Intravenous nutrient therapy: the “myers’ cocktail”

Review “Myers’ Cocktail”
Intravenous Nutrient Therapy:
the “Myers’ Cocktail”
Alan R. Gaby, MD
It was not clear exactly what the “Myers’ Building on the work of the late John Myers,
cocktail” consisted of, as the information provided MD, the author has used an intravenous
by patients was incomplete and no published or vitamin-and-mineral formula for the treatment
written material on the treatment was available. It of a wide range of clinical conditions. The
appeared that Myers used a 10-mL syringe and modified “Myers’ cocktail,” which consists of
administered by slow IV push a combination of magnesium, calcium, B vitamins, and vitamin
magnesium chloride, calcium gluconate, thiamine, C, has been found to be effective against acute
vitamin B6, vitamin B12, calcium pantothenate, asthma attacks, migraines, fatigue (including
vitamin B complex, vitamin C, and dilute hydro- chronic fatigue syndrome), fibromyalgia, acute
chloric acid. The exact doses of individual com- muscle spasm, upper respiratory tract
ponents were unknown, but Myers apparently used infections, chronic sinusitis, seasonal allergic
a two-percent solution of magnesium chloride, rhinitis, cardiovascular disease, and other
rather than the more widely available preparations disorders. This paper presents a rationale for
containing 20-percent magnesium chloride or 50- the therapeutic use of intravenous nutrients,
reviews the relevant published clinical
The author took over the care of Myers’ research, describes the author’s clinical
patients, using a modified version of his IV regi- experiences, and discusses potential side
men. Most notably, the magnesium dose was in- effects and precautions.
creased by approximately 10-fold by using 20- (Altern Med Rev 2002;7(5):389-403)
percent magnesium chloride, in order to approxi-mate the doses reported to be safe and effective Introduction
for the treatment of cardiovascular disease.1, 2 Inaddition, the hydrochloric acid was eliminated and the vitamin C was increased, particularly for prob- more, Maryland, pioneered the use of intravenous lems related to allergy or infection. Folic acid was (IV) vitamins and minerals as part of the overall not included, as it tends to form a precipitate when treatment of various medical problems. The au- thor never met Dr. Myers, despite living in Balti- more, but had heard of his work, and had occa- patients, and it soon became apparent that the sionally used IV nutrients to treat fatigue or acute modified Myers’ cocktail (hereafter referred to as “the Myers’”) was helpful for a wide range of clini- cal conditions, often producing dramatic results.
of his patients sought nutrient injections from the Over an 11-year period, approximately 15,000 author. Some of them had been receiving injec-tions monthly, weekly, or twice weekly for manyyears – 25 years or more in a few cases. Chronic Alan R. Gaby, MD – Past president of the American Holistic problems such as fatigue, depression, chest pain, Medical Association; author of Preventing and ReversingOsteoporosis, and co-author of The Patient’s Book of or palpitations were well controlled by these treat- ments; however, the problems would recur if the Correspondence address: 301 Dorwood Drive, Carlisle,PA 17013.
patients went too long without an injection.
Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002 Page 389
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injections were administered in an outpatient set- Theoretical Basis for IV Nutrient
ting to an estimated 800-1,000 different patients.
Conditions that frequently responded included asthma attacks, acute migraines, fatigue (includ- can achieve serum concentrations not obtainable ing chronic fatigue syndrome), fibromyalgia, acute with oral, or even intramuscular (IM), adminis- muscle spasm, upper respiratory tract infections, tration. For example, as the oral dose of vitamin chronic sinusitis, and seasonal allergic rhinitis. A C is increased progressively, the serum concen- small number of patients with congestive heart tration of ascorbate tends to approach an upper failure, angina, chronic urticaria, hyperthyroidism, limit, as a result of both saturation of gastrointes- dysmenorrhea, or other conditions were also tinal absorption and a sharp increase in renal clear- treated with the Myers’ and most showed marked ance of the vitamin.3 When the daily intake of vi- improvement. Many relatively healthy patients tamin C is increased 12-fold, from 200 mg/day to chose to receive periodic injections because it en- 2,500 mg/day, the plasma concentration increases hanced their overall well being for periods of a by only 25 percent, from 1.2 to 1.5 mg/dL. The highest serum vitamin C level reported after oral administration of pharmacological doses of the results have been presented at more than 20 medi- vitamin is 9.3 mg/dL. In contrast, IV administra- cal conferences to several thousand physicians.
tion of 50 g/day of vitamin C resulted in a mean Today, many doctors (probably more than 1,000 peak plasma level of 80 mg/dL.4 Similarly, oral in the United States) use the Myers’. Some have supplementation with magnesium results in little made further modifications according to their own or no change in serum magnesium concentrations, preferences. In querying audiences from the lec- whereas IV administration can double or triple the tern and from informal discussions with colleagues serum levels,5,6 at least for a short period of time.
at conferences, the author has yet to encounter a practitioner whose experience with this treatment ert pharmacological effects, which are in many has differed significantly from his own.
cases dependent on the concentration of the nutri- ent. For example, an antiviral effect of vitamin C ports, there is only a small amount of published has been demonstrated at a concentration of 10- research supporting the use of this treatment. There 15 mg/dL,4 a level achievable with IV but not oral is one uncontrolled trial in which the Myers’ was therapy. At a concentration of 88 mg/dL in vitro, beneficial in the treatment of musculoskeletal pain vitamin C destroyed 72 percent of the histamine syndromes, including fibromyalgia. Intravenous present in the medium.7 Lower concentrations magnesium alone has been reported, mainly in were not tested, but it is possible the serum levels open trials, to be effective against angina, acute of vitamin C attainable by giving several grams migraines, cluster headaches, depression, and in an IV push would produce an antihistamine ef- chronic pain. In recent years, double-blind trials fect in vivo. Such an effect would have implica- have shown IV magnesium can rapidly abort acute tions for the treatment of various allergic condi- asthma attacks. There are also several published tions. Magnesium ions promote relaxation of both case reports in which IV calcium provided rapid vascular8 and bronchial9 smooth muscle – effects relief from asthma or anaphylactic reactions.
that might be useful in the acute treatment of va- This paper presents a rationale for the use sospastic angina and bronchial asthma, respec- of IV nutrient therapy, reviews the relevant pub- tively. It is likely these and other nutrients exert lished clinical research, describes personal clini- additional, as yet unidentified, pharmacological cal experiences using the Myers’, and discusses effects when present in high concentrations.
potential side effects and precautions.
