Supplements

Hi all, so I’m 5 years post ablation with Sabine Ernst in London for my paroxysmal afib, last year or two I’ve been experiencing a lot of pvc’s, my burden on last two holter monitors were 2.85% and 1.8%… granted not as much as some but I get very anxious over them to the point I’ve stopped exercising as I hate the feeling of them when I exercise.

I’ve noticed lots here have success with supplementing mag and potassium, I’ve tried magnesium in past but didn’t really feel it helped, I always thought you needed to be very careful with potassium as it could be dangerous.

So I’d appreciate any advice of what’s best supplements to buy to see if they help, give me your best suggestions, bare in mind I’m in the uk so may not get certain brands you use.

Thanks Scott

Scott,

The issue with electrolyte safety is kidney function status. If your kidneys are healthy, they will excrete any excess. If not, your body can accumulate electrolytes, which can be dangerous. This is true with potassium, magnesium and sodium.

In my case, any magnesium seems to work, though I don't suggest oxide as it is generally considered the least bioavailable. My suggestion is to start low and slowly increase to bowel tolerance, then back off a little bit. The magnesium glycinate or di-magnesium malate are usually good forms. Then add in potassium. I favor potassium citrate powder. Potassium, when taken as a bolus, will be immediately dumped into the urine, so a bit over time is my strategy. I put 2 tsp of potassium citrate powder in a liter or so of water and drink over the day. 2 tsp of the powder is about 4 g of potassium. Per this [lpi.oregonstate.edu] the adequate intake (AI) of potassium is 3,400 mg/day. From the same source, "A meta-analysis of nine prospective cohort studies showed that daily potassium intakes ranging between 3,510 mg and 4,680 mg were associated with a 30% reduced risk of stroke. I've personally taken 10 g of potassium as a bolus without ill effect - not that I'm suggesting this.

George

I just had the strangest thing! My latest RBC Mg test came back at 6.2!! I've never been above 5,8. It leaped up from 5.0 just one month prior. Three things may have been the cause..... I stopped taking my Mg Glycinate Chelate powder sipping it all day, and switched to the same brand (Designs for Health) Magnesium Buffered Chelate BisGlycinate Same amount, 750 mg (I started stow and built up to this amount like George reccomends) Or maybe it was because I visited one of those "FLOAT" spas 6 days before the test, where they say there's 1,000 lbs of Epsom salts in the water and you float. The local spa was running a half price sale so I tried it. Very relaxing, but that made me decide to take epsom salt baths 3X a week at home (MUCH less expensive . Plus I started taking Betaine HCL with breakfast and dinner when I consume the most Mg capsule to help me digest it. I'm wondering if the sipping of the liquid Mg all day caused me to be low in stomach acid therefore not absorbing as much? So, there are some ideas you can try. Best yet is to soak 30 to 40 min in not too hot water, but hot, with 2 cups Epsom salt (MgSO4) and 1 cup baking soda. I don't know what the baking soda is for but Dr. Denis Goodman says to use it in his book Magnificent Magnesium. Take a lot of deep breaths, relax......Re: exercise, Dr. John D Day in his book, The Afib Cure, exercise every day, but not too much...... Avoid blood sugar spikes, and keep A1C below 5.7 among other things. NO alcoholic beverages.....drains your magnesium. We are all different. My hubby does not take Mg, sweats profusely during exercise, has a beer or whiskey every night and his RBC Mg is 6.5 and never had a hearth rhythm issue.

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GeorgeN
The issue with electrolyte safety is kidney function status. If your kidneys are healthy, they will excrete any excess. If not, your body can accumulate electrolytes, which can be dangerous. This is true with potassium, magnesium and sodium.

One important thing to note with potassium is that you also have to be cautious about potassium-sparing drugs even if your kidneys are perfect. These include spironolactone, ACE inhibitors, and ARBs, all three of which are common hypertension meds. If you're taking any of these drugs, I would be extremely cautious with potassium supplements. In fact, if you're taking any of these then I would stick to food sources for potassium.

Carey- what about high K drinks like Coconut water?

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susan.d
Carey- what about high K drinks like Coconut water?

