Dehydration and salt depletion

In Nov last year my cardiologist increased my flecainide dosage from 150mg per day (taken in one dose) to 100mg x 2 daily. Prior to this I was experiencing 1-2 episodes per month, each averaging a duration of 8 hours. Since the increase in flecainide I have been Afib free ....until last weekend. I had one episode on Saturday and another on Monday, both lasting 9 hours. The Monday episode resulted in me going to A & E Dept because I was anxious and panicky about the fast heart rate and feelings of pressure in my chest. (It was 140-190 throughout the episode apparently). Eventually I self terminated as normal and discharged with the advice to see my GP to discuss where I go from here. I told my GP that I have noticed that the episodes mainly occur when I have sweated a lot either due to to physical exertion, warm weather or hot flushes in the night (I am 48 and believe I am starting that funny time of life for us ladies!). He agreed that there appears to be link and his opinion was that I am losing minerals and salt through exessive sweating and also that the flecainide may not be staying in my body for as long as a result, hence the Afib episodes at weekend. He does not want to increase the flecainide at this point (neither do I) and advised that instead of drinking water when I become hot or sweating, I should drink isotonic drinks or other hydrating fluid containing minerals including potassium to replace the lost minerals. He also stressed the importance of replacing lost salt in my body and that it would be an idea to eat a bag of crisps (potato chips to you outside the UK I think!) to address this. This is where I am a little confused because this advice seems to be at odds with the many references on this site stressing the importance of lowering sodium/salt intake whilst increasing potassium. Is there an execption when we are dehydrated?

Cathie

Yes, there is an exception - you lose both salt and potassium when sweating, so both should be replaced in your drinking water.

As for the bag of crisps, your doc is a nutritional innocent.
Potatoes turn into sugar in the body. Bad for us.
All the chips I've seen are cooked in evil cooking oil - this has a very bad effect on general health.

William

Crisps are a bad idea as they will spike your blood sugar and therefore insulin. The insulin spike will cause more electrolyte depletion.

I suggest getting potassium chloride powder and sea salt. Then make up your own electrolyte drink with a 4 potassium to 1 sodium ratio.

Thanks to you both Willam and George for your help and advice. George, when you say 4 potassium to 1 sodium ratio, what measurement units are you referring to and how much per litre of water?

I understand from the forum that flecainide can stop working eventually but I am so disappointed that I have had these episodes. It is so frustrating because I can't really be sure if the relapse was totally due to dehydration or whether it is because the flec is starting to lose its effacacy. Has anyone else experienced a 'blip' on flecainide then been ok again without having to increase the dosage? Anyway I am going to increase my potassium/magnesium intake through my diet as well as keeping an eye on my hydration and see what happens, I will let you know.

Kind regards
Cathie

Cathie:

Most people need some salt, low salt diets causes low potassium. On a low sodiium diet kidney tubules stimulated by aldosteron have to reabsorb more sodium (to maintain its plasma concentration) at the expense of potassium, which is excreted--so low sodium intake leads to the loss of too much potassium, i.e. the Sodium/potassium pump.

Liz

Cathie - dehydration was what caused my first afib attack, and it is still a major trigger. I drink water that has potassium & magnesium added, in addition to supplements of both. Mostly I try and make sure I drink lots of water daily.

Katy

Kathie,

I had a real ride on flecainide last summer. After taking it 50 mgs. 2x day without having any problems for about nine months, last July into August, I started to have weekly then daily episodes. It was terrible, I was diagnosed with atrial flutter, then taken off the flecainide because the EP felt that the flecainide was organizing the fib into flutter. This thinking led to a flutter ablation. After that I was then put back on the flecainide which didn't work well ( I had afib eveyday in Jan) and February 1st I went to the ER in atrial something (The different doctors disagreed over the EKG. If there is any humour in this, it was their back and forth argument, no fib, flutter, fib flutter, doctor ping pong) which led to them raising the flec dose to 250 mgs. daily, 150 at night. That same week, I decided to start the magnesium intra-muscular injections that I had stopped in July. I never put it together, but I should of, that my mag. levels, after being quite good, had dropped significantly, and this shift had caused the flutter. I am back on the shots now, one every five days, and I have only had one very short episode since Feb. 1. The great thing is also I have reduced my flec intake back to 50 2x a day with the goal of weaning off by the end of the year. I have also gone completely paleo and that seems to have eliminated any food allergies that might have caused a mineral absorption problem. I was close to being Paleo prior, but I held on to eating that oatmeal (George I know you warned me about insulin spikes) and then finally said no more.