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In addition to having direct pharmacologi- the interval between treatments can be gradually cal effects, IV nutrient therapy may be more ef- increased, and eventually the injections are no fective than oral or IM treatment for correcting intracellular nutrient deficits. Some nutrients are Other patients require regular injections present at much higher concentrations in the cells for an indefinite period of time in order to control than in the serum. For example, the average mag- their medical problems. This dependence on IV nesium concentration in myocardial cells is 10 injections could conceivably result from any of times higher than the extracellular concentration.
the following: (1) a genetically determined impair- This ratio is maintained in healthy cells by an ac- ment in the capacity to maintain normal intracel- tive-transport system that continually pumps mag- lular nutrient concentrations;11 (2) an inborn error nesium ions into cells against the concentration of metabolism that can be controlled only by main- gradient. In certain disease states, the capacity of taining a higher than normal concentration of a membrane pumps to maintain normal concentra- particular nutrient; or (3) a renal leak of a nutri- tion gradients may be compromised. In one study, ent.12 In some cases, continued IV therapy may be the mean myocardial magnesium concentration necessary because a disease state is too advanced was 65-percent lower in patients with cardiomy- opathy than in healthy controls,10 implying a re-duction in the intracellular-to-extracellular ratio The Modified Myers’ Cocktail
to less than 4-to-1. As magnesium plays a key role See Table 1 for the nutrients that make up in mitochondrial energy production, intracellular magnesium deficiency may exacerbate heart fail- ure and lead to a vicious cycle of further intracel- able injectable form of pantothenic acid (vitamin lular magnesium loss and more severe heart fail- B5). One milliliter of B complex 100 contains 100 mg each of thiamine and niacinamide, and 2 mg each of riboflavin, dexpanthenol, and pyridoxine.
by producing a marked,though transient, increasein the serum concen-tration, provides awindow of opportunity for Table 1. Nutrients in Myers’ Cocktail
ailing cells to take upmagnesium against asmaller concentration Magnesium chloride hexahydrate 20% (magnesium)
gradient. Nutrients takenup by cells after an IV Calcium gluconate 10% (calcium)
infusion may eventuallyleak out again, but perhaps Hydroxocobalamin 1,000 mcg/mL (B12)
some healing takes placebefore they do. If cells are Pyridoxine hydrochloride 100 mg/mL (B6)
repeatedly “flooded” withnutrients, the improve- Dexpanthenol 250 mg/mL (B5)
B complex 100 (B complex)
It has been the author’sobservation that some Vitamin C 222 mg/mL (C)
patients who receive aseries of IV injectionsbecome progressivelyhealthier. In these patients, Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002 Page 391
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All ingredients are drawn into one syringe, and 8-20 mL of sterile water (occasionally more) months, he received a total of 63 IV treatments is added to reduce the hypertonicity of the solu- for acute exacerbations of asthma. In most in- tion. After gently mixing by turning the syringe a stances, a single injection resulted in marked im- few times, the solution is administered slowly, provement or complete relief within two minutes, usually over a period of 5-15 minutes (depending and the acute symptoms did not recur. Occasion- on the doses of minerals used and on individual ally, a second injection was needed after a period tolerance), through a 25G butterfly needle. Occa- of 12 hours to two days, and during one episode sionally, smaller or larger doses than those listed three treatments were required over a four-day in Table 1 have been used. Low doses are often period. As the patient grew, the nutrient doses were given to elderly or frail patients, and to those with gradually increased; by age 10 he was receiving hypotension. Doses for children are lower than 10 mL vitamin C, 3 mL magnesium, 1.5 mL cal- those listed, and are reduced roughly in propor- cium, and 1 mL each of B12, B6, B5, and B com- tion to body weight. The most commonly used regimen has been 4 mL magnesium, 2 mL cal- cium, 1 mL each of B12, B6, B5, and B complex, once; on that occasion the patient presented with 6 mL vitamin C, and 8 mL sterile water.
generalized urticaria, angioedema, and unusually severe asthma, after the inadvertent ingestion of successfully treated with the Myers’. The num- an artificial food coloring (FD&C red #40) and bers of patients treated and proportion that re- other potential allergens. Three separate injections sponded are, for the most part, estimates.
given over a 60-minute period produced transientimprovement each time. However, the symptoms returned, and he was taken to the emergency room with a two-year history of asthma. During the pre- Despite that single treatment failure, the vious 12 months he had suffered 20 asthma at- patient and his parents reported that IV nutrient tacks severe enough to require a visit to the hospi- therapy worked faster, produced a more sustained tal emergency department. His symptoms ap- improvement, and caused considerably fewer side peared to be exacerbated by several foods, and effects than the conventional therapies he had re- skin tests had been positive for 23 of 26 inhalants ceived previously in the emergency room.
tested. His initial treatment consisted of identifi- cation and avoidance of allergenic foods, as well dozen asthmatics (mainly adults) with the Myers’ as daily oral supplementation with pyridoxine (50 for acute asthma attacks; in most instances, marked mg), vitamin C (1,000 mg), calcium (200 mg), improvement or complete relief occurred within magnesium (100 mg), and pantothenic acid (100 minutes. A few patients received maintenance in- mg), in two divided doses with meals. On this regi- jections once weekly or every other week during men, he experienced marked improvement, and difficult times and reported the treatments kept had no asthma attacks requiring medical care un- til nearly 11 months after his initial visit.
