Let’s continue our conversation with Andrea Rosanoff, Ph.D., about the great importance of the mineral magnesium. In Part One (February 2015), we discussed the importance of magnesium for producing the energy needed for most of the body’s life processes. In Part Two (March 2015), we chatted about how magnesium is needed for the utilization of vitamin D, itself an extremely important vitamin/hormone. In Part Three (April 2015), we reviewed the possible benefits of magnesium on longevity. Now, let’s look at the many ways in which magnesium affects heart and artery health.

Dr. Rosanoff is a nutritional biologist and the director of research at The Center for Magnesium Education & Research, LLC in Pahoa, HI. Dr. Rosanoff spent her undergraduate years at the University of California at Berkeley studying biological sciences and then taught science for several years before returning to graduate school. After earning her M.S. and Ph.D. degrees in nutrition from UC Berkeley in 1982, Dr. Rosanoff began her study of nutritional magnesium, especially as it relates to health in the developed world. Her work as the senior chemical specialist for Dialog Information Services and information analyst at Chevron Res & Tech. Corp. gave her early training of and access to the online scientific literature, which she now uses in her research and teaching on all aspects of nutritional magnesium.

Her main research interests include the development of the nutritional magnesium paradigm of cardiovascular disease, the role of magnesium nutrition in osteoporosis, diabetes, psychobiological and renal disease, global spreading and generational effect on nutritional magnesium of the processed food diet and the role of magnesium in stress reactions. Some of her recent publications include studies on changing food crop magnesium concentrations and their possible impact on human health, magnesium supplementation and hypertension, a comparison of magnesium supplements with statin pharmaceuticals, and the rising calcium to magnesium ratio of dietary intakes in the United States.

Andrea Rosanoff, Ph.D.

In addition to her work presented in peer-reviewed journals and at scientific conferences, Dr. Rosanoff is interested in explaining health aspects of nutritional magnesium to the general public. She co-authored with the late Mildred S. Seelig, M.D., a book entitled, The Magnesium Factor (published in 2003), which discusses scientific literature through 2002 on nutritional magnesium’s impact on risk factors for cardiovascular disease. She wrote, produced and narrated an animated two-minute video entitled, Balancing Calcium and Magnesium in 2008, which can be viewed at her Web site (www.MagnesiumEducation.com). Through the Center for Magnesium Education & Research, Dr. Rosanoff continues to foster knowledge of magnesium research; with IAPN the Center sponsors International Symposia bringing together magnesium researchers from all over the world to discuss and present research on magnesium in agriculture and its connection to human nutrition. The Center is also spearheading a group to apply to the U.S. Food and Drug Administration for a health claim for magnesium in hypertension plus a second effort to reevaluate the serum magnesium reference range.

Passwater: Dr. Rosanoff, when we discussed magnesium and longevity last month, we touched on the fact that several studies indicate magnesium reduced the risk of dying from cardiovascular disease. As we have mentioned in your bio and as I know from your 2003 book with Mildred Seelig, M.D., this is a topic you have examined in great detail. In 1977, when my book, Super-Nutrition For Healthy Hearts was published, I devoted a chapter to this subject. There was considerable evidence of an inverse association between magnesium and heart disease at that time, mostly through the effect of hard water, which is rich in magnesium.

Rosanoff: Yes, the factor in water’s “hardness” has been shown to be magnesium and perhaps the ideal calcium-to-magnesium ratio (Ca:Mg ratio). The list of such studies is vast. As I mentioned last month, I cited 27 peer-reviewed articles, published between 1969 and 2012, in a paper showing how high-magnesium drinking water lowers sudden cardiac death and heart disease in communities (1).

In 1980, Dr. Seelig published a comprehensive book on this subject with a 78-page bibliography of peer-reviewed literature (2). One of the best general articles about magnesium and human health was the first article published in the first volume of the journal Magnesium in 1982 by Dr. J.R. Marier (3).

Passwater: Let’s remind our readers just how dramatic the relationship is between magnesium and reduced death rate from heart disease.

