When a Panic Attack, Isn't

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

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

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

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

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

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

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

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

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

Gingivitis, Periodontitis, Infective Endocarditis, and MVP

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Might MVPS Originate with Sleep Apnea?

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

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

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

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

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

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

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

A Brief Warning About Magnesium Supplements

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

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

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

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

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

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

Airplane (Plane) Travel and MVPS

If you've ever travelled on an airplane, you know that it's a torture session for MVPS sufferers. While I must confess that there's no cure for the mile-high jitters I'd like to take a moment to share some not-so-common knowledge about plane travel which may help you handle the experience more calmly in the future.

In recent years, various cities have enacted legislation intended to reduce airplane noise. While this is great for peaceful neighborhoods, it results in very steep takeoffs at full power. The idea is to "blast off" as steeply as possible in order to reach high altitude before jet noise can annoy residents living near the airport. Personally, I think that anyone who chooses to live near an airport knows what he's getting into, and should plan accordingly. But nonetheless, we have this policy in practice. McCoy Airport in Irvine, California is one example.

Having taken off from McCoy on numerous occasions, I experienced near-syncope repeatedly. At the time, I had not yet been diagnosed with MVP or MVPS, so I just assumed that all the other passengers must be experiencing the same, but just relaxing and not bothering to mention the severe dizzy feeling. I imagined that the pilot must be wearing "G-pants" characteristic of military pilots, which maintain blood pressure under high acceleration, and thus normal brain function. Little did I realize at the time, this problem was entirely my own. Now, at the very least, I try to drink some mineral water before takeoff in order to ensure adequate blood volume. (I don't drink so much that I drain the electrolytes out of my body.) I usually also take 100mg of magnesium glycinate, which may help my nerves and circulatory system deal with the impending stress, although I would classify this behavior as experimental. During particularly heavy acceleration, I inhale moderately in order to temporarily increase my blood pressure, and thus sustain my brain's oxygen supply.

Since the McCoy days, of course, I've learned about MVPS, and have made substantial efforts to improve my physiological reactions to the stresses of flight. Here are a few of my techniques:

Flight Schedule

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Most of us tend to fly for a few hours at a time, rather than across oceans. In the former case, this allows us to select the flight time with substantial freedom.

I like to choose flights in the morning, or if unavailable, then late at night. I avoid afternoon and evening flights whenever economically feasible. The reason is that the sun heats the atmosphere, resulting in a higher probability of high winds in the afternoon, and to a lesser extent, the evening. Higher winds create greater turbulence, and thus a notably less pleasant flying experience. On the plus side, morning and late night flights tend to be cheaper.

Incidentally, on one occasion, I was flying out of a desert city on a perfectly clear day. But, against my advice, this was an afternoon flight, which meant that invisible hot air was convecting up from the desert floor into the atmosphere. About a minute into the flight, the plane was buffetted by a massive gust of wind, which forced us upward. Everyone shouted in terror. But nonetheless, the pilot was able to clear the rough patch in a few minutes. You should realize that the pilots and crew do their jobs every day, and are relatively unphased by events that you might find terrifying. And, if possible, fly in the morning or at night.

I actually prefer morning over night because I like to fly with very little in my stomach, and a minimal safe blood sugar level, as covered in the next section.

Diet Before and During Flight

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The day before, I stop eating in the afternoon or evening. The morning of the flight, I get up, often before dawn, and grab a few handfuls of pecans or blanched almonds. I throw in a few steamed veggies for fiber, which matters when one is sitting for hours in cramped conditions. Critically, I eat no significant carb or sugar sources. Then, I eat nothing else until I'm on the flight, or if possible, until I land. This keeps me from being excessively hungry, but also thwarts my body's ability to push the adrenaline button in response to turbulence, etc. Just remember not to try any new foods immediately before a flight, as a plane is no place to discover that you're allergic to something.

During the flight, I try to stick to veggies. If you have low blood pressure, then salted peanuts may be OK as well, but as a rule they're loaded with pesticide and omega-6, and thus have no place in a healthy diet. (Ironically, organic peanuts can be even more dangerous on account of aflatoxin, but some safe brands do exist.)

You may not even realize that most airlines' websites allow their customers to order special meals up to 24 hours before a flight. I make a habit of selecting my meal in this way, and have been generally satisfied with the results. Once, though, I ordered a "diabetic" meal, and received a plate of food loaded with fruit and junk snacks. I suppose they meant "a meal for those who want to become diabetic"!

