How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask DrThomasMd Your Own Question

DrThomasMd
DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience:  Training in all aspects of health care, complementary and alternative medicine, prevention, health.
24257177
Type Your Health Question Here...
DrThomasMd is online now
A new question is answered every 9 seconds

Are there people on here that I can consult regarding nutritional

Customer Question

Are there people on here that I can consult regarding nutritional problems such as mineral deficiencies? I do not want any advice concerning homeopathic remedies as they have never had any effect. However I do need nutritional and supplement advice badly.

I have quite a few issues but one that has been causing severe symptoms lately is electrolyte problems. I seem to have symptoms of deficiency or excess of potassium but I am struggling to figure out what to do. I did have low potassium when I was recently in the hospital for a severe GI bleed caused by aspirin. Ever since I have been extremely sensitive to sodium and potassium. I seem to go back and forth between hypokalemic symptoms and hyperkalemic symptoms. My symptoms during the worst episodes are - muscle twitching, muscle cramps, severe muscle weakness, tingling on my face, hands, and feet, very weak heart rate, and shortness of breath. Calcium seems to help a lot temporarily and I am at risk for calcium deficiency for many reasons. Sodium also seems to help but not as much. I do not really know if my body is low on potassium reserves or what is going on. What do you think I should do?
Submitted: 2 years ago.
Category: Health
Expert:  DrThomasMd replied 2 years ago.
Hello
What is your specific question?
Customer: replied 2 years ago.
DId you get the response I just typed because it did not seem to post?

If not, my specific question for the moment is whether you are qualified in nutrition? I came on here hoping to find a nutritionist or nutritionally trained doctor to consult with about my issues. If you are not qualified can you please refer me to a section on here where I can post my questions about nutrition.
Expert:  DrThomasMd replied 2 years ago.
No post from you other than this.
I am nutritionally trained, board certified in integrative medicine, board certified in internal medicine, trained in functional medicine..etc.

But I have still not seen a question to know if this is going to be feasible.
Let me know what the question is.
Customer: replied 2 years ago.
First off I apologize that this is a complicated case. I have a subscription so I have unlimited questions so I hope you can help considerably since you are certified in nutrition and alternative medicine. If you want to space out your answers so you get paid more then please let me know. Please try to answer all of my questions. First some medical history to reference here and for future questions.

I have been struggling with weight and high/low blood sugar for quite a while after having been bedridden for over a year. I have since been on a low carbohydrate high protein diet for 6 months and was able to lose 40 pounds on that with lots of exercise and small doses of caffeine (25-50mg/day). I have tried all kinds of diets but that is the only one that has ever worked for me. I was feeling marked improvement until that all came to a halt when I was hospitalized about 1.5 months ago for severe GI bleed caused by aspirin. I do not know how many nutrients I may have lost during that and before the bleeding became severe. I have been struggling tremendously to recover from that as these electrolyte and other nutritional problems were far lesser issues before the GI bleed. Prior to that I had been able to exercise hard for nearly 2 hours per day, was losing about 2 pounds per week, and gaining muscle. Now I have debilitating symptoms and can only exercise briefly and with much less intensity or I feel like I will pass out.

To try to make up for the caloric deficit required in order to lose weight I have been taking supplements but I have been struggling to figure out what to take and how much so to not cause imbalance with other nutrients. A few times for a while I was taking too much of individuals and caused worse problems. In particular I have struggled to get enough calcium and magnesium due to lactose intolerance and that magnesium rich foods are not very plentiful. I have long struggled to get enough nutrients from food alone so supplements have been very necessary, especially when exercising hard and losing weight.

My diet has been eating mostly chicken, turkey, lean beef, beans, some low carb veggies and leafy greens, whole wheat crackers, eggs, and egg white protein shakes mixed with fruit juice. Even when in the past I had very low body fat I still weighted 230 pounds because I am very muscular so I generally need substantially more nutrients than a normal person, especially protein (typically needed 100-150 grams per day depending on activity level). Exercise has been a major issue as I know that requires even larger amounts of nutrients and that is how I had recovered very substantially from my other issues before the GI bleed. I also sweat profusely which might be contributing to the electrolyte problems.

I have had mild symptoms of mineral and vitamin deficiencies for a while but ever since the GI bleeding and further bed rest deconditioning they have become pretty severe. The worst have been the very high sensitivity to sodium and potassium that are producing episodes severe enough to pass out unconscious sometimes. During the worst episodes the symptoms have been muscle twitching, muscle cramping, severe muscle weakness, very weak heart rate, tingling on my face, hands, and feet, feeling cold arms and legs, and shortness of breath. They always seem to be worst after exercise and when I eat foods very high in potassium such as egg protein shakes, bananas, or orange juice. I have used calcium and salt water to treat the most severe episodes and so far this has showed profound temporary improvement, especially the calcium.

