My Exatest and its lesson

Hi! Here's hoping this will be helpful:

For some time my blood pressure had been rising. I tried many things to control it, all the time reading up on the subject -- various drugs and their action, the RAAS, salt (sodium) restriction, diet. Studying 'The High Blood Pressure Solution' by Richard D. Moore, MD, PhD, I gave his reasoning a trial by upping potassium (K) intake "to the max", about 12 grams per day (I made sure my kidneys are fine), while eliminating table salt to see what might happen. The result after about a week was great BP, about 115 over 75. Then a strong salty taste on my lips developed, which I thought was probably from increased aldosterone / sodium retention by the kidneys. So I slacked off on the K, and the BP went back up to typical 160 / 90. With Dr. Moore's science validated, and wanting numbers for guidance, I ordered the Exatest kit to be sent to my doctor, who then did the painless scraping off of live epithelial cells under my tongue, sending the sample back to Cellular Diagnostics' lab for analysis. The results were significant. As I had expected, seven years of WW plus some supplementing had made IC magnesium nicely high, while the potassium / sodium ratio (Dr. Moore's "K Factor") was very low, below range.

Intracellular levels, mEq/L (range in parentheses):

MAGNESIUM: 41.5 (33.9 - 41.9)
CALCIUM: 4.6 (3.2 - 5.0)
POTASSIUM 85.5 (80 - 240) (very low)
SODIUM: 4.6 (3.8 - 5.8)
CHLORIDE: 3.9 (3.4 - 6.0)
PHOSPHORUS: 16.8 (14.2 - 17.0)

Intracellular elemental ratios:

PHOSPHORUS / CALCIUM: 3.7 (3.5 - 4.3)
MAGNESIUM / CALCIUM: 9.0 (6.1 - 12.2)
MAGNESIUM / PHOSPHORUS: 2.5 (1.8 - 3.0)
POTASSIUM / CALCIUM: 18.6 low (19.1 - 38.0)
POTASSIUM / MAGNESIUM: 2.1 low (2.4 - 4.8)
POTASSIUM / SODIUM: 18.6 low (19.4 - 38.9)

There was a big lesson for me in the low K/Na ratio. Being slow in taking myself to task by increasing K intake, I started having the weirdest arrhythmias. Frequently, without apparent cause, my heart rate would suddenly switch from ~60 bpm NSR to a steady 45 bpm (with wooziness from reduced blood flow), and some time later just as suddenly back to NSR. Never any other arrhythmia, no afib, just back and forth between ~60 and 45. I supposed that the sinus node (SN) was intermittently dropping out, leaving the atrio-ventricular (AV) node as pacemaker with its slower rate of 45. This went on for several days before I finally got the message (!) and gave the SN the potassium it needed to do its automatic pacemaking. I can imagine a worst case had I gone to the ER with this complaint: "Diagnosis: SSS" (sick sinus syndrome). Hospitalization. Maybe ablation of the SN, artificial pacemaker implantation, etc. Worst of all, nothing done to correct the underlying cause, namely intracellular potassium deficiency and low K/Na ratio affecting muscles, brain, kidneys -- all body cells and systems (see Dr. Moore's book), unrecognized because the serum potassium was "normal".

Exatest was developed by Burton Silver, PhD and colleagues to overcome serious limitations in all other ways of assessing electrolyte status. Exatest provides needed insight into cardiac malfunctioning. Perhaps there are others doing the same things, such as Dr. Jonathan Wright's Meridian Valley Labs [www.meridianvalleylab.com]. Serum values for Mg are without value in afib, can even be dangerously misleading by providing false assurance of normalcy while the heart and body cells and systems suffer from improper levels of electrolytes, or from improper ratios between them. Red blood cell (RBC) analysis can't determine Mg levels in metabolically active cells, although the word "cell" might make it seem that it does. Importantly it does determine the level of free Mg++ in SERUM (see Dr. Herbert Mansmann's web page [barttersite.org]). Serum K values can also be useless or misleading in afib -- it can be quite "normal" while IC levels are low, as in a case of IC Mg being low (magnesium is needed for release of the energy in ATP to power the pumping of K into the cells against its high concentration gradient). My heart's 'weirdness' was quickly corrected with potassium dosing, probably because of the high IC magnesium. I am now on a trial of spironolactone to see if this "potassium sparing' drug will bring about good blood pressure without having to take in so much potassium. I don't like some of its unique side effects, so i'll be looking into other drugs with similar K sparing characteristics: triamterene, amiloride.

