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Wellness by Designs - Practitioner Podcast
Magnesium’s Role in Cardiovascular Care with Gina Robertson
Could one overlooked mineral be the missing link in cardiovascular care?
Magnesium might just be the most critical yet underutilised nutrient for heart health, according to naturopath and former heart failure nurse Gina Robertson. In this compelling episode, Gina draws on her years in cardiac wards and naturopathic practice to uncover magnesium’s profound impact on cardiovascular disease, particularly in conditions like hypertension, arrhythmias, and post-operative recovery.
From reversing life-threatening arrhythmias in seconds to halving rates of post-surgical atrial fibrillation, Gina shares powerful clinical examples and explains why standard blood tests miss magnesium deficiency in most patients. You'll learn how this essential mineral transforms stiff, non-compliant vessels into more elastic channels, reducing cardiac strain, and why stress may be one of the biggest drivers of magnesium depletion today.
We dive into the nuances of magnesium supplementation, including the best forms for specific conditions (think glycinate, orotate, citrate, glycerophosphate), practical dosing strategies, and when to consider topical applications. Gina also highlights complementary nutrients, key dietary considerations, and cautions around renal impairment.
Whether you're supporting patients or your own cardiovascular health, this episode offers evidence-based insights that challenge conventional care—and could shift the way you approach heart health forever.
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
Welcome back to Wellness by Designs. I'm your host, Andrew Whitfield-Cook, and joining us today is Gina Robertson, a naturopath registered nurse and former heart failure specialist nurse. Today we're going to be speaking about the importance of magnesium in cardiovascular disease. Welcome, Gina, how are you? And thanks so much for your time.
Speaker 2:Thank you for having me really appreciate this opportunity.
Speaker 1:Oh, Gina, it's our pleasure. Firstly, can I ask you, like myself, you're a registered nurse. I can still remember me being bashed over the head saying that natural medicine didn't work and was all load of bunkum and that sort of thing. What piqued your interest in natural medicines to begin with?
Speaker 2:I think this dates back to 2001 when I did the ACNEM course, australasian College of Nutritional Environmental Medicine, and that was their primary course and of course there was a lot about magnesium. So that always really, really stayed with me, particularly in the context of heart failure, chronic diseases, hypertension and arrhythmias, and so that's been a real long-term interest.
Speaker 1:What piqued your interest to do the ACNEM course?
Speaker 2:I mean, you know, I think I already had a leaning and I was doing a lot of research into natural medicines, bioidentical hormones, a whole lot of things really grabbed my interest.
Speaker 1:And that's kind of when it all started. Gotcha, and tell us a little bit about your history as a registered nurse, working in cardiac wards and intensive care.
Speaker 2:So most of my career was spent in intensive care. So that was both general and cardiothoracic intensive care with a little bit of PEDS in there as well in there as well and I gave that away probably when I was. I'd been in that for a long time and I was starting to struggle with the shift work, so that kind of dates back From there. I went on and did pathology hospital in the home and that was where I got my entree into the world of heart failure and from there I ended up moving back to Sydney and got a job there doing heart failure in a major Sydney hospital.
Speaker 1:Right A very famous Sydney hospital Right, a very famous Sydney hospital, I might add. Yep. So you were working in the wards there. What sort of things did you see? We were talking off air just before, and you surprised me in that at least one of the specialists there started to use IV magnesium for certain indications.
Speaker 2:Yeah, this was really interesting, Andrew. This was in a post-op neurosurgical intensive care and the neurosurgeon used to run intravenous magnesium at extremely high, much higher than normal infusion rates, and his aim was to push the serum magnesium and we know that serum magnesium is pretty useless for assessing magnesium generally but he used to push the serum magnesium up to about 2.0 and above even higher than that in order to address the vasospasm for patients that had had clipping of subarachnoid hemorrhage. Aneurysms yeah, yeah, aneurysms, or yeah, yeah, aneurysms yeah, yeah.
Speaker 1:So just for people who aren't with this sort of language. Um, the clipping is to stop the aneurysm, the, you know, berry aneurysm or something like that, correct?
Speaker 2:yes, yep, yep. Interestingly, um, I was at a later stage working in a Melbourne intensive care. I had a while living down there and I had a patient that went into SVT, otherwise known as supraventricular tachycardia, with a rate a classic rate of about 180. And he had a history of ischemic heart disease. He had a history of ischemic heart disease and I ran to get the intensivist. After I flicked him across to a 12 lead ECG on his monitor and his ST segments had dropped drastically, meaning he was starting to show signs of ischemia. At that rapid heart rate, unsurprisingly, the intensivist came up to the patient, drew up a whole ampule of magnesium sulfate and literally slammed it in and I went thinking he was going to drop his blood pressure drastically, but in fact within about 10, 15 seconds he reverted into sinus.