At that time the child, now six years old, mented as an effective treatment for acute asthma.
presented for an emergency visit with mild but In one study, 38 patients with an acute exacerba- persistent wheezing and difficulty breathing. He tion of moderate-to-severe asthma that had failed was given a slow IV infusion containing 6 mL to respond to conventional beta-agonist therapy vitamin C, 1.4 mL magnesium, and 0.5 mL each were randomly assigned to receive, in double-blind of calcium, B12, B6, B5, and B complex. The fashion, IV infusions of either magnesium sulfate symptoms resolved within two minutes and did (1.2 g over a 20-minute period) or placebo (sa- line).13 Peak expiratory flow rate improved to a Page 392 Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002
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significantly greater extent in the magnesium group (225 to 297 L/min) than the placebo group the Myers’ that has been studied as a treatment (208 to 216 L/min). In addition, the hospitaliza- for acute exacerbations of asthma. In an early re- tion rate was significantly lower in the magnesium port, a series of IV infusions of calcium chloride group than in the placebo group (37% vs. 79%; p relieved asthma symptoms in three consecutive < 0.01). No patient had a significant drop in blood patients, with relief occurring almost immediately pressure or change in heart rate after receiving after some injections.20 Intravenous and IM ad- ministration of an unspecified calcium salt tem- porarily inhibited severe anaphylactic reactions in tients with acute asthma who were being treated with inhaled beta-agonists and IV steroids were randomly assigned to receive an IV infusion of cium may have contributed to the beneficial ef- magnesium sulfate (2 g over 20 minutes) or sa- fect observed in asthma patients. Oral vitamins line placebo, beginning 30 minutes after presen- C22 and B623,24 and IM vitamin B1225 have each tation.14 Among patients with severe asthma (de- been used with some success against asthma, al- fined as forced expiratory volume in 1 second though none of these nutrients has been tested as [FEV ] less than 25 percent of predicted value) a treatment for acute attacks. Intramuscular ad- compared with placebo, magnesium significantly ministration of niacinamide has been shown to reduced the hospitalization rate (33.3% vs. 78.6%; reduce the severity of experimentally induced p < 0.01) and significantly improved FEV . How- asthma in guinea pigs,26 and pantothenic acid ap- ever, magnesium treatment was of no benefit to pears to have an anti-allergy effect in humans.27 patients with moderate asthma (defined as baseline On one occasion, a patient’s asthma at- FEV between 25 and 75 percent of predicted tack was treated with IV magnesium alone. Al- though the symptoms resolved rapidly, they re- In two placebo-controlled studies of asth- turned within 10-15 minutes. The remaining con- matic children, IV magnesium sulfate significantly stituents of the Myers’ (without additional mag- improved pulmonary function and significantly nesium) were then administered, and the symp- reduced hospitalization rates during acute exacer- toms disappeared almost immediately and did not bations that had failed to respond to conventional return. Thus, it seems the Myers’ is more effec- therapy.15,16 A dose of 40 mg per kg body weight tive than magnesium alone in the treatment of (maximum dose, 2 g) given over a 20-minute pe- riod appeared to be more effective than 25 mg perkg. Higher doses of IV magnesium sulfate (10-20 Migraine
g over 1 hour, followed by 0.4 g per hour for 24 hours) have been used successfully in the treat- from frequent migraines, which appeared to be ment of life-threatening status asthmaticus.6 In a triggered in many instances by exposure to few studies, IV magnesium failed to improve pul- environmental chemicals or, occasionally, to monary function or to reduce the need for hospi- ingestion of foods to which she was allergic.
talization.17,18 However, a meta-analysis of seven Allergy desensitization therapy had provided little randomized trials concluded that IV magnesium benefit. Over a six-year period, the patient was reduced the need for hospitalization by 90 per- given IV therapy on approximately 70 occasions cent among patients with severe asthma, although for migraines. Nearly all of these injections the treatment was not beneficial for patients with resulted in considerable improvement or complete relief within several minutes, although a fewtreatments were ineffective. Through trial anderror, it was determined her most effective regimen Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002 Page 393
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was 16 mL vitamin C, 5 mL magnesium, 4 mL calcium, 2 mL B6, and 1 mL each of B12, B5, and B complex. The 4-mL dose of calcium was found have responded to the Myers’, with results lasting to provide better relief than lower calcium doses.
only a few days or as long as several months. Pa- Over the years, a half dozen other patients tients who benefited often returned at their own have presented one or more times with an acute discretion for another treatment when the effect migraine. In almost every instance, the Myers’ had worn off. One patient with fatigue associated produced a gratifying response within a few min- with chronic hepatitis B experienced marked and progressive improvement in energy levels with a treatment for migraine has been demonstrated in recent clinical trials. In one study, 40 patients fatigue syndrome (CFS) received a minimum of with an acute migraine received 1 g magnesium four treatments (usually once weekly for four sulfate over a five-minute period.28 Fifteen min- weeks), with more than half showing clear im- utes after the infusion, 35 patients (87.5%) re- provement. One patient experienced dramatic ben- ported at least a 50-percent reduction of pain, and efit after the first injection, whereas in other cases nine patients (22.5%) experienced complete re- three or four injections were given before improve- lief. In 21 of 35 patients who benefited, the im- ment was evident. A few patients became progres- provement persisted for 24 hours or more. Patients sively healthier with continued injections and were with an initially low serum ionized magnesium eventually able to stop treatment. Several others concentration (less than 0.54 mMol/L) were sig- did not overcome their illness, but periodic injec- nificantly more likely to experience long-lasting improvement than were patients with initially There is some research support for the use higher serum ionized magnesium levels. In a of parenteral magnesium in patients with fatigue.
