A Country Doctor Writes:

You would think simple atomic particles like sodium, magnesium and iron would be evenly distributed throughout the body and that their blood levels would tell us whether we have enough of them in our bodies.

I already knew that that was not the case with sodium or magnesium. Tonight I learned that the same situation exists with iron.

Low sodium can be associated with swelling of the brain and rapid neurological deterioration, but if it develops slowly, the brain may not suffer as much as if it happens acutely.

Magnesium is shuffled from our tissues into the blood stream if our serum levels drop, which means even people with normal serum levels can have severe intracellular magnesium deficiency.

Tonight at 9:51 pm, the EMR still open on my laptop computer, I was in a Facebook messenger video with my lady friend. A patient who I’m not friends with socially sent me a video link to a neurology talk by a neurologist in Spain speaking with an Italian accent about restless leg syndrome. This is a condition that didn’t get much attention in my 5 1/2 year medical school curriculum at Uppsala University in Sweden, even though this disease is also called Ekbom’s disease and named after an Uppsala neurology professor before my time.

It is well known that iron deficiency can play a role in restless leg syndrome. The video stressed the point that brain levels of iron and serum levels of iron and ferritin don’t correlate very well. In this case, just as with magnesium, other bodily functions may be prioritized – If we are trying to overcome anemia we may sacrifice the brain iron levels to make more red blood cells and when we do that both the blood count and the serum iron and ferritin levels may look pretty good while the brain is suffering.

Tonight’s lesson is, once again, that blood tests don’t always tell you what’s going on in the part of the body where the symptoms are. And, by the way, in case anybody thought restless leg syndrome is a disease of the legs, it’s all happening in the brain!