Supplements and Drugs

Hi Everyone. I am now 6 weeks post-index ablation.

I have read a lot on here about supplements and some concerning medications.

I am currently experiencing a-fib with atrial flutter about 65-75% of the time. I convert nearly every day in the morning around 7-8am and typically sink back into a-fib around 3-4pm. I am sticking rigidly to my EP's continuing demand that I take propafenone 225mg and metoprolol 37mg, along with Eliquis 5mg, twice per day.

I have been taking Magnesium Taurate to bowel tolerance, along with about a gram of potassium per day, for about three weeks. I can tolerate about 500-700 mg MgTaurate per day right now.

I have not noticed any benefit to supplementation to date.

My questions are:

1) Is there anything else I can do with supplementation right now? (I see this as an experimental process and am being patient with it)
2) If I am in a-fib 75% of the time, why in the world should I be staying on the prop and metro? They obviously are not working.

Ryan

Ryan,

"2) If I am in a-fib 75% of the time, why in the world should I be staying on the prop and metro? They obviously are not working. "

The metro should be for rate control, not really to keep NSR. Wonder if a higher dose of prop would work any better. Also wonder whether your afib % would be higher without it? Don't think your 225mgx2 is near the max dose.

George

Hi George,

I typically have aberrant tachycardia when in afib, so my resting HR in a-fib is 120-130 bpm. The metro doesn't even dent that. I'll ask the Dr. about the prop as well next time we talk. I wondered if anyone here had experience with these two drugs and could offer insight, thanks for yours.

Hi Rylar,

Sorry to hear you're having so much afib after an ablation. I was on propafenone for over 6 years prior to my ablation. I started on the 225 mg dose twice a day and was bumped up fairly quickly (within 3 weeks) to 325 twice a day. I tinkered with my dosages occasionally on my own to try to reduce it to 225 mg twice a day, but i would always eventually go back into afib and go back on the regular dose of 325 twice a day. I was also on metropolol twice a day at 25 mg. My EP told me a propafenone dose of 225 mg twice a day rarely works for those who need daily meds, but he will start patients on it just in case it's sufficient to do the job.

I'm not sure why your EP has you on a low dose of propafenone. Are you having severe side-effects?

Best wishes as you get this figured out.

Doreen

No side effects at all. I'll ask him about going to 325 twice per day. I have communicated with him the frequency of my a-fib but he never volunteered to increase the dosage to try that, so assumed it was not an option.

Ryan - While an ablation may obliterate troublesome cardiac cells, other cardiac cells still need the required nutrients for proper function and heart meds typically don’t restore those. Actually, drugs help deplete the all-important magnesium so your diligence in daily repletion becomes top priority.

Try to determine just how much magnesium you are actually getting with that Mg/taurine combination. It could be that you aren’t taking in all that much magnesium. Remember that many afibbers find they need to take 800 mg and often higher doses of just magnesium…preferably in the amino acid chelate form (magnesium glycinate or bisglycinate) because that’s the most likely to reach the target cells easily.

Assess also your calcium intake from dairy …milk and cheese. According to Cardiologist, Thomas E. Levy, MD, JD author of “Death by Calcium,” most people consume far too much calcium …typically from dairy sources and that is known to overpower magnesium. Arrhythmias are just one complication of the imbalance. Increased calcium-to-magnesium ratios cause increased absorption of calcium and decreased absorption of magnesium which results in an absorbed calcium-to-magnesium ratio that is greater than the actual ratio of Ca:Mg taken in. While basic dietary guidelines typically emphasize that this ratio should be 2:1… the healthy ratio is actually the reverse with much more magnesium then calcium. This is important for those with arrhythmias because calcium is excitatory to cells whereas magnesium is relaxing.

Many afibbers (including me) found through the Exatest that they were low in intracellular magnesium. This is not serum magnesium but rather what’s actually inside heart cells (cardiac myocites) where Mg functions
(myo meaning muscle; cyte meaning cell).

From The Strategy:
Magnesium’s regulatory role in energy production, in the biosynthesis of catecholamines and other neurotransmitters needed for neuromuscular activity, as well as neurological excitability, muscle relaxation after contraction, and bone metabolism, gives magnesium a key role in musculoskeletal function and health.


Then after establishing your daily magnesium intake, consider also that you need optimal potassium intake either from food or supplements. It’s far easier to get enough potassium than magnesium from food sources. Yet, many people are consistently low in daily potassium and often much too high in sodium. Here again, the higher the sodium, the lower the potassium and the more likely the heart activity of afib or flutter because the lack of potassium allows for a faster time between heart beats (refractory period). When that happens, you are at much higher risk for slipping in and out of some form of aberrant heartbeat.

Another relevant clip on this ratio from The Strategy:

THE SODIUM-POTASSIUM PUMP – as it relates to afibbers

Richard D. Moore, MD, PhD (8) goes into great detail about the function of the sodium/potassium pump (Na/K pump) and what he calls the K Factor. (K for potassium; Na for sodium). While he is specifically addressing hypertension in his book, The K Factor, the science fits for afib as well because “tissue compliance” is dependent upon a dietary intake of potassium that provides a favorable ratio of K to Na in the body and ultimately, cells… every cell in all tissue of your whole body.

Early man’s consumption of sodium and potassium worked out to about 11,000 mg daily of potassium and only 690 of sodium. A ratio of about 16:1. (Moore) Other sources say the potassium was around 6,000 mg with 600 mg sodium. Salt was not a big factor in early man’s diet.

Dr. Moore says: “The low ratio of potassium to sodium in the typical American diet is one of the biggest - perhaps even the biggest -cause of bad health in our country.” So, let’s examine what this might mean to afibbers.

