The Super Colon Lady Gets a Colonoscopy – Prevent Cancer Foundation

Strange as it might seem, it is a good moniker to have if you travel with a 20 ft. long, 8 ft. high giant inflatable colon.  The Prevent Cancer Super Colon^® exhibit helps bring colorectal cancer awareness, and a message of early detection, to communities all across America. 

If you read Part I: The Super Colon Lady Gets a Colonoscopy you know that, like many people, I had been dragging my feet about getting screened for colorectal cancer.  Now, I have talked with my gastroenterologist (G.I. doc) and her nurse, and scheduled the procedure.  Together we decided I would be completely knocked out and my entire bowel cleansing prep would include a couple of laxative pills to get things moving (really?), two 10 oz. bottles of magnesium citrate and lots of fluids. 

Many of us do not drink the amount of fluids we need every day for a healthy body, so when it comes time for a colonoscopy the fluid intake is intimidating. DRINK ALL THE FLUIDS THE DOCTOR TELLS YOU.   It’s important to have enough water in your system to avoid dehydration and it will help everything come out better later on (again, really?). 

Follow your doctors directions to the letter; you do not want to re-do the do-do.  Here are some helpful insights:

4 days before your procedure

• Drink at least 8 – 10 glasses(8oz) of water a day
• Up you fiber intake (vegetables and fruits)
• Cut out the red meat
• Try having soup for one meal a day
• Stock up on clear fluids for “the day” and wet wipes
• Buy a flavored version of magnesium citrate, preferably lemon-lime, and the rest of your prep kit.

“The Day Before” the following clear liquids are allowed (starting in the morning I had something every hour): DO NOT DRINK ANYTHING RED OR PURPLE!!!

• Water
• Clear broth such as chicken broth, beef broth, vegetable broth (these really help you keep up your energy)
• Clear beverages such as sodas, tea, coffee
• Juices like apple juice, grape juice, prune juice(a little overkill), cranberry juice, kool aid, lemonade (the grape juice helps cut the taste of the prep, so rinse it down with a glass)
• Ices/Jell-O Italian ices, Popsicles without fruit, Clear Jell-O (I loved the Jell-O, it made me feel like a kid; an old wrinkly, cranky kid, but I wasn’t hungry)
• Take your prep on the time schedule given to you by your doctor.   Do not leave the house for the rest of the day or night. (I’m going to be a standup comedian when I grow up.)

I started my prep at 3pm with the laxative pills and continued with my first bottle of magnesium citrate at 7pm.  The best way to drink this is chilled or over ice.  Do not drink it in one gulp (don’t think you could), but you can use a straw and the liquid will be automatically aimed to the back of your throat where there are fewer taste buds. I had the “pleasant sparkling” lemon lime flavor and I thought I was going to burp it up.  Big help here is to keep moving, do not lie down or sit down; there will be plenty of time for that later.  My prep did not kick-in for about 1 ½ hrs.  Be sure to get those wet wipes; otherwise your tushy will feel as sore as your nose after a bad cold day with lots of Kleenex.  Sorry for that extra-special image!  

By the time I took my second 10oz bottle, at around 12midnight, I was almost completely cleaned out.   The second bottle did not cause anywhere near the same amount of bathroom time and I went to bed and fell sound asleep.  The next morning I had nothing before the procedure and my husband drove me to the hospital.  Since I was going to be knocked out, I needed someone to drive me home.

The hospital was great!  I put on a cute gown (come on people, nobody looks good in this shade of green) talked with my G.I. doc and got my anesthesia through an I.V.; then I blinked and asked when we were going to start.  That was it, I was finished.  Lucky me, I was as clean as a whistle and do not have to another colonoscopy for 10 years.

Hope this helps!  The prep was relativity painless and I am going to be better at keeping hydrated all of the time; my skin loves me. I also like being the one in control of my colon health.

Just do it!  Go find a good G.I. doc you can talk with and decide what procedure works for you (take my advice, get knocked out, it was simple).

How to Drink Magnesium Citrate Without Gagging?

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While consuming the Magnesium Citrate, many people may feel queasy. Magnesium Citrate tastes best when it’s refrigerated or served over ice. Use a straw so that the liquid will be automatically directed to the back of your throat, where there are less taste buds, but avoid downing it in one swallow (don’t think you could).

Read on if you’re wondering how to drink magnesium citrate without giggling. This article will help you understand what to eat and drink before you take it. You can also find out how much magnesium citrate to take before a colonoscopy. If you take too much magnesium citrate, you may experience unpleasant side effects. However, if you follow these guidelines, you’ll have no problems taking magnesium citrate.

Side effects

Before taking magnesium citrate, you may want to know what to expect. Symptoms of this supplement may include gagging and difficulty breathing. These reactions may last several hours and will not indicate a severe problem. However, you should take it at least two hours before or after a meal and do not take larger doses than the recommended dosage. If you experience gagging, drink the supplement on an empty stomach at least an hour before or two hours after a meal. You should measure the liquid magnesium citrate using a particular dose-measuring device or syringe.

Taking this supplement without gagging is possible, but you must consult your doctor first. Taking more than the recommended dose can lead to severe side effects. For some people, magnesium citrate causes diarrhea or bloody stools. In severe cases, it can cause rectal bleeding. You should avoid fatty and starchy foods to reduce the chances of developing any side effects. Instead, choose sushi, poke bowls, and curries with white rice. Avoid whole grains, legumes, and tough meats because they clog the digestive tract. Instead, choose fruits and vegetables that don’t have skin or avoid them entirely.

A good time to take this preparation is an hour before the procedure. First, mix it with yogurt if you want to drink it on an empty stomach. Then, drink it on an empty stomach for about half an hour. The preparation will cause your bowel movement to be more relaxed and faster than usual. Be sure to drink plenty of clear liquids until you have passed the test. It would help if you also drank plenty of liquids throughout the day. Try drinking up to 64 ounces of liquids.

