Tonic water/quinine

I started drinking tonic water for night time leg cramps that develop following bicycling. Apparently, doctors used to prescribe it for the effect of quinine on muscle cramps, but the FDA won't allow them to recommend/prescribe it anymore due to some negative cardiac events associated with quinine at certain dosages. Despite this FDA warning about quinine, I find the low amount of it in tonic water to be very beneficial, both for leg cramps, but also it seems to have an extra benefit of reducing the incidence of PACs and LAF, at least for me. 4 ounces in the evening seems to do the trick. Brand I use is Q Tonic because they use agave as the sweetener. Any thoughts about adding tonic water into one's anti-afib regiment?

Taylor

Hum, I may have to try that again. I was worried the quinine might have negative affects. Thanks for the heads upl

Dee

If if works, wonderful! Here is some info on the reason for the FDA action:

Quote
Quinine was available in the U.S. in over-the-counter and prescription products that were used for treating leg cramps. In 1994, the Food and Drug Administration banned OTC sale of quinine, and in 2007 restricted prescription quinine exclusively to the treatment of malaria. The agency took this action because some people have life-threatening responses to quinine.

<[www.ncbi.nlm.nih.gov]
<[www.consumerreports.org]
<[www.chron.com]


George



Edited 1 time(s). Last edit at 08/04/2014 09:27AM by GeorgeN.

Taylor
thats very interesting. I frequently have leg cramps and twitches just from daily walking etc at work and some other activities. So is there really much quinine in tonic water? I mean surely it would be worth a try for me. The FDA hasnt banned tonic water so I dont suppose it would hurt to try

I've successfully helped a number of friends with cramps by suggesting oral and/or transdermal magnesium. Here is a search on transdermal mag posts: <[www.afibbers.org]

Here is an n=1 story. My friend said when she went home at night and took off her shoes, her toes curled under from cramping. I suggested an immediate fix with a supersaturated solution (just enough water to dissolve the crystals) of mag sulfate (epsom salt) as described here <[www.enzymestuff.com] on her feet. Then, I also suggested starting taking oral mag to bowel tolerance. The transdermal epsom salts provided immediate (well 20 minutes, like Jackie said) relief. She then started taking the oral mag the next day. After some days (I don't recall how long), she no longer needed the transdermal. The oral mag was enough. That was 5 or 6 years ago. She continues with the oral mag and only uses the transdermal when she does large amounts of exercise, which depletes her mag even more (like all day cross country hut to hut skiing with a pack at high (10,000-13,000') elevation. Then she uses the transdermal mag in addition. Subsequently, I gave her a bag of my mag chloride crystals (nigari) to make mag oil (again, a supersaturate solution of mag chloride and water that feels like "oil" but is not) from. She generally uses that instead of mag sulphate now, but both work.

George

Leg cramps are the #1 classic sign of dehydration and as close seconds the lack of key electrolytes (magnesium, potassium and the right amount of sodium...) they all work in synergy but you absolutely must have the solid intracellular base of magnesium for the other electrolyte to work. Magnesium relaxes muscles. When absent, calcium predominates and causes neuro-excitability or contraction.

Optimizing your IC magnesium can take time. IV or IM magnesium infusions help but most of us don't have access to that...so the topicals (or transdermals) as George recommends and uses in combination with continual intake of supplemental magnesium will help maintain the IC levels that the cells require for proper functioning... whether leg muscles or heart. They all need need the raw materials.

While the minor amount of quinine in tonic water may help soothe, it's far better to hydrate with pure water... avoiding chemically treated tap water.. and not take in sugar or other sweeteners. It comes down to repleting the electrolytes and quinine doesn't do that.

Jackie

I now this sounds elementary maybe a bit dumb. I have a lot of muscle "twitching" in my calves. Very frequent especially in latet evening. Could this be dehydration or is my body telling me I need somethign as you mention? I have mentioned this to my EP and he never addresses it. Sometimes it is just like the muscles are reacting as if they are getting little electric jolts through the calves
thanks
Tim

Tim - Could be the combination of both...low magnesium and dehydration. It's easy enough to test that out... start by drinking plenty of pure water... and if you aren't supplementing with magnesium... start at once and slowly ramp up your dosing. Restless leg syndrome is a classic sign of magnesium deficiency as well.

Jackie

Tim,

Ten years ago, at the beginning of my afib career, I developed eyelid twitches or fasciculations. I didn't really notice till I was in the midst of trying to figure out my afib. Then I paid attention. They went away after 3 or so months of regular magnesium supplementation.

