Is the Ketogenic Diet Safe?

Written by Dr. Steve Chaney on . Posted in Ketogenic Diet

Is The Ketogenic Diet Effective?

Author: Dr. Stephen Chaney

ketogenic dietThe ketogenic diet has been around for a while. It has been used to control epilepsy in children since the 1920s. Nobody is quite sure why it helps control epilepsy, but it does. Once a mainstay of therapy, it is now primarily used as an adjunct to anti-epileptic drugs.

However, recently the ketogenic diet has gone mainstream. It’s no longer just for epilepsy. It has become the latest diet fad. If you believe the claims:

  • Hunger and food cravings will disappear. The pounds will melt away effortlessly and rapidly.
  • You will feel great. You’ll have greater mental focus and increased energy.
  • Physical endurance will increase. You’ll become superhuman.
  • Type 2 diabetes will disappear.
  • Your blood sugar, cholesterol, and triglyceride levels will improve, reducing your risk of developing diabetes and heart disease.

What’s not to like? This sounds like the perfect diet. But, are these claims true? More importantly, is this diet safe?

What Is Ketosis?

what is ketosisKetosis is a natural metabolic adaptation to starvation. To better understand that statement let me start with a little of what I’ll call metabolism 101.

Metabolism 101:

The Fed State: Here’s what happens to the carbohydrate, protein & fat we eat in a meal.

  • Most carbohydrates are converted to blood sugar (glucose), which is utilized in three ways:
    • Most tissues use glucose as their primary energy source in the fed state.
    • Excess glucose is stored as glycogen in muscle and liver.
    • Glycogen stores are limited, so much of the excess glucose is stored as fat.
  • A few tissues such as heart muscle use fat as an energy source. Excess fat is stored.
  • Protein is also used in three ways:
    • Some of it is used to replace and repair the protein components in muscle and other tissues.
    • In conjunction with exercise, protein can be used to increase muscle mass.
    • Excess protein is converted to fat and stored.

The Fasting State: Between meals:

  • Most tissues switch to fats as their primary energy source. Fat stores are utilized to fuel the cells that can use fat.
  • Brain, red blood cells, and a few other tissues still rely solely on glucose as their energy source.
    • Liver glycogen stores are broken down to keep blood glucose levels constant and provide energy for these tissues. (Muscle glycogen stores are reserved for high intensity exercise).
    • As liver glycogen stores are depleted, the body starts breaking down protein and converting it to glucose.

ketogenic diet problems and solutionsStarvation – The Problem: If the fasting state were to continue for more than a few days, we enter what is called starvation. At this point we have a serious problem. Fat stores and carbohydrate stores (liver glycogen) exist for the sole purpose of providing fuel during the fasting state. Protein, however, is unique. There are no separate protein stores in the body. All protein in our body is serving essential functions.

To make matters worse, our brain is metabolically very active. It consumes glucose at an alarming rate. Thus, large amounts of glucose are needed even in the fasting state. If protein continued to be converted to glucose at the same rate as during an overnight fast, our essential protein reserves would rapidly be depleted. Irreversible damage to heart muscle and other essential organs would occur. We would be dead in a few weeks.

Starvation – The Solution: Fortunately, at this point a miraculous adaptation occurs. Our bodies start to convert some of the fat to ketones.

  • All tissues that use fat as an energy source during fasting can also use ketones as an energy source, sometimes with greater efficiency.
  • Over a period of several days, the brain adapts to ketones as its primary energy source. This greatly reduces the depletion of cellular protein to supply blood glucose.
  • However, red blood cells and a few other cells still require glucose as an energy source. Essential protein reserves are still being depleted, but at a far slower pace.
  • With these adaptations, humans can survive months without food if necessary.

There are a few other adaptations that make sense if we think about the dilemma of going long periods without food.

  • Appetite decreases.
  • Metabolic rate decreases, which helps preserve both protein & fat stores.

 

What Is The Ketogenic Diet?

