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با اینکه منیزیم را میتوان در بسیاری از غذاها از جمله دانهها (سویا، بادام)، غلات، میوهها (انگور و لیمو) و سبزیجات یافت، اما بسیاری از مردم از کمبود آن رنج میبرند. در مطالعاتی که در ایالات متحده آمریکا صورت گرفته نشان داده که بیشتر مردم میزان کافی از منیزیم را از رژیم غذایی خود دریافت نمیکنند. کمبود منیزیم (هیپومنیزیمی) در حدود ۱۰ درصد از افراد بستری در بیمارستان مشاهده میشود که سبب بدتر شدن وضعیت بیماریهای دیگر فرد میگردد. هیپومنیزیمی مزمن با بسیاری از بیماریهای مزمن دیگر مثل دیابت، اختلالات قلبی، پوکی استخوان و پرفشاری خون در ارتباط است. بطوری که نشان داده شده که کمبود منیزیم سبب افزایش احتمال مرگ در بیماران بستری در ICU میشود.
برخی مشکلات و بیماریها سبب برهم خوردن تعادل منیزیم در بدن میشود به طور مثال آلودگی به ویروسهای گوارشی که سبب تهوع، اسهال و استفراغ میشود؛ سبب کاهش موقتی منیزیم خون میگردد. برخی بیماریهای مزمن مثل سندرم روده تحریکپذیر، زخمهای رودهای، پانکراتیت، هایپرتیروئیدی و مشکلات کلیوی سبب هیپومنیزیمی مزمن میگردد. مصرف بیش از حد چای، نمک و الکل و تعریق زیاد و استرس طولانی مدت نیز سبب کاهش سطح منیزیم میشود.
علائم کمبود منیزیم شامل: تحریکپذیری، عصبی شدن، مشکلات خواب، تهوع و استفراغ، سرگیجه، اسپاسم عضلانی، خستگی، تنفس سریع، مشکلات رشد ناخن، آریتمی و در نهایت تشنج است.
مطالعات گوناگونی روی اثرات مفید منیزیم در درمان انوع بیماریها انجام شده است که به طور کلی میتوان منیزیم را به عنوان درمان مکمل در بیماریهایی از قبیل دیابت، آسم، فیبرومیالژیا، آریتمی و بیماریهای قلبی، پرفشاری خون، سردردهای میگرنی، پره اکلامپسی، سندرم پیش قاعدگی و سندرم پای بیقرار دانست.
در یک سری اختلالات و بیماریهای ارثی به دلیل نقصهای ژنتیکی و مادرزادی در توبولهای کلیوی که وظیفه بازجذب منیزیم را دارند، منیزیم از راه ادرار دفع میگردد و فرد دچار هیپومنیزیمی میگردد. این بیماریهای ژنتیکی بر اساس نوع نقص ژنی که ایجاد شده ، طبقه بندی میشود به طور مثال در سندرم بارتر کلاسیک، که ناشی از جهش در ژن CLCNKB است، و این ژن کد کننده نوعی کانال کلر در توبول نزولی کلیه می باشد نوزادان دچار این بیماری ارثی معمولاً دچار هیپومنیزیمی، هیپوکالمی، آلکالوز متابولیک و هایپر آلدسترونیسم ثانویه هستند. سندرم گایتلمن که در سنین کودکی و بلوغ تظاهر میکند ناشی از جهش در ژن یک کانال عبور دهنده همزمان کلر و سدیم در توبول نزولی کلیه است که سبب کاهش منیزیم و اختلالات متابولیکی همزمان دیگر میگردد. تا کنون ۱۰۰ نوع جهش ژنی شناخته شده است که میتواند سبب اختلال هیپومنیزیمی میگردد که در جدول زیر انواع شایع آن نشان داده شده است.
افزایش سطح منیزیم (هایپرمنیزیمی) یک اختلال نسبتاً ناشایع بوده و به دلیل دفع ناقص منیزیم و افزایش بازجذب از کلیه ها و یا مصرف بیش از حد منیزیم از راه خوراکی است و معمولاً با علائمی مثل افت فشار خون بروز میکند.
