To date, there appears to have been very little research into this connection. Yet, I believe these conditions are related more than statistical luck would suggest. Perhaps future studies will support this hypothesis. In the meantime, I would like to present the idea for your consideration, in the hopes that we might prevent further coincidence of these 3 costly diseases.
The connection between MVP and MVPS has been discussed in many places, this blog included. But I believe that each of these conditions has a direct relationship to sleep apnea, and more generally, sleep disturbances.
Sleep apnea refers to the condition in which you stop breathing in your sleep, usually due to a temporary collapse of the wind pipe. After many seconds or a minute, your brain notices the resulting oxygen debt, and shocks your heart with adrenaline. You awaken, gasp for air, and settle back to sleep. In the longrun, if untreated, stroke, cardiac arrythmia, or heart attack may ensue. Fortunately, there are a wide variety of treatments available. (In my case, I had a tonsillectomy to widen my airway, and use an auto CPAP to breathe better at night. As added protection, if I can't bring my auto CPAP with me, I keep a portable pulse oximeter wired to my finger, which blasts an alarm if my blood oxygen drops below a programmable threshold. Trust me, it was worth every penny.) Unfortunately, sufferers may go many years without diagnosis, as the only obvious symptom is fatigue, which can be caused by almost anything. From my own experience, I can confidently assert that apnea episodes become worse when I'm most exhausted. I can't explain why, other than, perhaps, the brain takes longer to send an awakening adrenaline spike when required, leaving me hypoxic for longer.
How MVP Influences Sleep Apnea
How could a leaky heart valve possibly relate to a collapsing trachea? Bear with me...
Here's what happens: MVP sufferers, as we know only too well, experience palpitations from time to time. These palpitations depend on the degree of valve malformation, as well as diet and exercise. They are easy to sense while lying in bed, as their vibrations reflect off of the mattress, and back into our bodies. It's as if someone were constantly tapping us on the chest while we're trying to sleep. It's not painful. But it is annoying, or even frightening in some cases.
As a result, we stay awake for hours, struggling to ignore the signal. And occasionally, a PVC will strike, startling us with momentary disorientation, often resulting in an adrenaline spike -- if not a panic attack -- which is hardly conducive to sleep. Meanwhile, we're getting increasingly exhausted.
Of course, the next work day won't cut us any slack. We still have to wake up at the same time in the morning. So after a bad night of flakey heart beats, we're ready to drop. Our exhaustion level may culminate in terrible apnea episodes for the reasons I suggested above. If you're lucky enough not to have apnea, you will still no doubt suffer from chronic exhaustion. Granted, pretty much every disease in the book can cause exhaustion. But if you're staying awake at night, trying to ignore your heart beat, it's not helping the situation.
I've tried meditation; I'm not good enough to make it effective to ignore the beats. Besides sleep aids, which are inadvisable because they harm the liver and invite bad apnea episodes, only a CPAP seems to work. But if you don't have apnea, I'm not sure if a CPAP would help you (or if you could even obtain one legally). I wish I had a better answer for you, apart from eating right, keeping in shape, and using safe doses of magnesium glycinate to treat the worst spells.
How Sleep Apnea Influences MVP
I alluded to this in my Intro article. Adrenaline spikes blast the cardiovascular system into action, rather like flooring the accelerator of your car. Just as racecar behavior isn't good for the longevity of your engine, I can hardly imagine that constant adrenalization is good for your heart valve (not to mention the rest of your body).
Sleep apnea results in massive adrenaline spikes because, frankly, we might well die of hypoxia without them. While this keeps suffers from dying in the shortterm, it threatens them with stroke and other problems in the longterm. And with respect to MVP, it most definitely increases the hydrodynamic pressure on the valve, rather like rapidly squeezing the water out of a balloon.
As far as I can tell, standard MVP advice is to avoid lifting heavy weights. (They never did tell me what "heavy" meant, but I get the general idea.) The reason for this, it seems to me, is that heavy lifting produces high pressure on the valve. Since the valve in MVP sufferers is already damaged, and abnormally flexible (due to the associated connective tissue abnormality), it is more likely to suffer damage than in a normal person, on account of the pressure induced by heavy lifting.
In this sense, a massive adrenaline spike is equivalent to heavy lifting: it spikes the blood pressure into the stratosphere, and thereby, over time, damages the valve.
As the valve worsens, more palpitations and PVCs occur. This in turn exacerbates the apnea, by the process described above. It's a viscious circle!
How MVPS Influences Sleep Apnea (and Sleep Quality, Generally)
This one is obvious: MVPS suffers are, if nothing else, hyperresponsive to adrenergic stimuli. In other words, if the phone rings, we leap from our chairs in terror, only to realize a few seconds later that the adrenaline spike was unjustifiable.
Since light and sound are adrenergic stimuli, we are easily awakened by nighttime sounds, or the morning sun cracking through the blinds. As a result, we awaken easily. This results in greater fatigue, which as I mentioned above, is a perfect storm for sleep apnea.
One remedy is to do like me, and wear blinders and ear plugs during sleep. Just be aware that some blinders do not "breathe" like cotton because they contain waterproof fabrics inside. In particular, avoid "airplane" blinders. In this case, they may cause your eyes and frontal brain to heat up, resulting in yet more discomfort. A strip of cotton cut from an old T-shirt might make a much more thermally conductive blindfold. Ear plugs are great to, but be sure you can hear your alarm through them. They also obviously need to be replaced every so-often for sanitary reasons. And most definitely, dry your ears with tissue paper before inserting them, in order to avoid harboring bacteria.
Finally, being an MVPS sufferer makes me hypersensitive to heat and cold. I frequently pull up the blankets at night because I'm too cold to sleep. In the morning, I awaken, sweating from the accumulated heat. This is a stress on the heart, but it's difficult to correct. The best I can do is to (1) turn the air conditioner or heater on half and hour before bed to stabilize the bedroom temperature and (2) keep multiple thin layers of blankets, so that I can precisely adjust the temperature throughout the night by adding or removing one at a time.
How Sleep Apnea Influences MVPS
This is perhaps the most disturbing interaction of all. But I've lived through it, so I can attest this interaction most precisely.
As I mentioned, sleep apnea involves periods of hypoxia in sleep. One awakens, gasping for air. (There is also another condition, known as sleep paralysis, which can result in the perception of hypoxia, and even gasping for air, when in fact no hypoxia occurs. This is one reason for the failure to properly diagnose sleep apnea. As I have both conditions -- more paralysis in the past, more apnea now -- you can imagine the test hell I went through, while the doctors played football with the data.) After suffering thousands of apnea bouts, I became deeply aware of the problem at some subconscious level. I got a few panic attacks just by feeling the sensation of my throat closing. The sensation may well have been real. It can be caused, for instance, by an allergic reaction to certain foods. (At the time, I was a walnut binger, but did not know that I was allergic to the skins.) The throat closure never resulted in any significant breathing impedance. It did, however, trigger some visceral memory of apnea episodes, immediately manifesting in a panic attack on these occasions. After all, if you get the sensation that you're being strangled, I assure you that your brain stem will get to work immediately to free you. But when you're not actually being strangled, a panic attack can result.
As a result of the above correlations, I would recommend that all MVP and MVPS sufferers get sleep studies to check for apnea and other sleep disturbances, and conversely that sleep apnea sufferers get echocardiograms to check for valve pathology.
I should caution that sleep studies are hopelessly flawed, in that we all have widely varying sleep quality, whereas these expensive ($2500) tests occur on a single night. Therefore, I always tried to create bad sleep conditions before the study, in order to make my problems obvious in the data. I told my doctor this, so that he would be aware that he is looking at a worst case, and not a typical one. Specifically, I would eat and sleep like a typical American the night and day before: I'd stay up late the night before, drinking caffeinated soda (to utterly ruin my sleep quality). The next day, I'd have pizza with lots of cheese (to create PVCs and sustain my excessive blood sugar level). Then, I'd go out for a run in the evening, to create lots of inflammation and rev my metabolism just before I need to go to sleep.
At one point, my preparations worked so well that I could not sleep at all during the study. They concluded that my failure to sleep was due to my inability to use a CPAP (which was incorrect, and subsequently cost me 2 years of bad sleep in the absence of such). However, thankfully, my doctor concluded (correctly) that I had a horrible case of sleep apnea, and dragged me into the operating room. The surgery brought me back from near-comatose to merely "dazed and confused". At this point, I'm only "tired". One day, I hope to fully awaken again. Until then, I hope I can help a few other people through this blog.
Anyhow, I would bet big money that there's more of a correlation than chance would dictate, among these diseases. Please consider this before you repeat my years of painful ignorance.
Tuesday, February 10, 2009
Friday, February 6, 2009
Why I Don't Do Low-Carb
Low-carb diets, such as the Atkins and Rosedale diets are a brilliant way to lose weight without feeling hungry. I was on the latter for over 2 years before switching to caloric restriction with optimal nutrition (CRON), which is probably the best diet currently known to science, in December 2007.
Low-carb is a proven weight-loss diet, but it's also popular among MVPS sufferers because it tends to keep blood glucose levels lower and more even throughout the day. That, in theory, reduces the adrenaline spikes that plague chronic candy eaters and soda drinkers. The problem is, low-carb diets impede proper hydration. As a result, they tend to create electrolyte imbalances -- particularly with regards to essential trace minerals -- which can in turn result in the familiar panicky MVPS symtomology. This is why I don't do low-carb. More on this hydration problem below.
The main theory behind CRON is that by eating fewer calories but not compromising on nutrition, we can live longer. This is accomplished by: (1) just like burning less fuel in a car keeps its engine cleaner for more years, burning less food in an organism creates less internal pollution; and (2) your body falsely concluding that the environment is lacking in food, necessitating the devotion of caloric energy toward tissue repair, instead of high athletic performance and reproduction. (There are some studies which suggest that, although sustained performance drops due to the low calorie budget, the body will, after a few months under sufficient caloric restriction, generate new mitrochondria (cellular batteries), resulting in increased peak performance.)
So yes, one's sex drive does drop somewhat, which in my opinion is a small price to pay for feeling so many fewer aches and pains (as CRON lowers inflammation). And on the tissue maintenance front, there is one notable exception: wound healing. If you get cut, you'll leak like a faucet, due to reduced platelet aggregation. This is apparently nature's way to ensure that you don't die of a heart attack or a stroke before you can find abundant food again, and reproduce. In my case, it also resulted in emergency surgery at one point, so CRON is not advisable in dangerous environments where injury is likely, or medical facilities are incompetent. Maybe I'll share that story in another post.
Sometimes, if I have a lot of physical work to do, I eat more. Basically, I try to eat what my physical workload demands, although I'm human and certainly have overshot sometimes. That's why I also take a number of powerful supplements, including resveratrol, to hopefully make up for my occasional gluttony. Still, I'm lean, although I'd like to get back to thin. Yes, thin men look less attractive to women, which is another price to consider. I sometimes think, for this reason, that CRON is better suited to women. What good is a long life, if we men can't find interested partners?
Anyhow, I followed the Rosedale Diet for over 2 years. In that time, I had a number of horrible spates of "insatiable thirst", in other words, the feeling of extreme thirst which was not satisfiable, no matter how much I drank.
