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Can Magnesium Today Keep Diabetes Away?
Jessica Jeanne Wolff
September 24, 2007
Mr. Jones, the results of your tests are back, and you have DIABETES. Basically, diabetes is a chronic disease, affecting well over twenty million Americans, for which there is no cure. (http://diabetes.org/diabetes-statistics/prevalence.jsp). It has the potential of negatively impacting every organ of your body. If you wish to live to an old age and maintain an active lifestyle, you will have to make a few changes: diet, exercise, lose weight, stop smoking, stop drinking, control that blood pressure, lower that cholesterol … This is truly life altering news. Now, just think how you would feel if you were then told that by adding magnesium to your diet you could have prevented or at least delayed the onset of diabetes.
Diabetes is a disease in which circulating blood glucose levels are high, but the glucose, which the body needs for energy, is unable to move into the cells of the body to be converted into energy. This occurs for two reasons. The first is that the pancreas is not producing enough insulin, the hormone necessary to move the glucose from the bloodstream into the cells. The second is that the body is unable to utilize the insulin efficiently therefore requiring more and more insulin production to get the job done. Eventually the pancreas can no longer meet this demand (http://www.cdc.gov/diabetes/faq/basics.htm).
There are two types of diabetes. Type 1, often referred to as insulin dependent diabetes or juvenile onset diabetes, is primarily due to genetic factors. It generally manifests itself early in life because the pancreas is unable to produce any insulin or very little insulin (http://www.mayoclinic.com/health/type-1-diabetes/DS00329/DSECTION=1). However the most predominant form of diabetes, accounting for 90 to 95% of all diagnosed cases, is type 2 diabetes, often referred to as non-insulin dependent diabetes or adult onset diabetes. In type 2 diabetes either your body does not produce enough insulin, or your cells have become insulin resistant (http://www.diabetes.org/type-2-diabetes.jsp). With insulin resistance the cells from muscle, fat, and the liver are unable to use the insulin produced by the pancreas properly. Although the pancreas receives signals from the body to produce more insulin, and in fact does produce more insulin, it is unable to meet the demand because of the phenomena of insulin resistance (http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.htm ). Excess body fat, especially around the waist and upper part of the body, seem to play a key role in insulin resistance (http://adam.about.com/reports/Diabetes-type-2.htm). The end result is that the individual with insulin resistance has an excess of both glucose and insulin circulating through their blood simultaneously. This condition is often associated with high LDL (bad cholesterol) levels, low HDL (good cholesterol) levels, high triglycerides, and high blood pressure. This concomitant grouping has been labeled metabolic syndrome. Eventually, individuals with insulin resistance alone or metabolic syndrome, if left untreated, will end up with type 2 diabetes (http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.htm). Although usually diagnosed in adults forty years of age or older, the incidence of type 2 diabetes has been steadily increasing among children and adolescents at an alarming rate. There was a ten fold increase in this age group between 1982 and 1994 with a later study in 1996 reporting that one third of all new cases of diabetes in children were now type 2 (http://adam.about.com/reports/Diabetes-type-2.htm). This rise in the number of cases is thought to coincide with the obesity epidemic in this population. An even more alarming statistic comes from the National Diabetic Information Clearinghouse (NDIC) stating that in 2002, fifty-four million United States adults had pre-diabetes, a condition in which the blood glucose is above normal but not yet at the type 2 diabetic level. This condition places them at a greater risk of developing type 2 diabetes within ten years (http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.htm).
Diabetes: The cost financially, physically, and psychologically
In 2002 alone over $132 billion was spent on diabetes between direct medical costs and indirect costs such as disability, work loss, and premature mortality (http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm). 3.
Unfortunately, this dollar amount pales in comparison to the possible physical cost the diabetic faces namely: increased risk of heart attack, increased risk of stroke, kidney disease, high blood pressure, blindness, nervous system diseases, erectile dysfunction, amputations, dental disease, complications of pregnancy, decreased ability to heal after surgery or injury, and an increased susceptibility to many other illnesses (http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm).