I did show hypokalemia the entire time in the hospital and felt what seemed to be severe *hyper*kalemic symptoms when I was given large potassium supplements. I have also felt strong symptoms that could be attributed to low calcium and magnesium reserves. I have had hypocalcemia in the past several times so I also have a history of low calcium.

Overall I am trying to figure out what/how much to eat and which/how much supplements to take in order to support the exercise required to recover from the deconditioning, anemia, nutritional issues, and get my weight down to a healthy level. Right now I feel the exercise is just making things worse because I am either low, not getting enough, or taking in too much of certain nutrients.

Specific questions -

What do you think could be causing these seeming electrolyte problems? And how do you distinguish hypokalemic from hyperkalemia symptoms as the descriptions I have seen are often the same? How do you treat hypokalemia without causing hyperkalemia and vice versa? I know supplementing with potassium can be dangerous for this reason.

If I am deficient in calcium would it be harmful to take larger amounts than RDA for a while? My intake had been very low for many months but I did not realize it until seeming deficiency symptoms became worse such as painful joint injuries, tooth pain and decay, muscle twitching, and numbness. These all improve substantially after taking more calcium and magnesium.

Do you think the consequences of the GI bleed could have a lot to do with these electrolyte and nutritional problems?
Expert:  DrThomasMd replied 2 years ago.
OK
Hypokalemia or such problems will not correct if there is magnesium deficiency...which is what your symptoms are..magnesium deficiency.
It is intracellular so serum magnesium is a worthless measurement..anything under a level high in the range is suspect.
An intracellular [red cell] magnesium is more reliable.
Calcium and potassium will not balance correctly unless the magnesium is corrected.
This is not done well with food or oral supplements [takes a year in some cases].
Magnesium taurate is somewhat reliable.
A trans dermal magnesium is much faster...4 weeks.
It is not harmful to take 1500 mg of calcium, but i don't think calcium is the primary problem.
The GI bleed is not the current problem in electrolyte imbalance.

Kidney function must be assessed.
DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Thank you very much. You are obviously well versed in this as my doctor dismissed me outright when I recited from medical literature that potassium/sodium issues will not correct if there is magnesium deficiency. She only measured serum and it was low normal.

These recent severe symptoms do seem much more in line with potassium and sodium dysregulation but I know calcium and magnesium are intimately related. My doctor said my kidney tests were fine but that is the same doctor that dismissed my claims of magnesium deficiency.

Which values should I check to evaluate kidney function?

I have been taking magnesium for many months (oxide for a while, now citrate and amino acid chelate recently) and that has seemed to have a good temporary effect, however I can't take more than about 800mg per day without getting diarrhea which I know can worsen other nutrient losses. I am also worried that too much magnesium will disrupt other minerals such as calcium which I certainly have not been taking enough of for a long time. A lot of these symptoms are described with calcium deficiency as well, especially the numbness and tingling, muscle twitching, weak heart beat, and shortness of breath. I know I have been doing a lot of things that deplete calcium. And as I said I have shown hypocalcemia many times in the past and it was at the bottom of normal in the recent hospitalization.

How will taking extra magnesium affect other minerals/vitamins, especially calcium?

If the GI bleed is not a factor then why did these symptoms get so much worse soon after? I actually felt substantially more stable when I first got out of the hospital but after being on omeprazole (which I have since read is notorious for causing malabsorption) for a month and being bedridden for another month I have been slowly feeling worse. My doctor did say my recent red blood cell count had abnormal size and my hemoglobin was still only 11, up from 6 at the lowest. She said to keep taking iron.

How do I determine if I am low on reserve of potassium or am too high? In spite of blood levels showing hypokalemia, why do you think I feel severe *hyper*kalemic symptoms when eating or taking higher amounts of potassium? Should I supplement with potassium or eat more potassium?

What form of transdermal magnesium should I get and what should I expect?

Are there ways to take magnesium sublingually to bypass the GI tract?

What about Epsom salt (magnesium sulfate)?


I really need to figure out something quick that can offer substantial improvement because these symptoms are quite severe and I can't end up in the hospital again because they will not know how to treat this. Other than the blood transfusions everything they gave me before only made things worse.

Any advice or guidance I would really appreciate.

Thank you so much for your help.
Expert:  DrThomasMd replied 2 years ago.
Kidney
CMP
Urinalysis
Urine protein to creatinine ratio.
Mag oxide gives diarrhea because it is not absorbing well enough
A trans dermal cream or sublinguil drops will.
magnesium tells calcium where to go to some degree.
Iron is the main thing that needs replacement with too much blood loss. Mag and K are both important as well however.
Potassium is accurately reflected by serum levels unless there is an acid base imbalance..then the levels are not entirely accurate.
I don't think your symptoms are from potassium as long as serum levels are correct.
Potassium unlike magnesium is plentiful in plant foods.
Mag sulphate is not as well absorbed transdermally as mag chloride..and you might not need the sulphate.
You can find an alternative doctor to kickstart mag IV
here
www.acam.org
If you call them.