When taking magnesium citrate, take it on an empty stomach. If you do not do this, you might end up with indigestion and diarrhea. The chelate form of magnesium can also contain sugar, irritating your digestive tract. Make sure the magnesium citrate you buy is listed as an inactive ingredient. The amount you take depends on your age and digestive health. You should also consult your doctor before taking magnesium citrate regularly.

Side effects of magnesium citrate

If you are a nervous indigestion sufferer, you might want to know more about the side effects of magnesium citrate. While you can buy it without a prescription at drugstores, it’s used in a medical setting for constipation and acid indigestion. For example, your doctor may prescribe it before a procedure like a colonoscopy. However, you should consult with your doctor before using magnesium citrate.

Some people may find it hard to tolerate magnesium citrate and experience a rash or hives. Other side effects include coughing, difficulty breathing, and swelling of the face, tongue, and throat. In some cases, magnesium citrate may interfere with other medications or vitamins. Before starting a new supplement, speak to your doctor to avoid serious side effects. You may also want to avoid taking magnesium citrate if you have a medical condition that could cause gagging.

Another way to avoid gagging is to take magnesium citrate a few hours before the appointment. Take the preparation with a full glass of water, as sipping the pill over a more extended period may reduce the effectiveness of magnesium citrate. If you still don’t get a positive result, you can retake magnesium citrate. You can buy it over the counter. It can help you lose weight fast.

It is also important to note that magnesium citrate is best taken on an empty stomach. If taken on an overly full stomach, magnesium citrate may affect the baby. Take the supplements a few hours before or two hours before meals. If you experience any side effects, you should contact your doctor. However, magnesium citrate is generally safe to use during pregnancy and nursing. It is best to follow the directions on the label.

The magnesium citrate dosage varies, but it’s generally 10 ounces for adults. Children six to twelve should take 5 ounces. However, children younger than six should seek the advice of their pediatrician. In addition to the side effects of magnesium citrate, you should drink at least eight ounces of water to replace fluids lost through bowel movements. You should also be aware of magnesium toxicity, especially if you drink much water with magnesium citrate.

Magnesium citrate dosage

You’re not alone if you’re concerned about the potential for gagging when you drink magnesium citrate. Many people are trying to avoid the taste altogether, but there are a few things you can do to get the correct dosage without vomiting. You can start by ensuring you drink at least eight ounces of water before taking magnesium citrate. That way, you can ensure that you get enough fluids to propel the liquid through your digestive system.

Another way to avoid gagging is to take your tablet on an empty stomach. You should also avoid eating anything that contains legumes or whole grains, as they will clog your digestive tract. Try to stick to plain, skinless vegetables for the time being, as these are more likely to contain magnesium. However, if you still can’t stop feeling queasy, you can always mix magnesium citrate with some yogurt to make it easier to swallow.

When used as directed, magnesium citrate can help you lose weight by increasing intestinal transit and water volume. It is safe for short-term use as a laxative, but you should avoid using it regularly as it can have unwanted side effects. Magnesium is a necessary mineral to use in the body and helps it absorb other nutrients. Taking it correctly can help you lose weight, but you should never exceed recommended dosages.

Another way to avoid gagging after magnesium citrate is to follow up with a glass of water immediately afterward. It’s important to remember that magnesium citrate is best taken on an empty stomach. So always follow up with a glass of water afterward, as this will minimize complications. This way, you’ll be sure to pass a bowel movement in one to three hours. This should help you to get on with your daily life without gagging.

Fortunately, magnesium citrate is generally safe to take on an empty stomach, but you should drink plenty of water. The recommended dosage for adults is ten ounces, while for children six to twelve, you can take it in small doses. Remember to drink at least eight ounces of water afterward to replace any fluid you lost. You can also drink the medicine with water in a single sitting or divided over two.

Side effects of magnesium citrate before colonoscopy

Magnesium citrate has some side effects before colonoscopies, which is an ordinary laxative. It’s also used to treat acid indigestion and constipation. Therefore, before a colonoscopy, you should consult a doctor to determine the best dosage. The following are some of the most common side effects of magnesium citrate. They include dizziness, headache, stomach pain, vomiting, and stools that are colorless or darkened.

The MagCitrate is an osmotic laxative, which means that it increases intestinal water. While other forms of magnesium don’t have laxative properties, magnesium citrate promotes bowel motility and helps relieve constipation. However, be sure to take this medication as directed by your health care provider. Intake of this laxative should occur half an hour to six hours before your procedure.

It’s important to note that using magnesium citrate before a colonoscopy may increase your risk of developing hypermagnesemia. However, this medication is relatively safe for pregnant women and breastfeeding mothers. Likewise, it’s safe for children, although younger ones should seek the advice of a pediatrician. You should avoid taking this medication if you have any severe health conditions. Before beginning a magnesium citrate regimen, you should also consult your doctor about your medications and supplements.

Another common side effect of magnesium citrate before a colonoscopy is dehydration. Make sure to drink a lot of water. A good solution would be a lemon-flavored polyethylene glycol-electrolyte solution. These are effective colonoscopy preparations and are safe for most patients. If you have chronic constipation, you should avoid magnesium citrate before colonoscopy.

to accept or not? – Food on vc.ru

Reminder publication material.

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The text was written in collaboration with Anastasia Ivanova.

The magic of magnesium is irresistible. It is taken by the author of The Four-Hour Workweek, Tim Ferriss, for sleep, anti-aging fighter Peter Attia, to saturate cells with energy, even Gwyneth Paltrow, from stress. And millions more customers around the world – for the heart, blood vessels, normalization of pressure and blood sugar levels, strengthening bones and, of course, from muscle spasms. Can they all be wrong? Reminder brought together experts and facts to figure it out.

