Triggers and Risk Assessment Management

Triggers and Risk Assessment Management

My ongoing mission with the Afibber’s Forum is about “creating awareness.”

It is both important and relevant that afibbers attempt to identify their arrhythmia triggers. Equally important is identifying and managing Lifestyle Risk Factors (LSRF) aka Risk Factor Assessment and Management to help optimize overall health. Many LSRFs are arrhythmia triggers and can be unique to that individual but many are also commonly-known, well-recognized as culprits in the general Afib population. Often new afibbers are unaware the ‘trigger’ connection is so extensive.

While it’s true that we are all unique individuals with genetic variations and biological-trait aspects, it’s also true that commonly-known ‘triggers’ or stimulators of arrhythmia, once identified, can be managed, eliminated or imbalances corrected to help lessen or even eliminate Afib events. These can be single or multiple factors. Identification is often no easy task and what works for one, may not for another; but there are many well-known, common triggers; so as a start, it’s useful to be aware and do a self-assessment.

Recognizing the potentials and identifying culprits is one of the first steps toward progress and ultimately, improved health overall because often what lies at the heart of some triggers is related to nutritional deficiencies and imbalances. This applies whether or not you have an ablation, because, ultimately, your overall nutritional status strongly influences health status over time.

Over the years, Afib forum members have shared their various triggers identified from a wide variety of source/causes such as alcohol, medications, digestive issues including GERD, Hiatal hernia, H. pylori infection, leaky gut syndrome (LGS), Candida overgrowth, gluten sensitivity, chemicals in food such as MSG, high natural glutamate content from long cooking times, aspartame, food dyes, BPA, pesticide residues from non-organic foods and even organic food that’s imported, (now we have the GMO and glyphosate residue issue), chemical odors, gasoline vapors, environmental toxins, heavy metal toxicity, acidic tissue pH, sleep apnea, postural influences, over-exercise, hot weather, dehydration, magnesium and/or potassium deficiencies, calcium overload and various metabolic imbalances such as hypoglycemia, adrenaline surges, over-production of cortisol, thyroid abnormalities, genetic defects and more.

Most frequent are the imbalances and deficiencies found in core electrolytes that assist in proper heart function including electrical conductivity. Therefore, initial self-assessments typically begin with lifestyle. dietary habits and intake of foods often thought to be ‘normal’ foods but turn out to be empty calories loaded with processing chemicals, sodium and minimal health benefits. Many Rx medications deplete magnesium.

At the top of the list is often an over-consumption of calcium (food and supplements) which blocks magnesium function and a high-sodium intake which blocks potassium function—both essential for Normal Sinus Rhythm. Then, there are also subtle findings through both personal experimenting as well as metabolic testing that includes, in addition to the essential electrolyte or heart minerals, assessing nutrient status for that which assists with production of the energy molecule, ATP, and the influence that systemic inflammation contributes to an irritable heart as measured by various elevated markers such as High Sensitivity C-Reactive protein, elevated homocysteine, ferritin, and the other important test markers as listed in the recent Clot Risk post. In addition to helping form blood clots more easily, elevated inflammation can make cells irritable and is excitatory to nerve cells. If it’s a heart cell, then arrhythmia can occur.

Antiarrhythmic drugs and beta blockers may help in some cases but not in others because many of the fundamental nutrients may be too low to offer the necessary functional support along with the drug component.

Additionally, while you can have a successful ablation, if core nutrient deficiencies or triggers are still present, that can cause problems in other ways not related to arrhythmia but still working behind the scenes to undermine your long-term health.

Ideally, and if possible, it’s very useful to have specific metabolic testing to assess your individual, relevant nutritional status, to target areas that need improvement to help ensure fewer health issues as one ages. (And we are all aging every moment we are breathing.) As an example, one of the core nutrients essential for heart energy (ATP) production, Co-enzyme Q10, has a natural production decline in one’s early 20’s with severe decline noted by age 35. Without testing and supplementing, those who are abnormally low early on in life will undoubtedly suffer from one or more deficiency-related issues. So the point I’m illustrating here is that there are many avenues to check to ensure that your body is receiving and utilizing all the nutrients it requires on a daily basis - 24/7 - to function and keep you as healthy as possible. We have always reminded our readers that “Afib is our Canary in the Coal Mine”…. It’s a signal something in the body is amiss and needs to be identified and managed properly.

