Friday, 22 April 2016

Promoting autophagy with the aid of periodic, habitual therapeutic fasting for brain cancer management

I am inclined to conclude that the studies presented here in relation to fasting and autophagy provide sufficient evidence to support a key aspect of my metabolic strategy to manage brain cancer.... and no, its not just because I am biased. ;-)

I have been experimenting with personalised fasting protocols lately, allowing for what I feel could be a theoretically viable symbiotic relationship of periodic, habitual therapeutic fasting + complimentary dose specific supplementation of fish oils + salt preparations + magnesium chloride supplementation as a specific, targeted, individualistic approach. I base this approach on my exhaustive research undertaken over the years following my diagnosis, scrutinising decades of evidence based, peer reviewed research to falsify or validate my hypotheses. I will attempt to explain why and how I believe implementation of such an approach could yield positive results for my n=1 experiment:

Numerous individuals have queried my dietary protocol, however it could reasonably be postulated, based on the evidence and underlying physiological mechanisms of this type of dietary manipulation, that the most significant benefits would likely come from calorie restriction and fasting. The metabolic state prior to commencement of a fast and personal dietary choices upon completion of such endeavours are undoubtedly of vital importance of course so as to not raise IGF-1 and upregulate mTOR during the re-feeding phase. 
The gut microbiota before, during, and after fasting is another subject of great interest to me but I won't go into that because it is fairly complicated territory to cross over and I don't have time to talk about the trillions of bacteria involved despite it being critical to all aspects of health and all life on this planet as we know it... primordial poop and all that jazz.

Back to autophagy, fasting, and re-feeding....

Growth factors must be regulated via continued calorie restriction and considered selection of macro and micronutrients. In the fasted state these undesirable growth factors that act in a cascading domino fashion on reactant signalling pathways are metabolically inhibited or 'dulled' for want of a better expression (at least I tried eh? could have just said 'regulated'), so we want to continue to take advantage of this rather than cause an upsurge of insulin and contributory growth factors during the re-feeding stage. The same thing happens (the inhibition of stated growth factors) with hyperbaric oxygen therapy so it makes sense how all this fits together in powerful synergy to increase metabolic stress on tumour cells. In preparation for re-feeding I consume exogenous ketones (Ketoforce or KetoCaNa, available here http://prototypenutrition.com/ketoforce.html#!prettyPhoto to blunt the response of growth factors and to prevent over-consumption of food once I start eating again. This is to ensure that the whole practice of the fast is not counterproductive.


The benefits of fasting: mTor in the spotlight- IMG- http://jcs.biologists.org/content/120/3/379
I believe that my restricted, dairy free ketogenic diet may effectively be mimicking (or at least I hope!) some of the favourable metabolic adaptations that come with a prolonged fasted state, with the benefit of continuous daily nourishment to maintain my current satisfactory weight. I have little stored body fat to tap in to so it would be nice to keep some functional strength and adequate bone density. On the plus side, due to the stringent approach I have adopted, my metabolic flexibility is comparable to that of a small (healthy) child.
Fasting helps to regulate cascading signalling pathways like mTor and IGF-1.
Turbulence must ideally be steadied in the midst of the re-feeding phase,
maintaining consistent, therapeutic blood glucose readings.
IMG- http://www.anbg.gov.au/flags/semaphore.html

Fasting on a ketogenic diet is something I do habitually and it can be incredibly beneficial for cancer management as I will attempt to explain. If I were a food guru I would advise against fasting because it is remarkably effective under the right circumstances and I wouldn't be able to make much money off of you with my magical foods (diminished returns you see, I can't live in a box). I may even throw the 'starvation mode' myth at you if I was feeling particularly nasty. Yes I do love 'magic mushrooms', but I also like to think I have a moral compass that guides me in the right direction when exploring these investigations and going over all the information with a fine toothed comb.