I think food sources are always safe unless you take it to extremes. They get absorbed slowly and aren't as concentrated as supplements. The obvious exceptions would be food and drinks with added potassium chloride, which would include low-sodium V8 juice and almost all salt substitutes. If you have kidney issues (or don't know) or if you're on potassium-sparing drugs like I mentioned above, I would schedule a blood workup with your primary doc a couple times per year if you're going to supplement potassium. After a year or so and a few blood tests, you should know how your body handles it.

Carey

When you cite low sodium V8 as an obvious exception, can you explain why you see it as different than Coconut Water? Were you making a distinction because the potassium chloride is an additive? How do you see that in terms of different results than drinking coconut water ...
Thanks

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Carey
I think food sources are always safe unless you take it to extremes.

Years ago, there was a person who used an agricultural (Cardy brand) agricultural meter to test potassium levels in saliva, which correlate with serum levels (I know Carey had one also). The person posted about going to an all inclusive resort and eating liberally at the fruit part of the buffet. He saw levels in the high 5's or low 6's, if memory serves. So food can cause an increase if you do take it to extremes, as Carey says.

More on the meters in this post & others in the thread: [www.afibbers.org]

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Allegra1215
Carey

When you cite low sodium V8 as an obvious exception, can you explain why you see it as different than Coconut Water? Were you making a distinction because the potassium chloride is an additive? How do you see that in terms of different results than drinking coconut water ...
Thanks

Good question.

Two reasons: First, the amounts in LS V8 are typically much higher than coconut water (850 mg per 8-oz of V8 vs. 575 mg per 8-oz of coconut water).

Second, the potassium in V8 is added potassium chloride, which is instantly available to your digestive tract, whereas the naturally occurring potassium in foods is generally bound to other elements in the food, so it has to be broken down by your GI tract first. End result is slower absorption.

For people who need an instant bolus of potassium to try and break an afib or flutter episode, I've been recommending LS V8 for years. But it's just that -- a bolus. It will raise your potassium levels quickly, but if you have healthy kidneys they will also remove it quickly. So if what you need is raising your daily baseline levels, then a slow intake works better. Consequently, food sources are a better choice for daily supplementation.

Tomatoes are the key ingredient in V8 juice, i grow lots of tomatoes and make juice and sauce out of them, so seems like a person could buy tomato juice for their potassium level, also sweet potatoes and regular potatoes have potassium.

Potatoes - the potassium ring is just under the skin. Peeling them ...

Carey

Ok that makes sense. I struggle to keep my potassium on an even level (based on symptoms) due to intestinal surgeries. I have found that with the V8 (LS), if I drink it very slowly (sips), I can alleviate the effects of the bolus flushing out by the kidneys some. When I use coconut water, the absorption seems so slow and/or erratic that I sometimes think it's not doing the job. I imagine that's because of other foods/drinks that may impact how quickly a food source is absorbing.

As to the meter reading, I have been using a "proxy" of sorts (be it less accurate); i use a Kardia to track. When my potassium is low-ish (when I've had it tested), my T waves are flatter and the p waves low, and my heart rate very slightly higher. When I then drink something like V8 to supplement, my T waves almost immediately peak up a bit, the p waves become more prominent and my heart rate slows a bit and my ectopics minimize or disappear. While it by NO means is precise, it gives me a feel for what is going on with my potassium. I often gauge where it's at in the evening or early morning and make a decision to eat another banana etc. and what to supplement (drinks, etc). (Just for the record, I have had my potassium etc checked many times (often monthly) in the years due to my situation and have had no issues ever with it being high (although it has been low), my kidneys are fine and I take no significant meds that retain or increase potassium).....I'd also like to mention that I found an article here in the files that was very helpful in guiding me...I'm blanking on the name of the author but it was incredibly detailed and spoke to many aspects such as the waxing and waning of potassium over the day etc.

Also, I've wondered if any of you who use the Kardia a lot have noted similar correlations especially perhaps when dealing with PACS etc.

Friends,

I've followed the links above for the Cardy potassium meters and am arriving at dead ends. Does anyone have a current link?

Thanks! Lance

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ln108
I've followed the links above for the Cardy potassium meters and am arriving at dead ends. Does anyone have a current link?

I believe the Cardy manufacturer was bought by Horiba and the Cardy meter discontinued. The one discussed in those threads really was quite old and obsolete now by modern standards.

