Magnesium – essential for eighty percent of our body’s chemistry.

Magnesium is a trace mineral essential for 80% of body function, (muscular contractions, energy production, removal of infected or precancerous cells, etc). It is used in over 300 enzymes required for metabolism and other chemical reactions in the body such as synthesis of DNA or proteins. (1)

This post is eleven pages long and can be read as a tabbed document: (doc)

Health Conditions linked to Magnesium inadequacy.

  • Circulatory System: Hypertension, Heart Disease, Stroke, Arrhythmias, Atrial fibrillation, Dyslipedemias.
  • Metabolic: Diabetes, Metabolic Syndrome.
  • Respiratory: Asthma, COPD, Other Lung/Respiratory.
  • Central Nervous System (CNS): Depression, Anxiety, ADHD, Migraine, Pain Relief, Addiction, Sleeplessness, Stress.
  • Muscle/Skeletal: Low Back Pain, Osteoarthritis, Other musculoskeletal (~ muscle cramps, twitches, other chronic joint pain), Osteoporosis, Sarcopenia.
  • Immune System/Other: Pre-eclampsia, Kidney disease, Crohn’s Disease, Chronic Fatigue Syndrome, Colon inflammatory diseases/IBD, Inflammation, Some Cancers.
  • (todaysdietitian/Modern Day Human Magnesium Requirements)(Seelig/Rosanoff, 2003)

Calcium/Magnesium ratio within cells affects our health.

When magnesium within cells is lower than normal calcium is allowed to enter in excess. Elevated amounts of calcium within the interior of cells acts as a signal to start different types of activity. Increased calcium to magnesium balance within a cell may cause different actions based on the type of cell.

  • Elevated calcium to magnesium ratio within cells could cause blood vessels to constrict which would increase blood pressure. Vasoconstriction within the heart could cause a random heart rate (arrthymias). Platelets within the blood would become stickier and more prone to clot which could increase risk of strokes.
  • Cholesterol and glucose over-production may occur in liver cells. Glucose uptake by muscle and fat cells could decrease. Insulin over-production could occur in pancreas cells. Which could lead to Type 2 Diabetes or Metabolic Syndrome.
  • (39, 40, 41, 42) (todaysdietitian/Modern Day Human Mg Requirements)

Summary Points:

  • Magnesium is essential for 80% of body function, (muscular contractions, energy production, removal of infected or precancerous cells, etc), (1),
  • Adequate protein and phospholipids (ATP-AdenosineTriPhosphate –> energy release –> ADP-AdenosineDiPhosphate) are needed for cells to be able to have a full reserve supply of magnesium. (MgATP, 6, 7, 8) Magnesium is located within cells primarily (greater than 99%, 12), as free ion or in an inactive form on molecules of protein or ATP., which means typical blood based lab tests are not helpful for diagnosing chronically low levels of magnesium. See a previous post for more information, food sources and supplement types, and a free etext reference.
  • Magnesium adequacy through diet or supplementation may help improve symptoms for patients with migraine headaches, Alzheimer’s dementia, hypertension, cardiovascular disease, recovery after a cerebrovascular stroke, and type 2 diabetes mellitus (type 2 DM). (9) Muscle cramps may be due to low magnesium levels (9) or an imbalance with calcium levels.
  • Magnesium supplementation may also help some types of psychiatric conditions such as anxiety, depression, bipolar disorder, schizophrenia. See: Magnesium and the Brain: The original chill pill, (psychologytoday.com). Mental health problems have been escalating in the U.S. and other developed countries, lack of jobs and increased social isolation and cyberbullying are involved, however magnesium/calcium imbalance are also factors. See: Latest Suicide Data Show the Depth of U.S. Mental Health Crisis, (bloomberg.com).
  • While you need adequate intake of protein for holding reserve supplies of magnesium within cells, you need adequate magnesium for the body to be able to build new proteins or modify protein structure, and to build more DNA or RNA (which uses the nucleotide ATP), (9, 10, 11, 12, 13, 14, 15) and in ATP hydrolysis (release of the stored energy from glucose metabolism in the Kreb’s cycle), (18) and the Kreb’s cycle. (7) Magnesium deficiency led to lower levels of ATP within red blood cells and increased amounts of ADP, from a 6:1 ratio of ATP:ADP to 2.5:1 at the lowest magnesium level. (19)
  • Which means supplementing only magnesium or only protein may not fully help protect against cardiovascular stroke or migraine pain or other symptoms associated with magnesium deficiency such as hypertension and Type 2 Diabetes.
  • Cancer prevention may also be possible by preventing chronic low levels of magnesium as mutations in DNA may be more likely with inadequate magnesium. Excess calcium or imbalance in vitamin D and calcium/magnesium balance may also be involved in increased cancer risk. (10, 13) Magnesium is used by white blood cells during apoptosis of infected or damaged cells and autophagy, the removal of cells by white blood cells, may help protect against Alzheimer’s dementia. Both apoptosis and autophagy are the typical defense against precancerous cells or mismarked cells that may lead to autoimmune reactions. Once cancer is established magnesium supplements would be inadequate alone as a treatment and would also be providing the nutrient to the cancer cells.

Magnesium and calcium are electrolytes – electrically active ions similar to sodium and potassium.

Magnesium is an electrically active trace mineral/metal that is predominantly found within cell fluid and bone matrix. Only about one percent of the body’s magnesium is found in the blood plasma fluid, circulating throughout the body within blood vessels, and also through the lymphatic and glymphatic systems. (Gervin 1983, ref) (interstitial fluid) Calcium is chemically electrically active in a similar way to magnesium. Both metals can donate or accept two protons and are chemically written with a +2, while sodium and potassium can donate or accept one proton which would be written as +1.

Sodium and potassium are typically referred to as electrolytes however calcium, magnesium and other electrically active ions are also found in blood plasma and in the fluid around cells, called extracellular fluid or interstitial fluid. The fluid within cells is called intracellular fluid or cytoplasm and it also contains ions/electrolytes. The balance of ions within the different types of fluid varies somewhat however the overall average is similar to the balance of ions in sea water. The total fluid volume is about 60% of our body’s weight, of that most is found within cells, 60% intracellular fluid, and of the 40% extracellular fluid, 20% is blood plasma transported in arteries and veins, and 80% is interstitial fluid, transported in the lymphatic system. (Lymphatic fluid, 4) Magnesium would be in greater concentration in the 60% intracellular fluid and calcium would be in greater concentration in the 40% extracellular fluid.

