Circadian Rhythmicity - Sunlight a La Carte: How to "Hack" Your Circadian Rhythm With 30min of Light Therapy Per Day

Image 1: The last installment was all about avoiding artificial  light, today we will use it to our advantage.

In the last installment of the SuppVersity Circadian Rhythm Series, we have taken a brief look at some of the physical aspects of light, in general, and how they relate to the physiological effects sunlight and artificial light exert on our biological clock. We have identified the omnipresence of unnatural "light" (in the broadest sense)  in our 24/7 x 365 world as one of the, if not the most important reason that our natural circadian rhythm and all the metabolic and endocrine parameters that depend on it got out of balance and we have discussed a couple of things that could be useful for anyone to either regain or retain the natural rhythm our genes have evolved with. In today's installment we are now (figuratively) turning back the time and take a look at the beneficial effects the same light(s) that keep(s) us awake, when we are long supposed to sleep, can have on the accuracy of our biological clock, earlier in the day.

Let the sun shine in your eyes to feel it in your heart ;-)

Now, that the day's are long and the sun is up or at least about to rise, when we are making our way to the bathroom to shower, brush our teeth, brew our coffee and grab something to eat (or continue our fast) before we pour ourselves into our daily business, many of you may already have forgotten those dark winter days, when you leave the house in darkness and sit in the office all day and are happy to see the last rays of the sun, when you jump into your car and head home, to the gym or to wherever you may be going on an "afternoon", your body can hardly distinguish from the darkest night.

Image 2: Selected physiological functions and their circadian pattern (Richter. 2011).

Scientists have long coined a specific term for this syndrome: Seasonal affective (SAD). Despite the fact that SAD has become more or less synonymous with the dreaded "winter blues", however, the depressive mood many people experience during the winter months, may be the most prominent, but certainly ain't the only symptom of a whole set of pathologies that are directly or indirectly related to a mismatch between your biological and social clocks. Against the background that the former controls a whole host of very important physiological processes (see image 2), it stands to reason that the consequences of this mismatch are not restricted to psychological problems. Moreover,  the number of patients and non-patients, i.e. people who simply regard symptoms such as...

• sleep problems - oversleeping but not refreshed, cannot get out of bed, napping in the afternoon
• overeating - carbohydrate craving leading to weight gain
• depression, despair, misery, guilt, anxiety - normal tasks become frustratingly difficult
• family / social problems - avoiding company, irritability, loss of libido, feeling emotionally 'numb'
• lethargy - too tired to cope, everything an effort
• physical symptoms - often joint pain or stomach problems, lowered resistance to infection
• behavioral problems - especially in young people

as part of their nature, for whom the occurrence of these problems is still seasonal, is constantly declining, so that what began as "seasonal affective disorder" has long lost both, its restriction to "affect" and its "season-"ality. A phenomenon, by the way, which should hardly surprise us. After all, we have done our very best to get rid of all kinds of all the inconvenient and unproductive seasonality in our lives, so that cynics would probable argue, that we are now paying the price for the 24/7 + 365-days-a-year availability of everything... 

From seasonal affective to circadian affective and physiological disorders

Before we are digressing any further into philosophical consideration, let's take a more scientific 2nd look at the enlightening (all puns intended) connection between the "winter blues", obviously a matter of circannual rhythmicity, and its high(er)-frequency equivalent the 'daily affective disorder'.

Figure 1: Circadian and circannual rhythm are both influenced by the sunlight and insufficient light exposure in the "high in intensity light hours" of the summer days can have the same detrimental effects on your psychological and physiological well-being as the dreaded "winter blues" aka "seasonal effective disorders" - no wonder they also respond to the same treatment strategies, i.e. dawn simulations and / or bright light therapy (respective data from Terman. 2006.)

The collage of data and illustrations I have come up with in figure 1 should actually make it pretty obvious: Despite the fact that the term 'circadian affective and physiological disorders' I have already used in the caption of this paragraph does not exist, the symptoms by which it makes itself felt, the sleep problems, the ravenousness, the depressive undertone, the lethargy, the tiredness, etc. are virtually identical.

Figure 2: Illustration of normal circadian rhythmicity (green), in seasonal affective disorders (SAD, red) and a circadian mismatch due to a phase-shift (violet); the units are more or less arbitrary.

In the end, you could probably argue that "SAD" is nothing but the "natural" accumulation of a light debt and results in a similar suppression of the natural amplitude (= degree of ups and downs, figure 2, green) of the circadian rhythm as a mismatch of the internal clock with external time emitters, above all the light of the sun.

How to "hack" your circadian rhythm

Despite the fact that the outcome of seasonal depressive disorders, on the one hand, and the downstream effects of permanent "social jet lag", or other misalignments of your biological clock and the "social time" you are living in, on the other hand, are in fact almost identical, the classic "winter blues" is the result of simple light deprivation, while the more complex pattern of circadian disorders has an intensity and a phase component and will necessarily have to be fixed differently.

