Atrial fibrillation - Afib


(Bob ) #21

Tearing the order up a little, if circulating ketones slow the pulse and prolong the time between heart beat electrical complexes, that’s essentially what a Beta blocker does (as I understand it). When I had my first cardiologist visit (2014), he put me on one, which I get the impression is “here: take this for the rest of your life”. That and a baby aspirin a day.

The drawback to being on any medication is that if your own attempts to balance your minerals remove the root cause and you fix your arrhythmia problem, they’ll think the medication is what fixed you.


#22

The beta blocker metoprolol is very useful to treat atrial fibrillation. Doctors, and fair enough, then extend the logic of acute medical care into the realm of long term prevention. I had the same experience with a team effort between one set of emergency doctors (after cardioversion of my second (of 3) atrial fibrillation episodes) and my general practitioner doctor. i think it must be standard of care. So I went on metoprolol beta blocker daily for a week. My experience was that it was like chronic fatigue syndrome in a pill. i couldn’t get out of bed or off the couch. My blood pressure and heart rate went too low. We halved the dose with no improvement. Then my GP doctor took me off the medication.

Some confounders that may have led to my experience of the beta blocker being too effective were:

  1. I had concurrently started Magnesium orotate and potassium supplementation. Yes, I did advise my doctor.
  2. When a patient goes to emergency, and they monitor and treat, it becomes the start of an enforced intermittent fast (on IV fluid support), as the emergency team are always looking toward a possible cardioversion under general anaesthetic as a likely course of treatment. That fasting period can elevate blood ketones in a ketogenic eater. The betahydroxybutyrate ketone can complement the magnesium, potassium and pharmaceuticals, possibly, to overcorrect the fast heart rate.

(Bob ) #23

What a coincidence! :wink: Metoprolol is what I’m taking. Very common drug, cheap generic.

I didn’t have your reaction to it, and hardly notice being on it. I had been taking Diovan for blood pressure and they cut that in half since the Metoprolol is supposed to lower BP, too. Four years later, I still take both of them. My “resting” pulse is typically the low 60s.

My only disappointment with going keto is that I’ve heard of so many people who got off their BP meds and GERD medicines, and I’m still on 'em. I’ve tried to quit the Prilosec (low dose) that I take a few times but have never made it. The heartburn comes back worse than I used to have to when I started taking the stuff.


#24

“The active ingredient in PRILOSEC (omeprazole magnesium) for Delayed-Release Oral Suspension, is 5-Methoxy-2-[[(4-methoxy-3,5-dimethyl-2-pyridinyl)methyl]sulfinyl]-1H-benzimidazole, magnesium salt (2:1)”. https://www.rxlist.com/prilosec-drug.htm#description

interesting to see Prilosec is combined to a magnesium salt.


(Robert Hollinger) #25

Not sure it helps since you’re not on it but perhaps some of the effects of the medication may be relevant but…I am 99.9% sure my one instance of AF was directly caused by Lisinipril. My BP wasn’t controlled and they doubled the dosage. The AF started that day or the next. Every doctor has told me that’s nonsense but it is listed as a side effect and it is used to treat AF which means it is plausible it can cause it because it’s messing with those mechanisms.

I am also convinced that Benicar caused extreme tachycardia. again the day they doubled the dose (20 to 40mg) I was on the elliptical and barely exerting and my hr was up to 180 and I felt horrible.


(Bob ) #26

That is an interesting “coincidence”. I wonder how you could know, other than changing from Lisinipril to another BP pill?


(Bob ) #27

and if the “magnesium salt” behaves like other magnesium salts. Does the magnesium become available, or is it too tightly bonded to the rest of the molecule? Is our body able to break it down, or does the entire molecule go into the acid pumps in the stomach to shut them down?


(Robert Hollinger) #28

well I stopped taking Lisinpril and never had it happen again (t least that I noticed). Not exactly scientific …


(Bob ) #29

But what else can you do? Start the Lisinpril again and see if you get afib again? That’s a “no thanks” in my book.


(Robert Hollinger) #30

well if I wanted to be more scientific I could take one for the team…but…nah!


#31

Lisinopril is an ACE inhibitor. ACE stands for angiotensin converting enzyme.

“Lisinopril is used to treat high blood pressure (hypertension) in adults…” https://www.drugs.com/lisinopril.html

Hi Robert. Your observation can be right. Biology is complex. I hope you don’t mind if I dig into your experience with some thought exercises. Atrial fibrillation is an uncomfortable feeling, like falling in love, or an impending heart attack disaster, so it can start a whole cascade of stress hormone responses that can make the condition worse.

Looking at Linsopril’s physiological mechanisms, my observation (not a medical opinion. I am not a human doctor) is two things spring to mind. Doubling the dose is a bold move, but as long as it was still in the recommended dose range, it was probably ok to try. If that dose change suddenly dropped your blood pressure too low your heart would respond by beating faster. That faster heart rate response could then flip, trip, trigger an AF episode, if other conditions were favourable to AF like a concurrent electrolyte imbalance (as can happen with a ketogenic diet it seems).


#32

The second observation, and chain of thoughts, is that the ACE inhibitor medications like Linsopril may cause the kidneys to retain potassium. Increased circulating potassium can cause the heart rate to slow significantly, that’s why we should all be very careful with potassium supplementation, and why potassium supplements are at such low concentrations. when the heart slows significantly and there are long pauses between beats, then the heart may seek to normalise the rhythm of beats back to a more normal higher rate.

