This is obviously a complex issue. On one hand, magnesium has clearly helped
@A.B., by his own testimony, yet magnesium made
@Sidereal's symptoms worse. This in itself is understandable, but then
@melamine says:
A.B. and Sidereal have described the primary lung symptom I experience for periods of time, in conjunction with a feeling of pressure or tightness in the chest area -
This seems to be confusing, as these symptoms are due to opposite causes.
@melamine also questions the role of mitochondrial function here, which is a very reasonable question, and certainly enters into the picture.
It is possible to sort all this out into a coherent picture, though, and I will attempt to do so.
I agree with the general thrust of your argument but I do think that in severe and very severe ME, even though the patient has an underlying severe deficiency, magnesium supplementation can be detrimental due to muscle weakness and vasodilation.
This occurs only with an overdose of magnesium - one that causes severe CNS side effects. It's important to remember that multiple studies have shown that the majority of the U.S. population is deficient in magnesium. There's no reason to believe that this is any different in other parts of the Western world, or that ME/CFS patients suffer from this less. To the contrary, Dr. Myhill found that intracellular RBC magnesium tests showed her patients uniformly deficient in magnesium. That is why she has stated that magnesium injections "are so helpful that it is pointless progressing onto other things without trying these first." It is due to her statements that I started magnesium by nebulizer, and have experienced great improvements over the last year as a result.
EDIT: I should add, as I mention later, that not everyone can tolerate these injections, and that for many, the starting dose that Dr. Myhill recommends is too high. I elaborate on this in
this post.
It's also important to note that muscle weakness is often caused at least partially by magnesium deficiency, as magnesium is necessary for proper mitochondrial operation, as well as the generation of new mitochondria. Although not all mitochondrial problems are due to magnesium deficiency, without sufficient magnesium, it is impossible for mitochondria to work properly.
I would also add that Dr Goldstein spoke of the fact that if every ME/CFS case was having glutamate/NMDA excess then everyone would have a positive response to ketamine which quite clearly they do not.
Do you have a reference here? In any case, ketamine is very different from magnesium. Magnesium is required for proper neurological functioning; ketamine is not. You can live fine without ketamine (most people do), but you can't live without magnesium. Ketamine's functions are purely neurological, at least as far as we know, while magnesium plays multiple essential roles in bodily function. People can become tolerant to ketamine to the point where it's no longer effective; this does not happen with magnesium, due to its essential role in body chemistry.
Some do well with NMDA agonists (though I would question whether that reflects a true improvement or just short-term stimulation / fake energy while worsening the underlying redox problem).
It's important to note that different NMDA agonists have different effects. For example, glutamate is the most powerful NMDA agonist. Yet no one does well by ingesting excess glutamate, such as MSG. Yet many people do well on Provigil, which is another NMDA agonist. Provigil also helps in the production of ATP in the mitochondria, which undoubtedly contributes to its beneficial effects.
NMDA agonism in and of itself does not provide lasting benefits. But if combined with treatments that address the fundamental energy deficit in ME/CFS, it can provide impressive symptomatic relief. (Provigil helped me lead a near-normal life for over eight years.) However, many people are too sensitive to tolerate any NMDA agonists at all, and for these people, such drugs can easily worsen their condition.
I still can't tell though what is autonomic dysfunction versus my cells cannot make energy at a mitochondria level when I do any exertion and therefore cannot breathe.
Fortunately, magnesium addresses both problems simultaneously.
Like Sidereal I have experienced a distinct sensation of weakness in the chest. Also some chest pain and tachycardia (but only after a bronchitis). And magnesium does help - no chance of a mistake.
The symptoms of CNS depression and dysautonomia can be very similar, and this is where it can get confusing. The former is made worse by extra magnesium, while the latter is improved by adding magnesium.
CNS depression is not a typical symptom of ME/CFS, and in all the cases we've been talking about, it's been caused by excess magnesium intake. So I think it's quite safe to say that breathing problems experienced by someone who is not supplementing their magnesium are not a symptom of CNS depression. In these cases, such as
@A.B.'s, proper magnesium supplementation will typically help (as he found).
I don't know how much I'm taking, about a teaspoon full of magnesium sulfate. I'm guessing that's about 1g?
One teaspoon of magnesium sulfate is 1.5 grams. The effect it has depends on the method of administration. How are you taking it?
@Gingergrrl - In that kind of situation, my symptoms tend to be more localized - to my arms in your example, as well as contributing to overall exhaustion and PEM to one degree or another. My lung symptoms seem to have become part of low level background noise in the past year or so, but when they're more noticeable they can remain so for weeks or more and have tended to be at least as bad when I lie down as any other time.
Due to the near universal magnesium deficiency in our population, as noted by Dr. Myhill, I think that at least some of your problem can be attributed to lack of magnesium, and that a gradually increasing magnesium therapy would be something that would be very worthwhile to try. I would expect it to help significantly.
My weakness only got that bad if I tried supplementing something that forces energy production on a system that can't handle it, stuff you see people here frequently keeling over from, like methylfolate, methyl B12, CoQ10, D-ribose etc.
As I noted in my previous post, a hypersensitivity to magnesium as you have described is typically indicative of a severe magnesium deficiency. Due to the hypersensitivity of the NMDA receptors that this implies, this can result in hypersensitivity to all sorts of drugs and supplements, including all the ones you list.
@Sidereal, as yours is a rather complex case, we should probably talk more about this via PM.