It is my firm conviction that the first order of business for an afibber should be to determine the intracellular electrolyte levels. Even if paid 'out of pocket'. There might well be great eventual savings in cost, frustration, misery, and health if it should turn out to be a simple, correctable, electrolyte problem, affecting the entire body and brain, not just the heart. Check for insurance coverage -- Medicare covered my Exatest fully. Anything, but get the numbers so you know where you're going with your effort to get rid of the affliction. I've become convinced that afib is often a symptom of things wrong throughout, a 'blessing in disguise' wake-up call that can't be ignored. It was for me, a very fortunate one who got rid of afib 7 years ago by purely nutritional means when my Board Certified cardiologist and the EP doubted it was possible. It took a lot of reading, puzzling, trial and error and time, but if Exatest had been available at the time, and this great forum from Hans Larsen?

Best wishes!

Erling, 81, NSR.

Thank you, Erling, for this very important post and for sharing your knowlege and experiences. As Fran would say: Brilliant!

Certainly, your dramatic reversal of the initial afib, the increase/decrease in blood pressure and the last session with the node conduction serve as the most impressive documentation we’ve seen here in one person’s mission to conquer AF by addressing the root cause. It’s a true eye-opener. You’ve connected the dots. Congratulations!!! We can all benefit from your experience.

Moreover, I must apologize for being so ignorant with my misguided impression that the red blood cell evaluation is sufficient to measure magnesium levels. I finally ‘get’ that it is not. Thank you for beating me over the head with the proverbial 2 x 4. You have my full attention.

As you say, a new afibber will save a huge amount of time, energy and frustration if the Exatest is ordered immediately and the imbalances addressed accordingly. It will be money well spent. For those still struggling to conquer afib, this is the next vital step. Do the Exatest.

Thanks again for this.
Jackie

Readers here should spend time at the Exatest website… [www.exatest.com]

It’s hugely important to understand that the cells scraped from under the tongue are epithelial cells and directly reflect what’s also found in epithelial cells of the heart.

Conclusions from a few of the many research documents found on the Exatest website:

Conclusions Sublingual epithelial cell [Mg]i correlates well with atrial [Mg]i but not with serum
magnesium. [Mg]i levels are low in patients undergoing cardiac surgery and those with AMI. Intravenous
magnesium sulfate corrects low [Mg]i levels in AMI patients. Energy-dispersive x-ray analysis
determination of sublingual cell [Mg]i may expedite the investigation of the role of magnesium
deficiency in heart disease.

Epithelial and atrial [Mg]i levels were lower than in healthy individuals
studied at that time and correlated poorly with serum magnesium
[(Mg)i = intracellular magnesium]
[tiny.cc]

Conclusions Sublingual epithelial cell [Mg]i correlates well with atrial [Mg]i but not with
serum magnesium. [Mg]i levels are low in patients undergoing cardiac surgery and those
with AMI. Intravenous magnesium sulfate corrects low [Mg]i levels in AMI patients.
Energy-dispersive x-ray analysis determination of sublingual cell [Mg]i may expedite the
investigation of the role of magnesium deficiency in heart disease.
[tiny.cc]

Conclusion: Reduced tissue magnesium stores may represent a significant risk factor for arrhythmias associated with abnormal repolarization, particularly in patients...
[tiny.cc]

Costs for Exatest

I phoned Intracellular Diagnostics so that I could explain what’s involved about costs of Exatest.

The total billable cost is $570

For someone who has absolutely no insurance, the cost is $250.
It has to be someone who has no insurance and won’t try to pay the $250 and then submit to their ins co. after the fact. They use this fee as a ‘write-off’ or contribution to charity.

For Medicare – They bill Medicare who pays 80% of the cost – so 80% of $570 and then secondary insurance would pick up whatever is contracted for…assuming there is secondary. They handle all the paperwork and accept assignment which means there is no further billing on any balance.

For Private Insurance – the patient has to pre-pay $250 upfront along with copies of the insurance cards and they will file the claims. So it’s $250 plus whatever the insurance company allows. The patient has to works it out with the insurance company how to get back the upfront money. Because there are so many variables in insurance plans, deductibles, etc., they just collect that basic $250 and wait for the rest of whatever the ins. company sends to complete the transaction.

In some states, Quest labs will get test kits and submit but that particular lab has to phone Intracellular Diagnostics and make arrangements…so if a person uses Quest regularly, they should ask the lab if they will handle the Exatest and verify the cost.


[www.exatest.com]

You said:

"I've become convinced that afib is often a symptom of things wrong throughout, a 'blessing in disguise' wake-up call that can't be ignored. It was for me, a very fortunate one who got rid of afib 7 years ago by purely nutritional means when my Board Certified cardiologist and the EP doubted it was possible. It took a lot of reading, puzzling, trial and error and time, but if Exatest had been available at the time, and this great forum from Hans Larsen?"

