Family Practice Nutritional Therapy for Functional Disorders

Medical Journalist Report of Innovative Biologics

From interviews with holistic health professionals who employ advanced therapeutic techniques and from searches of the world's medical literature, this monthly column offers current information on holistic medicine, orthomolecular nutrition, diet, exercise, imagery, and other alternative methods of healing and diagnosis.

According to Harrison J. McCandless, M.D., Assistant Professor of Medicine and Family Practice at the University of California, Los Angeles College of Medicine, there are well over 20 million patients with depression in the United States divided by less than 24,000 psychiatrists to take care of them. Moreover, 15% of these functionally involved people commit or attempt to commit suicide. The average psychiatrist has a caseload of about 40 patients per year so the question arises, "Who is to look after all of those additional people suffering from stress disorders, somatoform disorders, personality disorders, anxiety disorders, obsessive-compulsive disorders, adjustment disorders, panic disorders, phobias, and more? The numbers swell to approximately 80 million Americans. It represents the combined populations of metropolitan New York City, Chicago, Boston, Los Angeles, Washington, D.C., Philadelphia, Seattle, Atlanta, and Dallas. Dr. McCandless believes that there is a pressing need for family physicians to lend a helping hand with these many potential patients.

Here is an example of what's to be done in family practice: As Cynthia Roscoe of Milwaukee, Wisconsin described it to me, the severe anxiety attacks she'd been having for the last 7 months were close to unbearable. "When one hits, my chest tightens," the 28-year-old woman said, "my palms sweat, I have a sense of dread, and it feels like I'm losing control." The attacks for Cynthia frequently arrive spontaneously in a variety of situations where ease of exit is difficult, in places like supermarket lines, buses, crowded stores, restaurants, and elevators.

"Immediately flee," Cynthia said, "even if it means that I have to leave a bag of groceries I'm waiting to pay for." This, despite her having no prior history of any psychiatric disorder. She felt bewildered about her symptoms and the reason they arose. Also, the young woman worried about the way they had begun affecting her job, her marriage, and her life in general. Agoraphobia was coming upon her. Cynthia had started to shun restaurants and department stores and was avoiding all situations she associated with attacks of anxiety: places where she could not easily make an immediate exit.

Her husband wanted Cynthia to consult a psychiatrist to whom they were referred by a friend. She did attempt to confirm an appointment, but the nearest opening this psychiatrist could offer was two months away. Both of the young Roscoes recognized that Cynthia needed help much sooner.

She visited a long-time doctor friend of her father's and mother's, a local general practitioner, who is a Fellow of the American Academy of Family Physicians. From this family practice specialist Cynthia received supportive, warm and nurturing understanding. He listened to her at length and performed a physical examination. At first he prescribed the tranquilizer Valium[Trademark], which, she explained calmed her between episodes but did not block the frequent panic attacks. As it happens, one in eight adult Americans take sedatives or tranquilizers during the course of each year, according to a 1988 Lou Harris survey.

After some additional testing and evaluation, Cynthia's doctor changed his treatment approach and instead prescribed a specific nutrient formulation, which is the subject of this article. She practically became a research subject, because her physician was basing his nutritional therapy on clinical studies and certain information reported in the German and other European medical literature.[ 1, 2, 3, 4]

The treatment worked well. Cynthia Roscoe has returned to full functioning and has had only a few isolated panic atacks during the two years since her nutritional therapy began. No longer is she a candidate for anti-anxiety agents of any kind. Her problem, it was found, relates to dysfunctional magnesium metabolism rather than mental or emotional dysfunction.

Dysfunctional Disorders

Sometimes the question of which comes first - physical illness or disease-related dysfunction - medically labelled as "functional disorders" - is just like the question about the chicken or the egg. It really doesn't matter which comes first. You just waste a lot of time sitting around puzzling about it. Patient problems that physicians see frequently and label "functional," are generally poorly understood, and often don't get handled well.

Difficulties begin with the many ways in which the term "function" is used. "For some it refers simply to unexplained symptoms," says Samuel B. Guze, M.D., who is Spencer T. Olin, Professor and Head of the Department of Psychiatry, Washington University School of Medicine, St. Louis. "For others, it refers to symptoms that appear to be related to emotional reactions or to stressful life events. Still others use it euphemistically in place of 'hypochondriacal' or 'imaginary.' Some consider it simply is a synonym for 'psychiatric.' Finally, and perhaps most unfortunately, many users of the term follow no precise definition and include all of these meanings in a jumbled, thoughtless, and sometimes pejorative fashion. Obviously, chaotic usage can lead only to confusion and obfuscation."[ 5]