What chronotype am I? Find out and become a part of a scientific study! While it is unquestionably possible to come up with an indefinite number of "classes" between the classic "early bird" (=person who raises with or before sun rise) and the "owl" (=person who rises, when the birds are having lunch), the scientific branch of chronotyping, which is occupied with the study of human rhythms in behavioral and cognitive functions, has come up with (you guessed it) a standardized questionnaire, the "Munich Chronotype Questionnaire", you can fill out here and will receive a "personal profil" via email.

Figure 4: Suggested starting times for 10,000-lux 30-minute session; timepoint is ~8.5h after the estimated melatonin onset (Termann. 2005)

If you don't want to wait or don't trust the German researchers, you can also download the modified Horne-Östberg Questionnaire, here. When you've filled it out, you will be able to calculate your "Morningness Eveningness Score." Based on that score you can then locate your suggested starting time in figure 4. The respective recommendations are based on a paper by Terman from 2005 and have been developed for SAD, so take them as what they are guidelines, not rules!

While research suggests that the correct timing of light exposure/therapy is of little or no importance as far as its beneficial effects on depression scores are concerned (Wirz-Justice. 1993), the so-called "circadian phase-delay", as scientists refer to the "time-shift" between natural and social clock (see figure 2, violet), must not be ignored if you intend to realign or protect yourself from future misalignment of your social and biological time domains.

The situation in figure 2 (violet), for example, depicts a ~4h phase shift, which would get you up and out of bed with the dreaded "2-AM wake-up call" (by the way pretty common in people who overtrain), 4h before your time!  

Now what can you do to battle this problem? Get out of bed switch on your 10,000 lux light therapy lamp, log on to facebook, check a couple of emails and sip a strong coffee? If you want to and can afford to be back to bed at 6 PM, go for it. If you don't you better stay in bed (and in the dark!), get up as you would "like" to and take a 30min "light shower" 1-2h after the time your morningness-eveningness score   would dictate (see infobox "What chronotype am I?") This will help you to push the onset of melatonin release gradually backwards until you reach the point, where it is ~8.5h before your "optimal" or necessary wake-up time.

For someone with an MEQ score of 45 who would ideally get up at 7 AM but won't make it to the office in time if he isn't up at least 1h "before his current time", on the other hand, a different strategy would be necessary.

Instead of turning around and sleeping the day away, he would set the alarm clock ahead by about 1h, jump out of bed at 5:00 AM, get his 30 min of bright light therapy in front of his 10,000 Lux lamp and do his regular morning routine afterwards. As soon as it becomes easier to get out of bed, it's time to set the alarm clock to 5:30 AM and eventually to 6:00AM.

It should be obvious, that even that will never be optimal for someone who is a born owl, i.e. a person whose genetic clock is set to wake him up, when the rest of the world has just had lunch. The daily and most importantly regular, early and intense light exposure in the morning is  going to help him to get out of bed easier and it will also increase his chances that the earlier onset of melatonin production combined with the tricks I have outlined in the last installment of this series allow him to fall asleep in time and get his 7-9h of sleep before the next light therapy session.

Warning: Guidelines and examples are no blueprints! These examples, as well as the figures in the infobox on chronotypes are very broad recommendations! You won't be able to avoid experimenting in order to pinpoint the optimal regimen for you.

Ok, I am convinced, what device shall I get?

What's that Valkee device? Is that any good? While there is a sponsored study on the efficiacy of the Valkee bright light device a "plug in your ear" light therapy device, the study is uncontrolled, which renders is more or less impossible to say how much of the observed beneficial effect the scientists measured by two different tests (HAMD-17 & BDI-21) were simply the result of a placebo effect (Timonen. 2012).

Figure 3: Comparison of BDI improvements of the Valkee device and classic light therapy (based on Timonen. 2012 and Meesters. 1993, respectively)

This does not mean that this device does not work, it just means that light therapy through the eyes is a well-established method not just to treat depressive disorders, but also to reprogram your circadian rhythm. The Valkee, on the other hand, could be a mobile and thus very convenient alternative (or adjunct) to the classic devices. It does yet still lack credible independent research that would prove its effectiveness - something like the 1993(!) study by Meesters et al. I picked as a comparison and in which only 4 days of light therapy with a classic 10,000 lux lamp had slightly more pronounced effects than the Valkee, even 10 days after the therapy had ended (see figure 3; note: It must be said that this is at best a binary comparison, because a quantitative comparison of the study outcomes from these studies can would at best serve as a basis for a hypothesis that would then have to be verified in a future trial).