Please Click Accept to give answer credit so I am compensated for time and expertise. Come back if needed. Bonuses and positive feedback most helpful. Answers for informational purposes only, not to replace your physician advice or visit.
Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites.

DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.
The only readings I have for kidney function are from the first blood draw in the ER:
low hemoglobin 6, low hematocrit 20 low, BUN 10, Creatinine 0.8, Total protein 6.7, low Potassium 3 , low Calcium 8.7.

Can you tell anything about my kidneys from that? My doctor said my kidneys were fine and I hope she was right. Like I said my potassium was low on every blood draw in the hospital and they gave me several potassium pills so the levels are not good. Also I had brought my own calcium and when I took those in the hospital I felt profound improvement for a few days.

Why do you think I feel severe symptoms when I eat or take a lot of potassium at a time? How can I take in enough potassium if I always feel these symptoms when I eat more? I am most concerned about the numbness and tingling and extreme weakness, and very weak heart beat. I have never felt symptoms that intense before the GI bleeding.

What dose of magnesium should I be taking if I am so depleted?

It could be a coincidence but these symptoms did seem to get worse when I recently cut my carbohydrates even more and increased exercise because I found that I had been gaining fat since the GI bleed. My muscles have been recovering far slower since doing so and I have been feeling weaker and weaker. I also went from eating too much salt to possibly not getting enough because I sweat so profusely (I can see a thick ring of salt around my neck on my shirt usually so it seems I lose a LOT of electrolytes from sweat).

Could recently cutting my carbohydrates even further and reduced sodium be a part of this?
Customer: replied 2 years ago.
Oh and my sodium was also low at 134 when I was in the ER.
Expert:  DrThomasMd replied 2 years ago.
Kidneys are fine from this
Potassium needs to be rechecked now
500 mg a day on a trans dermal system, even 700 ..with your docs knowledge.

The high protein diet is terrible and unhealthy.

Real food, plant food and not too much.
The basic rule.
With some variations.

Your Adrenal function should also be checked.
AM cortisol.
DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.
I consulted with you 2 weeks ago about my nutritional issues. I hope you can review the above thread if you have forgotten for context.

Since I have been taking more calcium and magnesium the high salt and potassium sensitivity has seemed to have improved. However I am still struggling greatly trying to figure out the calcium and magnesium issue. When I try to take more than 600mg of magnesium in a day I frequently get diarrhea (today I went 4 times and it was almost like brown water). I know diarrhea only worsens the problem with deficiencies and electrolyte balance.

What type(s) of magnesium cause the least GI problems, specifically the type that would allow maximum dosing with the least diarrhea? Can you please recommend very specific types, maybe even brand names.

I have tried magnesium oxide, citrate, rice protein chelate, and vegetable protein chelate. Oxide and citrate seem to be the worst for diarrhea and I have felt the most dramatic improvement from the vegetable protein chelate (Source Naturals Magnesium Chelate). I have not tried taurate yet. I have read quite a few articles that say magnesium glycinate causes the least diarrhea. Do you agree with that?

Also I am having a lot of trouble figuring out the ratio of calcium to magnesium. If I have too much calcium I feel overly sedated and very weak. If I take too much magnesium I often feel overstimulated. I have read these are typical effects but I am having trouble figuring out how to determine how much to take of each as it seems different every day. Do you have any advice on determining that?


Customer: replied 2 years ago.
I consulted with you 2 weeks ago about my nutritional issues. I hope you can review the above thread if you have forgotten for context.

Since I have been taking more calcium and magnesium the high salt and potassium sensitivity has seemed to have improved. However I am still struggling greatly trying to figure out the calcium and magnesium issue. When I try to take more than 600mg of magnesium in a day I frequently get diarrhea (today I went 4 times and it was almost like brown water). I know diarrhea only worsens the problem with deficiencies and electrolyte balance.

What type(s) of magnesium cause the least GI problems, specifically the type that would allow maximum dosing with the least diarrhea? Can you please recommend very specific types, maybe even brand names.

I have tried magnesium oxide, citrate, rice protein chelate, and vegetable protein chelate. Oxide and citrate seem to be the worst for diarrhea and I have felt the most dramatic improvement from the vegetable protein chelate (Source Naturals Magnesium Chelate). I have not tried taurate yet. I have read quite a few articles that say magnesium glycinate causes the least diarrhea. Do you agree with that?