single-blind trial that included 30 patients with an One study found magnesium deficiency, demon- acute migraine, IV administration of magnesium strated by an IV magnesium-load test, in 47 per- sulfate (1 g over 15 minutes) completely and per- cent of 93 patients with unexplained chronic fa- manently relieved pain in 13 of 15 patients tigue, including 50 with CFS.31 In a second study, (86.6%), whereas no patients in the placebo group the mean erythrocyte magnesium concentration became pain free (p < 0.001 for difference between was significantly lower in 20 patients with CFS groups).29 In addition, magnesium treatment re- sulted in rapid disappearance of nausea, vomit- ing, and photophobia in all 14 patients who had tients with CFS were randomly assigned to re- ceive, in double-blind fashion, 1 g magnesium sulfate IM or placebo, once weekly for six weeks.
has also been reported to abort an episode of clus- Twelve (80%) of 15 patients given magnesium ter headaches in seven of 22 patients (32%), and a reported improvement (e.g., more energy, a better series of three to five injections provided sustained emotional state, and less pain) and fatigue was relief in an additional two patients (9%).30 eliminated completely in seven cases. In contrast, It is not clear whether the Myers’ is more only three (18%) of 17 placebo-treated patients effective than magnesium alone for migraines; improved (p = 0.0015 for difference between however, one patient did experience noticeable groups), and in no case was the fatigue completely eliminated. According to one report, at least halfof CFS patients with magnesium deficiency ben-efited from oral magnesium supplementation;however, some patients needed IM injections.33 Page 394 Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002
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Other investigators, using the IV magnesium-load month between treatments. However, they were test, found no evidence of magnesium deficiency never as severe as they were before she began re- in patients with CFS, and observed no improve- ment in symptoms following a single infusion of proximately 30 patients with fibromyalgia; half have experienced significant improvement, in a to be helpful for patients with unexplained fa- few cases after the first injection, but more often tigue,35 as well as those with CFS.36 While the re- sults obtained with the Myers’ may be attribut- The beneficial effect of parenteral nutri- able in part to vitamin B12, many patients who ent therapy has been confirmed by one study pub- responded to IV therapy obtained little or no ben- lished only as an abstract. Eighty-six patients with chronic muscular complaints, includingmyofascial pain, relapsing soft tissue injuries, and Fibromyalgia
fibromyalgia, received IM or IV injections of magnesium, either alone or in combination with with a six-year history of fairly constant myalgias calcium, B vitamins, and vitamin C.37 Improve- and arthralgias, with pain in the neck, back, and ment occurred in 74 percent of the patients; of hip, and tightness in the left arm. Six months pre- those, 64 percent required four or fewer injections viously she was found to have an elevated sedi- for optimal results. A minority of patients required mentation rate (50 mm/hr). She was diagnosed by long-term oral or parenteral magnesium to main- a rheumatologist as possibly having polymyalgia tain improvement. The positive response to rheumatica, although the diagnosis of fibromyalgia parenteral magnesium is consistent with the ob- was also considered. Her history was also signifi- servation that nearly half of patients with cant for migraines about eight times per year and fibromyalgia have intracellular magnesium defi- chronic nasal congestion. Physical examination ciency, despite having normal serum levels of the revealed extremely stiff muscles, with decreased range of motion in many areas of her body.
The patient was given a therapeutic trial Depression
consisting of 6 mL vitamin C, 4 mL magnesium, 2.5 mL calcium, and 1 mL each of B12, B6, B5, with a history of depression and anxiety since and B complex. At the end of the injection, she childhood. He had been in psychoanalysis for the got off the table and, with a look of amazement, past eight years. A therapeutic trial with IV nutri- announced her muscle aches and joint pains were ents was considered because the patient reported gone for the first time in six years. This treatment that consumption of alcohol (known to deplete was repeated after a week (at which time her symp- magnesium) aggravated his symptoms, and be- toms had not returned), followed by every other cause he was taking a magnesium-depleting thi- week for several months, then once monthly for azide diuretic for hypertension. He was initially three years. Her initial regimen also included the given 1 mL each of magnesium, B12, B6, B5, and identification and avoidance of allergenic foods B complex, which resulted in a 70-80 percent re- and treatment with low-dose desiccated thyroid duction in his symptoms for one week. A second (eventually stabilized at 60 mg per day). She dis- injection produced a similar response that lasted covered that eating refined sugar caused myalgias two weeks. Through trial and error it was deter- and arthralgias, and that thyroid hormone im- mined the most effective treatment was 5 mL proved her energy level, mood, and overall well magnesium, 3 mL B complex, and 1 mL each of being. During the three years of monthly mainte- B12, B6, and B5. The addition of calcium to the nance injections she reported symptoms would injection appeared to block some of the benefit.
begin to recur if she went much longer than a Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002 Page 395
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Both oral and IM administration of the same nu- patient that his heart would not last more than trients were tried but found to be ineffective.
another month, so the patient declined the ampu- Weekly injections provided almost complete re- lief from symptoms and allowed him to discon- tinue psychotherapy. The patient noted that rap- of magnesium sulfate (1 g) for eight weeks, and idly administered injections provided longer-last- prescribed oral supplementation with vitamins C ing relief than did slower injections. The infusion and E, B complex, folic acid, and zinc. The mag- rate was therefore carefully and progressively in- nesium injections appeared to reduce the pain in creased, without causing any adverse side effects his gangrenous toes considerably, with the ben- or changes in blood pressure or heart rate. The efit lasting about five days each time. Six weeks patient reported that when the treatment was given after the first injection, his ejection fraction had over a one-minute period, the effect would last increased from 19 percent to 36 percent and he no approximately two weeks, whereas a slower in- longer required supplemental oxygen. After eight jection (such as five minutes) would last only a weeks, the IM injections were replaced by weekly week. Approximately four years after initial treat- IV injections, consisting of 5 mL magnesium, 1 ment, he was able to reduce the frequency of in- mL each of B12, B6, B5, and B complex, and a low-dose (0.2 mL) trace mineral preparation (MTE-5 containing: zinc, copper, chromium, se- or anxiety have shown a positive response to the lenium, and manganese). After a total of 18 Myers’. However, this treatment should not be months, his weight had increased from 113 to 147 considered first-line therapy for major depression.
pounds, which was remarkable as cardiac cachexia It seems to be helpful only for certain subsets of is generally considered to be irreversible. In addi- depressed individuals, such as those who also suf- tion, the gangrenous areas on his toes had sloughed fer from fibromyalgia, migraines, excessive stress, and been replaced almost entirely by healthy tis- or alcohol-induced exacerbations. Shealy et al sue. Intravenous therapy was continued and even- have observed an antidepressant effect of IV mag- tually reduced to every other week. The patient nesium in some patients with chronic pain.39 lived for eight years and died at age 87 from mul-tiple organ failure.