The information we have compiled in the just mentioned last installment of this series does also come very handy, when you are clicking through the various product descriptions that will turn up when you enter the search token "light therapy lamp" into your favorite product search engine. Basically there are two different systems you can use if you want to try to "hack" (I know that this term is ludicrous, but I'll use it anyway, 'cause its also fashionable and would boost the sales if I ever intended to make an ebook out of this text ;-):

• a 10,000 lux full natural daylight spectrum white energy lamp or light therapy device, which will provide the full natural spectrum (you remember that's the sum of all frequency components of the sunlight, see  figure 2 in the last installment) without the potentially carcinogenic UV part - I don't have to tell you that this implies that you won't get tanned, right?
• a blue light that produces a light that has the same spectral composition as the blue sky on a summer day and is likewise devoid of the invisible high frequency ultraviolet part of the spectrum

According to the claims of the producers of such devices the blue light allows for shorter exposure times to achieve the desired effects.

This assumption does unquestionably seem reasonable, but the same is true for the hilarious notion that eating more protein will make you gain proportionally more muscle or that the presence of cholesterol in arterial plaque would verify that cholesterol is the cause of heart disease. Independent and controlled large(r) scale trials to support these claims are yet scarce and in the case of an even more innovative device, the fancy Valkee "brain stimulation set" that's supposed to shine light through your ears onto the recently discovered light sensitive proteins in your brain (for more info on the Valkee, check out the infobox on the right and the website of the producer), simply non-existent.

I personally did therefore decide to buy a classic white energy light system, also in view of the fact that you can simply place it right next to you at the breakfast table, the newspaper, your computer screen or wherever you want during your morning "circadian rhythm hacking sessions" *rofl* - this is by the way I use my device - at least if the weather / season / my wake-up time doesn't allow me to use the sun instead; and believe me, the blue light or Valkee could hardly be more convenient.

Side effects, summary & guide:

Bright light therapy guide

Intensity & wavelength requirements For white light pick a device that emits the full-spectrum of the visible light at 10,000 lux (measured at the level of the eyes of the user!)

Distance from light source Remain positioned at approximately 20–60 cm from the light source; don't stare directly into the light, the lamp just has to be in your field of view

Time of day for application In 90% of the cases the morning is the best time to apply light therapy; different rules do apply if you have to adapt your biological clock to a totally unnatural social rhythm, as it would for example be the case if you work night-shifts.

Dose 30 min at 10,000 lux, more does not necessarily help more, if you feel sleepy too early rather implement a second sitting

Onset of effect and maintenance 3–7 days till the effect sets in; if you use it to enforce an unnatural rhythm the effect will probably vanish shortly after discontinuation of therapy

In case of non-response double-dose, if you feel sleepy before your time; start earlier or add melatonin (3-10mg) before bed, if you can't get to bed in time.

In the end, it is still up to you, which device you want to buy. The guidelines in the overview on the right, which is based will probably work for the blue light systems and the Valkee, as well (assuming that those do work ;-). It is yet still by no means sure if and to which extend you can benefit and there are even occasional reports of allegedly mostly transient side effects, such as...

• hyperactivation and/or difficulty to fall asleep, which is by the way not just restricted to cases in which you apply the light too late in the day
• light headaches and/or nausea, which are particularly likely to occur in the transition periods or can be a simple consequence of starting starting out with a too hefty (=long) dose
• visual side effects, which are usually a result of staring into the light, which is not necessary for the light therapy to work, so don't do it

Other than that, Terman & Terman mention in a 2005 review paper that in their trials on patients with all sorts of serious psychological disorders, like manic depression or bipolar disorders, it was often necessary to increase the dosages, both time- and intensity-wise slowly to avoid flare-ups of these pre-existing problems. Compared to your average energy drink, let alone pill, the 30-min in front of a light therapy lamp are yet still child's play... its effects on the other hand are longer lasting and way more far-reaching.

A sneak peak on the next installment: In the next installment of the Circadian Rhythm Series we are going to leave the light out, only literally, of course, and devote ourselves to such profane things as food, what your biological clock tells you about when and what to eat and which effects this can have on your physique, performance and overall health.

References:

• Baroni BM, Leal Junior EC, Geremia JM, Diefenthaeler F, Vaz MA. Effect of light-emitting diodes therapy (LEDT) on knee extensor muscle fatigue. Photomed Laser Surg. 2010 Oct;28(5):653-8. Epub 2010 Jul 13.
• Blouin AG, Blouin JH, Iversen H, et al. Light therapy in bulimia nervosa: a double-blind, placebo controlled study. Psychiatry Res. 1996;60:1 9.
• Braun D, Sunday S, Fornari V, Halmi K. Bright light therapy decreases winter binge frequency in women with bulimia nervosa: a double-blind, placebo controlled study. Compr Psychiatry. 1999; 40:442-8.
• Howland RH. An overview of seasonal affective disorder and its treatment options. Phys Sportsmed. 2009 Dec;37(4):104-15.
• Lam RW, Goldner EM, Soplyom L, Remick RA. A controlled study of light therapy for bulimia nervosa. Am J Psychiatry. 1994;151: 744-9.
• Meesters Y, Jansen JH, Beersma DG, Bouhuys AL, van den Hoofdakker RH. Light therapy for seasonal affective disorder. The effects of timing. Br J Psychiatry. 1995 May;166(5):607-12. 
• Reiter RJ, Rosales-Corral S, Coto-Montes A, Boga JA, Tan DX, Davis JM, Konturek PC, Konturek SJ, Brzozowski T. The photoperiod, circadian regulation and chronodisruption: the requisite interplay between the suprachiasmatic nuclei and the pineal and gut melatonin. J Physiol Pharmacol. 2011 Jun;62(3):269-74.
• Terman M, Terman JS. Light therapy. In: Kryger MH, Roth T,  Dement WC, eds. Principles and Practice of Sleep Medicine. 4th  ed. Philadelphia, Penn: Elsevier; 2005:1424-1442. 
• Terman M, Terman JS. Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective Disorder. Am J Psychiatry. 2006; 163:12.
• Timonen M, Nissilä J, Liettu A, Jokelainen J, Jurvelin H, Aunio A, Räsänen P, Takala T. Can transcranial brain-targeted bright light treatment via ear canals be effective in relieving symptoms in seasonal affective disorder? A pilot study. Med Hypotheses. 2012 Apr;78(4):511-5.
• Wirz-Justice A, Graw P, Kräuchi K, Gisin B, Jochum A, Arendt J, Fisch HU, Buddeberg C, Pöldinger W. Light therapy in seasonal affective disorder is independent of time of day or circadian phase. Arch Gen Psychiatry. 1993 Dec;50(12):929-37. 

Magnesium Round-Up: Know If You Are Deficient, Whether You Need More, Where to Find It, How Dietary Mg Contents Changed & How Magnesium Interacts W/ Vitamin D

24%, 23% and 22% of the DV for magnesium that's what you can find in one serving of sunflower seeds (0.25cup), halibut (4oz) and a large(r) banana - now you tell me it was impossible to get your magnesium from dietary sources.

After having handled half of the Science Round-Up from Thursday yesterday, yesterday, there is still something left to serve: seconds to the seconds, if you will and probably not so "new" as the average SuppVersity news. In order not to bore you, I will yet refrain from telling you how important magnesium is and how it is involved in thousands of enzymatic reactions ... you know the whole magnesium-guru-spiel all too well, anyway. I mean, anyone doing a cursory Google search will have to conclude that there is nothing magnesium cannot cure, right?. Whatever you may suffer from, someone has already found out that it must be related to magnesium deficiency or, even more profitable, taking the wrong form of magnesium supplements.

Apropos deficiency: How do you even know you are deficient?

What sounds like a question that could be answered in one, at best two sentences turns out to be one of the root causes of the whole confusion about magnesium. Based on a standard blood test you can only exclude that your levels are (a) so high or (b) so low that you better head straight to the emergency room. Magnesium is, just as the other electrolytes, simply too important for your body to have them drop below a certain margin in which your heart works optimally. So if there is not enough magnesium around, your body will tap into tissue stores the status of which is obviously not identical to the serum levels on a standard lab test.

Table 1:The lion's share of magnesium to replete your serum levels is not coming from your red blood cells and therefore RBC levels are only a proxy and not a 100% reliable marker of total body mg status (data based on Elin. 1987)

According to Maurice J. Arnaud who wrote a review with the telling title "Update on the assessment of magnesium status" in 2008, the most reliable method to assess the whole body magnesium status would be a metabolic ward study in the course of which a so-called "loading test" would be performed, But...

"[b]alance studies are time consuming, labour intensive and need well trained staff. They are often performed in a metabolic unit and require complete urine and faecal collections; therefore it is not a method that can be applied as a routine test for the evaluation of Mg status. Loading tests are simplified balance studies where absorption is supposed not to be disturbed when Mg is given orally so that body retention is calculated from urine elimination. Mg administration during a loading test can be either oral or intravenous and it is important that the subjects have normal kidney function. Urine is collected for 24 hours following administration of the Mg load as Mg excretion by the kidney has been shown to have a circadian rhythm . Under these conditions, the loading test is supposed to be a reliable indicator of Mg status." (Arnaud. 2008)

With the erythrocyte (red blood cell) test for magnesium, there is however an alternative available, which may not be just as reliable but appears to show a relatively high correlation with whole body magnesium levels in many, but not all studies (Malon. 2004).

How likely is it that you are deficient?

Honestly, I would hope that it is unlikely, because if that is the case for someone who is not taking supplemental magnesium you can almost be sure that her or she is following a healthy whole foods diet.

Table 2: Overview of age groups with more than 5 % of intakes below the lowest recommended intake levels in 7 European countries; T, toddlers (1–3 years (both sexes)); C, children (4–10 years); Y, youth (11–17 years); A, adults (18–60 years); S, seniors (.60 years); capitals, both sexes; lower case, women only; lower case italic, men only (Mensik. 2013)

If you take a look at table 2 you will see that even the average German gets enough magnesium in his diet, irrespective of his age, and much contrary to our neighbors in the East, West and Northwest (I could not resist to mark zinc another of those purported minerals of which conventional wisdom tells you that you simply cannot get enough from your diet).