Psychologically the individual is made to take on a new identity: a Diabetic. They become the disease. From now on you are a Diabetic and not simply a person who has the disease diabetes. You should wear a medic alert bracelet or carry a medic alert card in your purse or wallet identifying you as a Diabetic. When questioned by any medical personnel they will ask if you are a Diabetic. Society does not put that label on many disease states. You are not a cancer, a heart attack, or a stroke; but you are a Diabetic.
Can the addition of magnesium to the diet prevent or delay the onset of diabetes?
4. Magnesium is a mineral necessary for more than 300 of the enzyme reactions occurring in the body. Although magnesium is found in foods such as dark green leafy vegetables, avocados, corn, beans, peas, nuts, seeds, and whole unrefined grains, depletion of magnesium from the soil has steadily decreased the amount of magnesium in these foods (http://www. krispin.com/magnes.html). The processing of foods, as well as the refining of flour, removes most of the magnesium content (http://www.life- enthusiast.com/twilight/shealy/magnesium.htm). As a result, natural dietary magnesium intake has declined by more than 50% in the last century. The USDA estimates that 75% of Americans do not consume even the recommended daily requirements of this mineral 5. (http://www.naturemade.com/WellnessTopics/wt_articles.asp?articleid=84). The RDA for magnesium has recently been updated to 420mg for men and 320mg for women in the United States (http://www.jctonic.com/include/minerals/magnesiu.htm).
First, magnesium is an essential cofactor for several enzymes necessary for glucose metabolism. Therefore, it helps to regulate levels of blood glucose. Secondly, magnesium enhances insulin secretion, which aids in the movement of glucose into the cells. Finally, magnesium increases tissue sensitivity to insulin thus decreasing the affects of insulin resistance
(O’Connell, 2001). It is well documented throughout the literature that low magnesium levels are commonly found in individuals with type 2 diabetes. It is suggested in the literature that these low levels of magnesium in some way contribute to diabetic complications (Hans, Sialy, & Bansal, 2002).
What does the medical research offer on the prevention of diabetes by the addition of magnesium?
Although there is a plethora of research and review articles linking hypomagnesemia to the deleterious effects of diabetes, most of which concluded with recommendations to investigate the link between magnesium intake and the prevention of type 2 diabetes, only a few studies have actually been carried forth to answer this question. However, the eight major prospective studies did contain large numbers of participants followed for long periods of time; between six and eighteen years. The outcome of the majority of these studies demonstrated an inverse relationship between magnesium intake and the risk of type 2 diabetes.
The objective of the Nurses’ Health Study (NHS) was to examine the risk of developing type 2 diabetes. This study began in 1976 when a group of 121,700 female registered nurses, aged 30-55 years, completed mailed questionnaires on their medical history and lifestyle characteristics. A follow-up study was sent every two years to update information on potential risk factors and identify newly diagnosed cases of diabetes. The response rate to the follow-up questionnaires was greater than 90%. Diet was first evaluated in 1980 using food frequency questionnaires, with repeat evaluations every 2-4 years. With the exclusion of participants who at baseline reported a history of diabetes, cardiovascular disease, or cancer, 85,060 women were followed over 18 years (1980-1998). Statistical analysis demonstrated a significant inverse association between magnesium intake and the risk of type 2 diabetes (Lopez-Ridaura et al., 2004).
The Health Professionals’ Follow-up Study (HPFS) was carried out by the same group of researchers as the NHS, using the same criteria with the same objective. This study began in 1986 when questionnaires were mailed to 51,529 male United States health professionals between the ages of 40 and 75. After exclusions for a history of diabetes, cardiovascular disease, or cancer, 42,872 men were followed with biennial questionnaires for over twelve years (1986-1998). The response rate to the follow-up questionnaires was also more than 90%. A consistent inverse association between magnesium intake and the risk of type 2 diabetes was observed (Lopez-Ridaura et al., 2004).