 

ketogenic diet keytonesProponents of the ketogenic diet advocate achieving a permanent state of ketosis without starving yourself. That is achievable because the real trigger for ketosis is low blood sugar, not starvation.

The starting point for the ketogenic diet is low-carb, high-fat diets like Atkins. However, ketogenic diets go beyond traditional low-carb, high-fat diets. They restrict carbohydrates even further to <10% of calories so that a permanent state of ketosis can be achieved. Basically, the ketogenic diet:

  • Eliminates grains and sugars.
  • Eliminates most fruits.
  • Eliminates starchy vegetables (root vegetables, corn, peas, beans, squash & yams).
  • Reduces protein intake. That’s because dietary protein will be converted to glucose when blood glucose levels are low.

You are left with a highly restrictive diet that allows unlimited amounts of fats & some vegetables and moderate amounts of meats, eggs, and cheeses.

The Ketogenic Diet Is Not For Wimps

ketogenic diet tough#1: You have to be committed. As noted above, this is a highly restrictive diet. You will have great difficulty following it when you eat out or are invited to a friend’s house for dinner. You will also have to give up many of your favorite foods.

#2: The transition is rough. Physiological adaptation to the ketogenic diet will take anywhere from a couple of days to a week or two. During that time, you will have to endure some of the following:

  • Headaches, confusion & “brain fog”
  • Fatigue
  • Hunger
  • Lightheadedness and shakiness
  • Leg cramps
  • Constipation
  • Bad breath
  • Heart palpitations

#3: There are no “cheat days”. On most diets, you can have occasional “cheat days” or sneak in some of your favorite foods from time to time. The ketogenic diet is different. A single “cheat day” is enough to take you out of ketosis. If you want to resume the ketogenic diet, you will need to go through the transition period once again.

Is The Ketogenic Diet Effective?

ketogenic diet effectiveWith this background in mind, let’s evaluate the claims made by proponents of the ketogenic diet. I’ll rate them on the “Pinocchio Scale”. “Zero Pinocchios” means they are mostly true. “One Pinocchio” means they are half true. “Two Pinocchios” means they are mostly false.

Zero Pinocchios (Mostly True Claims):

  • Reduced hunger. This is part of the starvation response.
  • Improved mental focus and increased energy. In part, this is simply in contrast to the “brain fog” and fatigue of the transition phase. However, you have also eliminated all foods that can cause blood sugar swings from your diet. Blood sugar swings can affect both mental focus and energy levels.
  • Rapid weight loss. If we focus on short term weight loss, this is true because:
    • A lot of the initial weight loss is water. Glycogen stores retain water. As glycogen stores are depleted, the water is lost along with them.
    • Most people inadvertently reduce their caloric intake on a highly restrictive diet like this. For example, fats are often consumed along with carbohydrate-rich foods (butter with toast, sour cream with potatoes, cream cheese with bagels). While it is easy to say that unlimited consumption of healthy fats is allowed, most people reduce their consumption of fats in the absence of their carbohydrate-rich companions.
    • Note: Proponents of the ketogenic diet will tell you that the weight loss associated with the ketogenic diet is because you are burning fat stores. You will only burn fat stores when dietary fat intake is not sufficient to meet your energy needs. In other words, you burn your fat stores when “calories in” are less than “calories out” – just as with any other diet.
  • Reversal of type 2 diabetes. Because carbohydrates are restricted in this diet, blood sugar and insulin levels will be low. If you are on medications, those will need to be adjusted by your physician.

 

One Pinocchio (Half-True Claims):

  • Improved cholesterol and triglyceride levels. The jury is out on this one. Some studies show an improvement on the ketogenic diet. Other studies show them getting worse.
  • Increased physical endurance. This is only true for low-intensity endurance exercise. It is not true for any exercise or event that requires spurts of high intensity exercise. That’s because:
    • The muscle fibers used for low intensity endurance exercise utilize ketone bodies with high efficiency. That means you can run for miles as long as you don’t care how fast you get there.
    • The muscle fibers used for high-intensity, short-duration exercise cannot adapt to use of ketone bodies because they lack sufficient mitochondria. They require glycogen stores, which are depleted on a ketogenic diet. Even in endurance events like marathons most people want to sprint to the finish line. They won’t be able to do that if they are on a ketogenic diet.

