Thursday, June 17, 2010

Casein or Calcium from Dairy Exacerbates Palpitations?

I haven't posted in a long time, because I've largely completed my brain dump of what I've learned about MVPS and MVP from personal experience.

But I've been thinking lately about palpitations, and what makes them worse. I've gotten so good at controlling them that I can basically shut them off with diet and exercise protocol. As I've mentioned in the past, cheese appears to be a prime contributor. Cottage cheese and milk seem almost as bad. However, I can consume 50 or 100g of butter in a day, and have no palpitations at all. So I'm starting to revise my theory that omega-6 is the culprit, as it's present in all these. But casein is one of the few ingredients common to cheese, cottage cheese, and milk, but absent from butter.

I've also observed that some cheeses cause palpitations more intensively than others. The difference appears to be protein content; the more protein (equivalently, the less fat) by percentage, the worse the palpitations.

Now why would a dairy protein, which surely doesn't much influence blood viscosity, contribute to palpitations? I have no idea. I'm just following the data where it leads me. Perhaps palpitations are more influenced by heart rhythm than blood viscosity, and perhaps casein does something disruptive in this regard. If you're a cardiology PhD student, then you just found your thesis study topic!

I would be remiss if I didn't mention here how cheese made from grass-fed cows is rich in conjugated linoleic acid and vitamin K2, which may serve to protect us from cancer and thwart vascular calcification, respectively. But these nutrients are found in the fat. So you might switch from your skim or part-skim cheese to the richer stuff. But if it comes from grain-fed cows or a nonsense processed food company, look elsewhere. If you think I'm nuts, then read what this PhD neurobiologist and nutrition researcher has to say about the matter.

I have to wonder whether casein is also the culprit in the association between skim milk and prostate cancer, as described in this Reuters article. A friend of mine, who is as much a nutrition nut as I am, once told me that rodents who obtained more than 5% of calories from casein, developed atypically high rates of cancer. Consider that heresay, but perhaps you can Google around and find the data.

By the way, I finally got off my longterm addiction to milk last year. For that matter, I rarely consume cottage cheese anymore, either (although it's a good sugar-free calcium source). But I do eat a stick of butter every 3 days or so, an egg almost daily, and probably a 300g of cheese a week. My high-fat diet (which, critically, is omega-3-6-balanced) keeps me lean and allows me to avoid the "afternoon drowsies" so familiar to those who eat lots of refined carbohydrate.

In writing this, it just dawned on me that calcium, like casein, is common to most dairy foods except butter. I wonder if it's actually the calcium that's to blame. As this study and many others appear to confirm, low serum magnesium exacerbates MVP. Magnesium and calcium have similar chemical properties; the same can be said of sodium and potassium. We find that ions with such similarities tend to compete with one another in the body. I wonder if these high-calcium dairy foods are causing magnesium to be out-competed in its role in regulating heart rhythm, for a period of several hours following digestion.

Let's not forget that calcium is a necessary nutrient. I haven't noticed palpitations from other sources. Perhaps there is something about the dairy delivery mechanism of this nutrient that's to blame.

So it could be casein, calcium, both, or neither. If it turns out that casein or dairy-delivered calcium drives palpitations, then I want 5% of your Nobel Prize! ;-)

Friday, January 29, 2010

Red Wine and Mitral Valve Prolapse

Every month or so, I have a look at my blog statistics, which tell me which keywords people use to find me. Occasionally, the keywords themselves suggest new insights into the MVP(S) phenomena which I had never considered, particularly when I see multiple occurrences of similar word combinations at different times. Today, I found these three entries relating wine to MVP, which accounted for about 6% of this month's traffic from Google queries -- statistically significant, considering that any food might be suspected of causing PVCs, particularly those (unlike red wine) which most people associate with heart disease. Have a look:

1. what is the effect of wine on mitro valve prolapse?

2. wine chemicals mitral valve prolapse

3. "red wine" +"premature ventricular contractions" pizza

In the last case, I would bet that it was the cheese on the pizza. But taken as a whole, these queries suggest that there may be an association between wine and MVP. Even if such an association exists, it might not be causal, i.e. perhaps wine and cheese are indeed commonly consumed together, so people erroneously suspect that the wine is to blame for PVCs, when in fact the cheese is causing the problem (as discussed in previous posts). But then again, maybe not. Maybe the alcohol content in wine results in mild dehydration, promoting small blood volume changes or excessive water consumption that may result in PVCs.