Knowing that most of you are probably Americans, I can calm you down. You are not worse than your British friends. In fact, the NHANES data from 1999-2000 suggests that the average American Caucasian and Mexican man below 50 gets enough magnesium from his food only! Unfortunately, the same cannot be said for the women, and both male and female African Americans who have trouble meeting their requirements even if one accounts for the additional magnesium from supplements (NHANES).

Magnesium and the athlete

A note on magnesium and cramps: While there is evidence that altered serum osmolality and altered serum electrolyte concentrations, notably hypochloraemia, hyponatraemia, and hypocalcaemia (=not hypomagnesaemia) can cause generalized skeletal muscle cramping at rest in specific clinical settings, "data from well-conducted prospective cohort studies show that athletes with acute EAMC are not hyponatraemic, hypochloraemic, or hypocalcaemic and do not have an abnormal serum osmolality." (Schwellnus. 2008).

For the average athlete, a low magnesium intake is yet rather the exception and can even be problematic for athletes with a high anaerobic-to-aerobic ratio who suffer from increases in blood mg due to an overall reduction on blood volume after intense workouts, anyway (Cordova. 1992; Joborn. 1985; Monteiro. 2005; Monteiro. 2006). It is thus no wonder that not magnesium deficiencies, but high magensium levels are a problem that is commonly observed in athletes. I mean, what are you supposed to do, when even your mother "lies" to you about cramps being caused by magnesium deficiency?

"The most common alterations were higher serum phosphate (29/61, 47%) and magnesium concentrations (28/61, 46%). Abnormalities of serum phosphorus and magnesium concentrations were detected in almost half of the athletes. Hyperphosphataemia and hypermagnesaemia were the most common abnormalities." (Malliaropoulos. 2012)

The data Malliaropoulos et al. analyzed came from 130 elite track and field athletes (65 males and 65 females, age range 20-30 years) from the National Athletics Sports Medicine Center database in Thessaloniki, Greece. And maybe some of them were even on the proven non-ergogenic ZMA (zinc + magnesium + vitamin B6; cf. Wilborn. 2004).

So where do you get your supplemental magnesium from and how much?

I am not going to tell you to stop supplementing with magnesium if you feel that this has done you good in the past. It is after all an important mineral. What I want to remind you of is yet the fact that taking 100% of the RDA is imho the absolute maximum. Even if you don't end up with high levels due to supplementing more and don't care about wasting money, there is one thing that's commonly overlooked about human physiology and that is how the intake and excretion of nutrients are highly inter-related. In other words, if your body switches into a "get rid of magnesium" mode it is likely you are loosing other electrolytes you do not supplement in copious amounts (e.g. salt ;-), as well.

Figure 1: Plasma an bone (primary axis) as well as red blood cell (RBC; 2ndary axis(!)) content after 14 days of supplementation with identical amounts of magnesium in different organic and inorganic forms (Coudray. 2005)

As far as the best forms are concerned the number of studies comparing multiple forms to each other is limited and the inter-comparison of different studies not really legit. Therefore I have simply copied + pasted the figure that went with a previous article on the matter - as you can see, you can generally use whatever form of magnesium you want - even the cheap oxides, which worked wonders for anxiety ridden ladies in a study by De Souza et al. that was published in the Journal of Women's Health & Gender-Based Medicine in March 2000. As long as you take your magnesium supplements in reasonably low doses - the dose in the De Souza study for example was 200mg + 50mg B6 - and over a long enough period, they are going to bring your levels back up - if not sooner, then later.

Magnesium depletion of our foods

A note on topical Epsom salt from the early 20th century: While I did tell you on the show that I could not find peer-reviewed adequately powered studies on the topical absorption of magnesium in the for of mg oil or Epsom salt, I found a comment in a 1915 paper on the potential harm caused by cosmetics quite enlightening, esp. the part on the economic value of respective products, where Martin I. Wilber writes that the ability of respective products to penetrate the "unbroken skin has as yet not been demonstrated" and cautions against the sue "of the now widely advertised lotions containing magnesium sulphate or Epsom salt", of which "the latter preparations serve very well to show the gullability of that portion of the public that is desirous of improving its facial appearance. As Epsom salt, magnesium sulphate can usually be purchased for 5 cents a pound, while in the form of any one of the popular skin or wrinkle lotions it is sold at the rate of from $2 to $4 a pound." (Wilbert. 1915) You see, there were snake,... ah I mean mg oil vendors all over the place even 100 years ago ;-)

Aside from the almost cult-like worship of epsom salt baths and topical ng oils, the notion of a general depletion of mg in the foods we eat is one of the favorites among the bazillion of websites run by people who hoax you to believe they were concerned with your physical health, when all they are concerned with is their own financial health.