 

Two Pinocchios (Mostly False Claims):

  • ketogenic diet mythsLong term weight loss. Some long-term success has been claimed in a highly controlled clinical setting. However, most studies show:
    • People regain some or most of the weight after 6 months to a year.
    • After 1 or 2 years, there is no difference in weight loss between high-fat/low-carb diets and low-fat/high-carb diets.
    • That’s because:
      • Most people cannot stick to restrictive diets long term, and this diet is very restrictive.
      • Once you go off this diet, even for a short time, your glycogen stores will be replenished and the water weight will return along with the glycogen.
      • The reduction in metabolic rate and the reduction in muscle mass associated with the ketogenic diet make it difficult to keep the weight off long term
  • It is a healthy diet.
    • This is a healthy diet only from the point of view that it eliminates most fast foods and processed foods.
    • However, any diet that eliminates 2 and a half food groups (grains, fruits, and starchy vegetables) is setting you up for long term nutritional deficiencies. It is possible to cover some of those deficiencies with supplementation, but supplements can never provide all the nutrients found in real food.

 

Is The Ketogenic Diet Safe?

ketogenic diet safeFor most people the ketogenic diet is likely to be safe for short periods, maybe even a few months. However, I have grave concerns if the diet is continued long term.

  • I have already mentioned the likelihood this diet will create nutritional deficiencies. Long term, those deficiencies could have severe health consequences.
  • Proponents of the diet recommend that protein intake be limited so that “optimal” ketosis can be achieved. If the dieter is successful at doing that, it will result in a gradual depletion of essential cellular protein reserves as discussed above. Long term, that has the potential to weaken heart muscle, compromise the immune system, and damage essential organs.
  • Ketones can damage the kidneys. In the short term, damage is likely to be minimal as long as plenty of water is consumed. However, long term ketosis could be a significant concern for your kidneys.

I have seen proponents of the ketogenic diet shrug this off as a concern only if protein intake is excessive. They are missing the point. The problem is the ketones, not the protein.

  • Long term ketosis has the potential to cause osteoporosis. That is because the so-called “ketones” are actually organic acids except for the small amount of acetone that gives your breath a fruity smell. Organic acids must be neutralized to keep our body pH in the normal range. There are multiple mechanisms for neutralizing organic acids. One of those mechanisms involves dissolving bone and releasing calcium carbonate into the bloodstream. This slow dissolution of bone will continue for as long as someone is in ketosis.

 

Proponents of the ketogenic diet shrug this off by saying that you never get into ketoacidosis on their diet. Again, they are missing the point. Ketoacidosis simply means that the production of organic acids has become so great that all the body’s mechanisms for neutralizing those acids have become overwhelmed. Ketoacidosis occurs in uncontrolled diabetes and can be deadly. The problem is the slow dissolution of bone during long term ketosis, not a short-term crisis like ketoacidosis.

If you are considering the ketogenic diet for weight loss, my recommendations would be to:

  • Consider other equally effective, but less demanding, weight loss programs. Look for programs that help you preserve muscle mass and teach you healthy eating habits that can be sustained for a lifetime.
  • If you do decide to follow the ketogenic diet, only use it for a short period of time to jump start your weight loss. Then switch to a diet program that has been clinically proven to improve your health long term. Examples would be the Mediterranean diet and the Dash diet.

If you are choosing the ketogenic diet for health reasons, I would recommend the Mediterranean diet or Dash diet instead.