In the Women’s Health Study which was started in 1993, 39,345 United States’ women, forty-five years of age and older, were followed for an average of six years with food frequency questionnaires. Although this study was originally designed to evaluate the use of aspirin and vitamin E in the prevention of cardiovascular disease and cancer in older women, researchers also examined the association between magnesium intake and the incidence of type 2 diabetes. Plasma fasting insulin levels were also measured on a sample (349) of women from the study to examine the relationship between insulin levels and magnesium intake. The result of the study supports the protective role of higher intake of magnesium in reducing the risk of developing type 2 diabetes, especially in overweight women (Song, Manson, Buring, & Liu, 2004).
In the Iowa Women’s Health Study the objective was to examine the association between women’s risk of developing type 2 diabetes and the intake of carbohydrates, dietary fiber, and dietary magnesium. This study consisted of 35,988 post-menopausal Iowa women, free of diabetes at baseline, followed with food frequency questionnaires for six years. The 127 item food frequency questionnaire was similar to that used in the NHS. Reported cases of diabetes were validated through the participant’s physician. The data from this prospective study once again indicated a strong inverse relation between dietary magnesium intake and the risk of type 2 diabetes (Meyer et al., 2000).
A different study, published in the April 2006 issue of Circulation, focused on magnesium intake and the incidence of metabolic syndrome, often a precursor to type 2 diabetes, in a population ranging in age from 18 to 30. The Coronary Artery Risk Development in Young Adults Study (CARDIA) is comprised of 4637 Americans free from metabolic syndrome at baseline. This study is an ongoing, multi-center, longitudinal study. So far, they have been followed for fifteen years with interviewer-administered quantitative food frequency questionnaires, and their magnesium intake was derived from the nutrient database developed by the Minnesota Nutrition Coordinating Center. Ninety-nine toenail samples were randomly checked at the two year examination for magnesium concentration to validate magnesium intake. 74% of participants returned for the fifteen year examination. The results showed that a higher magnesium intake was associated with a reduced risk of each individual component of metabolic syndrome (He et al., 2006).
The Atherosclerosis Risk in Communities Study (ARIC) found no relationship between dietary magnesium intake and the risk of type 2 diabetes. AIRC researchers examined the risk for type 2 diabetes in over 12,000 middle aged adults without diabetes at baseline. The study went on for six years. Fasting serum magnesium levels as well as dietary magnesium levels were measured. Although a graded inverse relationship between serum magnesium levels and the incidence of type 2 diabetes was seen in white participants; no such association was demonstrated in black participants. There was no association detected between dietary magnesium intake and the risk for type 2 diabetes in black or white participants (Kao et al., 1999).
The final study which was recently published in the May 14, 2007 issue of Archives of Internal Medicine combined a prospective study on fiber and magnesium intake and the risk of type 2 diabetes with a meta-analysis of existing prospective studies through May 2006 for fiber and magnesium intake and the risk of type 2 diabetes. Nine cohort studies on fiber and eight studies on magnesium intake were identified. The prospective study of 9,702 men and 15,365 women, aged 35 to 65 years, was observed for the incidence of diabetes from 1994 to 2005. Dietary intake of fiber and magnesium were measured with food frequency questionnaires. The results showed that higher cereal fiber intake was associated with a reduced risk of type 2 diabetes, but magnesium intake was not significantly associated with diabetes risk. The meta-analysis found that both higher cereal fiber and magnesium intake were associated with a reduced risk of type 2 diabetes. Although food frequency questionnaires were used in all of the studies, the difference in questionnaire design limits the comparability of questionnaire data across studies and their interpretation in quantitative terms. Recognized flaws in the design of the prospective study, such as not screening the study population for diabetes at baseline, led researches to question its outcome thus reaching the final conclusion that both higher cereal fiber and magnesium intake may decrease diabetic risk (Schulze et al., 2007).
