Leyla Weighs In: Drug-Induced Magnesium Depletion

Registered dietitian nutritionist Leyla Muedin discusses a New England Journal of Medicine paper (July 2024, cited via Holistic Primary Care) warning about drug-induced magnesium depletion, especially from diuretics, proton pump inhibitors (e.g., Nexium, Prilosec), and certain antibiotics. She notes magnesium is often not routinely measured despite links between deficiency and cardiovascular, metabolic, and neurological problems, including arrhythmias (AFib, long QT, torsades), endothelial dysfunction, and longer ICU stays. Prevalence estimates range from 7–11% (up to 20%) in hospitalized patients and 2–4% among outpatients, with higher rates among long-term PPI and diuretic users. She reviews symptoms and causes, explains limits of serum magnesium testing, highlights associations with diabetes, alcohol use, low potassium and calcium, and outlines evaluation options and oral repletion approaches, favoring better-absorbed forms like magnesium glycinate over oxide due to diarrhea risk.

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Harvard-trained psychiatrist Dr. Georgia Ede is the author of "Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health." She links diet to the mental health crisis and dementia risk. Ede explains that conventional psychiatric training ignored nutrition, and she later incorporated dietary strategies alongside medication and psychotherapy after personal health experiences. She emphasizes focusing on metabolic and nutritional quality—especially stabilizing blood sugar and insulin—rather than simplistic plant-vs-animal messaging. She argues some animal foods are needed for brain nutrients like B12 and EPA/DHA. She discusses ketogenic diets as a way to lower insulin, produce ketones, improve brain energy, and reduce inflammation, citing case reports and a study of hospitalized patients where many improved and 44% reached remission. She critiques nutrition epidemiology as unreliable and outlines three “quiet” dietary tiers: whole-food low-glycemic, ketogenic, and carnivore, plus practical issues like electrolytes and gradual transition.

Dr. Hoffman continues his conversation with Harvard-trained psychiatrist Dr. Georgia Ede, author of "Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health." 

Dr. Bret Scher, medical director of the Coalition for Metabolic Health, discusses making metabolic health the foundation of medicine amid rising obesity and type 2 diabetes and reports that 93% of Americans have suboptimal metabolic health. Scher defines metabolic health using markers including glucose, insulin, triglycerides, HDL, blood pressure, and waist size, and cites evidence linking insulin resistance to heart disease, stroke, cancer, psychiatric illness, and other complications. They discuss simple self- and lab-assessments (waist-to-height ratio, fasting insulin with glucose/HOMA-IR, triglyceride-to-HDL ratio, CGMs). Scher critiques the Eat Lancet report for assuming one optimal diet, reliance on low-quality nutrition epidemiology, potential nutrient shortfalls, and environmental oversimplification, while supporting newer dietary guidelines that allow lower-carb approaches. Part two covers contradictory nutrition studies, distinctions between low-carb and ketogenic diets, emerging “metabolic psychiatry” and ketogenic therapy for mental illness and cognitive decline, limits and rebound risks of GLP-1 drugs, and Coalition efforts to improve school food and influence policy.

Dr. Hoffman continues his conversation with Dr. Bret Scher, medical director of the Coalition for Metabolic Health.

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Leyla Muedin, a registered dietician nutritionist, shifts the discussion beyond cholesterol and statins to “hidden” cardiovascular risks from insufficient vitamin K and folate intake. Citing Cleveland Clinic and other research, she notes a high prevalence of vitamin K deficiency in the U.S. and widespread inadequate folate intake globally, including low folate levels among women of reproductive age. She explains that vitamin K2 may help inhibit arterial and soft-tissue calcification via activation of matrix GLA protein, with studies linking higher K2 (MK-7) intake to lower coronary heart disease risk and slowed coronary artery calcification. Folate supports vascular function through homocysteine metabolism, with evidence associating higher folate intake with lower cardiovascular mortality, emphasizing active 5-MTHF over folic acid due to conversion limitations in many people. She also notes statins can downregulate vitamin K metabolism and encourages discussing risks, benefits, and supplements with a doctor.