The replacement is the HORIBA LAQUATWIN - B-731, which is the one I used for two years. I know it's accurate because I validated it 5 times against lab results. I will warn you, however, that measuring your potassium levels accurately isn't simple and takes discipline. If you read the reviews on the product it's quite clear many people buy them without realizing it's a sensitive lab instrument and has to be used accordingly. For example, by calibrating it before every single test. People think they can skip that but you can't.

I bought the meter because I was using huge doses of potassium to keep my flutter in check and to stop episodes, so I had to have real-time measurements of my potassium levels to keep from killing myself. The thing is, when you take a potassium reading, that's a snapshot in time and your levels can be quite different an hour later. For example, exercise will increase your levels dramatically, but then once you stop exercising they will drop back rapidly. You'd be amazed how rapidly potassium levels can change, so for the average person I don't really see how a potassium meter is useful. I definitely don't think it's worth the money (and don't forget you'll also need to buy calibration fluid).

Thanks, Carey. Sounds complicated and likely, as you say, not terribly useful for those taking modest doses of K.

Carey, I'm sorry I don't know all of your backstory - can you give me a capsule version at least about your bouts with flutter, how it came about, your efforts with potassium (and why you stopped) and the ultimate outcome.

I can tell that my potassium is, as you say, all over the place throughout the day via symptoms (including ectopics), kardia readings, etc.

Thanks



Edited 1 time(s). Last edit at 11/05/2021 04:03PM by Allegra1215.

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Allegra1215
Carey, I'm sorry I don't know all of your backstory - can you give me a capsule version at least about your bouts with flutter, how it came about, your efforts with potassium (and why you stopped) and the ultimate outcome.

Following my 4th ablation, I was left with atrial flutter that ran at rates between 230 and 250 bpm. These episodes happened multiple times per week and nothing we tried would prevent them or convert them other than cardioversions. Also, nothing would slow it down either. No amount of metoprolol or diltiazem had the slightest effect on the rate. Sometimes the episodes would eventually stop on their own, but that typically took 6+ hours, and as you might imagine spending 6 hours with a heart rate of 250 bpm is no fun. So I became a frequent flyer at the local ER, often showing up 2-3 times per week. I tried everything except amiodarone (flecainide, Multaq, Tikosyn, sotalol) and not a single one of them had any effect whatsoever.

And then after reading a paper I found here in the library on the effects of potassium on arrhythmias, I read a bunch more on the subject and decided to give low-sodium V8 juice a try. I guzzled two large cans (12oz each) on an empty stomach. Lo and behold, 20 minutes later the flutter stopped. I was amazed, I but wasn't sure if it was coincidence, so I tried it again and again, and sure enough it worked every time. So I bought a case of the stuff and kept it handy.

But V8 gets old pretty quickly, so I began looking for better ways to get a fairly substantial dose of K+ in my body quickly. My EP and PCP both refused to prescribe K+ supplements, particularly because I was taking an ACE inhibitor, which causes K+ retention. But again I found more information in the library here on how to measure your serum K+ levels with a meter and saliva, and also discovered that you can buy pure K+ chloride in bulk form on Amazon. So I bought a meter and a kilo of KCl.

Step 1 was to verify that the meter was giving me accurate results. So I asked my doc for standing orders at Quest Labs for an electrolyte panel whenever I wanted. Then I went to the lab, got bloods drawn, and immediately went to my car and tested my saliva right there, generally within 1-3 minutes of the blood draw. The results came back just slightly off by about 0.2, which isn't clinically meaningful. I repeated this test 5 times and each time the results matched, so I knew the measurements were accurate.

Then I had to figure out dosing. What I eventually found was that it took 3 grams (yes, 3000 mg) of potassium chloride on an empty stomach to terminate an episode within an hour (longer on a full stomach). The meter was essential to figuring this out because it would have been suicidal to attempt this without knowing my K+ levels right now (not from a lab test yesterday) because I was raising my K+ levels above the normal range and into borderline dangerous territory.

What I also eventually discovered was that if I kept my K+ levels at 4.5 or higher, I could prevent episodes entirely. But unfortunately, my normal set point was around 3.2, so keeping it at 4.5 was extremely hard (borderline impossible because the kidneys rapidly remove excess K+).