Some primary care physicians are willing to order these tests but often it’s necessary to consult with a practitioner who is nutritionally oriented with the goal to find underlying deficiencies, genetic defects that facilitate nutritional deficiencies. Example: many people with methylation defects have multiple problems and specific testing is the only path to progress. Modern physicians practicing functional medicine or restorative medicine and Naturopaths can order tests as can some Board Certified Clinical Nutritionists, depending on state laws. Insurance typically does cover many of the tests. Life Extension Foundation works with Lab Corp so patients can order many of their own tests (but not all) at relatively low fees when there is no insurance or no prescribing access.

There’s much more to this topic and there are many previous posts on various tests if you use the search engine. Check GeorgeN’s posts on genetic testing.

This overview awareness post is offered to stimulate your interest in self-assessment of Risk Factors. Whether or not you have afib, it’s wise to make changes and improvements for overall health and longevity.

Here our website, if you haven’t discovered the topic boxes titled Afib Resources - [www.afibbers.org] and the Archived Conference Room … please visit for many very useful reports that examine atrial fibrillation. [www.afibbers.org]

We are all here to help. You can help, too, by adding your unique trigger findings to this post so future readers can benefit and also participate.

Knowledge is power.
Jackie



Reference links
Tests for helping identify inflammatory markers – This post lists several past links for important lab tests… [www.afibbers.org]

Berkley Comprehensive HeartLab test [moghissimd.com]

Boston Heart - [www.bostonheartdiagnostics.com] - tests for Lipids, risk of forming blockages, Inflammation, Metabolics, Genetics.

Quest Diagnostics has Cardio IQ Test - [questdiagnostics.com]

Intracellular Diagnostics – ExaTest – specific for intracellular levels of electrolytes [exatest.com]

Genova Diagnostics Metabolic profile [www.gdx.net]

23andme - [www.23andme.com]

Life Extension Lab Testing [www.lifeextension.com]

"At the top of the list is often an over-consumption of calcium (food and supplements) which blocks magnesium function and a high-sodium intake which blocks potassium function—both essential for Normal Sinus Rhythm."

Strange, Dr. Brownstein, my Holistic doctor, has said to me after every one of my blood workups that I need to get more salt in my diet. How do you interpret that?

Liz

Thank you for this information Jackie - it is so easy to get overwhelmed by all of the information! I really appreciate the links provided. If one is just starting out and we do not have any knowledge on a patient's levels - which tests would you recommend we order in level of priority?

Liz,

On my low carb, ketogenic, fasting program. I make it a point to consume a lot of salt. When insulin is low, as it is on my program most of the time, the low insulin signals the kidney to dump a lot of sodium. At a conference I attended last weekend, Steven Phinney MD presented data that lowest mortality in a large study was 5 g/day of sodium (not NaCl alone). Higher mortality with less.


George

I do recall that you said you consume salt---I guess I don't eat a lot of carbs, I eat a lot of fruits/veggies and meat. I do eat some bread, probably my insulin is low. I cook my own food, so I don't consume a lot of salt. There was an article on Drudge a few days ago from a doctor in England who said we need salt and what is being said about salt being so bad for us is wrong.

I have a problem with some of these articles saying this is bad, that is good, I have learned throughout my life what is true today is wrong tomorrow.

Liz

Quote
Jackie
It is both important and relevant that afibbers attempt to identify their arrhythmia triggers.

It was generally gas build up in my stomach and esophagus. July 1 to August 9 episodes were typically preceded by burping. In the past when I had gas I tried eliminating specific foods, Lactaid, Beano, digestive enzymes, Gas-X, and activated charcoal. Limited success.

Liz - With those who cook and eat whole foods sensibly, the risk of consuming too much sodium is low by comparison to someone who eats commercially-prepared foods almost exclusively. The points offered are general observations but overall lifestyle compounded by years of the same habits can often be contributory to health ailments, not the least of which would be a typical case of too much sodium and virtually nothing in the way of providing potassium.

Everyone needs some sodium. Some, need more than others and it always relates to balancing out the sodium/potassium ratio that is required by the body. Conference Room Session 72 discusses the physiological importance of "The Potassium/Sodium Ratio in Atrial Fibrillation"....

Introduction
Sodium and potassium! Biophysicist Richard D. Moore explains: "For purely physical reasons (connected with the law of osmotic equilibrium), inside the cell the sum of sodium and potassium must be constant. This means that... sodium and potassium are unalterably linked together like two children on a teeter totter. You can’t change one without changing the other.