Magnesium powers membrane transport channels – a natural calcium channel blocker.

Within the cells magnesium may be used within enzymes, over 300 require the trace mineral, or may provide their electrical power to cell membrane transport channels which allow certain chemicals to enter the cell while blocking others – when adequate magnesium ions are available to block the channels including some involved in sodium/potassium balance. (16, 18) Magnesium deficiency seemed to decrease the activity of the sodium/potassium channels in an animal based study. It led to increased intracellular sodium levels which could be a mechanism for the increased risk of arrythmias (irregular heart rate) with magnesium deficiency. (17)

Magnesium in muscles and the inner ear (tinnitus).

Magnesium causes relaxation of muscles – blocking entry of calcium into the muscle fiber, and calcium entry causes muscle contractions within smooth muscle fibers (such as the muscle fibers of the gastrointestinal tract) or striated muscle fibers (found in the muscles with voluntary control such as those of the arms and legs, and also in the heart which is not under voluntary control). (31, 32, 33, 34, 35, 36, 37) Magnesium deficiency can be an underlying cause of muscle cramps or twitches (such as a nonstop twitch in the eyelids) (9), and may also be a factor in tinnitus (nonstop or intermittent ringing or buzzing sounds in the ears/ear). (28) Daily supplementation with 532 milligrams of magnesium was found helpful to relieve symptoms of tinnitus in a small clinical trial. (30) Magnesium inhibits glutamate channels which are involved in activating the hair cells of the ear canal. It may also help by helping relax blood vessels to the inner ear and increasing blood flow. (29)

Magnesium is stored within the cell in an inactive form on protein molecules or ATP.

Even within the cells the majority of magnesium stores are not available in the electrically active form. Most of the back-stock of magnesium within cells is stored on proteins or molecules of ATP (the nucleotide involved in the Kreb’s cycle production of usable energy {ATP bonds} from glucose). (MgATP, 6, 7, 8)

This means magnesium deficiency can take a long time to be seen because of the extra stored within cells on proteins and ATP and the extra stored within our bone matrix can be slowly released to continue powering the 300+ enzymes and membrane channels in every cell of the body. What happens eventually however is a depletion of the backstock of magnesium on the cellular proteins and ATP and osteoporosis can develop in the bone matrix leaving fragile bones at risk for fractures — and also cell membranes at risk to an influx of too much calcium, or other excitatory chemicals such as glutamates or aspartic acid/aspartate, leaving brain cells at increased risk from food additives, or dehydration, or ischemic stroke.

Protein deficiency in the diet or increased metabolic need for protein might increase risk of low magnesium levels being available in case of a stroke. If a stroke occurred treating with intravenous magnesium fairly soon can help reduce cell damage and preserve abilities. When the body is well supplied with protein, ATP, and magnesium then the stored magnesium would be available in case of a stroke or physical brain trauma. If protein availability was limited the damage from a stroke might be more severe due to less magnesium being available for release.

Protein-energy malnutrition is a type of malnutrition involving a diet low in protein more than calories. The condition was formerly known as kwashiorkor and was first recognized in tropical infants/children. Severe edema with a bloated abdomen is typical visible symptom. (See image, page 30, 46) When magnesium deficiency is also severe the condition is more likely to result in death and strokes are also more common. The serum magnesium level of children with protein-energy malnutrition was found to be significantly lower than in the control group. Low magnesium in drinking water has been associated with increased risk of cerebrovascular disease or death by stroke. (45)

Incomplete protein in the diet seems to be involved – plant sources of protein do not all contain adequate amounts of all the essential amino acids. Missionary work historically may have increased the risk of Protein-energy malnutrition in recently weaned toddlers due to an educational message that eating insects is wrong – eating a diet with inadequate amounts of essential amino acids is what is wrong. In modern times, unfortunately, children in Africa are now being taught to not catch and eat crickets because they are likely contaminated with the pesticides that are commonly used on farm fields.

The amino acids considered essential for a child’s diet include: Arginine, Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine. The traditional African diet in some areas includes complete protein from peanuts and cowpeas are only low in tryptophan. (46) Millet and sorghum are commonly used grains which are low in tryptophan, lysine, methionine, and threonine. (47) The nutrient content of food insects depends on their stage of growth, however on average they are considered a good source of complete protein – providing a similar ratio of essential amino acids as meat or fish. Food insects are also a good source of essential fatty acids, similar to fish, and provide fiber and trace minerals including “copper, iron, magnesium, manganese, phosphorous, selenium and zinc.” (48)

Food insects and breastmilk also have in common N-acetyl glucosamine (within insects it is found in the form of the fiber chitin which is not typically thought of as digestible by humans however the enzyme chitinase has been found in human gastric fluid). (49, p 74, section 6.1.8: 50) Intake of N-acetyl glucosamine may help support a healthy intestinal mucousal lining. Impaired mucous lining of the intestine and reduced amounts of “enterocyte heparan sulfate proteoglycan (HSPG),” and “abnormal sulfated glycosaminoglycan (GAG) metabolism” have been observed in patients with protein-energy malnutrition (kwashiorkor). (49) Providing magnesium sulfate by intramuscular injection helped survival for children with protein-energy malnutrition compared to the control group in a small clinical trial. (51)

Magnesium is needed for vitamin D, CoQ10, and cholesterol production.

Magnesium deficiency can lead to low levels of the inactive and active form of vitamin D. Magnesium supplementation is needed to reverse a type of bone degenerative condition called vitamin D resistant rickets. (20) Supplementing with vitamin D and/or calcium has been popular however the benefits against fracture risk and osteoporosis have been unclear or show little benefit. (22) The need for magnesium supplementation instead of or in addition to vitamin D and calcium supplements is in area worth further study. (21) Magnesium is also involved in earlier steps involved in vitamin D production – biosynthesis of cholesterol (23) from which vitamin D can be formed in the skin when sunshine is available.