I typically aim for at least 1 day a week of no food with a controlled water intake. The benefits of intermittent fasting have been well documented both in the academic literature and to the general public over the past few years (Michael Mosley's blood sugar diet anyone?, 5:2 diet?). 
For my personalised approach to periodic fasting, keeping the containment of seizure activity in mind, salts are added to my water and fluid intake is closely monitored to prevent 'breakthrough' seizures (by maintaining homeostasis of electrolytes in the brain as I expel urine throughout the fasting period). Some may also benefit from this if they ever feel light-headed during a fast but this may simply be the case if they are not metabolically adapted to utilising fats as a predominant fuel source. On a well structured ketogenic diet for cancer management this should be a seamless transition because the diet itself mimics a fasted state as mentioned previously in this post. In this state fatty acids are already an obligitory source of cellular energy production by peripheral tissues and also the brain of course. 
I can have 'breakthrough' seizures if I fail to maintain desirable therapeutic ratios of electrolytes in the brain.
IMG- http://www.bioquicknews.com/node/1863
Can we query current rationalities and approaches to nutrigenomics?

The pre-eminent curiosity that I retain regarding health practitioners is that specialists in nutrition on occasion appear to not possess the adequate level of biochemical grounding to explain the vital processes happening at the cellular level during fasting and through manipulation of eicosanoids (fatty acids), conversely from my personal experiences, experts in biochemistry don't apply their vast knowledge of these complex physiological systems to basic fundamentals of nutrition in a sensible, practical sense. In other words, the nutrition experts sometimes oversimplify very complicated metabolic processes and the biochemist could be overcomplicating his or her work that could be applied practically via simple means. This is purely based on observational, subjective personal extrapolations of course. Disclaimer, don't shoot me. ;-)
The alimentary canal- human digestive tract.
IMG- http://igbiologyy.blogspot.co.uk/2013/04/52-human-alimentary-canal.html
I suggest a more balanced approach where these complicated mechanisms are explained in sufficient detail and with careful cogitation, along with their appropriate practical applications. In other words why go around the moon to get to the sun even though space travel in itself is complicated. A rocket scientist has a complicated job but we have sent monkeys into space. The monkey just needs to know how to practically apply this information with enough detail. You can probably tell by now that I like my appreciably contrived analogies. With a new dawn of 'personalised medicine' approaching on the horizon however, I am encouraged by the direction in which we are heading.


Eicosanoids and cancer- could nutrition professionals benefit from a greater understanding of the numerous underlying processes of physiological processes to improve complimentary treatment protocols? IMG- http://www.nature.com/nrc/journal/v10/n3/fig_tab/nrc2809_F3.html
Autophagy- essentially the process of 'self-eating'!... in a good way (clearing out the rubbish)

    As demonstrated aptly by Pac-Man, lysosomes are organelles that contain digestive enzymes. They digest excess or worn out organelles, food particles, and engulfed viruses or bacteria. Lysosomes are like the stomach of the cell. http://study.com/academy/lesson/lysosome-definition-function-quiz.html
As we begin to think about autophagy in general, and the specific mechanisms of mitophagy, the genius of the human body's innate natural survival adaptations reveal themselves in quite remarkable ways. Its all very clever when we delve just a little deeper into it. If we don't feed the body it will be more efficient at doing some essential housekeeping! I feel it is appropriate to give the analogy of someone who has a messy house, cleaned once per week (typically Sunday because there are less time constraints and other responsibilities to deal with). The house can be cleaner if all resources can be employed to the task at hand with no alternative concurrent responsibilities. With respect to our physiological requirements in a fasted state, the digestive system is able to take a much needed rest from metabolising nutrients from food, focusing all of its energies on cleansing organs, doing some dusting, and clearing out the rubbish!
Because I want to break free- a significant role of mitophagy involves the removal of damaged,
depolarised mitochondria. Nutrient deprivation is the key activator of autophagy.   
I enjoy the process because it allows time for contemplative introspection. I'm so glad that I push myself to the limit even though it can be quite challenging at times. Fasting teaches you a lot about what your body and mind are capable of, and the sense of well-being I experience is very satisfying. I do often feel as though I could be doing more but that may simply be my natural personality and state of mind, mentally flawed in certain situations perhaps, but a useful mental state to make the most out of trials and tribulations that life throws at me. I enjoy fasting and I am practicing this today and tomorrow (a 2 day fast), it provides me with a time to slow down and reflect on life. I use this time to listen to my body and clear my mind of what should be trivial concerns and negative thoughts.
Scientists understand that controlling the lysosomal-autophagic pathway
allows for effective approaches to modulate cellular clearance.
Complex processes clearly, but simple applications.
IMG- 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638014/
I found this great explanation of autophagy via Dr. Jason Fung's article on fasting and autophagy which details everything better than I can! I really admire his work. You can follow the link on the picture below to learn more.