Cellular biophysics tells us that one of several dozen energy-consuming mechanisms in living cells uses about 25% of the total energy of that cell and therefore is of vital importance to that cell. This mechanism is the Na-K pump and it’s the key to survival for every cell in our body. Not only does this specialized pump keep potassium levels in the cell high and sodium levels low, but it makes an electrical current which is carried by positive sodium ions that the cell uses for itself, but also serves to regulate acid and calcium levels inside the cell. Dr. Moore says: “When a living cell is exposed to a substance that specifically inhibits the Na-K pump and without affecting any other mechanism…that cells dies. So this pump is of vital importance to everyone – afibbers especially.

Must view: video simulation of How the Sodium-Potassium Pump Works.
[tinyurl.com]

Quote from Principles of Biochemistry, 1992:
The activity of this Na/K-ATPase in extruding Na+ and accumulating K+ is an essential cell function. About 25% of the energy-yielding metabolism of a human at rest goes to support the Na/K-ATPase.
25%!! Think about it! If we don’t have these pumps working, imagine how this affects heart tissue, especially.

Dr. Moore says the ideal ratio of dietary intake will be between 2 and 4 parts potassium to one part sodium. In his book, he emphasizes 4:1.

His message: “The sum of intracellular K+ Na is a constant… meaning you can’t raise IC potassium unless you lower IC sodium.”

Moore) (8) Chapter 4, p. 78: The Key Problem: An Imbalance in the Ratio of Potassium to Sodium (The K-factor)
"For purely physical reasons (connected with the law of osmotic equilibrium), inside the cell the sum of sodium plus potassium must be constant. This means that sodium can go up only if potassium goes down. Likewise, if potassium goes up, sodium must go down. So potassium and sodium are unalterably linked together like two children on a teeter-totter. You can't change one without changing the other."

POTASSIUM AND THE REFRACTORY PERIOD.
Potassium prolongs the refractory period…or the time when the heart is resting between beats. At this time, heart cells can’t be stimulated to contract.

Supporting biochemistry:
In the resting state, cardiac muscle cells are polarized due to gradients established by the active inward transport of potassium ions and the outward transport of sodium ions. Various stimuli-including drug-induced effects-can cause shifts in these gradients, producing a decrease in the internal negative membrane potential. This process is known as depolarization.(9)

Adverse effects or clinical consequences of potassium depletion predominantly affect the cardiovascular and neuromuscular systems. Both respond to the associated hyperpolarization of electrical tissue.
The presence of hypokalemia (potassium depletion), decreased membrane permeability to potassium (which prolongs action potentials), shortens refractory periods and increases the incidence of spontaneous and early depolarizations.
For cardiac cells, the result of these alterations is a propensity for arrhythmias, particularly in persons who are taking digitalis (Rutecki & Whittier) (10)

Caution: "A note of caution about beta blockers. Beta blockers diminish the regulation of serum K during potassium loading. In the presence of beta blockers, plasma potassium can spike during a potassium load."
Dr. Moore (8) Chapter 19, Information for the Physician, p. 323,
Drugs That May Make the K Factor Dangerous

It's not simply the amount of potassium that's important, it's the dietary and IC potassium-to-sodium ratio, which needs to be at least 4:1 (end of excerpt)

Here’s the link to The Strategy so you can start at the beginning and read more. Two topics that will be in the revised version, include the importance of maintaining alkaline tissue pH continually and also the importance of vitamin D on heart cell function. [www.afibbers.org] and the Alkalinity post is here: [www.afibbers.org]

Start with your daily dietary assessment of those electrolytes/minerals… ie, magnesium, potassium, sodium and calcium so you know if you are eating wisely and safely. That’s a start. Let me know if I can help you with supplement recommendations.

Hang in there. I know how frustrating this can be.

Best to you,
Jackie

Thanks Jackie. I suspect that I should be taking much more potassium than I am. I take two 600mg potassium gluconate tablets per day right now, which seems laughably small compared to the 6000-12000mg daily intake in early humans. Do you have other "better" recommendations and daily levels that I should aim for in potassium supplementation?

I will switch over to magnesium glycinate to see if that makes a difference. When you suggest 800 mg of Magnesium, I assume you are referring to 800 mg of chelated pills.

I forgot to mention that I am aware that the potassium gluconate pills only have 99mg actual potassium

When did you start taking the potassium supplements? Just to let you know when I took potassium supplements I got AF, I quit taking the Pot. and the daily runs ceased. Have you had your potassium levels checked, my pot. was always near the top, so maybe for me I am a lot different than most on here, but I will never take potassium supplements.

Liz

Ryan - Yes, sorry - I was referring to the magnesium glycinate dosing.

As far as your potassium intake goes, and yes, obviously, early man took in much more daily, you should calculate your intake values from a typical day's food consumption and then augment from there. It's smart to do a daily food intake diary so you know what you typically take in from food because you obviously don't want too much potassium. And if your magnesium inside the cells isn't optimized yet, then too much potassium can backfire into afib.

This is why we often say we are experiments of one... as we are all biochemically, biophysically unique. You have to tinker with dosing for both magnesium and potassium as none of us are identical in requirements, intake and utilization.

If you perspire a lot, then your electrolyte needs will be much higher. If you eat commercially-prepared foods, the typical high-sodium content will block potassium so you have to consider that and add more to compensate or adjust the high sodium intake which is better because of other reasons. Try to get to the 4:1 ratio with your food.

While we can generalize more typically with Mg dosing recommendations, potassium requirements and dosing become highly individualized because of the obvious. Many afibbers have benefited from the use of the CardyMeter to reliably monitor potassium levels. There are many posts on the topic and also this Conference Room report [www.afibbers.org]

Send me a PM if I can help refine your protocols.

Best to you,
Jackie