Magnesium acts similarly to statin medications and is the natural version of a calcium channel blocker medication. (23) Statins have been prescribed to many people in hopes that chemically inhibiting the production of cholesterol would help protect against heart disease, unfortunately the theory has not been proven effective – while cholesterol levels are reduced in about half the patients using the medication, the lower cholesterol levels have not also been associated with reduced mortality from cardiovasclar risks. For patients without heart failure or renal dialysis or for those over age 75 the use of statin medications helped prevent revascularization and major coronary events in about 20% of research trials that were reviewed. (24)

The cardiovascular benefits of statin medications may be due to the inhibition of an interim step in cholesterol formation – mevalonate. Magnesium would also affect mevalonate formation however in a regulatory way – controlling whether or not the reaction happens rather than only inhibiting it. (23) β-Hydroxy β-methylglutaryl-CoA, (HMG Co A) is converted into mevalonate which then can be converted into cholesterol or the provitamin coenzyme Q10. (26)

Lack of CoQ10 may cause muscle pain and lead to mitochondrial dysfunction.

Statin medication use may cause muscle and joint pain in some users, possibly due to inhibition of Coenzyme Q10 production. Supplements of CoQ10 (200mg/day) may help reduce the muscle pain symptoms for some patients and could also be protecting against a risk of mitochondrial dysfunction caused by low levels of the the coenzyme. (25)

  • Mitochondrial dysfunction may be a cause of chronic fatigue – low energy production by mitochondria within cells would leave every function in the body with less energy to perform their jobs. Mitochondrial dysfunction may be involved in many conditions including autism, Alzheimer’s disease, muscular dystrophy, Lou Gehrig’s disease, diabetes and cancer. (clevelandclinic/mitochondrial diseases)

Magnesium helps protect health, and improve our energy level and mood.

Symptoms of magnesium deficiency are often treated with medications (such as calcium channel blockers or statins) instead of providing magnesium. Other medications commonly used to treat symptoms that might involve magnesium deficiency include: beta blockers, blood thinners, anti-hypertensive medications, insulin or metformin, anti-depressants, anti-anxiety medications, anti-inflammatory medications. (43) (todaysdietitian/Modern Day Human Magnesium Requirements)

Adequate protein and phospholipids are also needed for cells to be able to store extra magnesium in an electrically inactive form and magnesium is needed for their synthesis. This might help explain why supplements of magnesium help some patients more than others. Someone who is more chronically ill or malnourished or who has impaired metabolism may need more complete nutrition support rather than only providing a magnesium supplement. Topical supplements of magnesium may be needed for patients with malabsorption problems or for those who don’t seem to be helped by increasing dietary sources.

Excess calcium in proportion to magnesium in the diet or from supplements may also be part of the problem for some patients. (44) The average modern diet can include calcium rich dairy products at each meal and snack. Tofu, beans, almonds, sesame seeds, and dark leafy green vegetables are also good sources of calcium.

Free Continuing Education credit for nutritionists/diet techs:

  • For any dietitians or diet techs, much of the first reference list is from a free continuing education webinar, register for this: Andrea Rosanoff, PhD, and Stella Lucia Volpe, PhD, RDN, ACSM-CEP, FACSM, Recorded Webinar: Modern Day Human Magnesium Requirements: The RDN’s Role, Today’s Dietitian https://ce.todaysdietitian.com/node/69241#group-tabs-node-course-default1  The second list is from the last post from the section about magnesium and hypercoaguability.

Disclaimer: This information is being provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individualized health care guidance. Please see an individual health care provider for individual health care services.