On longer flights, or if you're headed for a nutcase republic with unknown food standards, pack some nuts or other sensible snacks in your carryon. A small amount of very rough German bread (the expensive stuff sold in the gourmet section) wouldn't hurt, as you'll need some fiber.

Disturbing Noises

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As an MVPS sufferer and a determined engineer, I make a concerted effort to detect and understand the sources of in-flight sounds which spook me. Unfortunately, I must admit that I have yet to take a flight in which no plane-related sound is new to me. Planes are immensely complex electromechanical beasts, so you should always expect something new and disconcerting.

1. Jet throttling

Perhaps most disturbing noise on a plane is jet throttling. Yes, I know that the jets are loud and annoying. But any constant noise tends to be ignored by the brain, so it doesn't startle anyone. It's the throttling which can yield adrenaline bursts. You've reached cruising altitude, and are floating along in the breeze, when suddenly, you're pressed into the back of your seat, and the jet noise flares up. Or, worse, you're still climbing on full throttle, when the plane suddenly levels off, and the jet noise simultaneously dampens. It sounds like the engines have failed!

I doubt it. In the first case, while the pilot may already be at cruising altitude, he may want to climb a bit further in order to avoid rough weather that he sees on his radar. Or, he may have been assigned to a higher altitude by nearby air traffic control on the ground. Or he may simply be compensating for a previous loss in altitude due to similar reasons.

In the second case, yes, the jets are in fact throttling down. But that doesn't mean that they've stopped! Nevertheless, dependably, it still startles me when the plane stops accelerating and the jet noise dampens appreciably. At least, I understand why.

Actually, a pilot friend of mine told me that there are, in fact, everyday cases in which pilots essentially turn the jets off and glide. This is common during airport approach. After all, you can't land at 900 km/h! Nonetheless, the gliding alternates with bursts of jet power. You may have noticed this behavior during final approach.

The frequency of jet throttling during final approach is higher than at any other time during a flight, as the pilot must surgically adjust the plane's speed and heading in preparation for runway touchdown. At the same time, he must lower the flaps on the wings, and eventually, the landing gear. Both of these adjustments cause the plane to become less aerodynamic, resulting in greater turbulence. This is why final approach is almost always the most turbulent phase of a flight. In fact, I once landed in the outer bands of a hurricane in a 747, which was certainly the roughest approach I've ever experienced. To make matters worse, we were landing on an island whose geography invited wind gusts to begin with. All I can recommend is that you look at the ground if possible. As you slowly descend, you'll probably calm down.

Incidentally, modern planes are designed to tolerate the failure of one, and sometimes more, engines. My friend was once on board a plane, one of whose engines failed. They made an emergency landing safely.

2. Toilet flushing

No, this isn't the sound to which you are accustomed in your home. For some good engineering reasons, airplane toilets vacuum waste out of the bowl, rather than rely on water alone to drain it. If you're seated near a lavatory, you'll surely hear a loud and sudden vacuum sound, as though a hole has ripped into the side of the plane! But in a few seconds, the sound will cease. Learn this sound, then learn to ignore it.

3. Call button pings

This is the famous "ping" or "bong" sound heard multiple times throughout a flight. Although it's perfect for causing adrenaline spikes, all it means is that someone has pressed their flight attendant call button, likely as not, to request another beer.

4. Cracking sounds

Imagine: you're somewhere north of 30,000 feet, and the pilot comes on the speaker to ask you to fasten your seat belts because there's "15 minutes of rough weather ahead". No sooner do you comply, than the airplane drops several hundred feet in a few seconds! First, you lose your stomach as the plane drops. Then, as it finds more stable air and levels off, you're pushed into your seat. At the same time, you hear distinct cracking and popping noises, of the same sort that you heard when the airplane was taxiing for takeoff. It sounds like the plane is breaking up!

Well, the plane is changing shape. But this all part of its engineering. If you don't know, most of the structure and skin of a plane is made of titanium. Titanium is a metal with an astounding tolerance for distortion: it can be bent substantially, only to snap back into its original form when released. The same happens after an event such as the one above (called "hitting an air pocket"), and also when the plane accelerates or slows in the forward direction, resulting in small changes in its length.

Air pockets are no doubt the most disturbing aspect of plane travel. While rare, you might encounter a bad one from time to time. For certain, it will cause an adrenaline burst, but at least you'll be a bit more relaxed after the fact.

