As follow up to the other post about Magnesium I thought I ask this question about appropriate testing for magnesium for the AF crowd.

I just got tested via Request a Test for magnesium via a RBC test. The reference normal range is between 4.2 and 6.8 mg/dl. My results came back at 5.5. Subsequently, I've stumbled across some literature suggesting that your intracellular level is most important for good heart function. There is the expensive ExaTest that tests intracellular mineral electrolyte levels and is considered the gold standard for magnesium testing.

There is a guy whom I presume many of you are familiar with who writes an interesting blog about AF, Travis Van Slooten. He realized that despite the regular magnesium blood tests were showing him to be normal, the Exatest showed him to be deficient despite taking mag supplements for a year.

Here's a article about his experience: [www.livingwithatrialfibrillation.com]

I'm not sure what the upshot is - I have quite a bit of twitching in my legs and elsewhere in my body which typically correlates to a mag deficiency but also points to that I might need to supplement with a small amount of calcium.

Carolyn Dean recommends a RBC test result above 6 so going by that measure, I'm low.

Curious to see if others have pursued Exatest testing and what their experience has been.

[drcarolyndean.com]

Hi,
Re: Mg testing and RBC Mg vs IC Mg, here are facts from two essential resources:

-- The Magnesium Factor (2003) by Drs Mildred Seelig MD MPH and Andrea Rosanoff PhD, pp 30,31:

Magnesium status is hard to assess. If someone has a serum magnesium level that is way below or above normal, he or she is sick and probably in the hospital. But within the normal range of serum magnesium, one cannot predict whether any given individual is deficient or adequate in magnesium nutrition. One reason is that less than 1 percent of the body's magnesium is in the serum. This small percentage is not representative of the body's stores of magnesium, which is mostly inside muscle and other cells. Likewise, the magnesium content of red blood cells (RBCs) is more indicative of gender, race and age than of nutritional status. Additionally, magnesium intake at time RBCs are formed influences the level of magnesium in the RB cells. Young RBCs contain more magnesium than do old RBS. Given these facts, a doctor who suspects that magnesium deficiency may be causing early symptoms and orders a test for serum or RBC level will likely not get results confirming a low magnesium status. Such negative results will likely cause the doctor to disregard (mistakenly) low magnesium as a possible cause of the problem.

-- The EXAtest Interpretation Guide by biophysicist Burton Silver PhD

Magnesium

Measurement of intracellular levels with the EXA test is vital to maintain and treat many medical syndromes. Serum levels, RBCs and lymphocytes do not adequately reflect cell or tissue levels of magnesium.

In a number of previous posts offered several years ago, we've discussed the reliability and usefulness of ExaTest and the reasons why the serum and RBC analysis can be misleading... as Moerk's post indicates. Unfortunately, a good number of physicians fail to understand why the intracellular evaluation is more accurate and certainly critical information... as it not only measures IC magnesium, but calcium, potassium, sodium, chloride and phosphorous and reports the various ratios also important to monitor with arrhythmia... ie, magnesium/calcium and potassium/sodium - especially, plus others.

At the time we were actively posting, I contacted ExaTest to learn about fees and if insurance covered. I learned they accepted Medicare (which I used) and they also would discount the fee by about half as long as an insurance claim was not going to be submitted. You can call and ask about the current fee schedule.

I've had two ExaTests which definitely provided me with the most accurate and reliable insight to electrolyte status and certainly helped motivate me to optimize dosing more diligently. Also, a couple of my important ratios were off which gave me additional incentive to be constantly diligent with food and supplement intake.

I scanned the report by Travis and note he mentions muscle twitching. That's an acknowledged, classic symptom and tip-off that IC magnesium is low. It's commonly talked about in functional/restorative medicine circles and also is a cause of restless leg syndrome. They recommend using the topical forms of magnesium mentioned in the recent 'topical magnesium' thread by stef along with baths of Epsom salts or magnesium sulfate. The topical forms are known to relax muscle pain and twitching in 15 - 20 minutes and often repeat applications are needed as well.

Jackie

"Carolyn Dean recommends a RBC test result above 6 so going by that measure, I'm low. "

I did the Exatest 12 years ago and I was at the very low end of normal for mag. I haven't bothered to repeat as I know I have to supplement with magnesium to bowel tolerance to stay in afib remission. For me, this can be 3-5g/day of mag (I know this is very high for most).

