Dr. Berg vs Nuun electrolytes

I’m thinking of carefully adding some electrolytes to my diet.

I know the precautions about kidney function.

I have Dr. Berg at home, it has 1000mg of potassium. Is that ok?

How about Nuun?

Link to Dr. Berg electrolyte drink contents:

[drive.google.com]

My suggestion would be to consume slowly over a number of hours, as potassium as a bolus will be very quickly excreted by healthy kidneys.

My own experience is that any supplemental calcium can be a negative for me with respect to afib. I keep my intake to 4 or 500 mg /day from all sources. Your mileage may vary.

With normal kidney function you can ingest as much potassium as you want if you get it via food. It's a natural way of doing like George does by taking it slowly over the course of the day except that it's delivered to your body more slowly and evenly.

An interesting thing about potassium and salt is that humans evolved in a potassium rich, salt poor world. Think about the average Neanderthal on the African plains. Where is he going to find salt? Unless he lives on the coast, almost nowhere. But potassium is available in almost everything he eats: fruits, green vegetables, root vegetables, nuts, seeds, meat, fish, you name it. The end result of this is how our bodies evolved to excrete potassium readily but to retain salt. And then came farming of grains, which led to the modern world where the tables have completely turned. The average western diet is extremely potassium deficient and loaded with salt. Totally backwards from the diets our bodies adapted to over millions of years.

So have all the kiwi fruit and sweet potatoes you want instead of supplements. Cheaper, better, tastier!



Edited 1 time(s). Last edit at 04/18/2023 11:49PM by Carey.

Quote
Carey
With normal kidney function you can ingest as much potassium as you want if you get it via food. It's a natural way of doing like George does by taking it slowly over the course of the day except that it's delivered to your body more slowly and evenly.

An interesting thing about potassium and salt is that humans evolved in a potassium rich, salt poor world. Think about the average Neanderthal on the African plains. Where is he going to find salt? Unless he lives on the coast, almost nowhere. But potassium is available in almost everything he eats: fruits, green vegetables, root vegetables, nuts, seeds, meat, fish, you name it. The end result of this is our bodies evolved to excrete potassium readily but to retain salt. And then came farming of grains, which led to the modern world where the tables have completely turned. The average western diet is extremely potassium deficient and loaded with salt. Totally backwards from the diets our bodies adapted to over millions of years.

So have all the kiwi fruit and sweet potatoes you want instead of supplements. Cheaper, better, tastier!

Interesting! Had a bad episode last night, therefore wanted to add some electrolytes , carefully (I'm slightly desperate). I've been avoiding taking any, as side effects of weaning off Metoprolol were horrid, and didn't want to upset my system further.

Agree getting as much as possible using a healthy diet.

I just read the supplement chapter of the book " The Afib Cure" and it seems good I'm very careful.

Quote
GeorgeN
My suggestion would be to consume slowly over a number of hours, as potassium as a bolus will be very quickly excreted by healthy kidneys.

My own experience is that any supplemental calcium can be a negative for me with respect to afib. I keep my intake to 4 or 500 mg /day from all sources. Your mileage may vary.

I will tread carefully… the 1000mg seems a bit much to me, considering they put max 100mg in pills to avoid overdose.

Will see cardiologist soon. Will have a chat.

Quote
hds
I will tread carefully… the 1000mg seems a bit much to me, considering they put max 100mg in pills to avoid overdose.

If you have normal kidney function, it will not be a problem. I've taken 10 grams as a bolus with no issue (I'm not suggesting others do this). However I do consume 4 grams over the day, every day. Also, as Carey suggests, I eat a lot of foods in my diet that are high in potassium.

If someone has compromised kidney function, they need to be aware of potassium in foods as well. I recall one of our members who had a Cardymeter (an agricultural potassium meter that some use to determine saliva potassium and correlate that with serum levels - see PDF in our Conference Room archives) noted when he went to an all inclusive resort and was consuming a lot of high K foods in addition to his normal supplement, his imputed serum level was at 5.2, the very upper limit of normal. I personally do not have this issue and my serum K levels test in the low 4's.

