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2011-03-10 Forrest Nielsen, PhD Sleep Quality, Chronic Inflammation and Magnesium Therapy

March 10, 2011, By Kirkham R. Hamilton, PA-C
© copyright 2011, Prescription 2000, Inc.
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KIRK HAMILTON: Hi, my name is Kirk Hamilton, your host of Staying Healthy Today. Our message is simple: To provide you credible usable health information from interviews and our educational resources to help you Stay and Be Well in the busy modern world. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com website, the home of Staying Healthy Today Radio, for our free educational services.

Today's show topic is "Sleep Quality, Chronic Inflammation, and Magnesium Therapy." Our guest today is Dr. Forrest Nielsen from the USDA's Grand Forks Human Nutrition Research Center in Grand Forks, North Dakota. He recently co-authored a paper entitled "Magnesium Supplementation Improves Indicators of Low Magnesium Status and Inflammatory Stress in Adults Older Than 51 Years With Poor Quality Sleep" in the journal Magnesium Research in 2010.

Welcome Dr. Nielsen. Thanks so much for coming on the show today.

DR. FORREST NIELSEN: I'm pleased to be here.

KIRK HAMILTON: So tell me about your educational background and current position. I know that you work at the Grand Forks Human Nutrition Research Center and when you get to that point explain what that kind of governmental body does.

DR. FORREST NIELSEN: Well I received my BS in 1963 and MS in 1966 and PhD in 1967 with a major in biochemistry from the University of Wisconsin in Madison. When after two years in the army I was recruited to become a scientist, the first scientist actually, on the newly opened Grand Forks Human Nutrition Research Center which is part of the US Department of Agriculture, Agriculture Research Service. I arrived there in 1970 and have been there ever since. I was hired because my majors were pretty much trace elements. I did zinc research while I was at the University of Wisconsin and worked on the possible importance of nickel while I was in the army, and the center's mission at that time was to determine the importance of trace elements in human nutrition.

KIRK HAMILTON: Well I must tell you I'm very impressed as I'm finishing up a book project and I have been very fortunate to go to the website of the US Department of Agriculture, their Economic Research Service and people like you, and, I have found, you know, people sometimes gripe at the government, I'm duly impressed with all the great data that you all have accumulated there. I really am. You know as much criticism sometimes with governmental agencies occurs I found just some fabulous work. So what are some of the other goals of Human Nutrition Research Center.

DR. FORREST NIELSEN: Well you know I was the center director there for 16 years from 1985 to 2001. And then I stepped down to once again work full time on research, and shortly after I stepped down the mission of the laboratory was directed to change by the Agriculture Research Service. It's now dealing with obesity, which you I'm sure, you're aware has become a pretty hot topic in political ranks and so we - our focus is no longer on trace elements. And this is when I changed my focus into magnesium instead of the trace elements I worked on before.

KIRK HAMILTON: Well let's get into that. The article you wrote was "Magnesium Supplementation Improves Indicators of Low Magnesium Status and Inflammatory Stress in Adults Older Than 51 Years With Poor Quality Sleep" and that was in Magnesium Research. So, tell me about what was your main interest there. Was it poor quality sleep is such a frequent occurrence? Or magnesium deficiency is so common? Or inflammation is a buzz word now?

DR. FORREST NIELSEN: Inflammation is a buzz word now. Actually, you know I just mentioned that I'm now what's considered a research nutritionist at the Human Nutrition Research Center. And why did I get interested in magnesium? Well basically it was because obesity is characterized by chronic inflammatory stress. And it's also characterized by decreased serum magnesium or low magnesium intakes. So when the center began emphasizing obesity I changed my research focus on the possibility that magnesium deficiency can exacerbate conditions characterized by chronic inflammatory stress. So the reason I did that was because magnesium deficiency, severe magnesium deficiency in animals it causes an inflammatory type like state.

KIRK HAMILTON: So which comes first? The obesity or the inflammation or magnesium deficiency?

DR. FORREST NIELSEN: Well basically obesity causes inflammation I understand basically, and then that magnesium might exacerbate it. But on the other hand people who are obese are generally low in magnesium so that might be a reason why the inflammation shows up. I don't think we are clear what's the cause or the effect there but they seem to be related.

KIRK HAMILTON: How about when you talk about sleep? I mean one of the most frequent - in fact, I work in a primary care clinic and we do lifestyle nutrition and we use some pharmaceuticals and I will say that probably the number one complaint is not falling asleep, but it's being able to stay asleep and have good quality sleep. And so that's why my ears perked up when you started talking about the magnesium, the inflammation. What got you interested in the sleep aspect?

DR. FORREST NIELSEN: Well sleep is characterized, especially sleep deprivation - it's characterized by chronic inflammatory distress. And obese people often have sleep disorders. And so I thought when a lady in the community here in Grand Forks said she would help fund a study if I would look to see if magnesium supplementation would improve sleep quality, because she thought it did, I jumped at the chance because it seemed to fit right into my program where I'm looking at magnesium maybe exacerbating conditions which are characterized by chronic inflammatory stress.

