Mg, K Anecdote

Dear Afibbers,

It’s been many years since I’ve posted anything on afibbers.org. After two successful ablations in Bordeaux, one for atrial fib (2005) and one for atrial flutter (2011), life has been grand.

However, very recently I experienced a condition which I feel is related to lone atrial fibrillation, something to which those of you that have remained fit into your senior years may be predisposed - Prinzmetal angina AKA variant angina (angina due to coronary vasospasm).

In my younger years I ran plenty of marathons. Now at 70 I exercise for at least 45 minutes a day, 7 days a week. Here in Hawaii that means lots of sweating and loss of magnesium and potassium, not only in the sweat but also in the urine, as sodium (and water) are reabsorbed and potassium/magnesium are excreted during rehydration.

This is one of the reasons that LAF is 10 times more common in endurance sports enthusiasts. The other is the strong vagal tone (low HR) that they often develop.
[www.ncbi.nlm.nih.gov]

The brilliant French cardiologist Philippe Coumel RIP was the first to define the triad of conditions required for atrial fibrillation – a defective substrate, autonomic imbalance, and a trigger. More importantly he authored the forward to Hans’ first book on LAF.

The trigger (atrial ectopics) is usually ultimately electrolyte related and this IMHO is what connects LAF and coronary vasospasm (Prinzmetal angina).
Well over a decade ago I posted some pertinent research on the vital roles of K and Mg in LAF.
[www.afibbers.org]
Sometimes you forget what you wrote. Perhaps I have a touch of cerebral vasospasm, dare I say dementia, as well.

One evening 15 minutes into an 8pm movie in a cold theater 90 minutes after dinner I experienced peculiar numbness in my right arm lasting about 10 to 15 minutes. 2 1/2 hours later while going horizontal to sleep, the numbness in my right arm returned and was accompanied by chest discomfort but no shortness of breath. This lasted a couple of hours and was accompanied by intermittent nausea and vomiting. My diagnosis was gastroesophageal reflux disease (GERD).
The next morning after walking the dogs and a light breakfast the right arm numbness recurred with nausea and vomiting lasting 10 or 15 minutes.
I wasn’t able to explain away the right arm numbness on the basis of GERD and terminated my daily exercise regimen.
The following morning I decided to give myself a light stress test with a very slow jog in the park. After a few minutes I could just feel the onset of the same right arm numbness.
I immediately terminated the jog and proceeded to a nearby laboratory for a blood troponin (marker for cardiac ischemia/infarction).
It was definitively positive (1.51ng/ml, normal <0.03). I diagnosed myself with Prinzmental angina and visited a cardiologist shortly thereafter who concurred after a normal EKG.
I had become quite remiss (lazy) with my supplementation regimen and consequently jumped on Mg supplementation to bowel tolerance (500 mg elemental/day). Although there were no more typical late evening/early morning vasospastic episodes at rest (follow up troponin 11 days post event was .075, 28 days post event .009) strangely every time I exercised in the morning I could feel a touch of numbness in my right armpit that never progressed but that terminated if I stopped. This would not occur if I exercised after 8AM or in the afternoon.
I also increased my potassium supplementation with 400 mg three or four times a day – the slight numbness seems to be slowly decreasing.
“Plasma potassium follows a diurnal rhythm with a peak at noon and a trough at midnight.”
“Urinary potassium excretion peaks in the early morning between 0530 and 0730.”
[afibbers.org]

Google Prinzmetal angina – when does it occur (night and early morning), why does it happen (sudden changes in autonomic tone, Mg deficiency, …), … Calcium channel blockers are often prescribed (diltiazin, verapamil, …) for vasospasm. IV magnesium sulfate is often administered to alleviate the vasospasm. Not surprisingly magnesium is a natural calcium channel blocker.

Most know that it is impossible to address a K shortfall in the face of a Mg shortfall and I appear to be a urinary magnesium waster. This was my conclusion based on an entire year of aqueous magnesium (http://afibbers.org/Wallerwater.pdf) intake to bowel tolerance with intracellular magnesium evaluation by EXAtest (http://www.exatest.com) before and after this yearlong trial.

The importance of magnesium and potassium in LAF, Prinzmetal angina, and many other maladies such as migraine headaches, Raynaud’s phenomenon not to mention the epidemic of constipation, muscle cramps, and other cardiac arrhythmias cannot be over emphasized. ALL muscle and nerve cells rely on nothing more than the in/out flow of potassium, sodium, and calcium mediated by ATP, the creation of which requires magnesium.

