Exercise, PPIs and LAF

My first-ever post anywhere. I am a 48yo male, diagnosed 5 years with GERD, at first with esoph. erosion (non-Barrett's); 3 months of Nexium, then 4 years on Prilosec. I also take beta-blocker for BP, co-q10, extra D, fish oil, sometimes mag. citrate at night, and occasional dig. enzyme capsules. Managed the GERD ok, not great (some days are an indescribable war with gas, bloat, fog). Since then, made self-discovery of gluten/lactose intolerance. Last fall, I sensed Afib AND pvcs were ramping up. No other cardiac findings, other than 15 yr.s high BP. Getting scared, I sought 10-day monitor with Electrophysiologist, who found some pvcs (usually in mornings), and the more-troubling (according to Dr.) Afib (usually while going to sleep). Was recommended ablation, even though Dr. conceded it is likely due to esoph./vagal irritation. I know in my heart this problem is due to gas/acid/undigestible food. Two questions: ablation is the blanket answer--is this my only avenue? What about a cure for the issue!? And, while exercising (elliptical), I notice HR of 157 for first 10 minutes or so (yeah, scary), but then I always burp, and HR falls down to more-normal 110 for remainder of workout. Is this ok, normal, preventable? Any help is welcome, and thank you for reading the saga!

Hello afibbers and welcome. It's not at all uncommon for gastric distress, GERD, bloating, etc to underlie the onset of an afib event. If you use the search feature for some of those terms, you'll find an abundance of posters asking similar questions and discussing their findings.

Ultimately, the solution for gastric distress is the fact that it's commonly due to the inability to produce enough of one's own stomach acid. Therefore, food isn't broken down so it can be metabolized and just lies in the stomach and putrefies.... which causes gas, bloating, irritation to the vagus nerve. The solution is not to take a PPI or acid blocker but to restore the natural function of producing one's own stomach acid. Aids such as vitamin B 12 and zinc plus digestive enzymes and alkalizing can be a good start.

Along with your search, go to these links related to the topic of digestion. I wrote them as a result of learning more about my own gastric distress issues which also involved intestinal issues such as Candida overgrowth and Intestinal Permeability aka Leaky Gut Syndrome. Start reading and feel free to send me a PM if you need clarification. Also, several people with H. pylori infections found that once eliminated, the Afib disappeared as well….so if you haven’t been tested to rule out that and other gut pathogens, that’s another important avenue to investigate.

It can take a while to get all of this under control but many people report their Afib either goes away completely or only surfaces when certain culprit foods or beverages such as caffeine or alcohol are consumed.

Included in the links below is one on the topic of Alkalinity which addresses not only the issue of the ability to produce enough natural stomach acid, but the importance of always maintaining an alkaline tissue pH throughout the body… extremely helpful for afibbers and everyone else with an interest in overall health. We suggest the use of the magnesium bicarbonate water… home made version called Waller Water or WW… which not only alkalizes tissue but also is an excellent source of magnesium … the mineral/electrolyte in which about 80% of afibbers are deficient.

This clip from the Alkalinity post:

Stomach Acid – The importance of
Stomach acid is also important and is another influence of what’s going on in the body since it affects the voltage and many other things as well.

All chronic illness is defined by having low voltage and by the ability to make new cells that work. So if we have inadequate exercise so muscles are running at low voltage, we drink only electron stealers such as coffee, black tea (not green tea), alcohol, and acidic water we are basically going to go around with low voltage and not be able to make new cells.

It’s my opinion that no one can be well if they don’t have adequate stomach acid. Several reasons for that… one is the fact that the human body is designed to never, ever absorb proteins. You must only absorb amino acids.

The system is designed so that when you eat a protein, stomach acid is supposed to break it down to amino acids which get absorbed and go downstream where you make your own proteins. This is important because it’s the only way that your immune system knows what ‘you’ and what is something that will hurt you. The thymus gland (behind the sternum) contains the data base of all the proteins that make up ‘you.”