Rosanoff: Interesting recent studies have been conducted in Spain on people who were at risk for cardiovascular disease (4, 5). These subjects’ baseline magnesium intake—after being followed for about five years on a Mediterranean diet especially high in either nuts (a high magnesium food) or extra-virgin olive oil (may be high in magnesium)—were predictive of future health, as those with the highest magnesium intakes were definitely healthier, showing a 40% lower risk of death from cardiovascular disease.

One meta-analysis (i.e., a collection of several studies, in this case, 16 studies), showed that when dietary magnesium goes up, the risk of death by cardiovascular disease and cardiovascular disease itself goes down (6). For blood magnesium, combining these studies showed that higher circulating magnesium levels significantly lower the rates of sudden cardiac death.

The Adamopoulos study found that patients with low serum magnesium (i.e., equal to or less than 2 mEq/L) were at a 38% higher risk of death from cardiovascular disease and a 14% higher risk of hospitalization for cardiovascular disease (7).

Passwater: Now, there are several mechanisms known to involve magnesium and heart health. You cover several of them in your book. The overall improvement in heart health may be due to the summation of all the individual effects of magnesium. In 1977, I attributed most of magnesium’s benefit to its role in energy production, normalization of heartbeat and blood pressure. What are the main interrelationships with magnesium and cardiovascular health that you note today?

Rosanoff: Heart disease is predicted and diagnosed using several risk factors: people with one or more risk factors have a higher chance of having a heart attack than do people with fewer or no risk factors. However, it’s not an all-or-nothing thing; even people with zero risk factors have heart attacks, and those with several risk factors may never have a heart attack. Modern medicine tries to treat these risk factors, keeping them in their “normal” range, thinking that this will prevent the disease state from progressing further. It is a totally different view to consider heart disease as a nutritional magnesium-deficit disease, and although there is a lot of old and new research promoting this concept, it is just now barely making its way into the current thinking on heart disease.

Dr. Seelig and I noted that all the risk factors of heart disease have a link with low magnesium status. We thought that writing our book, The Magnesium Factor, which describes the research associating low magnesium with each of the major heart disease risk factors, one by one, would make a convincing case that heart disease just may be a magnesium-deficiency disease.

Passwater: Okay, let’s look at them one at a time. What is one of the most important relationships?

Rosanoff: Hypertension, or high blood pressure, is the most widespread risk factor for heart disease and was probably the first heart disease risk factor ever discovered. Early in the 20th century, life insurance companies found that people with high blood pressure were a bad risk for life insurance. Those with “normal” blood pressure were a good risk. They collected much data on human blood pressure, and this information became the first real “risk factor” for heart disease.

It is commonly treated with diuretics among other blood pressure medications. The diuretics make one lose water, thus taking pressure off the cardiovascular system of heart, veins and arteries. Unfortunately, these medicines also cause the loss of potassium and magnesium in the urine, and both these essential nutrients are vital for normal blood pressure—potassium to balance sodium in the body tissues and magnesium to balance calcium. Other blood pressure medications such as ACE inhibitors, calcium channel blockers, beta-blockers and others turn out to be medicines that cause the “sparing” of magnesium (i.e., they affect the cell physiology so it needs less magnesium to do its job).

In 1980, an article appearing in the journal, Science, showed that coronary arteries exposed to low concentrations of magnesium became very tense, and when more magnesium was put in their environment, their tension relaxed (8). After 1980, there were many studies of oral magnesium therapy for blood pressure, with seemingly disagreeing results. With such a “mixed” message about research with magnesium therapy for hypertension, it was not seen as a viable medical recommendation, especially as the new blood pressure medications were just coming in and they were all quite good at lowering blood pressure. Unfortunately for many, they have side effects that can be unpleasant and even unhealthy.

However, when one really looks closely at all the oral magnesium for hypertension studies, one finds that there really is a unifying theme: tests on people with high blood pressure only show a drop in the group’s mean blood pressure when the oral magnesium dose is greater than 480 mg per day. Some tests did not use this high a dose of magnesium, so they showed negative results. But, there is more: if people in the study are taking blood pressure medications, and have high blood pressure still, they only need a magnesium dose of 240 mg/day to show a drop in the group’s mean blood pressure. Studies where individuals start out with largely normal blood pressure show no change when given magnesium supplements. That’s because magnesium seems to “normalize” blood pressure rather than reduce it as do the medications. Magnesium will not lower a normal blood pressure, but if given in the right dose, it will lower a high blood pressure.