So, both atrial fibrillation and angina can be physiologic (LAF and Prinzmetal) with significant autonomic and electrolyte inputs.
[www.ncbi.nlm.nih.gov]

PC, MD

Hi PC,

Thanks for posting!! Very interesting!!

Caused me to look at my last troponin test (Feb 2019) of 0.4pg/mL (realizing these values change quickly).

On potassium, I've gotten in the habit of putting 2 tsp (4 g of elemental K+) potassium citrate powder in around a liter of water and drinking over the day - my version of time release. Magnesium continues to be the factor that keeps me in relative afib remission after all these years. Six or so years ago, I learned that excess calcium intake from food significantly impacted my normally good afib control (stress eating wheels of brie during a divorce).

As an aside, I visited Hans & Judy in April and they are doing well.

Mahalo,

George

Great to hear from you again PC - I have been missing those 'brain-cramp' posts of yours!

Good to know you are doing well post-Bordeaux also - I headed there myself in Aug 18 and had a PVI by Prof Jais. After a couple of episodes of ectopics and bigenimy in the first couple of months all OK so far but fully prepared for a touch-up procedure at some point in the future. I still get quite a lot of ectopics daily but thankfully they don't lead to AF anywhere near as readily as they used to pre-PVI.

A timely reminder about the importance of Mg. My Exatest in 2010 was pretty dire at 31.7 Mg and 7.0 Ca. My AF is genetic on my mother's side and my take is that my substrate issue is electrolyte handing issues. I've tried Mg supplementation many times in all of its forms including MgSO4 IM injections, oral supplementation and Epsom salt baths but have never noticed any improvement at all. That said, I'm once again on the Waller Water and am just going to stick with it - maybe I just haven't stuck with it long enough and am expecting too much improvement too quickly. Ironically enough one of the things that discourages me to some extent from doggedly sticking with the Mg is that I recall you having 2 Exas a year apart and saw hardly any improvement on the second despite some really quite determined efforts to raise IC Mg. I do wonder if my electrolyte mishandling is what it is and there's not a heck of a lot I can do about it end of. Even so, the WW is cheap and easy to make and surely can't hurt! Maybe I need to throw some K Gluc. in it too.

Over the last few years what has become massively apparent to me is that MSG is by far my main trigger. Between 2014 and 2016 (inclusive) I had 4 episodes of AF - 3 of which were after Chinese take-away food, and I only had Chinese TA food 3 times during that time period - pretty convincing correlation I'd say! No more Chinese TA food for me! Too many MSG-laden crispy snacks will have the same effect guaranteed, so I stick to plain crisps only and only occasionally at that. The other thing I have done recently is shed 41 lbs this year and am now 193 lbs (6' 4"). (I was a hefty 266 lbs back in 2008.)

Mahalo (pinched off George!),

Mike F.



Edited 2 time(s). Last edit at 08/30/2019 07:30PM by mwcf.

Like Mike, I was missing "brain cramp" posts! A link to PC's Pathologic vs physiologic afib paper. Also a discussion in our Conference Room.



Edited 1 time(s). Last edit at 08/30/2019 12:37PM by GeorgeN.

Once again PC, many thanks for your latest interesting thought piece above. It's great to hear from you again and, as always, you are more than welcome here on the forum!

Cheers and Aloha!
Shannon

Hello, PC ~ It certainly is nice to see you your name here again. So glad to see your ablations continue to serve you well.

On the topic of your new symptoms, I'm wondering if you've investigated the potential, vasodilating benefits of enhanced nitric oxide (NO) production using L-arginine and L-citrulline? I haven't specifically researched that effect on Prinzmetal angina, but recall the amazing vascular benefits reported for a variety of symptoms improved by boosting NO production in two popular books on that topic.

Glad to see you continue using the WW. I've continued to use it daily for a number of 'balancing' purposes including maintaining alkalinity with all those important downstream benefits.

I certainly wish you success in finding a solution.

Best to you,
Jackie




No More Heart Disease by Louis J. Ignarro, PhD and Nobel Laureate in Medicine

The Nitric Oxide (NO) Solution by Nathan S. Bryan, PhD and Janet Zand, OMD

G'day PC,

Good to hear from you again. Your 70 now! Maybe you need to put some elasticity back into those old arteries of yours by eating natto food again every 2nd day? (Some recent natto food studies):

[www.ncbi.nlm.nih.gov]

[www.ncbi.nlm.nih.gov]

I'm still afib free after 15yrs of eating natto food every 2nd day. Finally convinced another afibber “Colindo” or Colin to start on natto food. He went from several long afibs a month to a couple of short afibs a year. We both think we are definitely onto something here.