When you make white blood cells, they go through the thymus and the data base gets downloaded into the white cells which are on patrol checking for outsider protein… they check the data base to see if it’s ‘you’. When a protein is found that is not in the data base, it is viewed as harmful and the white cell calls up the immune troops which build antibodies to destroy that protein and if it can’t destroy it, it stuffs it into fat cells.

If you eat a protein and you don’t have enough stomach acid to break it into amino acids and the whole protein goes downstream and is absorbed, you now become allergic to everything you eat and after meal, you have a mini case of the flu going on as your immune system attacks what it thinks is harmful proteins there to hurt you. So having all that immune system constantly working is obviously a problem.

Another point on stomach acid. … Alkaline Water
People don’t often understand what happens when you drink alkaline water. They say,” If I drink alkaline water, it will just dilute my stomach acid and make my digestion worse,” but that’s not the way it works at all.

Whenever anything goes into the stomach, if you have the ability to make adequate amounts of stomach acid, your stomach acid will go to a pH of 2. So if I put alkaline water in my stomach, I’m going to make a whole lot more stomach acid in order to get down to the pH of 2.

It’s important to recognize that every time you make a molecule of hydrochloric acid, you simultaneously put a molecule of sodium bicarbonate out into the blood and that’s the way that the blood gets more alkaline and has more electrons.

It's a lot of reading but you'll reap many benefits by understanding why the GERD occurs in the first place.

Best to you,
Jackie


No More Heartburn
[www.afibbers.org]

Digestive Wellness: What You Need to Know
[www.afibbers.org]

The Gut Connection to Afib
[www.afibbers.org]

Alkalinity, pH, Healing and Voltage – The Inside Story
[www.afibbers.org]


This (following) link is a compilation of numerous posts on the topic of GERD, heartburn, etc.
[www.afibbers.org]

H.pylori
[www.afibbers.org]

I am grateful to you, Jackie, for a quick response and a lot of info to share. Just to clarify: I was, fairly recently, given an upper endoscopy, with tissue taken to test for H. pylori, which was negative. Obviously, the practice is ingrained that GI's give PPIs for esoph. erosion, and it worked well. Sadly, I am "hooked", as recently I forgot to take it and within 8 hours of missing the dose, became painfully sick. I will read your link to see how I can begin this daunting journey out. No comments about the exercise issue? And no mention of digestive enzymes...I assume you find that another bandaid to the real problem? They definitely help me feel better (less bloat, gas, irritation) after a meal of meat or extra fiber.



Edited 1 time(s). Last edit at 08/28/2015 06:13PM by afibbers.

afibber - Pleased to see that you've ruled out the H.pylori. How about the Candida?

Sorry that I didn't comment on the exercise observation. My immediate thought is that since you are still on the PPIs, then that underlies the core issue... not enough stomach acid to digest food properly... they do work as advertised, but disrupt what Mother Nature intended. You'll have more of an idea how that fits if you manage to wade through all the info at those reports and posts.

Meanwhile, I did neglect to comment that digestive enzymes are a definite help... as well as using probiotics for intestinal health. I rely on both to maintain gut health and comfort.

While I didn't take Rx drugs for my GERD problems...which were relatively minor.... I had a holistic doctor at the time that recommended a complete digestive enzyme ... the one I've settled on that works best for me is by Source Naturals... Essential Enzymes... and for a while when I ate a protein-containing meal, I also added a capsule of betaine hydrochloride in addition the the Source Naturals. That worked very well and I no longer need to use the HCl, but I continue using the digestive enzymes with most meals.

To ensure adequate stomach acid production, I did have vitamin B 12 injections and currently still take both B12 sublinguals and a generous dose of zinc just to be sure that I have the raw materials to produce stomach acid.

Hope this helps.

