Why do the Japanese have less heart disease?

24. April 2011 William Davis (49)
We should look to the Japanese to teach us a few lessons about preventing heart disease. A Japanese male has only 65% of the risk of an American male (despite 40% of Japanese men being smokers), while a Japanese woman has 80% less risk than an American woman. While the U.S. is near the top of the list of nations with highest cardiovascular risk, Japan is the lowest.

What are they doing right?

There is no one explanation, but several. Genetics probably does not play a substantial role, by the way, as demonstrated by observations of Japanese people who emigrate to Western cultures. People of Japanese heritage living in Hawaii, for instance, develop the same cardiovascular risk as non-Japanese living in Hawaii. They also develop obesity and diabetes.

Among the factors that likely contribute to reduced risk in Japanese people:

--A style of eating that does not include a lot of sweet foods. No breakfast cereal or donuts for breakfast, for instance, but miso soup with tofu, fish, green onions, and daikon (as takuan, or pickled radish).
--Seaweed--It's probably a combination of the green phytonutrients and iodine. Typical daily iodine intake is in the neighborhood of 5000 mcg per day from nori, kombu, wakame, and other seaweed forms. (The average American obtains 125 mcg per day of iodine from diet.)
--Seafood--Fish in many forms not seen in the U.S. are popular.
--Green tea--Consumption of green tea has been confidently linked to reduced cardiovascular risk, probably via visceral fat-reducing, anti-oxidative, and anti-inflammatory effects. Although tea in Japan is often the less flavonoid-rich oolong tea, softer benefits from this form are likely.
--Soy--Tofu, miso, and soy sauce are staples. It's not clear to me whether soy is intrinsically beneficial or whether it is beneficial because it serves to replace unhealthy alternatives. (Genetic modification may change this effect.)
--Reduced exposure to cooked animal products (except seafood). This is not a saturated fat issue, but probably an advanced glycation end-product/lipoxidation issue that result from cooking.
--The lack of a "eat more healthy whole grain" mentality, the advice that has plunged the entire U.S. into the depths of a diabetes and obesity crisis (along with high-fructose corn syrup and sugar). Noodles like udon and ramen do have a place in their diet, as do some dessert foods. But the overall wheat exposure is less--no bagels, sandwiches, and breakfast cereals.
--Less overweight and obesity--The above eating style leads to less weight gain.

Japanese foods have a unique taste, consistency, and mouth-feel that go well with saltiness, thus the downside of their diet: salt consumption. On a broad scale, high salt consumption has been associated with hypertension and gastric cancer. But the tradeoff has, on the whole, been a favorable one.


One study trying to find some answers:

Dietary patterns and cardiovascular disease mortality in Japan: a prospective cohort study.

Shimazu T, Kuriyama S, Hozawa A et al.
Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Japan.


We prospectively assessed the association between dietary patterns among the Japanese and CVD mortality. Dietary information was collected from 40 547 Japanese men and women aged 40-79 years without a history of diabetes, stroke, myocardial infarction or cancer at the baseline in 1994.
During 7 years of follow-up, 801 participants died of CVD.

Factor analysis (principal component) based on a validated food frequency questionnaire identified three dietary patterns: (i) a Japanese dietary pattern highly correlated with soybean products, fish, seaweeds, vegetables, fruits and green tea, (ii) an 'animal food' dietary pattern and (iii) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. The Japanese dietary pattern was related to high sodium intake and high prevalence of hypertension. After adjustment for potential confounders, the Japanese dietary pattern score was associated with a lower risk of CVD mortality (hazard ratio of the highest quartile vs the lowest, 0.73; 95% confidence interval: 0.59-0.90; P for trend = 0.003). The 'animal food' dietary pattern was associated with an increased risk of CVD, but the DFA dietary pattern was not.

The Japanese dietary pattern was associated with a decreased risk of CVD mortality, despite its relation to sodium intake and hypertension.

Niacin: What forms are safe?

20. April 2011 William Davis (52)
Niacin, or vitamin B3, remains a confusing issue for many people. It shouldn't be.

It doesn't help that most physicians and many pharmacists also do not understand the basic issues surrounding niacin. The only reason why there is any level of prevailing knowledge about niacin is that Kos Pharmaceuticals managed to "pharmaceuticalize" a niacin preparation, prescription Niaspan, that provided the revenue to fund professional "education."