Quote
GeorgeN
If someone has compromised kidney function, they need to be aware of potassium in foods as well. I recall one of our members who had a Cardymeter (an agricultural potassium meter that some use to determine saliva potassium and correlate that with serum levels - see PDF in our Conference Room archives) noted when he went to an all inclusive resort and was consuming a lot of high K foods in addition to his normal supplement, his imputed serum level was at 5.2, the very upper limit of normal. I personally do not have this issue and my serum K levels test in the low 4's.

Thanks, that gives some more confidence.
In a recent panel it came back as 3.8 for me (a little over a week ago).

Quote
hds
Thanks, that gives some more confidence.
In a recent panel it came back as 3.8 for me (a little over a week ago).

Serum potassium can change over the day, as the guys who used the Cardymeter will tell you. However, most afibbers have found that between 4.5 & 4.9 seems to be a sweet spot. Non afibbers seem to be able to tolerate much lower serum levels. I was discussing this with GP I had when afib first appeared. At the time, some of the meds he was using for hypertension would lower the serum potassium levels below 3. He was questioning why they didn't all have afib. My response was it was likely genetics. In any case 4.5 is a better number. If you were at 3.8, I wouldn't worry about the potassium you are consuming.

You can go to our ancient Conference Room Archives and do a find (control F on a Windows machine and Command F on a Mac) for the ones with potassium in the title and read all about it. There are four: 14A, 37, 72 & 74. A number of these were written by Patrick Chambers MD, who posted here. He last posted a couple of years ago. .

Quote
GeorgeN

Thanks, that gives some more confidence.
In a recent panel it came back as 3.8 for me (a little over a week ago).

Serum potassium can change over the day, as the guys who used the Cardymeter will tell you. However, most afibbers have found that between 4.5 & 4.9 seems to be a sweet spot. Non afibbers seem to be able to tolerate much lower serum levels. I was discussing this with GP I had when afib first appeared. At the time, some of the meds he was using for hypertension would lower the serum potassium levels below 3. He was questioning why they didn't all have afib. My response was it was likely genetics. In any case 4.5 is a better number. If you were at 3.8, I wouldn't worry about the potassium you are consuming.

You can go to our ancient Conference Room Archives and do a find (control F on a Windows machine and Command F on a Mac) for the ones with potassium in the title and read all about it. There are four: 14A, 37, 72 & 74. A number of these were written by Patrick Chambers MD, who posted here. He last posted a couple of years ago. .

Thanks for the link. Very useful. No shortage of information to read!

I’m still early in this and my recent episodes were scary (dizzy/headache, and noticed my body was a bit oxygen starved, it felt like). Seems that with Multaq the Afib patterns are not at a high HR but possibly also make blood flow less efficient than my previous episodes. 14 episodes last month. Therefore the support is greatly felt.

On the bright side stress test results were good. Good pumping function and no blockages. So seems general heart structure is ok. MRI next week…

I have low kidney function, not out of 'normal' range, but rattling against the lower limit. Every time my blood has been taken and I see the results, my K levels are low. So, I drink about half a cup of coconut water each day, or I eat a couple of dried apricots as insurance. Beets are also an excellent source of potassium.

Quote
gloaming
I have low kidney function, not out of 'normal' range, but rattling against the lower limit. Every time my blood has been taken and I see the results, my K levels are low. So, I drink about half a cup of coconut water each day, or I eat a couple of dried apricots as insurance. Beets are also an excellent source of potassium.

When I first started looking at electrolytes, over 18 years ago, learned that some people have a genetic tendency to "waste" them. I came across a Dr. Herbert Mansmann Jr., who was in this category & had spent a lot of time, late in his career researching this. His specific issue was wasting magnesium. There is more info on him in this post from 13 years ago. [www.afibbers.org] (he passed in 2007 at age 83)

I wonder if it is possible, even if you have lower kidney function, if you also have a tendency to waste electrolytes?

I'm pretty sure I'm in this category for magnesium due to the quantity I can take daily without loose bowel issues.

Quote
GeorgeN

I have low kidney function, not out of 'normal' range, but rattling against the lower limit. Every time my blood has been taken and I see the results, my K levels are low. So, I drink about half a cup of coconut water each day, or I eat a couple of dried apricots as insurance. Beets are also an excellent source of potassium.