Jackie

I have no idea about Candida, but I have some of the symptoms. I do take the Source Naturals Essential Enzymes, as well as sublingual B-12, and recently have started oregano oil, in case I do have bad bacteria. I am mentally overwhelmed at the prospect of diving into all this, with all the conflicting info out there (some say fish oil helps, others say avoid it like the plague; also, my Dr. and I spent many years settling on the right med/dose for BP, long before any of these other problems existed, but there are clear links between beta-blockers and vagus nerve issues). Thanks to forums like this, though, it's comforting to share and learn.

Journal Cardiac Rhythm Management December 2010 [www.innovationsincrm.com]

ABSTRACT.
Proton pump inhibitors (PPIs) are powerful H+/K+-adenosine triphosphatase (ATPase) blockers commonly used to treat gastrointestinal illness. H+/K+-ATPase is present in myocardial tissue, and PPIs may affect intracellular calcium. We sought to test the hypothesis that PPIs are proarrhythmic. We evaluated PPI use in 80 patients with focal tachycardias attributed to an automatic or triggered rhythm: 40 consecutive focal atrial tachycardia (AT) and 40 consecutive right ventricular outflow tract ventricular tachycardia (RVOT VT) patients. Controls included patients with re-entrant rhythms attributed to anatomic abnormalities: 40 consecutive AV nodal re-entrant tachycardia and 40 consecutive atrial–ventricular reciprocating tachycardia patients. Twenty patients (13%) were taking a PPI. Fifteen (19%) focal arrhythmia patients compared with 5 (6%) of the controls were taking a PPI (p =  0.034). The proportion of focal AT patients on PPIs alone was significantly greater than controls (p =  0.009). After adjusting for potential confounders, PPI use was associated with a 3.6 greater odds of focal arrhythmia (95% CI, 1.2–11.1 greater odds, p =  0.025), a 4.5 greater odds of focal AT (95% CI, 1.3–15.7 greater odds, p =  0.018), and a nearly significant 3.5 greater odds of RVOT VT (95% CI, 0.89–13.9 greater odds, p =  0.074). PPI use is associated with focal arrhythmias. - See more at: [www.innovationsincrm.com]

Ok, Moerk, thanks for the info. So with this, I suppose I can assume that combining PPIs with beta-blockers is a double dose of Afib makers. Is it really a case of Dr.s not being able or interested in reading this evidence like we do?

Yes, it is a lot to learn about, but critically important--foundationally for overall good health which always begins with gut assessment.

Your doctor should take the lead and order the appropriate testing to rule out any and all influences that can promote arrhythmia. And, it goes without saying, using a PPI just delays finding the true source. You may need to find a practitioner of functional or restorative medicine to do the appropriate and reliable testing so you can make the progress you need. As I mentioned about the H.pylori... afib in those people went away once the H.pylori was also eliminated... but it all takes time and a huge dedication and participation on the part of the patient. In reality, though, what are the options?

Keep in mind that if there is Candida (yeast), it can affect the entire GI tract from mouth to anus and cause symptoms the entire length.... some of which you may not even be aware.

When I tested positive for Candida via Genova Comprehensive Stool Analysis (CDSAP) with parasitology) which also tests for other parasites and bad bacteria, etc... [www.gdx.net] I used a product called Candex (by Pure Essence)... for about 3 months and then retested to be sure it was gone.[www.pureessencelabs.com] Also avoiding foods that feed the Candida is important.

Oil of Oregano...such as the most potent version known as p73 from North American Herb and Spice helps as an adjunct for other bacteria as well. [p-73.com]


Jackie

Additionally... these reports on PPIs should be noted (esp. the causing of low Mg levels)http://www.medpagetoday.com/Gastroenterology/GERD/25147


FDA Warns GERD Drugs May Deplete Magnesium
By Peggy Peck, Executive Editor, MedPage Today
Published: March 02, 2011
5 comment(s)
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WASHINGTON -- Use of proton pump inhibitors (PPIs) regularly for a year or longer may lead to low levels of circulating magnesium, which may increase the risk of leg spasms, arrhythmias, and seizures, according to an FDA warning.
The FDA noted that PPI-associated hypomagnesemia was generally reversed with magnesium supplements, but in about 25% of cases "magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued."