Cardiovascular Disease
Of the handful of other patients with an- gina or heart failure who received IV or IM injec- home in end-stage heart failure, after having suf- tions of magnesium (with or without B vitamins), fered four myocardial infarctions. During the pre- all showed significant improvement. The results vious 12 months, spent mostly in the hospital, he with angina are consistent with those reported by had become progressively worse; his ejection frac- others using parenteral magnesium therapy.40-42 tion had fallen to 19 percent and his body weighthad declined from 171 pounds to a severely Upper Respiratory Tract Infections
cachectic 113 pounds. He was confined to bed and required supplemental oxygen much of the time.
with a cold and a one-day history of fatigue, nasal He also had severe peripheral occlusive arterial congestion, and rhinorrhea. He was given an IV disease, which had resulted in the development of infusion of 16 mL vitamin C, 3 mL magnesium, gangrene of six toes. A peripheral angiogram re- 1.5 mL calcium, and 1 mL each of B12, B6, B5, vealed complete occlusion of both femoral- and B complex. By the end of the 10-minute treat- popliteal arteries, with no detectable blood flow ment he was symptom free. The cold symptoms to the distal extremities. Two independent vascu- did return the next day but were only 10 percent lar surgeons had recommended bilateral above- the-knee amputations to prevent development ofsepticemia. However, the cardiologist advised the Page 396 Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002
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received the Myers’ for an acute respiratory in- Narcotic Withdrawal
fection experienced marked improvement, either immediately or by the next morning. Approxi- morphine came to the office in the early stages of mately half of patients given this treatment re- withdrawal, with diaphoresis and extreme agita- ported that it shortened the duration of their ill- tion. He was given an IV infusion of 16 mL vita- ness. Patients who benefited tended to have a simi- min C, 5 mL magnesium, 2.5 mL calcium, and 1 lar response if treated for a subsequent infection, mL each of B12, B6, B5, and B complex. In his whereas non-responders tended to remain non-re- agitated state he was unable to sit still on the exam table, so we walked up and down the hall with a butterfly needle in his arm. Halfway through the history of chronic sinusitis. Avoidance of aller- injection, he was able to sit still, and by the end of genic foods and oral supplementation with vita- the injection his withdrawal symptoms were alle- min C and other nutrients had provided only mini- viated. The symptoms returned 36 hours later; he mal benefit. She was given an IV infusion of 20 therefore came for another treatment, which again mL vitamin C, 4 mL magnesium, 2 mL calcium, relieved the symptoms within minutes. He re- and 1 mL each of B12, B6, B5, and B complex; turned the next day, still symptom free, for a third this protocol was repeated the next day. At the time injection, which carried him uneventfully through these injections were given she had been experi- the remainder of the withdrawal period.
encing persistent sinus problems for a year. Hersymptoms resolved rapidly after the injections and Chronic Urticaria
she remained relatively symptom free for more than six months. The same treatment given at a chronic urticaria with hives present somewhere later date was also helpful, although the benefit on her body nearly every day for 10 years. An al- was not as pronounced as the first time.
lergy-elimination diet and oral supplementation with vitamin C and other nutrients provided little had a similar response to back-to-back injections, or no relief. She was given an IV infusion of 12 while a few others showed no improvement.
mL vitamin C, 3 mL magnesium, 1.5 mL calcium,and 1 mL each of B12, B6, B5, and B complex.
Seasonal Allergic Rhinitis
The same treatment was repeated the following day. After these injections the hives resolved rap- history of seasonal allergic rhinitis, occurring each idly and did not recur for more than a year. When spring and lasting about a month. Symptoms in- the lesions did recur, the IV treatment was repeated cluded nasal congestion, itchy eyes, and fatigue.
During a symptomatic period, an IV infusion of12 mL vitamin C, 3 mL magnesium, and 1 mL Athletic Performance
each of B12, B6, B5, and B complex provided rapid relief. This treatment was repeated as needed high school wrestler developed a flu-like illness during the hay fever season (once weekly or less) four days before a major tournament. Two days and successfully controlled his symptoms. In sub- before the three-day tournament, when it appeared sequent years he began the IVs shortly before, and he might have to miss the event, he was given an repeated them periodically during, the hay fever IV injection of 16 mL vitamin C, 5 mL magne- season; this approach prevented the development sium, 2.5 mL calcium, and 1 mL each of B12, B6, B5, and B complex. The next morning he remarkedthat he had more energy than he had ever had in Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002 Page 397
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his life. This energy boost persisted for the dura- treatments. Of three patients with acute dysmen- tion of the tournament, at which he took second orrhea treated with the Myers’, two experienced place, a better performance than at any other time almost instant pain relief. One patient with chronic obstructive pulmonary disease intermittently re- In this era in which many athletes are us- ceived weekly IV injections and reported the treat- ing performance-enhancing drugs, it is not the ments improved his strength and breathing.
author’s intention to encourage athletes to seekanother “boost” with IV nutrients. However, this Choice of Ingredients and
case does demonstrate that nutritional factors can Administration
play an important role in athletic performance.