When I first started looking at electrolytes, over 18 years ago, learned that some people have a genetic tendency to "waste" them. I came across a Dr. Herbert Mansmann Jr., who was in this category & had spent a lot of time, late in his career researching this. His specific issue was wasting magnesium. There is more info on him in this post from 13 years ago. [www.afibbers.org] (he passed in 2007 at age 83)

I wonder if it is possible, even if you have lower kidney function, if you also have a tendency to waste electrolytes?

I'm pretty sure I'm in this category for magnesium due to the quantity I can take daily without loose bowel issues.

I don't know - I am considering have myself tested to find out (Exatest I believe is one way). It might make sense, as I had a strong inflammatory response from Covid (Afib hit me on day 2 of Covid - I was quite sick) that is still present (sore joints, hoarse voice). My PCP thinks I may have a form of long Covid. Apparently, you waste magnesium under these conditions. Also add on stress, and lack of sleep - magnesium wasters too.

I was discussing this with my wife today: why 25 days between first and second episode? She immediately noted I was in bed for most of that period and isolated, so lots of sleep (sometimes 10-11 hours per day) and no stress from normal situations that would normally occur (work or family). Once I was not isolated anymore and was back in normal home situation, immediately had my second episode, and after that the period between them became shorter and shorter.

I sent my general cardiologist a question if it's OK to supplement magnesium (I don't see why not!). The book "The Afib Cure" mentions the following:

Quote
The Afib Cure
Magnesium is a good place to start, because if ever there was a supplement that even the most traditional of all traditional doctors could accept, it would have to be this essential mineral, which is responsible for hundreds of biochemical reactions in the human body. Nonetheless, the plant-light diet of most Americans means millions upon millions of people are magnesium deficient. Prominent cardiologists have even called magnesium deficiency a principal driver of cardiovascular disease and a public health crisis.

Low magnesium levels have long been observed in AFib patients. Magnesium works its magic by calming the cell-to-cell electrical channels in the heart. It has even been shown to help treat AFib in many studies, and it can make some antiarrhythmics like sotalol or dofetilide much safer. Magnesium can also calm palpitations from premature atrial or ventricular contractions, known as PACs and PVCs.
We have some patients who swear magnesium is the secret to treating their AFib. If that’s true—and some research suggests it may indeed be—it might partly be because it is quite effective at also helping people sleep—and deep, restful, restorative sleep is absolutely vital for anyone who wants to put their AFib into remission.

So long as your kidneys are healthy and you don’t take more than the recommended dosage, magnesium is remarkably safe. The most common side effect is loose stools, which can usually be resolved by simply taking a lower dose or switching to a different form of magnesium.
Perhaps the best news when it comes to magnesium is that most people don’t need to supplement for it. Unless you are taking a stomach-acid-blocking medicine, or have other gut absorption issues, you can pack your diet full of magnesium just by eating nuts, seeds, and greens—the more greens the better, in fact. If you do need extra supplementation, and you are concerned about the purity of supplements, your doctor can prescribe a prescription version of magnesium.

Quote
hds
Perhaps the best news when it comes to magnesium is that most people don’t need to supplement for it. Unless you are taking a stomach-acid-blocking medicine, or have other gut absorption issues, you can pack your diet full of magnesium just by eating nuts, seeds, and greens—the more greens the better, in fact. If you do need extra supplementation, and you are concerned about the purity of supplements, your doctor can prescribe a prescription version of magnesium.

For me, I take 7 HCl (hydrochloric acid) tablets with each meal. I eat salads out of large mixing bowls & probably eat close to a pound of nuts & seeds daily (& I'm not vegan). On top of that, I consume north of 3 grams of supplemental magnesium (elemental weight) in the form of glycinate, di-magnesium malate and magnesium chloride. When I reduce the mag supplements, I get breakthrough afib



Edited 2 time(s). Last edit at 04/20/2023 08:16AM by GeorgeN.

Quote
GeorgeN

Perhaps the best news when it comes to magnesium is that most people don’t need to supplement for it. Unless you are taking a stomach-acid-blocking medicine, or have other gut absorption issues, you can pack your diet full of magnesium just by eating nuts, seeds, and greens—the more greens the better, in fact. If you do need extra supplementation, and you are concerned about the purity of supplements, your doctor can prescribe a prescription version of magnesium.