 

The Bottom Line

 

  1. The ketogenic diet is the latest diet fad. I give it a C+ compared to other popular diets.
  2. This is not a diet for wimps.
    • It is a highly restrictive diet
    • The transition period as you adjust to the diet is rough.
    • There are no “cheat days”
  3. Some of the claims made for the ketogenic diet are mostly true, some are half-true, and some are mostly false. I help you sort them out in the article above.
  4. Short term, the diet is probably safe for most people. However, long term I have several concerns.
    • The diet is likely to create nutritional deficiencies. Long term, those deficiencies could have severe health consequences.
    • The diet is likely to gradually deplete essential cellular protein reserves. Long term, that could weaken heart muscle, compromise the immune system, and damage essential organs.
    • The diet has the potential to damage the kidneys.
    • The diet has the potential to cause osteoporosis.
    • The metabolic rationale for those concerns is discussed in the article above.
  5. If you are considering the ketogenic diet for weight loss, my recommendations would be to:
    • Consider other equally effective, but less demanding, weight loss programs. Look for programs that help you preserve muscle mass and teach you healthy eating habits that can be sustained for a lifetime.
    • If you do decide to follow the ketogenic diet, only use it for a short period of time to jump start your weight loss. Then switch to a diet program that has been clinically proven to improve your health long term. Examples would be the Mediterranean diet and the Dash diet.
  6. If you are choosing the ketogenic diet for health reasons, I would recommend the Mediterranean diet or Dash diet instead.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (11)

  • Eroca Zeviar

    |

    Love your detailed specicifity and clarity. With so many group things online ie Betrayal system and group anti cancer infos, many different diets being promoted without the public really knowing enough to make an informed choice based on real proven knowledge.

    Thanks for your valued presentation.

    Reply

  • Merlena Cushing

    |

    Thank you so much for an incredibly compelling and thorough article. I will simply say I second the accolades given by Eroca…she put it very well. We are indebted to you for your continued articles here and on FB and your generosity in sharing them with all of us. Bless you!

    Reply

  • Judy LaBrune

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    Thank you for clarifying the Ketogenic diet! I’ve heard several people talking about how great it is. This article will be very helpful in sharing the myths and truths.

    judy

    Reply

  • Bonnie zeman

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    We use keto but it is with two life shakes a day. Also the life strip. I suppose it is not true keto. But they are losing a pound a day. We really pay attention to fats, butter, mayo, 100% cold pressed virgin olive oil and coconut oil. Purified water every hour. So far it has worked great. All top grade meats, fish, chicken and eggs. And huge amts of veggies. We also check on them every week.

    Reply

    • Dr. Steve Chaney

      |

      Dear Bonnie,
      It looks more like the Atkins diet to me. As I said in the article, it will succeed short term, but it will be hard to maintain that weight loss long term. I would also remind you that the only diets proven to be healthy long term are the Mediterranean and DASH.
      Dr. Chaney

      Reply

  • Justin Carlson

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    Dr. Chaney I appreciate your efforts of looking into the ketogenic diet, which indeed is becoming popular, but many of your conclusions seems to be based on speculation and lack scientific backing. It also seems unfair to call the diet a fad, when it is used as a treatment for many medical conditions today (chronic fatigue syndrome, neurodegenerstive diseases, etc.) due to the increased energy that ketones yield per unit compared to glucose. Instead of brushing this diet off as a fad, you should be treating it as a legitimate diet and give specific advice on how to eat properly and get the right nutrition when in ketosis. I think that would be most beneficial for your readers.

    Reply

    • Dr. Steve Chaney

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      Dear Justin,

      I did open my article by saying that the keto diet was well established for treatment of epilepsy in children. I am also aware of the research into its use for other neurodegenerative disorders. It is not as well established for those uses, but the research is promising. If my article was focused on those uses of the keto diet, it would have been completely appropriate to discuss how to follow it.

      I was focusing on the current usage of the diet to lose weight and to promote long term health. Those applications of the keto diet are unproven at present. The studies to date support short term weight loss and the improvement of blood parameters that may or may not equate with long term health outcomes. At this point we have no long term studies showing that the weight loss is maintained long term or that there is an improvement in health outcomes long term. Until we have that kind of evidence, I think it is appropriate to consider it a fad diet.