A topical application of a supersaturated solution of epsom salts, as I referenced above, should give nearly immediate results if magnesium is the issue.

George

Thanks George
what is the best form for me to take (ingest). I try the magnesium spray sometimes but find it can burn my skin.

Tim,

The glycinate form, as Jackie suggests is good for oral use. I also use dimagnesium malate orally, in powder form (purchased from an equine supplier - I've talked to them and it is made by Albion) <[www.performanceequineusa.com] Unless you are like me and need huge quantities, you don't need the same dose as a horse... (I do, however).

If the chloride is irritating, you might try epsom salts in solution. You could also dilute the solution before putting it on.

I use all of the following:

Waller Water concentrate (mag bicarb solution) <[www.afibbers.org]

Mag chloride solution -1/2 cup nigari (mag chloride crystals in 2 liters water) <[www.naturalimport.com] I purchased 40 kg before the earthquake, so don't know about radiation in this product

dimagnesium malate (as above)

magnesium glycinate

I'm unusual in that I can take 3-5g of mag/day without bowel issues! My quantities of the above vary over time. For example, my bowel tolerance is lower on vacation with less stress.

George

Tim - My response to you about magnesium and dehydration was incomplete. (Sorry)…. I should have also mentioned the importance of magnesium's action in the sodium/potassium ion pump mechanism and the essential function of potassium in relation to sodium in the body... important for everyone but especially critical for afibbers. Without magnesium, those pumps can’t function and the critical balance of potassium to sodium is the bottom line for afibbers.

Spend time reviewing at least the introduction to Conference Room Session 72 [www.afibbers.org] – posted below for convenience. The discussion that follows at that link also provides invaluable information on this topic and serves to help us understand the critical need for afibbers to have the proper intake as well as reserves of these essential electrolytes. This all fits together; it can't be any other way.

Jackie


Proceedings of 72nd Session
February 7, 2011 – June 11, 2011

SUBJECT: Potassium/Sodium Ratio in Atrial Fibrillation

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]

From the article Paleolithic Nutrition Revisited: A twelve-year retrospective on its nature and implications: [2]

"The nutritional needs of today's humans arose through a multimillion year evolutionary process during nearly all of which genetic change reflected the life circumstances of our ancestral species. But, since the appearance of agriculture 10,000 years ago and especially since the Industrial Revolution, genetic adaptation has been unable to keep pace with cultural progress. Natural selection has produced only minor alterations during the past 10,000 years, so we remain nearly identical to our late Paleolithic ancestors and, accordingly, their nutritional pattern has continuing relevance. The pre-agricultural diet might be considered a possible paradigm or standard for contemporary human nutrition."

Sodium (Na) and potassium (K) are critical nutrients, but today’s typical diet might supply 5 times the amount of Na, and only 1/4th the amount of K that we evolved with. In our evolutionary past the kidneys became configured to optimize the body's cellular Na and K levels by conserving the sodium available and by discarding excessive potassium. Our kidneys have essentially not changed since then, but the typical diet is now upside down, with disease-causing consequences for all cells and systems.

Our bodies are 'The Body Electric'.[3] Each of the body's cells is like a battery (10, 20 trillion?), charged to their functional voltage by the enzyme Na/K-ATPase, commonly called 'Na/K pump', or 'sodium pump'. "Depending on cell type, there are between 800,000 and 30 million [Na/K] pumps on the surface of cells. They may be distributed fairly evenly, or clustered in certain membrane domains, as in the basolateral membranes of polarized epithelial cells in kidney and intestine".[4]

Na/K pumps span the cell membrane, and generate the electrical voltage (potential) to charge the cell/battery by continuously pumping ~3 Na+ ions out of the cell in exchange for ~2 K+ ions pumped in.[5, 6] In cardiac muscle a 'trans-membrane potential' of about 90 millivolts (mV) is generated (negative inside), which provides for the cell's electrical requirements: voltage-gated ion channels, calcium pumps, etc. To attain this functional voltage requires the intracellular K/Na ratio to be at least 20 to 1 [7], which in turn requires the dietary K/Na ratio to be at least 4 to 1.[1] The kidneys ideally maintain serum K and Na at the levels they were evolved to maintain, but the high intracellular K/Na ratio can not be attained if intracellular Na is too high (as Dr. Moore explains, above).