Passwater: What’s next on your list?

Rosanoff: Blood levels low in the carrier for cholesterol called high density lipoprotein. High blood cholesterol levels have been touted as a risk factor for heart disease for some time. As many of our readers know, it turns out that there is more than one kind of cholesterol: low density lipoprotein (LDL)-cholesterol, which when high is predictive of heart disease, and HDL-cholesterol, which when too low is also quite predictive of heart disease. Some doctors even think that a low HDL-cholesterol is even more dangerous than a high LDL-cholesterol.

Medications for treating high cholesterol are mainly statins, which lower LDL-cholesterol and have other beneficial effects. Magnesium

is an important co-factor for the major biochemical reaction that sets off the production of cholesterol. When magnesium is low in the cell, this enzyme is not so well controlled, and too much cholesterol can be produced (9). This is the same enzyme that the statins work on. When magnesium is too low, cells cannot make enough HDL-cholesterol, and this “good” cholesterol becomes too low. Is it the low HDL-cholesterol that makes one have a heart attack or is it the low magnesium?

Such is the case for all the heart disease risk factors; Is it the risk factor that is “causing” the heart disease or is it the low magnesium status that creates both the risk factor as well as sets up the body for heart disease? (Please see Figure 1).

Passwater: How about C-reactive protein as a risk factor for heart disease?

Rosanoff: The same can be said for C-reactive protein, which when high is a risk factor for heart disease. Well, guess what? When magnesium status is low, C- reactive protein goes up (10).

Passwater: What about smoking? Isn’t that a major risk factor for heart disease?

Rosanoff: Yes, it is. And each time one smokes a cigarette, the basal metabolism rises for a while. A raised metabolism requires more of all the essential nutrients, among them magnesium. Thus, a person who smokes has a higher magnesium requirement than a similar person who does not smoke. Not only are they stressing their lungs, but they likely do not take enough magnesium to meet all their requirements. Believe it or not, being cold is a risk factor for heart disease. Being cold, just like smoking, raises the basal metabolism rate, requiring more magnesium.

Passwater: How about hereditary heart disease? How can that possibly relate to magnesium?

Rosanoff: Dr. Seelig believed and I believe that there are families with higher magnesium requirements than other families. Those families where magnesium requirement is especially high will show much more heart disease than families where the magnesium requirement is low. This is the thinking behind the magnesium paradigm of heart disease.

Passwater: Isn’t stress an important risk factor for heart disease?

Rosanoff: It is surprising for some to learn that emotional and mental stress can be risk factors for heart disease. One study shows a strong link between many stresses and heart disease risk. If the odds ratio (OR) is greater than 1.0, then having heart disease is considered to be “associated” with the stress, including reporting:

• Work stress (OR 1.38 –2.14)

• Home stress (OR 2.12)

• Financial stress (OR 1.33)

• Having a very stressful event in the past year (OR 1.48)

• Depression (OR 1.55)

The results crossed continent, age, gender and race in 52 countries (11).

Passwater: Magnesium is well-known to help the body deal with stress, in more ways than heart disease, but let’s talk about that in the next interview.

For now, let me remind our readers that a 2011 study published in the American Journal of Clinical Nutrition showed that magnesium greatly lowers the risk of sudden cardiac death (12). We mentioned this last month, but let’s look at the main findings again.

Rosanoff: That study and a 2013 study (13) show that low dietary and plasma magnesium are each associated with heart health risk and sudden cardiac death risk. The 2011 study by Stephanie E. Chiuve, Sc.D., and colleagues dramatically showed that higher plasma magnesium (2.1 mg/dL versus 1.9 mg/dL) lowers the risk of sudden cardiac death by 77%, and that for each 0.25 mg/dL increase in plasma magnesium, the risk of sudden cardiac death dropped by 41%.