The FDA's notice included the prescription drugs: esomeprazole magnesium (Nexium), dexlansoprazole (Dexilant), omeprazole (Prilosec), omeprazole and sodium bicarbonate (Zegerid), lansoprazole (Prevacid), pantoprazole sodium (Protonix), rabeprazole sodium (AcipHex) and the combination product esomeprazole magnesium/naproxen (Vimovo).
Also included were OTC formulations of the drugs: Prilosec OTC, Zegerid OTC, and Prevacid 24-hour.

The FDA warning follows reports that PPIs given to patients who undergo stenting and other percutaneous cardiovascular events may increase the risk of heart attack or stroke.

Moreover, there have been reports linking PPI use to increased risk of Clostridium difficile diarrhea.

The latest alert from the FDA says physicians "should consider obtaining serum magnesium levels prior to initiation of prescription PPI treatment in patients expected to be on these drugs for long periods of time."
The risk of hypomagnesemia may be greater when PPIs are given to patients who are already taking drugs that are known to deplete magnesium, including digoxin and diuretics.

"For patients taking digoxin, a heart medicine, this is especially important because low magnesium can increase the likelihood of serious side effects," the FDA said.



FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs)
[www.fda.gov]

Safety Announcement
[3-2-2011] The U.S. Food and Drug Administration (FDA) is informing the public that prescription proton pump inhibitor (PPI) drugs may cause low serum magnesium levels (hypomagnesemia) if taken for prolonged periods of time (in most cases, longer than one year). In approximately one-quarter of the cases reviewed, magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued.

Previous post on PPIs...

The use of PPIs or proton pump inhibitors for GERD (gastric esophageal reflux disease), heartburn etc. has become common-place and many find it offers immediate relief. Used long-term, however, PPIs can cause trouble.
Afibbers, especially, need to be very aware that PPIs are documented to cause hypomagnesia … the very mineral/electrolyte that keeps our hearts in Normal Sinus Rhythm as well as supports bone remineralization along with calcium, vitamin D, Vitamin K2 MK7 and several trace minerals.

As documented in the a small 2010 study, long term use of this class of medication has been associated with severe hypomagnesemia (low blood levels of magnesium). Symptoms in addition to arrhythmias include muscle cramps, fatigue, headaches including migraines, unsteadiness, and paresthesia to tetany and seizures.

As afibbers, we know that in order for potassium to work to provide heart energy (voltage) to heart cells which keeps us in NSR, we must first have optimal stores of intracellular magnesium.
Awareness is the key here. If you use PPIs and have arrhythmia, start connecting the dots.

Knowledge is Health.
Jackie

Source: Hypomagnesemia and proton pump inhibitors: below the tip of the iceberg, Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series.

[allmanmedicinbd.se]
QJM. 2010 Jun;103(6):387-95. Epub 2010 Apr 8.

Hypomagnesaemia due to proton-pump inhibitor therapy: a clinical case series.
Mackay JD, Bladon PT.
Source
Victoria Hospital, Blackpool FY3 8NR, UK. dr.mackay@bfwhospitals.nhs.uk
Abstract

BACKGROUND:
Reports since 2006 have identified proton-pump inhibitor (PPI) therapy as a cause of hypomagnesaemia, in a total of 13 cases.


RESULTS:
Patients were 68.8 +/- 8.6 years old when they presented with severe hypomagnesaemia, having been on PPI therapy for a mean of 8.3 +/- 3.5 years. Eight patients were on diuretics at initial presentation. There was significant morbidity as eight patients remained on PPI therapy after presentation for a mean of 2.75 +/- 1.54 years. There were 18 emergency hospital admissions with severe hypomagnesaemia. Oral and parenteral magnesium supplements were relatively ineffective at correcting the problem, but stopping PPI therapy lead to prompt resolution of the hypomagnesaemia (within 2 weeks in five carefully monitored patients), with symptomatic benefit. Hypomagnesaemia recurred if PPI therapy was re-introduced because of troublesome dyspepsia. However, pantoprazole, the least potent PPI, largely relieved dyspepsia and hypomagnesaemia did not inevitably develop when combined with oral magnesium supplements.