Granted, I'm presuming that the first two queries were entered by people who had noticed a spike in their MVP activity (most commonly, PVCs or the associated head spins). But perhaps there was some other reason for these two. Still, it suggests an association between MVP and wine.

Incidentally, red wine appears to contain several compounds conducive to heart health. Ethanol is somewhat debatable in this regard: On the one hand, it dilates blood vessels, reducing the probability of arterial blockage. On the other, it's frankly a poison which the liver must work to neutralize. It may also serve to amplify the rate of absorption of the beneficial compounds, which are probably more soluble in aqueous ethanol than pure water. And while you could get all the same good compounds from grape juice, you'd also get plenty of fructose, which in my opinion is highly undesirable. For my part, I just pour the contents of a grape extract capsule (from Life Extension Foundation, with whom I have no affiliation) into water, and dissolve them. The result is cold grape skin tea -- not delicious, but an acquired taste, and probably a healthier way to obtain grape compounds than either wine or water.

Anyhow, I doubt that wine in moderation causes PVCs, but the queries are noteworthy. Looking at the very different query styles exhibited above, it appears that they were entered by three different people. So researchers, you might want to keep this in mind for your next study on MVP agonists...

Friday, October 30, 2009

The Art of Hydration, Part 2

As I discussed in The Art of Hydration, good hydration is particularly important for MVPS sufferers. But the catch is that, conventionally, sugar is an essential component.

Sugar intake causes your insulin level to rise temporarily, which in turn signals your cell membranes to open up in order to imbibe the sugar. When this occurs, it's possible to sneak water-soluble nutrients into through the membranes as well. That's why we feel hydrated by fruit with water.

I have no problem with this hydration methodology, in principle. As long as one uses berries for hydration, or exercises sufficiently after eating some other fruit, the temporary rise in blood sugar won't have much impact on longterm health. I would also add that flossing and brushing are critical, shortly after the fact.

But wouldn't it be nice if we could hydrate without sugar at all? In principle, a vitamin pill taken with water accomplishes this feat. But vitamin pills are loaded with excessive iron and manganese, and intuitively it can't be a great idea to subject sections of your digestive tract to ultrahigh mineral salt concentrations. And without sugar, your cells will be less interested in admitting the nutrients. What we need is a fat-soluble vitamin pill that can effuse through the cell membrane -- mostly fat itself -- without requiring the havoc induced by insulin.

Such a pill is the holy grail of low-carb dieters. It means that we can avoid the hazards of sugar, yet fully nourish our cells by feeding them nutrients bound to fat-soluble molecules. The lack of such a pill has been the reason why I've worked so hard to figure out how to hydrate with fruit, in such a manner as to minimize the impact on diabetes and gingivitis. It can be done, but it is, truly, an art.

Recently, however, I found that there is a fat-soluble multivitamin already on the market. I just happened to run across it during my compulsive browsing of nutrition literature. It's called a "sardine"!

That's right, sardines are loaded with nutrients too numerous to mention. Have a look at this data from Nutrition Data. All with zero carbs.

They are also one of the few low-mercury fish, according to Got Mercury. Note that the region in which they're caught also matters, with Norwegian brisling being some of the cleanest on the planet. This is due to their low position on the food chain, and the pristine waters in which they are caught. (You can't avoid methyl mercury in fish entirely. It has permanently entered the food chain, thanks to centuries of coal burning.) My favorite brand, with exceptional processing hygiene and delicious flavor, is King Oscar. The taste is slightly smokey, which probably means that they've been lightly smoked. But I don't worry about such low concentrations of carcinogens, in light of the extraordinary nutrient density. For the paranoid, you can eat them with 300mg of alpha lipoic acid, which loves to bind with free radicals and presumably heavy metals. And -- why not -- some tumeric to add an Indian flair and protect your colon from cancer.

When I eat these particular sardines, which I enjoy with steamed organic spinach and organic shiitake mushrooms, my hunger ceases about 10 minutes later and stays down for hours. It's like my body is saying: "Thanks for the nutritional bounty. I'm loaded." Even when I eat healthy nuts, my hunger takes much longer to shut down. Therefore, I suspect that it's the nutrient diversity, and not merely the amount of any particular one, which accounts for such thorough satiation. Indeed, I like the taste so much that I often crave another can. But for the most part, I just can bring myself to eat more. I'm full.