After much trial and error, including plenty of blood tests, I finally nailed the problem. I would be surprised if other low-carb dieters didn't have the same issue:
The insatiable thirst problem
1. The Rosedale Diet didn't require me to count calories, so I'd consume massive amounts of pecans, and worse, almond butter, to satisfy my hunger. No doubt I exceeded the protein guidelines of the diet.
2. The high level of fat in these nut products blocked the absorption of water-soluble trace nutrients. I'm not sure whether this blockage occurred in the intestines or at the cell membranes, but it was obvious from my thirst that something was wrong.
3. I got blood tests from a kidney doc, but all was normal, probably because I took the tests in the morning, long after my kidneys had worked all night to restore homeostasis.
The problem got so bad, after 2 years, that I began to research hydration intensely. (You would think that this might have occurred to me earlier, but let's just say I'm a slow learner.) I discovered that sugar was actually required for hydration -- not for the reason that it provides energy, but because it triggers a rise in insulin. The insulin, in turn, instructs the cells to open their membranes to the blood, in order to imbibe sugar. In the process, they also imbibe other substances from the blood, in this case, trace minerals which are critical to proper hydration. (I don't want to come across as an advocate of the old theory that insulin's role is mainly as a sugar-regulating hormone, rather than a global metabolic regular. In this case, I'm just focussing on this one particular role.)
Now, if you consume very little sugar to begin with (because, after all, we're talking about low-carb diets), and on top of that, your system is clogged with fat (albeit the monosaturated variety found in almonds and pecans), you don't have much opportunity to jam water-soluble micronutrients into your cells. (That's why you need to shake oil-and-vinegar salad dressing; fats don't like to mix with water-soluble substances.) Worse still, I was taking my daily vitamin pill in a single shot, meaning that the sudden high influx of micronutrients was more likely to saturate the already-constricted transport system into the cells.
I caught on to all this when a friend of mine told me that body builders often dirnk grape juice before taking their muscle-building supplements. Apparently, they do this so that the cells will open up for the sugar, only to receive the supplements moments later, before they can close again.
Granted, I'm oversimplifying this: cells have many molecular portals for many different purposes. But it seems clear to me, if from none other than the personal experience of satisfying my own thirst, that sugar is an effective means of opening our cell membranes for long enough to feed them with micronutrients. After all, if you eat sugar, it makes you thirsty, which I would say amounts to a hormonal signal that our cell membranes have opened and are demanding water and micronutrients. Fat never does this.
Now, as any competent nutritionist will tell you, high blood sugar is proinflammatory and leads to any number of diseases. It might be the single most damaging cause of aging, next to respiration itself. So we have an obvious problem here: how do we hydrate effectively without inviting diabetes due to high blood sugar?
Let's start with the popular glucose theory: By now, must people are familiar with glycemic index (GI), which is basically a measure of peak glucose level pursuant to the consumption of a given amount of a given food, and glycemic load (GL), which is the total amount of glucose leached into the blood from the same. Soft drinks have an extremely high GI, in that they can rapidly raise your blood sugar. But you could eat a giant bowl of lentil beans with a much higher GL: even though the lentils will never raise your blood sugar as high as a few ounces of cola, they will, given many hours of digestion, eventually release more sugar into your blood.
Now, the theory goes that you'll prevent diabetes more effectively, by eating low-GI foods, with only secondary concern for GL. In other words, while lower GL is preferable, GI is what influences diabetes more profoundly. So dieticians constantly remind us to eat complex carbs instead of soft drinks, white bread, and fruit.
This is where I have some disagreements. Let's forget about sugar for the moment, and just look at nutritional value. We can throw out soda, white bread, crackers, French fries, and anything else that modern humans have squirted out of a factory and called "food". For the purposes of GL and GI analysis, that leaves 2 major sugar sources: complex carbs like those found in grains, legumes, and squashes, which eventually turn into sugar; and sugars like those found in fruits.
Imagine that you had a magic wand that could remove all the sugar and carbs from any food, instantly. Wave it at brown rice, and you'd have mineral-rich brown husks with a modest density of antioxidants. Wave it at a pumpkin, and you'd have omega-6-rich, fiber-rich pumpkin seeds. Wave it at almost any sort of berry, and you'd have a fibrous spherical shell loaded with some of the most healthful chemicals known, in high concentration.
In other words, minus the carbs and sugars, fruits -- particularly berries -- offer denser nutrition than do complex carbs. Critically, they tend to contain many nutrients that you can't find in a vitamin pill, unlike the popular trace minerals found in, say, rice bran. (OK, rice bran is rich in phosporous, which is hard to obtain, but have you ever tried to get over-the-counter pterostillbene or anthocyanin, found in blueberry skins?) It's also easier to extract the carbs and sugars from fruits, as they tend to lack the complex carbs found in grains, legumes, and squashes.
So what does this mean? It means that the sugar from fruit -- again, particularly berries -- rushes into our blood, leaving behind a cornocopia of healthy chemicals. Complex carbs, on the other hand, leach sugar into our blood all day long, causing the brain to become insulin-resistant, while at the same time paying us comparatively little in terms of beneficial chemicals.
The problem, of course, is GI: fruit -- even berries -- cause a huge spike in our insulin level, which is allegedly more prodiabetic than even the prolonged, but lower, insulin rise due to the slow digestion of complex carbs.
Now, remember that magic wand? We all have one. It's called "exercise". Think about it this way: if you eat of a bowl of blueberries, then hit the step aerobics class or the morning bike ride 15 minutes later, you interrupt your glycemic rise, diverting all that sugar into your muscle cells, where it gets burnt as energy. Instead of allowing high levels of sugar to remain in the blood or the cellular machinery itself -- where, in both cases, it would bind with functional proteins and cause horrendous damage, rather like putting chewing gum in your car's engine -- the process of respiration converts it into less toxic byproducts. Conveniently, the "berry chemicals" still floating in your blood will help deal with these byproducts, not to mention the air pollution you're inhaling during your exercise, from rubber gym mats or vehicle exhaust. Most likely, you'll also get a more effective cardio workout with some sugar fueling your cells, resulting in better fitness.
But what if we'd taken the low-carb approach? We're afraid of anything that might spike our blood sugar. So instead of cancer-suppressing blueberries, we eat lentil beans for breakfast, in a serving containing same number of calories. We get some trace minerals, but nothing that our vitamin pill doesn't give us anyway. We also get a lot more iron, which we don't want, as it starts to get toxic not far above the 100% RDA already found in our vitamin pill. We get some fiber, but the fruit also has this. We hit the gym a bit later (say after 30 minutes) because it takes longer to digest, meaning that our blood sugar will peak later. Unfortunately, the rise in blood sugar happens more slowly, so we're more sluggish with the cardio routine. Then, worse, after we're done at the gym, our blood sugar continues to be moderately elevated for hours while the beans digest. So there we are, sitting at the office, glycating our proteins to death, literally gumming up the mechanics of our biochemistry, while we sweat due to an accelerated metabolism which is struggling to dump its excess energy. Likely as not, we're also tired around midday, because our blood sugar is elevated. (Strange, isn't it, how both low and high blood sugar results in fatigue?) So there goes our economic productivity as well. Finally, when it's all over, we have what? Some minerals that we could have gotten from a pill, some fiber, and generally speaking, far smaller quantities of beneficial chemicals than we would have obtained from a calorically equivalent serving of berries.
Now, I do eat lentils, rice, barley, and other whole grain beans from time to time. (I never eat cereal or other bogus refined "foods".) However, I eat them because I enjoy them, and sometimes need variety -- not because they provide significant health benefits. Granted, on the rare occasion that I need to perform hard physical work all day, they provide a steady influx of blood sugar more effectively than do monofats such as olive oil and nut oils, which are a staple of my diet. So I do, on rare occasion, find their GI and GL properties useful. But generally, I gobble a few handfuls of blueberries -- or, on occasion, a less beneficial fruit that I just happen to crave -- and then head to the gym 15 minutes later. When I return, my blood sugar is back to about normal, but my blood is loaded with beneficial chemicals.
Be careful, of course, not to rot your teeth. Fruits tend to be acidic and sweet -- the perfect insurance for your dentist's secure retirement. Just brush after breakfast.
Thus, I try to match the blood-glucose-vs.-time curve of the foods I eat, with my physical workload in power-vs.-time, so that stable blood glucose can be maintained, while also providing the hydrating benefits of sugar consumption and a significant ingestion of beneficial fruit chemicals. Most blood glucose curves consist of a single spike, which then gradually fades into a normal (fasting) blood glucose level. By definition, the spike is steeper for high-GI than for low-GI. However, it tends to fade faster with high-GI than low-GI. That's because high-GI foods release their glucose rapidly, then have nothing more to give. If we can overlap a burst of physical exercise with the would-be-peak in blood glucose, then we can obtain the benefits of fruits -- especially berries -- without the proinflammatory downside. On the other hand, if we're planning to work in the yard all day, it would be more useful to load up on complex carbs, and burn them continually.
One note about glucose: we really shouldn't talk about glucose at all. We should be talking about insulin, or better still, its biochemical manager, leptin. Glucose is just one of many sugars which can create a rise in insulin. That's why 20th-century dieticians thought that they had found the answer to diabetes when they learned to cook with fructose ("fruit sugar"): fructose-sweetened foods triggered a much smaller rise in blood glucose (duh, because they contain fructose, not glucose). However, the proinflammatory and insulin effects are similar, resulting in the same pathology, which we call "type II diabetes". So while I refer to blood glucose just to allow a comparison between my glucose management approach, which is a dietary strategy, and GI and GL, which are glucose impact measurements, I would prefer to talk about "insulin management" (IM):
Insulin management (IM)
1. Provides the full hydration benefits of sugar consumption, without the damage. Exercise is used to prevent blood sugar spikes after eating fruit.
2. Provides a burst of energy for high-performance cardio, or sustained energy for sustained physical labor.
3. Provides all the benefits of anticancer fruit chemicals, without the sugar damage.
4. Provides delicious dietary variety.
5. Advocates monofats with sufficient omega-3 (chiely DHA and EPA from fish oil, or perhaps ALA from flaxseed oil) as a caloric staple.
6. Loads of veggies.
7. Sources protein from nuts, vegetables, and egg whites (not yolks).
8. Avoids all meat sources, due to toxins in the fat and high levels of the amino acid methionine, which some evidence suggests may shorten lifespan. A weekly serving of low-mercury fish, not caught in polluted water, is OK.
9. Avoids all dairy products, which cause PVCs and allergic reactions (notably nasal congestion), and contain high levels of the protein, casein, which has been substantially linked to cancer in animal models. Dairy is OK for brief periods of muscle building (which MVP sufferers probably shouldn't do very intensely anyway), but should be stopped when body mass plateaus.
By the way, numerous studies suggest that consuming high-GI foods with cinnamon reduces the intensity of the ensuing insulin rise. I hypothesize that this is because some molecule in cinnamon operates like insulin, insofar as the latter's cell-membrane-opening ability is concerned. What this means is that, if you dust your morning berries with cinnamon -- to the tune of about 1 gram per day -- you'll decrease your odds of type II diabetes even further. It will also give you a super energy burst in the gym. I did this once, with milk and cinnamon prior to swimming. I don't suggest it. My muscles got so much energy that I could no longer supply them with sufficient oxygen. I had to stop and relax.