Also I am having a lot of trouble figuring out the ratio of calcium to magnesium. If I have too much calcium I feel overly sedated and very weak. If I take too much magnesium I often feel overstimulated. I have read these are typical effects but I am having trouble figuring out how to determine how much to take of each as it seems different every day. Do you have any advice on determining that?
Expert:  DrThomasMd replied 2 years ago.
magnesium is poorly absorbed in many supplements.
500 mg a day should be the dosage.

Magnesium taurate is the better oral supplement, absorbs better.
You can try glycinate as well. It has had favorable reviews.

Calcium I prefer to get mostly from food, and keep the ratio of calcium to mag 1:1 as far as supplements go.

Let me know if you have further questions, details or need clarification, just use reply.......

Please Click Accept to give answer credit so I am compensated for time and expertise. Come back if needed. Bonuses and positive feedback most helpful. Answers for informational purposes only, not to replace your physician advice or visit.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites.
DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.
Will any type of magnesium cause diarrhea if you take large amounts (more than 500mg)?

Do you recommend a specific product that you have experience with that works best? Does capsule form or tablet form effect the rate of digestion, and maybe more likely cause diarrhea?

I always seem to get diarrhea if I take more than 400mg of any form. However I have not tried taurate or glycinate yet. Do you have any tips for taking larger amounts without it causing diarrhea?

The issue with calcium is that I am lactose intolerant and also seem to have developed an allergy to cheese over recent years, which I used to be able to tolerate. Now it is causing weak rapid heart rate, sweating, and breathing difficulty. What foods besides dairy are best for getting sufficient calcium?

And also since the calcium supplement by itself often causes over-sedation, is that because it is not being absorbed by the bones or cells, or does it mean I am taking too much at a time?


Customer: replied 2 years ago.
I was notified this thread was "closed". Did you get my recent questions on 4/3?
Expert:  DrThomasMd replied 2 years ago.
Hello
Taurate you can actually take 300 mg and it might be as good as more with the other supplements.
So 500 of taurate ought to be adequate and probably not cause diarrhea.
The trans dermal and sub lingual forms do not cause diarrhea at all.

Foods for calcium..dairy is not the best.
Dark greens, cooked. Kale, collard, turnip, etc...better than milk
Broccoli.

Dairy does not have the greatest calcium to phosphorus ratio, so it is listed with high calcium foods, but this is somewhat erroneous

See various lists for more ideas
http://www.healthaliciousness.com/articles/foods-high-in-calcium.php

Let me know if you have further questions, details or need clarification, just use reply.......

Please Click Accept to give answer credit so I am compensated for time and expertise. Come back if needed. Bonuses and positive feedback most helpful. Answers for informational purposes only, not to replace your physician advice or visit.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites.
Customer: replied 2 years ago.
I am still trying to determine how much calcium and magnesium I should be taking because they both continue to have very strong effects, either positive or negative.

Today I took only 500mg of calcium by it self many hours after taking magnesium. Within an hour I started feeling very weak, chest tightness, increases thirst, increased urination. This has happened many times since I started taking more calcium but seems to reverse when I take more magnesium, or take less of both. Sometimes it took a few days to reverse if the doses of calcium were really high.

A few weeks ago I did have what seemed to be strong signs of calcium deficiency. To that point I had hardly been taking any and was not eating much calcium either. The seeming deficiency symptoms of sore joints and joint injuries that would not heal, teeth and gum pain, and muscle twitching - these almost immediately started improving when I started taking more calcium. I have had these symptoms many times before because of lacking dietary calcium and each time these same symptoms improved with calcium supplementation.

I am wondering if maybe I overcompensated and took too much calcium because it seemed to help the seeming calcium deficiency symptoms so much. Several times I have taken over 3 grams of calcium in a day however I noticed that although some things improved I would feel much more fatigued for a day or two. I want to try and figure out a dose for both that has neutral effects and stick with that, however no matter what ratio I try the effects seem to be different almost every day.

Do you think that possibly that by overcompensating for what seemed initially to be a calcium deficiency caused/worsened a magnesium deficiency by high levels of calcium driving down magnesium?

Is it not healthy or normal to be feeling such strong symptoms from calcium? If I continue feeling such symptoms should I cut back on calcium until I do not feel them so strong, or increase magnesium accordingly to compensate for the calcium?

Customer: replied 2 years ago.
Another question is in regards XXXXX XXXXX numbness and tingling. I feel pretty consistent numbness/tingling on my hands and feet which seems to spread to my lower legs and arms when I take too much or too little of either calcium or magnesium but I am not sure which is causing it - low/high magnesium, low/high calcium, or also maybe high/low sodium/potassium.