I mentioned all of this in my Youtube video. I have added it here to act as a sort of appendix:

What is clear to me is that there are several benefits to these physiological responses to fasting and calorie restriction. I wanted to show that this can be explained through the basic fundamentals of cell biology.


In my Youtube video I mentioned expression of FGF21 and PARa during fasting in humans and other animals. Its complicated but there are numerous benefits to this in relation to fasting. The diagram may help to detail the biochemical mechanisms better than I can. Clear as mud?
IMG-http://www.nature.com/nm/journal/v19/n9/fig_tab/nm.3334_F1.html















'There are multiple interactive pathways and molecular mechanisms by which CR (calorie restriction) and IF (intermittent fasting) benefit neurons including those involving insulin-like signaling, FoxO transcription factors, sirtuins and peroxisome proliferator-activated receptors. These pathways stimulate the production of protein chaperones, neurotrophic factors and antioxidant enzymes, all of which help cells cope with stress and resist disease. A better understanding of the impact of CR and IF on the aging nervous system will likely lead to novel approaches for preventing and treating neurodegenerative disorders.' http://www.sciencedirect.com/science/article/pii/S1568163706000523

This study shows that circulating levels of FGF21 are markedly increased by fasting in humans and are part of the late stages of the body's adaptive response to starvation — a protective mechanism that evolved to aid survival in periods of famine. http://www.nature.com/nrendo/journal/v12/n1/full/nrendo.2015.202.html

The Peroxisome Proliferator Activated Receptor alpha (PPARα) is a transcription factor that plays a major role in metabolic regulation. The map puts PPARα at the center of a regulatory hub impacting fatty acid uptake, fatty acid activation, intracellular fatty acid binding, mitochondrial and peroxisomal fatty acid oxidation, ketogenesis, triglyceride turnover, lipid droplet biology, gluconeogenesis, and bile synthesis/secretion. In addition, PPARα governs the expression of several secreted proteins that exert local and endocrine
functions. http://www.sciencedirect.com/science/article/pii/S221287781400043X

It all actually started for me with the Valter Longo studies for cancer management as soon as I received my diagnosis and read 'Cancer as a Metabolic Disease'. Here are some of those studies that sparked my initial enthusiasm for this approach:

Dietary restriction and cancer management
http://www.nature.com/onc/journal/v30/n30/abs/onc201191a.html

Fasting and IGF-1
http://cancerres.aacrjournals.org/content/70/4/1564.short

Fasting cycles retard growth of tumours and sensitise a range of cancer cell types to chemotherapy
http://stm.sciencemag.org/content/scitransmed/4/124/124ra27.full

Sunday, 10 April 2016

More thoughts, experiments and investigations on curcumin in vivo

Following on from my last post, I have been questioning myself more about optimal dosages for supplementation of curcumin, particularly in light of such studies whereby 'high' amounts of the compound are tolerated with minimal to zero toxicity reported. One particular study caught my eye.