      Dr. Chaney

      Reply

  • Bill Moore

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    Interesting. I’ve been on a keto diet for 4 years now and pretty much all the ‘1 and 2’ Pinocchio’s you claim simply aren’t so. I know many (many) people that have stayed on this diet for years and are very happy with it. Is it difficult? Not at all. Does society do it’s absolute best to make it difficult? Very much so.

    You should try reading what people actually doing this diet say vs. a doctor who is, clearly, biased against something he doesn’t fully understand and, frankly, shouldn’t be writing about.

    If you’d like to see a community of people (over 270,000 of them) on keto, go here: https://www.reddit.com/r/keto/ You’ll find many people that can give you actual real world facts as well as the science behind why it works and why it works long term.

    If you’re a science geek, go talk to the 14,000 plus PhD’s and keto nerds who study this stuff for a living here: https://www.reddit.com/r/ketoscience/

    Reply

    • Dr. Steve Chaney

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      Dear Bill,

      Let me start by reminding you of my credentials. I taught human metabolism and nutrition to medical students for 40 years, and received numerous teaching awards during that time period. It is fair to say that I am an expert on human metabolism and how that metabolism is affected by our diet.

      I appreciate that your experiences with the keto diet have been positive, and that there is a small community of adherents who have also had positive experiences. In the scientific community, we call those case reports and consider them the least reliable level of proof. Scientists prefer to do clinical studies to see if the same observations are true for the majority of people who follow the diet. For example, it is clear from existing clinical studies that most people who follow the diet achieve short term weight loss, which is why I recommended it for that purpose. However, the important question is whether most people can stick with the diet long enough to maintain that weight loss for two years or more. I laud you for your discipline of being able to stick with the diet for 4 years, and I suspect you have managed to maintain your weight loss. However, until I see published clinical studies showing that most people who embark on the keto diet maintain their weight loss for two years or more, I cannot recommend it for that purpose, and it deserves 2 pinocchios.

      As for the 1 pinocchios, even the proponents of the keto diet say that it is good for endurance exercise, but not for things like sprinting. As for the cholesterol and triglyceride levels, most proponents of the keto diet conveniently ignore the fact that not all reports support improved levels. Personally, I think that is likely to be the case, but we need to remember that improvements in cholesterol and triglyceride levels may or may not translate into improved health outcomes. Until long term studies on health outcomes have been conducted, we cannot claim the keto diet is healthy.

      Dr. Chaney

      Reply

  • Paul

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    I would like to see the research that you talk about but don’t quote! It seems you are one of the many not up with numerous studies showing the many benefits of a ketogenic diet. It is not hard and if you call not eating grains restrictive, you obviously don’t know what a well-formulated keto diet is. You can even do keto as a vegan if you don’t want to eat animal products. When you break down triglycerides, the glycerol back bone is converted into glucose, so you always have enough glucose for the brain. I could go on, but seriously check to see what many Doctors that understand this diet are saying like Dr Mercola.

    Reply

    • Dr. Steve Chaney

      |

      Dear Paul,

      Let me start by reminding you of my credentials. I taught human metabolism and nutrition to medical students for 40 years, and received numerous teaching awards during that time period. It is fair to say that I am an expert on human metabolism and how that metabolism is affected by our diet.

      I am aware of studies on the benefits of the keto diet and referred to some of them in my article. Those are all short term studies, and do not provide evidence for long term health outcomes. For example, unless there are published studies showing that most people can stick to a diet and maintain weight loss for at least one or two years, it cannot be recommended as a successful weight loss approach. Similarly, there are studies showing that adhering to a Vegan, Mediterranean, or DASH diet over decades results in improved health outcomes (lower prevalence of heart disease, cancer & diabetes). In spite of the fact that high fat, low carb diets have been around since the 50s, I am unaware of a single study showing they result in improved long-term health outcomes. In the absence of that kind of evidence, they cannot be recommended as healthy diets.