برای درمان هیپومنیزیمی و مصرف منیزیم به عنوان درمان جانبی در بیماریهای دیگر انواع قرصها، کپسولها و شربتهای مکمل حاوی منیزم در مقادیر مختلف وجود دارد. در این مکمل ها معمولاً منیزیم را با انواع مواد معدنی و ویتامینها همراه میکنند. که در برخی موارد جذب منیزیم با در حضور این مواد بیشتر و در برخی موارد جذب منیزیم کمتر میگردد. نمونه شایع این مکملهای معدنی قرصها و کپسولهای کلسیم، منیزیم و زینک است. منیزیم با مهار ترشح هورمون پاراتیروئیدی و تحریک ترشح کلسیتونین سبب افزایش نشت کلسیم روی استخوان میشود. اما کاربرد همزمان آنها در یک قرص به دلیل رقابت این دو کاتیون دو ظرفیتی در جذب از طریق روده چندان مناسب به نظر نمیرسد. منیزیم بهتر است با ویتامینهای گروه B بخصوص B۶ مصرف شود زیرا B۶ سبب تنظیم جذب منیزیم میگردد.
منیزیم در فرمهای مختلفی وجود دارد. فرمهای موجود از منیزیم شامل: منیزیم هیدروکساید، منیزیم سولفات، منیزیم لاکتات، منیزم گلوکورونات، منیزیم کلراید و منیزیم سیترات است. منیزیم هیدروکساید معمولاً به عنوان آنتی اسید و ملین کاربرد دارد. منیزیم سولفات از راه خوراکی به عنوان ملین و همراه با مولتی ویتامینها و از راه موضعی به فرآوردههای آرایشی- بهداشتی کاربرد دارد. فرمهای منیزیم لاکتات، منیزیم گلوکورونات و منیزیم سیترات از راه خوراکی جذب بالایی دارند و معمولاً در مکملها به کار میروند. همچنین انواع قرصهای مکمل منیزیم به شکل آهسته رهش تولید شدهاند که جذب بالاتری را فراهم میکنند.
در برخی اختلالات متابولیکی هیپومنیزیمی به اندازهای است که نیاز به مصرف مقادیر بالای منیزیم از راه خوراکی وجود دارد. در این موارد یکی از راهها، استفاده از فرآوردههای ترکیبی حاوی ۶ تا ۱۰ درصد منیزیم است که به طور محلولهای خوراکی با پایه آبی ارائه میشود. از این رو داروخانه ها اقدام به تهیه فرآوردههای خوراکی حاوی منیزیم کلراید و منیزیم سیترات در قالب داروی ترکیبی، بر اساس دستور پزشک و نیازهای اختصاصی بیماران میکند.
منابع:
Swaminathan R. Magnesium Metabolism and its Disorders Clin Biochem Rev. ۲۰۰۳ May; 24(2): 47–۶۶.
Aydin H, Deyneli O, Yavuz D, Gözü H, Mutlu N, Kaygusuz I, Akalin S. Short-Term Oral Magnesium Supplementation Suppresses Bone Turnover in Postmenopausal Osteoporotic Women. Biol Trace Elem Res. ۲۰۰۹ Jun 2.
Bartlett HE, Eperjesi F. Nutritional supplementation for type 2 diabetes: a systematic review. Ophthalmic Physiol Opt. ۲۰۰۸ Nov;28(6):503-23. Review.
Bendich A. The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms. J Am Coll Nutr. ۲۰۰۰;۱۹(۱):۳-۱۲.
Bo S, Pisu E. Role of dietary magnesium in cardiovascular disease prevention, insulin sensitivity and diabetes. Curr Opin Lipidol. ۲۰۰۸ Feb;19(1):50-6. Review.
Rowe BH, Edmonds ML, Spooner CH, Camargo CA. Evidence-based treatments for acute asthma. [Review]. Respir Care. ۲۰۰۱;۴۶(۱۲):۱۳۸۰-۱۳۹۰.
Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. ۲۰۰۹ Jun;25(5):446-52.
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