5. Wind sounds

I've noticed, routinely, that wind sounds can get much louder, or much quieter, without the jets throttling. Huge changes in volume can occur in seconds. Most likely, this is due to changes in wind direction as the plane flies. Logically, the sound perceived inside the cabin depends on the direction and speed of the wind outside. Relax. It happens.

6. Galley sounds

If you sit near the galley (kitchen), you'll hear clicking and banging at odd times. This is usually the crew manipulating meals and meal carts before and after passenger service. The worst sound, undoubtly, is the occasional careless flight attendant who uses excessive force to pound the meal cart into its stowage compartment.

Steep Turns

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After takeoff, the pilot usually has to turn. After all, it's very unlikely that the runway just happens to be aligned with your destination! Get used to it.

Before landing, the same applies. Depending on the geography, the plane may need to make several complete circles around the airport during descent. Generally but not always, the pilot will slightly increase the throttle during these turns in order to obtain better control. So expect some acceleration, even though this is the decelerating part of the flight.

The other day, I was stuck in the air for about 15 minutes as the pilot circled, but did not descend. This often happens when he is waiting for landing clearance. As a rule, such events are more common around holidays, in addition to the usual airport madness at such times. Consider travelling during less insane and expensive periods.

While steep turns are never comfortable, you can inhale to reduce faintness. And it's always important to ensure adequate hydration in the dry plane cabin, which has the added benefit of helping you maintain sufficient blood pressure during such turns.

Turbulence and Air Pockets

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While air pockets are rare but very frightening, remember that airplanes are designed to fly in very rough weather, and pilots have radar to help them avoid the roughest patches.

Turbulence is really no different than low-grade air pockets that occur hundreds or thousands of times during a flight. Most often, it occurs when the plane passes near or through a cloud. The different air densities cause the plane to accelerate or decelerate rapidly in a random direction. If the bump is sufficiently large, the pilot may cause more turbulence by turning the plane back the other way. It's not fun, but it's routine and safe.

Typically, bouts of turbulence last a few minutes, then subside. They can even occur during a full-power takeoff, as the jets push forward, but the wind may be blowing from the side.

However, exceptions exist. My worst turbulence episode (and one of my longest ever sustained adrenaline bouts) lasted about 3 hours. I was on a transoceanic flight, and the turbulence persistently pounded the plane. I wondered why the pilot did not simply turn off course for a short distance, and avoid the bad weather. When I returned home, I found the answer: we had been caught in a storm about 200km wide and 2400km long! At the time, I was oblivious to my MVPS condition, and suffered immensely. 3 hours of frequent shaking, with cracking noises at an altitude of several kilometers, is not my idea of fun! Still, I might as well have slept through it all, as I arrived safe and sound. Hats off to the aeronautical engineers!

If you're particularly disturbed by turbulence, then breathing exercises may help. You may also benefit by chatting about life with other passengers who seem to ignore the bumps. Likely as not, they're frequent travellers who understand that plane travel is very safe, frightening bumps notwithstanding.

Safety Statistics

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I wish my physiology listened to my rational mind. But in this case, it often has a mind of its own. At least, then, I can sort of relax in the knowledge that flying is very safe, and that flight crew do it for a living. It doesn't help my stomach any, but it does allow me to fly, instead of spending vastly more time and money on international boat cruises! Still, if you can take the train, try it. You might see a new part of the world up close.

The Art of Hydration

I discussed hydration at length in this post. Since then, it's been on my mind, and I figured I should share a few more refinements.

As you may have read, several years ago a study came out which claimed that people who eat in response to hunger tend to have a lower body mass index (i.e. less fat) than those who eat according to a schedule. When you think about it, this makes sense. I mean, let's say I'm hungry at 5pm. I grab a salad, or worse, a donut. By 7pm, I'm no longer hungry, but after all, it's my scheduled dinner time. So, I eat. As you can see, if you add up this unnecessary excess for a few weeks, it will start to amount to visible pounds.

I conjecture that a similar principal relates to hydration. Namely, if we hydrate "because it's time to take my vitamin pill" or "because it's time for my morning shake" -- or worse, if we refuse to hydrate because "it's not lunch time yet" -- then we are just begging for electrolyte imbalances in our systems. It's never fun, or healthy, to have too little or too much of a critical nutrient floating around. And when we correct the balance, we may overshoot, leading to a dangerous oscillation in homeostasis.

So I'm starting to think that I should hydrate when I feel thirsty, and until I feel satisfied. Never more or less often. I might fudge a bit before a meal or a long hike, when I know that I'll soon need extra water in preparation for digestion or perspiration. But generally, I will try to drink -- and eat water-soluble supplements -- purely in response to hormonal queues. I think our bodies, having evolved over billions of years, are much better at determining when we need key infusions of electrolytes, than is the clock on the wall.