I did seem to have calcium deficiency and those symptoms did improve considerably before, but like I said maybe I overcompensated and aggravated low magnesium levels. Which do you think is more responsible for the numbness and tingling - low/high calcium or low/high magnesium?
Expert:  DrThomasMd replied 2 years ago.
many researchers feel a one to one ratio is good for supplementation. I use magnesium supplementation without calcium, and get the calcium from food.
In fact ideally we would use the balance in food, but most food is magnesium poor.
Any actual electrolyte imbalance could contribute to tingling, but magnesium would be more common.
Calcium is present in a lot of food stuffs, it is far easier to get too much.
Please Click Accept to give answer credit so I am compensated for time and expertise. Come back if needed. Bonuses and positive feedback most helpful. Answers for informational purposes only, not to replace your physician advice or visit.
Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites.
DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.

Dr. Thomas, 3 weeks ago I had a seeming episode of heat exhaustion and showed low potassium, low sodium, and mild Anemia on blood work. Only a basic panel was checked. These symptoms stabilized after about a week of taking electrolyte replacement drinks and electrolyte supplements.

This past week I have had about 8 episodes of watery diarrhea and have been since experiencing severe episodes of dehydration, to the point where I appear very pale, cold, and have collapsed unconscious. I have painful muscle cramps and muscle twitching all over. I have had to keep replacing electrolytes and drinking water or these dehydration episodes continue to worsen until I can't stand upright without passing out unconscious. The diarrhea seems to have stopped as last 2 days movements were no longer liquid.

Other symptoms seem to depend on severity of dehydration - extreme weakness, dizziness, fluctuations between low and high blood pressure, alternate between weak and slow pulse (<50) and weak but fast pulse, shortness of breath, nausea, excessive thirst and urination, chest tightness, cold/pale skin and collapsed veins when most dehydrated.

Initially my doctor thought I had depleted electrolytes from the heat exhaustion and electrolyte replacement seemed to do the trick then. However after the more recent diarrhea these dehydration episodes have become severe unless I am frequently replacing fluids and taking all 4 major electrolytes.

 

I have been drinking electrolyte replacement drinks and eating foods high in potassium and magnesium, moderately high in sodium, and taking magnesium glycinate and calcium. The magnesium has seemed to have had dramatic effect when taken with potassium, but is has not lasted more than a few hours unless I continue taking small amounts. I remember when I had reported these same symptoms before you had said potassium deficiency will not correct until magnesium deficiency is corrected. That has seemed the case here as potassium alone only seems to worsen my symptoms.


What do you think is going on?
What do you recommend for treatment?

 

How serious might this be, and if it were to worsen at what point should I seek emergency care?

Expert:  DrThomasMd replied 2 years ago.
Hello again
Sorry for the delay
It will be faster to find me by request in medical
Have stool samples been done?
Customer: replied 2 years ago.

I had a stool sample checked for blood after the heat exhaustion out of concern there was further internal bleeding but it was negative. I don't know what test my Dr did for that.


 


My watery stools recently have looked like brown colored water. During that time I was going several times a day (9 total times I think) with it watery every time. The last three days it has returned to once a day and it is more solid, still kind of gooey but solid and brown colored.


 


I suppose it is possible there has been more bleeding but my Anemia now was only a 2 point drop in hemoglobin between May and September. During that time I felt much more stable than I do now. Hct, RDW, RBC were also mildly low 3 weeks ago.


 


I had felt far more stable before the heat exhaustion, exercising every day, etc. For a week after that I felt huge improvement from electrolyte replacement and magnesium, calcium supplements. Currently I have again felt strong improvement from these but it does not last, and if I don't continue supplementing the dehydration continues to get worse until it is so severe I black out unconscious and show all the symptoms I listed before.

Expert:  DrThomasMd replied 2 years ago.
What was your exact sodium and potassium value and what are they now?
Customer: replied 2 years ago.

After the heat exhaustion, when I was much more stable, after I had already been rehydrating and replacing electrolytes, sodium was 132, potassium 3.4.


 


I do not have current values as I can't get them checked during these episodes of dehydration because the symptoms are way too intense to be going to get blood drawn.

Expert:  DrThomasMd replied 2 years ago.
OK
These are ok and not serious.

Right now you need stool samples
The test for blood checks nothing and these are special tests
Parasites....3 samples at least collected at different times. The doc will give you home kits or you can pick them up at the lab on his order.
Also test for bacteria and for c-difficile.

Thyroid function tests need to be done if not done recently.
Hyperthyroid can do this.
This is not part of the routine labs already done.

If this continues and there are no lab explanations, colonoscopy should be considered.

Let me know if you have further questions. Just use reply if you are not done.

Please rate one of the positive ratings: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

Customer: replied 2 years ago.

I am fairly certain the diarrhea was caused by food poisoning. I am less concerned about that now since it has seemed to have stopped over the last 2 days. But I am very concerned about recovering from the effects of the severe watery diarrhea for several days.


 


How long does it take for potassium and sodium to replenish if they are severely depleted from diarrhea or other causes? What kind of doses are needed? Does it take a long time to recover from like it does with magnesium deficiency?