The key word is puzzling. I have a strong feeling that many people who could get rid of afib by non-surgical means don't because they don't really believe that it's a problem that they can puzzle their way through. We're not used to being our own doctors. But after a rather insane amount of research, I've got my own problem well under control, with nary a doctor's visit.

And just like you, I've discovered that my problem was not my heart per se, but appears to be something else entirely. I wouldn't have known about it if arrhythmia hadn't clued me in.

Nick, great observations. I too believe there are underlying reasons for afib and when the body is off balance, it can lead to more serious things than afib and I too believe afib was my wakeup call.

I am finding more and more that if I fail on my potassium intake I get ectopic beats and I think that can be the first step to afib. I am going to try and talk my doctor into ordering the Exatest test for me as I thing I am good on Magnesium, but I think my body waste potassium. Thanks Erling for your observations too.

Sharon

Erling:

You said that you developed a "strong salty taste on your lips, so you slacked off on your potassium", why do you think that happened and what would that be an indication of?

I would like to see the same tests done simultaneously, blood/exatest, to see what the difference would be. Thank you for your article I am copying it to take to my holistic doctor this coming Monday.

Liz

Sharon:

You think we get afib because our bodies are off-balance, I would suspect most people's bodies are "off-balance" yet they don't develop afib. I firmly believe afib is inherent, it probably does develop when something goes awry in our bodies, sometimes balance can be restored but not always.

Liz

Jackie and Erling,

Thanks for these most informative posts. I find that Mg and K supplementation really do help me control my AF and skipped beats. I routinely get a good noght sleep thanks in large part to the supplementaion of K & mg et al. I do not take a good nights sleep for granted.

Erling
How did you address the very low K level. How effective was the treatment? How long did it take to normalize? If it is an IV infusion of K do you have to get this done on a periodic basis ? for the rest of your life?

Why do you think you have a very low K level after years of maxium K supplementation? Have you had your adrenal glands xrayed for abnormalities? Or is it enough to find out that your intracellular levels are low and just treat the low levels even though you may be treating symptoms?

Please forgive the flurry of questions but I am confused as to what to do on a step wise basis after you find out as Erling did that your levels are low.


Thanks,

Dennis

Hi Erling,

So a couple of questions - did you have a contemporaneous serum potassium test around the time of the Exatest? Also what form of K were you using to get the salty taste? How were/are you taking it over the day?

Would seem that potassium wasting would be the issue in your case - then the question is why. Certainly normal kidneys do that, but you seem to be on the extreme ed of it.

Cheers,

George

Liz - Louise recently posted that her serum potassium test was normal but the Exatest indicated she was low. That's probably a common finding.

The really interesting and most valuable findings of the Exatest are the ratios of the various electrolytes to the antagonists.... ie, sodium to potassium. If sodium completely dominates, then it's obvious why a person may be having trouble with controlling the afib. Same with the calcium:magnesium ratio.

Jackie

Erling:

Sorry for my fatuous question about what you thought was the cause of the salty taste, I re-read your post, you did answer it.

L

Hi Jackie,

Thank you very much for your supporting words, for your entire informative post, the important Exatest links and quotes. It's very good to see the growing interest.

Regarding RBC testing, you should never apologize. I remember well you're BB dialogue with PC to assure yourself that the magnesium level in RBCs was indeed equivalent to, or indicative of, the level in heart muscle cells. Coming from PC, we all accepted it. It was only when I stumbled upon Dr. Mansmann's paper (in my post) that it became apparent that RBCs don't accumulate more magnesium than they're 'born' with, which is the level in the serum at that time. Muscle cells must increase their magnesium level over that in the serum in order to be functional.

We will all appreciate having the detailed information on Exatest costs and insurance, hopefully encouraging many to 'just go for it'. Thank you for providing it. A question, though: If one has no insurance the cost is 'only' $250, but one would still have to pay for an (uninsured) office visit to have the test done -- or is there another way? It's completely non-invasive and painless, simple to perform, and the provided instructions are very clear and easy to follow.

Erling

Hi Nick!

"But after a rather insane amount of research, I've got my own problem well under control, with nary a doctor's visit."