Now, you may notice that sardines are loaded with cholesterol. "What a shame," you say. I'm not worried in the slightest. Why? Because it would appear that the cause of cardiovascular disease is, among other hazards, oxidized deposits of cholesterol-rich plaque on the artery walls, as opposed to cholesterol in and of itself. The best way to oxidize your cholesterol is to smoke and eat sugar. After all, how could the Okinawan islanders of Japan live well into their eighties, despite eating high-cholesterol seafood in such high quantities? And why aren't French cheese connoisseurs dropping dead in droves? For an exceptionally high quality analysis of the available data, and some other great superfoods, visit Cholesterol and Health.

Take care. I'm gonna have an egg. Meanwhile, take a moment to radically improve your cardiovascular health by learning about vitamin K2, which is found in high concentrations in some cholesterol-rich foods, and prevents arterial calcification that can kill you!

When a Panic Attack, Isn't

A couple weeks ago, I managed to get a fever, which is rare for me. It spiked to 38.3C, whereas my normal is 36.0C. But I didn't bother going to the doctor because it appeared to be a typical seasonal flu. Instead, I stayed home and did the usual things necessary to deal with it.

My temperature slowly started to return to normal. But then, I awakened in the middle of the night with a tight chest and labored breathing. I thought it might be due to the almonds I'd eaten, to which I'm mildly allergic, but hopelessly addicted (which is only possible because I balance their high omega-6 fat content with sufficient omega-3 from other foods).

Whatever the cause might have been, the effect persisted, and I decided that I needed to see a doctor promptly, in case I was coming down with aggressive pneumonia or who-knows-what. It was about 5am, so I called a cab.

Now, a year ago, I had bought a great little pulse oximeter from Nonin Medical. It shows my blood oxygen saturation percentage, and heart rate. The reason was that I have sleep apnea, but sometimes I prefer to sleep without the aid of a CPAP. In that case, I want an alarm to awaken me if my oxygen drops to an unacceptably low level, which for my preference is 91%. So I simply put the laser clamp on my finger, and go to sleep. It has worked quite well, saving me from mild hypoxia on a number of occasions. Although, I do wonder whether it would actually extend life, as I get quite an adrenaline spike when the way-too-loud alert goes off in the middle of a night, which could in principle cause a stroke when lying down.

Back to the taxi. I brought my Nonin along in order to determine whether my groggy state was due to "fever insanity" or hypoxia. Unfortunately, I had dumped the batteries prior to my last plane trip, in order to ensure that the device would not pose any overheating danger while sitting in my luggage. So I had the cab stop at a convenience store. I picked up some batteries, and started monitoring myself.

I noticed that my heart rate was elevated, around 100bpm. (My normal baseline is 48bpm, up from 38bpm a few years ago, when I was doing 134 floors on the stairmaster in 20 minutes.) I figured it was just nervousness, and ignored it. The important thing was that my oxygen was 98% (my new normal, thanks to air pollution or perhaps a chronic mild lung infection, down from 99% a year ago, back in the USA).

When I got to the hospital, after relaxing in the waiting room a few minutes, they took my vital stats. My heart rate had fallen to 91bpm, which the nurse said was "normal". I looked at her, puzzled. I said my baseline was 48bpm. She asked if I was an athlete, and I said yes (albeit much less so than before my MVPS days). I was a bit nervous, but not excessively so, which made me wonder why my heart rate was so high. Maybe I was having a panic attack without being aware of it; I wondered how that could possibly work.

Finally, I got in to see the doctor. I asked him about the heart rate, and he explained that it was a normal consequence of my illness. Apparently, it's a defensive response to infection, just like elevated body temperature. He explained that it would remain elevated until I returned to normal temperature. That is, in fact, what happened.

So just because you're experiencing shortness of breath with a rapid heart rate, does not mean that you're having a panic attack. If you can manage to calm yourself, and the symptoms persist, it's probably something else, such as the flu. I learn something new everyday!

Saturday, September 5, 2009

Gingivitis, Periodontitis, Infective Endocarditis, and MVP

As anyone with MVP should know, infective endocarditis is a serious threat to heart valve health. It can occur when bacteria adhere to the leaflets, cemented in place by platlets, fibrin, and other material from one's own circulatory system. For mechanical reasons no doubt related to the fluid dynamics of the valve, it's evidently difficult for out macrophages (white blood cells) to locate and destroy such deposits. The longterm result can be premature valve decomposition, potentially requiring repair or replacement.