 


What is the best way to go about it?


 


 

Expert:  DrThomasMd replied 2 years ago.
They are not badly depleted at all
Not critical
A week
What I would be more concerned about is magnesium which is not measure, and I would supplement extra on that.
Sodium and potassium you can get from food and electrolyte drinks.

Magnesium as magnesium taurate, 300 to 500 mg daily.

As long as your docs know what you are doing, of course.

.

Please rate one of the positive ratings: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

 

DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.

 


 


I have a few follow up questions for this thread.


 


 


 


 


It does seem that high sodium intake has been the trigger for these recent severe episodes of electrolyte symptoms. High sodium diet for several months seems to have slowly worsened these symptoms over time. Then they became worse after an episode of heat exhaustion, and then severe after the watery diarrhea. I have only had blood checked after the heat exhaustion a month ago when potassium was low along with several other things. I don't know how low potassium is now, or how low magnesium is. However as you said in the past the blood levels don't reflect the intracellular levels.


 


Lately whenever I have consumed larger amounts of sodium and then lose much water, either through sweat or urine I feel worsening slow and weak heart beat, dizziness, and shortness of breath, tingling, muscle spasms, twitching, painful muscle cramps, excessive thirst and urination. If I don't start drinking water and taking electrolytes they continue to worsen until I can't even stand up without blacking out.


 


 


Do these sound more like the effects of high blood sodium, or high sodium causing or aggravating low potassium? Or more to do with low magnesium or calcium?


 


 


 


 


 


I am very concerned that I have again caused magnesium deficiency, and that is what is causing my again very high sensitivity to sodium and potassium. 2 months ago I could eat 5-10 grams of sodium in a day and hardly feel a difference. Right now more than 1 gram over an hour and my blood pressure shoots up from 130/80 to 180/100, pulse gets very slow and weak, I feel very dizzy and short of breath, muscles twitching, painful muscle cramps, dry mouth and increased thirst, and increased urination.


 


 


 


 


 


Magnesium glycinate has again had a strong temporary effect reversing these symptoms many times now. And increasing potassium rich foods also seems to help reverse these symptoms especially when taken with the magnesium. However as soon I as eat more than about 1 gram of sodium even spread over a few hours, the symptoms start worsening again quickly.


 


 


How long supplementing with magnesium does it take for sodium retention/sensitivity to improve?


 


Are there other mineral/vitamin deficiencies that can cause or worsen sodium sensitivity/retention? I have read b vitamins, especially B6 affect magnesium metabolism but I am not sure how?


 


If magnesium deficiency is present how much longer does it take for potassium levels to normalize, particularly replenishing intracellular levels?


 


Does it affect the amount of magnesium absorbed if I take it with an equal amount of calcium? I have found I feel even worse without balancing the magnesium with calcium.


 


 


 


 


 


 

Expert:  DrThomasMd replied 2 years ago.
Hello again!
I think I have recommended blood tests and working with a functional medicine doctor that can take care of you.
www.functionalmedicine.org
If not, before , then now.

Magnesium blood levels should be at least 2.5.

A relative magnesium deficiency does not usually affect sodium.

High sodium intake is of course not a good idea.

However passing out on standing up implies orthostasis, a drop in blood pressure, and might not have anything to do with your minerals.
This needs work up as well.
Electrolytes, calcium and magnesium should now by checked.
Thyroid studies
AM Cortisol
Orthostatic checks.
If the doctor thinks this might be autonomic dysfunction than a tilt table test.

You might start with the functional medicine doctor first as they will have a good handle on electrolyte interactions with hormonal and neurotransmitter function.

Let me know if you have further questions. Just use reply if you are not done.

Please rate one of the positive ratings: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.

I have a few more questions regarding magnesium deficiency and electrolyte imbalance.


 


I have continued to supplement with magnesium glycinate and the short term improvement in all my symptoms is usually very strong and obvious. Conversely when I do not take enough magnesium I feel greatly intensified symptoms when taking/eating substantial amounts of calcium, potassium, or sodium. I remember you saying and my reading many times that electrolyte imbalance will never resolve without adequate magnesium.


 


I am curious of other dependencies. I am aware that for potassium to absorb into the cells there needs to be sufficient magnesium, and that magnesium is essential for proper calcium absorption, metabolism, and storage in the bones.


 


Does magnesium absorption depend on any minerals or vitamins for absorption into the body?


 


Once absorbed into the blood does magnesium depend on any mineral or vitamins in order to be properly absorbed into the cells (like potassium requires magnesium to enter the cells)?


 


I have read that magnesium is stored mostly in the bones. Is magnesium dependent on any minerals or vitamins in order to be properly stored into the bones?


