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

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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

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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

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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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