meal-induced LAF

I have LAF since Feb 2012 (heart strong, valves good), and my AF has been progressively getting more frequent, now daily at 4-7 hrs per day. Mg and K supplementation helps a lot, but it requires more and more Mg as the months go by. My AF is almost always induced by eating meals. I have gone to 4 smaller meals per day, but it still occurs at meals. It seems that any meal larger than a snack (piece of fruit) will start AF.

In looking at possible fixes for meal-induced AF, I see suggestions for anti-cholinergics like Norpace.

Here is the rub:
I also notice that the Evoxac I am taking for dry mouth (my ENT says I may have a touch of Sjogrens syndrome) is a cholinergic drug, and its description includes warnings about arrythmias in patients with "serious cardiovascular disease".

From Evoxac description at [dailymed.nlm.nih.gov] , I read "EVOXAC (Cevimeline) can potentially alter cardiac conduction and/or heart rate. Patients with significant cardiovascular disease may potentially be unable to compensate for transient changes in hemodynamics or rhythm induced by EVOXAC®. EVOXAC® should be used with caution and under close medical supervision in patients with a history of cardiovascular disease evidenced by angina pectoris or myocardial infarction."

So if meal-induced AF can be countered with an anti-cholinergic, then I wonder if my long-term use of a cholinergic (Evoxac) is the root cause of my AF?

Evoxac is great for the dry mouth, but if it is indeed giving me AF that pushes me into a life of ablations and anti-arrythmic drugs and cardioversions, I wonder if there is an alternative for the dry mouth that has no arrythmia warning.

I am very interested in hearing the experiences of others out there with meal-induced LAF, and also those with LAF who also take Evoxac or Salagen for dry mouth.

Comments on the cholinergic connection also appreciated.

Thanks much.



Edited 3 time(s). Last edit at 08/04/2012 08:13AM by gehauser.

Your comment, Mg and K supplementation helps a lot, but it requires more and more Mg as the months go by is very telling and extremely important. Start reading the recent contributions by Erling on Magnesium so that you understand it is THE absolute #1 critical core nutrient for your heart function and all of the other cells in your entire body. You must continue to take as much magnesium as you can tolerate without the bowel issues.

If your AF consistently triggers with every meal, then be suspect of

1) a food sensitivity - most often gluten/gliaden protein molecule in wheat, rye, oats, barley, spelt, triticale, eggs, dairy, soy, nuts, shellfish and some fish
2) lack of digestive enzymes (including stomach acid) that start breaking down food
3) Candida overgrowth that is stimulated quickly by the intake of starchy carbs or any sugar including fruit sugar. Candida (yeast) responds rapidly to carbs/sugar and it expands rapidly which then can create stretching in various parts of the GI tract and stomach and that impingement on the vagus nerve can easily be a trigger for AF
4) chemicals in food that include colorings, food additives, preservatives, taste enhancers such as MSG can be excitotoxic and some reactions are immediate
5) avoid any form of artificial, chemical sweetener. Read labels...as they are hidden everywhere.

There is a pulse check strategy that works easily to help eliminate food sensitivities....You can only do it with one food at a sitting...
Before you put anything in your mouth... check your pulse and record it.. (usually easy on the inner wrist - radial pulse point) but if youcan't find it, then lightly check the carotid artery in your neck.
Eat one food and check your pulse in 30, 60 and 90 minutes...a consistent elevation indicates a food sensitivity. Keep a log of every food you check so you can see the pattern. If you eat a "reactive" food before bed, the result can be elevated pulse all night... and that may in turn be a trigger for AF.

This pulse check is just time consuming - certainly costs nothing and can quickly target culprit foods.

Keep in mind that with the autoimmune factor of Sjogrens... you should already be observing a gluten-free and dairy free because the gluten/gliaden protein and the casein of dairy are aggravating to those with autoimmune issues.

I presume you are in the care of a physician who is a specialist in auto-immune diseases and that you have been checked for iodine and vitamin D deficiency?

Best to you,
Jackie

Thanks, Jackie, it's always good to hear from you. Many stimulating ideas there.

I am continuing at 1100 mg Mg/day (my current tolerance), but the Mg increases my blood pressure (dunno why) and I had to start Benazepril (ACE inhibitor) to counter that.

I watch my diet - it is pretty pristine for the Meniere's I have. I minimize gluten and dairy but I don't cut it out altogether. I never seem to suffer from indigestion or reflux .

Can you tell me what kind of Dr administers tests for Candida ? Would that be a gastroenterologist?

And what about the EXAtest? My GP said he would not know how to administer that.

I see only a neurotologist (ENT with extra inner ear training) for the Meniere's, and I see EP#2 for the AF (will see Dr Tchou, EP#3, on Aug 9 for ablation consult). I probably will find a local rheumatologist for the Sjogren's - not sure that is what I have, but it is a pretty severe dry mouth case. Ior it was, 8 yrs ago, when I started the Evoxac. I worry that a rheumatologist would just put me on some big drug that suppresses my immune system and make me susceptible to different kinds of disease. I am really down on long term use of any more drugs.

I am trying an experiment now where I cut back on (and eventually eliminate) the Evoxac to see if AF improves. I am only 4 days into this, but the AF seems to be better in last couple days. Time will tell. Not sure if I can stop the Evoxac - sipping water just does not get it (water lasts about 6 minutes). I am hoping the Biotene OTC products may allow me to stop or reduce Evoxac.