Magnesium in short supply?

Magnesium is in the top of the most popular dietary supplements. There are at least three reasons for this.

• This metal really plays a very important role in the life of the body. It is needed by mitochondria for energy production. Neurons – for the transmission of electrical impulses. Ribosomes of cells – for the synthesis of proteins. With its help, damaged DNA molecules are restored, muscles contract and cholesterol is excreted. Magnesium is involved in 500+ intracellular biochemical reactions and activates 300+ enzymes. And it is not produced inside the body. And this means that we are dependent on its receipt from the outside.
• According to frequently cited information, about 30% of Russians receive less than 70% of their daily magnesium intake. But don’t panic! We found the original epidemiological study and hasten to reassure: it does not refer to all Russians, but only to 2000 patients of several clinics.
• Magnesium deficiency can be suspected by anyone, even if a standard analysis of plasma or blood serum showed that everything is normal. The catch is that 99% of magnesium is contained inside the cells (about 60% is in bone tissue, the rest is in the muscles, brain, kidneys and liver), from where it is released into the blood when necessary to maintain optimal concentration. So a normal level of magnesium in the blood does not exclude its deficiency at the cellular level. Therefore, popular health publications are often advised to focus on external signs of deficiency. And there are so many of them (from apathy and high blood pressure to irritability and caries) that making a “diagnosis” for yourself is as easy as shelling pears.

The true diagnosis of magnesium deficiency is a complex of tests, including ECG, myography, bone density, saliva, urine, nails and hair. Therefore, even if your legs often cramp, goosebumps appear or your eyelid twitches (these are the most characteristic signs of magnesium deficiency), only a specialist can establish the real cause.

Magnesium as medicine

The logic behind the use of magnesium in medicine is based on two principles.

1. If you have a deficiency, you need to make up for it in order to eliminate the risk of complications.
2. Since magnesium is necessary for the performance of certain functions, it means that if they are impaired, it can be useful, even if there is no obvious or pronounced deficiency.

There are no questions about the first principle. A number of studies show that taking magnesium when deficient does indeed reduce the risk of complications such as heart attack—sometimes by more than a third (1, 2). The second principle is more difficult.

Based on the fact that magnesium is involved in biochemical processes that affect dozens of vital functions, it can be prescribed for almost any disease – like vitamins. Therefore, magnesium supplements are often taken “just in case” for conditions as diverse as osteoporosis, chronic fatigue syndrome, and even mental disorders, including depression. But at the same time, patients, especially those suffering from serious diseases, are never treated with magnesium alone.

So, without a placebo-controlled study, it is impossible to understand what exactly produced the therapeutic effect. There are too few such studies to draw definitive conclusions. In this situation, the most reliable criterion is the practical experience of medical specialists. To get first-hand information on the most proven uses of magnesium, we reached out to several experts.

Cardiovascular diseases

As an electrolyte (conductor of electrical signals), magnesium plays an important role in the functioning of the cardiovascular system. For example, if there are fewer magnesium ions in the cells of the heart, the electrolytic balance is disturbed. This is often observed in arrhythmia and acute coronary insufficiency. Therefore, injections of magnesium sulfate are indeed used in intensive care when a heart rhythm disorder is life-threatening.

It is believed that magnesium generally has a beneficial effect on blood pressure. A meta-analysis of 11 placebo-controlled trials found that magnesium supplementation in people with chronic disease did indeed reduce blood pressure, albeit slightly: systolic by an average of 4 mm and distolic by 2 mm. Previously, magnesium injections were also done during hypertensive crises (this is a sharp increase in pressure), says cardiologist Anton Rodionov.

But in fact, there is no point in using them for hypertension, because after a decrease in pressure, a “rebound” follows. Experiments on the use of magnesium injections in the treatment of acute myocardial infarction have also yielded conflicting results. One study found a 16% reduction in mortality. And the other two did not confirm this effect (1, 2).

But with additives, everything is more or less clear. “Dietary supplements with magnesium, in principle, cannot serve as medicines for cardiovascular pathologies,” says cardiologist and cardiovascular surgeon Alexei Utin. Anton Rodionov shares the same opinion: “Popular and widely sold drugs containing magnesium (panangin, asparkam) have neither an evidence base nor clinical meaning.”

Headache and migraine

One of the symptoms of magnesium deficiency is headaches and migraines. But does taking it help ease the headache? “If it were that simple, we would have beaten migraine a long time ago,” says neurologist Daria Korobkova from the University Headache Clinic. “Migraine is associated with the malfunctioning of pain neurons, its course depends on a huge number of factors, and magnesium is just one brick in this multicomponent scheme. ” There are several small, placebo-controlled studies proving the effectiveness of magnesium in migraine prevention.

The American Migraine Foundation therefore recommends 400–500 mg of magnesium oxide per day for this purpose. According to Daria Korobkova, she also often recommends magnesium preparations as an additional remedy to her patients suffering from episodic and menstrual migraines (these subjects participated in clinical trials of magnesium). In her experience, magnesium “works well” in such cases, but she cannot call its effectiveness high.

Diabetes

Not all people with type 2 diabetes are magnesium deficient, and magnesium deficiency does not always lead to diabetes. However, there is clearly a connection between the two states. Magnesium is involved in the processing of glucose, and its deficiency reduces the sensitivity of cell receptors to insulin. Because of this, cells lose their ability to absorb sugar from the blood in the right amount. In addition, in type 2 diabetes, kidney function is often impaired, so too much magnesium is excreted from the body along with the liquid. This is theory. What about practice?