For me, I take 7 HCl (hydrochloric acid) tablets with each meal. I eat salads out of large mixing bowls & probably eat a close to a pound of nuts & seeds daily (& I'm not vegan). On top of that, I consume north of 3 grams of supplemental magnesium in the form of glycinate, di-magnesium malate and magnesium chloride. When I reduce the mag supplements, I get breakthrough afib

That’s good to know. I’m a pescatarian but seems need to up the ante on nuts/seeds.

I just had some ectopics (early evening for me), which indicates for me that when I go to bed I will have another episode… I looked up interactions between Eliquis and Magnesium and there seem to be some concerns, and there is the recommendation to space it by 2 hours. My last episode was really rough so I hope to be able to avoid it. I’m a little scared to get another bad episode. Too worried about the interactions at the moment to take magnesium. I will introduce more magnesium through diet for now until I get more details from cardiologist.

What is your RBC Mag level, George?

George, when I read several months ago of our Mg consumption, I was doubtful that you could live in any kind of equilibrium with that level of consumption. Not for long. But, I hafta say, you have this figured out, and I would have to agree with you that some of us are exceedingly poor absorbers of some of our nutrients. You especially.

Just for ranging purposes, could you put up a typical day's all-up intake, all sources, and post a figure for us. On the face of it, it's astounding.

Quote
gloaming
George, when I read several months ago of our Mg consumption, I was doubtful that you could live in any kind of equilibrium with that level of consumption. Not for long. But, I hafta say, you have this figured out, and I would have to agree with you that some of us are exceedingly poor absorbers of some of our nutrients. You especially.

Just for ranging purposes, could you put up a typical day's all-up intake, all sources, and post a figure for us. On the face of it, it's astounding.

I'm pretty sure I absorb the mag well, otherwise I'd have continual loose stools. I'm guessing I excrete it rapidly in my urine.

Brief history of afib.

July 2004, first episode a couple of days after training on a 14,000' mountain for a race up another 14er', woke up with it and self-converted in the ER after a couple of hours. For the next 2 months had afib every 10-14 days for 6-9 hours, self converting. Then had a 2.5 month episode, converted in 20 hours with 300 mg flec. Started figuring out a remission plan in ernest. Had another episode a month later that also converted in 20 hours after 300 mg flec. Continued to tweak my plan, as I was creating it out of whole cloth. Had an episode in March 2005 after breaking trail in 3' of snow with 70# pack snowshoeing in for an overnight camp with Scouts. Constructed a 3 person snow cave. Had afib in the cave at 11PM and converted it in an hour or so with 300 mg flec. Had another episode in April and realized I'd not bothered to replace taurine, which had been part of my plan.

After this, got my afib remission "plan" titrated pretty well and went without afib for over 2 years. I then thought "I'm cured" and quit all my supplements. Had afib within 24 to 48 hours. Decided stopping the supplements (magnesium, potassium & taurine) was a bad plan, didn't need to retest the stopping idea and restarted them.

I'm traveling at the moment, so I have no scale with which to weigh all my food (don't eat processed food with labels). I can tell you I get approximately 2.4 grams of magnesium from 2 tsp of di-magnesium malate powder, 0.5 grams from 2 tsp magnesium bisglycinate powder and 0.2-0.5 grams from "magnesium oil" (a supersaturated solution of water and magnesium chloride). I dump a bunch of nigari (MgCl2 the Japanese use to coagulate tofu) into a glass & put water in so there are still some undissolved flakes. I consume around 6 tsp of this daily. I purchase the nigari in 20 Kg bags. I've never bothered to weigh everything on a gram or milligram scale and do the chemistry to figure out how much mag this is giving me. I can say I've run my consumption of magnesium above 5 g/day for extended periods of time in the past. If you read my post linked above [www.afibbers.org] about Dr. Herbert Mansmann, he consumed over 20g/day for a year to get rid of his diabetic neuropathy, and routinely consumed 5g/day after that. He was obese such that he could not fit in a bathtub.