At the time of this writing, cyanocobalamin is a widely available form of injectable vitamin B12, Hyperthyroidism
whereas hydroxocobalamin can be obtained only through a compounding pharmacist. While both treated with the Myers’ once or twice weekly for forms of the vitamin are effective, hydroxocobal- several weeks. In one case, the treatment con- amin is preferred because it produces more pro- trolled the symptoms of hyperthyroidism, although longed increases in serum vitamin B12 levels.48 there was no reduction in thyroid-hormone lev- It has been the author’s impression (and els. The injections were discontinued after medi- that of other clinicians) that some patients who re- cal therapy had restored the hormone levels to spond to IM vitamin B12 injections do not experi- normal. In the other case, symptoms improved ence the same benefit when vitamin B12 is given markedly after the first injection and thyroid-func- as part of the Myers’. It is possible that vitamin C tion tests, measured two weeks later, returned to or another component of the Myers’ destroys some of the vitamin B12,49 or that IV vitamin B12 is lost The potential value of IV nutrient therapy more rapidly in the urine than IM vitamin B12.
for patients with hyperthyroidism is supported by Therefore, for some patients receiving IV nutrient several studies. Serum and erythrocyte magnesium therapy, the vitamin B12 is given IM in a separate levels have been found to be low in patients with Graves’ disease.43 In addition, daily IM injections of magnesium chloride (20 mL of a 14-percent either as magnesium chloride hexahydrate (20% solution) for 3-7 weeks reduced the size of the solution), commonly called magnesium chloride, thyroid gland and improved the clinical condition or magnesium sulfate heptahydrate (50% solution), of three patients with hyperthyroidism.44 Intrave- commonly called magnesium sulfate. Although nous vitamin B6 (50 mg per day) was reported to most clinical research has been done with relieve muscle weakness in three patients with magnesium sulfate, some experts prefer magnesium hyperthyroidism,45 and animal studies indicate chloride for IV use because of its greater retention vitamin B12 can counteract some of the adverse in the body.50 The author has used magnesium effects of experimentally induced hyperthyroid- chloride almost exclusively for IV therapy, while reserving the more concentrated magnesium sulfatefor IM administration. For those using magnesium Other Conditions
sulfate, it should be noted that 1 g (2 mL of a 50- percent solution) is equivalent to 0.8 g (4 mL of a provide rapid relief for patients with acute muscle 20-percent solution) of magnesium chloride (each spasm resulting from sleeping in the wrong posi- contains 4 mMol of magnesium). In addition, if 50- tion or from overuse. It also has been observed to percent magnesium sulfate is given IV instead of relieve tension headaches in many cases. One pa- 20-percent magnesium chloride, it should be diluted tient (a 70-year-old female) with chronic torticol- lis experienced moderate pain relief with periodic Page 398 Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002
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Injectable vitamin C is currently available temporarily and not resumed until the symptoms in concentrations of 222 and 500 mg per mL. The have resolved (usually after 10-30 seconds). Pa- author typically uses the lower concentration for tients with low blood pressure tend to tolerate less IV therapy. If the higher concentration is used, it magnesium than do patients with normal blood should be diluted appropriately with sterile water.
pressure or hypertension. In a small proportion of Occasionally, trace minerals were included patients, even a low-dose regimen given very as part of a nutrient infusion. The usual dose was slowly causes persistent hypotension; in those 0.2-0.5 mL of MTE-5, which contains (per mL): cases, the treatment is usually discontinued and zinc 1 mg, copper 0.4 mg, chromium 4 mcg, sele- may or may not be attempted at a later date.
nium 20 mcg, and manganese 0.1 mg. The prepa- ration was diluted six-fold and administered over a have adverse consequences, some patients appear period of 1-2 minutes in a separate syringe at the to experience more pronounced benefits from end of the Myers’ push. Two adverse reactions have rapid infusions than from slower ones, presum- been noted with 10 mg of zinc given by slow IV ably because of higher peak serum concentrations push; consequently, when giving trace minerals by of nutrients. While both the risks and benefits IV push, very small doses are used. Trace minerals should be taken into account in determining an should not be mixed in the same syringe with the infusion rate, when in doubt one should err on the components of the Myers’, as doing so often causes side of safety. When administering the Myers’ to a patient for the first time, it is best to give 0.5-1.0mL and then wait 30 seconds or so before pro- Side Effects and Precautions
ceeding with the rest of the infusion. Doing so may The Myers’ often produces a sensation of help one distinguish between a vasovagal reac- heat, particularly with large doses or rapid admin- tion and a hypotensive response to the injected istration. This effect appears to be due primarily compounds. Patients who experience a vasovagal to the magnesium, although rapid injections of reaction at the beginning of an infusion can usu- calcium have been reported to produce a similar ally tolerate the remainder of the treatment after effect.22 The sensation typically begins in the chest and migrates to the vaginal area in women and to For elderly or frail individuals, it may be the rectal area in men. For most patients the heat advisable to start with lower doses than those listed does not cause excessive discomfort; indeed, some in Table 1, or to consider IM administration of patients enjoy it. However, if the infusion is given magnesium and B vitamins as an alternative to IV too rapidly, the warmth can be overbearing. Some therapy. However, many elderly patients have tol- women experience a sensation of sexual pleasure erated, and benefited from, IV therapy.
