Author: Admin (---.vnnyca.adelphia.net)
Date: 09-01-02 17:07
Karen wrote:
Trevor, since so many sarcoid sufferers are concerned about bone loss, I thought this might be of interest:
In today's issue (Sept 1, 2002) of USA weekend, the "Eat Smart" column by Jean Carper promotes the benefits of magnesium. She says that one of the ten benefits of magnesium is strong bones. "Magnesium is as vital as calcium in preventing osteoporosis", says the University of North Carolina's Mildred Seelig. "It's essential for normal bone metabolism." In a Swedish study, magnesium, but not calcium, helped prevent hip fractures in older women. Tufts researchers found high magnesium intake predicted higher bone mass and less bone loss in older people.
"Many people needlessly suffer pain-including fibromyalgia, migraines and muscle cramps-because they don't get enough magnesium," says Seelig, a leading magnesium researcher at UNC. "Many people worsen the problem by loading up on calcium, which flushes magnesium out of cells," according to Lawrence Resnick, MD., a professor of medicine at Cornell Medical Center. He urges getting at least 1 milligram of magnesium for each 2mg of calcium.
According to Carper, the recommended daily allowance for magnesium is 320mg for women, 400mg for men. Avoid magnesium if you have kidney disease. You need extra if you drink alcohol or if you take diuretics or high doses of calcium, since those all deplete magnesium. Other benefits claimed for magnesium include: helps stabilize heart rhythms, cuts odds of dying from common "ischemic" heart disease (blocked or narrowed arteries), helps normalize blood pressure, improves insulin activity and may cut diabetes' risk and complications, reduces intensity and duration of migraines, aids in sound sleep, relieves muscle cramps and painful myalgias, and contributes to safer pregnancies.
Trevor, do you have any insight into magnesium and how it can help a sarc patient?
Karen
Karen, thanks for your excellent post!
But there are fundamental differences between the biochemistry in a patient with active sarcoid inflammation, and an individual without that active inflammation. The reason that there are problems with bone mass in Sarcoidosis arise because of this altered biochemistry, and every treatment for Sarc patients has to take into account that their biochemistry is working a little differently. The article mentioned supplementation dangers in patients with "kidney disease". but did not, of course, mention the very real dangers in sarcoidosis. 
Take, for instance, the fact that Magnesium deficiency is associated with a low value for serum 1,25-dihydroxyvitamin-D3. Not one of the sarc patients who have measured their 1,25-D has a low value. Every one of them is in the top percentile, 99% of the population would have lower values. This is not a good place to start when suggesting magnesium supplementation might be useful in Sarcoidosis 
For that is what each of the researchers quoted in the newspaper is suggesting: adding large quantities of magnesium to your diet in the hope of achieving better bone health.
The high 1,25-D of most sarcoid patients does not cause hypercalcemia (dangerously high levels of calcium) solely because the Parathyroid Hormone (PTH) continues to function correctly. Yet magnesium exerts its calcitropic actions by acting on the PTH. Your PTH is still working, so do you really want to play around with it? What might be good advice for IDDM (Insulin Dependent Diabetes Mellitus] patients who don't have sarcoidosis is certainly not good advice for IDDM patients with Sarc!
Some sarc patients took Vitamin D supplements for decades thinking that they would strengthen their bones, only to find out now, when it is too late, that the vitamin D supplements actually made their bones weaker by producing too much 1,25-D
There really is only one answer to bone loss in sarcodiosis: get control of your 1,25-dihydroxyvitamin-D3 and bring its concentration down to normal (and, of course, taper off any Prednisone). This will involve staying indoors amd watching your diet. Both of which may require changes in your lifestyle.
In any case, you need to have your serum 1,25-D tested ASAP and the test repeated whenever you have a checkup. It should be 20-34 pg/ml (in Canada, UK, Australia that equates to 52-88 pmol/L).
Meanwhile, eat a balanced, healthy, diet of balanced, healthy, foods. Don't use dietary supplements unless you know EXACTLY what they are going to do in YOUR body.
So, until somebody comes up with better advice, I suggest you follow the treatment guidelines in our "Remission in Sarcoidosis" paper, which are summarized in this simplified version.
Trevor
ps: A short time ago, Belinda suggested seeking out DOs. Over the next two weeks I expect that you will find a big push from a leading DO to promote what we have found. That should make it easier for all of you to find doctors who have been trained to listen to the patient, trained to try and understand complex issues, and who are trained in issues of diet and nutrition. And above all, they are licensed to prescribe your 1,25-D tests and ARBs with (hopefully) less ingrained resistance...
pps: There is an excellent review article online that explains all of the issues involved in Bone growth, loss and regeneration. While necessarily complex, it does give more detail on all the key issues I have summarized above: 1,25-D, PTH, and the ravages of Prednisone.
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I thought everybody did that... 