Yes, there is Dr. Scordo's admonition that thirst always comes late, i.e. we're already in debt by the time we feel thirsty. Still, I'd prefer to be slightly late, than to base my fluid intake on the time of day.

As a result, I've started to move my habitual morning half-vitamin-pill into the afternoon or evening. I try to eat an entire pill everyday, or slighlty more if I'm seriously dehydrated. (Watch out for iron poisoning.) But I'm making more of an effort to eat a nibble here, and a nibble there. I find consistently that I can hydrate myself all day long on a single pill if I do this. But if I swallow the whole thing with my veggie-rich breakfast, my body seems uninterested, and probably excretes most of it, leaving me with powerful thirst later in the day.

Since I'm not thrilled with the idea of drinking sugar in order to improve hydration (even though it does work quite well), I try to practice "dry hydration", in which I nibble a tiny piece of vitamin pill, and wash it down with sufficient distilled water. (The great thing about distilled water is that it's much safer than tap, or even bottled water. But if you drink too much of it without added trace minerals, you'll dehydrate.) The trick with dry hydration is that, in my case, it takes about 20 minutes to feel hydrated, after drinking. Whereas, with milk, the effect occurs within seconds.

Ironic, isn't it, that a dairy product which causes PVCs (albeit less than with cheese), would be such a fabulous and immediate source of hydration? It also contains the likely-carcinogenic protein, casein. But I must admit, when nothing else works, milk does. Just get the organic whole fat stuff (4%), as opposed to skim. This way, you'll get fewer pesticides, and, if you're male, the higher fat milk also lacks the prostate cancer risk recently associated with skim milk. Perhaps this lower risk applies to other cancers too, but it has yet to be demonstrated. That's right: less saturated fat, implying a higher cancer risk, in this particular case. However, this study from the American Journal of Epidemiology seems to suggest an only moderately elevated risk due to skim (23% higher, for aggressive prostate cancer, with at least 2 servings per day). This Harvard study talks more broadly about dairy, calcium, and vitamin D in general, and seems to point to a similar conclusion. Still, I'd rather slightly increase my cancer risk, but stay hydrated and avoid more serious and immediate hazards.

I hope to find a substitute, but so far, milk "just works". Soy milk causes me shortterm memory problems, likely due to the high manganese content. It also contains phytic acid, which upsets the stomach, and isoflavones, estrogen-like substances which could therefore be carcinogenic. Unsweetened almond milk works almost as well, and isn't quite as unhealthy, but it's hard on the bank account.

I should add that raw milk is probably the healthiest form of this substance, and might actually be beneficial to drink, all things considered. But it's not cheap, and comes with the risk (although remote) of bacterial infection.

Finally, while we're on the topic, please test your vitamin D level. This can be done through your doctor with a cheap blood test. As you may know, there is mounting evidence that it has a significant role in cancer suppression. Indeed, the anticancer benefits of resveratrol consumption may in part be due to its upregulation of vitamin D receptors. And please note the mention in the Harvard study linked above, which claims that frequent milk drinkers tend to have lower levels of the protective form of vitamin D, despite the fact that milk is a rich source of the vitamin (although this might simply imply that people who drink a lot of milk tend to stay out of the sun).

Now for some fun. Do you like sorbet, or sherbert, or whatever they call frozen sweet stuff? Here's a tasty way to hydrate, get some wonderful plant chemicals into your blood, and avoid the all-day-long elevated blood sugar levels associated with complex carbohydrate consumption.

I live in a tropical region, where we have lots of fabulous fruit. Last week, I bought some wonderful dragon fruit. But in my haste, I accidentally threw it into the freezer instead of the fridge. The next morning, I was dismayed to find that I'd ruined one of my favorite fruits! But I so love the taste, that I decided to eat it anyway after a 30-second thaw in the microwave. It was still frozen, but more like a thick sorbet or sherbert at this point, than a block of ice.

To my delight, it turned out to be highly refreshing, especially given the hot days we've had lately. It also takes much longer to enjoy, given its firm consistency. I discovered that I enjoy it more when it's impossible to gobble it down. Every bite is sort of like cold candy. But there's so much fiber (not to mention frozen water) in it that, for 15 minutes of eating, I only get about 80 calories! Directly afterward, I hit the gym, and burn it all off, leaving nothing left to elevate my blood sugar. (By contrast, when I have oats in the morning, I get very hot a few hours later, and its lasts for many more. No doubt, this is my body temperature rising as the result of excessive glucose metabolism.)

