Nutrients
Fernando Guerrero-Romero, Moises Mercado, Martha Rodríguez-Morán, Claudia
Ramírez-Renteria, et al; This article cites 36 references.
The objective of this study was to evaluate the association of serum magnesium-to calcium ratio with mortality from severe COVID-19.
The serum magnesium-to-calcium ratio is being used as a mortality predictor in
patients with cardiovascular and neoplastic diseases, but “there are no previous
reports evaluating the calcium-to-magnesium ratio as a biomarker for mortality
from COVID-19.”
These authors hypothesized that hypomagnesemia might play an important role in
the pathophysiology and mortality from COVID-19.
The clinical and laboratory data of 1,064 patients, average age of 60 years, were
analyzed. Study subjects were hospitalized by COVID-19. [by, not with]
“Eligible participants were individuals older than 20 years with a positive
polymerase chain reaction (PCR) test for SARS-CoV-2 and a diagnosis of severe
COVID-19.”
The data of 52% of patients who died were compared with the data of 48% of
patients who recovered: “Data from patients discharged per death were compared
vs. data from patients discharged per recovery.”
The magnesium-to-calcium ratio was calculated as total serum magnesium levels
(mg/dL)/calcium (mg/dL).
BACKGROUND FROM DAN MURPHY:
Normal serum magnesium levels are 1.7-2.2 mg/dL (for math, use 2.0)
Normal serum calcium levels are 8.5-10.2 mg/dL (for math, use 10.0)
A rounded typical serum Mg++/Ca++ ratio would be 2/10 = 0.2 mg/dL.
My favorite books on magnesium are:
The Magnesium Factor by Mildred Seelig, MD, PhD, 2003
The Magnesium Miracle by Carolyn Dean, MD, 2014
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Cure Your Fatigue by Morley Robbins, MBA, 2021
These references insist that serum magnesium levels are a poor indicator as to
one’s magnesium levels; they insist that the only acceptable test is RBC magnesium
levels, and the acceptable range is 6.0-6.5 mg/dL.
Carolyn Dean, MD, a true magnesium expert, says:
“Serum magnesium levels are entirely inaccurate.”
“The serum magnesium test is a highly inaccurate assessment of total
magnesium status.” “Magnesium must remain at an effective level in
the blood to keep the heart beating properly. To maintain this crucial
balance, when serum magnesium levels drop, magnesium is pulled out
of bone and muscles to fill the gap.”
“The magnesium RBC test is more reliable.”
Also, Dr. Dean notes that “vitamin B6 is a cofactor for magnesium absorption.”
Dale Bredesen, MD, is a neurologist at UCLA. In his 2017 book, The End of
Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline, he notes:
“Measuring levels of magnesium in your red blood cells, where most of
it resides, produces a more accurate reading than measuring in
serum.”
•••••
I like this study and the prior Article Review 51-22 on magnesium and COVID. My
concern is that the authors used serum magnesium levels, not RBC magnesium
levels, which I believe to be more accurate.
KEY POINTS FROM THIS ARTICLE:
1) Coronavirus disease-19 (COVID-19) is an acute respiratory syndrome due to
infection with SARS-CoV-2 virus.
• “The clinical spectrum of COVID-19 ranges from an asymptomatic carrier
state, or a mild upper respiratory tract infection, to a devastating acute
respiratory distress syndrome with multiple organ failure and high mortality
rate.”
2) “Obesity, type 2 diabetes, arterial hypertension, decrease in immune
response, cytokine storm, endothelial dysfunction, and arrhythmias, which are
frequent in COVID-19 patients, are [also] associated with hypomagnesemia.”
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3) “Several of the well-known COVID-19 risk factors and some co-morbidities
such as acute renal failure, arterial and venous thrombosis, cardiac failure, and
arrhythmias are linked to magnesium deficiency.” [Important]
4) “Magnesium is a calcium antagonist.” [Key Point]
5) Each group was matched (the 52% that died v. the 48% that recovered) in
terms of covariables, including obesity, diabetes, glucose levels, hypertension, and
chronic obstructive pulmonary disease.
• Men and women who died had higher serum calcium levels.
• Men and women who recovered had higher serum magnesium levels.
• “The proportion of individuals who exhibited a magnesium to-calcium ratio
≤0.20 was significantly higher in the individuals discharged per death than in
those discharged by recovery (93.5% vs. 14.7%, respectively).”
• “In the whole population, as well as in women and men, the magnesium-tocalcium ratio was inversely correlated with the discharge per death.”
• “The best cut-off point for the magnesium-to-calcium ratio for identifying
individuals at high risk of mortality from COVID-19 was 0.20.”
• Having a magnesium-to-calcium ratio ≤0.20 increased death in men by 493%
and women by393%.
6) Conclusions:
• “The magnesium-to-calcium ratio ≤0.20 is strongly associated with mortality
from severe COVID-19 provides a new insight that could be useful in the
management of the disease.”
• “Monitoring serum calcium and magnesium levels during hospitalization may
represent a useful strategy for the early identification of high-risk patients,
which would allow timely treatment and appropriate surveillance.”
• In the treatment for COVID-19, “restoring a magnesium-calcium balance is
mandatory.” [Key Point]
• Findings “emphasizes the important role that the magnesium-calcium balance
may play in the prognosis of COVID-19.”
7) “Hypomagnesemia could be a biomarker of a poor outcome from COVID-19.”
8) “Hypomagnesemia has been found to be inversely associated with
cardiovascular disease and chronic inflammation, entities related to a poor outcome
from COVID-19.”
9) “The best cut-off point of the magnesium-to calcium ratio for identifying
individuals at high risk of mortality from COVID-19 was 0.20.” [see math above]
10) “Hypomagnesemia is associated with a decrease synthesis and activation in
vitamin D, an increase in oxidative stress and cytotoxic activity of T lymphocytes,
and with the triggering of cytokine storm.” [Key Point]
• “Hypomagnesemia is also related to abnormal platelet aggregation,
coagulation abnormalities, endothelial dysfunction, and myocardial damage,
entities frequently identified in severely ill COVID-19 patients.”
• Low serum calcium levels are a prognostic factor in determining increased
severity of COVID-19.
Daniel J. Murphy DC, DABCO