We have put a lot of research into natto food and we both think it is the phytoestrogen Genistein that is behind our success. Bit of a brain cramp below but I think you can handle it!

Cheers
Dean

Genistein and Natto

[www.ncbi.nlm.nih.gov]

Genistein is a major bioactive isoflavone, abundant in some vegetables, that has proven to have beneficial cardiovascular effects in both animal and human studies (5).

Kv4.3 is responsible for the primary transient outward K+ current in the heart (30). This channel is an important repolarizing current that determines the amplitude and duration of action potential in the heart. Inhibition of transient outward K+ currents, which are mainly mediated by atrial and ventricular Kv4.3 in humans, may contribute to prolongation of action potential duration (8).

Consequently, Kv4.3 channels are a potential therapeutic target for antiarrhythmic drugs (41).

The inhibitory effect of genistein on Kv4.3 may, therefore, have antiarrhythmic activity that could explain, at least in part, its cardiovascular effects.

Plasma concentrations of genistein were relatively low and generally <40 nM in humans consuming diets devoid of soy, but were considerably higher in vegetarians (32).

However, the average plasma concentration of genistein in Japanese subjects consuming a traditional diet was 0.1–0.27 μM, and plasma genistein concentrations as high as 2.4 μM were measured (1, 15).


“The results obtained in this study demonstrate that hKir2.1 channels are down-regulated by protein tyrosine kinase inhibition, suggesting that epidermal growth factor receptor kinase participates in the modulation of human cardiac excitability.”


Genistein and Cancer

“Genistein and daidzein induce apoptosis of colon cancer cells by inhibiting the accumulation of lipid droplets.”

“One of the major isoflavones in soybean is genistein which can inhibit proliferation and induce apoptosis in cancer cells”

Dean, I have been looking at Youtube videos on how to make Natto. Do you make yours or buy it already made?

Thank you for your in-depth post.

I was considering using the Waller Water but their site specifically states to NOT use this protocol if one is on a blood pressure med. I am on Diltiazem and felt it would be wise for me to not do this. I am wondering if you are on a blood pressure med and if so how does this protocol affect your heart / health?

I hope I've possed my question without offense and correctly. I do not mean to intrude or offend but am searching for all things that would benefit my Afib.

Thanks for your consideration regarding my question.

respectfully, Reeder

Aloha all,
Thank you for all the posts.
Thank you George for the better link to my article.
Thank you Jackie for the arginine insight. Unfortunately foods high in arginine and low in lysine (chocolate, nuts, ...) cause other problems for me. Arginine is linked to nitrates (Viagra, Cialis) for fast acting vasodilation and should be excellent for angina (not to mention ED).
Mike, preablation MSG was my biggest risk factor. Post ablation it’s Mg.
Dean I think Hans is also a big fan of natto.
and Reeder, not sure why your MD advises against waller water.
Diltiazim is a calcium channel blocker type vasodilator like magnesium. Most likely he fears excess vasodilation (hypotension).
The bicarbonate can affect your blood bicarbonate and pH noticeably, as I have personally experienced. Perhaps this is the reason. There are many natural sources of magnesium (nuts, seeds, ...) not to mention other excellent magnesium supplements chelated to amino acids (glycinate, aspartate,…) or magnesium citrate that don’t affect blood bicarbonate.
You might consider adding vitamin B6 (pyridoxal phosphate), which is a required cofactor for almost 1/3 of those reactions requiring magnesium, to your regimen. It’s also called the dream vitamin and is water-soluble.
I am not on any meds.
Good luck
PC

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I was considering using the Waller Water but their site specifically states to NOT use this protocol if one is on a blood pressure med. I am on Diltiazem and felt it would be wise for me to not do this.

Reeder, when you say "their site" what site are you referring to. If it were me, I'd start with a low dose and see what happens. It is possible they magnesium could lead to hypotension. Again, if that happened to me, I'd lower the BP med and increase the mag. I'm not a doc and I'm not suggesting you do this.

Aloha Mike,
I’m visiting the Philippines now with my wife, so I’ll be brief.
I had the same problem pre and post ablation. For me it’s all about K. As Jackie always says, “K calms the heart.” I proved this for myself via three consecutive Holter monitors - one without K, one with 300 mg q 3h, one without K.
I had 10x more PACs when off K. And you can’t improve intracellular K in the face of a Mg def.
Is it worth paying 10x more for Natale for a tenth of the PACs?
K is incredibly cheap and has other benefits too.