I did an RBC as per Dr. Dean last summer. It came back 7.9 (range 4.2-6.8). Hence I don't think I'm low on anyone's scale.

The Exatest is great. My experience was that it was expensive and I had to use an integrative MD who didn't take insurance and was also expensive, on top of the test.

What I ask myself is, "what would I do differently if I had information from an Exatest retest?" Nothing, I'd continue to supplement with magnesium to bowel tolerance.

For my first ExaTest, my functional chiropractor ordered it for me (no charge). It was sent to him, I picked it up and did the collection myself and returned it. As mentioned previously, it was billed through Medicare. Zero cost to me.

George has done an outstanding job of 'curing' his Afib and aggressive magnesium supplementation is obviusly a strong proponent for him. Once again, congrats, George!

It should be emphasized as a precaution that it's very important to determine if you have healthy kidney function before supplementing with large amounts of magnesium (or other minerals); otherwise it can be damaging. For obvious reasons, magnesium supplementation is also contraindicated in cases of Bradycardia and AV blockade.

Jackie

In recommending measurement of intracellular (IC) electrolytes, in this case EXAtest and magnesium, it's important to clarify the confusion of reference ranges. The confusion begins with the word 'cell', leading unwittingly to suppose red blood CELL magnesium level is the same for muscle CELLs, this forum's concern being performance of cardiac muscle cells.

But, RBCs (erythrocytes) are vastly different from muscle cells (myocytes) in structure, function, and Mg level. In fact, the only obvious commonality seems having phospholipid serum membranes!

The main 'job' of RBCs is transportation and distribution of oxygen and CO2 throughout the body's cells and systems, whereas the job of myocytes is forceful contraction. Myocyte contraction requires energy in the form of the fuel molecule ATP complexed with magnesium as MgATP.

Looking at the differences in Mg reference ranges furthers the understanding:

Serum: 1.3 - 2.1 mEq/L [barttersite.org] (Lab Diagnosis of Magnesium Deficiency -- Herbert C Mansmann Jr MD)
RBCs: 4.04 - 6.9 mEq/L (ditto)
Myocytes: 34.0 - 40.0 mEq/L [www.exatest.com] [www.afibbers.org]

Note the ~twenty fold greater level of IC Mg vs serum Mg. This is an important clue to oftentimes difficulty in attaining IC Mg sufficiency. To attain this huge increase Mg must be pumped into the cell by specialized pumps in the myocyte serum membrane, energized by MgATP*. But if IC Mg is deficient so will be MgATP, leaving the pumps' activity inhibited and IC Mg unimproved, a situation termed 'refractory magnesium deficiency', oftentimes requiring heavy Mg supplementation for a very long time to overcome.

The only way to actually know if Mg intake via food + supplements is bringing IC Mg levels up to where they belong is by testing. And, since IC Mg is so very important for cardiac performance, for health in general, the recommendation will always be to test, not guess. To get clear about cost and insurance and other details, here is the EXAtest contact e-mail form: patientservices@exatest.com

* As disease progresses, cells lose their ability to function properly. Most of the cells of the body maintain a very high magnesium concentration relative to that in the blood serum. For example, there is about twenty times as much magnesium inside the cells of a healthy heart as there is in the serum. This high concentration of magnesium is necessary for cells to perform their various biochemical tasks. However, maintaining this steep concentration gradient between cells and blood requires a great deal of energy. The laws of random motion cause magnesium ions to leak continually out of the cells and into the bloodstream. Each time a magnesium ion leaks out, another one must be pulled back in by special pumps that reside on the cell membrane. Alan R Gaby MD, MSc biochem



Edited 2 time(s). Last edit at 04/17/2016 02:19AM by Moerk.

Thanks All,

Very much appreciate the clarification and advice. I think the next step is to order the Exatest to see what's really going on at a cellular level. My calves are twitching away as I type this!

Daniel

Daniel,

For immediate relief for your twitching calves, go to my posts on topical mag, linked here: <[www.afibbers.org]

I've had friends use topical mag with good success. You can start with applying a supersaturated solution of epsom salt and water. One friend who's toes would "curl under" at the end of the day when she took her shoes off - fixed it right away. Oral mag is more convenient in the long run.

George

Wise decision, Daniel.

