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Magnesium Deficiency in Cancer Patients Receiving Platinum-based Chemotherapy

A colleague of mine, Dr. Valero ND, recently published an article on magnesium deficiency in cancer patients who have undergone platinum based chemotherapy: cisplatin, carboplatin, oxaliplatin, etc and I would like to review it here for you as I believe the information contained in the article to be incredibly useful for cancer.  

 

Source: http://schoolpress.cdn.whipplehill.net/stjohns80/72/files/2014/12/cisplatin__a2011_lg.jpg
Source: http://schoolpress.cdn.whipplehill.net/stjohns80/72/files/2014/12/cisplatin__a2011_lg.jpg

Magnesium deficiency is a relatively common nutritional deficiency, with up to 75% of the population consuming insufficient amounts daily. Cancer patients are at increased risk of deficiency either from gastrointestinal loss of magnesium from diarrhea, reduced absorption from low stomach acid, kidney damage, or  chemo-induced depletions. A review of the literature found that hypomagnesemia was found in 29%-100% of patients who have undergone platinum based chemotherapy. One study by Buckley et al reported the incidence of hypomagnesemia to be 41% after 1 course of treatment and 100% after 6 courses of treatment with cisplatin. These depleted levels of magnesium typically last for 4 to 5 months after the last round of chemotherapy, but in children can even persist for years after cancer treatment.

Serum magnesium does not appear to be a reliable indicator of magnesium deficiency, as bioavailable magnesium is found intracellularly (within the tissues), and not in serum (blood stream). There are a wide variety of clinical signs and symptoms that can be used for screening for hypomagnesmia:

Mild

muscle cramps

constipation

fatigue

anxiety

restless leg

insomnia

irritability

loss of appetite

numbness

tingling

headache

depression

Major

hypocalcemia

hypokalemia

high blood pressure

tremor

cardiac abnormalities

ataxia

migraines

asthma

hypoparathyroid

Severe

seizures

metabolic alkylosis

psychiatric distrubance

cortical blindness

 

High energy requirements due to rapid proliferation, dedifferentiation, and cell immortality is one characteristic of cancer cells. Magnesium is necessary in these cellular processes therefore, tumor tissue often stores magnesium and can lead to low levels of magnesium in healthy tissue.

Magnesium deficiency can contribute to the development of the ideal cancer terain by inducing inflammation, oxidative stress, and by inhibiting DNA repair enzymes. Adequate levels of magnesium are important in DNA replication and repair. There are cellular checkpoints in DNA replication that help to prevent mutations from occurring. It has been hypothesized that a decrease in magnesium activates the gene TRPM7, which increases intracellular calcium and activating calcium-dependent cell proliferation, leading to tumour growth.  Animal studies by Wolf et al noted that lung metastasis nearly doubled in magnesium-deficient mice. Solanki et al found that magnesium supplementation protects against cisplatin-induced kidney injury in human ovarian tumor mouse models without compromising the cytotoxic effects by cisplatin. A small study consisting of only 36 patients with NSCLC (lung cancer) who were receiving cisplatin found that tumor response rates were 59.3% in the magnesium + chemo group compared to 38.5% in the control group. Evidence regarding magnesium supplementation with platinum based chemotherapeutics is sparse but these studies are encouraging.

Magnesium repletion, either through oral or IV means, seems to be important for preventing more severe symptoms of deficiency. Read more about the various types of magnesium supplements here (link to come). Not all magnesium supplements are created equally.