels of Mg rose rapidly in the magnesium infusion group 15 minutes post-infusion and, although declining over the 6-hour observation period, remained considerably higher than the level in the placebo group (saline infusion only).

• Intracellular level of Mg increased rapidly in the magnesium infusion group 15 minutes post infusion and continued to rise throughout the 6-hour observation period. Somewhat surprisingly, the intracellular Mg level also increased somewhat (over baseline) in the placebo group over the 6-hour period. The Hartford researchers speculate that the ablation procedure itself, most likely the anaesthesia, facilitates the transfer of magnesium from serum to intracellular space.

• The intracellular calcium concentration increased significantly in the Mg infusion group post infusion, but gradually reverted to baseline over the 6-hour period.

• The intracellular potassium concentration increased by about 50% from baseline to the end of the PVI procedure and then began to drop off at the 6-hour mark.

The authors of the report conclude that future studies are needed to evaluate the electrophysiologic benefits of magnesium repletion and the effects of routine procedures and anaesthesia on intracellular electrolytes.
Shah, SA, et al. The impact of magnesium sulfate on serum magnesium concentrations and intracellular electrolyte concentrations among patients undergoing radio frequency catheter ablation. Connecticut Medicine, Vol. 72, May 2008, pp. 261-65

Editor’s comment: A 2006 LAF Survey (LAFS-11) found that, among a small sample of 7 afibbers who had EXAtest results, all 7 were either below or very close to the lower normal limit. The Hartford report provides important additional evidence to support the conclusion that afibbers are likely low in intracellular magnesium even though their blood serum levels may be normal. It is also of interest that replenishing magnesium via an infusion not only increases intracellular Mg concentration, but also increases intracellular potassium levels. This is all good support for our long-held conviction that lone afibbers with normal kidney function are likely to benefit from supplementing with magnesium, potassium, and taurine (facilitates the uptake of Mg and K)."

Hans

There are some interesting articles on the potassium/magnesium connection here [barttersite.org]


Self Care of Magnesium Deficiency by Herbert C. Mansmann, Jr. M.D.
<[barttersite.org];

& more generally [barttersite.org]

Hans,

Many thanks for that.

You state towards the end of the above post:

"Editor’s comment: A 2006 LAF Survey (LAFS-11) found that, among a small sample of 7 afibbers who had EXAtest results, all 7 were either below or very close to the lower normal limit."

What were the IC Magnesium (and IC Calcium and Mag/Ca ratio) results for those 7 individuals please?? The raw data alone (just raw numbers only obviously) would be helpful to me for comparison purposes. For all I presently know, and with regards to IC Mag only, my 30.7 might be lower than those 7 or it might be somehwere in the middle of those 7. I did yesterday read one article by Dr Silver of EXAtest where the average IC Mag for folks just admitted to ER for heart attacks was 30.7 and this not unreasonably made me suspect that 30.7 is VERY low. But if one or more of the 7 in your sample had IC Mag LOWER than 30.7, then my own figure would arguably not be all THAT bad. If none of your sample of 7 had a figure lower than mine, then I know my situation is quite severe CI Mag-wise. And this for me right now would be really useful to know.

Thanks,

Mike F.

Mike,

I happened to have helped PC on the analysis of the data set. Here is what was provided from the seven. I don't have my own sheet handy, but as I recall, I was at the low end of normal. It was enough to motivate me to do a serious mag supplement push, which has continued for over 5 years.

33.8

34.3 (12/29/02) and 34.6 (12/24/03)

34.6 after supplementation with 800 mg per day for 4 weeks, Mg, meq. Note blood level was 2 before and after supplementation but Mg increased intracelluarly

35 micrograms/gram on 9/27/2000, blood intracellular magnesium was low .

Exatest 31.4 mEq/L

30.0 10/17/05

34.8 10 Oct 04 ref range 33.9 - 41.9

George

George,

Thanks for the above figures.

Am I correct in deducing form your figures that the Exatest results (IC Mag-wise) for the 7 were:
33.8
34.3
34.6 (after 4 weeks supplementation with 800mg)
35.0 (????)
31.4
30.0
and 34.8
????

If so, then my 30.7 figure IS very low, and I should as Hans suggests strive to get the IV Mag program sorted out.

Thanks again,

Mike F.

Mike,

What I posted is how people responded to the question of IC Mag. I'm not at the computer where I have the original questions to so I can't post how the question was phrased. I believe your interpretation is correct - it is the one I'd make and yes the 30.7 is very low.

You might also look at this article on causes of low mag & see if there are any correctable causes in your lifestyle. Lynn's heavy metal issues should be added to the list.

<[barttersite.org];

George

George,

Thank you for digging out those numbers!

Hans

Thanks George. And maybe my 30.7 is all the worse given that I'd been taking 600 Mag glycinate for 2-3 months prior to the test AND been taking epsom salts baths 2-3 times a week for the last year too....
Mike F.

Mike - remember what I mentioned about the cell envelope being damaged by bad fats.. and then magnesium receptors thereby distorted or crimped so magnesium can't access inside the cell. There is always much to consider when magnesium levels are low. I hope to be finalizing an interesting post on this topic this weekend and will post shortly. Jackie

Mike,

FYI, here is the question that was asked in the survey:

20. Intracellular magnesium from sublingual scrapings (in meq/liter with date of test):

George

Being new to this forum I am playing "catch-up" with all of the information. After looking at the information provided regarding magnesium, there is no doubt that in general, we are deficient because of our diets. Have there been any direct studies that show a causal-effect relationship between low potassium and AF?

Thank you.