KIRK HAMILTON: So you had a citizen who was willing to donate money to study this?

DR. FORREST NIELSEN: Yes.

KIRK HAMILTON: Wow, that's pretty good!

DR. FORREST NIELSEN: So that's what really got me into sleep. Before that my major focus has been more on bone but still this seemed to fit right into the inflammatory stress aspect of my study and obesity aspect of the study.

KIRK HAMILTON: Is it the inflammation that irritates you somehow at night that doesn't make you sleep, or is it the magnesium deficiency that makes biochemical changes that affects the sleep?

DR. FORREST NIELSEN: Well I would say that it's more - we really don't know what for sure. We just know that sleep deprivation results in increased C-reactive protein and the other indicators of chronic inflammatory stress. I'm not so sure that chronic inflammatory stress really has an impact on sleep. I think the inflammatory stress is more a marker of poor quality sleep or sleep deprivation. And the reason why that is the marker is because things like magnesium might be low because it requires an increased amount when sleep deprivation occurs. We're really not clear yet what the relationship between magnesium and sleep deprivation and chronic inflammation is, but I think it's more of a marker of poor quality sleep.

KIRK HAMILTON: So you chose to use 320 mg of magnesium citrate. So can you tell me where that dose came from and, two, why you chose magnesium citrate?

DR. FORREST NIELSEN: The reason I chose magnesium at that level is that I wanted to ensure that all subjects were receiving at least the recommended dietary allowance for magnesium including men for which the current RDA is about 420 mg per day. Based on dietary surveys I assumed that everybody was eating at least 100 mg per day. So I thought a supplement of 325 mg per day would make sure that everybody's getting the RDA. Now the reason I didn't go any higher than that is because the Food and Nutrition Board of the Institute of Medicine has stated that the upper limit for intakes of magnesium is 320 mg of magnesium as a supplement beyond what's already taken in the food. That's why I used that. And I used magnesium citrate because it was more available. Studies show that it might be more available than a common type found in supplements called magnesium oxide. We gave the capsules to these people throughout the day, usually during the mealtimes. Generally it was requested to consume two capsules during the morning meal, two during the evening meal, and one during the noon meal. If they missed one of them, we asked them to still try to take it sometime else during the day.

KIRK HAMILTON: So it was five capsules a day to get up to the 320 mg of elemental magnesium?

DR. FORREST NIELSEN: Yes because the capsules were pretty big and you know magnesium citrate, there's a lot - the citrate molecule has a lot of molecular weight so each capsule only contained about 64 mg of magnesium in it.

KIRK HAMILTON: So tell me about who you used in the study and kind of what happened to the subjects in the study with the magnesium supplementation.

DR. FORREST NIELSEN: Well I didn't get quite the results that I had hoped for. The supplementation resulted in whether I fed the magnesium citrate supplement or placebo containing sodium citrate. All the subjects improved in their sleep quality according to tests that we did called Pittsburg Sleep Quality Index. We also found during the study that people who were consuming less than the estimated average requirement or less than the recommended dietary allowance (for magnesium), RDA or EAR, were associated with a higher body mass index or more overweight, and they also were associated with a higher plasma C-reactive protein which is an indicator of chronic inflammatory stress. Unfortunately only 40 participants who reported poor quality of sleep had CRP levels, the C-reactive protein levels above 3, which is an indicator of chronic inflammatory stress. So I didn't find as many people with a poor quality of sleep having chronic inflammatory stress that I hoped for, and this might have had some impact on my findings. Nonetheless, we found during the study that magnesium supplementation increased erythrocyte magnesium, it increased serum magnesium especially those people who had low levels and in all the subjects as well as in improving the poor quality sleep. So there seems to be an association between the two, but I couldn't definitively say that, hey it was the magnesium that did it. It could have been a placebo effect or something else that affected magnesium levels, and as a result this improved sleep. I say there is an association between magnesium status and sleep, but I didn't get the definitive answer I wanted from this study.

KIRK HAMILTON: I got it. Well I can just tell you clinically, we have a little cocktail - it's not a cocktail, it actually comes from a supplement of 500 mg elemental magnesium and 500 mg elemental calcium that comes in a tablespoon, and we give it before bed and you know it's my little pet supplement for the elderly who might be constipated, having difficulties sleeping and have muscle cramps because it does it all at once and I know it works at night. So I'm sure that there's a component there of magnesium. There is no real harm in taking the magnesium unless you get loose stools, correct? If somebody took a little more?

DR. FORREST NIELSEN: That's the basic first sign of too much magnesium. In our study you know we lost a couple people because they complained about having loose stools type of thing, and some of the other ones mentioned that their stools were looser, but that would be the major problem with taking magnesium at 320 mg per day.

KIRK HAMILTON: Would it be fair to say that magnesium is kind of an anti-inflammatory nutrient so to speak?