Niacin can be helpful to increase HDL, reduce small LDL particles and shift them towards the more benign large particles, reduce triglycerides, and reduce lipoprotein(a).

So here's a brief description of the various forms that you will find niacin:

Immediate-release niacin--Also called crystalline niacin or just niacin. This is the original niacin that releases within minutes of ingestion. Because it releases rapidly, it triggers the most intense "hot flush." While this form of niacin works wonderfully well, is the safest, and is dirt cheap, the majority of people are simply unable to tolerate the intense flush. It also works best taken twice a day, generating two intolerable flushes per day.

Slow-release niacin--These preparations were popular in the 1980s, since the slow 12 to 24 hour pattern of release minimized the annoying hot flush. But, with prolonged use, it also became apparent that an unnaceptable frequency of liver toxicity developed. Unfortunately, this means that any niacin preparation that trickles niacin out over an extended period, including many of the slow-release preparations now sold in health food stores and pharmacies, have potential for liver toxicity. These preparations should be avoided.

6-hour release niacin--Releasing niacin more slowly than immediate-release niacin but more rapidly than slow-release niacin, 6-hour release (or what the Niaspan people call "extended-release" niacin) is nearly as effective as immediate-release niacin with approximately the same low potential for liver toxicity. It is far less liver toxic than slow-release niacin. 6-hour release niacin therefore offers the best balance between effectiveness and safety. Preparations that show this pattern of release include Niaspan ($180 per month), the poorly-named Sloniacin (about $8 per month), and Enduracin (about $7 per month) for 1000 mg per day. (Some Track Your Plaque Members have also determined that several other over-the-counter preparations have been demonstrated to share a similar pattern of release.)

Then there are the scam products that have no useful effect at all:

Flush-free or no-flush niacin--Inositol hexaniacinate, or 6 niacin molecules bound to the sugar, inositol, has no effect in humans, at least not with the dozen or so preparations that I've seen used. Nor are there any data to document the effectiveness of flush-free niacin. It's also more expensive.

Nicotinamide--This niacin derivative likewise has no effect on the usual targets for niacin treatment.

While I used to prescribe Niaspan, the ridiculous pricing and aggressive marketing really turned me off. I now advise my patients and our online followers to use only Sloniacin or Enduracin, unless you can tolerate immediate-release niacin.

Introduction to the New Track Your Plaque book, version 2.0

18. April 2011 William Davis (0)

Out with the old,
in with the new  



“I believe that you are suffering from what is called a fatty degeneration of the heart.”

Dr. Tertius Lydgate to Mr. Casaubon on making a diagnosis with the new medical device, the stethoscope.

George Elliot
Middlemarch, 1871





Old notions in medicine have a peculiar way of lingering.

In 1882, Dr. Robert Koch discovered the tubercle bacillus in tissues of people with “consumption.” By connecting a bacterium with the disease, he usurped the long held notion that tuberculosis was a degenerative disease caused by lack of fresh air. But, for decades after Dr. Koch’s revelation, the “bad air” belief persisted. Surgical collapse of the lung, a painful and barbaric treatment for tuberculosis, persisted well into the 1960s, years after effective antibiotics were discovered in 1947.

The medical community of the 19th century viewed mental illness as the hereditary end-product of ancestral nervousness, alcoholism, prostitution and criminal behavior, a bias that remained widespread well into the mid-20th century. Nazi physicians invoked the theory of heritable “mental degeneration” to justify wholesale extermination of schizophrenics. Electro-convulsive therapy (ECT, or “electroshock therapy”) was widely applied to treat schizophrenia, depression, homosexuality, and criminal behavior for over 30 years, gradually abandoned (at least in its original form) after years of abusive application to subdue patients, demonized in the 1975 movie, “One Flew Over the Cuckoo’s Nest,” depicting the author’s real-life experience with ECT.

Long after a theory or practice has been discredited, it can persist, refusing to die. The new and improved may not be adopted into mainstream practice for years, even decades.