As to that daily vitamin pill, I take half in the morning, directly after my fruit, while my cell membranes are wide open and ready to swallow the micronutrients. I take the other half in the afternoon, also usually with a handful of fruit -- a much small sugar dose than with breakfast. This separation keeps my electrolyte balance more stable, which inhibits MVPS symptoms. Be careful, though: vitamin pills are typically low in vitamin D, vitamin K, phosphorous, selenium, zinc, calcium, and magnesium. I eat brocolli for vitamin K (but you might prefer watercress, parsley, or spinach), unsalted pumpkin seeds for phosphorous, shiitake mushrooms for selenium, and supplements for the others.
I also take a number of supplements to protect myself from sugar and pollution. Remind me to post them in the future.
Until next time. I think I'll have a blueberry-strawberry-cinnamon salad in the morning before I hit the gym. Oh yeah, and it doesn't hurt that I consume about 18 pounds of organic broccoli-cauliflower mix per week. I steam it for 5 or 6 minutes in the microwave, just to the point of caramelization (in which the sugars flow to the surface), resulting in a satisfying meaty taste with no burn marks. Throw on some pecans, olive oil, a dash of pepper, and a table spoon of tomato sauce, and you have a very satisfying IM-compliant meal!
Low-carb is a proven weight-loss diet, but it's also popular among MVPS sufferers because it tends to keep blood glucose levels lower and more even throughout the day. That, in theory, reduces the adrenaline spikes that plague chronic candy eaters and soda drinkers. The problem is, low-carb diets impede proper hydration. As a result, they tend to create electrolyte imbalances -- particularly with regards to essential trace minerals -- which can in turn result in the familiar panicky MVPS symtomology. This is why I don't do low-carb. More on this hydration problem below.
The main theory behind CRON is that by eating fewer calories but not compromising on nutrition, we can live longer. This is accomplished by: (1) just like burning less fuel in a car keeps its engine cleaner for more years, burning less food in an organism creates less internal pollution; and (2) your body falsely concluding that the environment is lacking in food, necessitating the devotion of caloric energy toward tissue repair, instead of high athletic performance and reproduction. (There are some studies which suggest that, although sustained performance drops due to the low calorie budget, the body will, after a few months under sufficient caloric restriction, generate new mitrochondria (cellular batteries), resulting in increased peak performance.)
So yes, one's sex drive does drop somewhat, which in my opinion is a small price to pay for feeling so many fewer aches and pains (as CRON lowers inflammation). And on the tissue maintenance front, there is one notable exception: wound healing. If you get cut, you'll leak like a faucet, due to reduced platelet aggregation. This is apparently nature's way to ensure that you don't die of a heart attack or a stroke before you can find abundant food again, and reproduce. In my case, it also resulted in emergency surgery at one point, so CRON is not advisable in dangerous environments where injury is likely, or medical facilities are incompetent. Maybe I'll share that story in another post.
Sometimes, if I have a lot of physical work to do, I eat more. Basically, I try to eat what my physical workload demands, although I'm human and certainly have overshot sometimes. That's why I also take a number of powerful supplements, including resveratrol, to hopefully make up for my occasional gluttony. Still, I'm lean, although I'd like to get back to thin. Yes, thin men look less attractive to women, which is another price to consider. I sometimes think, for this reason, that CRON is better suited to women. What good is a long life, if we men can't find interested partners?
Anyhow, I followed the Rosedale Diet for over 2 years. In that time, I had a number of horrible spates of "insatiable thirst", in other words, the feeling of extreme thirst which was not satisfiable, no matter how much I drank.
After much trial and error, including plenty of blood tests, I finally nailed the problem. I would be surprised if other low-carb dieters didn't have the same issue:
The insatiable thirst problem
1. The Rosedale Diet didn't require me to count calories, so I'd consume massive amounts of pecans, and worse, almond butter, to satisfy my hunger. No doubt I exceeded the protein guidelines of the diet.
2. The high level of fat in these nut products blocked the absorption of water-soluble trace nutrients. I'm not sure whether this blockage occurred in the intestines or at the cell membranes, but it was obvious from my thirst that something was wrong.
3. I got blood tests from a kidney doc, but all was normal, probably because I took the tests in the morning, long after my kidneys had worked all night to restore homeostasis.
The problem got so bad, after 2 years, that I began to research hydration intensely. (You would think that this might have occurred to me earlier, but let's just say I'm a slow learner.) I discovered that sugar was actually required for hydration -- not for the reason that it provides energy, but because it triggers a rise in insulin. The insulin, in turn, instructs the cells to open their membranes to the blood, in order to imbibe sugar. In the process, they also imbibe other substances from the blood, in this case, trace minerals which are critical to proper hydration. (I don't want to come across as an advocate of the old theory that insulin's role is mainly as a sugar-regulating hormone, rather than a global metabolic regular. In this case, I'm just focussing on this one particular role.)
Now, if you consume very little sugar to begin with (because, after all, we're talking about low-carb diets), and on top of that, your system is clogged with fat (albeit the monosaturated variety found in almonds and pecans), you don't have much opportunity to jam water-soluble micronutrients into your cells. (That's why you need to shake oil-and-vinegar salad dressing; fats don't like to mix with water-soluble substances.) Worse still, I was taking my daily vitamin pill in a single shot, meaning that the sudden high influx of micronutrients was more likely to saturate the already-constricted transport system into the cells.
I caught on to all this when a friend of mine told me that body builders often dirnk grape juice before taking their muscle-building supplements. Apparently, they do this so that the cells will open up for the sugar, only to receive the supplements moments later, before they can close again.
Granted, I'm oversimplifying this: cells have many molecular portals for many different purposes. But it seems clear to me, if from none other than the personal experience of satisfying my own thirst, that sugar is an effective means of opening our cell membranes for long enough to feed them with micronutrients. After all, if you eat sugar, it makes you thirsty, which I would say amounts to a hormonal signal that our cell membranes have opened and are demanding water and micronutrients. Fat never does this.
Now, as any competent nutritionist will tell you, high blood sugar is proinflammatory and leads to any number of diseases. It might be the single most damaging cause of aging, next to respiration itself. So we have an obvious problem here: how do we hydrate effectively without inviting diabetes due to high blood sugar?
Let's start with the popular glucose theory: By now, must people are familiar with glycemic index (GI), which is basically a measure of peak glucose level pursuant to the consumption of a given amount of a given food, and glycemic load (GL), which is the total amount of glucose leached into the blood from the same. Soft drinks have an extremely high GI, in that they can rapidly raise your blood sugar. But you could eat a giant bowl of lentil beans with a much higher GL: even though the lentils will never raise your blood sugar as high as a few ounces of cola, they will, given many hours of digestion, eventually release more sugar into your blood.
Now, the theory goes that you'll prevent diabetes more effectively, by eating low-GI foods, with only secondary concern for GL. In other words, while lower GL is preferable, GI is what influences diabetes more profoundly. So dieticians constantly remind us to eat complex carbs instead of soft drinks, white bread, and fruit.
This is where I have some disagreements. Let's forget about sugar for the moment, and just look at nutritional value. We can throw out soda, white bread, crackers, French fries, and anything else that modern humans have squirted out of a factory and called "food". For the purposes of GL and GI analysis, that leaves 2 major sugar sources: complex carbs like those found in grains, legumes, and squashes, which eventually turn into sugar; and sugars like those found in fruits.
Imagine that you had a magic wand that could remove all the sugar and carbs from any food, instantly. Wave it at brown rice, and you'd have mineral-rich brown husks with a modest density of antioxidants. Wave it at a pumpkin, and you'd have omega-6-rich, fiber-rich pumpkin seeds. Wave it at almost any sort of berry, and you'd have a fibrous spherical shell loaded with some of the most healthful chemicals known, in high concentration.
In other words, minus the carbs and sugars, fruits -- particularly berries -- offer denser nutrition than do complex carbs. Critically, they tend to contain many nutrients that you can't find in a vitamin pill, unlike the popular trace minerals found in, say, rice bran. (OK, rice bran is rich in phosporous, which is hard to obtain, but have you ever tried to get over-the-counter pterostillbene or anthocyanin, found in blueberry skins?) It's also easier to extract the carbs and sugars from fruits, as they tend to lack the complex carbs found in grains, legumes, and squashes.
So what does this mean? It means that the sugar from fruit -- again, particularly berries -- rushes into our blood, leaving behind a cornocopia of healthy chemicals. Complex carbs, on the other hand, leach sugar into our blood all day long, causing the brain to become insulin-resistant, while at the same time paying us comparatively little in terms of beneficial chemicals.
The problem, of course, is GI: fruit -- even berries -- cause a huge spike in our insulin level, which is allegedly more prodiabetic than even the prolonged, but lower, insulin rise due to the slow digestion of complex carbs.
Now, remember that magic wand? We all have one. It's called "exercise". Think about it this way: if you eat of a bowl of blueberries, then hit the step aerobics class or the morning bike ride 15 minutes later, you interrupt your glycemic rise, diverting all that sugar into your muscle cells, where it gets burnt as energy. Instead of allowing high levels of sugar to remain in the blood or the cellular machinery itself -- where, in both cases, it would bind with functional proteins and cause horrendous damage, rather like putting chewing gum in your car's engine -- the process of respiration converts it into less toxic byproducts. Conveniently, the "berry chemicals" still floating in your blood will help deal with these byproducts, not to mention the air pollution you're inhaling during your exercise, from rubber gym mats or vehicle exhaust. Most likely, you'll also get a more effective cardio workout with some sugar fueling your cells, resulting in better fitness.
But what if we'd taken the low-carb approach? We're afraid of anything that might spike our blood sugar. So instead of cancer-suppressing blueberries, we eat lentil beans for breakfast, in a serving containing same number of calories. We get some trace minerals, but nothing that our vitamin pill doesn't give us anyway. We also get a lot more iron, which we don't want, as it starts to get toxic not far above the 100% RDA already found in our vitamin pill. We get some fiber, but the fruit also has this. We hit the gym a bit later (say after 30 minutes) because it takes longer to digest, meaning that our blood sugar will peak later. Unfortunately, the rise in blood sugar happens more slowly, so we're more sluggish with the cardio routine. Then, worse, after we're done at the gym, our blood sugar continues to be moderately elevated for hours while the beans digest. So there we are, sitting at the office, glycating our proteins to death, literally gumming up the mechanics of our biochemistry, while we sweat due to an accelerated metabolism which is struggling to dump its excess energy. Likely as not, we're also tired around midday, because our blood sugar is elevated. (Strange, isn't it, how both low and high blood sugar results in fatigue?) So there goes our economic productivity as well. Finally, when it's all over, we have what? Some minerals that we could have gotten from a pill, some fiber, and generally speaking, far smaller quantities of beneficial chemicals than we would have obtained from a calorically equivalent serving of berries.