Speaker 1:Wow.
Speaker 2:And I was absolutely amazed and it kind of occurred to me that what had happened there was with him slamming magnesium in as a bolus dose, which you never do. It's too vasoactive to do that. This was magnesium sulfate. He got a peak serum level enough to revert him out of that SVT back into sinus.
Speaker 1:Into sinus.
Speaker 2:Wow, it was quite astonishing to watch that.
Speaker 1:Well, that's experience for you. That's really interesting, isn't?
Speaker 2:it Interestingly while we're talking about arrhythmias, the post-operative heart bypass whether that was bypass grafts or valve repairs used to come out from theatre with magnesium loaded into their maintenance IV, their fluid, and the idea with that was to reduce the risk of post-operative atrial fibrillation, which is a common side effect post-operatively. So that was interesting cooperatively um.
Speaker 1:so that was interesting and, um, you know, this gels with the work of uh professor frank rosenfeld down at the alfred in victoria um years ago now and he used now he preferred magnesium orotate and it was actually the orotic acid he was after um, but magnesium on its own has this vasodilatory effect and helps with normal sinus rhythm as well. But, very interestingly, the work that he did was reducing atrial fib by 50%, reducing hospital stays by 30%, reducing the cost to patient of $2,300. And so the hospital went as you were. We like this Hospital saving. Yes, don't worry about the patient saving, hospital saving. But I thought it was very interesting those improvements in patient outcomes.
Speaker 2:Very groundbreaking study, that one.
Speaker 1:Yeah, so let's sort of go into magnesium and its role in the cardiovascular system. Can you take us through the major points here?
Speaker 2:I think magnesium is the first thing that comes to mind when dealing with any patient with hypertension, and I think the best way for me to explain this is Andrew, if I gave you a balloon, you would just take a big breath and blow it up. No issues at all. However, if I gave you a hot water bottle and asked you to blow it up, you would bust a gut trying to distend the hot water bottle, and that kind of equates to what's happening to the heart trying to expel its output into the systemic circulation. And if that circulation is stiff and non-compliant or left ventricular afterload, then the heart is really going to struggle to do its job, which is to pump and deliver oxygenated blood out to the tissues. So magnesium is the missing link here to help with turning that hot water bottle into a balloon, as it were. In other words, a stiff, non-compliant circulation trying to help that to relax, as in the account of vasospasm we talked about before in intensive care post-op neurosurge patients.
Speaker 1:So that afterload is basically back pressure from a non-elastic arterial system correct.
Speaker 2:Yes, exactly. So magnesium is the first thing that comes to mind.
Speaker 1:What's interesting to me is that when you look at dietary guidelines, even cardiovascular stuff, they'll always mention potassium first and never magnesium. Why I don't get it?
Speaker 2:I think it's a lack of understanding about the level to which magnesium is involved with over 600 different enzyme systems and its relationship to the ATP pump, calcium and so forth, and there's just a lack of recognition there. For example, I had a heart failure patient who is going back probably about nine years or so. She was really struggling and I recommended a really good quality magnesium supplement for her and only to be reported by the cardiac rehab nurse who put in actually a complaint by saying that why is Gina recommending magnesium? Because her blood levels are normal. And I just shook my head and said well, you know, that is completely irrelevant, since the vast majority of magnesium is actually intracellular. It's not within the vascular space or the serum space at all.
Speaker 1:This smacks of true ignorance of physiology. And there are certain elements, electrolytes, cations, anions, which just don't measure well as a serum level. You know chromium, zinc, there's so many, and yet do you think this might be the issue about why these nutrients, let's say, are dismissed? Because if we can't measure them, it's not easy, we can't send them to the pathology lab. So what's the point? And yet every now and again you'll get a surgeon, like those that you've mentioned, who know their physiology and they know what this important electrolyte can do in acute, you know emergent situations. So it's really funny how people don't know about it.
Speaker 2:Yeah, it's really important and it's. Magnesium deficiency, whether it's significant or relative, is a huge and a widespread issue, particularly since people are dealing with a massive amount of stress, which is going to increase their need for magnesium, not less so. In fact, they would need more magnesium and I think for us as practitioners, we need to take on board the vast and different roles that magnesium plays. For example, I had a child in emergency one time who had severe bronchospasm, refractory to all of the normal things that they do with ventolin and bronchodilators in general, and there must have been a very astute emergency physician at the time who organised for that child to have some intravenous magnesium and that just resolved the bronchospasm. So it's far, far broader than we, even as naturopaths, have understood.