Historically, the American Heart Association (AHA) recommend prophylactic antibiotics for anyone with MVP, to be delivered prior to dental surgery or even cleaning. The theory was that such treatment would preemptively inhibit bacterial infection as a result of septic dental plaque seeping into the bloodstream. Although the theory may have been correct, the AHA recently concluded that the risk inherent in taking antibiotics actually exceeded the risk eliminated by preventing this very isolated, rare source of endocarditis. Antibiotic overuse runs of risk of resistant bacterial infection, liver stress, and the destruction of one's beneficial gut bacteria which serve as part of our digestive and immune systems.

Furthermore, the AHA concluded that "daily activities", taken in the aggregate, constitute a greater risk than occasional dental procedures. No doubt this includes flossing, which as we all know, produces bleeding gums for those of us with gingivitis (gum inflammation) and periodontitis (gum disease). They have since issued a revised recommendation.

Until a couple months ago, I had been fighting gingivitis and losing the battle. Now, I produce only faint amounts of blood when I brush and floss, well within acceptable safety limits. I'd like to tell you how I won the war.

Earlier this summer, I was producing oral blood flows lasting up to 30 minutes after the fact. This is not only a bacterial hazard. At some point, it constitutes a blood loss hazard. Indeed, recent blood tests indicated that my red blood cells were disproportionately young. In other words, my body was struggling to compensate for the blood I was losing orally. It got so bad that at one point, my gums would open and bleed in my sleep, probably due to the dry air in my bedroom. In the morning, I'd awaken with the familiar alkaline taste in my mouth, as blood has an alkaline pH of 7.4. I'd spit up telltale reddish yellow fluid, left to wonder just how much I'd leaked. Yikes!

The first step was to use Metrogyl, a topical oral antibiotic whose active ingredient is metronidazole. You can get this, or a superior alternative product, from your dentist. I just rubbed it on my gums and swished it between my teeth, then spat it out, before eating each meal. After a week of use, my bleeding level had subsided, but it still wasn't what I'd call safe. I was getting worried, particularly on account of the unflattering blood tests mentioned above.

I stopped after the recommended one-week course, as I didn't want to invite the longterm problems of antibiotic use. At this point, I decided to experiment with changes in dental and nutritional habits.

The first change I made was to floss every day, whereas in the past I had been sloppy about my flossing habits, particularly on days when I didn't eat much, or just ate vegetables. Now, I floss once a day, no matter what. I rinse my mouth with purified water after the fact, in order to get the junk out. I also don't brush when my gums are bleeding, as there's all sorts of nasty stuff in toothpaste, possibly including bacteria, that I don't want in my blood. Therefore, these activities are separated by a healing period of an hour or more. And perhaps it's better to brush first.

And when I floss, I make sure to get into both little pockets at the base of neighboring teeth. (Your teeth are curved inward where they meet the gums, creating a pocket on each side of the tooth.) So I go up and down at least twice for every gap that I floss. I'm not particularly gentle, either, as I've heard numerous dentists recommend that we allow our gums to toughen, probably due to the formation of scar tissue at a microscopic level.

While no longer necessary, during my heavy bleeding periods, I would swish concentrated salt water between my teeth before and after flossing and brushing, in order to keep bacteria to a minimum. You can experiment with the salinity; I was using about a teaspoon in 4 ounces of water, which is extreme. You can also gargle salt water to cut down the bacterial population in your throat, which no doubt feeds your gingivitis, to some extent. But don't swallow, and reduce the salinity if you can't do it without gagging.

One other dental tip: I'm careful not to brush my gums crosswise, which causes them to recede, exposing the boney roots of the teeth. I brush firmly in little circles, taking care to push up or down against the gumline -- never sideways.

The second change, to which I attribute most of my success, was dietary. Surprise, surprise, when I cut out sugar (including fruit, except for avocados and tomatoes), the gingivitis stopped within days. If I eat so much as a slice of watermelon, it comes back the same day. So now, despite my love of dragon fruit as I explained in an earlier post, I've switched to tomatoes as my source of quick energy and hydration. Even then, I only eat them when I feel dehydrated, or need fast energy for impending physical labor.