Now, I do eat lentils, rice, barley, and other whole grain beans from time to time. (I never eat cereal or other bogus refined "foods".) However, I eat them because I enjoy them, and sometimes need variety -- not because they provide significant health benefits. Granted, on the rare occasion that I need to perform hard physical work all day, they provide a steady influx of blood sugar more effectively than do monofats such as olive oil and nut oils, which are a staple of my diet. So I do, on rare occasion, find their GI and GL properties useful. But generally, I gobble a few handfuls of blueberries -- or, on occasion, a less beneficial fruit that I just happen to crave -- and then head to the gym 15 minutes later. When I return, my blood sugar is back to about normal, but my blood is loaded with beneficial chemicals.
Be careful, of course, not to rot your teeth. Fruits tend to be acidic and sweet -- the perfect insurance for your dentist's secure retirement. Just brush after breakfast.
Thus, I try to match the blood-glucose-vs.-time curve of the foods I eat, with my physical workload in power-vs.-time, so that stable blood glucose can be maintained, while also providing the hydrating benefits of sugar consumption and a significant ingestion of beneficial fruit chemicals. Most blood glucose curves consist of a single spike, which then gradually fades into a normal (fasting) blood glucose level. By definition, the spike is steeper for high-GI than for low-GI. However, it tends to fade faster with high-GI than low-GI. That's because high-GI foods release their glucose rapidly, then have nothing more to give. If we can overlap a burst of physical exercise with the would-be-peak in blood glucose, then we can obtain the benefits of fruits -- especially berries -- without the proinflammatory downside. On the other hand, if we're planning to work in the yard all day, it would be more useful to load up on complex carbs, and burn them continually.
One note about glucose: we really shouldn't talk about glucose at all. We should be talking about insulin, or better still, its biochemical manager, leptin. Glucose is just one of many sugars which can create a rise in insulin. That's why 20th-century dieticians thought that they had found the answer to diabetes when they learned to cook with fructose ("fruit sugar"): fructose-sweetened foods triggered a much smaller rise in blood glucose (duh, because they contain fructose, not glucose). However, the proinflammatory and insulin effects are similar, resulting in the same pathology, which we call "type II diabetes". So while I refer to blood glucose just to allow a comparison between my glucose management approach, which is a dietary strategy, and GI and GL, which are glucose impact measurements, I would prefer to talk about "insulin management" (IM):
Insulin management (IM)
1. Provides the full hydration benefits of sugar consumption, without the damage. Exercise is used to prevent blood sugar spikes after eating fruit.
2. Provides a burst of energy for high-performance cardio, or sustained energy for sustained physical labor.
3. Provides all the benefits of anticancer fruit chemicals, without the sugar damage.
4. Provides delicious dietary variety.
5. Advocates monofats with sufficient omega-3 (chiely DHA and EPA from fish oil, or perhaps ALA from flaxseed oil) as a caloric staple.
6. Loads of veggies.
7. Sources protein from nuts, vegetables, and egg whites (not yolks).
8. Avoids all meat sources, due to toxins in the fat and high levels of the amino acid methionine, which some evidence suggests may shorten lifespan. A weekly serving of low-mercury fish, not caught in polluted water, is OK.
9. Avoids all dairy products, which cause PVCs and allergic reactions (notably nasal congestion), and contain high levels of the protein, casein, which has been substantially linked to cancer in animal models. Dairy is OK for brief periods of muscle building (which MVP sufferers probably shouldn't do very intensely anyway), but should be stopped when body mass plateaus.
By the way, numerous studies suggest that consuming high-GI foods with cinnamon reduces the intensity of the ensuing insulin rise. I hypothesize that this is because some molecule in cinnamon operates like insulin, insofar as the latter's cell-membrane-opening ability is concerned. What this means is that, if you dust your morning berries with cinnamon -- to the tune of about 1 gram per day -- you'll decrease your odds of type II diabetes even further. It will also give you a super energy burst in the gym. I did this once, with milk and cinnamon prior to swimming. I don't suggest it. My muscles got so much energy that I could no longer supply them with sufficient oxygen. I had to stop and relax.
As to that daily vitamin pill, I take half in the morning, directly after my fruit, while my cell membranes are wide open and ready to swallow the micronutrients. I take the other half in the afternoon, also usually with a handful of fruit -- a much small sugar dose than with breakfast. This separation keeps my electrolyte balance more stable, which inhibits MVPS symptoms. Be careful, though: vitamin pills are typically low in vitamin D, vitamin K, phosphorous, selenium, zinc, calcium, and magnesium. I eat brocolli for vitamin K (but you might prefer watercress, parsley, or spinach), unsalted pumpkin seeds for phosphorous, shiitake mushrooms for selenium, and supplements for the others.
I also take a number of supplements to protect myself from sugar and pollution. Remind me to post them in the future.
Until next time. I think I'll have a blueberry-strawberry-cinnamon salad in the morning before I hit the gym. Oh yeah, and it doesn't hurt that I consume about 18 pounds of organic broccoli-cauliflower mix per week. I steam it for 5 or 6 minutes in the microwave, just to the point of caramelization (in which the sugars flow to the surface), resulting in a satisfying meaty taste with no burn marks. Throw on some pecans, olive oil, a dash of pepper, and a table spoon of tomato sauce, and you have a very satisfying IM-compliant meal!
Wednesday, February 4, 2009
Intro
DISCLAIMER: I am not a doctor, and this is blog is not intended to diagnose, treat, or cure any condition. My intention here is simple: after going through hell for 2 years with mitral valve prolapse syndrome (MVPS), as opposed to merely mitral valve prolapse (MVP), largely left to discover the causes and effects empirically, I want to benefit other suffers by sharing what I've learned. Use it as a launchpad for your own research, and to suggest questions for your cardiologist, neurologist, or other medical expert. Above all, I would like to share some practical suggests for symptom management, if not improvement in the underlying pathology.
Bear in mind that MVPS is still a hotly debated syndrome, with some doctors questioning its mere existence. Herein, from firsthand experience, I will present my own definition. Eventually, I suspect that the medical community will define which symptoms are and are not associated with this condition.
By the way, some research has indicated that MVP may be inherited or spontaneous. However, according to Scordo (see book references below), it does not appear in babies at all, and thus develops as one's genome interacts with the environment over time. Perhaps this implies that MVPS follows the same pattern, although this is uncertain due to ambiguity in its definition.
So call me Mitral Mike. In 2006, I was diagnosed with mitral valve prolapse using an echocardiography, which essentially means that I have leaky heart valve.
The events leading up to this diagnosis, and following it for about a year, constituted the hardest and most terrifying part of my life. Perhaps I'll tell you my story later, but right now, I'd rather focus on helping you get well.
Let me begin by telling you the bottom line: In April, 2007, I ended up on the floor of my apartment, hyperventilating intensely for probably half an hour, with my vision gradually going blurry at the periphery, and tightness in my chest. I could hardly breathe. I could hardly move. Waves of terror radiated through my brain, each one passing like a suffocating wave. I clawed my way across the floor to my cell phone, and struggled to dial my friend's number.
Now, in January 2009, I live profoundly free of fear, in a way which I never imagined humanly possible even before my diagnosis; and the symptoms of my MVPS are rare and fleeting, and though they may startle me, do not result in persistent panic. I can tell you how I accomplished the first part, but you probably won't believe me, so let's just focus on the clinical stuff that we can address empirically, which I hope will help you manage your symptoms.
Consider the following books as essential supplemental reading. I'd suggest reading the Scordo book before the Hendricks book. Jointly, they started me on the path to wellness, which I have gradually augmented with my own symptom management techniques, often based on tips from discussion sites on the internet. (Not everything on the Web is junk, you know. You have to experiment and research carefully for yourself.)
Suggested Reading
1. Taking Control: Living with the Mitral Valve Prolapse Syndrome by Dr. Kristine A. Scordo
2. Conscious Breathing: Breathwork for Health, Stress Release, and Personal Mastery by Gay Hendricks, PhD
Because MVP is comparatively well-defined and understood, this blog is mostly about MVPS. In my view, MVP is one of many symptoms of MVPS. However, because heart valves are easy to analyze scientifically, compared to "panic attacks" or the other subjective symptoms of the latter, the former was deemed the disease, and the latter, one of its side effects . In reality, I think that a small set of genes is the cause, and the heart valve anomaly just happens to be the most obvious effect. Frankly, I would not be surprised if it turned out that decades of heart-pounding adrenaline attacks characteristic of MVPS contributed to the heart valve pathology that is MVP. (However, MVPS cannot be the entire cause of MVP, as we do know that MVP is also associated with a connective tissue disorder, which would at least partly explain the infirmity of the valve leaflets, and thus perhaps their susceptibility to damage by adrenaline-induced heartrate acceleration.)
As this article from Emedicine puts it:
"Besides the symptoms attributable to the MR, various neuroendocrine and autonomic disturbances occur in some patients with mitral valve prolapse. In these patients, prolapse may be an epiphenomenon of the underlying autonomic or neurohumoral illness. The term mitral valve prolapse syndrome is often used to refer to the collection of these manifestations. However, in a significant proportion of patients, the mitral valve prolapse is trivial, and no such associated manifestations are present. In these patients, mitral valve prolapse constitutes an essentially benign condition."
Common MVPS Symptoms
1. MVP.
You can have all the other symptoms of MVPS, and not have MVP. Or occasionally, the reverse may be true. This is further evidence that there is a common genetic cause to most aspects of MVPS, including MVP; MVP does not cause MVPS and visa-versa, perhaps with exception of adrenaline-induced valve pathology, about which I conjectured above.
2. "Head spins" and "mental resets".
Sudden disorientation, lasting about a second, and directly pursuant to
premature ventricular contractions (PVCs).
I am not talking about syncope (fainting), although this does occur in a minority of patients. When these events occur, I get the sensation that time has skipped a fraction of a second, and perhaps the room is spinning for this brief moment. The spinning is not persistent, as would be the case with vertigo. Most likely, the "time skippage" is due to the brain reacting to a very unexpected sudden alteration in the heart rhythm, which has the side effect of temporarily suppressing conscious thought. (After all, it's well known that our thought processes largely switch off in emergencies; to the uneducated brain stem, a change in heart rhythm is definitely an emergency.) The more severe PVCs, when I used to get them (I get only little ones now), could jolt my brain so hard that I'd forget the last few seconds of thoughts.
I'm not kidding about this. One night, when I was having massive and frequent PVCs, I did a little experiment: I would think of several words, and imagine corresponding images in my mind. For example, I would think "apple" and simultaneously see an apple in my mind's eye. Then, as soon as I realized that I had suffered a PVC, I would go back and try to remember the last 5 words. Again and again, I would remember only the first 3 or 4; it was always the last word(s) that were missing -- those which I was thinking about at the time of the PVC. It would appear that these head spins have the effect of hitting the reset button on shortterm memory, which would certainly explain the perception of "time skippage".
If you're wondering whether these events are due to something else, I've had 3 full brain MRIs. Except for a spot which was tracked by 3 neurologists and found to be benign (perhaps the result of a bicycle accident when I was younger), no pathology is evident, such as an arteriorvascular malformation, which might otherwise explain the above. And these events are 100% correlated to a time period of about 5 seconds after the sensation of a PVC in my chest. Case closed.