'A dose escalation study was conducted to determine the maximum tolerated dose and safety of a single dose of standardized powder extract, uniformly milled curcumin (C3 Complex™, Sabinsa Corporation). Healthy volunteers were administered escalating doses from 500 to 12,000 mg.' http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-6-10

12,000 mg is a lot considering I take 1,500 mg per day which I deem to be the optimal therapeutic dose for me as an individual. There may be situations by which higher doses may be more beneficial though I believe the dosages I maintain at the moment should be adequate for my current aims. 

The results of the study revealed some thought provoking findings though I dd wonder about the 17 participants that did experience issues:


'Seven of twenty-four subjects (30%) experienced only minimal toxicity that did not appear to be dose-related. No curcumin was detected in the serum of subjects administered 500, 1,000, 2,000, 4,000, 6,000 or 8,000 mg. Low levels of curcumin were detected in two subjects administered 10,000 or 12,000 mg.'

The study goes on to say that 'no toxicity appeared to be dose related', indicating that of those 17 participants there may have been extraneous factors or sensitivities to the curcuminoid formulation regardless of the dose ingested. I also believe that because the trial was looking at a single, oral dose of this formulation, it may have been enough to explain some of these mild, adverse effects. Nevertheless, they concluded that ,'The tolerance of curcumin in high single oral doses appears to be excellent.' 

Given the relatively very high doses used in the study on the whole and the fact that only mild toxicity was reported, I would say that this conclusion appears to be valid but I would like to see more studies using high such high doses for comparison in order to truly validate these findings. 

Another aspect of curcumin I have been looking into is a hypothesis I had about curcumin being beneficial to combat neurodegenerative disease, in part by acting as a chelating agent. http://content.iospress.com/articles/journal-of-alzheimers-disease/jad00330

http://www.in-corpore.ch/news/heavy-metal-toxicity-causes-and-treatment/

It is of upmost importance to consider this as we see that in neurodenerative diseases we typically see elevated levels of copper and iron in the brain 



Copper http://www.livescience.com/29377-copper.html
Iron http://www.livescience.com/29263-iron.html











Iron (Fe) and copper (Cu) are essential to neuronal function; excess or deficiency of either is known to underlie the pathoetiology of several commonly known neurodegenerative disorders. This delicate balance of Fe and Cu in the central milieu is maintained by the brain barrier systems, i.e., the blood–brain barrier (BBB) between the blood and brain interstitial fluid and the blood–cerebrospinal fluid barrier (BCB) between the blood and cerebrospinal fluid (CSF). http://www.sciencedirect.com/science/article/pii/S0163725811002014

http://www.sciencedirect.com/science/article/pii/S0010854509001258

http://www.sciencedirect.com/science/article/pii/S0969996199902504?np=y

It is worth noting, as I referenced in my magnesium and epilepsy report, that a hallmark of many neurodenerative diseases is an impaired blood brain barrier (a so-called 'leaky brain'), which would make these homeostatic interventions more necessary. A suitable analogy may be that it is like keeping an open wound clean to avoid infection. We don't want an accumulation of metals in the brain as it would allow the disease to progress.

...and with conditions like epilepsy we know excess (or insufficient levels of) copper acts as a seizure trigger. http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1157.1972.tb04397.x/abstract

Keeping all this in mind I then began to wonder if the same benefits of curcumin as a chelating agent could apply to mercury toxicity. I eat a lot of fish so I have been contemplating this benefit/risk conundrum for some time. Interestingly I then found this rodent study- 

http://onlinelibrary.wiley.com/doi/10.1002/jat.1517/abstract;jsessionid=0447181CD798D7026E04D05B1B9A485F.f03t01?userIsAuthenticated=false&deniedAccessCustomisedMessage

The results indicated that- 'Curcumin treatment (80 mg kg−1 b.w. daily for 3 days, orally) was found to have a protective effect on mercury-induced oxidative stress parameters, namely, lipid peroxidation and glutathione levels and superoxide dismutase, glutathione peroxidase and catalase activities in the liver, kidney and brain.'


http://www.europeanlaboratory.nl
There is no requirement for mercury of course (its all bad!) so this would be welcome news if humans can benefit in a similar fashion. Effective doses would need to be established of course. The European Laboratory of Nutrients (ELN), do Toxic Elements tests that would enable me to see what is going on in my body and could enable me to be more thorough with my own experiments. They can be found here and it would probably be a great idea to have these tests for those who experience brain fog or have a history of neurodegenerative disease in their family. http://www.europeanlaboratory.nl



It is a difficult balance at times however the problem is typically too much rather than too little. 