References

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  16. Dorup I, Skajaa K, Thybo NK. Oral magnesium supplementation restores the concentrations of magnesium, potassium and sodium-potassium pumps in skeletal muscle of patients receiving diuretic treatment. J Intern Med. 1993;233(2):117-123. https://www.ncbi.nlm.nih.gov/pubmed/8381850
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  19. Flatman PW, Lew VL. The magnesium dependence of sodium-pump-mediated sodiumpotassium and sodium-sodium exchange in intact human red cells. J Physiol. 1981;315:421-446. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1249391/
  20. Deng X, Song Y, Manson JE, et al. Magnesium, vitamin D status and mortality: results from US National Health and Nutrition Examination Survey (NHANES) 2001 to 2006 and NHANES III. BMC Med. 2013;11:187. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765911/
  21. Rosanoff A, Dai Q, Shapses SA. Essential nutrient interactions: does low or suboptimal magnesium status interact with vitamin D and/or calcium status? Adv Nutr. 2016;7(1):25-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717874/
  22. Jill Jin, MD, MPH, Vitamin D and Calcium for Preventing Fractures, Guidelines, JAMA Patient Page, JAMA Network, April 17, 2018 https://jamanetwork.com/journals/jama/fullarticle/2678617
  23. Rosanoff A, Seelig MS. Comparison of mechanism and functional effects of magnesium and statin pharmaceuticals. J Am Coll Nutr. 2004;23(5):501S-505S. https://www.ncbi.nlm.nih.gov/pubmed/15466951
  24. Cholesterol Treatment Trialists’ Collaboration  Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials., The Lancet, Vol 393, Issue 10170, pp407-415, Feb. 02, 2019, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext
  25. Deichmann R, Lavie C, Andrews S. Coenzyme q10 and statin-induced mitochondrial dysfunction. Ochsner J. 2010;10(1):16–21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096178/
  26. Pacanowski MA, Frye RF, Enogieru O, Schofield RS, Zineh I. Plasma Coenzyme Q10 Predicts Lipid-lowering Response to High-Dose Atorvastatin. J Clin Lipidol. 2008;2(4):289–297. doi:10.1016/j.jacl.2008.05.001 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598393/
  27. Mitochondrial Diseases, ClevelandClinic.org, https://my.clevelandclinic.org/health/diseases/15612-mitochondrial-diseases
  28. Tinnitus and Magnesium, tinnitus.org, https://www.tinnitus.org.uk/tinnitus-and-magnesium
  29. Joseph Mercola, MD, Can Magnesium Relieve Your Tinnitus?, Prohealth.com, https://www.prohealth.com/library/can-magnesium-relieve-your-tinnitus-47779
  30. Cevette MJ, Barrs DM, Patel A, et al., Phase 2 study examining magnesium-dependent tinnitus., Int Tinnitus J. 2011;16(2):168-73. https://www.ncbi.nlm.nih.gov/pubmed/22249877
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  32. Altura BM, Altura BT. Role of magnesium ions in contractility of blood vessels and skeletal muscles. Magnesium Bull. 1981;3(1a):102-114. http://www.magnesium-ges.de/jdownloads/Literatur/Altura/altura_1981_role_of_magnesium_ions_in_contractility_of_blood_vessels_and_skeletal_muscles_444.pdf
  33. Konishi M. Cytoplasmic free concentrations of Ca2+ and Mg2+ in skeletal muscle fibers at rest and during contraction. Jpn J Physiol. 1998;48(6):421-438. https://www.ncbi.nlm.nih.gov/pubmed/10021496
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  35. Yang ZW, Gebrewold A, Nowakowski M, Altura BT, Altura BM. Mg(2+)-induced endothelium-dependent relaxation of blood vessels and blood pressure lowering: role of NO. Am J Physiol Regul Integr Comp Physiol. 2000;278(3):R628-R639. https://www.physiology.org/doi/full/10.1152/ajpregu.2000.278.3.R628
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  38. Seelig MS, Rosanoff A. The Magnesium Factor. 1st ed. New York, NY: Avery Penguin Group; 2003:278-279; 369-370 https://www.barnesandnoble.com/p/the-magnesium-factor-mildred-seelig/
  39. Resnick L. The cellular ionic basis of hypertension and allied clinical conditions. Prog Cardiovasc Dis. 1999;42(1):1-22. https://www.ncbi.nlm.nih.gov/pubmed/10505490
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  41. Rosanoff A. Nutritional magnesium is associated with metabolic syndrome, cardiovascular disease and its risk factors, and other NCDs: a bibliography. Magnesium Education website. http://www.magnesiumeducation.com/the-mg-hypothesis-of-cardiovascular-disease-abibliography
  42. Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012;70(3):153-164. https://www.mgwater.com/articles/Rosanoff/(09)%20Suboptimal%20Magnesium%20Status%20in%20the%20United%20States.pdf
  43. Rosanoff A, Capron E, Barak P, Mathews B, Nielsen FH. Edible plant tissue and soil calcium:magnesium ratios: data too sparse to assess implications for human health. Crop Pasture Sci. 2015;66:1265-1277. http://agris.fao.org/agris-search/search.do?recordID=US201600101821
  44. Rosanoff A. Rising Ca:Mg intake ratio from food in USA Adults: a concern? Magnesium Res. 2010;23(4):S181-S193. https://www.mgwater.com/Ca-Mg.pdf
  45. Karakelleoglu C, Orbak Z, Ozturk F, Kosan C. Hypomagnesaemia as a mortality risk factor in protein-energy malnutrition. J Health Popul Nutr. 2011;29(2):181–182. doi:10.3329/jhpn.v29i2.7863 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126992/
  46. Florence Dunkel, Learning from Sanambele: Role of Food Insects in Village Nutritional Health, Montana State University-Bozeman (a Power Point presentation) http://www.montana.edu/mali/documents/pptsaspdfs/worldHungerDunkelSanambelepresentationsmallpdfvsn.pdf
  47. Sorghum and Millets in Human Nature, fao.org, http://www.fao.org/3/T0818E/T0818E0d.htm
  48. The Contribution of Insects to Food Security, Livelihoods and the Environment, fao.org, http://www.fao.org/3/i3264e/i3264e00.pdf
  49. Beatrice Amadi, Andrew O Fagbemi, Paul Kelly, et al., Reduced production of sulfated glycosaminoglycans occurs in Zambian children with kwashiorkor but not marasmus., The American Journal of Clinical Nutrition, Vol 89, Issue 2, Feb 2009, pp 592–600 https://academic.oup.com/ajcn/article/89/2/592/4596718
  50. Arnold van Huis, Joost Van Itterbeeck, Harmke Klunder, et al., Edible insects: Future prospects for food and feed security, Food and Agriculture Organization of the United Nations, Rome, 2013, FAO.org, http://edepot.wur.nl/258042
  51. Joan L.Caddell, MD., Magnesium in the therapy of protein-caloriemalnutrition of childhood., The Journal of Pediatrics, Vol 66, Issue 2, Feb 1965, pp 392-413, https://www.sciencedirect.com/science/article/abs/pii/S0022347665801974

Article in the lower right hand column of the Science Direct topic page on Albumin Antibody: – it has a thorough description and graphic (Figure 1) about the blood brain barrier and seizures.

  1. N. Marchi, … D. Janigro, in Encyclopedia of Basic Epilepsy Research, 2009, Inflammation: Cerebrovascular Diseases, Seizures, and Epilepsy Seizures; Epilepsy, and the Blood–Brain Barrier, “Systemic pathologies causing BBB failure may be due to hypertension, stroke, blood hyperosmolarity, or systemically mediated inflammatory processes (due to the production of TNF-α, IL-1β, IL-6, histamine, arachidonic acid, or reactive oxygen species)”

References from the last post on hypercoaguability and the NF-kB inflammatory pathway.

  1. DiNicolantonio JJ, Liu J, O’Keefe JH. Magnesium for the prevention and treatment of cardiovascular disease. Open Heart. 2018;5(2):e000775. Published 2018 Jul 1. doi:10.1136/openhrt-2018-000775 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045762/
  2. Andrea Rosanoff, PhD, and Stella Lucia Volpe, PhD, RDN, ACSM-CEP, FACSM, Recorded Webinar: Modern Day Human Magnesium Requirements: The RDN’s Role, Today’s Dietitian, https://ce.todaysdietitian.com/node/69241#group-tabs-node-course-default1
  3. Karen Skene, Sarah K. Walsh, Oronne Okafor, Nadine Godsman, et al., Acute dietary zinc deficiency in rats exacerbates myocardial ischaemia–reperfusion injury through depletion of glutathione., British Journal of Nutrition, Vol 121, Issue 9 14 May 2019 , pp. 961-973, https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/acute-dietary-zinc-deficiency-in-rats-exacerbates-myocardial-ischaemiareperfusion-injury-through-depletion-of-glutathione/15953E00DA3E69629F36F9F6FE5079A8
  4. Karl T. Weber,1,* William B. Weglicki,2 and Robert U. Simpson3 Macro- and micronutrient dyshomeostasis in the adverse structural remodelling of myocardium, Cardiovasc Res. 2009 Feb 15; 81(3): 500–508. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639130/
  5. Li YC. Vitamin D: roles in renal and cardiovascular protection. Curr Opin Nephrol Hypertens. 2012;21(1):72–79. doi:10.1097/MNH.0b013e32834de4ee https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574163/
  6. Benjamin Senst; Prasanna Tadi; Hajira Basit; Arif Jan., Hypercoaguability, STATPearls, Last Update: April 29, 2019. https://www.ncbi.nlm.nih.gov/books/NBK538251/
  7. Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy–A Review. Nutrients. 2016;8(2):68. Published 2016 Jan 28. doi:10.3390/nu8020068 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772032/

High blood pressure and possible ethnic differences

On page 66 of a new book Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, by Thomas Bollyky, it is mentioned that early Western medical personal working in Africa in the 1920s were surprised to find no cases of hypertension/high blood pressure among the native African people. Only one native woman was known to be overweight and it was noted that she worked in a brewery which led the medical person in the document to speculate whether beer drinking could be fattening (yes it can). The first case of hypertension in a native African person wasn’t noted until the 1940s.