 


How much magnesium do I need to supplement with in order to make sure the magnesium reserves are being replenished and the supplements are not just treating my symptoms only acutely?


 

Expert:  DrThomasMd replied 2 years ago.
Magnesium absorption is inadequate because most supplements do not absorb well and you are only getting a fraction of what you take, and if you take too much it simply causes diarrhea or loose stool and less absorption.

It is not particularly dependent on other minerals or vitamins to absorb or store.

So the best supplementation, as I always say, is a trans dermal magnesium, a cream that has magnesium chloride that absorbs through the skin. Or soaks, or sub lingual drops.

As far as oral supplementation, magnesium taurate.

A safe dose in all cases as long as your kidneys are fine is 500 mg a day.

This can be in addition to any magnesium in your multivitamin.

Let me know if you have further questions. If you have any concerns just use reply to expert until you are ready to rate a positive for your satisfaction..

Please click on one of the positive ratings [smiley faces]: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas



DrThomasMd, Board Certified MD
Category: Health
Satisfied Customers: 57785
Experience: Training in all aspects of health care, complementary and alternative medicine, prevention, health.
DrThomasMd and 5 other Health Specialists are ready to help you
Customer: replied 2 years ago.

I have many electrolyte imbalance/deficiency symptoms as I described above, but I am trying to figure out what is causing the neurological symptoms as that might be a big clue in figuring out which electrolytes are most out of balance.


 


I have been feeling severe muscle cramps, spasming, and twitches all over my body and my eyes for weeks and they have been getting worse, despite eating lower sodium, high potassium diet. I know the heart is a muscle also and it seems to be strongly effected when these symptoms are the worst, feeling chest tightness, big shifts in blood pressure and pulse, and breathing difficulty. They also seem to worsen when I get too dehydrated which is often because of excessive urination. The excessive urination seems strongly to be caused by the electrolyte imbalance as some days it is much less an issue when I try different combinations of electrolytes.


 


Which electrolyte(s) are most responsible for the muscle cramping, spasms, and muscle and eyes twitching?


 


I know calcium, magnesium, sodium, and potassium all play critical roles in muscle function but it has been very difficult to figure out which is causing the worst of the cramps and spasms. I can't figure out for certain but it does seem that when I take much higher magnesium, although my blood pressure, pulse, and shortness of breath improve a lot the cramps seem to actually worsen. Calcium seems to improve the cramps sometimes but seems to worsen other symptoms. I can't really tell how much the potassium affects the cramps because since it is in food it absorbs much slower.

Expert:  DrThomasMd replied 2 years ago.
Hello
Refresh my memory
Have you seen a neurologist and had any pertinent testing?
Customer: replied 2 years ago.

I don't know how much detail you need to refresh your memory. Do you not have access to the previous posts on this thread? I asked you questions recently about magnesium deficiency. I will just re-write to make sure.


 


This is not a problem for a neurologist. It is clearly due to electrolyte imbalance and other nutrient related issues as these are longstanding issues with me. I have had blood tests done many times over the last year and recently. I have shown at different times low readings of potassium, sodium, calcium, and magnesium (low normal, although I have had pronounced symptoms indicating magnesium deficiency and very pronounced improvement from supplementation).


 


Over the past 2 months I have had heat exhaustion twice, a week of watery diarrhea from food poisoning which has since stopped. Prior to that for several months I had been exercising and sweating heavily, consuming a high sodium diet low carbohydrate diet to lose weight. I have ever since had severe symptoms of electrolyte deficiencies and frequent continued episodes of dehydration because of excessive urination, which varies widely from normal frequency to as often 40 times per day, seeming to depend heavily on electrolyte intake.


 


The most prominent symptoms have been wide fluctuations in blood pressure (as low as 90/50, as high as 180/110), wide fluctuations in resting pulse (40-110), varying shortness of breath from moderate to severe, varying excessive thirst and urination, painful muscle cramps, muscle spasms, muscle twitching, back and neck pain, eyes twitching. These symptoms have strongly correlated with hydration and electrolyte intake, sometimes improving, sometimes worsening greatly.


 


Right now I am asking which electrolyte(s) are most likely causing the severe muscle cramps, muscle tightness, muscle spasms, muscle twitching, back and neck pain, eye twitching because these seem like major clues to figuring out what I need most?


 


It must be either or some combination of magnesium, calcium, potassium, sodium, because when I do guess right the muscle symptoms improve markedly but only temporarily. Then when I guess wrong they worsen greatly.


 


I have continued with magnesium glycinate which often has shown strong improvement in many symptoms, but sometimes seems to worsen the muscle symptoms when in higher amounts, perhaps affecting calcium levels.