This may be a useful supplement to take for patients who have a gadolinium based contrast agent when having MRI scans in light of recent evidence. 

'Newer reports have emerged regarding the accumulation of gadolinium in various tissues of patients who do not have renal impairment, including bone, brain, and kidneys.' http://link.springer.com/article/10.1007%2Fs10534-016-9931-7

It would be interesting to see if patients who have fewer MRIs with the contrast for the same stage of disease live longer than those who have the imaging procedure more frequently. I suspect we would never see a study like that due to reasons of efficacy (ironic perhaps in light of this study), however it would be interesting to see if there is any correlation. I know correlation does not always equal causation but there are probably ways you could qualitatively measure this alongside subjective observational findings.

https://en.wikipedia.org/wiki/MRI_contrast_agent#/media/File:Omniscan_nima.JPG



Thursday, 7 April 2016

Curcumin: Problems and promises

I take curcumin regularly. This is a nice visual representation of how it potentially acts as an anti-cancer agent providing all conditions requiring therapeutic efficacy are met.




Bioavailability is key here to make the most of the therapeutic benefits of curcumin. If you take it as a supplement make sure it is paired with piperine and is taken in therapeutic doses. We need more in vivo studies in brain tumour patients to elucidate what would act as an optimal dose, crossing the blood brain barrier so I will continue to research this medicinal compound. 


'Major reasons contributing to the low plasma and tissue levels of curcumin appear to be due to poor absorption, rapid metabolism, and rapid systemic elimination. To improve the bioavailability of curcumin, numerous approaches have been undertaken. These approaches involve, first, the use of adjuvant like piperine that interferes with glucuronidation; second, the use of liposomal curcumin; third, curcumin nanoparticles; fourth, the use of curcumin phospholipid complex; and fifth, the use of structural analogues of curcumin (e.g., EF-24). The latter has been reported to have a rapid absorption with a peak plasma half-life. Despite the lower bioavailability, therapeutic efficacy of curcumin against various human diseases, including cancer, cardiovascular diseases, diabetes, arthritis, neurological diseases and Crohnʼs disease, has been documented. Enhanced bioavailability of curcumin in the near future is likely to bring this promising natural product to the forefront of therapeutic agents for treatment of human disease.' 




As the acclaimed philosopher Karl Popper explained, a good scientist should constantly be trying to prove themselves wrong in order to have a truly unbiased opinion. This forms the basis of pure, valid, reliable scientific research.


If I am trying to prove myself right all the time without a healthy degree of skepticism I may ignore the challenges and barriers that appear to be appropriate considerations when undertaking my own research. Preconceived notions must be forgotten to avoid so called 'pseudo-science', this is always my approach.

It is only by seeking to disprove my theories and scrutinising the methods and conclusions of these studies that I can come to a valid conclusion once I have all the evidence and all questions have been answered. Knowledge is about probability and contingency, we are justified in believing whatever seems most probable given our current data and we should always be willing to revise our beliefs in light of new data. My metabolic approach to my specific situation will progressively evolve as I continue to question myself and learn more.

Monday, 4 April 2016

Current ketogenic diet proposals for cancer management are questionable

I've been saying for a while now that these ketogenic diet proposals for cancer management have been deeply flawed- the inclusion of dairy and the lack of consideration for the role particular amino acids play in proliferation of these defective cells. 


Wednesday, 30 March 2016

An explorative essay: Can magnesium chloride raise seizure threshold?