      If the keto diet simply eliminated grains, it might would be more acceptable. However, most descriptions of the keto diet I have seen also restrict starchy vegetable, most fruits, and legumes. With that kind of restriction (especially the legumes), it is hard to see how a Vegan diet and the keto diet would be compatible.

      You can get some glucose from the glycerol backbone, but that is not enough to supply the body’s needs. That is why many of the description of the keto diet also recommend that you restrict protein.

      Dr. Chaney

      Reply

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Latest Article

Does Magnesium Optimize Vitamin D Levels?

Posted February 12, 2019 by Dr. Steve Chaney

The Case For Holistic Supplementation

Author: Dr. Stephen Chaney

 

Does magnesium optimize vitamin D levels?

magnesium optimize vitamin dOne of the great mysteries about vitamin D is the lack of correlation between vitamin D intake and blood levels of its active metabolite, 25-hydroxyvitamin D. Many people who consume RDA levels of vitamin D from foods and/or supplements end up with low blood levels of 25-hydroxyvitamin D. The reason(s) for this discrepancy between intake of vitamin D and blood levels of its active metabolite are not currently understood.

Another great mystery is why it has been so difficult to demonstrate benefits of vitamin D supplementation. Association studies show a strong correlation between optimal 25-hydroxyvitamin D levels and reduced risk of heart disease, cancer, and other diseases. However, placebo-controlled clinical trials of vitamin D supplementation have often come up empty. Until recently, many of those studies did not measure 25-hydroxyvitamin D levels. Could it be that optimal levels of 25-hydroxyvitamin D were not achieved?

The authors of the current study hypothesized that optimal magnesium status might be required for vitamin D conversion to its active form. You are probably wondering why magnesium would influence vitamin D metabolism. I had the same question.

The authors pointed out that:

  • Magnesium status affects the activities of enzymes involved in both the synthesis and degradation of 25-hydroxyvitamin D.
  • Some clinical studies have suggested that magnesium intake interacts with vitamin D intake in affecting health outcomes.
  • If the author’s hypothesis is correct, it is a concern because magnesium deficiency is prevalent in this country. In their “Fact Sheet For Health Professionals,” the NIH states that “…a majority of Americans of all ages ingest less magnesium from food than their respective EARs [Estimated Average Requirement]; adult men aged 71 years and older and adolescent females are most likely to have low intakes.” Other sources have indicated that magnesium deficiency may approach 70-80% for adults over 70.

If the author’s hypothesis that magnesium is required for vitamin D activation is correct and most Americans are deficient in magnesium, this raises some troubling questions.

  • Most vitamin D supplements do not contain magnesium. If people aren’t getting supplemental magnesium from another source, they may not be optimally utilizing the vitamin D in the supplements.
  • Most clinical studies involving vitamin D do not also include magnesium. If most of the study participants are deficient in magnesium, it might explain why it has been so difficult to show benefits from vitamin D supplementation.

Thus the authors devised a study (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018 ) to directly test their hypothesis.

 

How Was The Study Designed?

magnesium optimize vitamin d studyThe authors recruited 180 volunteers, aged 40-85, from an ongoing study on the prevention of colon cancer being conducted at Vanderbilt University. The duration of the study was 12 weeks. Blood was drawn at the beginning of the study to measure baseline 25-hydroxyvitamin D levels. Three additional blood draws to determine 25-hydroxyvitamin D levels were performed at weeks 1, 6, and 12.

Because high blood calcium levels increase excretion of magnesium, the authors individualized magnesium intake based on “optimizing” the calcium to magnesium ratio in the diet rather than giving everyone the same amount of magnesium. The dietary calcium to magnesium ratio for most Americans is 2.6 to 1 or higher. Based on their previous work, they considered an “ideal” calcium to magnesium ratio to be 2.3 to 1. The mean daily dose of magnesium supplementation in this study was 205 mg, with a range from 77 to 390 mg to achieve the “ideal” calcium to magnesium ratio. The placebo was an identical gel capsule containing microcrystalline cellulose.