In addition to the mag, I take 4 grams of potassium as 2 tsp potassium citrate powder that I dissolve in a liter of water with 1/2 tsp sea salt and consume over the day. 1/2 tsp of taurine powder, which is about 2 g taurine. I limit calcium intake from all sources to between 4 & 500 mg/day. As I've posted many times, I limit long duration activity to a Zone 2 level (see paragraph 2 here). Generally this eliminates exercise as a trigger for vagal afib for me. I can do short duration high intensity exercise. I have a protocol on a fan bike where I warm up for 3 minutes at 50 watts, then do 8 cycles of 15 seconds as hard as I can and 15 at 50 watts. After the 8 cycles, I cool down for 3 minutes. My fan bike will report instantaneous calories/hour and my max for a couple of seconds during the 15 seconds is around 2700 (note I can only sustain that for a few seconds). I also do strength training of various kinds but a lot of 90 second "Timed Static Contractions (TSC)" where you do the first 30 seconds at 50% effort, then slowly increase to 70% effort for the next 30 seconds and finally "as hard as you dare" (essentially all out) for the final 30 seconds. I have a 100 gallon stock tank I use as a cold plunge in the winter. Commonly it is 50% ice & I have to break it up with a hammer or 8# sledge hammer before I get in. I stay in for 3 minutes at the beginning of the day. Warm up inside my house, exercise and then 30 minutes in a near infrared heat lamp sauna. I normally fast 16 - 18 hours daily and break my fast after exercise. I first keto-adapted in 2009. I eat a lot of carbs (100-200 g/day) for someone who tests positive every morning for serum beta hydroxybutyrate though probably 50 g of those are fiber. I've never un keto-adapted. I periodically water fast for up to 7 days. I'm 67. I weigh what I did in Grade 10 and am leaner than I was then.

While my mag intake is high, I have a number of non-afibber friends who take 1 to 2.5 g elemental mag/day, so it is not unheard of. My mag bowel tolerance has increased over time. I think it was around 800 mg in 2004. Mag bowel tolerance is very individual. My wife's is about 400 mg.

I list all of this to give an idea of my lifestyle. I'm not suggesting anybody do what I do. It may not be appropriate for any others. Also on my flec used on-demand for conversion. A dose of 300 mg is only appropriate for those who weigh more than 70 Kg (154 #'s). In the last year, I figured that 200 mg works better for me as 300 will convert me to flutter, which I then have to convert back to afib (without taking any more meds) to then convert to NSR (without taking more meds). For me, 200 converts me directly to NSR. In retrospect, the 300 mg dose has been doing this flutter conversion since near the start of using flec (since I have tracked almost every episode with a beat to beat recording heart rate monitor).



Edited 1 time(s). Last edit at 04/21/2023 01:03PM by GeorgeN.

I'm not sure if what Carey said can be echoed enough. The average American's diet is probably 5-10 to 1 salt to potassium these days. And, according to Loren Cordain (whom I've had my disagreements with), hunter gatherer's ratio was essentially reversed.

This is one of the issues you'll find with some low-carb diet promoters. They'll say we evolved to eat more salt and cite that there's salt in the blood of the animal. Sure, I found a calculator on the internet showing that there are about 3000mg of sodium in a liter of blood (please check my math), but I can't recall reading anywhere in Weston A. Price or Vilhjálmur Stefánsson where they mention indigenous populations emphasizing blood in their diets. Plus, I seriously doubt there would be enough blood to go around the entire group to amount to the American diet.

That said, there is a response to low-carb diets called natriureses of fasting whereby the body dumps sodium and potassium, and that's the reason they promote more additional sodium intake. GeorgeN, however, is relatively low carb (and is ketogenic parts of the day), but I do see that he does take 1/2tp of sea salt. I remember reading on this forum (I think) probably 10-15 years ago from a guy that said he ate meat only and zero salt and was able to keep his Afib at bay doing so.

I'll get off my obsession about human origins soap box now



Edited 2 time(s). Last edit at 04/21/2023 10:59AM by JohnG.

Thanks to you both. I am quite familiar with Keto/Low Carb as I did that for about a year, and felt quite good, also losing about 11 kg in the process, which was my goal. I didn't go into ketosis....I thought that was a bit much. I have learned that the extremes are best avoided, but that some of the inherent 'truth' can be useful, so I went low carb and did well. Unfortunately, my AF over the past two years has really cramped me and I have gained it all back. I am feeling very well after a second ablation (Holter on 10 May), and can't wait to resume all my activities. If only the weather her on the wet coast would improve. I have a brand new premium refractor telescope that hasn't passed a single photon through to my brain, and I purchased it three months ago! Lifting its components would have sent me into AF.

