flecanaide

My afib episodes seem to be getting closer together and longer. My last one was 9-27-17 and lasted 44 hours. I had an ECG (to confirm) and then was given flecainide 50 mg. It ended three hours after I took it but seemed like it was about to stop anyway.
I woke up at 6 am in AFIB this morning (11-5-17) and took the flecainide immediately (chewed it). I also took my BP med, atenolol. It's now been almost three hours and still going. I have not had a follow up visit with cardiologist since the episode in sept due to their computer problems and my schedule. The label on the drug says take once a day, but I was instructed to take one to see if it would end. What I am wondering is if I can take another one? It's Sunday so there is no one to call to ask. I can't see that it would hurt anything as I know some people are on it daily anyway. I know that no one can give me medical advice but I am just asking for opinions. I do not want this to drag on into tomorrow.
I also recently (august) found out that I have type 2 diabetes and have been working to get my numbers down and have lost about 25 pounds. I am eating extremely low carb and my numbers are almost normal for non-diabetic. I am doing intermittent fasting a few days a week and have eaten only complex carbohydrates since diagnoses. I know that diabetes can make me more vulnerable to stroke and I am not on blood thinners other than nato. I am also wondering if the intermittent fasting could make me more vulnerable to attack of afib.

Be careful on the flec. Anti-arrhythmics are not drugs you want to risk overdose with. I’d wait to see how things go and call your cardiologist on Monday morning.

As for the fasting, that is great for lowering blood sugar but not so good for electrolytes. Try to supplement potassium and magnesium while fasting. The Waller Water recipe (posted many times here) would be great for the Mg. I’m sure you could also dissolve a powdered potassium supplement in it on your fasting days.

I'm fasting 16 hours - so through the night and then until 16 hours have passed so usually around noon. I always supplement postassium and magnesium, taurine, etc.

50 mg is actually a pretty small dose. The usual dosage for using flecainide as a PIP is 300 mg. However, checking with your doc first would be wise.

I very much doubt that fasting makes you more (or less) vulnerable to afib.

Not being on an anticoagulant is the risky thing you're doing, especially with the diabetes and being female. I don't know how old you are but that makes you at least a CHADS 2.

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Carey
50 mg is actually a pretty small dose. The usual dosage for using flecainide as a PIP is 300 mg. However, checking with your doc first would be wise.

I very much doubt that fasting makes you more (or less) vulnerable to afib.

300 mg is the standard PIP flec dose for those who weigh more than 70 kg (154#'s), 200 mg for those who weigh less.

Yes fasting and a low carb diet can make you more vulnerable to afib, or at least to trigger an afib episode in an existing afibber! I have personal experience with this. It is well known. I knew it was a risk when I first "keto adapted" in 2009. I described in more detail here <[www.afibbers.org] . When you go very low carb, keto or fast, your insulin levels drop. This signals the kidney to excrete sodium (conversely high insulin signals the kidney to conserve sodium). This excretion can be so strong that potassium is also excreted as the body tries to keep the sodium potassium ratio in balance. Best practices are to supplement with 5g/day of sodium (about 12.5 g sodium chloride salt) and additionally potassium and magnesium with low insulin. I've been keto adapted since 2009 and eaten once a day since June 2015 and have fasted 5 consecutive days 13 times since May 1st of this year (I'm weight stable). I'm well acquainted.

George

Thank you George. This is very helpful. I have been on a very low salt diet for a couple of years now. My profile says I have been on this forum for two years, but in reality it has been at least since 2012. I track everything on My Fitness Pal and my sodium is usually between 400 and 600 mg a day. I track the potassium I consume and then at the end of the day take enough supplement to put it at 3500. My diet is not entirely keto but is very low carb. I try to keep all carbs at under 30 a day. I've lost about 25 pounds and am at about 174 so above would qualify for that standard dose of flec. My blood sugars are nearly normal. (I was diagnosed in Aug.) I eat a lot of fish,low salt turkey, low salt cheese, plain yogurt, avocados and a few berries, eggs low salt bacon, sometimes baked chicken. So do you think I should up my salt? I have been doing intermittent fasting, 16 hr fast, 8 hours eating.
I know that I am at higher risk for stroke, and I am 66. I also have hypertension, but the low-salt has taken care of that. And my blood sugar is almost under control, and will be eventually. (no meds for diabetes) My mother had afib and died from a hemorrhagic stroke and so that along with other side effects makes me want to avoid blood thinners, although if my episodes continue to get longer and longer I will consider it. I have been taking nattokinase, omega threes, cinnamon and magnesium bisglycinate.
Right now I am in my 6th hour of afib after having taken the flec at the onset.

Hi ,

I have been on the 5:2 diet for about 4 years now. That is normal eating for 5 days and 600 calories on the other 2 days.
I have Monday and Thursday as my diet days.
When I first started I lost quite a lot of weight but I also seemed to get afib sometimes the day after a fast day, so now I restrict my calorie intake to 900 on the fast days and have no problems.
There is one thing I would like to share and that is for the last 4 months I have been taking Kefir, half a cup each morning with my breakfast (about 60 calories) and have had no afib. Touch wood.



Edited 1 time(s). Last edit at 11/05/2017 01:04PM by colindo.

George, do you mean 5 grams of sodium per day, or 5 mg? That sounds like a huge amount.

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GeorgeN
300 mg is the standard PIP flec dose for those who weigh more than 70 kg (154#'s), 200 mg for those who weigh less.

Good point.