Back to the 21st century: What if you realized that, by quirks of human nature and the uneven adoption of health information, your doctor practiced medicine appropriate for 1985? 1975?

While digital information nowadays is transmitted at the speed of light, disseminating as fast as it takes the next juicy tidbit to be “virally” reproduced via social networking websites, it’s the human factor that still operates with the inertia of human behavior. Habits and attitudes slow the adoption of new information in time measured not in seconds, but in years or decades.

A century ago, 20 years were required for the new technology of blood pressure measurement to be adopted after its introduction in the U.S. in 1910, since physicians were long comfortable with the practice of “pulse palpation” (feeling the pulse). (The arcane language of pulse palpation persists to this day, terms like “pulsus parvus et tardus,” the slow rising pulse of a stiff aortic valve; and the "water-hammer" pulse of a leaking aortic valve.)

The discovery of new, health-changing information today in the 21st century disseminates through the ranks of modern healthcare providers at much the same pace as measuring blood pressure did in the early 20th century.

It’s also tempting to paint American medicine as a fiefdom intent on maintaining exclusive rein over health information. Look back over the hierarchical relationship of medicine over nursing in the past century: When blood pressure measurement was adopted on a broad scale in the 1930s, it was practiced only by physicians, since nurses were deemed incapable. (Modern-day nurses should surely have a hearty laugh over this.) Stethoscopes, around even longer than blood pressure cuffs, weren’t permitted to fall into the hands of nurses until the 1960s, since the medical community feared that nurses might command too much control over patient care. Even after nurses were permitted to have their own stethoscopes, great pains were taken to be certain the nurses’ version was readily distinguishable from the “real” tool wielded by physicians; nurses’ stethoscopes were therefore labeled “nurse-o-scopes,” or “assistoscopes,” and were required to be smaller and flimsier.

Old and ineffective doesn’t always give way to new and better at once; it is slowed by habit as well as an unwillingness to relinquish control.

Somehow technology marches on. But it does so unevenly, sweeping some along in its first wave, others in its wake, some never at all.

Just as effective antibiotics to cure tuberculosis were available for 20 years while surgeons continued to remove patients’ lungs, so better solutions to heart disease are already available but not yet employed by your neighborhood physician. The primary care physician may have heard about some of the newest means to prevent heart disease, but is too overwhelmed with the day-to-day of sore throats, diarrhea, and rashes. Cardiologists, intent on inserting the next best stent or defibrillator, have little but passing interest in strategies that might halt or reverse the heart disease that can be “managed,” no matter how imperfectly, with procedural solutions like angioplasty and bypass surgery. We should bear these flawed human tendencies in mind as we explore the world of heart disease prevention.

We need look no farther than the front page of the newspaper to find evidence of the failure of present-day heart disease detection and management. Over the past several years, headlines have carried the likes of Tim Russert, Bill Clinton, Larry King, Dick Cheney, David Letterman, Tommy Lasorda, Ed Bradley, Mike Ditka, Walter Cronkite, Alberto Salazar, all heart disease sufferers. Some, like talk show host David Letterman, survived their brush with heart catastrophe and underwent successful bypass surgery. Others, like marathoners Fixx and Salazar, raised none of the conventional red flags for heart disease. All received standard, “modern” medical care . . . all the way up to their heart attack, bypass surgery, or untimely death.

Like the sphygnomanometer (blood pressure) cuffs of 1910, Track Your Plaque represents an example of the new. But, unlike the simple practice of taking blood pressure in the early 20th century, Track Your Plaque represents an entirely new way to look at coronary heart disease: a new way to measure it, a new way to identify its causes, and a new way to seize control over it, often to the point of achieving reversal of the process. It also puts control over much of this process into your hands and away from hospitals, cardiologists, and heart procedures. 

I could speak of revealing “secrets,” but that’s not true. In Track Your Plaque, I simply convey information about heart disease that you were likely unaware existed, strategies that doctors fail to discuss. I assemble them into a “package” that, together, create an enormously empowering unique approach to prevent heart disease and heart attack.

Track Your Plaque also challenges the high-tech status quo, practices that occupy exalted places in the enormous cardiovascular healthcare machine that has dominated American healthcare for the past 40 years. I propose that high-tech hospital procedures should join the practice of ECT for homosexuality and insanity¾and become yet another relic of the past.