Attempts to use magnesium in the treatment of diabetes have yielded conflicting results, says endocrinologist Denis Lebedev. Although the subjects’ blood sugar levels decreased after taking the drugs, a test for glycated hemoglobin (a key indicator for controlling diabetes) did not reveal a statistically significant change. The authors of the meta-analysis came to the same conclusion, summarizing all the studies on this topic over the past six years, included in the largest scientific databases. The intake of microelements and vitamins is justified in old age and with food restrictions, Denis Lebedev believes. But not all diabetic patients need magnesium supplements. They are not appointed on a regular basis.

Muscle spasms

Magnesium is the first thought that comes to mind when the leg muscles cramp at night. And in cases where seizures are caused by excessive exercise, and not by neurological diseases and age-related problems, this really works – such is the conclusion of the authors of an authoritative Cochrane review. Another thing is that, according to a special controlled study, this is more of a placebo effect. If you’ve ever suffered from calf cramps and experienced relief from taking magnesium supplements, you’ll find it hard to believe. But chiropractor and muscle pain expert Paul Ingram reminds us that we have no reason to expect that increasing blood levels of magnesium will benefit muscles. Because we just “don’t know how it works”.

Sleep disorders

Low magnesium levels correlate with insomnia. This is the only reinforced concrete argument in favor of taking magnesium for sleep disorders. Because the biology of how magnesium interacts with sleep is poorly understood. And studies of practical applications give conflicting results. The authors of one major review even suggest that magnesium supplements are prescribed simply because they are much cheaper than sleeping pills. But there are exceptions. In one small placebo-controlled study, the quality of sleep in subjects increased by as much as 75-85% in 4-6 weeks. At least in their own opinion.

Aleksey Moskalev, head of the laboratory of genetics of longevity and aging, also believes that magnesium in the form of citrate, malate or taurate has a calming effect before sleep. Neuroscientist and science podcast author Andrew Huberman agrees. True, he himself prefers magnesium L-threonate, which more effectively overcomes the blood-brain barrier, that is, it more actively penetrates from the blood plasma into the brain tissue. “200-400 mg about 30 minutes before bedtime has a powerful hypnotic effect,” says the scientist. But at the same time, it emphasizes that people with cardiovascular diseases should consult a doctor before such experiments.

Food additives

Magnesium supplements are available as tablets, powder, solutions, capsules, and even chewing gums. But in this case, it is not the form that matters, but the content.

Dosage . The recommended daily dose of magnesium is 300 mg for women and 400 mg for men. But there is an important nuance here: the more magnesium enters the body at a time, the worse it is absorbed in the intestines. Therefore, it is better to take it several times a day in small portions.

Composition . Which supplement to choose is also not just a matter of convenience. Due to the high chemical activity of magnesium, it makes no sense to take it in its pure form. (Unless for the sake of a laxative effect: it absorbs water, diluting the contents of the intestine.) Therefore, it is commercially available in the form of compounds with other substances, mainly organic acids. According to the principle of operation, these compounds do not differ from each other. The active ingredient in them is the same. Their task is simply to deliver magnesium to the small intestine, where it is absorbed into the blood. And everyone copes with this task. But how much magnesium gets from the intestines into the blood depends on the size and chemical properties of the molecules with which it is connected. And according to this parameter, additives differ. Here is the rating of dietary supplements according to the degree of absorption of magnesium.

MAGNESIUM GLUCONATE ⭐⭐⭐

Used in medicine for magnesium deficiency. It is sold in online stores under the names Mag-G, Magonate, Magonate Natal, Magtrate. May cause nausea and diarrhea.

MAGNESIUM OROTATE ⭐⭐⭐

Orotic acid magnesium salt. The magnesium content is just over 3%.

MAGNESIUM MALATE ⭐⭐

Magnesium salt of malic acid. The magnesium content is about 7%.

MAGNESIUM CITRATE ⭐⭐

The most popular form is magnesium with citric acid. The magnesium content is 5%.

MAGNESIUM L-THREONATE ⭐⭐

Magnesium salt of threonic acid. The patented formula is Magtein, specially designed to facilitate the penetration of magnesium from the blood into the brain tissue. The magnesium content is about 3%.

MAGNESIUM TAURATE ⭐⭐

Connection with a taurine molecule. The magnesium content is less than 4%.

MAGNESIUM OXIDE ⭐

Combination of magnesium with oxygen. The low level of bioavailability is compensated by the highest concentration of magnesium among dietary supplements – 50%. More often than other additives causes side effects – nausea, stomach cramps and diarrhea.

Iron, zinc and phosphorus, as well as oxalic acid, which is abundant in spinach and cabbage, can interfere with the absorption of magnesium into the blood from the small intestine. Magnesium also has a difficult relationship with calcium, which is also absorbed in the small intestine and competes with it for a place in the sun. But vitamin D, on the contrary, is friends with magnesium and enhances its absorption.

Transdermal magnesium

Despite the best efforts of manufacturers, the bioavailability of magnesium from dietary supplements remains quite low. Hence the idea to deliver it to the body in other ways. For example, through the skin.

Creams and sprays

And also gels, soaps, oils and lotions, mainly with magnesium chloride (it is in second place in magnesium concentration after oxide – 30%). The American naturopath Norman Shealy was the first to speak about their effectiveness. In 2005, he published a comparative table, from which it followed that by rubbing a cream with magnesium into the skin, you can fill the deficit much faster than with the help of nutritional supplements (in one and a half months, and not in six months). It is this research that is usually meant when it is repeated as a mantra that magnesium is better absorbed through the skin. The problem is that there is no study – only a brief abstract with conclusions is available. And several screening tests with animals and people did not confirm them. Apparently, the author rubbed not only magnesium. So in a large review of current research on this topic, transdermal use is not recommended.