Question: Does the Western style of living or working or export of Western products cause hypertension in native Africans? If native Africans living in their traditional environment using their traditional diet have no risk for hypertension then what changed that caused an increased risk? This topic is also important for prenatal health as preeclampsia can include hypertension/high blood pressure and it does tend to be an increased risk for women with African American ancestry. The DASH diet may be helpful, for more on preeclampsia risk factors and possible tips for prevention or management, see Preeclampsia & TRP Channelseffectivecare.info

Dr. Agbai’s discovery that helps protect against symptoms of Sickle Cell Anemia – Thiocyanate.

Yes per Dr Agbai who has worked with patients in Africa and in the U.S., the standard diets are different. There is a difference in type of starch and amount of starch in typical African or Jamaican diet and western U.S. style diet, and there is a difference in amounts of foods that contain thiocyanate. The yams commonly grown in Africa are larger and woodier/less sweet than sweet potatoes and they are also a good source of thiocyanate.

Thiocyanate is a phytonutrient that helps protect against Sickle cell anemia by preventing the red blood cells from forming the sickle shape instead of the normal round indented shape (like a tire or doughnut shape that has a filled in shallower center). It is important to eat adequate iodine and protein rich foods that contain methionine (found more in animal product protein sources than in a vegan diet) in order to protect thyroid health.

Listen to interviews with Dr. Agbai by the radio show Your Own Health and Fitness: http://www.yourownhealthandfitness.org/?page_id=509

Agbai O. Anti-sickling effect of dietary thiocyanate in prophylactic control of sickle cell anemia. J Natl Med Assoc. 1986;78(11):1053-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2571427/

There may be a slight difference in retention of calcium and loss of magnesium that would be protective with a diet low in calcium might may increase risk of metabolic syndrome type conditions when excess calcium.

I’ve discussed this topic of potential differences between western style diet and traditional African culture and possible differences in health in my early days of blogging when I found a research article from ~ 1970s that noted ethnic differences in health outcomes but did not take into account possible differences in average ethnic diet at the time. (I haven’t found that article in my files yet. I will update this post if I do find it.) To get to the point directly – people with native African ancestry may have kidney differences that conserve calcium better, and possibly not conserve as much magnesium, as other ethnic groups. This would be protective when calcium was not very available in the diet but then would be an increased negative health risk if the diet contained a lot of calcium or phosphorus.

There is known problems in medical research in the U.S. with bias in research studies towards use of white males as study participants with less information gathered about minority groups and females.

Before discussing calcium and magnesium and kidney health in more detail – briefly – there is bias in medical research towards white males. Research studies over the years have often had more limited numbers of minorities and females among the experimental and control groups or as a focus of research. A summary of the issue was included in a recent article in the New York Times that is focused on the potential benefits and risk of bias in the use of Artificial Intelligence (AI) in medical diagnostic processes or other medical roles.

” Medicine has long struggled to include enough women and minorities in research, despite knowing they have different risk factors for and manifestations of disease. Many genetic studies suffer from a dearth of black patients, leading to erroneous conclusions. Women often experience different symptoms when having a heart attack, causing delays in treatment. Perhaps the most widely used cardiovascular risk score, developed using data from mostly white patients, can be less precise for minorities. ” – Dhruv Khullar

“A.I. Could Worsen Health Disparities,” by Dhruv Khullar, The New York Times, Opinion, Jan. 31, 2019

It is not racist or sexist to discuss differences in physiology and the potential effects those differences might have on health. It is discriminatory to only study one group of people primarily and then try to treat everyone else as if they weren’t individuals but were all instead exactly like the group that had been studied. It is discrimination to not treat individuals as individuals or to pretend that differences don’t exist.

Adequate magnesium is needed for preventing high blood pressure, cardiovascular disease, and many other chronic conditions including dementia.

Low magnesium levels, particularly when there is also plenty of phosphorus may increase cardiovascular risks. Adequate magnesium levels are protective and elevated magnesium is unusual and may be increase cardiovascular risks. In good health the body maintains magnesium and other electrolyte levels within specific ranges. (5) Higher magnesium levels have also been associated with higher levels of potassium and of albumin, a blood plasma protein, (6), which is important for fluid balance and transport of a variety of chemicals in addition to magnesium (such as steroids, fatty acids, and thyroid hormones (wikipedia/serum albumin), about 30% of serum magnesium is carried in a non-electrically active form on proteins, primarily albumin (Clinical Biochemistry/serum magnesium) (9).

Alzheimer’s dementia and other types of dementia are more common in blacks than whites in the U.S. and may be a risk earlier in life too, early onset Alzheimer’s can occur in the forties and fifties instead of the more frequent age of diagnosis after age 60. See: African Americans Face Greater Risk of Alzheimer’s Disease than Whites, usatoday.. The reason is not known but the increased frequency on high blood pressure in blacks is thought to be a risk factor.