Na/K pumps are proteins, synthesized within the cells, each consisting of many hundreds of the 20 different amino acids in chain-like linkage, assembled in accordance with nuclear DNA codes, then folded and configured for their specific function. Code errors (genetic or by damage) or lack of required amino acids (genetic or dietary) can result in dysfunctional Na/K pumps (channelopathies) possibly resulting in low cell voltage. Having sufficient cellular amino acids available for protein synthesis is essential.[9] There are excellent computer-generated images of the Na/K pump protein structure at the Protein Data Base website.[5]

Na/K pumps are powered by the energy molecule adenosine-triphosphate (ATP), which for function requires an attached magnesium ion (Mg-ATP). ATP is synthesized from oxygen and food molecules in a process requiring Coenzyme Q10, carnitine, magnesium, ribose, phosphate, and many co-factors. In body cells the continuous pumping of K and Na consumes about 25% of the ATP produced, while in high energy-demand heart, brain, and neurons the consumption is as much as 70%.[4] Therefore, if ATP and magnesium are deficient, and if the intracellular ratio of K to Na is low, the cells' voltage will be low. Low cell voltage may express as abnormalities in cells and systems throughout, as in blood pressure, kidney function, electrically excitable tissues of the heart and brain.

In heart muscle cells the resting membrane potential (phase 4 of the cardiac cycle)[8] is the voltage of the cell while resting before being excited to de-polarize (discharge) and contract. Low resting voltage can trigger AF, and can be an explanation for the cyclical nature of paroxysmal AF. From the web page Cardiac Action Potential: [10]

"Phase 0 is the rapid depolarization phase. The slope of phase 0 represents the maximum rate of depolarization of the cell and is known as dV/dt max. This phase is due to the opening of the fast Na+ channels causing a rapid increase in the membrane conductance to Na+ (GNa) and thus a rapid influx of Na+ ions (INa) into the cell - a Na+ current. The ability of the cell to open the fast Na+ channels during phase 0 is related to the membrane potential at the moment of excitation. If the membrane potential is at its baseline (about -85 mV), all the fast Na+ channels are closed, and excitation will open them all, causing a large influx of Na+ ions. If, however, the membrane potential is less negative [lower voltage], some of the fast Na+ channels will be in an inactivated state, insensitive to opening, thus causing a lesser response to excitation of the cell membrane and a lower Vmax. For this reason, if the resting membrane potential becomes too positive [lower voltage], the cell may not be excitable, and conduction through the heart may be delayed, increasing the risk for arrhythmias."

This means that a slower depolarization (discharging) of the atrial muscle cells' voltage results in shortening of phase 2 of the action potential and the cells’ refractory period (the time period during which cells are at zero volts and can’t be excited), which increases the risk for AF.

Therefore, if atrial cell voltage is generally low, for reasons above, NSR might be on a proverbial razor's edge. If voltage drops just a bit lower AF might result, especially if there are other predisposing conditions, such as fibrosis [12] or electrical remodeling. AF induced release of sodium-lowering hormones such as ANP and BNP results in increasing the intracellular K/Na ratio, thus the cells' voltage, and NSR might return. In this case all body cells will have higher voltage, and one's body-mind might well experience well-being until the next cycle, as all cells and functions will have benefited by having higher voltage.

Erling

References
1. Richard D. Moore, MD, PhD. The High Blood Pressure Solution (2001)

2. Paleolithic nutrition revisited: A twelve-year retrospective on its nature and implications [www.nature.com]

-- Herb Boynton, Mark F. McCarty, Richard D. Moore. The Salt Solution (2001)

-- Paleolithic Diet [en.wikipedia.org]

-- Paleolithic diet v. standard diet potassium/sodium ratios
[www.afibbers.org]

3. Robert Becker, Gary Selden. The Body Electric: Electromagnetism and the Foundation of Life (1998)

4. The Na/K-ATPase (Sodium Pump) [www.vivo.colostate.edu]

5. Na/K pump [www.pdb.org]

-- Na/K pump structure [www.pdb.org]

6. Na/K pump animation
[www.brookscole.com]
p.html

7. Burton B. Silver, PhD. For K/Na ratio see [www.afibbers.org]

8. Understanding the cardiac cycle [www.afibbers.org]

9. Eric R. Braverman, MD, The Healing Nutrients Within (2003)

10. Cardiac action potential [en.wikipedia.org]

11. The Strategy – Metabolic Cardiology [www.afibbers.org]

12. K. Shivakumar, MD [www.afibbers.org]