Figure 2: Changes in mineral content of selected food types from 1940-2002 (Thomas. 2007)

It is, as the data in figure 2 goes to show you true that the amount of magnesium in many of the foods we consume is lower these days than it was amidst WW2. The mg loss in meats, for example, is  driven by the processing, while corned beef has lost almost 50% of its "original" mg content, the amount of mg in roast beef and steaks is still the same, the one in turkey is even up by ~30% and for chicken it remained 100% stable (Thomas. 2007). It is also a very intriguing coincidence that the same websites will usually also tell you how we are all not just magnesium deficient, but also copper toxic. Strange in view of the fact that the average reduction in copper is -62% and thus >2x higher than that of magnesium.

Magnesium supplementation for special conditions

Before closing this round-up with a bottom line, I am briefly listing a couple of things related to magnesium or rather a deficiency in this important mineral that could be solved by simply upping your dietary and/or supplemental magnesium intake.

• 

  Higher vitamin D levels increase MG uptake from the gut and supplementation with VD has been shown to increase mg in obese, yet not in normal individuals (Farhanghi. 2009). On the other hand, mg has recently been found to be necessary for the production of calcitriol from 25OHD (Matsuzaki. 2013)

  anxiety - mg is the gate-keeper at the NMDA receptor and interacts with the GABA receptors; a deficiency can cause anxiety, the use of extra magnesium will yet not automatically solve the problem if you are not low to begin with
• depression - low cellular mg levels can precipitate if not cause depression(-like) symptoms, 150-300mg of magnesium glycinate or better taurinate can help (Eby. 2006)
• low vitamin D - while it is not yet sure if it helps with upping the storage form of vitamin D (25OHD), it has been recently established that magnesium is necessary for the production of calcitriol the active form of vitamin D; adequate levels of D also facilitate mg absorption very high levels of vitamin D, on the other hand, have been associated with low / imbalanced mg levels - probably due to their effects on calcium homestasis
• constant stress / burnout - initially low mg levels will lead to a hyper activity of the stress-axis within the HPTA; the constantly overtaxed CNS will then give in and you will end up totally burned out (Sartori. 2011); this state cannot be reversed by magnesium supplementation, alone, but it can aid the recovery process which is largely based on taking off of everything that stresses you

Whether or not simply eating more high magnesium foods will be enough or whether you actually have to buy supplements to work on these and other issues will also depend on whether

• you can digest / absorb it, which would be hampered due to vomiting, diarrhea, bowel resection, intestinal and biliary fistulas or hemorrhagic pancreatitis
• lose too much mg over the kidneys, due to chronic parental fluid therapy, osmotic diuiresis, hypercalcemia, diuretics, aminoglycosides, amphotericin B, pentamidine, cisplatin, cyclosporine, alcohol metabolic acidosis (ketosis, starvation, alcoholism), renal diseases, or
• suffer from endocrine disorders like primary or secondary aldosteronism, diabetes, hyperthyroidism or hyperparathyroidism

If anything of these sounds familiar, I would certainly consider testing my mg levels (erythrocyte test) before and while I was supplementing and that's not about wasting money on potentially unnecessary supplements, but much more about making sure that you actually get, absorb and retain enough magnesium.

---

Bottom line: Magnesium is certainly an important mineral, but its effects must not be seen in isolation, it should not be supplemented in copious amounts in isolation without medical indication and it may not be misunderstood as a natural pharmacological agent - it works by (a) replacing a deficiency or (b) countering an imbalance. Plus: It is not generally impossible to get your 300-400mg of magnesium from your diet.

References:

• Arnaud MJ. Update on the assessment of magnesium status. Br J Nutr. 2008 Jun;99 Suppl 3:S24-36.  
• Bohl CH, Volpe SL. Magnesium and exercise. Crit Rev Food Sci Nutr. 2002;42(6):533-63. Review.
• Cordova A. Changes on plasmatic and erythrocytic magnesium levels after high-intensity exercises in men. Physiol Behav1992; 52: 819-21.
• Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67(2):362-70. 
• Elin RJ. Assessment of magnesium status. Clin Chem. 1987 Nov;33(11):1965-70. Review.
• Farhanghi MA, Mahboob S, Ostadrahimi A. Obesity induced magnesium deficiency can be treated by vitamin D supplementation. J Pak Med Assoc. 2009 Apr;59(4):258-61. 
• Joborn H, Akerstrom G, Ljunghall S. Effects of exogenous catecholamines and exercise on plasma magnesium concentrations. Clin Endocrinol (Oxf)1985; 23: 219-26; (Oxf).
• Malliaropoulos N, Tsitas K, Porfiriadou A, Papalada A, R Ames P, Del Buono A, Lippi G, Maffulli N. Blood phosphorus and magnesium levels in 130 elite track and field athletes. Asian J Sports Med. 2013 Mar;4(1):49-53.
• Malon A, Brockmann C, Fijalkowska-Morawska J, Rob P, Maj-Zurawska M. Ionized magnesium in erythrocytes--the best magnesium parameter to observe hypo- or hypermagnesemia. Clin Chim Acta. 2004 Nov;349(1-2):67-73.  
• Matsuzaki H, Katsumata S, Kajita Y, Miwa M. Magnesium deficiency regulates vitamin D metabolizing enzymes and type II sodium-phosphate cotransporter mRNA expression in rats. Magnes Res. 2013 May 1;26(2):83-6.
• Mensink GB, Fletcher R, Gurinovic M, Huybrechts I, Lafay L, Serra-Majem L, Szponar L, Tetens I, Verkaik-Kloosterman J, Baka A, Stephen AM. Mapping low intake of micronutrients across Europe. Br J Nutr. 2013 Aug;110(4):755-73.   
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Gingko Biloba, Your Dopaminergic Brain Viagra. Plant Extract Stimulates Sexual Arousal via the Paraventricular Nucleus and the Mesolimbic System.