The manifestations of functional disorders have long been a familiar part of every primary care practice. All too often, they have also been a source of frustration to the family physician. Anxiety symptoms as represented by a loss of function can be chronic and disabling. They can complicate other illnesses, often decreasing patient cooperation with treatment regimens and worsening outcome. In the absence of clear guidelines, the symptoms of a functional disorder may appear vague, diffuse, and undefined.[ 6]

Many patients with dysfunctional disorders are victims of diagnosable psychiatric complaints such as anxiety neurosis, depression, schizophrenia, or hysteria. Some are suffering from what are not usually considered psychiatric conditions that, however, are also recognized primarily by their symptom patterns; migraine is an excellent example. Insomnia and other sleep disturbances; hyperventilation syndrome; obesity; dysmenorrhea and other menstrual difficulties; esophageal regurgitation, dyspepsia, and the irritable bowel syndrome; impotence and frigidity - all are easily recognized conditions of obscure etiology and pathogenesis that fall into the "functional" wastebasket. This is true at least until it becomes known in some cases that a specific physiological or biochemical defect is responsible, as in our observed case of Cynthia Roscoe.

Physicians too often fail to take patients with dysfunctional disorders seriously. Diagnostic concern is sometimes limited to ruling out more serious pathology. When this has been done by means of extensive laboratory tests and X-ray films, the physician may consider his or her job completed if the patient is reassured that there is "nothing seriously wrong" and is advised to "stop worrying" or to "change lifestyle." Such meaningless statements that get substituted for real treatment are nonsense.

Correction of Functional Disorders from Mineral Deficiencies

In a European published paper, "Is There an Alternative Approach to the Therapy of Psychosomatic Disorders?" Drs. P. Leskow and G. Dietz state: "The suppression of symptoms by the administration of psychotropic drugs may seem to be the most convenient solution for both patient and physician; this approach, is, however, only useful as a tentative, support measure. It is today well established that biochemical disorders of the nervous system are usually the result of disruptions of the electrolyte and trace element balance, with deficiency symptoms, especially those due to magnesium, being most important. The underlying cause of this phenomenon is the dramatically reduced bioavailability of the magnesium element in our food supply."[ 7]

Magnesium replacement therefore often becomes a requirement for those patients with functional disorders. This is also true of a number of other trace elements, such as zinc, which reacts metabolically in the maintenance of the immune system and carbohydrate metabolism.

Reduced parathyroid function brings on a decreased secretion of parathormone; subsequently, one may anticipate its leading to hypercalcemia. Since magnesium deficiency correlates with hypocalcemia often accompanied by hypokalemia, magnesium supplementation should be accompanied by calcium and potassium restoration, as well, to achieve normal electrolyte balance.[ 8, 9]

Sources and Symptoms of Magnesium Deficiency

Magnesium is a natural calcium antagonist. It has a relaxant effect on cardiac muscle and smooth muscle, slows down heart activity, counteracts sympathicotonia, and is exactly regulated by the healthy kidneys.[ 10] When dispensed to the patient, magnesium's bioavailability becomes directly tied to the vehicle in which it is introduced. German studies indicate that the affinity of magnesium varies with different tissues. In combination with 2-aminoethyldihydrogen phosphoric acid, a naturally occurring nontoxic aminoethyl ester, magnesium locks onto nervous system tissue and produces a calming or sedation without side effect for patients with functional disorders.[ 11]

Leskow and Dietz described a clinical field trial that put the latter concept to the test for a broad spectrum of functional disorders of the autonomic nervous system. All of the nervous dysfunctions were present as a result of clinical- and laboratory-established magnesium deficiency states that had been created as a result of stress, alcohol abuse, unbalanced diet, hunger cures, frequent vomiting, diarrhea, laxative abuse, gastrointestinal absorption disorders, chronic liver disease, pancreatitis, insulin-dependent diabetes mellitus, diuretic therapy, glomerulonephritis, digitalis therapy, hyperthyroidism, and primary and secondary hyperaldosteronism.

The orally administered sugar-coated tablets contained 145.8 mg potassium salt of phosphoric acid mono-( 2-aminoethylester), 145.8 mg magnesium salt of phosphoric acid mono-( 2-aminoethylester), 58.4 mg calcium salt or phosphoric acid mono-( 2-aminoethylester), and are manufactured in Alsbach/ Bergstrabe-Haehnlein, West Germany by Dr. Franz Koehler Chemie GMBH under the name, Phosetamin[Trademark]. The same product is distributed in the United States by the Koehler Company U.S.A. of Mt. Vernon, Washington as Mynax[Trademark].