Speaker 1:You know that was one of the only sort of indications for magnesium sulfate in the old days was status asthmaticus, not even any cardiac issues. It was only status asthmaticus and I think maybe preeclampsia and that was never yeah, it was never ever used.
Speaker 1:Yeah, so back to cardiovascular disease. Let's talk about magnesium, and what sort of conditions can magnesium help? And then I think we'll delve into what forms of magnesium, what doses, and you know what else you use with it. So, firstly, what sort of conditions do you tend to favour? Does it tend to be useful?
Speaker 2:Yeah, Number one, hypertension, and I think without access to adequate testing, we should assume that people are deficient and are going to benefit. So, for example, you might choose a magnesium supplement once, even twice a day. Secondly, for arrhythmias, this is incredibly important because we are seeing an increase in particularly AF now SVT and you know other cardiac arrhythmias, and magnesium has a powerful role with helping to stabilize the electrical activity in the heart. So that's one of the first things that I would be thinking along those lines.
Speaker 1:So when you're mentioning AF, atrial fibrillation and we've spoken about supraventricular tachycardia before SVT when we're talking about atrial fib, you know the standard sort of progression is you'll get paroxysmal atrial fib, then you'll have all the time atrial fib or episodes which you know may have to be treated by cardioversion, and what normally happens is the patient then goes on blood thinners, your flecainide sort of thing, and then they'll look at perhaps cardiac ablation in the atrial, the what is it sinoatrial nodes or the atrium, and then possibly a pacemaker down the track potentially when you're talking about yeah, sorry, you go potentially, um, if people are cardioverted which is a fairly standard practice and and they're not preloaded and continue their magnesium post-procedure, they are very likely to revert back into atrial fibrillation, which is really disappointing.
Speaker 1:Right, so forgive me. So this is they continue their magnesium after cardioversion and it doesn't work, it doesn't hold them enough.
Speaker 2:It may not, because there's some irritation around those electrical pathways in the heart and it is common to revert back after being cardioverted, back into atrial fibrillation. But I think magnesium pre and post would have a really, really important role there.
Speaker 1:Right, gotcha. And do you ever combine it with looking for, like heart muscle damage markers, troponin I? Or is it more to do with intracellular issues like nerve transmission, if you like?
Speaker 2:I'd be probably more likely to try and get a copy of an echocardiogram report, because that's going to tell a lot about whether the heart is struggling, whether there's dyssynchrony, all of those sorts of issues within the heart. But you know, certainly there are lots of specialists, even at the hospital I worked in in Sydney, that specialised in electrical anomalies within the heart and that was kind of what they did. But for any ablation, any patient that has an ablation procedure coming up, the risk is that they can wipe out key electrical pathways and the patient will end up with a pacemaker or a defibrillator, which is a combined device.
Speaker 1:Right, forgive me for asking, because I'm asking for me here. Is this when we're talking about the central bundle that runs down the intraventricular space? Yes, you can damage that. Is that what it is?
Speaker 2:High up into the atrium. So before they do an ablation they have to do really complex and detailed electrical mapping of the heart to try and identify where is the locus of abnormal activity. So, this is something that we need to immediately be reaching for if we have patients with any arrhythmias and go in hard.
Speaker 1:Yeah gotcha. So forms of magnesium you and I have spoken about the work of Professor Frank Rosenfeld with magnesium orotate, but we've had magnesium aspartate. I spoke with Dr Ross Walker, who uses magnesium orotate aspartate, but we've got so many others that are involved in, or the ligands are involved in, either helping to transport that electrolyte or have other functions with, say, nerves for instance. So when do you sort of choose different forms or do you tend to go no, we'll always go with this.
Speaker 2:I often and I always have prescribed a glycinated form because I think that's generally reasonably bioavailable and fairly well tolerated. But I think there's a lot of evidence now, for I also recommend citrate for some patients as well. I think there's emerging evidence now for the use of threonate for neurological conditions and I think we, andrew, we will see an increase in three and eight prescriptions now because there's so many people now suffering from neurological issues as well. The Orotate I think there is evidence for that as well. I tend to kind of fall back to prescribing patterns, just using something that I know works well and can trust.
Speaker 1:What about using glycerophosphate like as a phosphate shuttle?
Speaker 2:like as a phosphate shuttle. Yeah, I think there's going to be glycerophosphate forms we will see more of now and that may show enhanced bioavailability and effectiveness as well. So I think we will now see more of the supplement companies formulating in that form of magnesium as well, so I think that will become more common now.