Two 24-hour dietary recalls were conducted at baseline to determine baseline dietary intake of calcium and magnesium. Four additional 24-hour dietary recalls were performed during the 12-week study to assure that calcium intake was unchanged and the calcium to magnesium ratio of 2.3 to 1 was achieved.

In short this was a small study, but it was very well designed to test the author’s hypothesis.

 

Does Magnesium Optimize Vitamin D Levels?

 

does magnesium optimize vitamin d levelsThis was a very complex study, so I am simplifying it for this discussion. For full details, I refer you to the journal article (Q Dai et al, American Journal of Clinical Nutrition, 108: 1249-1258, 2018).

The most significant finding was that magnesium supplementation did affect blood levels of 25-hydroxyvitamin D. However, the effect of magnesium supplementation varied depending on the baseline 25-hydroxyvitamin D level at the beginning of the study.

  • When the baseline 25-hydroxyvitamin D was 20 ng/ml or less (which the NIH considers inadequate), magnesium supplementation had no effect on 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D was 20-30 ng/ml (which the NIH considers the lower end of the adequate range), magnesium supplementation increased 25-hydroxyvitamin D levels.
  • When the baseline 25-hydroxyvitamin D level approached 50 ng/ml (which the NIH says may be “associated with adverse effects”), magnesium supplementation lowered 25-hydroxyvitamin D levels.

The simplest interpretation of these results is:

  • When vitamin D intake is inadequate, magnesium cannot magically create 25-hydroxyvitamin D from thin air.
  • When vitamin D intake is adequate, magnesium can enhance the conversion of vitamin D to 25-hydroxyvitamin D.
  • When vitamin D intake is too high, magnesium can help protect you by lowering 25-hydroxyvitamin D levels.

The authors concluded: “Our findings suggest that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. Further dosing studies are warranted…”

 

What Does This Study Mean For You?

magnesium optimize vitamin d for youThis was a groundbreaking study that has provided novel and interesting results.

  • It provides the first evidence that optimal magnesium status may be required for optimizing the conversion of vitamin D to 25-hydroxyvitamin D.
  • It suggests that optimal magnesium status can help normalize 25-hydroxyvitamin D levels by increasing low levels and decreasing high levels.

However, this was a small study and, like any groundbreaking study, has significant limitations. For a complete discussion of the limitations and strengths of this study I refer you to the editorial (S Lin and Q Liu, American Journal of Clinical Nutrition, 108: 1159-1161, 2018) that accompanied the study.

In summary, this study needs to be replicated by larger clinical studies with a more diverse study population. In order to provide meaningful results, those studies would need to carefully control and monitor calcium, magnesium, and vitamin D intake. There is also a need for mechanistic studies to better understand how magnesium can both increase low 25-hydroxyvitamin D levels and decrease high 25-hydroxyvitamin D levels.

However, assuming the conclusions of this study to be true, it has some interesting implications:

  • If you are taking a vitamin D supplement, you should probably make sure that you are also getting the DV (400 mg) of magnesium from diet plus supplementation.
  • If you are taking a calcium supplement, you should check that it also provides a significant amount of magnesium. If not, change supplements or make sure that you get the DV for magnesium elsewhere.
  • I am suggesting that you shoot for the DV (400 mg) of magnesium rather than reading every label and calculating the calcium to magnesium ratio. The “ideal” ratio of 2.3 to 1 is hypothetical at this point. A supplement providing the DV of both calcium and magnesium would have a calcium to magnesium ratio of 2.5, and I would not fault any manufacturer for providing you with the DV of both nutrients.
  • If you are taking high amounts of calcium, I would recommend a supplement that has a calcium to magnesium ratio of 2.5 or less.
  • If you are considering a magnesium supplement to optimize your magnesium status, you should be aware that magnesium can cause gas, bloating, and diarrhea. I would recommend a sustained release magnesium supplement.
  • Finally, whole grains and legumes are among your best dietary sources of magnesium. Forget those diets that tell you to eliminate whole food groups. They are likely to leave you magnesium-deficient.