That's absolutely wonderful! I applaud you and agree with everything you say. It sure does take a lot of puzzling - we both seem to be well equipped for it - but the payoff can be huge. When I came down with afib in late '95 I had recently retired from design engineering and its puzzles, so afib gave me something new to work on. Starting out with no particular interest in medical matters, my awful 'blessing-in-disguise' symptoms forced me to become interested. There was no Internet, no web for research, no afib forum, no email, no Exatest. The dark ages. No good information from the docs, just "lets try this drug and see if it helps you, here's a free sample," and "I think you ought to be on anticoagulation, here's a prescription and a lab referral". Left atrium ablation technology was in the future. But the thought of a lifetime of ever increasing attacks, coumadin, continuing doctor and ER and lab visits - this was unacceptable. I was determined to find a way out. All I could do was hole up at the local medical school library and puzzle. The breakthrough came the day I by 'chance' (seek and you shall find) found Dr. Mildred Seelig's 1980 book 'Magnesium Deficiency in the Pathogenesis of Disease' and opened it to Chapter 9, 'Magnesium Deficiency in Cardiac Dysrhythmia'. Imagine! This had been published 16 years previously! Based on research performed and published many years before that! Paul Mason put all 467 pages up on his fabulous website [mgwater.com], every section hyperlinked from 'Contents': [mgwater.com]

Keep puzzling, and be well! Erling

Yes, as Jackie indicates, I did find, thru my Exatest, that although my RBC levels of Potassium were in the normal range, my Exatest reading indicated that they were quite low. I doubled my Potassium, and all my ectopics dwindled away. Erling and Jackie are an amazing resource to all of us! I can't thank them enough.

Louise

Hi Erling,

Sheesh. Yeah, I realize I have it pretty easy, relatively speaking. Thank god for the internet.

Hi George,

Thanks for the thoughtful questions. Sorry about the late response.

1) Serum potassium was 4.6 mmol/L (9.2 mEq/L) on 11-11-08.
Exatest IC potassium was 85.5 mEq/L on 1-12 -09.

2) At the time of the salty taste I was using K gluconate powder added to the KCl in Low Sodium V8 juice, between meals, in addition to a high K food diet salted with KCl, a 'salt substitute'. This was my test of Dr. Moore's science in his 'The High Blood Pressure Solution'.

3) I agree, it would seem that my kidneys were wasting potassium -- at least at that time. Kidney functioning is a big head scratcher for me, but here's what I think I understand: It seemed reasonable to me that when the blood pressure lowered so nicely with the high K / low Na experiment, the kidneys didn't like it and responded to the low BP via the RAAS by releasing renin (R), producing angiotensin (A), releasing aldosterone (A) in a complex system (S) of blood pressure control. Kidneys need good blood flow for good filtering, raising BP to get it if necessary. Aldosterone causes the kidneys to 'waste' potassium to the urine while returning sodium to the blood, thereby raising blood pressure -- and causing the salty taste on my lips?. I took this "logic" to an endocrinologist, hoping for a good adrenal gland / steroid hormone work-up, but got nothing. I might try again with a different doctor. My present trial with 'potassium sparing' spironolactone might be worthwhile. I will have a repeat Exatest in January, PCP willing.

Thanks again, George. Your thoughts are appreciated.

Erling

Erling,

Just seen and read this thread - fascinating stuff. And enough to compel me to finally get my a$$ into gear and get the exatest done (I've already contacted Exatest and have all the info/my doc on board).

The kidney/RAAS issue is intriguing and I look forward to reading more posts from your good self as you unravel the puzzle - as I'm sure you will! I tried spiro about 7 years ago - ONE pill - and it had quite a profound effect on me as in I think I had more PACs (but no AF) in the 12 (or 24hrs - can't remember which) hours after that tab than at any other time I can think of. My serum K has varied between 4.1 and 4.9 over the last 10 years with no particular trend up or down over that time (last reading was 4.1), but it is clear to me now that the serum K levels totally do NOT at all reflect the all-important scenario in the heart cells. Interesting also about the RBC Mag - I'd always previously thought that indicative and had privately paid for a RBC mag test about 5 years ago (the results of which were - if worth anything at all... - low end of normal range. I also at that time had a Mg urine wasting test that came out at mildly-Mg-deficient. SOOO... Exatest here I come for some PROPER info! As well as 3g taurine, I currently take 400-800mg mag (from glycinate) and 3-4g K (50% from gluconate powder AND 50% from green coconut water), but without the Exatest as a base, I really cannot be sure how much good or otherwise I'm doing with my protocol......

Kind Regards,

Mike F.

Hi Dennis, sorry for being slow in answering your good questions:

> "How did you address the very low K level. How effective was the treatment? How long did it take to normalize? If it is an IV infusion of K do you have to get this done on a periodic basis for the rest of your life?"