Magnesium baths

This practice dates back to the 18th century, when a spa with an unusual mineral water was opened in the English town of Epsom – a natural solution of Epsom salts (magnesium sulfate). Now this mixture is credited with various healing properties: it helps to relax and lose weight, relieves pain, and from the most toxic – “removes toxins”. But initially it was thought that she just had a laxative effect, which is closer to the truth: taking capsules or tablets with magnesium sulfate sometimes causes diarrhea.

The only study on the effects of magnesium baths was conducted in England, with 19 students from the University of Birmingham. For 12 minutes a day they lay in a solution of magnesium sulfate (1 g / 100 ml) at temperatures up to 55 degrees. At the end of the study, the concentration of magnesium in the blood increased in most of the subjects, albeit slightly. It had no effect on their health. But questions remain.

Magnesium molecules are small enough to penetrate the skin barrier. Magnesium ions labeled with fluorescent markers actually penetrate into the upper layer of the skin, using the openings of the hair follicles as a loophole. But for the cellular absorption of magnesium, special transport channels are needed, but there are none in the skin. How could magnesium get into the blood of students? There are several assumptions. The first is boring, but the most plausible: through the lungs with steam. The second is much more fun: due to the absorption of magnesium ions by the mucous membrane of the anus. In the same way, the body could absorb alcohol from a hot bath. But, as Paul Ingram rightly notes, if you really want to take magnesium (or alcohol), then it is more pleasant and easier to do it through your mouth.

Dietary supplements or food?

On this issue, all the experts we interviewed were unanimous. Why take a magnesium supplement at all if you are not deficient when there are so many tasty foods rich in this micronutrient around? Here are some examples.

• Dark Chocolate: One slice provides approximately 64 mg of magnesium (16% of the daily requirement).
• Avocado: One medium-sized fruit contains 58 mg of magnesium (15% of the daily requirement).
• Cashews: A 28g handful of nuts provides 82mg of magnesium (20% of the daily requirement).
• Brazil nuts: 100 g (approximately 12-15 pieces) cover the daily requirement for magnesium by 100%.
• Beans: A cup of boiled black beans provides 120 mg of magnesium (30% of the daily requirement).
• Banana: 37 mg magnesium (9% DV) per piece.
• Salmon: 178g half fillet contains 53mg magnesium (13% DV).

The benefits of normal food are not limited to the fact that it is tastier and more nutritious. There are two more important points.

Compatible. Dietary supplements with magnesium should not be taken together with antibiotics (tetracyclines and quinolones), because magnesium forms sparingly soluble compounds with them. Real food has no such restrictions.

Side effects. When taking supplements, an overdose is possible, which is accompanied by such unpleasant symptoms as nausea, abdominal cramps and diarrhea. And it, in turn, can cause dehydration and loss of magnesium. When consuming nuts, pumpkin seeds and salmon, you do not face an overdose. Also because in this case the “smart” algorithm works. The body itself regulates the level of assimilation: it increases from the average 30-40% to the maximum 80% if there is little magnesium in the products, and reduces to 25% if there is too much.

The use of magnesium citrate allows the prevention of preterm birth in pregnant women at high risk of miscarriage | Tetruashvili N.K., Gromova O.A., Serov V.N.

Introduction
Recurrent miscarriage is a complex polyetiological problem. The process of interaction of the blastocyst with the maternal endometrium plays a central role in this pathology. Factors that disrupt the normal course of implantation and placentation include hormonal, autoimmune, alloimmune, and anatomical factors [1].