Image 1: Gingko biloba
trees are one of a kind, with
no close living relatives
(image Schwabe Pharm.)

I bet you got one of those Viagra spam mails, today, as well, didn't you? Well, although I assume you would not need the small blue pills, anyway, you may be interest to read that researchers from the People's Republic of China may have found a viable Viagra alternative in a longstanding (pun intended ;-) ingredient of Traditional Chinese (and meanwhile also Western) Medicine: Gingko biloba.

In order to elucidate the underlying mechanisms of previously (Yeh. 2010) observed beneficial effects of Ginkgo biloba extract on noncontact erections in male rats, Yeh et al. (Yeh. 2011) recorded both copulation, as well as non-contact erections in a group of 20 male Long-Evans (telling name, isn't it?) rats, which had been randomly assigned to a treatment (50mg/kg body weight Gingko biloba extract [EGb 761 from Schwabe Pharmaceuticals], human equivalent 8mg/kg ~ 640mg for an 80kg man) or a control group. 14 days after initiation of treatment, there was "a significant increase in the number of NCEs [non contact erections]" in the 10 rats of the treatment group. Furthermore,

[...] the expression of catecholaminergic neurons in the PVN [paraventricular nucleus] and the VTA [ventral tegmental area] was seen [to be significantly increased ...] and tissue levels of dopamine and 3,4-dihydroxyphenylacetic acid in the NAc [nucleus accubens] were also markedly increased in the EGb 761-treated animals. However, the norepinephrine tissue levels in the PVN and the NAc in the EGb 761-treated group were not significantly different from those in the controls.

In other words, the increased number of catecholaminergic neurons did not, as one might have expected, increase the total amount of the stress-related neurotransmitter /hormone norepinephrine. In agreement with previous work by Mas et al., 1990; Pfaus et al., 1990; Pleim et al., 1990;Wenkstern et al., 1993; Tsai et al., 2006, it's dopaminergenic effects in the nuccleus accubens (dopamine levels in the increased by 66%), on the other hand, had profound effects on their sexual behavior (cf. figure 1).

Figure 1: Effect of Gingko biloba extract @ 50mg/kg on non-contact erection frequency in male Long-Evans rats before and after 14 day treatment (data adapted from Yeh. 2011)

In view of the effect, that the scientist do not want to "exclude that EGb 761 treatment may also influence dopaminergic activity in other brain areas", these results may be of interest even to those among you, who do not have any trouble "getting it up".

Note: The mechanism by which Gingko biloba increases sexual desire is different from the one of PDE-5 inhibitors such as avanafil, lodenafil, mirodenafil, sildenafil citrate, tadalafil and all the other "-afils". While the systemic effect on nitric oxide induced vasolidation of Viagra and Co. will help with erection quality and quantity, Gingko biloba probably won't help if blood flow restriction in your most valuable part is an issue. The different mechanisms of action, on the other hand, would suggest the two would make an interesting stack. And in fact back in 2010 Kim et al. found that "GBE [Gingko biloba extract] could increase the relaxant potency of mirodenafil even at a minimally effective dose" (Kim. 2010).

With dopamine playing an important role in behavior and cognition, voluntary movement, motivation, punishment and reward, inhibition of prolactin production (juicers did you read that?), sleep, mood, attention, working memory, and learning, the implications of this finding reach beyond sexual function alone. Even in the etiology of the dubious central fatique syndrome, every second visitor of one of the major internet health bulletin boards claims to experience, these days, may involve dopamine or rather a lack thereof (Caldizán Uzón. 2008). That being said, the group of patients who benefit from one of the readily available over-the-counter Gingko biloba supplements may soon expand from best agers, who are concerned about cognitive decline to (pre-)andropausal men who want to regain their interest in the fairer sex and, eventually, everyone who feels he/she would benefit from some additional dopaminergic drive.

Chronically Fatigued? Taking a Meditative Time-Out With Qigong Twice Weekly Will Improve Mental + Physical Symptoms by ~50% & Increase Telomere-Length by 75%!

Image 1 (myrtlebeachalternatives): This picture captures the essence of Qigong artistically.