"Thus, in the perspective of biophysics, it makes no sense to talk about either sodium or potassium alone - these two
substances always affect each other in a reciprocal relation. Hence their ratio ... reflects the state of the living cell more
completely than either sodium or potassium alone... It is not only a simplifying concept, but a much more scientifically
valid measure of the state of health of the living cell.

"Reflecting the action in the cell, potassium and sodium always work in a reciprocal manner in the whole body... This
means that increased consumption of potassium will drive sodium out of the body through the kidneys. Thus,
potassium has been called "nature’s diuretic"... This is an example of the fact that elevation of sodium inside our body
cells must always be accompanied by a decrease in the potassium level." [1, 11]
Source: [www.afibbers.org]

And, going right along with this on potassium intake... we know from the science as well as from afibbers who have checked their potassium regularly by the CardyMeter, too much potassium intake can also be a trigger or stimulator of afib. It's all about balance and your own, specific nutrient intake and utilization.

Dr. B. is probably thinking that your good diet may have too much potassium relative to your sodium intake and by taking in some sodium, that should help balance to the proper ratio. It's also known that when intracellular magnesium is low, then too much potassium intake contributes to arrhythmia.

That said, and as an example, we all know people who have horrible diets and drink alcohol to excess and don't have a hint of arrhythmia. This is the individual biochemical/physical uniqueness that we've talked about for many years. Figuring out your own uniqueness is the challenge. If your tests indicate you are low in sodium, then that's where your focus should be.

As George indicates, his program indicates a need for more sodium and that works for him. Others, may not be able to tolerate large amounts of sodium.

As all of us 'veteran afibbers' know from years of experience.... we can only give general tips and guidelines as to what might be triggers or culprits. The challenge is fine-tuning the requirements to fit your own uniqueness. There are, however, fundamental biochemical basics we've emphasized that are known to help manage arrhythmia in many afibbers... and typically, the "core" electrolytes are involved, but those aren't the only target nutrients.

Jackie



Edited 1 time(s). Last edit at 08/11/2017 09:42AM by Jackie.

Michael7777 - For those with stomach gas, reflux and discomfort, it typically comes because there isn't enough production of one's own natural stomach acid to break down food consumed... therefore, undigested food lies in the stomach and putrifies....which creates gas, bloating, pain and so on.

As always, looking at the underlying cause of the problem is the first step...especially when digestive enzymes and such don't seem to help. Typically, in this case it's because the person is low in core nutrients involved in the production of one's own stomach acid or hydrochloric acid....such as Vitamin B12 - methylcobalamin and zinc. There can be other elements involved as well. Functional medicine practitioners can test to determine what nutrients are deficient so that the patient can use those targeted nutrients and specific enzymes to restore the gastric function back to normal.

Using PPIs and such causes other problems eventually because the underlying source of the problem wasn't addressed in the first place.

Jackie

Thanks Jackie. I never used proton pump inhibitors. I will try to learn more about functional medicine practitioners.

I used PPIs for about 3 years before stopping earlier this year. I found that the magnesium supplementation is far more effective in the absence of PPIs versus the presence of them. PACs which were a daily occurrence are now so rare it's not uncommon for me to go several days without a single one.

It's become so peaceful I've begun to slack off on my dietary restrictions and eat like a 20-year old! (I know, it won't last but heck it's summertime...)

Wolfpack... just coincidentally, I recently checked the package insert for the PPI, Aciphex... wanting to learn if they offer precautions. So, at least for this one, your findings are 'spot on' for using magnesium. Others who have the inability to produce enough natural stomach acid, have to embark on the path of restoring that function as ongoing GERD can become very serious.

As you say, Hey, it's summer... so enjoy it while you can.. but don't be too neglectful of all your great nutritional support habits...

Best to you...
Jackie

The package insert says:

What are the possible side effects of rabeprazole (Aciphex)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using rabeprazole and call your doctor at once if you have symptoms of low magnesium such as:

dizziness, confusion;
fast or uneven heart rate;
jerking muscle movements;
feeling jittery;
diarrhea that is watery or bloody;
muscle cramps, muscle weakness or limp feeling;
cough or choking feeling; or
seizure (convulsions).

Less serious side effects may include:
headache;
upset stomach, mild diarrhea;
insomnia or nervousness; or
a rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. [www.rxlist.com]