What are "normal" triglycerides?

12. April 2011 William Davis (67)
Among the most neglected yet enormously helpful values on any standard cholesterol panel is the triglyceride value.

Triglycerides traverse the bloodstream by hitching a ride on water (serum)-soluble lipoproteins, or lipid-carrying proteins. We measure triglycerides as an indirect index of triglyceride-containing lipoproteins.

Triglycerides are a basic currency of energy. While the average American ingests around 300 mg of cholesterol per day, he or she also ingests 60,000-120,000 mg (60-120 grams) of triglycerides, i.e., 200 to 400 times greater amounts, from fat intake. Zero triglycerides in the diet or in the bloodstream is not an option.

But what represents too much triglycerides in the bloodstream? There are several observations to help us make this determination:

1) When fasting triglycerides are 133 mg/dl or greater, 80% of people will show show at least some degree of small LDL particles.

2) When fasting triglycerides are 60 mg/dl or less, most (though not all, since genetic factors enter into the picture) people will show little to no small LDL particles.

3) When fasting triglycerides are 200 mg/dl or greater, small LDL particles will dominate and large LDL particles will be in the minority or be gone entirely.

4) When triglycerides are 88 mg/dl or greater after eating, then risk for heart attack is doubled. Non-fasting triglycerides in the 400+ mg/dl range are associated with 17-fold greater risk for heart attack.



From Austin et al 1990. "Phenotype A" means that large LDL particles dominate; "phenotype B" means that small LDL particles dominate.

Note that conventional "wisdom" (i.e., NCEP ATP-3 guidelines) is that triglycerides of up to 150 mg/dl are okay, a level that virtually guarantees expression of small LDL particles and increased cardiovascular risk.

Based on observations like these, in the Track Your Plaque program we aim for fasting triglycerides of no higher than 60 mg/dl and postprandial (after-meal) triglycerides of no more than 90 mg/dl.

Curiously, while fat intake (i.e., triglyceride intake) plays a role in determining postprandial triglyceride blood levels, it's carbohydrate intake that plays a much larger role. That will be an issue for another day.

1985: The Year of Whole Grains

9. April 2011 William Davis (30)
In 1985, the National Cholesterol Education Panel delivered its Adult Treatment Panel guidelines to Americans, advice to cut cholesterol intake, reduce saturated fat, and increase "healthy whole grains" to reduce the incidence of heart attack and other cardiovascular events.

Per capita wheat consumption increased accordingly. Wheat consumption today is 26 lbs per year greater than in 1970 and now totals 133 lbs per person per year. (Because infants and children are lumped together with adults, average adult consumption is likely greater than 200 lbs per year, or the equivalent of approximately 300 loaves of bread per year.) Another twist: The mid- and late-1980s also marks the widespread adoption of the genetically-altered dwarf variants of wheat to replace standard-height wheat.

In 1985, the Centers for Disease Control also began to track multiple health conditions, including diabetes. Here is the curve for diabetes:


Note that, from 1958 until 1985, the curve was climbing slowly. After 1985, the curve shifted sharply upward. (Not shown is the data point for 2010, an even steeper upward ascent.) Now diabetes is skyrocketing, projected to afflict 1 in 3 adults in the coming decades.

You think there's a relationship?

Have some more

7. April 2011 William Davis (37)
Wheat, via exorphin effects, is an appetite stimulant. Eat a whole wheat bagel or bran muffin, you want another. You also want more of other foods. You also want something to eat every two hours due to widely-swinging insulin-glucose responses: blood sugar high followed by a sharp downturn that triggers a powerful impulse to eat (thus the cravings for a snack at 9 and 11 a.m. after a 7 a.m. breakfast).

If wheat is a stimulant of appetite, then removing it should yield reduced appetite and reduced calorie intake. That is precisely what happens.

When wheat products are removed from the diet--without calorie restriction, without counting fat or carbohydrate grams, no exercise program, no cleansing regimen, no skipping meals . . . nothing--calorie intake drops 350 to 400 calories per day. This calorie figure remains curiously consistent across multiple studies in which wheat was eliminated.