I've also considered that, because PVCs are preceded by "weak beats", i.e. the heart beats once very hard in order to compensate for the previous beat being too weak, it's possible that the head spins are actually due to temporary brain hypoxia. While you can hold your breath for much longer, and still think clearly, it's possible that the temporarily reduced blood pressure associated with a PVC causes brain hypoxia much more rapidly, resulting in the perceptions described above. But as I mentioned above, I think there is a second mechanism at work, which is the brain stem's obsession with perfect heartbeat: the strange sensations are partly due to the brain stem briefly switching into panic mode, then (usually) back out of it, in response to an unexpected irregular heart beat. Occasionally, particularly with larger PVCs, the brain stem fails to exit panic mode, in which case cognitive thought processes remain suppressed, and a full-fledged panic attack (discussed below) may ensue. In any event, PVCs are merely one of many causes of MVPS panic attacks, the latter being discussed more below.
3. Orthostatic hypotension (or more generally, low blood volume).
If you feel light-headed when you stand up quickly, you may simply have too little blood in your system to keep your brain fully oxygenated during this exercise. Your heart may beat more rapidly (tachycardia) in order to compensate, but it may be unable to do so quickly enough due to the leaky valve. In some sense, this is a desirable condition, since it may imply that you have low blood pressure (which I think is a better problem than high blood pressure).
There are a few easy measures you can take to mitigate this problem:
(1) As you rise from your chair or bed, inhale over the course of the rise. This creates increased pressure in your chest, which tends to sustain higher blood pressure. Actually, fighter pilots use a similar technique to maintain consciousness during high-G-force manoeuvers: they wear "G pants", which squeeze their legs at the proper time in order to prevent their blood from draining from their heads to their feet. Thus, by inhaling over the course of a few seconds as you stand up, the increased blood pressure will help keep blood in your brain.
(2) Stand more slowly. If 2 seconds is too fast, take 3. Or 5.
(3) Keep hydrated. For one thing, this means that you always have sufficient liquid in your body for optimal performance. As a result, your blood volume is larger, which means that the pressure will be slightly higher, allowing you to more easily maintain brain oxygenation as you stand. But make no mistake: hydration isn't just about water! You need salt (and, in my opinion, a proper balance of all required trace minerals). You also need sugar. (For all the bad press that it has received since Dr. Atkin's diet, sugar not only keeps you alive, it induces insulin to open your cell membranes, allowing nutrients to go where they are needed. For this reason, I think it's better to eat superfruits like berries, followed by your morning workout; than complex carbs like beans, followed by you sitting at a desk, or worse, going to bed. I also think caloric restriction is superior to a calorically unrestricted low-carb diet. Anyway, remind me if I forget to post my Atkins rant!) For now, just remember: hydration is critical to the management of orthostatic hypotenion and MVP itself, but hydration does not mean binging on distilled water!
4. Intermittant and migratory chest pain.
If you have any sort of chest pain, you need to identify the cause immediately in order to rule out life-threatening conditions. Just because your chest pain is characteristic of MVPS does not mean that it's due to MVPS.
Anyway, MVPS chest pain seems to focus on certain areas -- in my case, the upper right pectoral muscle, and occasionally the right side of the sternum -- but grow, shrink, and move from time to time.
Most doctors seem to be convinced that MVPS chest pain does not come from MVP. Indeed, there is a small (but in my opinion, still meaningful) statistical significance to the number of MVP sufferers reporting chest pain, compared to non-MVP-sufferers. (See Scordo's book, and of course Google, for the numbers.)
I would say, incontrovertably from my own experience, that chest pain can indeed result from MVPS. I say "incontrovertably" due to the evidence of precise time correlation: my chest pain would be worst immediately following an adrenaline burst. Think about it: an MVPS-induced adrenaline burst is associated with an increase in sympathetic nervous system activity, which results in an increase in pain sensitivity (i.e. never take caffeine before a visit to your dentist); second, adrenaline bursts pound on the cardiac and respiratory system, rather like flooring the accelerator of one's car, inevitably resulting in aches in the chest.
Most doctors say that MVP does not cause chest pain. There is some evidence that MVP does cause chest pain under certain pathological conditions, potentially due to mechanical stress on the valve or the heart's attempt to compensate for lower efficiency. Nonetheless, I think that most MVP sufferers who experience chest pain do so due to MVPS-related hyperadrenalization, and not MVP.
In my case, the evidence could hardly be more compelling: when the adrenaline burst occurs, the pain flares up; both usually subside within a minute. This is a clear correlation between the MVPS-induced adrenaline bursts and chest pain. But the relationship goes deeper than that:
Sometimes, however, post-burst pain would remain for hours, occasionally giving rise to the sensation of a heart attack. Why? In my case, which is no doubt not unique in this regard, it would persist because I had consumed large doses of inflammatory foods the same day: sugar, simple carbs, or (especially) cheeses (including cottage cheese).
Cheeses, in particular, seem not only to cause more lasting chest pain, but also an increased incidence of PVCs. The lasting pain may result from the high omega-6 content in cheese, which is proinflammatory. Cottage cheese contains more protein and less omega-6, but it causes increased PVCs as well, if not extended chest pain. I could be wrong about the omega-6 theory. But test it yourself: cheese of any type will result in increased PVCs within 6 to 12 hours (or if you already eat it, cut it out for a few days and monitor the effect). There's something in these dairy products which causes this. To a lesser degree, the same happens with milk. Omega-9-rich olive oil, and omega-3-rich fish and flaxseed oil, do not have this effect. Coconut milk, which is rich in saturated fat but is not a dairy product, seems to produce little or no increase in PVCs. Thus, perhaps, it's something else. Lactose? I don't know, but the effect is unmistakable.
Frankly, it might not be a chemical issue so much as a blood thickness issue: eating dairy products may increase blood viscosity, in particular by raising plasma triglycerides. Thicker blood puts more hydrodynamic drag on the valve leaflets. This is the main reason why boats move more slowly than airplanes: water is much more viscous than air. So axe the cheese from your diet, and closely monitor the effect on PVC number and severity. Cutting out cottage cheese, milk, and coconut milk may also help to some extent, but potentially to the detriment of your calcium and protein intake. (I take "Tums" as a supplement after breakfast, but no dairy products or coconut milk, and hardly ever have PVCs anymore.)
Interestingly, when I eat organic peanut butter, I do not experience an increase in PVCs, despite the obvious high viscosity and high omega-6 content of this food. This may be due to: (1) the fact that I pour off all the peanut oil into the trash before eating the "dry" butter, (2) the fact that it's rich in niacin, which is good for the heart, and (3) its high vitamin E content, which is antiinflammatory. By the way, organic peanut butter contains large amounts of the antioxidant, p-coumaric acid, which is actually increased by the otherwise oxidative roasting process used to produced roasted peanut butter.
Superdark (85%+) chocolate bars also do not cause me increased PVCs, despite having a high saturated and omega-6 fat content. This is consistent with the generally accepted principle that the moderate consumption of dark chocolate (particularly the nonalkalized variety) is conducive to cardiac health. But this would appear to contradict my theory that PVC intensity and frequency relate primarily to blood viscosity. However, superdark chocolate probably does not significantly increase plasma tryglycerides. Hmm... maybe my "Triglyceride-Induced PVC" theory is true.
My worst bout of chest pains ever, followed by a horrendous hyperventilating panic attack, was preceded by a night of gorging on pizza cheese without the crust. (What do you do when you're on a low-carb diet, and you're out with the guys, who have nothing to offer you but pizza? Smart answer: starve. Dumb answer: gorge on mozerrella, and flirt with disaster.)
5. Panic attacks.
These events are characteristically preceded by the sensation of a wave or cloth washing through the entire head for about a second, most perceptible on the face, and may or may not have an obvious environmental cause.
Many doctors (who no doubt do not have MVPS themselves) think that the panic attacks associated with MVPS are somehow indirectly due to the patient becoming anxious about his/her newly identified "heart problem". While such a discovery, however benign, might make anyone anxious, I can tell you from deeply personal, visceral experience that the "bad" news is not the cause of the panic attacks. Having analyzed myself under conditions of sudden extreme terror (which I assure you, is possible, albeit difficult), they result largely from one of the following causes:
(1) a PVC which temporarily interrupts normal blood rhythm to the brain, triggering some sort of massive sympathetic nervous system response in the brain stem, as suggested by the recent discovery that the brain monitors the heart rhythm with a level of diligence hidden to our conscious mind, to which I alluded in the above discussion of head spins;
(2) a sudden change in electrolyte balance, as by ingesting a large dose of potassium (e.g. low-sodium vegetable juice or several bananas) or highly bioavailable iron (e.g. eating a vitamin pill on an empty stomach, or eating more than 100g of dark chocolate in a day);
(3) a sudden change in body fluid volume (and probably therefore blood pressure and electrolyte concentration), as by urinating or donating blood;
(4) a very light wind which cools and tingles the skin, and thus mimics, to the unconscious mind, certain perceptions of electrolyte imbalance;
(5) the memory of any of the foregoing;
(6) the consumption of large amounts of chocolate (especially dark or organic) or walnuts, both of which produce migraine with aura in sensitive individuals, triggering fear and panic, and entirely separate from the bioavailable iron panic pathway related to the former.
6. Unusually flexible joints.
This is most obvious in the fingers. This is the connective tissue anomaly so often mentioned in MVPS literature. In the presence of chronic stress, it probably aids the gradual deformation of the valve, which ultimately manifests as MVP. According to Scordo's book, essentially no one is born with MVP; it develops as one ages. My theory is that when one combines the frequent adrenaline bursts of MVPS with overly stretchable connective tissue, then the result is eventually a floppy valve that doesn't quite snap shut. It's kind of like stretching a rubber band too many times; eventually, it becomes less inclined to snap back into its original shape.
It would be interesting to study whether teaching children with MVPS to suppress excessive adrenaline releases would manifest in a lower rate of MVP later in life. I guess the medical community must first decide on a clinical definition of MVPS!
More on adrenaline bursts below.
7. A depressed or indented sternum -- a "breast bone valley".
8. Scoliosis.
9. A straight spine, which I take from the literature to mean a spine without concavity at the base.
10. Electrolyte hypersensitivity.
Sensitivities to sudden changes in electrolytes, particularly involving potassium or iron, as discussed above. Critically, if you have MVPS, do not donate blood before speaking to your doctor. If you have the low blood volume typical of many MVPS sufferers, it could cause you to faint in response to blood donation. (It happened to me in 2004, at a blood drive at work. I wondered, at the time, why I couldn't tolerate the process as well as much much less fit colleauges!)
My first bout with electrolyte sensitivity was in around 1998. I had just had a visit to the dentist. During this particular visit, the dentist removed a number of mercury-silver fillings. Even today, dentists continue to use mercury-silver amalgum in fillings because they assert that they leach only trivial amounts of mercury. I might agree, but when they're heated and aerosolized during removal, I think it's possible that a dangerous amount of mercury is released.
Now, I knew about this threat, and knew that it might be preempted by injesting a vitamin pill (to thwart further mineral absorption) and vitamin C (which chealates heavy metals). However, I forgot to take either before the appointment. So immediately afterward, I headed to the nearest drug store and bought a bottle of vitamin pills, as I was on the way to work, and had no time to return home.
When I arrived at work, I ingested 3 vitamin pills in rapid succession. (DO NOT do this.) Worse, on account of the dental appointment, my stomach was empty. So an hour or so later later, I had something like 300% RDA of iron (beyond the tolerable upper intake level) flowing around in my blood.