On the plus side, I get a few good plant chemicals to keep in shape. I won't sell dragon fruit as a superfruit (although the Malaysian variety, which is deep red on the inside, might be). But it does help me to hydrate, and tastes very refreshing.

Notice that the fruit is cut in half. I strongly recommend doing so before freezing, as it's impossible afterward. Since this fortuitous accident, I now make a habit of slicing fruit in half, and dumping into a freezer-safe container before going to bed. By breakfast time, it's ready to eat.

I've since tried the same with papaya, although it's less rich in fiber, and therefore hits me too hard with sugar. If you aren't blessed with a cheap source of dragon fruit, then I recommend trying this with your favorite fiber-rich, thick-rinded fruit, for example, water melon. And if you feel the need, you can always nibble a piece of vitamin pill after consumption, in order to jam micronutrients into your cells when they open in response to insulin. Better still, dust your fruit in 1 gram of cinnamon, which will help prevent a dangerous insulin surge, and jam more energy into your cells sooner. (Just hit the gym within 20 minutes, or you'll overheat.) Bon appetit, and don't forget to floss!

Magnesium Glycinate vs. PVCs

As is customary, I eat one junk food meal every month, in order to keep me from getting too bored with healthy food. Yesterday was my junk day, and I took full advantage: 3 small veggie burritos (including cheddar cheese on one of them) and a 100g bar of white chocolate. The latter was not just for gastronomic delight; it was intended to verify my theory that cacao -- and not the fat and sugar in a chocolate bar -- is what causes the symptoms of excessive iron consumption (a tingling sensation all over the skin, if I'm right) and indeed panic attacks.

Rewind. In a previous experiment, I took concentrated cacao polyphenols on an empty stomach -- essentially the opposite of my white chocolate experiment. However, the point of the experiment was not to induce a panic attack or the sensation of iron poisoning; it was to see if I would get indigestion if I consumed this otherwise-very-healthy powder along with my morning elixer of grape skin extract plus 500mg of resveratrol. As I had routinely ingested 100g or more of dark chocolate in a day, I was hardly concerned about the MVPS-related effects of eating this small cacao pill. (NOTE: I have since moved the grape skin extract to mealtime, as my nutritionist friend has convinced me that it's best used to counteract the ill effects of caloric intake, as the French appear to have discovered of red wine; I eat it for the polyphenols, not the incidental 25mg of resveratrol. The 500mg of resveratrol, on the other hand, is better consumed in isolation, in my case, half an hour before breakfast.)

As usual, I removed all the pill caps and dumped the contents into a few ounces of water, and imbibed. To my surprise, a few minutes after drinking my cacao-augmented elixer, the unmistakable surge of panic attack symptoms filled my brain. Fortunately, my years of self-analysis and biofeedback training allowed me to take a back seat, watching myself, as it were, on the edge of a panic attack. (It's hard to explain popping out of yourself in order to remain focussed during such explosive neural activity. But by some miracle of brain function, it's possible.) As I sat in this cognitive "back seat", watching the panic attack attempt to unfold, I was thrilled by the observation that I had chemically induced this occurrence by the introduction of powdered cacao to an empty stomach. (Had I been testing for this effect, then I would not have believed the panic symtoms to have been genuine, as they might have been placebo effect.) After a few minutes, the attack subsided, never having evolved into the full-fledged emotional dysfunction of my early days with MVPS.

Back to white chocolate.

After eating maybe 10g with my 3 burritos earlier in the day, I ate perhaps another 25g just before bed, on an otherwise empty stomach. (I generally make my "junk food meal" just a single meal, in order to prevent bad dietary habits from leaking into the rest of my month. But in this case, I was sloppy.) I was so exhausted that even the high sugar content of the stuff didn't threaten to keep me awake. I settled down to bed, happily satisfied with a full stomach. (I usually eat a single meal in the morning, and stay hungry for the rest of the day. In this case, as I said, I was sloppy, junk food day notwithstanding!)

Maybe an hour later, I started having premature ventricular contractions (PVCs). Serious PVCs, like I've never had since the pizza night from hell in April, 2007. I was experiencing the usual resultant mental resets every minute or so. I started to think back on my day, wondering what I had eaten to deserve such a pounding. The cheddar cheese in the burrito didn't help, but it wasn't enough to cause more than a few weak PVCs. I'd also had some UHT milk (yes, I'm still a minor milk addict, even though my nutritionist friend tells me that its main protein, casein, appears to be carcinogenic). But even then, I didn't have enough dairy food to warrant this level of PVC activity.