Speaker 1:Yeah, and then you know we've also got accessory nutrients. You know taurine zinc, you know fish oil. Other things though, though of use. What else have you used to help? You know other cardiac conditions?
Speaker 2:Predominantly magnesium and, for example, I had a patient that recently had a quadruple bypass and trying to get him to understand the importance of magnesium and he's still actually not back on his magnesium as of now, three weeks post-operatively. But I don't want him going into atrial fibrillation. But I don't want him going into atrial fibrillation and it is important to support the energetics of the heart as well.
Speaker 1:You know, one of the things that interests me. It piqued my interest and that was I've got a couple of friends who have got atrial fib and one's got a pacemaker. But the use of quercetin, and there seems to be some evidence here with atrial fib have you ever used it?
Speaker 2:I do often use it and often use it as a zinc ionophore as well, so that's also been very useful. I think a lot of people during COVID actually got the CD zinc message and it was. I forget his name, he's passed on now, but he brought to the public's attention about how quercetin is acting as a zinc ionophore to get the zinc intracellular or to enhance intracellular transport of zinc.
Speaker 1:Right Now. Forgive me, was this the guy that put a private message to his friends on Facebook and it got out and he was a virologist? Was it that guy or somebody else?
Speaker 2:No, it was. The name will come to me later, but it was he actually treated. President Trump was in office at that time and he treated him as well when he got COVID. So he certainly used all of these C, cd and zinc with quercetin as an ionophore. So, potentially it has other roles with other minerals as well.
Speaker 1:Gotcha Okay. And what other sort of nutrients, other herbs in fact, do you use with cardiac conditions and where I remember there was a I keep defaulting and under. I don't think this is right, but it was a a trial on hawthorne leaves, and I keep going. Dart trials wasn't called the dart trial. That was diet and reinfarction. Um, there was a trial that was done on hawthorn, um, but quite some years ago. Do you ever use herbs, and for yes, and I do use that with heart failure.
Speaker 2:It's particularly useful with heart failure classifications. There's one, two, three and four. Four is I cannot get out of the chair or bed. I'm so breathless even at rest. Three is breathless on very minimal exertion. Two is where most people with heart failure sit. They're breathless with exertion such as going upstairs or an incline. And one is they have heart failure but they have no symptoms. So there is good evidence to use hawthorne in class two and three, so sometimes I might even use that as a standalone. For example, I've got a patient locally with myocarditis and post-jab and she is using the Hawthorne as well, amongst many other supplements.
Speaker 1:The other thing, of course. The other nutrient I guess we should talk about is ubiquinol. How often do you use it and do you tend to favour certain conditions? Do you ever use it judiciously? How high do you go?
Speaker 2:Yes, I use 300 milligrams a day of ubiquinol, not ubiquinone, because for most people, you know, once they're over 40, they're going to do better on ubiquinol. So I do use that. In fact, I recommended it for a patient with heart failure I saw yesterday, and it is all again about supporting mitochondrial energy production. So of course we're thinking magnesium, we're thinking B vitamins, we're thinking CoQ10, in this case, ubiquinol. So that is something that I definitely would recommend often. That is something that I definitely would recommend often.
Speaker 2:The other thing, andrew, that comes to mind is for so many patients are on proton pump inhibitors now and obviously we know that if you change stomach acid you're going to impede the absorption of magnesium, zinc, to impede the absorption of magnesium, zinc, folate, iron, b12, calcium and so on. So for those people, there are some that we're never going to get off PPIs, potentially those with Barrett's esophagus, possibly those with my hiatus hernia. So I'm kind of leaning more now to trying to bypass that absorption altogether and putting those people on a topical magnesium as well. So just using a really good quality magnesium spray.
Speaker 1:Right and clinical effects.
Speaker 2:Clinical effects are seen more rapidly, um, probably in kids, uh. So for kids with anxiety, um, really difficult to get to sleep, all of those sorts of things, and often the topical magnesiums are a magnesium chloride, um, but it seems to get fairly good absorption and you notice the effects more readily in those people. I've got one patient who is using topical magnesium, for he's got a diabetes-related peripheral neuropathy. His feet are affected, so he's using that both feet and he's getting really good results with that okay, and what about?
Speaker 1:um the?
Speaker 2:idea here is to get as much magnesium into the system as people can can cope with great, okay, so that leads on to my next question, that is, doses.
Speaker 1:Like we've got to obviously circumvent bowel tolerance, which I've had a wide breadth of experience here with different patients somebody who could tolerate NAFOL and we had to use a really poorly absorbed lower dose magnesium, and other people that can really, you know, really take a lot of magnesium in and without any effect on their stomach, on their intestines whatsoever. What's your experience? What does it show you? Is there a sweet spot with dosage with magnesium?