CONCLUSION:
These cases confirm that long-term PPI therapy can cause severe, symptomatic hypomagnesaemia, which resolves when PPI therapy is withdrawn. The serum magnesium should be checked annually in patients on long-term PPI therapy, or if they feel unwell.
PMID: 20378675 [PubMed - indexed for MEDLINE]


A Patient on Long-Term Proton Pump Inhibitors Develops Sudden Seizures and Encephalopathy: An Unusual Presentation of Hypomagnesaemia
Case Rep Gastrointest Med; 2012 Nov:632721.
Gandhi NY, et al.

Abstract
(AA)Objective: To present an unusual but known cause of hypomagnesaemia induced-hypocalcaemia in a chronic GORD (GERD) patient with severe symptoms with a review of the current literature.

Methods: Analysis of the clinical and laboratory findings of the patient and discussion of the multi-factorial nature of his disease and the underlying mechanisms.

Results: Our patient described features of magnesium deficiency such; as weakness, muscle twitches, and fits with clinical signs of hypocalcaemia: a carpal pedal spasm and paraesthesia. Preadmission blood results revealed low calcium and magnesium levels. He was admitted to ITU, when he presented with seizures and developed encephalopathy. The total vitamin D level was 52.4 nmol/L (>49.9). His U&Es and LFTs were within the normal range with the exception of potassium. He was on Omeprazole for his GORD. With omission of the PPI 1 day after admission and replacement therapy, his ion levels normalized.

Conclusion: Hypomagnesaemia is often undiagnosed and is associated with multiple biochemical abnormalities. Treatment focus should be aimed at stopping the PPI and replacing the magnesium. Over use of PPIs is a problem in practice, with the FDA issuing a warning over long-term use. Continued monitoring and decision making on dose reduction/withdrawal is essential to avoid complications.



Proton Pump Inhibitors – A Risky Experiment?
by Steven Sandberg-Lewis, ND, DHANP
Professor, Naturopathic Medicine, National College of Natural Medicine

From the Townsend Letter
February 2011


Refined carbohydrates and soda pop may cause GERD by inducing insulin resistance, which delays gastric emptying. The extreme example is gastroparesis, which may prevent the stomach from emptying for up to 8 to 10 hours. A full stomach is much more likely to reflux its partially digested contents into the lower esophagus. This gastric fullness mechanism applies to eating within 3 hours of bedtime as well. During sleep, gravity does not support the acid esophageal clearance and salivary secretion is decreased, leading to less lower esophageal neutralization of gastric acid. In addition, there are fewer esophageal contractions. A left lateral sleep position is more protective than sleeping on the right side (Dantas 2002).
[www.townsendletter.com]



Edited 1 time(s). Last edit at 08/29/2015 09:48AM by Jackie.

afibbers,

There are a number of people in Session 61 who had GERD as a trigger <[www.afibbers.org] A search on GERD in the PDF might be useful. On p 36 of the PDF, Brian says "Looking back I see the exercise that I thought was causing the AF as maybe aggravating my GERD?" On p 50, Larry says "Date: 11-20-07 10:01
The supplement protocol in my older post that you cited is still accurate. In addition, I have added a couple of table spoons of Maloxx before I jog. I believe there is some GERD, acid reflux issue at play in my case and the Maloxx seems to minimize the belching/burping/burning sensations that I get when jogging. I am presently still averaging about 1 episode of AF/year."

There are other GERD/exercise posts.

I support Jackie's suggestions to eliminate GERD with enzymes and HCL rather than PPI's.