Here are some ideas from Dr. Oz re: relief of Sjogren's, to add to Jackie's list. And for goodness sake, do yourself a favor and lose the EVOXAC! There are enough illnesses in the world, no need to embrace iatrogenically-induced afib!

< [www.doctoroz.com];

Above link no longer available---here is replacement.

[www.sharecare.com]

gehauser... I'm responding to your comments interleaved as you listed them:

Thanks, Jackie, it's always good to hear from you. Many stimulating ideas there.

I am continuing at 1100 mg Mg/day (my current tolerance), but the Mg increases my blood pressure (dunno why) and I had to start Benazepril (ACE inhibitor) to counter that.

My comment would be to look to your potassium intake. Magnesium should not increase blood pressure and in fact, often lowers it... but moreover, for the arrhythmia, you need first the base of optimal Mg inside heart cells...and then emphasis on the potassium-to-sodium intake. If you are low on potassium and sodium is high, it's understandable that your blood pressure would be up as sodium helps retain fluid. Can you elaborate on your daily intake of potassium from all food sources and supplements, if any. How does that compare to your sodium (salt) intake... from packaged, processed, or commercially prepared foods?


I watch my diet - it is pretty pristine for the Meniere's I have. I minimize gluten and dairy but I don't cut it out altogether. I never seem to suffer from indigestion or reflux .

What must be understood about gluten sensitivity or dairy..... is that it isn't just minimizing... you have to remove the offending proteins 100% absolutely. The effects of the positive change can take many months but often, people recognize improvements fairly rapidly.
It's an all-or-nothing approach but with that sensitivity and the consequences and symptoms, it's well worth the sacrifice.

Can you tell me what kind of Dr administers tests for Candida ? Would that be a gastroenterologist?

Any doctor can order the test from Genova Diagnostics.... (Comprehensive Diagnostic Stool Analysis). The patient does the stool collection at home. The doctor just is the ordering vehicle that facilitates processing the paperwork and billing. The results are sent to the doctor and they are very straight forward...either you have Candida or you don't. The doctor would have to set up an account with Genova. (check online for the details)

And what about the EXAtest? My GP said he would not know how to administer that.

With the Exatest, it's a very easy scraping of epithelial cells from the underside of the tongue...collected on a wood tongue blade. A doctor or nurse can easily do it. I did my own with no difficulty. Someone from the GPs office can call Exatest to learn the details of ordering, collecting the sample and returning for testing.

I see only a neurotologist (ENT with extra inner ear training) for the Meniere's, and I see EP#2 for the AF (will see Dr Tchou, EP#3, on Aug 9 for ablation consult). I probably will find a local rheumatologist for the Sjogren's - not sure that is what I have, but it is a pretty severe dry mouth case. Ior it was, 8 yrs ago, when I started the Evoxac. I worry that a rheumatologist would just put me on some big drug that suppresses my immune system and make me susceptible to different kinds of disease. I am really down on long term use of any more drugs.

On the Sjogrens... do a google and start reading about the observations consider a potential iodine deficiency and the dry-mouth symptom so common with Sjogrens so that you can discuss this with the rheumatologist. While I did not have Sjogrens or any other autoimmune disease, I definitely had a severely dry mouth for many years. It wasn't until I started taking supplemental iodine to dissolve a sialolith in the duct of my submandibular gland, that I realized what a help it was for the xerostomia or dry mouth. Over the treatment years, I have gone from a complete cotton-mouth to freely-flowing normal supply of saliva. I had various consults with specialists on how to treat the swollen gland and they all said just remove the gland which I was unwilling to do. My last consult was a chiropractor who recommended iodine and that was the end of the stone and the side benefit was abundant saliva and no dry mouth. I did use the Biotene which seemed to offer some relief so I hope you are able to transition off the Evoxac to something more benign.

The important point here is to get a definitive diagnoses whether or not you have the auto-immune disease so you know what you can or cannot use in the way of nutritional interventions.

Your GP can easily run a vitamin D test for you and that would also be important.

I certainly wish you well as you explore your options with all this. Please let us know how you are.
Best to you,
Jackie

Thanks, Jackie. That gives me lots of stuff to try.

For now, I am very happy to report that stopping the cholinergic drug Evoxac (that I took for 8 yrs for dry mouth/eyes) has stopped my AF.

Prior to stopping Evoxac, I was having 7 hrs per day AF (on/off over 16 hrs), but in the 5 days after stopping Evoxac, my afib burden has been:

day 1 - 24 min
day 2- 23 min
day 3 - 6 min
day 4 - 0 min
day 5 - 0 min (thus far today)

Needless to say, I am extremely happy with this result - I only have a few ectopics now, but even those seem to be in decline. If this success holds for several weeks, I may consider canceling my scheduled ablation in Oct.

I thank the Lord for putting the right info in front of me to think to stop the Evoxac, and for the resulting success thus far.

gehauser... I'm glad it was as "easy" as that.

As noted on the Evoxac's side effects website, readers are invited to report side effects. Since arrhythmia isn't listed, it would undoubtedly be useful if you went there and reported your experiences.

[www.evoxac.com]
,
Jackie