Passwater: Several physicians and researchers, including Drs. Stephen Sinatra and Fred Kummerow, have stressed in this column over the years that magnesium is a prime pillar in the prevention and treatment of heart disease. How would you sum it up?

Rosanoff: Today, magnesium use is becoming more and more common during heart treatment, along with medications. There are some calls to treat many people with these medications as a preventive of heart disease, but I believe that the science still strongly suggests that adequate magnesium nutrition and appropriate balance of calcium and magnesium intakes to 1.7–2.8 to 1 (Ca:Mg) is probably the best way to prevent cardiovascular disease.

In several placebo-controlled clinical studies, only oral magnesium has been given, with positive results for such conditions as high blood pressure, irregular heartbeat and atrial fibrillation. In addition, such studies with oral magnesium have shown improvements in HDL cholesterol, LDL cholesterol and blood triglycerides.

Passwater: Thanks for this discussion, Dr. Rosanoff. With all of these extremely important health benefits of magnesium, it’s hard to understand why magnesium is not better appreciated. Let’s catch our breath and come back next month to discuss another important role of magnesium: brain and nerve health. WF

Dr. Richard Passwater is the author of more than 45 books and 500 articles on nutrition. Dr. Passwater has been WholeFoods Magazine’s science editor and author of this column since 1984. More information is available on his Web site, www.drpasswater.com.

This editorial series is sponsored by Natural Vitality.

References:
1. R.A. Rosanoff, “The High Heart Health Value of Drinking-Water Magnesium,” Med. Hypotheses 81 (6), 1063–1065 (2013).
2. J.R.Marier, “Role of Environmental Magnesium in Cardiovascular Diseases. Magnesium,” 1, 266-276 (1982).
3. M. Seelig, “Magnesium Deficiency in the Pathogenesis of Disease,” NATO Advanced Study Institutes Series: Series B, Physics, Aug. 31, 1980.
4. M. Guasch-Ferre, et al., “Dietary Magnesium Intake Is Inversely Associated With Mortality in Adults a High Cardiovascular Disease Risk,” J. Nutr. 144 (1), 55-60 (2014).
5. M. Guasch-Ferre, et al., “Frequency of Nut Consumption and Mortality Risk in the PREDIMED Nutrition Intervention Trial,” BMC Med. 11, 164 (2013).
6. L.C. Del Gobbo, et al., “Circulating and Dietary Magnesium and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Prospective Studies,” Am. J. Clin. Nutr. 98 (1), 160–173 (2013).
7. C. Adamopoulos, et al., “Low Serum Magnesium and Cardiovascular Mortality in Chronic Heart Failure: A Propensity-Matched Study,” Int. J. Cardiol. 136 (3), 270–277 (2009).
8. P.D. Turlapaty and B.M. Altura, “Magnesium Deficiency Produces Spasms of Coronary Arteries: Relationship to Etiology of Sudden Death Ischemic Heart Disease,” Science 208, 198–200 (1980).
9. A. Rosanoff and M.S. Seelig, “Comparison of Mechanism and Functional Effects of Magnesium and Statin Pharmaceuticals,” J. Am. Coll. Nutr. 23, 501S–505S (2004).
10. F. Guerrero-Romero and M. Rodriguez-Moran, “Relationship Between Serum Magnesium Levels and C-Reactive Protein Concentration, In Non-Diabetic, Non-Hypertensive Obese Subjects,” Int. J. Obes. Relat. Metab. Disord. 26, 469–474 (2002).
11. A. Rosengren, et al., “Association of Psychosocial Risk Factors With Risk of Acute Myocardial Infarction In 11119 Cases and 13648 Controls From 52 Countries (the INTERHEART Study): Case-Control Study,” Lancet 364, 953–962 (2004).
12. S.E. Chiuve, et al., “Plasma and Dietary Magnesium and Risk of Sudden Cardiac Death in Women,” Am. J. Clin. Nutr. 93 (2), 253–260 (2011).
13. L.C. Del Gobbo, et al., “Circulating and Dietary Magnesium and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis Of Prospective Studies,” Am. J. Clin. Nutr. 98 (1), 160–173 (2013).

Published in WholeFoods Magazine, June 2015