Functional disorders which often are considered psychosomatic, respond to the magnesium/calcium/potassium phosphoric acid-mono-( 2-aminoethyl) ester, because the dysfunctions actually are magnesium deficiency symptoms, and show up as inability to concentrate, chronic fatigue, decrease in vitality, depression, difficulty in going to sleep, hyperexcitability, hyperkinesia, ataxia, tetanic syndrome, fasciculation, calf cramps, tendency for hyperventilation, tachycardia, anginal complaints, cardiac arrhythmias, gastrointestinal complaints, diarrhea, and malabsorption syndrome.

The listed symptomatology from magnesium deficiency likely has come as a result of ever present deterioration in the quality of food supplies in Western industrialized countries, especially in the high-technology societies of the United States and Canada. Crops are overfertilized in an unbalanced fashion. Cattle and hogs are raised assembly-line-style. Poultry is set immovably in tiny boxes under 24-hour lighting. In other words, most of us eat foods of quantity at the expense of quality. Authorities assure us that under such circumstances, bioavailability of electrolytes and trace elements are mostly lost.[ 12, 13, 14]

The Carrying Vehicle for Magnesium, Calcium, Potassium

Generically, the main vehicle comprising Phosetamin[Trademark] or Mynax [Trademark] is aminoethanol phosphate (EAP[Trademark]). It effectively transports the minerals magnesium, calcium, and potassium as a therapeutic modality with antiallergic and anti-inflammatory activity. Ethanolamine is released from the EAP at an exceptionally high rate. In experiments on rats, for instance, it was found that phosphoryl colamine of EAP has anabolic effects. The weekly recordings of the weights of the rats showed weight gains for the female animals, whereas the male rats were found to have put on much less weight. Also, during the 6 months of the experiments, the female animals were balanced, peaceful, and even-tempered, and their coats were clean and smooth.

The test animals were given 300 mg of EAP per kg body weight per day. The daily therapeutic dose in humans is usually 5.7 to 11.4 mg/kg intravenously, or 20 to 40 mg/kg by the oral route.

Mineral therapy with magnesium/ calcium/potassium EAP is an efficient therapeutic approach for the management of functional disorders in family practice. The EAP vehicle may be applied either in single-agent mineralization or in a combination of the three. Magnesium/calcium/potassium EAP does not give rise to any adverse reactions provided that indications, contraindications and dosage instructions are followed. A gap can be filled for the treatment of psychovegetative (functional) disorders using this nutritional approach.

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References
1. Guenther, T. Stoffwechsel und Wirkungen des intrazellularen Magnesiums. Klinische Chemie 124, 1976.

2. Loeffler, A. Magnesium-Therapie in der Allgemeinpraxis. Der Landarzt 31:425-426, 1955.

3. Haldimann, B. Importance Clinique du Metabolisme du Magnesium. Schweiz. med. Wschr. 112:1366-1368, 1982.

4. Fischer, B. Hypermagnesiurie bei Alkoholkonsum. Krankenhausarzt 51:340-346, 1978.

5. Guze, Samuel B. Functional Disorders: A Wasteland that Could be a Challenge. Hospital Practice, February 1983, pp. 10-15.

6. McGlynn, Thomas J. and Metcalf, Harry L., eds. Diagnosis and Treatment of Anxiety Disorders: A Physician's Handbook (Hershey, PA: American Psychiatric Press, Inc., 1989), p. vii.

7. Leskow, P. and Dietz, G. Is There an Alternative Approach to the Therapy of Psychosomatic Disorders? Therapiewoche 36:1576-1580, April 1986.

8. Anast, C.S.; Mohs, J.M.; Kaplan, S.L.; and Burns, T.W. Evidence for Parathyroid Failure in Magnesium Deficiency. Science 177:606, 1972.

9. Anast, C.S.; Winnacker, I.L.; Forte, L.R.; and Burns, T.W. Impaired Release of Parathyroid Hormone in Magnesium Deficiency. Journal of Clinical Endocrinology and Metabolism 42:707, 1976.

10. Holtmeier, H.J. Kaliumangel. Deutsch. Apoth. Ztg 125:437, 1985.

11. Heinitz, M. Mineralstofftherapie bei Psychosomatischen Erkrankungen. ER fahrungsheilkunde 34:110, 1985.

12. Cremerius, J. In Taschenburch der Praktischen Medizin (Stuttgart: Thieme, 1972), p. 1190.

13. Heaton, F.W.; Pyrah, L.N.; Beresford, C.C.; Bryson, R.W.; and Martin, D.F. Hypomagnesium in Chronic Alcoholism. Lancet 11:802, 1962.

14. McCollister, R.J.; Flink, E.B.; and Lewis, M.D. Urinary Excretion of Magnesium in Men Following the Ingestion of Ethanol. American Journal of Clinical Nutrition 12:415, 1963.

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