Speaker 2:I think, as you said, it's very individual. Some people will not even tolerate, um you know, like they might get diarrhea with a a sort of a half decent dose of magnesium glycinate, which to me is a very well tolerated, bioavailable form of magnesium. Um other people can soak it up like a sponge.
Speaker 1:Yeah, yeah, it's really amazing. I'll always remember this. The triathlete from Kilcoy. You know how you remember patients because of some aspect of them, the triathlete from Kilcoy and he just could not tolerate magnesium and in the end we had to use a pretty poorly absorbed phosphate type lower dose thing and he wasn't really getting great effect. But it was like all that he could handle with BALT on it. And that's when I spoke to him about perhaps find an integrative GP to do intravenous magnesium. Eventually I lost contact with him. The other side of the spectrum is I'll always remember this I did my neck drying my hair with a towel I mean these anecdotes but I took three teaspoons three times a day, so a total of nine teaspoons like that's two, four, six, three, six.
Speaker 1:1800 milligrams, massive and no bowel tolerance whatsoever. And I'll always remember. A few months later I related it to somebody who walked in to where I was practicing like this with tears in her eyes. I said what have you done? Put my neck out? I said okay, got her booked into somebody that was going to look after her treatment later on. But for now I said okay, let's get you onto the magnesium. And I said now I've taken three, three and three, total of nine teaspoons Right.
Speaker 1:And two weeks later and I said look, I don't normally do that, I normally go two and two for a high dose and as long as their renal function's okay. But a couple of weeks later she came back and she said I tried that nine teaspoons, like you said, but, gee, it cleaned me out. And I said, well, how did you take it, like three, three and three? She said no, no, nine teaspoons Stat. I said how did you stir it? But to me it's. She said it worked really well, but it cleaned me out. Um so, um, I just thought it was yeah, that it's a.
Speaker 1:It's a lesson in explaining instructions clearly to patients.
Speaker 2:I think it is really important to be um really specific with dosing. That one guy that I mentioned that's recently had a quadruple bypass. He overdosed on his magnesium and had the same thing. He he didn't follow my explicit instructions and he was, yeah, he had diarrhea. So it is something you know, no matter how explicit. I copy their prescription into their plan so that they know exactly what they should be doing. And some people just maybe they don't follow instructions well and they can overdo it. And the other thing of concern is to if people obviously, when I was a heart failure nurse, uh, I had a lot of patients with very, very reduced um renal function and once you get to an egfr of less than 30, you've really, really got to be cautious. As with any medicines and supplements some supplements, not all but magnesium is one of them where you really need to back off on that dosing because you don't want to cause them any issues, because obviously magnesium levels are controlled by the kidneys to some extent what was your level of cut off?
Speaker 1:what was your level of woo back off?
Speaker 2:40 egfr of 30 or less 30 or less, so gotcha often, as naturopaths, we're panicking about slightly reduced EGFR, but for many patients it's not really an issue and they can tolerate most meds and most supplements until their renal function is really markedly reduced.
Speaker 1:So I'd want to become cautious at that level.
Speaker 2:Yeah, so I'd want to become cautious at that level.
Speaker 1:Just a last question, Gina how can we encourage patients and what can we recommend with regards to lifestyle factors to help with their cardiovascular health?
Speaker 2:I think all the things that we do well as naturopaths, which is transitioning people to a whole foods diet rich in vegetables particularly the dark, green and leafy nuts and seeds, really good quality protein, moving away from sugar, which is going to deplete people's magnesium, chromium and and and so stress management is always going to be a big part of what we look at as naturopaths. And, for example, exercise, being outside in nature, grounding all the things that we want to encourage people to do to manage their stress. But I can say that stress is rampant right now and that's something as naturopaths I think that we do really well. And whilst magnesium, zinc, all of those B vitamins are going to help with a stress response, we still need to come in with dietary modifications and all of those lifestyle things. Stress management, you know, for some people it will be meditation, for other people exercise, grounding all of those sorts of things that we normally would do in a consult gina.
Speaker 1:There's obviously a wealth of expertise there through and I'm going to say it without, without fear, but many, many years of of practice. So thank you so much for taking us through not just magnesium but everything else that we can help use to help our patients with cardiovascular issues. Thank you so much for taking us through these today.
Speaker 2:Gina, yeah, you're very welcome.
Speaker 1:And thank you everyone for joining us. Remember you can catch up on today's show notes and the other podcasts on the Designs for Health website. I'm Andrew Whitfield-Cook. This is Wellness by Designs.