My kidneys tested healthy in November 08 so when the weird rhythm hit I started at once with high dose K gluconate powder and Low Sodium V8 juice in addition to a high K diet. It took only a day or two for heart rhythm to normalize. Now my K comes almost entirely from food, as it did before I got careless about diet, leading to the dysrythmia. Be certain of good kidney function before using high dose oral supplementation of potassium!

> "Why do you think you have a very low K level after years of maximum K supplementation? Have you had your adrenal glands x-rayed for abnormalities? Or is it enough to find out that your intracellular levels are low and just treat the low levels even though you may be treating symptoms?"

To clarify, there had not been years of maximum K supplementation -- that was only for a few weeks some months previously to test Dr. Moore's blood pressure solution science, after which I stopped. The weird rhythm was a one-time glitch in a long history of NSR and was easily corrected, being stable NSR ever since. Having the Exatest numbers was very important. Again to clarify, the likely problem was the low ratio between K and Na, not the low K level per se. Biophysicist Dr. Moore makes the important point that the sum of sodium and potassium within the cell is a constant (Na + K = constant) meaning IC potassium can't be raised without simultaneously lowering the sodium, which although appearing quite normal on my report was actually quite high, considering my dietary Na content had been near zero for a long time. This is the reason I speculated on the role of aldosterone in this puzzle. I have not had the adrenals evaluated, but I might. I'm considering a check for renal artery stenosis, but the spironolactone I'm now taking might be enough -- it blocks the action of aldosterone, hopefully normalizing the Na/K ratio and the blood pressure.

I suggest starting with an Exatest evaluation, looking for clues in all values, especially in the all important ratios. I wish you well.

Erling

Hi Mike! Thanks for writing, it's good hearing from you. I apologize for not having replied a month ago when you asked for my opinion on your supplement program [www.afibbers.org] I looked it over, thought I had nothing of value to add to Jackie's comments, then ran out of time. Thanks for your kind comments.

Your timing is interesting in that just yesterday, out of the blue, I got an email from Alexandra at ICD, mentioning that Mike Forster had not yet put in an order. I'll forward it to you.

The RAAS issue certainly is intriguing and important in this heart rhythm puzzle. The March 04 CR session 26 by Hans should be visited for excellent information: "The Aldosterone Connection -- Breakthrough?" [www.afibbers.org] I recall PC at one time giving spironolactone a try, kidding about the gynecomastia side effect. Not a big deal for a short term, low dose trial. If effective I'll probably switch to one of the other 'potassium sparing' drugs. Interesting that you had such a reaction to it, from just one pill (!), possibly an important clue, a short term abnormal spike in serum K? PC at one time puzzled on the desirability of a home test device for real-time serum K. We should focus on the dynamic EC / IC potassium / sodium changes during the cardiac cycle (single heartbeat), in particular how the length (time) of the cells' refractory period (ARP, or AERP) is affected, how this correlates with normal / abnormal heartbeats. Interesting that the antiarrhythmic flecainide (Na channels) and tikosyn (K channels) affect the cells' ARP.

RBC Mg testing is of course very important - Dr. Mansmann calls it the "Gold Standard" for determining 'normomagnesemia' - but as with potassium it doesn't reflect the all important (to us) level within heart muscle cells.

I hope you'll post your exatest report, good stuff for us to chew on.

Best wishes, Mike!

Erling

Hi Louise,

Thank you for being a good listener! It's great to know that the ectopics are gone. Like the Red Green show guy always says, remember we're pullin' for ya, we're all in this together. Are you still on tikosyn? Any chance you might end up canceling your scheduled ablation by Dr. Natale? My wish for you is that you'll become so solid in NSR that you'll see no need for it. My only concern with ablation as a fix is that it eliminates a rhythm symptom without restoring to health the atrial cells that are possibly causing the problem in the first place, giving a false impression of 'cure'. If the nutritional / biochemical needs of the heart cells aren't being met, then neither are those of other cells, like the cells we think with, move with, see with.

Best wishes!

Erling

Erling - you asked:

"If one has no insurance the cost is 'only' $250, but one would still have to pay for an (uninsured) office visit to have the test done -- or is there another way? It's completely non-invasive and painless, simple to perform, and the provided instructions are very clear and easy to follow. "

One ablatee has just received the kit ordered by his doctor and he phoned Intracellular Diagnostics (Exatest) to ask if he could take the sample scraping (cells) himself and thereby avoid the office visit. They told him, yes, definitely and if he had any trouble, he could call them and they would help walk him through it.

That would avoid the extra fee for the doctor's visit. When the results are returned, there is an Interpretation Guideline included that spells out what the results of the test indicate.

When I had my test, I did it myself, but had my holistic chiropractor order in the test as he was a Medicare provider.

Jackie