Even if the conclusions of this study are not confirmed by subsequent studies, we need to remember that magnesium is an essential nutrient with many health benefits and that most Americans do not get enough magnesium in their diet. The recommendations I have made for optimizing magnesium status are common-sense recommendations that apply to all of us.

 

The Case For Holistic Supplementation

 

magnesium optimize vitamin d case for holistic supplementationThis study is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No”. Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are they didn’t also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal.

That’s because most doctors and nutrition experts still think of nutrients as “magic bullets.” I cover holistic supplementation in detail in my book “Slaying The Supplement Myths.”  Other examples that make a case for holistic supplementation that I cover in my book include:

  • A study showing that omega-3 fatty acids and B vitamins may work together to prevent cognitive decline. Unfortunately, most studies looking at the effect of B vitamins on cognitive decline have not considered omega-3 status and vice versa. No wonder those studies have produced inconsistent results.
  • Studies looking at the effect of calcium supplementation on loss of bone density in the elderly have often failed to include vitamin D, magnesium, and other nutrients that are needed for building healthy bone. They have also failed to include exercise, which is essential for building healthy bone. No wonder some of those studies have failed to find an effect of calcium supplementation on bone density.
  • A study reported that selenium and vitamin E by themselves might increase prostate cancer risk. Those were the headlines you might have seen. The same study showed Vitamin E and selenium together did not increase prostate cancer risk. Somehow that part of the study was never mentioned.
  • A study reported that high levels of individual B vitamins increased mortality slightly. Those were the headlines you might have seen. The same study showed that when the same B vitamins were combined in a B complex supplement, mortality decreased. Somehow that observation never made the headlines.
  • A 20-year study reported that a holistic approach to supplementation produced significantly better health outcomes.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. When we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to our diet. I mentioned earlier that whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies of nutrients, phytonutrients, specific types of fiber, and the healthy gut bacteria that use that fiber as their preferred food source.

The Bottom Line

 

A recent study suggests that optimal magnesium status may be important for optimizing 25-hydroxyvitamin D status. This is one of many examples showing that a holistic approach to supplementation is superior to a “magic bullet” approach where you take individual nutrients to solve individual problems. For example, in the case of magnesium and vitamin D:

  • If you asked most nutrition experts and supplement manufacturers whether it is important to provide magnesium along with vitamin D, their answer would likely be “No.”  Even if they are focused on bone health, they would be more likely to recommend calcium along with vitamin D than magnesium along with vitamin D.
  • If your doctor has tested your 25-hydroxyvitamin D levels and recommended a vitamin D supplement, chances are he or she did not also recommend that you optimize your magnesium status.
  • Clinical studies investigating the benefits of vitamin D supplementation never ask whether magnesium intake is optimal. That may be why so many of those studies have failed to find any benefit of vitamin D supplementation.

I cover holistic supplementation in detail in my book “Slaying The Supplement Myths” and provide several other examples where a holistic approach to supplementation is superior to taking individual supplements.

In summary, vitamins and minerals interact with each other to produce health benefits in our bodies. Some of those interactions we know about. Others we are still learning about. Whenever we take high doses of individual vitamins and minerals, we create potential problems.

  • We may not get the full benefit of the vitamin or mineral we are taking because some other important nutrient(s) may be missing from our diet.
  • Even worse, high doses of one vitamin or mineral may interfere with the absorption or enhance the excretion of another vitamin or mineral. That can create deficiencies.

The same principles apply to what we eat. For example, whole grains and legumes are among the best dietary sources of magnesium. Eliminating those two foods from the diet increases our risk of becoming magnesium deficient. And, that’s just the tip of the iceberg. Any time you eliminate foods or food groups from the diet, you run the risk of creating deficiencies.

For more details about the current study and what it means to you read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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