Steven Gundry MD of Palm Springs is a cardiothorasic surgeon who has additionally been in the "longevity" business about 15 years. He treats a lot of autoimmune issues as well as many chronic illnesses. My wife and I are patients via phone calls. We do extensive blood tests, including many inflammation measures. Based on our genes and how prone we are to inflammation, he prescribed his "Matrix" diet for us. It is restrictive, but he says he has great success treating autoimmune issues with it. One of his patients said "he could see how compliant she'd been based on her test results!" I believe GERD ultimately has an autoimmune basis. Here is the diet:
<[www.dropbox.com]

George

Hello afibbers,

Like you I am a GERD afibber. I was diagnosed with a loose LES and was on Prilosec for 8 years. In the end I just threw them away in disgust and went cold turkey and amazingly the GERD symptoms gradually dissipated.

I still occasionally have the odd reflux so I found this simple solution really works for me:

Before meals try drinking a small glass of water that has a teaspoon or two of unfiltered apple cider vinegar. The cider vinegar must contain what’s called “mother of vinegar”. Some large supermarkets or health food shops sell it. It tastes awful but it works for me. Ordinary vinegar won’t work.

This website tells you all about it:

[www.apple-cider-vinegar-benefits.com]

You would think the acidic vinegar would make the GERD worse but it has the opposite effect (yes, Jackie, you were right in the end!).

Dean

A long shot, but.........

I had a sudden onset of gastric reflux, went in for an endoscopy, which found nothing. Started taking medication which helped. Began to look at anything that had changed around the time the gastric reflux began and came up with starting a probiotic (don't recall which one). So I stopped the probiotic and the GERD went away. No issues for the last 5? years.

To Dean, thanks for sharing your story, and I'm glad you were able to just stop PPIs cold turkey, then found ACV. But if you go back to my second post above, you'd see that just isn't going to work for me, as I am doubled over in pain after missing just one PPI dose. Will explore the copious links others here have offered to get off the PPIs.
On another, related note: happy to report a credible source of both my exercise-related afib, and a general sense that my exercise and breathing are being hindered by one of my supplements. I had run out of fish oil for a week and noticed a gradual decrease in afib, and positive changes to my lung capacity, especially during and after exercise. Bought fish oil again, and first day had a raging afib bout after exercise. Two days off fish oil and I feel almost zero afib. I know this could have many implications and is maybe not the end of my troubles here (or anyone else's reading this), but I do think it's worth posting (and hoping) about.

afibbers - There is abundant reporting on some brands of fish oil containing contaminants or is oxidized (rancid) and that certainly could be the reason for your experiences...so it's good that you've been able to track your events to that association.

It's certainly important for you to pursue weaning off the PPIs by supporting the body's natural requirements to produce your own stomach acid as nature intended rather than blocking production with a PPI or similar drug. When food isn't able to be broken down in the stomach and metabolized into nutrients the body requires for functionality, other problems will begin to surface as a result of those nutrient deficiencies.

If you can locate an experienced functional medicine practitioner in your area, it would be good to consult and receive supervision so you can restore healthy function to the stomach's parietal cells and evaluate the missing nutrients that help produce digestive juices.

Best to you,
Jackie

We've previously posted a number of discussions on the risks of taking PPIs... Once again, worth noting... a recent report calls attention to the June 2015 study findings on risks of PPIs.

According to the Stanford researchers PPIs are among the most widely used drugs in the world with over 113 million PPI prescriptions filled globally every year. Add to that over-the-counter versions of the drugs, and worldwide sales top $13 billion. In the U.S. alone about 21 million people use PPIs.

But they've been called one of the most dangerous and over-prescribed medications on the market.

The Stanford study published online in the journal PLoS One found that people taking PPIs were 16 percent to 21 percent more likely to suffer a heart attack and 122 percent more likely to die of cardiovascular disease.





Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population
Published: June 10, 2015
DOI: 10.1371/journal.pone.0124653
[journals.plos.org]