For information and preview, here is Travis Van Slooten's* article on his struggles finding out "Am I Magnesium Deficient?" when his doctor said he wasn't, and his EXAtest report showing yes indeed ! -- from his website [www.livingwithatrialfibrillation.com]

Shortly I'll detail how IC Mg deficiency causes AF -- the 'mechanism of action' -- and how attaining IC Mg sufficiency may cure AF.

* [www.livingwithatrialfibrillation.com]



Edited 3 time(s). Last edit at 04/17/2016 12:42AM by Moerk.

I'm curious - do cardiologists and EP's recognize the value of Exatest testing? If it indeed is such a valuable test, then why isn't it used by more mainstream doctors. The inertia of the standard issue medical establishment is not lost on me - I'm not that naive, but it would seem that if it is such a good marker, it would be invoked more often!

Daniel

Hi Daniel,

Pondering a reply I chose a question: Why would Gary Null PhD, Martin Feldman MD, Debora Rasio MD, Carolyn Dean MD, and Dorothy Smith PhD spend years digging out data to show conclusively, scientifically, that conventional medicine kills -- wait for it -- the equivalent of 6 fully loaded jumbo jets DAILY ?

Death By Medicine:

Life Extension Magazine August '06: [tbmseminars.com]

Book pages and reviews: [www.amazon.com]

Full length film: [www.youtube.com]



Edited 3 time(s). Last edit at 04/20/2016 03:07AM by Moerk.

Flowmaster - I'm glad you brought up the inertia topic as it's both puzzling and frustrating.

Your question is often addressed by those physicians who have moved up to use the next level of medicine... which is looking at functional or restorative methods rather than treating with Rx drugs that often don't work and have many side effects or the typical 'slash and burn' approach of removing or altering any suspect organ or collection of tissue involved.

The nutritional deficiency aspect of functional medicine typically lies at the core or fundamental cause cause once the proper testing is done. There are 'tests' and then there are tests. Some, more accurate than others. Good example is the typical TSH used traditionally for measuring thyroid function efficiency but has been known for ages that it's an unreliable measurement compared to others.

In the case of the ExaTest for afibbers, it's simply solid, accurate confirmation about intracellular measurements of critical electrolytes involved in cellular/electrical function of heart cells ...and, of course, other systems as well. Why the cardiologists/EPs aren't interested in getting to root causes is and has been a long-standing question. They are conscientious about potassium levels but seem to fail to recognize that it's more than potassium. At least we are able to take the ExaTest results and act on repletion methods ourselves with relative ease.

The ages-old observation by those practitioners who have successfully included functional nutrition in their new patient assessment protocols is that it's far less costly and invasive to take the nutritional approach compared to Rx drugs and various expensive procedures. The dichotomy has existed for a very long time but the tide is slowly changing in many areas and hopefully will begin to extend to cardiology and other specialties as well.

In the meantime, for those who want to have the assurance that their fundamental nutritional requirements are optimized throughout the whole body, these reliable, specialized tests such as ExaTest are essential confirmation.
Many other specialty testing includes various Comprehensive Metabolic Profile Testing such as Genova's metabolic profile analysis, organic acid profiles, antioxidant profiles, adrenal function, and such that offer far more than one's typical Labs from a routine checkup are available through those practicing the next level of individualized medicine.

Jackie

The deep science of EXAtest -- a seminar:

Exploration of Intracellular Space

Electrolytes of Cells and Tissues

Burton B. Silver, PhD

[www.exatest.com]

So, what is the best way to ensure (or grease the skids as best as possible) to increase intracellular mag?

I've started with liquid mag which I seem to be able tolerate more of without stool softening.

Daniel

IV Magnesium is the sure fire fastest way to boost IC mag levels, and topical Magnesium can work well too and is the next fastest next to IV mag in Myers Cocktails doing one Myers cocktail a week for the first 4 to 6 weeks and then switch to a Myers cocktail with thge 3 grams of Mag sulfate every two weeks for another month and then retest with EXATEST or jsut go by your bowel tolerance though that is not nearly as reliable as an EXAtest for determining your increase in ICmag from the baseline test.

IV magnesium sulfate at 3 grams is added to a Myers Cocktail (an IV nutritional cocktail including 10 grams or more of non-calcium based ascorbic acid or Vitamin C and all the B vitamins and a few others) is an excellent way to boost IC Mag levels.


Check with either a good board certified Fuctional Medicine MDs or Naturopathic physicians in your area to find one who provides nutritional IV and phlebotomy services.

Best wishes,

Shannon