Exploiting ionic changes in the epileptic brain to increase seizure threshold with oral supplementation of magnesium chloride

Epilepsy is a serious neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. Seizures are associated with neuronal ionic changes (Schwartzkroin, 1998) that can be managed with increased efficacy through magnesium chloride supplementation. Magnesium supplementation should be part of an essential component of a management strategy for any type of epilepsy to raise seizure threshold and maintain trace element homeostasis.

The form of magnesium that has been used most clinically and has the longest therapeutic use to treat epilepsy in the literature is magnesium sulphate, however this is not practical or convenient for patients with epilepsy. While there needs to be more research into other forms of magnesium to manage epilepsy, there remains adequate evidence to suggest that oral magnesium, particularly magnesium chloride, has numerous benefits to increase seizure threshold by modulating neuronal activity. Magnesium chloride is easy to ingest, convenient to apply, acts effectively as a central nervous system depressant, improves insulin sensitivity, and lowers plasma blood glucose. This essay will explain how these mechanisms can effectively contribute towards raising seizure threshold for patients with all types of epilepsy.

‘Non-synaptic mechanisms’ are an important consideration in an attempt to manage neuronal activity in epilepsy. This includes, but is not exclusive to ionic interactions that involve magnesium, potassium, sodium and calcium. Increases in the extracellular concentration of potassium in particular is of vital importance in order to consistently manage epileptic seizures however this is dependent on many cofactors.

Magnesium is involved with over 300 enzymatic reactions and has numerous mechanisms of action that make it an effective standalone treatment to modulate neuronal excitability with great efficacy and safety. ‘Regulation of ionic balance is a critical process that involves a complex array of molecules for moving ions into and out of brain cells-both neurons and glia’ (Schwartzkroin, 1998). Studies show that concentrations of copper, magnesium, and zinc are typically altered in the epileptic brain, particularly in those who receive anti-epileptic drugs (Saghazadeh et al., 2015) and this decreases seizure threshold. Anti-epileptic drugs will also contribute to a number of other imbalances such as vitamin D deficiency (Ali et al., 2004) that can trigger breakthrough seizures through disruption of trace element homeostasis which would require patients to increase medication as a result. Vitamin D deficiency in itself disrupts natural homeostatic mechanisms of calcium which can be managed not only through vitamin D supplementation (Teargarden, Meador and Loring, 2014) but also magnesium supplementation (Levine and Coburn, 1984).

Long term use of AEDs can result in micronutrient deficiencies
that could actually lower seizure threshold, resulting in need for
more medication in an attempt to mitigate these undesirable side effects.
The imbalance caused by these ionic changes in the epileptic brain, and influenced even more with anti epileptic drugs, can result in breakthrough seizures and a subsequent increase in medication as a questionable attempt to resolve the issue. Doctors have been accused of being unaware of these associative deficiencies, with less than 10% of neurologists recommending patients to take calcium and vitamin D to protect against the side effects of these drugs (Pack, 2008). The result would be an increase of their typical undesirable sedative side effects, bone mineral loss and possible further deficiencies. Certain drugs, such as Lamotrogine, do not possess sedating effects, but can disrupt circadian rhythm regulation mechanisms causing possible breakthrough seizures by inadequate functioning of melatonin from the pineal gland (Nzwalo et al., 2016, Quigg et al., 2016). The rhythmicity of these seizures are often associated with bimodal peaks of occurrence, particularly attributed to focal epilepsies, and specifically observed in temporal lobe epilepsy (Nzwalo et al., 2016), can potentially be mitigated via targeted therapeutic dose of oral magnesium chloride before seizure activity occurs.
  
Potassium, sodium, and calcium ratios are also important considerations as has been established in the literature over many years (Heinemann et al, 1986), however achieving adequate magnesium status is likely a greater challenge as our diets are likely deficient and there are numerous mechanisms of actions that will interact beneficially with these other elements that can be more easily attained through diet.