Recurrent miscarriage is a complex polyetiological problem. The process of interaction of the blastocyst with the maternal endometrium plays a central role in this pathology. Factors that disrupt the normal course of implantation and placentation include hormonal, autoimmune, alloimmune, and anatomical factors [1].
Pathogenetic mechanisms of early pregnancy termination are often implemented through endothelial dysfunction, microthrombosis, spasm of the spiral arteries, which leads to growth restriction and invasion of the trophoblast, impaired gas exchange, and a decrease in the hormone-producing function of the placenta. The emergence of endothelial dysfunction and microthrombosis largely contribute to infectious and inflammatory gynecological diseases [1,2].
Numerous early predictors of miscarriage are known from clinical practice: infectious diseases of the genitourinary tract, hemocoagulation factors (elevated levels of homocysteine, a tendency to thrombophilia), including acquired and genetic ones (antiphospholipid syndrome, mutations of factor V Leiden, prothrombin, PAI-1, GP IIIA, FGB, FXI, MTHFR / MTRR, thrombogenic DNA polymorphisms of genes, etc. ), spasmophilia (increased tone of the uterus, also accompanied by cramps in the calf muscles, spasms of the esophagus (the so-called “lump in the throat”), intestinal spasms, etc.) [2,3]. An increase in the tone of the uterus disrupts the uteroplacental blood flow and creates additional obstacles to the full development of the fetal egg. Increased uterine tone is often accompanied by significant discomfort in the pelvis and lower abdomen, up to pain [1,2].
It should be noted that spasm, hypertonicity of the myometrium and hypercoagulability are largely the result of an imbalance in the sympathetic and parasympathetic autonomic nervous system. Like hormones, potassium, magnesium, calcium and sodium ions are classified as systemic substances: for example, Na + and Ca2 + ions cause vasoconstriction, and K + and Mg2 + ions have an expanding effect. Ignoring the correction of autonomic disorders and deformed mineral balance in the complex therapy of habitual miscarriage reduces the effectiveness of treatment, and in some cases makes it completely unsuccessful [4].
The balance of potassium, sodium, magnesium, calcium is often considered in a simplified way, only in terms of the regulation of water-salt metabolism. We should not forget about the critical role of electrolytes in maintaining the balance of the autonomic nervous system. In particular, magnesium deficiency, like potassium deficiency, corresponds to hypersympathiconia, which is manifested by the aforementioned increase in uterine tone, convulsions, spasms of the esophagus and intestines [5]. Magnesium deficiency also contributes to a significant increase in the risk of thrombophilia [6] and a decrease in the activity of magnesium-dependent placental proteins [7]. Therefore, effective and safe compensation of magnesium deficiency in early pregnancy is a promising direction in the prevention of miscarriage.
The use of preparations of organic magnesium salts for oral administration (magnesium citrate), which have high bioavailability and practically no side effects, is a promising direction for effective and safe compensation of magnesium deficiency during pregnancy. A meta-analysis (7 studies, 2689 patients) presented in the Cochrane Evidence-Based Research Database (Cochrane Database) showed the effectiveness of oral administration of organic magnesium salts in the prevention of pregnancy complications [8]. It was found that the intake of organic magnesium salts up to 25 weeks. pregnancy significantly (compared with placebo) reduces the risk of preterm birth by 27% (OR 0.73; 95% CI 0.57–0.94), threatened miscarriage by 62% (RR 0.38; 95% CI 0.16–0.90)
and the risk of having children with low birth weight – by 33%
(OR 0.67; 95% CI 0.46–0.96) [8].
Therefore, in recent obstetric practice, oral use of preparations of organic magnesium salts in order to prevent placental insufficiency and early termination of pregnancy has received special attention. This article offers readers a brief overview of the fundamental molecular mechanisms of the impact of magnesium deficiency on the pathophysiology of miscarriage (thrombophilia, spasmophilia, fetoplacental insufficiency). To illustrate the clinical effects of the inclusion of preparations of organic magnesium salts in a set of measures for the prevention of miscarriage, two typical cases from practice are given.
Magnesium deficiency and thrombophilia
According to world data, up to 55–62% of cases of recurrent miscarriage are associated with defects in coagulation proteins or platelets [3]. One of the negative consequences of magnesium deficiency, leading to pregnancy complications (miscarriage, preeclampsia, etc.), is an increased tendency of blood to thrombosis [9,10]. And vice versa – magnesium preparations reduce the formation of blood clots [11,12], improving the overall and uteroplacental blood flow.
The main process of thrombus formation is a complex physiological process through which blood passes from a fluid state to a thrombotic state and vice versa. Although coagulation is the main process of hemostasis, the state of the coagulation system is far from the only factor influencing the formation of a thrombus. For example, in the second half of pregnancy, many women experience proatherogenic processes that narrow the lumen of the vessel and initiate platelet aggregation. Systematic analysis of the biological roles of magnesium [9] showed that it contributes to a decrease in thromboxane synthesis, weakening of hypercoagulability and vasoconstriction, and a decrease in inflammation of the vascular endothelium (Fig. 1).
In particular, fundamental research conducted for more than 30 years has repeatedly confirmed that magnesium is an effective antiplatelet agent [12], contributes to a significant decrease in thromboxane A2 levels [13], and inhibits its biological effects [14]. With magnesium deficiency in the blood, the levels of thromboxane A2 in blood plasma and urine increase [15].
Magnesium deficiency
and placental insufficiency
More than 700 Mg-dependent proteins have been found in the human body, of which at least 100 have been found in the placenta. Due to the fact that the placenta, first, contains many Mg-dependent proteins and, secondly, is one of the centers of energy metabolism (which also depends on magnesium), magnesium is fundamental for the functioning of the placenta and, therefore, for the development of the fetus. In a systematic analysis, the molecular functions of almost all known Mg-dependent placental proteins were considered and a generalized picture of the effect of magnesium and Mg deficiency on the functioning of the placenta was formulated [7] .
The mother-placenta-fetus system is formed and functions from the earliest stages of pregnancy until the birth of a child. Among the tissues of the human body, the placenta is characterized by one of the highest levels of magnesium. Placental Mg-dependent proteins control: 1) energy metabolism and metabolism in the placenta, 2) the state of the muscular, immune, connective tissue systems, 3) proliferation (division) and apoptosis of cells (Fig. 2).
energy metabolism. The less intense the transfer of energy and nutrients to the growing fetus through the placenta, the more likely will be malnutrition and immaturity of the fetus. Magnesium deficiency negatively affects the functioning of Mg-dependent carbohydrate metabolism proteins (in particular, glycolysis proteins) and fatty acids. For example, the glycolytic enzymes enolase (ENO1, ENO2), phosphoglucomutase (PGM1, PGM2, PGM3), and 6-phosphofructokinase (PFKP) have been found in significant amounts in placental tissues. All three of these key glycolytic enzymes require magnesium as a cofactor (Figure 3).
Magnesium and proteins of the immune system. Magnesium levels influence the specific and non-specific immune response [16]. At least 20 Mg-dependent placental proteins are directly involved in the functioning of signaling pathways in the immune system – in particular, through signaling from the cytokine TNF (“tumor necrosis factor”) and the regulation of adenosine levels. Magnesium deficiency will interfere with signal transmission, thereby weakening the intensity of the immune response.