DR. FORREST NIELSEN: I would say it is based on animal experiments. Now these are animal experiments and their deficiency is probably a little more severe than you would find normally in deficient humans. They find that this results in inflammatory changes which can lead to changes in heart function and bone function and things of this nature. So magnesium deficiency causes this. When they give magnesium to the animal it recovers so I would say yes, it's an anti-inflammatory agent or if they lack it, it causes inflammation. And because of this, if you have another condition called an inflammatory stress, say eating high levels of omega 6 versus omega 3 (fatty acids), or being obese or something like this. Being under some constant stress that results in increased inflammation, magnesium deficiency, even the more marginal types, say 50% of the requirement, more likely will exacerbate it, and giving magnesium will help alleviate it.

KIRK HAMILTON: What are your favorite dietary sources of magnesium?

DR. FORREST NIELSEN: Well my favorite sources is your nuts and your pulses like peas and beans and lentils, leafy vegetables, and another fairly good source of magnesium is milk, believe it or not. It's a moderate source but it still can contribute quite a bit towards the daily requirement for magnesium. The problem with Americans and why we have such a high incidence of probably marginal deficiency, somewhere eating oh between 180 and 250 mg per day or 237 mg per day, I think is really what the estimated average requirement should be. Is that there's not much magnesium in meats and in some of your regular refined foods or your vegetables like corn and potatoes type of things. Whole grains is another source, but there's people who just usually aren't eating whole grains, nuts, peas and lentils and green leafy vegetables.

KIRK HAMILTON: Really? Really? You're preaching to the choir, man. Don't get me started. Tell me while I got you here. You talked about bone and magnesium, did you say? Give me your two cents on magnesium's importance in bone because all you hear about is calcium, vitamin D and sometimes a few other trace elements.

DR. FORREST NIELSEN: Well this is one of my major focuses right now in my research. Obesity sometimes is associated with inflammatory stress which results in increased bone loss. My interest in this is to see whether that increased bone loss caused by obesity can be exacerbated by magnesium. I think it can because magnesium itself seems to even result in bone changes especially in strength and in trabecular bone type changes when low, if calcium intake is very very high. It's because calcium seems to be antagonistic to magnesium. And therefore if you don't give calcium and magnesium together you're not going to get any benefits from the calcium.

KIRK HAMILTON: Well while I have you here then, are you a 2:1 calcium/magnesium person, a 1:1 magnesium to calcium person? What would be your -

DR. FORREST NIELSEN: Oh, I would say 2:1.

KIRK HAMILTON: Okay.

DR. FORREST NIELSEN: You know, the recent requirement for calcium is about 1000. You know you should be getting at least 320 to 420 as the requirement by the human, you know, so recent requirements set up by the food and nutrition board, so that comes out to about 2:1. So I would say if you get RDA of both of them, you're gonna do alright. Trouble is most people don't get the RDA for magnesium and they seem to go overboard when they supplement themselves with calcium.

KIRK HAMILTON: So magnesium might work in bone by, one, being an anti-inflammatory agent and, two, also being part of the constituent of bone?

DR. FORREST NIELSEN: Well it's very important for the conversion of 25-hydroxy into 1, 25 (vitamin D) according to my animal experiments. And it's also shown that in animals if you have increases in inflammatory cytokines like TNF-a and IL-6 it results in bone changes that are detrimental in animals also. So yeah, it can do it through an anti-inflammatory basis and it also can do it through some effect on calcium.

KIRK HAMILTON: Well if I could summarize maybe part of what you said going back up to sleep, it would be that you don't want to be chronically inflamed to have good sleep, you want to have adequate magnesium on board, and not be obese.

DR. FORREST NIELSEN: But you know sleep is a common complaint for older individuals. They had a workshop on sleep health in aging held in 2003 and the summary of that workshop found that more than half of all people over age of 65 experienced sleep problems, and insomnia affects almost a third of the older Americans. And this can result, because of the chronic inflammatory stress, in increased risk for cardiovascular disease and for osteoporosis, for diabetes and things of this nature. And they find that this is not a natural part of aging. It's caused by the other factors including some of the drugs they take, but one of the major things they think it (poor sleep quality) is caused by is nutrient deficiencies and one of those might be magnesium.

KIRK HAMILTON: I'm with you. Alright, Dr. Nielsen, I think we're gonna wrap it up. Do you have any other closing comments you'd like to make?

DR. FORREST NIELSEN: Take some magnesium. You might sleep better.

KIRK HAMILTON: Well I will. And I hope you will too. And keep up with the great work at the USDA. I mean that. I have a great appreciation after spending hours on the websites digging through all the tables. That's I think money well spent in my opinion. So thank you.

DR. FORREST NIELSEN: Well thank you.

KIRK HAMILTON: And I want to thank you, the audience, for listening to this edition of Staying Health Today Radio. And until next time, Stay and Be Well.

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