von Ehrlich B

For decades the macrovascular system was in the focus of diagnostic and therapeutic medicine. The relevance of microvascular pathology was widely underestimated but is revealed in a new breaking through cardiological study (Covadis 2021). Increasing knowledge reveals the microvascular system (i.e. 95% )  as the essential target structure of chronic magnesium-depletion, mediating smouldering chronic disease processes (Oost 2021). Microvascular dysfunction could be the common basis fort the association of chronic Magnesium-deficiency and polytopic diseases of high-energy dependent organs: diabetic retinopathy, renal failure – diabetic and other -, microvascular=Non-Alzheimer dementia, diastolic cardial dysfunction (HFpEF – heart failure with preserved ejection fraction) - analoge art.hypertension – microvasc.angina, atrial fibrilation but also diabetic foot, diabetic neuropathy. The actual Covid 19 pandemic is related to microvascular pathomechanisms due to early studies.

Following earlier results reporting better survival of intensive care patients with highly normal magnesium as well as epidemiological associations (Iotti 2020, v. Ehrlich 2020) we recommended all patients from the beginning oft he Covid 19-epidemic high dose magnesium supplementation 15-25mmol (and zinc 20mg, Vit D 2000IE each/day).In the context of Covid 19 we can assume four constellations of possibly positive effects of this magnesium strategy:

1. Due to own limited cohorts the most evident: Tolerance of immunisation with Biontech Corona vaccine was distinctly better in our cohort of over 412 vaccinations compared with published data.
2. Rare but single patients with more intense adverse reactions had low magnesium and/or abnorm microvascular results in puls-wave-analysis.
3. Corona patients (also elderly) with documented high serum magnesium – and pre-supplemented- recovered from disease pleasing good.
4. Two postcorona-Long Covid patients with symptoms of fatigue, rediuced mental concentration and dizzyness reacted good after repeated parenteral magnesium infusion.

Whether Corona-antibody formation correlates with magnesium or zinc values is topic of running investigations. Systematic prospectve investigations are warranted. But due to the circumstances – regarding there are no evidence based alternatives – for healthy, for persons at risk, for patients at risk of magnesium depletion as well as for corona vaccination candidates optimizing of magnesium is justified (Global Mg Covid 19 project) – and independently the prevention of chronic microvascular disease-entities is justified. Personalized magnesium dosage in medical office should be oriented by  practical serum Mg/Ca (mmol/mg%) target 0,4 – including Calcium (Hu 2021). This approach seems us expedient and more successful didactically. (ambulant medicine : Mg/Ca serum; intensive care: ionized magnesium)