Your high heart rate sounds like a mag. deficiency to me, if your case parallels mine at all. Have you had your intra-cellular levels mag. levels checked? I ask this question, because I am convinced the medical people never identified the real problem, surprise, surprise. Common wisdom in the medical community is to keep raising the medication. It may work to a point, but then if the underlying problems aren't addressed, long term success is highly improbable if not impossible. The people on this forum are very knowledgeable, and I decided to systematically follow each suggestion that seem for them to have resulted in a significant benefit (mag, K, taurine, diet, low Na. Right now it is really working, and I anticipate that this regimen will continue work in the future. I finally got it.


Steve

I exercise hard for about an hour at a time, sweating profusely. Before I exercise I have a 5.5 oz V8 low salt vegetable juice (570 potassium and 80 sodium) - during the exercise I hydrate with water - afterwards I have an 11.5 oz can of V8 Fusion fruit and vegetable juice drink (sweeter, almost like a soda pop) potassium 380, sodium 110. I have never had an afib problem during or after exercise. My total sodium intake now is about 1300 mg/day - however I live in a fairly cool environment and don't sweat throughout the day.

Cathie,

Units would be milligrams of elemental Na & K.

I also agree with Steve regarding mag. I started a low carb diet about 21 months ago. There is a transient phase in these where you get rid of the water that is associated with the glycogen in your muscles. This depletes electrolytes.

Though I was supplementing with K & Mg, it was not enough. I kept adding more K, as my symptom was feeling my heart as I went to sleep. One day this led to afib. I converted in an hour with my normal PIP Flec of 300 mg. I went back to sleep and woke up an hour later in NSR but with a heart rate of 130. I got up and took 200 mg of Mg as glycinate tablet plus another 200 mg of Mg as citrate powder dissolved in water. My heart rate declined to 80 in 10 minutes. This is a normal post Flec heart rate. The citrate powder was obviously the active agent.

George

George,

I wonder if people were replete with mag, they could avoid taking a beta blocker while on Flec. When I went through that hellish period, I think a had short episode (1 minute) when I the flutter led to a 1-1 conduction rate. But that again must have been mag. related. What was revealing about getting off the Flec during the time I had the flutter was that I could terminate an episode by taking massive amounts of magnesium, way beyond bowel tolerance. I couldn't sustain NSR over a week by doing this but I could terminate an episode. I like you had a two month episode when I first found out that I had afib ( I know that you terminated it with flecainide), and I wonder if I had ingested high doses of magnesium back then I could have terminated it, even at say 4 weeks. Just a thought.

Steve

Steve,

Good thoughts. Don't know.

George

Hi all

Thanks for you interesting thoughts and advice, it is greatly appreciated. Much as I respect the opinions of the medical professionals I agree that they do not deal enough with the possible underlying causes of afib. Currently medication or ablation is the treatment I am offered but after reading some of your exeperiences I would be so frustrated if I opted for the ablation then in hindsight realised I could have beat or at least improved my afib through supplements/change of diet/lifestyle etc as so many of you have done.

Steve I have not had my intra cellular-levels mg checked, the docs over here (or anywhere else it seems!) don't ever seem to consider mineral or vitamin deficiency as a possible cause of afib. Pardon my ignorance but is this a test I need to ask my GP for or can you buy the test yourself over the counter at a chemist or pharmacy for example?

As I mentioned earlier, I am going to start with looking at my diet to ensure I eat plenty of potassium/magnesium rich foods and to keep my hydration levels up. Apart from dehydration, my only other known trigger is MSG which I avoid completely and sometimes emotional stress which is harder to avoid when worrying about having an episode is the cause of the stress/anxiety so a vicious circle! To break this cycle my GP prescribed Atenalol betablocker (25mg) to be taken just for the next 5 days so that I am calmer and thus less chance of triggering an anxiety related episode. He said that in future I should take the Atenolol if I have an episode to slow the heart rate down which makes sense given my high heart rate during afib (not to mention the terror this causes me!). It would also give the flecainde more chance of terminating the episode sooner?

Do you think that I am being realistic in firstly trying to improve things through diet/lifestyle changes alone, without supplements? I am a great believer in trying the least restrictive option first before adopting a more radical approach.

Finally I thought the potassium tables were brilliant and this will be very useful tool for when I next go food shopping. Incidentally, does anyone have a similar magnesium table?

Kind regards
Cathie

Hi Cathie,

Unfortunately, magnesium repletion is very difficult any way one tries to approach it. I couldn't achieve it until I started having the shots. My greatest success came after I changed my diet, but I still continue to need the supplements.

You state that "I am a great believer in trying the least restrictive option first before adopting a more radical approach." I know exactly what you are saying in that I was very reluctant to take potassium supplements. When I told my doctor of this decision, she asked me, "what do you think that you are doing, just eat a banana." I make this point because I finally realized that by agreeing to go on the medication, I had already jumped to a more radical approach than taking potassium supplements. This realization made it easier to accept the supplementation regimen.