Yes, I had the white chocolate bar. But chocolate bar fat never seems to cause me PVCs. (This may be related to the observation that dark chocolate does not appear to raise LDL cholesterol, and perhaps some other blood lipid parameters.) Anyway, I've eaten 200g of 70% dark chocolate in a single day, which causes severe symptoms of the sort descibed above, but not a single PVC. If I ate that much cheddar cheese, I'd be in PVC hell.)

So I couldn't figure out the cause of the PVCs. Nonetheless, they were so severe that I reasoned that my chances of atrial fibrillation, however remote, were materially elevated, and that therefore I must take emergency action. I pried my self out of bed, and headed for the magnesium glycinate bottle.

As I mentioned previously, magnesium glycinate is an excellent palpitation killer. (I do, however, recommend safer means of reducing palpitations, such as regular cardiovascular exercise and avoidance of dairy foods (get your vitamin D, calcium, and magnesium elsewhere), after a consultation with your cardiologist. But for me, it works on those rare nights that I have pronounced palpitations.) But this night was different. I wasn't experiencing mildly annoying palpitations; I was being hammered by PVCs.

I must admit that I didn't really know what to do, apart from the fact that I had to do something. Since I live in a part of the world effectively devoid of competent medical care, I needed to rely on my dietary knowledge. So, as I said, I turned to magnesium glycinate and hoped for the best.

Fortunately, my stomach was almost empty at this point. I chewed 100mg (half a tablet), and swallowed it with ample water. Within minutes, my PVCs stopped. When I returned to bed, they did not return, despite the fact that they are usually aggravated by a supine position. I slept normally for the rest of the night.

I would imagine that the magnesium glycinate went straight into my blood -- perhaps even through buccal absorption, short-cutting the digestive tract. Arriving at the heart, it penetrated the neural timing apparatus therein, and worked its magic. Yes, that's an extremely course and potentially inaccurate model of this supplement's method of action, but it's all I can hypothesize from my observations. Somehow, this stuff really works!

Back to the mysterious PVCs. When I got up in the morning, I had a second look at the chocolate wrapper. When you drop from 70% or 85% cacao to almost none at all, you need to replace the lost volume with filler. In this case, the filler turned out to be "milk powder" and "cream milk powder". Combined with the milk I drank and the cheddar that I ate, these concentrated sources of PVC and palpitation fuel could certainly have accounted for this awful attack. And I thought white chocolate was just lethicthin and sugar!

After all this trouble, my white chocolate experiment did at least produce results consistent with my cacao theory of panic attacks: I experienced no such symptoms, other than the brief justifiable nervousness derived from excessive PVCs. So the good news, it would appear, is if you have MVPS, you can safely eat white chocolate. But then, if you have MVPS, you probably also have MVP, in which case you can't, because it will induce PVCs. Sorry folks, I think the antichocolate advice has to stick. A small portion of 85% dark chocolate per day is probably safe, but if you're like me, you'll end up eating ever-increasing portions until you get so jacked by MVPS symptoms that you quit cold-turkey. It's a shame, as cacao is excellent for circulatory and brain health. Oh well. Stick to grape skin extract and mercury-free fish oil.

One other thing about dark chocolate: in high doses (over 50g per day, in my case), it appears to reduce my tolerance for toxins. Around here, I encounter massive amounts of pollution on a daily basis -- diesel exhaust, metal polish, insecticide, etc. I have consistently noticed that my tolerance for such abhorrent chemicals is much less when I have eaten large amounts of chocolate. This is counterintuitive, as in theory, the high epicatechin content therein should protect me from these poisons. My theory is that is that cacao somehow temporarily overwhelms the liver (perhaps due to the high caffeine, theobromine, and iron content). As a result, we feel unusually sick in response to low-level environmental toxicity; this is the liver's way of telling us that it's unable to metabolise poisons as fast as they're entering the bloodstream. I would suggest, therefore, that the longterm cardioprotective benefits of dark chocolate are best obtained in an unpolluted environment, in order to avoid the negative effects of shortterm liver overload. In my experience, this "liver overload nausea" starts about 5 hours after eating, and lasts for up to 10 more. It's also possible that the liver overload symptoms relate to the high saturated fat content in a chocolate bar, and not to the cacao; however, I seem to recall the same effect with chocolate powder.