in association with the vaginal warmth; on rare occasions, an orgasm may occur during an IV in- nesium and potassium may have an influx of po- fusion. Other patients have remarked their visual tassium into the cells after receiving IV magne- acuity and color perception become sharper im- sium.51 This occurs because magnesium activates mediately after an injection, as if someone had the membrane pump that promotes the intracellu- turned the lights on. In some cases, this effect lasts lar uptake of potassium. The shift of potassium from the serum to the intracellular space can trig- ger hypokalemia. The author has seen two patients develop severe muscle cramps several hours after lightheadedness or even syncope. Patients receiv- receiving a Myers’; both patients had been taking ing a Myers’ should be advised to report the onset medications known to deplete potassium. Hy- of excessive heat (which can be a harbinger of pokalemia also increases the risk of digoxin-in- hypotension) or lightheadedness. If either of these duced cardiac arrhythmias. As a first-year resident, symptoms occurs, the infusion should be stopped Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002 Page 399
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unaware of this potential problem, the author ad- reactions for every million ampules of IV B vita- ministered IV magnesium in the hospital to an eld- mins sold, and one report for every 5 million IM erly woman who was taking digoxin and a potas- sium-depleting diuretic. She quickly developed an It is possible the risk of anaphylaxis from arrhythmia, which required short-term treatment in the Myers’ is even lower than the low risk associ- ated with the use of IV thiamine. Many patients Patients considered to be at risk of potas- who receive parenteral thiamine are alcoholics, and sium deficiency include those taking potassium- alcoholism frequently causes magnesium defi- depleting diuretics, beta-agonists, or glucocorti- ciency. Animal studies suggest thiamine supple- coids; those with diarrhea or vomiting; and those mentation in the presence of magnesium deficiency who are generally malnourished. If a patient is hy- increases the severity of the magnesium defi- pokalemic, the hypokalemia should be corrected ciency.54 A deficiency of magnesium can lead to before IV magnesium therapy is considered. How- spontaneous release of histamine,55 and has been ever, a normal serum potassium concentration is reported to increase the incidence of experimen- not a guarantee against intracellular potassium tally induced anaphylaxis in animals.56 The pres- depletion. For patients considered to be at risk of ence of magnesium in the Myers’ might, therefore, potassium deficiency, administration of 10-20 mEq reduce the risk of an anaphylactic reaction to thia- of potassium orally just prior to the infusion, and mine. Moreover, as the Myers’ has been used suc- again 4-6 hours later is recommended. After this cessfully to treat asthma and urticaria, it is likely practice was instituted, no further problems with the formula as a whole provides prophylaxis against magnesium-induced muscle cramps were encoun- anaphylaxis. Nevertheless, practitioners who ad- minister IV nutrients should be prepared to deal with the rare anaphylactic reaction.
potassium to an IV push is strongly discouraged, A small number of patients (approximately because of the theoretical risk of triggering an ar- one percent) felt “out of sorts” for up to a day after rhythmia during the first pass when the bolus receiving an injection and, in two cases, this reac- reaches the cardiac conducting system.
tion lasted one and two weeks, respectively. It is Intravenous calcium is contraindicated in not clear whether these reactions were due to the patients taking digoxin. In addition, hypercalcemia preservatives in some of the injectable preparations can cause cardiac arrhythmias. For that reason, the (e.g., benzyl alcohol, methylparabens, or others) author has tended to leave calcium out of the Myers’ or to the nutrients themselves. In most cases (in- when treating patients with cardiac disease, al- cluding a few patients with asthma) preservative- though there is no strong evidence it is dangerous containing products were used because the use of multi-dose vials reduced the cost of treatment to Anaphylactic reactions to IV thiamine have the patient. However, for some individuals with been reported on rare occasions. Only three such known chemical sensitivities or other significant reactions have been identified in the U.S. litera- allergy-related problems, preservative-free prepa- ture since 1946. However, in the world literature, a total of nine deaths attributed to thiamine adminis- Although the Myers’ is extremely hyper- tration were reported between 1965 and 1985.52 tonic, it rarely seemed to cause problems related to These reactions have occurred after oral, IV, IM, its hypertonicity. Two or three patients developed or subcutaneous administration, and are believed phlebitis at the injection site; for those patients, later to be due in part to a nonspecific release of hista- treatments were diluted with sterile water to a total mine. Anaphylactic reactions have been seen most of 60 mL. Some patients experienced a burning often after multiple administrations of thiamine. In sensation at the injection site during the infusion; the United Kingdom, between 1970 and 1988, there this was often corrected by re-positioning the needle were approximately four reports of anaphylactoid or by further diluting the nutrients.
Page 400 Alternative Medicine Review ◆ Volume 7, Number 5 ◆ 2002
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spect, the Myers’ has been generally well tolerated, Malkiel-Shapiro B. Further observations on and no serious adverse reactions have been encoun- tered with approximately 15,000 treatments.
coronary heart disease: a clinical appraisal. SAfr Med J 1958;32:1211-1215.
Cost Considerations
Browne SE. Intravenous magnesium sulphatein arterial disease. Practitioner 1969;202:562- In 1995, the author’s last year in private practice, the cost of the materials for a Myers’ was Blanchard J, Tozer TN, Rowland M. Pharma- approximately $5.00. The use of preservative-free nutrients at least doubled the cost of materials.
ascorbic acid. Am J Clin Nutr 1997;66:1165- Nursing time and administrative factors repre- sented the majority of the cost of IV nutrient Harakeh S, Jariwalla RJ, Pauling L. Suppres- therapy. In 1995, the author’s fee for a Myers’ was $38.00. Other doctors have charged as little as replication by ascorbate in chronically andacutely infected cells. Proc Natl Acad Sci U S $15.00 or as much as $100.00 or more. Since 1995, the cost of most of the injectable preparations has Okayama H, Aikawa T, Okayama M, et al.
Bronchodilating effect of intravenous magne- sium sulfate in bronchial asthma. JAMA for this treatment. However, in a few instances, showing them that IV nutrient therapy had greatly Sydow M, Crozier TA, Zielmann S, et al.
reduced the overall cost of the patient’s health care High-dose intravenous magnesium sulfate in the management of life-threatening statusasthmaticus. Intensive Care Med 1993;19:467-471.
The Myers’ has been found by the author and hundreds of other practitioners to be a safe mediated by L-ascorbate. Biochim Biophys and effective treatment for a wide range of clini- cal conditions. In many instances this treatment is Iseri LT, French JH. Magnesium: nature’s more effective and better tolerated than conven- physiologic calcium blocker. Am Heart J tional medical therapies. Although most of the evidence is anecdotal, some published research has Brunner EH, Delabroise AM, Haddad ZH.