There may be differences in rate of urinary loss of albumin in different ethnic groups. With the presence of excess abdominal weight participants in a renal study of Hindustani-Surinamese, or African-Surinamese ancestry had an increased likelihood of albuminuria than participants of Dutch ancestry with the greatest risk found in the Hindustani-Surinamese group. (7) Asian Americans and African Americans were found to have better blood albumin levels in a renal study and the Asian Americans had better renal biomarkers compared to other ethnic groups in the study. (8)

When looking at hypertension and high blood pressure risk with the same diet in modern research there is a significant increased risk for African Americans to have high blood pressure and to have it occur earlier in life than in whites. (prevalence in the U.S. of hypertension in adults was “42 % for blacks and 28 % for whites,” (2011-2012)). (2)

So it is a good question – how did hypertension frequency in Africans in the 1920s change from zero to 42% for African Americans in the United States, in 2011-2012? Diet differences that were noted in 2009-2010 between white groups and African American groups were more cholesterol and sugar and less fiber, whole grains, nuts/beans/seeds, fruits and vegetables for the African Americans on average. Dairy intake was not mentioned as being significantly difference. In another research comparison calcium intake was lower on average in African Americans but so was magnesium (Table 1). (2)

Within the introduction and Diet and Blood Pressure sections of the article it is mentioned that ethnic differences in cardiovascular metabolism has been noted in African American groups and that their reduction in blood pressure when following the DASH diet was even better than the reduction in people of other ethnic background who followed the diet (it includes a magnesium rich Beans/Nuts/Seeds group as a daily/weekly recommendation). The INTERMAP study found an increased Sodium to Potassium ratio in urinary excretion and less total Potassium urinary excretion for the African American participants than white participants. (2)

Other research has also supported the idea that high blood pressure may have more to do with excess sodium (salt) intake in relation to low potassium intake than just having to do with the amount of sodium in the diet. Potassium is found in all vegetables and fruits in varying amounts, beans/nuts/seeds, and in liquid milk and yogurt. (Kidney dialysis and other patients with Chronic Kidney Disease have to avoid excess potassium so this article includes a list of potassium rich foods for the purpose of educating regarding what needs to be limited but for people of average kidney health it is a list of good sources to include in the diet: Potassium and Your CKD Diet, National Kidney Foundation.

Learning is an ongoing process, in the meantime some possible health tips for people of any ancestry:

  1. Adequate magnesium is essential for kidney and heart health and high blood pressure is an early symptom of low magnesium levels. Dietary sources may not be sufficient if intestinal absorption is poor or if renal losses are excessive. Epsom salt baths or footsoaks or magnesium chloride are topical forms. Adequate protein and phospholipids in the diet are also important to provide the albumin and other specialized transport molecules that carry magnesium and other chemicals within the vascular or other fluids of body tissue. More information about magnesium sources and symptoms of deficiency are available in a previous post: To have optimal Magnesium needs Protein and Phospholipids too.
  2. Adequate calcium and vitamin D are needed for health however excess may cause an imbalance between calcium and magnesium levels as magnesium is excreted along with excess calcium by the kidneys and less magnesium may be absorbed by the intestines as vitamin D causes increased absorption of calcium and magnesium but calcium may be more available in a modern processed food diet. For more information about vitamin D sources see: Light up your life with Vitamin D, peace-is-happy.org. Deficiency of calcium or of vitamin D can cause secondary hyperparathyroidism which can also be more common in renal failure due to excess phosphorus buildup and deficiency of active vitamin D. The healthy kidney is involved in activating vitamin D. (Secondary hyperparathyroidism, National Kidney Foundation) Calcium is plentiful in most dairy products and is also found in almonds, sesame seeds, beans, dark green leafy vegetables and other produce. Variations of a 2000 calorie menu plan shows that even a vegan diet can provide 1000 milligrams of calcium per day and a menu with dairy products can provide an excess with over 1600 milligrams of calcium, see: Healthy Hair is the Proof-of a healing diet.
  3. The DASH diet (Dietary Approach to Stop Hypertension) may help because it encourages potassium and magnesium rich vegetables, fruits, beans, nuts and seeds. Calcium is provided without being over recommended with two to three servings of dairy group foods. See example daily/weekly diet plan recommendations here: What is the DASH diet?, dashdiet.org.
  4. Adequate without excess protein helps protect the kidneys from having to overwork excreting nitrogen from excess protein breakdown. Adequate water is essential for kidney and vascular health as it helps with excretion of toxins and transport of nutrients and oxygen in the vascular system. More information about protein and water recommendations are available in a previous post: Make every day Kidney Appreciation Day.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. Thomas Bollyky, Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, 2018, MIT Press, https://mitpress.mit.edu/books/plagues-and-paradox-progress
  2. Chan Q, Stamler J, Elliott P. Dietary factors and higher blood pressure in African-Americans. Curr Hypertens Rep. 2015;17(2):10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315875/“Marked ethnic differences exist in bone metabolism and development of calcified atherosclerotic plaque (CP). Relative to European-Americans, African-Americans have lower rates of osteoporosis (despite ingesting less dietary calcium), form fewer calcium-containing kidney stones and manifest skeletal resistance to PTH (1,2,3). Systemic differences in regulation of calcium and phosphorus appear to be involved (4). Related phenomena may include the markedly lower amounts of calcified CP in African-Americans, despite the presence of more severe conventional cardiovascular disease risk factors (5,6,7,8,9). Together these observations suggest biologically mediated ethnic differences in the regulation of bone and vascular health.” […]  “The DASH/DASH-Na diet BP reduction was more pronounced for blacks compared to whites [313637]. Although the DASH dietary approach has been incorporated into lifestyle changes recommended for patients with HTN [3], data show that few hypertensive Americans consume diets even modestly concordant with the DASH diet and less so for blacks [38]. Only about 19 % of individuals with known HTN from NHANES 1999–2004 had DASH-concordant diets.”
  3. Barry I. Freedman, et al, Vitamin D, Adiposity, and Calcified Atherosclerotic Plaque in African-Americans,J Clin Endocrinol Metab. 2010 March; 95(3): 1076–1083. [ncbi.nlm.nih.gov/pmc/articles/PMC2841532/?tool=pubmed]  
  4. Potassium and Your CKD Diet, National Kidney Foundation, https://www.kidney.org/atoz/content/potassium
  5. Ryota Ikee, Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions, Renal Replacement Therapy2018 4:1,   https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-017-0142-7
  6. Noriaki Kurita, Tadao Akizawa, Masafumi Fukagawa, Yoshihiro Onishi, Kiyoshi Kurokawa, Shunichi Fukuhara; Contribution of dysregulated serum magnesium to mortality in hemodialysis patients with secondary hyperparathyroidism: a 3-year cohort study, Clinical Kidney Journal, Volume 8, Issue 6, 1 December 2015, Pages 744–752, https://doi.org/10.1093/ckj/sfv097
  7. van Valkengoed IG, Agyemang C, Krediet RT, Stronks K. Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio: the observational SUNSET study. BMC Nephrol. 2012;13:26. Published 2012 May 7. doi:10.1186/1471-2369-13-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492102/
  8. Frankenfield DL, et al., Differences in intermediate outcomes for Asian and non-Asian adult hemodialysis patients in the United States, Kidney International, Vol 64, Issue 2, Aug. 2003, pp 623-631 https://www.sciencedirect.com/science/article/pii/S0085253815493706
  9. M H Kroll, R J Elin, Relationships between magnesium and protein concentrations in serum. Clinical Chemistry Feb 1985, 31 (2) 244-246; http://clinchem.aaccjnls.org/content/31/2/244.long

Demyelination, continued.