As for checking your intra-cellular magnesium levels, you could start with having your GP order a red blood cell test. This would be a start, but then it would be advisable to have the Exatest (http://www.exatest.com, IntraCellular Diagnostics) or equivalent done. I don't recall an outfit in the UK performing an intra-cellular minerals test, but you might to check further. This test is the gold standard for checking magnesium levels.

Steve

Steve - I used only flecainide because the Toprol made me feel so awful. I continued to have breakthrough arrhythmia on doses of 150 mg BID... but once I optimized both magnesium and potassium, I went from events every day to zero. But for PIP dosing should I require it, I do use the beta blocker.

Jackie

Jackie,

That's right, I remember that you did that. My sense is that the malfunctioning cells can be overwhelmed with magnesium and the beta blocker is unnecessary, but I may be wrong. This forum is all about questioning conventional wisdom, so unorthodox speculation has a place.

Steve

Cathie I get my magnesium supplement from Health Monthly (based in the Channel Islands):

[www.healthmonthly.co.uk]

rgds
Heather

Thanks for the link Heather I have had a look and they have a wide range of magnesium products. How do I know which one is best for me? I am new to supplementing as you have probably gathered so any advice as a newbie would be appreciated.

kind regards
Cathie

Steve - my simplistic conclusion is that the overwhelming of magnesium works exactly 'as advertised' to then allow the function of the Na/K ion pumps to facilitate energy and maintain the requisite voltage that maintains NSR.

However, each criterion needs to be fully met and working in complete synergy... optimal magnesium, low sodium relative to the K/Na ratio and optimal potassium.

Magnesium is a natural sedative and muscle relaxant that functions as a beta blocker which inhibits the hormones that increase heart rate, ( norepinephrine and epinephrine). Said another way: Magnesium is nature's calcium channel blocker.

Jackie

Cathie, Its great that you are taking matters into your own hands. You care about your health more than anyone else cares for it. You know yourself better than anyone, and are in the best position to cure yourself.

That being said, please keep in mind that while the supplement and dietary changes many suggest here have been helpfull to some, there are others who have had little benefit from them. You must be very carefull to balance your expectations. For many, myself included, afib is a progressive condition, leading eventually to full time/permanent afib.

For many people the only "cure" and I use that term loosly, is ablation. The likelyhood af a successfull ablation can depend on the amount of time you have spent in afib, as afib can cause structural changes to your heart. Also, success can depend on the stage of afib you are currently in. Paroxysmal, persistant, or permanent.

So, please keep in mind that there is a ticking clock, and that you dont have unlimited time for these supplement programs to work their magic. You should simultaneously be looking into ablation costs, providers, and procedures. Best of luck to you in your hunt fo a "cure".

Curt, thanks for you thoughts, I do appreciate and agree with what you are saying. It is always wise to consider the wider picture and adopt a balanced view before making any decisions in life. I do understand the progressive nature of afib and that many people do not benefit from supplements/lifestyle changes. I was diagnosed with paroxysmal af in 2007. Since then I have chosen to follow the advice of my EP and cardiologist by exhausting the medication route before considering ablation. Both agree I have some way to go with the flecainide yet. If the time comes that I need an ablation I am fortunate that I can have it done on the NHS (free) and my EP also has a good reputation and success rate. I am being honest in that up until now I have not been paying much attention to my overall lifestyle apart from avoiding some known triggers. After arriving at this site and studying the possible benefits of lifestyle changes and supplementation I have decided to adopt an afib friendly lifestyle and and supplementing where I feel necessary but in addition to still taking my traditional meds. At the very least I should feel better in myself and if my afib improves then this will be an added bonus. If the regime does not work then of course I will consider ablation and be happy in the knowledge that at least I tried!.

Kind regards
Cathie

"I have decided to adopt an afib friendly lifestyle"
I know what you mean, but my attitude is to be afib hostile, and terminate with extreme prejudice anything that messes with my heartbeat.

"I do understand the progressive nature of afib"
I reversed that progression. Used extreme measures.
This is war.

William

"I reversed that progression. Used extreme measures.
This is war."

Right on! Never give up, keep trying to find what works for you...don't rely on drugs if you don't need to, they just deal with symptoms.

Cathie,

Curt is certainly correct that none of these approaches works for all (including ablation). My view is that the cost/risk/reward equation for lifestyle changes is very much skewed toward the reward as the cost/risks are low. So while they may not be successful, there is not a lot of downside to trying them (at least in my opinion).

The attitude expressed by Tom and William is common among those who have achieved remission. While adopting that attitude does not guarantee success, it gives it a much higher probability of occurring.

In this archived post, I talk about trying to develop a hardware/software application to foreshadow afib sufficiently in advance to take an on-demand med to ward off an episode.
[www.afibbers.org]

I bring this up as it illustrates just how motivated I was to attack this illness.

If you've not already done so, I suggest you read Hans' 12 step plan:
[www.afibbers.org]

Cheers,

George