 


I also have longstanding symptoms that seem to indicate calcium deficiency such as painful joints, easy joint injuries, brittle nails and hair, tooth pain and yellowing and rotting and chipping teeth, despite consuming no sugar and daily brushing. I know magnesium and calcium take much longer to replenish than potassium and sodium and these seeming calcium deficiency symptoms have been going on much longer. I know magnesium deficiency can cause chronic hypocalcemia and poor absorption so perhaps that is a major factor here.


 


Another question would be how much calcium would I need to consume per day to treat a long standing calcium loss/deficiency, accounting for my large frame of 6'1" 235 pounds?


 


 

Customer: replied 2 years ago.

 


Which electrolyte(s) deficiencies are most likely to cause severe muscle cramps (and in muscles that have not been exercised recently), muscle twitching, eye twitching, back and neck pain?


 


I feel many other symptoms mostly heart rhythm related but these muscular symptoms seem like if I can figure out what is causing those I can figure out which electrolytes I need more of at what times according to symptoms.


 


I have not been getting enough calcium for a long time because of my lactose intolerance and I have many symptoms of that which improve markedly when supplementing. Months ago I had the same symptoms and they had improved dramatically from increasing calcium and balanced with magnesium but over time they returned after months of high sodium diet, huge fluid losses from exercise, and watery diarrhea.


 


Right now sometimes the calcium dramatically improves my symptoms, but sometimes if I take too much calcium I feel much worse different symptoms. It seems too much calcium aggravates the magnesium deficiency. And too much magnesium aggravates the calcium deficiency. The ratio seems different every day and when I guess the ratio correctly I feel very marked temporary improvement, when not I feel much worse, with increased nausea and urination, and other symptoms.


 


How can you recover from a calcium deficiency when you also have a magnesium deficiency and magnesium so strongly affects calcium absorption and metabolism?



How can I determine how much calcium I need assuming long standing deficiency and that I am very large and at risk for poor absorption and losses for many reasons? I have painful joints, easy injuries, brittle hair and nails, rotting and sore teeth.

Expert:  DrThomasMd replied 2 years ago.
Hello
I can 't see anything that we have not covered already.
Is there a specific question?

The problem is that many of your symptoms are not from electrolyte imblance
I had asked you what types of doctors you have seen and what conclusions they have drawn.
Customer: replied 2 years ago.

 


 


 


 


 


 


 


These same symptoms have resolved over time many times before after figuring out proper supplementation and diet, this time however has been much more difficult to figure out. I can't figure out which are causing the which symptoms and how much I need of calcium, magnesium, sodium, potassium. If I take too much of any one it seems to aggravate the others and cause worse symptoms.


 


Specific questions:


 


Which electrolyte(s) are most likely to cause severe muscle cramps (even in muscles that have not been exercised recently), spasms, muscle twitching, eye twitching?


 


 


 


How do you recover from calcium deficiency without the increased calcium intake aggravating magnesium deficiency or causing low magnesium symptoms? How do you recover from magnesium deficiency without the increased magnesium interfering with calcium absorption or causing low calcium symptoms?


 


I have tried 1:2, 1:1, 2:1 calcium to magnesium and at different times one ratio seems to work for a few days and then I start feeling worse until I take more of the other. It seems like I am going back and forth between increased calcium causing low magnesium symptoms, and increased magnesium causing low calcium symptoms.


 


Could taking the highly absorbable forms of calcium glycinate and magnesium glycinate be causing too much to be absorbed at a time? The effects are very strong and often times a dose that works one day seems to greatly increase urination another day which I know flushes out other electrolytes.


 


How much quicker might these highly absorbable supplements correct magnesium or calcium deficiency?


 


 


How much of a role could potassium be playing? I know you had said that low magnesium prevents potassium repletion, and with the excessive urination I might be losing a lot there.


 

Expert:  DrThomasMd replied 2 years ago.
Cramps, magnesium potassium and calcium. Magnesium especially.
It is not clear you have calcium deficiency from anything you have presented, but it does not compete for absorption with magnesium, you can take them together even.
2:1 calcium to magnesium is the standard but 1:1 is promoted by some researchers.
The type of supplement matters more for magnesium High absorption is generally not the problem, but getting too much for too long can be.
Potassium is plentiful in food. The more vegetarian the diet, the more potassium.

Excessive urination has another cause, and again I recommend you start working directly with a doctor.
Specifically given your inclinations, a functional medicine trained MD of internal medicine or family practice.
www.functionalmedicine.org.

Your problems are not all due to mineral imbalance, nor with a regular diet and little supplementation should you have an imbalance, unless there is some other problem.

Let me know if you have further questions. If you have any concerns just use reply to expert until you are ready to rate a positive for your satisfaction..

Please click on one of the positive ratings [smiley faces]: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery
 
 
 
Chat Now With A Health Professional
DrThomasMd
DrThomasMd
4857 Satisfied Customers
Training in all aspects of health care, complementary and alternative medicine, prevention, health.