The last post got a little long and it included a link to another health writer who was summarizing a large amount of material on the topic of demyelination – it is amazing what you can learn by reading. I only mentioned the article, (22), briefly because it was already a long post and I hadn’t checked the other writer’s references, (it is primarily all medical research from peer reviewed journals (22.1)); and some of his recommendations are not typical, however I had read of them elsewhere so it seemed thorough and well written. The truly intriguing part for me was just how many other conditions there are that may be susceptible to demyelination and increased negative symptoms due to nerve degeneration.

I have a few of the problems that were mentioned and I have had early symptoms of nerve numbness and pain in my extremities – fingertips particularly. Health is easier to maintain then to restore once chronic conditions develop. I have managed to reverse the nerve numbness and occasional pain that I was having in my fingertips but it is with several daily or weekly health habits, not just a simple take-this-medication-once-a-day solution.

The list of psychiatric conditions that may also have demyelination summarized in an article about possible ways to regenerate myelin, (22):

  • Attention deficit hyperactivity disorder
  • Depression 
  • Bipolar disorder 
  • Dyslexia 
  • Language disorders 
  • Stuttering 
  • Autism 
  • Obsessive-compulsive disorder 
  • Cognitive decline 
  • Alzheimer’s disease
  • Tourette’s syndrome 
  • Schizophrenia 
  • Tone deafness
  • Pathological lying
  • (22)

That is quite a list – protect your oligodendrocytes, because they protect your ability to think and communicate, to control your ability to control your movements and to have stable moods, reduce anxiety, and control your ability to be able to read and speak and to be able to control your impulses and ability to prevent yourself from lying or saying things you don’t intend to say, and to be able to understand that your thoughts are your own thoughts, and to be able to hear accurately. The reference given for the information is this article: [45].

Neurology is the study of the nervous system, Psychiatry or Psychology is the study of mental health and neuropsychiatry is the study of mental symptoms caused by neurological conditions.

This topic of psychiatric conditions and other conditions that may also have demyelination is also reviewed in a summary of Neurotoxicology for neurologists: (6.Neurotoxicology). Neurology is the study of the nerves and nervous system. The nervous system includes the brain and spinal cord and all of the nerves throughout the body. It is subdivided into two main categories: the Central Nervous System (CNS) refers to the brain, the spinal cord and nerves of the brain and spinal cord; and the Peripheral Nervous System (PNS) refers to the nerves throughout the rest of the body. Neurologists are medical doctors who specialize in conditions affecting the nervous system. They may focus on a subspeciality within the field of neurology (What is a neurologist?, HealthLine) Interestingly dementia, chronic headaches, and Multiple sclerosis are mentioned as possible conditions they treat but all the other psychiatric conditions mentioned in the list that may involve demyelination are not mentioned.

The overview article on Neurotoxicology does mention that psychiatric symptoms may occur in patients with neurological conditions but that the symptoms tend to be dismissed by neurologists, and are not studied in depth, so more reliable information is needed about psychiatric symptoms presenting with neurological disorders  – see “Psychiatric and behavioural disorders.” (6.Neurotoxicology) An article for neurologists goes into more detail about psychiatric symptoms that might deserve consultation with a neurologist rather than having the patient only see a psychiatrist: Neurological syndromes which can be mistaken for psychiatric conditions. Early symptoms of Multiple sclerosis for example sometimes may be mistaken for a psychiatric condition. (Neurological syndromes) Talk therapy or psychiatric medications are not going to help a patient regenerate their myelin after all. Neuropyschiatrists are neurologists that also have a degree in psychology and specialize in treating patients with mental health and behavioral symptoms related to neurological disorders. (neuropsychiatrists)

PTSD was also mentioned as a psychiatric condition that may have demyelination.[45]

Reading the article that was referenced for the list of psychiatric conditions that may also have demyelination [45] provided an additional condition that was not added to the list in the summary article about potential ways to help regenerate myelin (22) – PTSD also may involve demyelination, and confirmed the rest of the list were mentioned [45] . The article also includes more background information about the function and development of the myelin sheath in learning and behavior.

Nerves with myelin provide a much faster signal and oligodendrocytes myelinate several different nerves so there is additional benefit in signals that work in a coordinated manner to also improve speed of function. The myelination occurs over time so the phrase practice, practice, practice applies. Peak time of life to learn skills is in our youth because that is when the majority of myelination occurs -starting in early childhood and continuing until the early twenties even up to age thirty. Healing after injury or learning a new skill later in life would still require the practice, practice, practice so the speedy pathways between groups of nerve cells develop their myelin sheaths in coordinated connections. [45]

This information may help show the difficulties faced by people with PTSD or other psychiatric conditions – the brain connections are coordinated in patterns learned from traumatic memories or are stuck in Obsessive Compulsive patterns. The problem with impulse control might also make more sense if there is simply “leaky” wiring in the brain. Signals that were intended to do one thing might end up activating other behaviors because the myelin sheath is no longer functioning as expected.

A cognitive therapy technique, involving frequent practice/repetition of new ways to talk to yourself – it might help strengthen more positive neural networks with new myelin sheath connections.

Learning new patterns of thinking, replacing traumatic or anxious thoughts that were learned as a child or during a traumatic phase of life can take time and a lot of repetition but it is possible, just like it can be possible to relearn how to walk or do other basic life skills after a stroke or traumatic physical injury. A book by Shad Helmstetter, PhD discusses how to rephrase your own internal self talk to be more positive and gives examples for a number of different types of concerns. I found the technique helpful for emotional overeating and share phrases that I wrote regarding healthy eating and lifestyle and a link to the book in a previous post: “What to Say When You’re Talking to Yourself.” The recommendation that I followed was to read the statements several times every day – for a while, months even. I don’t remember how long I read them daily but it was for quite a while and I still have the little ring binder of statements that I wrote.