Rapidly, my skin became numb at the surface, causing a "pins-and-needles" sensation. Though I may have made some slight progress in inhibiting the blood plasma uptake of mercury from the intestines, I had given myself some level of iron poisoning. I spent the next hour or so slowly and carefully sipping water, and urinating myself back to homeostasis.
Nowdays, I keep a 7-day pill organizer full with all my supplements, including multivitamins, to ensure that I get sufficient but not excessive nutrition. I even break my vitamins into a couple pieces for ingestion at different times of day, in order to maintain more stable plasma electrolyte levels and systemic hydration.
11. Chest tightness.
Diffuse but possibly intense, often mistaken for anxiety-related chest tightness, but persistent for days at a time, and only marginally relieved by sleep.
This tightness is constricting, rather like wearing a sweater that is much too small. However, it is distinct from the migratory chest pain described above.
This was one of the worst symptoms of my MVPS. I think, in my case, it related to the onset of sleep apnea which went undiagnosed for years, for which I have since received corrective surgery. It would not surprise me if there were a correlation between MVP, MVPS, and sleep apnea, as the latter increases adrenaline stress on the heart, and contributes to panic disorder, on account of terrifying hypoxic episodes.
Here's how I fixed my chest tightness, which at times was so intense that I could hardly get enough air to walk (this, after being a near-Olympian just days prior to the hyperventilation attack in April, 2007 that started the tightness): I tried all manner of foods -- eating more or eating less -- trying to discover a cause or find relief. Finally, after months of work, I discovered that salmon, milk, and shiitake mushrooms -- and nothing else in my diet -- relieved the condition to some extent; milk was the fastest. Truly perplexed by how these radically different foods were acting in a common way, I did some homework.
But first, I sought professional help. I had several doctors tell me that it was all just stress-related. In a sense, they were correct: MVPS was stressing out my autonomic nervous system, resulting in this problem. But in the sense of anxiety, they were wrong. I felt happy most of the time. In fact, I could generally breathe better when I was angry, perhaps due to improved respiratory function under the influence of adrenaline. On the other hand, I could be perfectly content with life, and the tightness would be there. The severity was mostly dependent on whether or not I was asleep, and on how recently I had had one of these "magic foods". It was also somewhat better in the morning than the evening. The worst tightness was immediately after exercise, suggesting that it had something to do with hydration, blood pressure, and electrolyte balance.
It turns out that the magic foods are all excellent sources of vitamin D (as D2 or D3), which is otherwise very hard to obtain (except from solar exposure). Somehow, vitamin D was allowing me to get some degree of chest tightness relief. Not surprisingly, I was subsequently diagnosed with a vitamin D defficiency (18, where optimal is something like 40-60, depending which study you read). (Just in case you think the docs always have the answers, I was the one who suggested the test, based on my empirical analysis. Sure enough, I was short on vitamin D.)
Using 800IU daily supplements, I cured the defficiency over a period of months. However, the tightness persisted to some extent. That's when my friend introduced me to Hendrick's book about breathing, noted above. Combined with yoga, it completely fixed the problem. My chest is so relaxed now that I no longer practice yoga, but I probably should. In fact, for a while, I was so relaxed that I had to encourage myself to adrenalize a bit on the highway, for safety reasons. As far as I can tell, these focussed exercises allowed me to reprogram my breathing rhythm, reducing the tightness.
The final piece of the solution was getting surgery to alleviate sleep apnea. With a wider airway, I was no longer struggling to breathe during the daytime, and my chest tightness has never returned since.
12. Adrenaline bursts.
These events occur seemingly without cause, manifesting in a pounding heart, as though you is about to crash your car, when in fact you may be relaxing on the beach. If you have these, check with your endocrinologist for other rare conditions such as adrenal tumors. But likely as not, this is just MVPS. I used to have these, until intensive self-monitoring allowed me to intervene and arrest them before they could occur.
Everyone gets adrenaline bursts when they're nervous. They are an important part of our fight-or-flight mechanism: if a tiger is about to eat you, it's time to run! Psychologists have long known that this ancient wiring causes stress reactions in our bodies today, despite the fact that we don't need to run from a dentist, or use super strength to invest in a crazy stock market. In short, our wiring has not kept pace with the shift in the nature of our threats, from physical to psychological.
The adrenaline bursts characteristic of MVPS are similar to anxiety-related adrenaline releases, but they are overexpressed. And typically, many more occur per day than one's stress load would otherwise suggest. For example, I would get terrifying heart poundings every time the phone rang. I would, of course, calm down, but not before slamming my heart valve and respiratory system for this completely unjustifiable reason. At my worst, I had probably a thousand perceptible spikes per day, which on average is one every several seconds for many hours.
Low-carb diets are often touted as a solution to such hyperadrenalization. In my case, it only made things worse. The reason, I think, is that hydration is difficult with these diets because the high fat content inhibits the absorption of water-soluble nutrients, particularly in the absence of sugar. At the time, I didn't realize this. As a result, no doubt, my electrolyte concentrations varied much more throughout the day than they should have, which no doubt contributed to the problem.
Positive imaging is commonly suggested as a solution: psychologists often tell us to imagine a beautiful beach scene when we're under immense stress. I think this only causes more stress, as it reminds us that we might not survive long enough to get there! In my case, it offered no help at all.
One of the most significant improvements came with medical hypnosis. I went to a medical hypnotist who, believe it or not, was recommended by my endocrinologist who did the vitamin D test. After a single session, I experienced approximately a 75% reduction in daily adrenaline spike count. It cost $300, but in my case, was highly effective. Part of the reason for my success is that I knew that the spikes were almost never justifiable, and thus had an irrational basis of activation, likely related to subconscious activity in the brain stem. Because I knew that the response was irrational, it was easier to combat with the help of a hypnotist; otherwise, I am virtually immune to hypnosis. After yoga and certain mental focus exercises, my adrenalization dropped so low that, as I mentioned above with regards to chest tightness, I had to struggle to adrenalize enough to avoid traffic accidents!
One other technique for minimizing adrenaline bursts may be to eat garlic or garlic gelcaps. There is ample evidence that they lower blood pressure, and seem to promote mood stability, perhaps via seretonin regulation. I haven't done much research on this, but I've read enough on reputable websites to recommend that you research it. At the very least, it might make your dinner taste better.
13. Plasma magnesium defficiency
According to this 1997 study, some cases of MVP are caused by plasma magnesium defficiency. Though magnesium defficiency as examined in the study is strictly a cause of MVP and not MVPS, I suspect that it also relates to the latter, as magnesium is critical for neurological function, implying that defficiency may contribute to the hyperadrenergic symptoms observed in MVPS sufferers. Note that the study does not say "insufficient dietary intake of magnesium", but rather refers to plasma (blood) levels of the element. So while you may get sufficient magnesium in your diet, it may or may not end up in your blood, depending on how well it is absorbed with the rest of the food that you eat.
My magnesium level is normal. However, I didn't test it until long after I had started occasional supplementation. So I don't know whether it was one of the causes of my MVPS.
Back in 2007 or so, I found a nurse on an MVPS discussion board who recommended magnesium glycinate as an MVPS treatment. Intrigued, I tried some.
For me, this stuff kills palpitations within an hour. It's incredible. In particular, I took a 200mg dose, which is 1 tablet. (The bottle says "400", but the serving size is 2 tables. Is this dangerous, or what?)
However, before you try this yourself, I would suggest that you try my other suggestions for eliminating palpitations, including cardiovascular exercise as recommended by your cardiologist. The reason is that we were not evolved to ingest pure concentrated minerals. Therefore, these tablets are hard on the kidneys, which are responsible for electrolyte balance. Also, like other magnesium supplements, they tend to cause mental confusion if used in sufficiently high doses for sufficiently many days in a row. The effect seems stronger than with magnesium oxide, which is likely due to the glycinate component: I believe that the glycinate allows the magnesium to penetrate neurons, including those in the brain, much more easily. For this reason, it may be equivalent, in a neurological sense, to a much higher dose of magnesium oxide.
Here's what the National Institutes of Health has to say about magnesium. In particular, see their comments on excess intake. Again, I think magnesium glycinate may be neurologically equivalent to several times as much magnesium oxide.
From my perspective, it beats the side effects of beta blockers. Therefore, on the rare occasion that I have palpitations, I take one of these.
Bear in mind that MVPS is still a hotly debated syndrome, with some doctors questioning its mere existence. Herein, from firsthand experience, I will present my own definition. Eventually, I suspect that the medical community will define which symptoms are and are not associated with this condition.
By the way, some research has indicated that MVP may be inherited or spontaneous. However, according to Scordo (see book references below), it does not appear in babies at all, and thus develops as one's genome interacts with the environment over time. Perhaps this implies that MVPS follows the same pattern, although this is uncertain due to ambiguity in its definition.
So call me Mitral Mike. In 2006, I was diagnosed with mitral valve prolapse using an echocardiography, which essentially means that I have leaky heart valve.
The events leading up to this diagnosis, and following it for about a year, constituted the hardest and most terrifying part of my life. Perhaps I'll tell you my story later, but right now, I'd rather focus on helping you get well.
Let me begin by telling you the bottom line: In April, 2007, I ended up on the floor of my apartment, hyperventilating intensely for probably half an hour, with my vision gradually going blurry at the periphery, and tightness in my chest. I could hardly breathe. I could hardly move. Waves of terror radiated through my brain, each one passing like a suffocating wave. I clawed my way across the floor to my cell phone, and struggled to dial my friend's number.
Now, in January 2009, I live profoundly free of fear, in a way which I never imagined humanly possible even before my diagnosis; and the symptoms of my MVPS are rare and fleeting, and though they may startle me, do not result in persistent panic. I can tell you how I accomplished the first part, but you probably won't believe me, so let's just focus on the clinical stuff that we can address empirically, which I hope will help you manage your symptoms.
Consider the following books as essential supplemental reading. I'd suggest reading the Scordo book before the Hendricks book. Jointly, they started me on the path to wellness, which I have gradually augmented with my own symptom management techniques, often based on tips from discussion sites on the internet. (Not everything on the Web is junk, you know. You have to experiment and research carefully for yourself.)
Suggested Reading
1. Taking Control: Living with the Mitral Valve Prolapse Syndrome by Dr. Kristine A. Scordo
2. Conscious Breathing: Breathwork for Health, Stress Release, and Personal Mastery by Gay Hendricks, PhD
Because MVP is comparatively well-defined and understood, this blog is mostly about MVPS. In my view, MVP is one of many symptoms of MVPS. However, because heart valves are easy to analyze scientifically, compared to "panic attacks" or the other subjective symptoms of the latter, the former was deemed the disease, and the latter, one of its side effects . In reality, I think that a small set of genes is the cause, and the heart valve anomaly just happens to be the most obvious effect. Frankly, I would not be surprised if it turned out that decades of heart-pounding adrenaline attacks characteristic of MVPS contributed to the heart valve pathology that is MVP. (However, MVPS cannot be the entire cause of MVP, as we do know that MVP is also associated with a connective tissue disorder, which would at least partly explain the infirmity of the valve leaflets, and thus perhaps their susceptibility to damage by adrenaline-induced heartrate acceleration.)