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This excretion can be so strong that potassium is also excreted as the body tries to keep the sodium potassium ratio in balance. Best practices are to supplement with 5g/day of sodium (about 12.5 g sodium chloride salt) and additionally potassium and magnesium with low insulin. I've been keto adapted since 2009 and eaten once a day since June 2015 and have fasted 5 consecutive days 13 times since May 1st of this year (I'm weight stable). I'm well acquainted.

Perhaps true for you, but 1) she's diabetic and 2) she's supplementing potassium. I'm skeptical that reasonable fasting would cause afib.

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jennifer92151
George, do you mean 5 grams of sodium per day, or 5 mg? That sounds like a huge amount.

Yes, 5 g/day. I was at a conference in August where Steve Phinney MD PhD <[www.amazon.com] (who has been researching low carb diets since ~1980) specifically said this. He's also said it previously. I'm sure it is individual. I don't measure, but I do make sure I liberally salt everything.

That being said, you could just increase the amount slowly.

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Carey
Perhaps true for you, but 1) she's diabetic and 2) she's supplementing potassium. I'm skeptical that reasonable fasting would cause afib.

At the time it happened to me, I knew it was a risk before I started. Don't have those references readily available 8 years hence. I was supplementing with 3 or 4g/day of potassium at the time as I thought that was the issue. At the time, I wasn't fasting, only doing a low carb diet as per Atkins induction - 20 g carbs + adequate protein + fat. As I've been on this board for > 13 years, this issue has surprised many who started a low carb diet, then posted about it here. It is elsewhere in the literature, but I don't have the motivation to do the searches.

Thank you again George. I had no idea how the low carb diet would affect me. I have been very carefully limiting salt. I am still in afib - about 17 hours now and will call the doctor in the morning.

A low carb diet should not be a low sodium diet!

Do you still supplement with potassium and if so, how much? What should the ratio be of sodium to potassium for someone on a low carb diet?

Jenifer,

Not really. After years of serum testing (which is a decent indicator, as opposed to magnesium where other tests are needed), I've found that if my magnesium intake is good, my serum potassium is in the 4's, which is where I want it. My diet has about 4+ g of potassium/day without supplementation.

Should note, there is a lot of individual variability & what works for me may not work for others.

My mother used to fix all her meals from scratch, not low carb - a lot of grains, legumes & veggies. She did not add salt. When her dementia progressed to the point that I needed to move her into memory care assisted living, their food was a lot of canned and other food that was very high in both sugar and sodium. She exhibited congestive heart failure symptoms in a short time - a week or two. Had to put her on a diuretic with added mag & potassium to keep her off oxygen. Also had this happen to an 80 year old friend in the last couple months.

In his book, The Salt Fix, <[www.amazon.com] researcher James DiNicolantonio presents research showing that low sodium can actually trigger the body to increase insulin to trigger the body to hold onto sodium.

Jackie has noted that excess sodium will trigger her afib.

Excess calcium is bad for me (is an afib trigger). I limit consumption to around 500-600 mg/day.

Best advice is to pay attention to how you feel and react under different scenarios.

George

I would urge great caution with potassium supplements to anyone with diabetes, and that includes artificially boosted foods like LS V8. Diabetes and kidney dysfunction go hand-in-hand, so any use of potassium should include frequent monitoring of electrolyte levels and kidney function. In fact, although I've used very high doses of potassium with great success, I always tell people with diabetes not to even consider doing what I did unless they've got their doctor solidly on board with it.

George I have downloaded the books you refer to. I am convinced about the salt but I feel like I am completely starting over now. I had done the low salt diet, potassium supplementation, taurine, magnesium, etc which has kept the afib episodes to three or four times a year. I've never eaten much salt, never salted my food, ever. I don't know how much to start with, and I don't know how much potassium I should be getting now. I feel really lost and am scrambling to try to figure it out. I have a cardiologist who is worthless. Where do you get serum testing? Through a lab or by working with a doctor? I would like to know my levels, but I don't know where to start.

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jennifer92151
I have a cardiologist who is worthless. Where do you get serum testing? Through a lab or by working with a doctor? I would like to know my levels, but I don't know where to start.

You start with a doctor and a routine physical. Basic blood work from any GP will include an electrolyte panel, which is something that anyone with diabetes should be doing periodically. You don't need a cardiologist for this. Find a local doctor of healthcare practice and schedule a physical. That will include the blood work you really should be doing routinely.

And again, I would urge you to exercise great caution with any electrolyte supplements (salt, potassium, calcium). If you haven't had an electrolyte panel in the last few months, you shouldn't even consider it. It can be truly dangerous. And unless you have an extremely unusual diet, the odds that you need to add salt are somewhere between zero and zero.

I am very recently diagnosed with type 2 diabetes, and my numbers are already nearly within normal range for a normal non-diabetic person but I did that with a very low carb diet. I am just beginning to read the books that George recommended, but it already looks like I may have brought on the diabetes with my low sodium diet. (I was only a little over weight, and had a good diet and exercised and have no family history.) I was eating 400-500 mg of salt a day. I have been on lots of potassium since I first got afib, at least since 2012 and I think before that. I will have to search for a doctor, or find a naturopath who will order the tests.

Jennifer:

Dr. Brownstein has a book "Salt your way to Health". He says Patients do not feel well when sodium levels are lowered. Their energy level drops and develop hormonal and immune system imbalances. He says "low-salt diets have been shown to raise fasting insulin levels". The kind of salt to use is "celtic sea salt" which contains minerals, refined salt only contains sodium and chloride.

Liz