'A slow potassium current (IsAHP) activated by the influx of calcium into the pyramidal neurons, plays a key role in controlling the repetitive firing of neurons throughout the brain.' http://pnbfiles.uconn.edu/PNB_Base/about/staff/facultysites/tasso/research.html 


Magnesium is an abundant mineral in the body serving many biochemical functions and it acts as an essential electrolyte for all living organisms. Magnesium deficiency decreases seizure threshold in human and animal models (Osborn et al, 2015) and studies have repeatedly shown that people with epilepsy have lower magnesium than people without epilepsy. Normal dietary magnesium intake is estimated to be 300–350 mg per day for adults but intake is still too low even amongst the general ‘healthy’ population. To make matters worse, hypomagnesia is associated with epilepsy (Capellarri, 2016, de Baaij, 2015) and a wide range of medical conditions. As a result, it is not a surprise that magnesium supplementation has been shown to be beneficial in the treatment of many neurological conditions in particular, including preeclampsia, migraine, and depression (Jeroen et al, 2015)

It is clear that magnesium supplementation is essential for most people at present and moreso for those with any type of epilepsy. As with most neurological conditions, a compromised blood brain barrier will increase the need for magnesium. It has also been shown in a number of cases to be more effective than medication alone and it may be possible to replace standard medication completely if trace element homeostasis is achieved for drug resistant epilepsy (Yuen and Sander, 2012,  Abdelmalik, Politzer and Carlen, 2012, Mason et al, 1994).
A compromised blood brain barrier, associated with many conditions of the brain, results in a greaterdemand for magnesium to maintain trace element homeostasis http://journal.frontiersin.org/article/10.3389/fncel.2014.00232/full

Magnesium comes in many forms as it needs to be bound to certain molecules for optimal ingestion so that it can get to the brain and central nervous system. Effectiveness for the therapeutic use required depends on bioavailability and desired response. Magnesium citrate, for example, has proven to be a very effective laxative, but may not be the most efficacious from for seizure management due to poor bioavailability and less taken up by the CNS.

It is interesting how magnesium citrate may not help manage seizure activity effectively (and could even trigger seizures-possibly due to poor absorption). Perhaps surprisingly, magnesium citrate should probably be avoided for most as it interferes with ceruloplasmin and can cause iron dysregulation as well as other health issues. The reason this form is worth mentioning as it is commonly used for children on strict ketogenic diets to manage constipation as magnesium citrate has a laxative effect. Magnesium chloride can cause patients to retain water, however potassium citrate, which is often used by patients on ketogenic diets to alkalise the urine for kidney health, can help to release these fluids and relieve this discomfort.

It is important to consider the mechanisms of action for magnesium. Seizures occur when the central nervous system becomes overstimulated. Magnesium can act as an effective CNS depressant, with numerous beneficial functions intracellularly and extracellularly to supress seizure activity to modulate neuronal excitability. The primary mechanism is most likely its ability to antagonize excitation through the N-methyl-d-aspartate receptor (Yuen and Sander, 2012).
'The primary mechanism is most likely its ability to
antagonize excitation through the N-methyl-d-aspartate receptor'
IMG- 
http://webvision.med.utah.edu/book/part-v-phototransduction-in-rods-and-cones/glutamate-and-glutamate-receptors-in-the-vertebrate-retina/

Most of the research regarding epilepsy comes from numerous studies on eclampsia (Berhan and Berhan, 2015) with some detailing treatment for status epilepticus (Tan et al, 2015). ‘Eclampsia is defined as de novo seizure in a woman with the hypertensive complication of pregnancy known as preeclampsia (PE), and is a leading cause of maternal and fetal morbidity and mortality worldwide.’ (Johnson, 2015)
Magnesium Sulphate has been in clinical use for almost a centrury
to treat epileptic seizures in women with pre-eclampsia.
 

Any kind of epilepsy results in a compromised blood brain barrier (Oby and Janigro, 2006). Like preeclampsia, neuroinflammation and a compromised blood brain barrier permeability (Johnson, 2015) increase the need for magnesium (‘leaky brain’) so a favourable response is gained from supplementation, reversing seizure activity. We know for example, that inflammatory molecules contribute to neuronal hyperexcitability (Lori, Frigerio and Vezzani, 2016) which would naturally decrease seizure threshold dramatically. Keeping blood glucose low is neuroprotective and anti-inflammatory, magnesium can do this effectively.