All of the studies used a similar design, primarily basing their findings on some type of food frequency questionnaire. Although adjustments were made for variables such as BMI, exercise, supplemental magnesium, age, and family history, the findings of the majority of the studies consistently demonstrated an inverse relationship between magnesium intake and the incidence of type 2 diabetes. Most, if not all studies, supported the need for additional investigation to prove that the results obtained were based on magnesium intake and not another variable. The evidence presented in these studies was not conclusive enough for the American Diabetes Association to make a recommendation for magnesium supplementation. Strongly encouraging individuals at risk for type 2 diabetes to include magnesium rich foods in their diet was as far as they would go.
Due to the increasing number of reported cases of diabetes worldwide and the estimate of 370 million diagnosed cases of diabetes by the year 2030, there is a renewed interest in diabetes prevention (Schulze et al., 2007). Now is the time to design studies that will conclusively ascertain the relationship between magnesium intake and the prevention of type 2 diabetes. For example, a double-blind study, including a population at high risk for developing type 2 diabetes such as a strong family history, pre-diabetic serum glucose levels, metabolic syndrome, obesity, and sedentary lifestyle, using placebo as well as differing strengths of supplemental magnesium would eliminate many inconsistencies identified in previous studies.
Why were the recommendations of the researchers to pursue more structured and conclusive studies disregarded?
Diabetes is multi-billion dollar industry in the United States alone. Many of the large pharmaceutical companies carry an extensive line of drugs for the treatment of type 2 diabetes and its sequela. The giant pharmaceutical companies have the financial resources to design and carry out studies that would prove the relationship between magnesium and the prevention of type 2 diabetes, but this kind of research has absolutely no benefit or profit to them. Instead, research and development dollars are spent on developing new and improved drugs for the treatment of diabetes not the prevention of diabetes. Now that diabetes is reaching proportions that will severely impact Medicare and Medicaid spending, the federal government will likely step in with independent research grants to fund medical research aimed at the prevention of type 2 diabetes.
Finally, with a family history of type 2 diabetes, increasing consumption of green leafy vegetables, nuts, whole grains, and taking a magnesium supplement is a miniscule lifestyle change compared to the life changing events associated with becoming a Diabetic.
Hans, C. P., Sialy, R., & Bansal, D. D. (2002, December 25). Magnesium deficiency and
diabetes mellitus. Current Science, 83 (12), 1456-1463.
He, K., Liu, K., Daviglus, M. L., Morris, S. J., Loria, C. M., Van Horn, L., Jacobs, D.R., &
Savage, P. J. (2006). Magnesium intake and incidence of metabolic syndrome among
young adults. Circulation, 113, 1675-1682.
Kao, W. H., Folsom, A. R., Nieto, F. J., Mo, J. P., Watson, R. L., & Brancati, F. L. (1999).
Serum and dietary magnesium and the risk for type 2 diabetes mellitus: The
Atherosclerosis Risk in Communities Study. Archives of Internal Medicine, 159 (18),
Lopez-Ridaura, R., Willett, W. C., Rimm, E. B., Liu, S., Stampfer, M. J., Manson, J.E., & Hu,
F.B. (2004). Magnesium intake and risk of type 2 diabetes in men and women. Diabetes
Care, 27 (1), 134-140.
Meyer, K. A., Kushi, L.H., Jacobs, D.R., Slavin, J., Sellers, T. A., & Folsom, A. R. (2000).
Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. American
Journel of Clinical Nutrition, 71 (4), 921-930.
O’Connell, B. S. (2001). Select vitamins and minerals in the management of diabetes. Diabetes
Spectrum, 14, 133-148.
Schulze, M. B., Schulz, M., Heidemann, C., Schienkiewitz, A., Hoffmann, K., & Boeing, H.
(2007). Fiber and magnesium intake and incidence of type 2 diabetes. Archives of Internal
Medicine, 167, 956-965.
Song, Y., Manson, J. E., Buring, J.E., & Liu, S. (2004). Dietary magnesium intake in relation to
plasma insulin levels and risk of type2 diabetes in women. Diabetes Care 27 (1), 59-65.
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