Placental proteins and apoptosis. Normal tissue growth in the placenta and fetus is the result of a delicate balancing act between cell proliferation (division) and cell apoptosis (programmed cell death). Violation of this balance will lead to pathology of the placenta, low birth weight and developmental defects of the embryo. As a key cofactor for more than 25 Mg-dependent apoptosis/cellular survival proteins (such as activin receptors, serine-threonine kinases, mitogen-activated protein kinases, etc.), magnesium helps maintain a balance between these two fundamental cellular processes.
Thus, magnesium is absolutely essential for maintaining the biological functions of the placenta. Magnesium deficiency leads to a decrease in its total amount in the placenta in complexes with both ATP and proteins. A decrease in the activity of Mg-dependent placental proteins causes defective functioning of the placenta. Replenishment of magnesium deficiency through preparations based on highly assimilable forms of organic magnesium will help maintain fetoplacental function.
Magnesium deficiency and spasmophilia
Magnesium supports the rapid recovery of the resting potential of the membranes of muscle cells (cells of the myometrium, smooth muscles of blood vessels and the heart, skeletal muscles, etc.). With magnesium deficiency, the duration of the resting phase is reduced, which leads to an increase in muscle tone, defective (shortened) diastole, and skeletal muscle cramps [17,18].
However, shortening the resting phase is far from the only way magnesium deficiency affects the functioning of muscle cells. It should be remembered that the tone of the myometrium and other muscle cells is regulated by the action of a number of neurotransmitters on their receptors. The biological effects of neurotransmitters are realized through a number of Mg-dependent proteins. First of all, it should be noted the most important role of magnesium in the regulation of the biological effects of catecholamines (adrenaline and noradrenaline), known stress hormones.
Under stress, the levels of catecholamines in the blood of pregnant women increase. The signal from catecholamines enters the b-2adrenergic receptors of muscle cells (myometrium, cardiomyocytes, etc.) and is transmitted into the cell through the signaling molecule of cyclic adenosine monophosphate (cAMP). The amplitude of this signal is limited by the activity of Mg-dependent adenylate cyclases (genes ADCY1, ADCY2, etc. , only 10 genes) and the rate of decay of excess cAMP by Mg-dependent cAMP-phosphodiesterases. Therefore, magnesium deficiency will contribute to a more enhanced muscle response to catecholamine stimulation, which will lead to hyperconstriction of smooth muscles, including the uterus and blood vessels of the placenta [19].
In addition, the Mg-dependent enzyme catechol-O-methyltransferase (COMT) (Fig. 4) is responsible for the inactivation of excess catecholamines in the blood. Obviously, COMT activity decreases with magnesium deficiency, which contributes to the maintenance of excess smooth muscle tone even at low stress levels. Increased vascular tone of the placenta leads to a decrease in the intensity of the blood circulation of the fetus and, consequently, to limit the intensity of development of its tissues and malnutrition. It is well known that stress is an important etiological factor in miscarriage [1–4].
Case studies
To illustrate the actual participation of organic magnesium salts in achieving the best results in the prevention and treatment of miscarriage, we present two typical cases from clinical practice. In both cases, the patients had a pronounced magnesium deficiency (ICD-10 code E61.2).
Clinical case No. 1
Patient I.V.V., 36 years old.
Complaints of scanty bloody discharge from the genital tract, nagging pain in the lower abdomen and lower back, constipation, general weakness, irritability, insomnia.
Pregnancy occurred spontaneously, menstruation was delayed by 2 weeks, pregnancy test was positive.
Anamnesis data: allergic anamnesis is not burdened; past illnesses: rubella, chicken pox, appendicitis and appendectomy in 1995
Gynecological diseases: in 1996, chlamydial and papillomavirus infection, cervicitis, cervical ectopia were detected. The patient and her husband were treated with macrolide preparations and metronidazole, smears were taken for oncocytology – stage I-II dysplasia, a second course of antibiotic therapy was carried out, control smears for oncocytology – no pathology was detected.
Menstrual function: menarche at 12 years old, regular menstrual cycle, menstruation every 28–30 days, 5–6 days each, moderate, painless.
Reproductive history:
• 1st pregnancy (2005) proceeded with the threat of interruption since the first trimester, was treated with antispasmodics in a hospital setting. The pregnancy ended in preterm labor at 35 weeks. – premature detachment of a normally located placenta, caesarean section, a child weighing 2030 g, 42 cm tall, girl, alive. Blood loss – 1800 ml, blood transfusion.
• 2nd pregnancy (2007) ended in spontaneous miscarriage for a period of 5-6 weeks. Conducted curettage of the walls of the uterine cavity.
• 3rd pregnancy (2009) ended in spontaneous miscarriage at 19 weeks, the miscarriage began with bleeding, curettage was performed, the size of the fetus corresponded to a period of 16 weeks.
• 4th pregnancy (2010) ended in early spontaneous miscarriage at a period of 7-8 weeks, a non-developing pregnancy was diagnosed (according to ultrasound, the size of the embryo corresponded to 5-6 weeks).
• 5th pregnancy, real, occurred spontaneously, without prior preparation, the patient applied for a period of 5 weeks. with signs of threatened miscarriage.
Objectively: on examination – a woman of the correct physique (height – 165 cm, weight – 60 kg). Hair on the female type.
Previous results of the examination: hormones are within normal limits, rectal temperature is biphasic, infection outside of pregnancy was not detected.
Inspection of the cervix in the mirrors and vaginal examination: the cervix is ​​tilted backwards, ectopia and cervicitis are determined, moderate bleeding from the cervical canal. On palpation, the cervix is ​​dense, formed, 3 cm long, the external os is closed. The body of the uterus is enlarged up to 6 weeks. pregnancy, in high tone. Discharge from the genital tract moderate, bloody. After a detailed examination according to the accepted algorithms, the patients with recurrent miscarriage were diagnosed with a pregnancy of 6 weeks. Threatened miscarriage. antiphospholipid syndrome. Habitual miscarriage.
Anticoagulant (enoxaparin), hormonal (dydrogesterone), antispasmodic (drotaverine) therapy, magnesium citrate with pyridoxine (Magne B6 forte) was prescribed. Against the background of the treatment for 5 days, a pronounced positive effect was achieved, the pains in the lower abdomen and lower back were stopped, the tone of the uterus returned to normal, the stool became regular, the patient’s psycho-emotional state improved, sleep normalized.
Therapy with Magne B6 forte was continued throughout pregnancy, which made it possible to avoid the appointment of tocolytic therapy.
The appointment of magnesium citrate with pyridoxine (Magne B6 forte, 1 tablet 2 times a day) made it possible to eliminate the adverse symptoms of magnesium deficiency – spastic constipation, insomnia, and normalize uterine tone. The daily dose of elemental magnesium as part of therapy was 200 mg (100 mg per 1 tablet), and pyridoxine – 20 mg (10 mg per 1 tablet). In a double-blind, placebo-controlled study in pregnant women, it was shown that the dose of pyridoxine is 30 mg / day. is a safe and effective therapy for nausea and vomiting, including in women at risk of miscarriage [20]. In this patient, under the influence of ongoing therapy, there were no signs of placental insufficiency, which, in particular, is explained by the complex effect of therapeutic measures with the inclusion of magnesium citrate and pyridoxine. A full-term girl was born weighing 3520 g, height 52 cm, Apgar score – 8–9points. Blood loss – 600 ml.
The course of pregnancy and drug therapy of the patient I.V.V. are shown in Figure 5.