Effect of parenteral magnesium on pulmonary demonstrated the efficacy of the Myers’ or some of its components. Widespread appropriate use of bronchial asthma. J Asthma 1985;22:3-11.
this treatment would likely reduce the overall cost Frustaci A, Caldarulo M, Schiavoni G, et al.
of healthcare, while greatly improving the health Myocardial magnesium content, histology, and of many individuals. Additional research is ur- gently needed to confirm the effectiveness of this infusion. Lancet 1987;2:1019.
treatment and to determine optimal doses of the Henrotte JG. The variability of human red various nutrients. Although double-blind trials blood cell magnesium level according to HLA would be difficult to perform because of the obvi- groups. Tissue Antigens 1980;15:419-430.
ous sensations induced by IV nutrient infusions, Booth BE, Johanson A. Hypomagnesemia dueto renal tubular defect in reabsorption of trials comparing the Myers’ with established thera- magnesium. J Pediatr 1974;85:350-354.
pies would be informative. Practitioners using this treatment are encouraged to report their findings.
Greenspon L. Intravenous magnesium sulfatefor the treatment of acute asthma in theemergency department. JAMA 1989;262:1210-1213.
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Bloch H, Silverman R, Mancherje N, et al.
Bekier E, Wyczolkowska J, Szyc H, Maslinski Intravenous magnesium sulfate as an adjunct C. The inhibitory effect of nicotinamide on in the treatment of acute asthma. Chest guinea pigs, anaphylactic mast cell degranula- Ciarallo L, Brousseau D, Reinert S. Higher- tion in mice, and histamine release from rat isolated peritoneal mast cells by compound 48- children with moderate to severe acute asthma.
80. Int Arch Allergy Appl Immunol Arch Pediatr Adolesc Med 2000;154:979-983.
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BM. Intravenous magnesium sulphate relieves Magnesium bolus or infusion fails to improve migraine attacks in patients with low serum expiratory flow in acute asthma exacerbations.
ionized magnesium levels: a pilot study. Clin Green SM, Rothrock SG. Intravenous magne- sium for acute asthma: failure to decrease sulfate in the treatment of acute migraine hospitalization. Ann Emerg Med 1992;21:260- attacks. Headache 2001;41:171-177.
Rowe BH, Bretzlaff JA, Bourdon C, et al.
BM. Intravenous magnesium sulfate relieves Intravenous magnesium sulfate treatment for cluster headaches in patients with low serum acute asthma in the emergency department: a ionized magnesium levels. Headache systematic review of the literature. Ann Emerg Pottenger FM. A discussion of the etiology of J, et al. Magnesium status and parameters of asthma in its relationship to the various the oxidant-antioxidant balance in patients with chronic fatigue: effects of supplementa- neurocellular mechanism with the physiologi- tion with magnesium. J Am Coll Nutr cal basis for the employment of calcium in its treatment. Am J Med Sci 1924;167:203-249.
cell magnesium and chronic fatigue syndrome.
conditions with large amounts of calcium. J sium and chronic fatigue syndrome. Lancet ascorbic acid in Nigerian asthmatics. Trop Clague JE, Edwards RH, Jackson MJ. Intrave- nous magnesium loading in chronic fatigue pyridoxal phosphate concentrations in adult syndrome. Lancet 1992;340:124-125.
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Ellis FR, Nasser S. A pilot study of vitamin Collipp PJ, Goldzier S 3rd, Weiss N, et al.
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Lapp CW, Cheney PR. The rationale for using Crocket JA. Cyanocobalamin in asthma. Acta high-dose cobalamin (vitamin B12). CFIDS Allergologica 1957;11:261-268.
Chronicle Physicians’ Forum 1993 (Fall):19-20.
Reed JC. Magnesium therapy in musculoskel-etal pain syndromes — retrospective review ofclinical results. Magnes Trace Elem1990;9:330.
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J, et al. Magnesium deficit in a sample of the in the prophylaxis and treatment of Wernicke- Belgian population presenting with chronic fatigue. Magnes Res 1997;10:329-337.
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Browne SE. Magnesium sulphate in arterial Magnesium-deficient diet aggravates anaphy- disease. Practitioner 1984;228:1165-1166.
lactic shock and promotes cardiac myolysis in Cohen L, Kitzes R. Magnesium sulfate in the guinea pigs. Magnes Trace Elem 1990;9:283- treatment of variant angina. Magnesium Disashi T, Iwaoka T, Inoue J, et al. Magnesiummetabolism in hyperthyroidism. Endocr J1996;43:397-402.
Neguib MA. Effect of magnesium on thethyroid. Lancet 1963;1:1405.
Rosenbaum EE, Portis S, Soskin S. The reliefof muscular weakness by pyridoxine hydro-chloride. J Lab Clin Med 1941;27:763-770.
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Watts AB, Ross OB, Whitehair CK, MacVicarR. Response of castrated male and femalehyperthyroid rats to vitamin B12. Proc SocExp Biol Med 1951;77:624-626.
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Herbert V. Vitamin B12. Am J Clin Nutr1981;34:971-972.
Durlach J, Bara M, Theophanides T. A hint onpharmacological and toxicological differencesbetween magnesium chloride and magnesiumsulphate, or of scallops and men. Magnes Res1996;9:217-219.
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Chapter 22 Solutions 22.1. (a) Diagram below. (b) The null hypothesis is “all groups have the same mean rest period,” and the alternative is “at least one group has a different mean rest period.” The P -value shows significant evidence against H 0, and the graph leads us to conclude that caffeine has the effect of reducing the length of the rest period. Note: Students mig


L’AMBIGUÏTE SYNTAXIQUE DU GROUPE NOMINAL COMPLEXE EN ANGLAIS MÉDICAL : PRÉMODIFICATION ET COORDINATION* François Maniez Centre de Recherche en Terminologie et Traduction Université Lumière Lyon 2 1 INTRODUCTION L'ambiguïté syntaxique est un phénomène inhérent à toutes les langues naturelles. L'introduction des langages contrôlés dans le domaine des scien

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