George, you must have great kidney function. I take only 200mg each night with my Co Q10 and statin. For potassium, I eat a pretty good diet, lots of nuts, coconut milk, dried apricots, beets seasonally or pickled, so I think I must be doing okay. The Mg is new, only started that early December. I'll enlist the support of my GP next time I see him about my kidneys and if I should be careful or monitor more frequently. As I said earlier, they're iffy.

Quote
JohnG
I'm not sure if what Carey said can be echoed enough. The average American's diet is probably 5-10 to 1 salt to potassium these days. And, according to Loren Cordain (whom I've had my disagreements with), hunter gatherer's ratio was essentially reversed.

This is one of the issues you'll find with some low-carb diet promoters. They'll say we evolved to eat more salt and cite that there's salt in the blood of the animal. Sure, I found a calculator on the internet showing that there are about 3000mg of sodium in a liter of blood (please check my math), but I can't recall reading anywhere in Weston A. Price or Vilhjálmur Stefánsson where they mention indigenous populations emphasizing blood in their diets. Plus, I seriously doubt there would be enough blood to go around the entire group to amount to the American diet.

That said, there is a response to low-carb diets called natriuresis of fasting whereby the body dumps sodium and potassium, and that's the reason they promote more additional sodium intake. GeorgeN, however, is relatively low carb (and is ketogenic parts of the day), but I do see that he does take 1/2tp of sea salt. I remember reading on this forum (I think) probably 10-15 years ago from a guy that said he ate meat only and zero salt and was able to keep his Afib at bay doing so.

John, I think William is the person you are thinking of. He drank distilled water, but added a couple of tsp of salt to it. Here is a search on his posts on salt: [www.afibbers.org]

Normal saline is 9 tsp/gallon of water and 9 g of salt/L. As salt is about 40% sodium, that would be 3.6 g/L. I believe this is supposed to mimic blood.

Natriuresis of fasting only became an afib issue for me once. That was during keto adaptation in 2009. I was using the 20g/day carbs approach and implemented it full stop. A number of days in, I could really hear my pulse in my ears when I was going to bed. I was convinced this would lead to an afib episode. I loaded up on potassium, was taking magnesium & I don't recall about sodium. One morning I woke up at 3AM in afib. I took 300 mg flec and after an hour or two I converted to what I now think was ~130 BPM flutter. Again in retrospect, I would previously commonly convert to ~ 85 BPM flutter, only I didn't realize it was flutter & thought it was higher speed NSR. It would convert to NSR after a few hours. This day, because of the high rate, I went and took a bunch of extra magnesium and the rate proceeded to drop into the 80's fairly quickly. This electrolyte disruption never was apparent or afib causative in all the years after. I've done a fair amount of fasting, including a period in 2017 where I did 19 cycles of water fasting 5 consecutive days out of every 14. I was not doing this to lose weight and was weight stable when comparing my weight on day 1 of a cycle to day 1 of the next cycle.

My recollection is that the paleo data suggest our ancestors consumed 4 times as much potassium as sodium (from Richard Moore, MD PhD, "The High Blood Pressure Solution.").

Not eating processed food, my sodium intake is not huge, but I do season food with it. Per University of Colorado Health Sciences nephrologist and fructose researcher, Richard Johnson, MD, high salt intake with high glucose can activate the polyol pathway and the body can convert the glucose to fructose. See a brief summary here: "Additional studies with mice found that a high-salt diet can also trigger the polyol pathway of fructose-to-fat production through dehydration (fat stores water for future use – hence the camel’s hump). That process is probably set about by fructose’s leading to more production of vasopressin, a hormone that regulates blood pressure by managing the body’s fluid levels, Johnson says."
[www.uchealth.org] For a much more detailed information, his book and a three part lecture series on YouTube. He also says that this can be offset by consuming enough water with salt as it is an osmolality issue.

I like pedialite unflavored hydrating liquid. I get my electrolytes when needed. I used to use it with Miralax when doing a colonoscopy prep. CVS brand tastes nasty. Pedialyte brand I like.
[www.pedialyte.com]