Case No. 2
Patient V.E.G., 29 years old.
Came in at 20 weeks gestation. She complained of pain in the lower abdomen and lower back, increased tone of the uterus, cramps in the muscles of the legs, anxiety, sleep disturbances.
Anamnesis data: heredity is not burdened.
Past diseases: rubella, chickenpox, mumps, tonsillectomy in childhood, chronic cholecystitis.
Menstrual function: menarche at the age of 13, menstrual cycle regular, menstruation after 26–28 days, 5–6 days each, moderate, painless.
Gynecological diseases: chronic salpingo-oophoritis (antibacterial therapy was carried out together with the patient and her husband in 2008).
Reproductive history: first marriage. 1st pregnancy is real.
Objectively: on examination, she is a woman of the correct physique, reduced nutrition (height – 170 cm, weight – 58 kg).
Examination of the cervix in the mirrors and vaginal examination: the cervix is ​​tilted backwards, clean, 2 cm long, moderate transparent mucous discharge from the cervical canal. On palpation, the cervix is ​​2 cm long, of a dense consistency, the external os is closed. The uterus is not enlarged, limited mobility, painless. Discharges are light, mucous.
According to the functional study of the state of the fetus, no violations were noted, the length of the cervix according to cervicometry with a vaginal sensor was 3.5 cm.
The patient has clinical signs of magnesium deficiency: cramps in the muscles of the legs, anxiety, sleep disturbances. In addition, complaints of pain in the lower abdomen and in the lower back indicate a periodically occurring increased tone of the uterus.
As the first line of therapy in this case, preparations of organic magnesium salts are prescribed orally – Magne B6 in a daily dose of 6 tablets or Magne B6 forte in a daily dose of 3 tablets. At the same time, in women of childbearing age, Magne B6 forte is preferable to magnesium preparations in the form of lactate dihydrate or orotate dihydrate. If in the diet of pregnant women there is an excess of animal proteins (red meat) and / or simple carbohydrates (sweets, confectionery), then there is often a deficiency of citrate anions, which leads to acidotic changes in the body, therefore, in such patients, it is important to supplement not only magnesium, but also citrates. For the same reason (citrate deficiency and the formation of an acidotic shift), Magne B6 forte is indicated for women who have had acute respiratory and other infectious diseases during the convalescence period. Against the background of treatment with Magne B6 forte, a faster regression of the clinical symptoms of magnesium and pyridoxine deficiency (normalization of uterine tone, night sleep, disappearance of cramps in the calf muscles and muscle twitches) was noted than with the use of magnesium in the form of lactate dihydrate or orotate dihydrate. The patient on the background of the use of Magne B6 forte noted a rapid improvement in well-being.
Such a fairly rapid normalization of the patient’s condition is probably due to the replenishment of magnesium deficiency, which occurs both as a result of an increased need for magnesium during pregnancy (especially in the second trimester), and due to its insufficient intake with food.
Therapy with Magne B6 forte tablets during pregnancy contributed to its prolongation in this patient and the birth of a full-term viable baby at term 39weeks pregnancy weighing 3456 g, height 50 cm, Apgar score – 8-9 points.
Conclusion
The normal content of magnesium and balanced metal ligand homeostasis is a prerequisite for the harmonious functioning of the female genital area, including the regularity of the menstrual cycle, the ability to ovulate, conceive, normal pregnancy and lactation. The daily requirement for magnesium for healthy women is 300 mg, during pregnancy this figure increases by an additional 150 mg [21,22].
Magnesium deficiency during pregnancy can occur for several reasons. One of the factors is its insufficient intake with food due to an unbalanced diet (refined food, carbonated drinks, easily digestible carbohydrates, soft water). In addition, magnesium absorption disorders are possible in diseases of the gastrointestinal tract. Increased excretion of magnesium ions from the body, which also leads to magnesium deficiency, occurs with the systematic use of laxatives, diuretics, and in renal pathology. The risk group is also made up of women with extragenital pathology – diabetes, hyperthyroidism, hypoparathyroidism, heart disease, hypertension. For women with similar diseases, it is advisable to prescribe magnesium supplements prophylactically to prevent magnesium deficiency.
The available data from fundamental and clinical studies suggest that the treatment regimens for pregnant women must necessarily include preparations containing organic magnesium salts that are approved for use in this contingent. With an unbalanced diet in terms of proteins and simple carbohydrates, which is common for most women of childbearing age, it is preferable to use magnesium citrate, because. this form allows you to eliminate the deficiency of citrate anions (drug Magne B6 forte). Therapy with modern oral preparations of organic magnesium salts is of particular importance during pregnancy and in the prenatal period due to the high bioavailability of magnesium in these preparations, their high proven efficacy, considerable experience in their use and high safety.
RU.MGP.12.04.17.

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