But I cut something else that most people don't consider junk food: dairy. Now, the only dairy product I eat is butter. Yes, it's high-cholesterol, high-saturated-fat food. But it satisfies (meaning that it prevents me from overeating), and is nonglycemic. You see, I found that drinking milk would always result in bad breath the following morning, aparently due to its sugar content. Cheese causes less of a problem, but still contains damaged milk protein due to pasteurization, which stimulates an invalid immune response because your body mistakes the protein for pathogens, resulting in increased systemic inflammation, which certainly won't ameliorate gingivitis. If you haven't heard of this, Google for the problems of dairy. You'd be better off not consuming this stuff, except perhaps for unpasteurized milk, which has its own hazards.

Of course, this leaves me with a calcium, magnesium, phorphorus, and vitamin D debt. (Protein is easily aquired from other sources.) But primitive humans didn't have milk (except as babies) or cheese, and survived just fine. So I get my calcium from brocolli (and to large extent, vitamin pills and Tums calcium tablets, both crushed and mixed with food so as to minimize the negative digestive impact); I get my magnesium from nuts; I get my phosphorus from pumpkin and sunflower seeds; I get my vitamin D from the sun and oral supplementation. I wish I had a better calcium source. Maybe I'll start taking chlorella. I'd rather not chew on fish bones, which might carry mad cow proteins, particularly if they're from farmed sources.

I also increased my uptake of brocolli and avocados, for their vitamin K content. Vitamin K helps the blood clot. If you can get it, parsley is the ultimate vitamin K source, but in most places, it's loaded with pesticide. Good for you if you can find the organic stuff.

Additionally, I started supplementing zinc, although I don't think this did much for my gingivitis, as I increased my intake weeks after it had already improved. Zinc is involved in the skin healing process. Be careful, though, as it's possible to overdose easily, as discussed in the Wikipedia article linked above. On the other hand, it's also very hard to acquire, as the best sources are bivalves like clams and mussels, which are often heavily polluted because they filter the water in their environment. I opt for zinc picolinate capsules, which are easily obtained at GNC or online. I pour the powder out and mix it with my food. As I've said in previous posts, I don't believe in "spike supplementation", i.e. giving the body massive, highly bioavailable injections of nutrients in the form of pills.

I made one other dietary change which won't apply to most of you. You see, my diet is so healthy, that my blood takes a long time to clot. (This is desirable because it reduces the probability of heart attack, stroke, and veinous thromboembolism.) The problem, clearly, is that at a certain point, my blood is so "thin" that my gingivitis refuses to heal up. And certainly, I need to discuss this with my doctor prior to any surgery. It also doesn't help if I get banged up in an accident! The change was this: in addition to increasing vitamin K intake, I cut back on grape extract and olive oil, both of which I love to consume, but which suppress plasma clotting factors, and thus platelet aggregation at the site of a wound. In parallel, I decreased my omega 3 intake, and increased omega 6, resulting in an increased clotting tendency. After my gingivitis subsided, largely due to my low-sugar diet, I increased my intake of these generally beneficial substances once again, to the maximum possible level short of inducing gingivitis. (I still moderate my olive oil intake, as it tends to dehydrate me, despite its benefits.) Indeed, most people in the industrialized world suffer from blood which clots too readily, so these measures probably do not apply to you (except perhaps for a week or so while attempting to close your gum wounds more rapidly, while you decrease sugar intake or apply topical antibiotics).

On the rare occasion that I need fruit, I floss and brush immediately afterward. Needless to say, this reduces my appreciation of the fruit to begin with, so I only do it when I need a massive burst of energy.

By the way, watch out for hidden sugar sources, such as the infamous high fructose corn syrup found in everything from ketchup to "healthy" wholegrain bread. Craving carbs? Have a bowl of lentils, spiced and buttered to taste!

By following these steps to combat your risk of infective endocarditis, you'll improve your health generally, and no doubt save money on dental work. To your health!

Thursday, May 21, 2009

Might MVPS Originate with Sleep Apnea?

As I speculated in this posting, MVPS and sleep apnea may reinforce one another. But when I recently discovered this report from 2005 by David L. Detrick, M.D. of the High Desert Sleep Disorders Center, I started to question whether, in fact, MVPS is the visible manifestation of sleep apnea on the sympathetic nervous system.