Once I had this all figured out, I never did another cardioversion. I could reliably terminate episodes every single time but preventing them was a tougher problem. I documented all this and showed it to my EP. He was very skeptical at first and both he and his NP kept telling me I was going to kill myself, but eventually he came around and agreed to prescribe both hefty K+ supplements and spironolactone, a potassium-sparing diuretic. This is a huge no no with big bold warnings on the drug, and it got a complete dismissal from my PCP and warnings from the pharmacist every time. But it worked. Between the drug and the supplements, I could keep my K+ levels about 4.5 pretty regularly. Taking the huge doses of K+ became mostly a thing of the past.

I spent 2 years doing this and wondering what the hell I was going to do about it long-term. I was looking at a probable AV node ablation and pacemaker for life. Then I got convinced by Shannon that Natale wasn't just a guy with a fan club. So in August 2017 I flew to Austin for my 6th and final ablation. I went into the lab with a heart rate of 248 and came out in NSR. A month later I stopped the Multaq early, and haven't experienced so much as a PAC since. I sold the meter on eBay last year.

That is a great story, Carey!

I'm not sure which document Carey was referring to, but we have a Conference Room archive that has a number of discussions on potassium.

The whole archive is here: [www.afibbers.org]

A search on it for potassium is here: [www.google.com]

Here are a few of the discussions:
[www.afibbers.org]
[www.afibbers.org]

Carey

Amazing story. It's a variation of my personal situation but yours is on steroids in comparison to mine so to speak. My fluctuating potassium and magnesium levels are the result of intestinal resection. I was ablated in January 2021 and have had two incidences of (atypical) flutter (cardioverted) since (no afib, not even a moment of it). Both took place during an intestinal upset situation. Been NSR since end of August (last flutter incident). Have been working hard to keep levels on an even keel. I also have/had PACs, PVCs - but have pretty much obliterated the PVCs through steady magnesium supplementation over months. The potassium is of course less up and down since the mag seems to be repleting. PACs calm down with potassium supplementation but it's not easy to keep it steady (since the intestinal issues will never be "cured"). My EP is all for another ablation (I'm not adverse) but thought I'd wait for one more incidence of flutter. I guess I'm really faced with the constant potassium/mag supplementation with the PACs. If I don't stay up near 5, the PACs start rolling in. To my thinking (and research), I clearly struggle with getting depleted intracellularly and that effects the conduction in the heart...

George, thank you for all the links. I had discovered some of these here but this is more extensive - every bit of it is helpful to me to aid my learning.

Carey, post ablation do you still any have potassium issues (i.e. PACs, etc) without your supplementation (or do you supplement still but at a lower level?)....

Thanks so much for sharing your story -- lots of interesting info and insight for me.
Makes me realize just how much the potassium /magnesium losses affect afibbers...sure makes me "wish" for an at home potassium test that was realistic to use.



Edited 2 time(s). Last edit at 11/06/2021 10:21AM by Allegra1215.

Allegra -

Nutrient absorption occurs in the intestinal mucosa. When there is impairment of that process (from a variety of causes), the interference deficiencies can result in a whole host of maladies. Functional testing has been available for years and helps target the etiology and measure nutrient deficiencies. Genova Diagnostics Comprehensive Stool Analysis is one of several evaluations that help identify whether or not the nutrients consumed make it through to intracellular areas. Inability to produce adequate stomach acid is another factor in nutrient absorption. Also, SIBO, Leaky Gut Syndrome..and more ….Many to consider.

Almost always, part of the solution is to supplement with high-dose forms of specific probiotics that support intestinal function and nutrient absorption once the testing indicates the status.

[www.ncbi.nlm.nih.gov]
[www.gdx.net]

Jackie

Jackie, thanks for your info...I'm going to read all that you have sent via links..
Clearly my impaired (missing) intestinal mucosa is a huge factor...diet is difficult as I know that my arrhythmia issues will benefit from low carb (was my preferred way of eating prior to the resections)...but the low carb then impacts the GI distress and I have been instructed to calm it with bland food (rice, potatoes, etc) - and this all in turn is involved in my nutrient (potassium/mag) up and down....add genetic factors to afib...and it's a perfect storm.

These links and information are helping me sort through all of this so I can work for the best possible solutions...

thanks so much