Adelfo took the word "holiday" to the heart and totally forgot about his blogpost, today. I guess this means I will have to pull something of interest out of my hat (or head?) and what would be better suited than a post about taking timeouts, well sort off... In a recently published paper in the Annals of Behavioral Medicine, R.T. Ho and his (or her?) colleagues from the University of Hong Kong report on the truly amazing progress a group of chronic fatigue patients made in the course of a 4-months Qigong intervention program (Ho. 2012).

Qigong means "life energy cultivation" and that's exactly what it does - it helps you cultivate the life energy that's so easily lost in our hectic and allegedly productive lives.

The participants in the intervention study took part in supervised Qigong exercise training (Wu Xing Ping Heng Gong, 五行平衡功) twice a week for five consecutive weeks. After this introduction period the 51 women and 13 men were advised to follow up on what they had learned in the supervised sessions and continue to practice their meditation techniques at home. Physical functioning and mental functioning were assessed by the Chinese version of the Medical Outcomes Study 12-Item Short-Form Health Survey (Ware. 1996; Lam. 2005) and telomerase activity was tested by a commercially available kit TeloTAGGG telomerase PCR ELISA (Roche) in the peripheral blood mononuclear cells before and after the 4-month intervention.

Video 1 (click to play): Qigong introduction video - whenever you meet this guy in your park, don't jog along laughing, join him!

What's Qigong?  Literally Qigong means nothing less than the "life energy cultivation". The idea behind this special form of meditation is to develop a special kind of awareness for yourself and your body and to breath, move and exercise in a way that is conducive to healing and meditation. Simplistically speaking it is a mixture of Chinese medicine, martial arts and philosophy that was developed to cultivate and balance you qi (chi), which is the afore mentioned "life energy" and to awaken your true nature. You may have seen and probably laughed about practitioners who have been moving (and most of all breathing) rhythmically on one of the greens in your local park while you were jogging along frantically listening to the latest hiphop or techno beats. I guess after reading the whole post you will look differently at those "freaks", whenever your paths cross next time...

If you take a look at the data in figure 1 (see below) you will have to agree that no matter how ridiculous a stupid Westerner like you or me may feel an "exercise" like this may be, the effects of this unconventional "workout + meditation" routine are beyond any doubt amazing!

Figure 1: Changes in physical and mental features of chronic fatigue (left) and telomerase length (right) in response to 5 weeks of supervised and 4 months (total) of a twice weekly Qigong program (based on Ho. 2012)

Just imagine what a fuss the pharma industry would make, if they had come up with some sort of serotonergic-dopaminergic double-whammy that would not simply spike you up or numb you, but return your physical and psychological functioning to normal, while at the same time saving your cells from aging prematurely by lengthening your telomerase (the enzyme that is responsible for the repair of cellular DNA)?

We would not have to turn to the Chinese to know better ... "Mens sana in corpore sano!"

Now you could certainly say that this is Chinese witchcraft and nothing a Western medical practitioner or scientists would let alone should rely on, but let's be honest:  Where has the $84-billion dollar psychiatric drug industry taken us, so far? Yeah, they have increased their own market and shareholder value, the patients overall well being let alone their life-expectancy still suck and that despite the fact that the Greek philosopher Thales from Miletus already knew that a "healthy soul" (mens sana) and a "healthy body" (corpore sano) are complementary sides of one and the same coin.

Image 2: Meditation is for hippies and losers who don't make it in our hard economy, right?

According to the medical paradigm of the 20ths and 21st century, which is keeping the aforementioned multi-billion dollar industry in (big) business, however, the intricate connection between psychology and physiology the forefathers of Western civilization were still well aware of, is a simple mechanistic one: One psychological well-being is a simple function of your neurotransmitter balance and if the latter is off, all you need to do is to take the right drug and you will bounce back into your highly productive self whose sole purpose it is to drive the economy to new heights. Rest, recuperation, relaxation, ... let alone meditation, that's for freaks and loser for those weaklings who cannot cope with the demands of the life of the 21st century, the economic selection pressure is going to to take care of those losers, right?

As sarcastic as it may sound, there is - as so often - more than just a grain of truth in the "economic selection pressure" hypothesis - yeah, I mean, look around: Those who fully subscribe to the idea are already falling victim to it. When the Ritalin-rush will finally wear off and their telomerase will have reached a length that allows for no more than another couple of weeks on this earth some of them will probably look differently at the "ridiculous clowns" in Central Park...

References:

1. Citizens Commission Human Rights International. Psychiatric Labels: The Facts Behind the Billion Dollar Marketing Campaign. < http://www.cchrint.org/psychiatric-disorders/ > retrieved July, 5 2012
2. Ho RT, Chan JS, Wang CW, Lau BW, So KF, Yuen LP, Sham JS, Chan CL. A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons with Chronic Fatigue or Chronic Fatigue Syndrome. Ann Behav Med. 2012 Jun 27.
3. Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14:539-547.
4. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity.Med Care. 1996;34:220-233.