Similar to the ketogenic diet, magnesium has had nearly a century of clinical use to treat epilepsy. It been used as prophylaxis and treatment of seizures associated with eclampsia however because of the availability of well studied anticonvulsant drugs it has not been tested widely in the treatment of epileptic seizures (Abdelmalik, Politzer and Carlen, 2012, Mason et al, 1994). As with the ketogenic diet, oral magnesium acts as a natural statin to reduce seizure threshold and keeps blood glucose low. (Guerrero-Romero et al, 2015) It is absolutely crucial to keep blood glucose consistent as hyperglycaemia has been shown to lower seizure threshold (Stafstrom, 2008).

In conclusion, restoration of specific ionic changes in the epileptic brain with supplementary therapeutic doses of magnesium chloride can be an effective strategy to increase seizure threshold. As a stand-alone therapy, or in combination with manipulation of trace elements and electrolytes and/or anti epileptic medications patients can attain improved seizure control through trace element homeostasis. It remains unclear whether these ions are causal to, or a cofactor in the development of epilepsy, however it has been demonstrated that seizure control can be maintained through ‘non synaptic mechanisms’, with magnesium being a key element with numerous mechanisms of action.  

Studies on magnesium chloride have demonstrated that it can be a convenient, efficacious supplemental therapeutic aid to increase seizure threshold. Magnesium chloride has shown to ingest efficiently due to its composition and its bioavailability is favourable. Taken orally it can assist in maintaining trace element homeostasis to either complement or replace drugs which can cause numerous trace element deficiencies. It is convenient and possibly the most efficient form of magnesium for ingestion as minerals need to be dissolved in gastric acid to go into the solution. Magnesium chloride has extra chloride molecules to produce hydrochloric acid in the stomach which enhances its absorption. It is pertinent to note that interaction with other trace elements needs to be taken into account however supplementation with magnesium chloride could provide patients with the most effective method on its own to better prevent neuronal hyperexcitability through its many promising mechanisms of action.














References

Abdelmalik, P. A., Politzer, N. and Carlen, P.L. (2012). Magnesium as an effective adjunct therapy for drug resistant seizures. The Canadian Journal of Neurological Sciences. 39(3):323-7. Available from http://www.ncbi.nlm.nih.gov/pubmed/22547512 [Accessed 02 February 2016]

Ali, F. E. et al. (2004). Loss of Seizure Control Due to Anticonvulsant-Induced Hypocalcemia. The Annals of Pharmacotherapy, 38(6):1002-5. Available from http://www.ncbi.nlm.nih.gov/pubmed/15084684 [Accessed 08 February 2016]

Berhan, Y. and Berhan, A. (2015). Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia. The Journal of Obstetrics and Gynaecology Research, 41(6):831-42. Available from http://onlinelibrary.wiley.com/doi/10.1111/jog.12697/full [Accessed 04 February 2016]

Cappellari, A. M. (2016). Neonatal focal seizures and hypomagnesemia: A case report. European Journal of Paediatric Neurology, 20(1):176-178. Available from http://www.ejpn-journal.com/article/S1090-3798(15)00179-8/abstract [Accessed 05 February 2016]

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Guerrero-Romero, F. et al. (2015). Oral magnesium supplementation improves glycaemic status in subjects with prediabetes and hypomagnesaemia: A double-blind placebo-controlled randomized trial. Diabetes and Metabolism. 41(3):202-7. Available from https://www.researchgate.net/publication/275589606_Oral_magnesium_supplementation_improves_glycaemic_status_in_subjects_with_prediabetes_and_hypomagnesaemia_A_double-blind_placebo-controlled_randomized_trial [Accessed 04 February 2016]

 

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