For example; if a heart rate is 48 (as some athletes boast*), but a normal sinus rhythm is 60 beats per minute, then the heart physiological mechanisms will start to insert extra beats into the long pauses between slow beats. These are premature heart contractions, and people feel them as palpitations or weird beats. If that state goes on for long enough, it can flip into atrial fibrillation. * To be fair to athletes, their ‘normal’ rhythm may be in the 40s. But if a medication puts a heart that is used to beating at 60 to 70 beats per minute at a much lower rate, then it is logical to think it would try to compensate.


(Robert Hollinger) #33

makes sense. not sure why doctors are so adamant that it couldn’t be the medication. they all wanted to play the blame game. it’s because you’re fat. just like the doctor who congratulated me when I was diagnosed type 2. (I really wish I could track him down with what I know now and let him know what an absolute @ss clown he is and that his recommendations are largely responsible for that condition. and the fact that doctors never checked insulin levels further implicates every doctor I’ve ever seen)

even a family member that is still licensed but doesn’t really practice went into hyper-defensive mode telling me it’s not possible and that it’s simply because I have all the risk factors. I get it. but how many people that have all the risk factors also are taking a medication that might have triggered the same types of conditions you described above? and how is it possible that there are skinny people that have AF? it’s obviously more complex than just lose weight.


#34

I’m going to try to link some ideas to generate some more questions, and/or plausabilities.

Robert, your experience of an AF episode in relation to sudden increased dose of an Angiotensin Converting Enzyme (ACE) inhibitor medication, made me think of a comment I made higher in the thread in discussions with @CFLBob.

We were surmising about the causes of the changes in electrolyte balance in pursuing a ketogenic way of eating. Bob mentioned the metabolism of glycogen stores leading to more body fluid loss, which in turn leads to electrolyte loss. Whereas I was thinking it had something to do with the effects of lowered insulin on the renin-angiotensin-aldosterone hormone system that helps regulate thirst and hydration. We’ve both probably got parts of the whole answer.

The angioteninogen part, from your Lisinopril experience/experiment, links into the renin-angiotensin-aldosterone thinking. I’m pretty sure Dr. Steve Phinney explains it more completely in his book, “The Art and Science of Low Carb Living”…

Anyhow, the point I wanted to get to is that there may be the possibility that ketogenic eaters may react and respond differently to medications for main stream (cardiac) patients due to physiological adaptations when in ketogenisis that may change basic physiology, such as electrolyte balance, from the considered norm. So we need to be careful with medication doses and ask our doctors about interactions with medications and a ketogenic metabolic state.


(Robert Hollinger) #35

granted in my case I was nowhere near ketogenic. I may have been relatively low carb or at least low processed carb because I was successfully controlling my type 2 without medication but I wasn’t particularly losing weight and definitely not in ketosis.


#36

Further, the altered state of ketogenisis, despite all its benefits, may have some only newly discovered consequences for health seekers. We start from a position of sub-optimal health, likely nutrient depleted, which may make explorers in this ketogenic way of eating more susceptible to unwanted side effects, like AF, from unmasking underlying, subclinical; making them clinical, individual physiological problems.

In the pursuit of health there is the high likelihood we will reveal our unhealthiness.

It, I think, means we should approach and pursue this ketogenic way of eating with care, follow the basics like adding enough salt, the right salt, and knowing our own health marker (lipids, electrolytes, biochemistry) status by getting regular monitoring tests done in cooperation with our medical practitioners. Then using supplements and adjusting the foods to improve the diet for our own, unique, individual needs.


(Madge Boldt) #37

Thanks for sharing your opinion. I was very surprised that my PCP thought that ketones could be a contributing factor. I have found nothing in the literature to support that statement.

My AFIB episode lasted for two days on and off. My rhythm has been solid for over a week, and an EKG on Monday proved that what I felt was reality - normal sinus rhythm.

I’ve been supplementing with magnesium for over 8 years (after initial AF diagnosis). I think the blood donation temporarily messed up the electrolyte balance, although bloodwork taken while I was in AFIB during that two day period was normal for NA and K. But I’ve also donated blood prior and had no issue, so it must have been a perfect storm of circumstances.

As others have stated, there are many factors that can cause an episode if you are paroxysmal. I was persistent before I had the corrective surgery 7 years ago, and no amount of supplementation, abstaining from caffeine/alcohol, and even vagal manuevers had any effect. In fact, prior to that surgery I did try a cardioversion. I stayed in rhythm for two months. I had no caffeine, no alcohol, no chocolate. But one night I slipped on the ice and as I got up, I felt my heart flip flop. Adrenaline! After that I was persistent again.


#38

Nourish Balance Thrive podcast has interviewed 3 people on this topic. Here is the latest.

http://www.nourishbalancethrive.com/podcasts/nourish-balance-thrive/critical-factors-healthspan-and-lifespan/

I am using the Kardia Mobile AFIB tester by AliveCor


#39

Thanks @Ketoe. Much appreciated. :smile: I’ll have a listen. I :heart: good quality podcasts. Do you have any links to the other 2 podcasts, perhaps? The two that have some information about AFIB and association with nutrition.


#40

Hi Franko,

  The website nourish balance thrive has all of their podcasts on the site I think one is an interview of Dr. Backx and the other one I do not recall. I know they may have a fourth one that interviews someone associated with kardia by alivecor. I believe you can do a search on their site if not you may be successful emailing them.

Please let me know how it goes?

Still running,

Ketoe