Often changing behavior patterns is easier when the new pattern is created first, rather then trying to stop the old first. Build the new and then the old is no longer needed.  Addition, I found the source of that idea:

“The secret of change is to focus all of your energy not on fighting the old, but on building the new.” – Socrates

A new way to think about demyelination – what is the underlying problem? Possibly excess cell death, at rates above the ability to breakdown and remove nucleotides (ATP, ADP, UTP, UDP).

The article on demyelination and cognitive disorders, [45] , also mentioned that adenosine plays a role in signaling oligodendrocytes to make myelin and an article with more information on the topic mentions that increased amounts of ATP, ADP, UTP, UDP can signal breakdown of myelin. Increased presence of those chemicals was suggested to possibly be due to increased cell death without normal clearing away of the old cellular material. And some types of Multiple sclerosis seems to involve increased levels of the enzyme that breaks down adenosine so there would be less available to signal the production of myelin. (8.adenosine in MS)

Take home point – protect against excessive cell death and/or mitochondria damage by not having excessive glutamate (11.link) or aspartate – excitatory amino acids that may be overly available in the modern processed food diet – and by having adequate magnesium to protect the cells from their interior by providing the needed energy to block ion channels in the cell membrane and prevent excessive amounts of calcium, glutamate or aspartate from being able to cross the cell membrane and enter the cell’s interior.

As usual however, it is not that simple, (not that avoiding glutamate and aspartate in the diet is easy, they are in many processed foods), other things can also cause excessive cell death.

  • Exposure to toxins in the environment or due to drug use, illicit or legal, can cause excessive cell death and lead to demyelination disorders. An overview:(6.Neurotoxicology)
  • Lack of oxygen can also be a cause. Lack of nutrients in general can increase the breakdown of cellular parts to provide enough nutrients however if malnutrition is severe and ongoing the breakdown (autophagy) can become excessive. (7.Metabolic Stress, Autophagy & Cell Death)
  • Traumatic injury and infection can increase the  rate of cell death above the level that the body’s detoxification systems can cope with clearing away the cellular material. Traumatic injury is associated with increased risk for infection for reasons that are not well understood, the immune system is considered functionally suppressed: (10.Immunobiology of Trauma) Also mentioned briefly in the Skeletal Muscle section of this overview: (6.Neurotoxicology).
  • Anything that causes excess oxidative stress may cause increased rates of mitochondria breakdown so protecting against stress is protecting the mitochondria which is protecting the cells. (7.Metabolic Stress, Autophagy & Cell Death) Mitochondria are the main energy producers within cells and make up about thirty percent of the volume of cardiac/heart cells. Other type of mitochondrial problems can also increase risk of their switching from promoting health through energy production into a mode that promotes cell death. One of the roles mitochondria play in normal health is storage of excess intracellular calcium. If the mitochondria become dysfunctional then the extra calcium is released into the cell where it can signal increased activity such as release of cannabinoids from the membranes. (9.mitochondria in CVD)

This is approaching really long again, so I am stopping here for now.

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./ 

  1. Jordan Fallis, 27 Proven Ways to Promote the Regeneration of Myelin. Feb. 18, 2017, Optimal Living Dynamics,   https://www.optimallivingdynamics.com/blog/25-proven-ways-to-promote-the-regeneration-of-myelin (22)
  2. Reference list: https://www.optimallivingdynamics.com/myelin-references (22.1)
  3. R. Douglas Fields, White Matter in Learning, Cognition, and Psychiatric DisordersTrends Neurosci. 2008 Jul; 31(7): 361–370.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486416/ [45]
  4. Butler CZeman AZJ, Neurological syndromes which can be mistaken for psychiatric conditions
  5. Anne Masi, Marilena M. DeMayo, Nicholas Glozier, Adam J. Guastella, An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options. Neuroscience Bulletin, Vol 33, Iss 2, pp 183–193, https://link.springer.com/article/10.1007%2Fs12264-017-0100-y (autism link)
  6. Harris JBBlain PG, Neurotoxicology: what the neurologist needs to know.

    (6.Neurotoxicology)

  7. Brian J. Altman, Jeffrey C. Rathmell, Metabolic Stress in Autophagy and Cell Death Pathways. Cold Spring Harb Perspect Biol. 2012 Sep 1;4(9):a008763 http://cshperspectives.cshlp.org/content/4/9/a008763.full (7.Metabolic Stress & Cell Death)
  8. Marek Cieślak, Filip Kukulski, Michał Komoszyński, Emerging Role of Extracellular Nucleotides and Adenosine in Multiple sclerosisPurinergic Signal. 2011 Dec; 7(4): 393–402.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224637/ (8.adenosine in MS)
  9. Sang-Bing Ong, Asa B. Gustafsson, New roles for mitochondria in cell death in the reperfused myocardium. Cardiovascular Research, Vol. 94, Issue 2, 1 May 2012, pp 190–196, https://academic.oup.com/cardiovascres/article/94/2/190/268169 (9.mitochondria in CVD)
  10. Dr. Daniel Remick, pre-ARC Director, Immunobiology of Trauma, pre-Affinity Research Collaborative (ARC), Boston University Medical Center, http://www.bumc.bu.edu/evanscenteribr/files/2009/07/pre-arcimmunologytrauma.pdf  (10.Immunobiology of Trauma)
  11. Howard Prentice, Jigar Pravinchandra Modi, Jang-Yen Wu, Mechanisms of Neuronal Protection against Excitotoxicity, Endoplasmic Reticulum Stress, and Mitochondrial Dysfunction in Stroke and Neurodegenerative Diseases. Oxidative Medicine and Cellular Longevity, Vol. 2015, Article ID 964518, 7 pages,Hindawi.com https://www.hindawi.com/journals/omcl/2015/964518/ (11.link
  12. Blaylock, R.L. (1996). Excitotoxins: The Taste That Kills. Health Press. ISBN 0-929173-25-2
  13. Blaylock, R.L. (a neurosurgeon) podcast Excitotoxinshttp://www.blaylockhealthchannel.com/bhc-ep-18-excitotoxins (Excitotoxins podcast)
  14. Excitotoxicity, Wikipedia, https://en.wikipedia.org/wiki/Excitotoxicity (Excitotoxicity)
  15. Aspartic Acid, Wikipedia, https://en.wikipedia.org/wiki/Aspartic_acid (Aspartic Acid/Aspartate)