It's not the most readable document for the lay person, but anyone with basic physiology education will understand from the numbers and charts that, in fact, MVPS has substantial overlap with the neurological symptoms of sleep apnea. Granted, sleep apnea is primarily due to physiological impairments which affect proper breathing during sleep. However, as the report illustrates in substantial detail, the resulting intermittent hypoxia induces increased sympathetic nervous system function -- not merely related to individual hypoxic episodes, but increasingly persistent into daytime physiological stress metrics, including blood pressure, oxidative stress, and hormone levels.

Granted, not all MVP sufferers have MVPS. But for those who have the latter, I would highly recommend a sleep study in order to look for sleep apnea. (Because it is a diagnostic procedure like an xray, you insurance may cover most or all of the cost.) Sleep apnea is a stealth disease, in the sense that it may result in few detectable symptoms early on. It's also very treatable, with or without surgery. But when ignored, it's a serious risk factor for cardiovascular disease, stroke, and accidental death due to impaired alertness.

I definitely believe that MVP and sleep apnea are separate diseases with different causes. But when they coexist in a patient (which I suspect occurs more than randomness would dictate, on account of their mutual reinforcement as detailed in my earlier post), then the latter may produce the physiological syndrome which we know as MVPS. In the absence of MVP, the syndrome is simply regarded as the physiological side effects of sleep apnea.

My original thinking was that MVPS and MVP are parallel results of a single set of genetic errors. But, to summarize, I now suspect that MVPS may be the result of sleep apnea. We only think of it as being directly related to MVP because -- I suspect -- that MVP is coincident with sleep apnea more than randomness would dictate.

Some experiments would need to determine whether (1) to what extent MVPS sufferers have sleep apnea, vs. control and (2) to what extent MVPS symptoms subside pursuant to a few months of CPAP use. (A CPAP is a respiratory assistance device for the treatment of sleep apnea.)

If I'm completely wrong, then hopefully I will at least save a few lives by encouraging people to detect and treat sleep apnea before they suffer a stroke or heart attack.

Tuesday, April 7, 2009

A Brief Warning About Magnesium Supplements

As I mentioned in my earlier post about magesium glycinate, this supplement seems to work wonders against PVCs. And like all magnesium supplements, it provides a useful level of relief of musculoskeletal aches and pains. I'm not sure why, but there is plenty of literature about this, and it certainly seems to work for me. Finally, if it functions like dietary magnesium, then it's also neuroprotective, although I'm not certain as to equivalance in this case. (Although, I have heard that brain surgeons occasionally recommend magnesium supplementation prior to surgery, as a means of prophylactically minimizing damage to healthy neurons.)

However, overdoses of magnesium in any form can cause arrhythmias, hypotension, and confusion. The National Institutes of Health puts the tolerable upper intake at just 350mg for adults. This would be exceeded by a single dose of KAL 400mg (2 tablets of 200mg each). And of course, don't forget to include the amount in your vitamin pill. Note, however, that the NIH article linked above does not place a limit on dietary, as opposed to supplemental, magnesium. This is probably because the body absorbs dietary magnesium much more slowly, resulting in minimal disruption to homeostatis.

Anyway, this is just a quick reminder to not think of supplemental magnesium -- or any supplement, for that matter -- as always better in higher doses. Still, the tolerable upper intake is only a one-size-fits-all advisory for people with all manner of physiological differences. Use it as a guide, but take more or less depending on how you feel, discussion with your doctor, and relevant medical tests. In moderation, it confers significant benefits to many MVP sufferers. It may also positively affect MVPS, considering its involvement with the nervous system.

Fundamentally, I never take magnesium supplements unless I have PVCs or intolerable chest pain. I prefer, when possible, to obtain my nutrients from food. I don't want to train my body to depend on supplements (other than a few super supplements that I must take every day, such as resveratrol, which perhaps I'll discuss in a later post).

Oh, if you're wondering why I thought to write this post, it's because I discovered a long time ago that high amounts of magnesium supplementation seemed to dull my shortterm memory for a few days thereafter. I researched, and found the likely cause.

Finally, as with other supplements which disrupt electrolyte balance, I suggest taking it in tiny nibbles, waiting for 5 to 20 minutes in between. And of course, don't forget that cardiovascular exercise is one of the best ways to keep your heart rhythm in sync, and to lower your dependence on supplements.