As this article from Emedicine puts it:
"Besides the symptoms attributable to the MR, various neuroendocrine and autonomic disturbances occur in some patients with mitral valve prolapse. In these patients, prolapse may be an epiphenomenon of the underlying autonomic or neurohumoral illness. The term mitral valve prolapse syndrome is often used to refer to the collection of these manifestations. However, in a significant proportion of patients, the mitral valve prolapse is trivial, and no such associated manifestations are present. In these patients, mitral valve prolapse constitutes an essentially benign condition."
Common MVPS Symptoms
1. MVP.
You can have all the other symptoms of MVPS, and not have MVP. Or occasionally, the reverse may be true. This is further evidence that there is a common genetic cause to most aspects of MVPS, including MVP; MVP does not cause MVPS and visa-versa, perhaps with exception of adrenaline-induced valve pathology, about which I conjectured above.
2. "Head spins" and "mental resets".
Sudden disorientation, lasting about a second, and directly pursuant to
premature ventricular contractions (PVCs).
I am not talking about syncope (fainting), although this does occur in a minority of patients. When these events occur, I get the sensation that time has skipped a fraction of a second, and perhaps the room is spinning for this brief moment. The spinning is not persistent, as would be the case with vertigo. Most likely, the "time skippage" is due to the brain reacting to a very unexpected sudden alteration in the heart rhythm, which has the side effect of temporarily suppressing conscious thought. (After all, it's well known that our thought processes largely switch off in emergencies; to the uneducated brain stem, a change in heart rhythm is definitely an emergency.) The more severe PVCs, when I used to get them (I get only little ones now), could jolt my brain so hard that I'd forget the last few seconds of thoughts.
I'm not kidding about this. One night, when I was having massive and frequent PVCs, I did a little experiment: I would think of several words, and imagine corresponding images in my mind. For example, I would think "apple" and simultaneously see an apple in my mind's eye. Then, as soon as I realized that I had suffered a PVC, I would go back and try to remember the last 5 words. Again and again, I would remember only the first 3 or 4; it was always the last word(s) that were missing -- those which I was thinking about at the time of the PVC. It would appear that these head spins have the effect of hitting the reset button on shortterm memory, which would certainly explain the perception of "time skippage".
If you're wondering whether these events are due to something else, I've had 3 full brain MRIs. Except for a spot which was tracked by 3 neurologists and found to be benign (perhaps the result of a bicycle accident when I was younger), no pathology is evident, such as an arteriorvascular malformation, which might otherwise explain the above. And these events are 100% correlated to a time period of about 5 seconds after the sensation of a PVC in my chest. Case closed.
I've also considered that, because PVCs are preceded by "weak beats", i.e. the heart beats once very hard in order to compensate for the previous beat being too weak, it's possible that the head spins are actually due to temporary brain hypoxia. While you can hold your breath for much longer, and still think clearly, it's possible that the temporarily reduced blood pressure associated with a PVC causes brain hypoxia much more rapidly, resulting in the perceptions described above. But as I mentioned above, I think there is a second mechanism at work, which is the brain stem's obsession with perfect heartbeat: the strange sensations are partly due to the brain stem briefly switching into panic mode, then (usually) back out of it, in response to an unexpected irregular heart beat. Occasionally, particularly with larger PVCs, the brain stem fails to exit panic mode, in which case cognitive thought processes remain suppressed, and a full-fledged panic attack (discussed below) may ensue. In any event, PVCs are merely one of many causes of MVPS panic attacks, the latter being discussed more below.
3. Orthostatic hypotension (or more generally, low blood volume).
If you feel light-headed when you stand up quickly, you may simply have too little blood in your system to keep your brain fully oxygenated during this exercise. Your heart may beat more rapidly (tachycardia) in order to compensate, but it may be unable to do so quickly enough due to the leaky valve. In some sense, this is a desirable condition, since it may imply that you have low blood pressure (which I think is a better problem than high blood pressure).
There are a few easy measures you can take to mitigate this problem:
(1) As you rise from your chair or bed, inhale over the course of the rise. This creates increased pressure in your chest, which tends to sustain higher blood pressure. Actually, fighter pilots use a similar technique to maintain consciousness during high-G-force manoeuvers: they wear "G pants", which squeeze their legs at the proper time in order to prevent their blood from draining from their heads to their feet. Thus, by inhaling over the course of a few seconds as you stand up, the increased blood pressure will help keep blood in your brain.
(2) Stand more slowly. If 2 seconds is too fast, take 3. Or 5.
(3) Keep hydrated. For one thing, this means that you always have sufficient liquid in your body for optimal performance. As a result, your blood volume is larger, which means that the pressure will be slightly higher, allowing you to more easily maintain brain oxygenation as you stand. But make no mistake: hydration isn't just about water! You need salt (and, in my opinion, a proper balance of all required trace minerals). You also need sugar. (For all the bad press that it has received since Dr. Atkin's diet, sugar not only keeps you alive, it induces insulin to open your cell membranes, allowing nutrients to go where they are needed. For this reason, I think it's better to eat superfruits like berries, followed by your morning workout; than complex carbs like beans, followed by you sitting at a desk, or worse, going to bed. I also think caloric restriction is superior to a calorically unrestricted low-carb diet. Anyway, remind me if I forget to post my Atkins rant!) For now, just remember: hydration is critical to the management of orthostatic hypotenion and MVP itself, but hydration does not mean binging on distilled water!
4. Intermittant and migratory chest pain.
If you have any sort of chest pain, you need to identify the cause immediately in order to rule out life-threatening conditions. Just because your chest pain is characteristic of MVPS does not mean that it's due to MVPS.
Anyway, MVPS chest pain seems to focus on certain areas -- in my case, the upper right pectoral muscle, and occasionally the right side of the sternum -- but grow, shrink, and move from time to time.
Most doctors seem to be convinced that MVPS chest pain does not come from MVP. Indeed, there is a small (but in my opinion, still meaningful) statistical significance to the number of MVP sufferers reporting chest pain, compared to non-MVP-sufferers. (See Scordo's book, and of course Google, for the numbers.)
I would say, incontrovertably from my own experience, that chest pain can indeed result from MVPS. I say "incontrovertably" due to the evidence of precise time correlation: my chest pain would be worst immediately following an adrenaline burst. Think about it: an MVPS-induced adrenaline burst is associated with an increase in sympathetic nervous system activity, which results in an increase in pain sensitivity (i.e. never take caffeine before a visit to your dentist); second, adrenaline bursts pound on the cardiac and respiratory system, rather like flooring the accelerator of one's car, inevitably resulting in aches in the chest.
Most doctors say that MVP does not cause chest pain. There is some evidence that MVP does cause chest pain under certain pathological conditions, potentially due to mechanical stress on the valve or the heart's attempt to compensate for lower efficiency. Nonetheless, I think that most MVP sufferers who experience chest pain do so due to MVPS-related hyperadrenalization, and not MVP.
In my case, the evidence could hardly be more compelling: when the adrenaline burst occurs, the pain flares up; both usually subside within a minute. This is a clear correlation between the MVPS-induced adrenaline bursts and chest pain. But the relationship goes deeper than that:
Sometimes, however, post-burst pain would remain for hours, occasionally giving rise to the sensation of a heart attack. Why? In my case, which is no doubt not unique in this regard, it would persist because I had consumed large doses of inflammatory foods the same day: sugar, simple carbs, or (especially) cheeses (including cottage cheese).
Cheeses, in particular, seem not only to cause more lasting chest pain, but also an increased incidence of PVCs. The lasting pain may result from the high omega-6 content in cheese, which is proinflammatory. Cottage cheese contains more protein and less omega-6, but it causes increased PVCs as well, if not extended chest pain. I could be wrong about the omega-6 theory. But test it yourself: cheese of any type will result in increased PVCs within 6 to 12 hours (or if you already eat it, cut it out for a few days and monitor the effect). There's something in these dairy products which causes this. To a lesser degree, the same happens with milk. Omega-9-rich olive oil, and omega-3-rich fish and flaxseed oil, do not have this effect. Coconut milk, which is rich in saturated fat but is not a dairy product, seems to produce little or no increase in PVCs. Thus, perhaps, it's something else. Lactose? I don't know, but the effect is unmistakable.
Frankly, it might not be a chemical issue so much as a blood thickness issue: eating dairy products may increase blood viscosity, in particular by raising plasma triglycerides. Thicker blood puts more hydrodynamic drag on the valve leaflets. This is the main reason why boats move more slowly than airplanes: water is much more viscous than air. So axe the cheese from your diet, and closely monitor the effect on PVC number and severity. Cutting out cottage cheese, milk, and coconut milk may also help to some extent, but potentially to the detriment of your calcium and protein intake. (I take "Tums" as a supplement after breakfast, but no dairy products or coconut milk, and hardly ever have PVCs anymore.)
Interestingly, when I eat organic peanut butter, I do not experience an increase in PVCs, despite the obvious high viscosity and high omega-6 content of this food. This may be due to: (1) the fact that I pour off all the peanut oil into the trash before eating the "dry" butter, (2) the fact that it's rich in niacin, which is good for the heart, and (3) its high vitamin E content, which is antiinflammatory. By the way, organic peanut butter contains large amounts of the antioxidant, p-coumaric acid, which is actually increased by the otherwise oxidative roasting process used to produced roasted peanut butter.
Superdark (85%+) chocolate bars also do not cause me increased PVCs, despite having a high saturated and omega-6 fat content. This is consistent with the generally accepted principle that the moderate consumption of dark chocolate (particularly the nonalkalized variety) is conducive to cardiac health. But this would appear to contradict my theory that PVC intensity and frequency relate primarily to blood viscosity. However, superdark chocolate probably does not significantly increase plasma tryglycerides. Hmm... maybe my "Triglyceride-Induced PVC" theory is true.
My worst bout of chest pains ever, followed by a horrendous hyperventilating panic attack, was preceded by a night of gorging on pizza cheese without the crust. (What do you do when you're on a low-carb diet, and you're out with the guys, who have nothing to offer you but pizza? Smart answer: starve. Dumb answer: gorge on mozerrella, and flirt with disaster.)
5. Panic attacks.
These events are characteristically preceded by the sensation of a wave or cloth washing through the entire head for about a second, most perceptible on the face, and may or may not have an obvious environmental cause.
Many doctors (who no doubt do not have MVPS themselves) think that the panic attacks associated with MVPS are somehow indirectly due to the patient becoming anxious about his/her newly identified "heart problem". While such a discovery, however benign, might make anyone anxious, I can tell you from deeply personal, visceral experience that the "bad" news is not the cause of the panic attacks. Having analyzed myself under conditions of sudden extreme terror (which I assure you, is possible, albeit difficult), they result largely from one of the following causes:
(1) a PVC which temporarily interrupts normal blood rhythm to the brain, triggering some sort of massive sympathetic nervous system response in the brain stem, as suggested by the recent discovery that the brain monitors the heart rhythm with a level of diligence hidden to our conscious mind, to which I alluded in the above discussion of head spins;
(2) a sudden change in electrolyte balance, as by ingesting a large dose of potassium (e.g. low-sodium vegetable juice or several bananas) or highly bioavailable iron (e.g. eating a vitamin pill on an empty stomach, or eating more than 100g of dark chocolate in a day);
(3) a sudden change in body fluid volume (and probably therefore blood pressure and electrolyte concentration), as by urinating or donating blood;
(4) a very light wind which cools and tingles the skin, and thus mimics, to the unconscious mind, certain perceptions of electrolyte imbalance;
(5) the memory of any of the foregoing;
(6) the consumption of large amounts of chocolate (especially dark or organic) or walnuts, both of which produce migraine with aura in sensitive individuals, triggering fear and panic, and entirely separate from the bioavailable iron panic pathway related to the former.
6. Unusually flexible joints.
This is most obvious in the fingers. This is the connective tissue anomaly so often mentioned in MVPS literature. In the presence of chronic stress, it probably aids the gradual deformation of the valve, which ultimately manifests as MVP. According to Scordo's book, essentially no one is born with MVP; it develops as one ages. My theory is that when one combines the frequent adrenaline bursts of MVPS with overly stretchable connective tissue, then the result is eventually a floppy valve that doesn't quite snap shut. It's kind of like stretching a rubber band too many times; eventually, it becomes less inclined to snap back into its original shape.
It would be interesting to study whether teaching children with MVPS to suppress excessive adrenaline releases would manifest in a lower rate of MVP later in life. I guess the medical community must first decide on a clinical definition of MVPS!
More on adrenaline bursts below.
7. A depressed or indented sternum -- a "breast bone valley".
8. Scoliosis.
9. A straight spine, which I take from the literature to mean a spine without concavity at the base.
10. Electrolyte hypersensitivity.
Sensitivities to sudden changes in electrolytes, particularly involving potassium or iron, as discussed above. Critically, if you have MVPS, do not donate blood before speaking to your doctor. If you have the low blood volume typical of many MVPS sufferers, it could cause you to faint in response to blood donation. (It happened to me in 2004, at a blood drive at work. I wondered, at the time, why I couldn't tolerate the process as well as much much less fit colleauges!)
My first bout with electrolyte sensitivity was in around 1998. I had just had a visit to the dentist. During this particular visit, the dentist removed a number of mercury-silver fillings. Even today, dentists continue to use mercury-silver amalgum in fillings because they assert that they leach only trivial amounts of mercury. I might agree, but when they're heated and aerosolized during removal, I think it's possible that a dangerous amount of mercury is released.
Now, I knew about this threat, and knew that it might be preempted by injesting a vitamin pill (to thwart further mineral absorption) and vitamin C (which chealates heavy metals). However, I forgot to take either before the appointment. So immediately afterward, I headed to the nearest drug store and bought a bottle of vitamin pills, as I was on the way to work, and had no time to return home.
When I arrived at work, I ingested 3 vitamin pills in rapid succession. (DO NOT do this.) Worse, on account of the dental appointment, my stomach was empty. So an hour or so later later, I had something like 300% RDA of iron (beyond the tolerable upper intake level) flowing around in my blood.
Rapidly, my skin became numb at the surface, causing a "pins-and-needles" sensation. Though I may have made some slight progress in inhibiting the blood plasma uptake of mercury from the intestines, I had given myself some level of iron poisoning. I spent the next hour or so slowly and carefully sipping water, and urinating myself back to homeostasis.
Nowdays, I keep a 7-day pill organizer full with all my supplements, including multivitamins, to ensure that I get sufficient but not excessive nutrition. I even break my vitamins into a couple pieces for ingestion at different times of day, in order to maintain more stable plasma electrolyte levels and systemic hydration.
11. Chest tightness.
Diffuse but possibly intense, often mistaken for anxiety-related chest tightness, but persistent for days at a time, and only marginally relieved by sleep.
This tightness is constricting, rather like wearing a sweater that is much too small. However, it is distinct from the migratory chest pain described above.
This was one of the worst symptoms of my MVPS. I think, in my case, it related to the onset of sleep apnea which went undiagnosed for years, for which I have since received corrective surgery. It would not surprise me if there were a correlation between MVP, MVPS, and sleep apnea, as the latter increases adrenaline stress on the heart, and contributes to panic disorder, on account of terrifying hypoxic episodes.
Here's how I fixed my chest tightness, which at times was so intense that I could hardly get enough air to walk (this, after being a near-Olympian just days prior to the hyperventilation attack in April, 2007 that started the tightness): I tried all manner of foods -- eating more or eating less -- trying to discover a cause or find relief. Finally, after months of work, I discovered that salmon, milk, and shiitake mushrooms -- and nothing else in my diet -- relieved the condition to some extent; milk was the fastest. Truly perplexed by how these radically different foods were acting in a common way, I did some homework.
But first, I sought professional help. I had several doctors tell me that it was all just stress-related. In a sense, they were correct: MVPS was stressing out my autonomic nervous system, resulting in this problem. But in the sense of anxiety, they were wrong. I felt happy most of the time. In fact, I could generally breathe better when I was angry, perhaps due to improved respiratory function under the influence of adrenaline. On the other hand, I could be perfectly content with life, and the tightness would be there. The severity was mostly dependent on whether or not I was asleep, and on how recently I had had one of these "magic foods". It was also somewhat better in the morning than the evening. The worst tightness was immediately after exercise, suggesting that it had something to do with hydration, blood pressure, and electrolyte balance.
It turns out that the magic foods are all excellent sources of vitamin D (as D2 or D3), which is otherwise very hard to obtain (except from solar exposure). Somehow, vitamin D was allowing me to get some degree of chest tightness relief. Not surprisingly, I was subsequently diagnosed with a vitamin D defficiency (18, where optimal is something like 40-60, depending which study you read). (Just in case you think the docs always have the answers, I was the one who suggested the test, based on my empirical analysis. Sure enough, I was short on vitamin D.)
Using 800IU daily supplements, I cured the defficiency over a period of months. However, the tightness persisted to some extent. That's when my friend introduced me to Hendrick's book about breathing, noted above. Combined with yoga, it completely fixed the problem. My chest is so relaxed now that I no longer practice yoga, but I probably should. In fact, for a while, I was so relaxed that I had to encourage myself to adrenalize a bit on the highway, for safety reasons. As far as I can tell, these focussed exercises allowed me to reprogram my breathing rhythm, reducing the tightness.
The final piece of the solution was getting surgery to alleviate sleep apnea. With a wider airway, I was no longer struggling to breathe during the daytime, and my chest tightness has never returned since.
12. Adrenaline bursts.
These events occur seemingly without cause, manifesting in a pounding heart, as though you is about to crash your car, when in fact you may be relaxing on the beach. If you have these, check with your endocrinologist for other rare conditions such as adrenal tumors. But likely as not, this is just MVPS. I used to have these, until intensive self-monitoring allowed me to intervene and arrest them before they could occur.
Everyone gets adrenaline bursts when they're nervous. They are an important part of our fight-or-flight mechanism: if a tiger is about to eat you, it's time to run! Psychologists have long known that this ancient wiring causes stress reactions in our bodies today, despite the fact that we don't need to run from a dentist, or use super strength to invest in a crazy stock market. In short, our wiring has not kept pace with the shift in the nature of our threats, from physical to psychological.
The adrenaline bursts characteristic of MVPS are similar to anxiety-related adrenaline releases, but they are overexpressed. And typically, many more occur per day than one's stress load would otherwise suggest. For example, I would get terrifying heart poundings every time the phone rang. I would, of course, calm down, but not before slamming my heart valve and respiratory system for this completely unjustifiable reason. At my worst, I had probably a thousand perceptible spikes per day, which on average is one every several seconds for many hours.
Low-carb diets are often touted as a solution to such hyperadrenalization. In my case, it only made things worse. The reason, I think, is that hydration is difficult with these diets because the high fat content inhibits the absorption of water-soluble nutrients, particularly in the absence of sugar. At the time, I didn't realize this. As a result, no doubt, my electrolyte concentrations varied much more throughout the day than they should have, which no doubt contributed to the problem.
Positive imaging is commonly suggested as a solution: psychologists often tell us to imagine a beautiful beach scene when we're under immense stress. I think this only causes more stress, as it reminds us that we might not survive long enough to get there! In my case, it offered no help at all.
One of the most significant improvements came with medical hypnosis. I went to a medical hypnotist who, believe it or not, was recommended by my endocrinologist who did the vitamin D test. After a single session, I experienced approximately a 75% reduction in daily adrenaline spike count. It cost $300, but in my case, was highly effective. Part of the reason for my success is that I knew that the spikes were almost never justifiable, and thus had an irrational basis of activation, likely related to subconscious activity in the brain stem. Because I knew that the response was irrational, it was easier to combat with the help of a hypnotist; otherwise, I am virtually immune to hypnosis. After yoga and certain mental focus exercises, my adrenalization dropped so low that, as I mentioned above with regards to chest tightness, I had to struggle to adrenalize enough to avoid traffic accidents!
One other technique for minimizing adrenaline bursts may be to eat garlic or garlic gelcaps. There is ample evidence that they lower blood pressure, and seem to promote mood stability, perhaps via seretonin regulation. I haven't done much research on this, but I've read enough on reputable websites to recommend that you research it. At the very least, it might make your dinner taste better.
13. Plasma magnesium defficiency
According to this 1997 study, some cases of MVP are caused by plasma magnesium defficiency. Though magnesium defficiency as examined in the study is strictly a cause of MVP and not MVPS, I suspect that it also relates to the latter, as magnesium is critical for neurological function, implying that defficiency may contribute to the hyperadrenergic symptoms observed in MVPS sufferers. Note that the study does not say "insufficient dietary intake of magnesium", but rather refers to plasma (blood) levels of the element. So while you may get sufficient magnesium in your diet, it may or may not end up in your blood, depending on how well it is absorbed with the rest of the food that you eat.
My magnesium level is normal. However, I didn't test it until long after I had started occasional supplementation. So I don't know whether it was one of the causes of my MVPS.
Back in 2007 or so, I found a nurse on an MVPS discussion board who recommended magnesium glycinate as an MVPS treatment. Intrigued, I tried some.
For me, this stuff kills palpitations within an hour. It's incredible. In particular, I took a 200mg dose, which is 1 tablet. (The bottle says "400", but the serving size is 2 tables. Is this dangerous, or what?)
However, before you try this yourself, I would suggest that you try my other suggestions for eliminating palpitations, including cardiovascular exercise as recommended by your cardiologist. The reason is that we were not evolved to ingest pure concentrated minerals. Therefore, these tablets are hard on the kidneys, which are responsible for electrolyte balance. Also, like other magnesium supplements, they tend to cause mental confusion if used in sufficiently high doses for sufficiently many days in a row. The effect seems stronger than with magnesium oxide, which is likely due to the glycinate component: I believe that the glycinate allows the magnesium to penetrate neurons, including those in the brain, much more easily. For this reason, it may be equivalent, in a neurological sense, to a much higher dose of magnesium oxide.
Here's what the National Institutes of Health has to say about magnesium. In particular, see their comments on excess intake. Again, I think magnesium glycinate may be neurologically equivalent to several times as much magnesium oxide.
From my perspective, it beats the side effects of beta blockers. Therefore, on the rare occasion that I have palpitations, I take one of these.
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