400 calories per day results in 21 lbs lost over 6 months, based just on calories. (3500 calories per pound lost.) That is what happens in wheat elimination diets: 21-26 lbs lost over 6 months.

Wheat is the processed food industry's nicotine, a means of ensuring repeat food purchases. It's also low-cost (subsidized by the U.S. government), high-yield, an ingredient that even has its very own withdrawal syndrome should you miss a "hit."

When MIGHT statins be helpful?

7. April 2011 William Davis (17)
I spend a lot of my day bashing statin drugs and helping people get rid of them.

But are there instances in which statin drugs do indeed provide real advantage? If someone follows the diet I've articulated in these posts and in the Track Your Plaque program, supplements omega-3 fatty acids and vitamin D, normalizes thyroid measures, and identifies and corrects hidden genetic sources of cardiovascular risk (e.g., Lp(a)), then are there any people who obtain incremental benefit from use of a statin drug?

I believe there are some groups of people who do indeed do better with statin drugs. These include:

Apoprotein E4 homozygotes

Apoprotein E2 homozygotes

Familial combined hyperlipidemia (apoprotein B overproduction and/or defective degradation)

Cholesteryl ester transfer protein homozygotes (though occasionally manageable strictly with diet)

Familial heterozygous hypercholesterolemia, familial homozygous hypercholesterolemia

Other rare variants, e.g., apo B and C variants

The vast majority of people now taking statin drugs do NOT have the above genetic diagnoses. The majority either have increased LDL from the absurd "cut your fat, eat more healthy whole grains" diet that introduces grotesque distortions into metabolism (like skyrocketing apo B/VLDL and small LDL particles) or have misleading calculated LDL cholesterol values (since conventional LDL is calculated, not measured).

As time passes, we are witnessing more and more people slow, stop, or reverse coronary plaque using no statin drugs.

Like antibiotics and other drugs, there may be an appropriate time and situation in which they are helpful, but not for every sneeze, runny nose, or chill. Same with statin drugs: There may be an occasional person who, for genetically-determined reasons, is unable to, for example, clear postprandial (after-eating) lipoproteins from the bloodstream and thereby develops coronary atherosclerotic plaque and heart attack at age 40. But these people are the exception.

Advanced topics in nutrition

5. April 2011 William Davis (0)
Nutrition in the modern world has become an increasingly problematic topic. From genetic modification to commercialized methods of mass production, we are having to navigate all manner of complex issues in food choices, particularly if ideal health, including maximal control over coronary plaque, is among our goals.

We will therefore be releasing a series of discussions on the Track Your Plaque website in the coming months, a series I call "Track Your Plaque Advanced Topics in Nutrition." These will be, as the series title suggests, discussions for anyone interested in more than the "eat a balanced diet" nonsense that issues from "official" sources. Among the topics to be covered:

1)Advanced Glycation End-products--both endogenous and exogenous, including peripheral issues like lipoxidation and acrylamides.

2)Dietary influences on LDL oxidation--including the concept of "glycoxidation." Protection from oxidative phenomena is not just about taking antioxidants.

3) Foods you MUST eat--We've talked a lot about foods that you shouldn't eat. How about foods you should eat?

The New Track Your Plaque Guide now available

4. April 2011 William Davis (5)
The New Track Your Plaque Guide is now available!

The Track Your Plaque program has evolved over its 8 year history. While the original Track Your Plaque book reflected the program details that got the program started back in 2003-2004, plenty has changed.

This new version of the book, what I call the program Guide, represents version 2.0 of Track Your Plaque and includes:

--Updated lipoprotein treatment strategies--including new and expanded treatment choices for small LDL and lipoprotein(a).

--An entire chapter on vitamin D and its crucial role in cardiovascular health and plaque control.

--A new and expanded diet--All the reasons why the New Track Your Plaque Diet can achieve spectacular improvement in lipids/lipoproteins, reversal of insulin resistance/pre-diabetes/diabetes, weight loss, reduction in blood pressure, etc. are discussed in considerable detail. The diet is crafted to achieve maximum control over both metabolic responses and coronary plaque.

--An entire chapter on the role of omega-3 fatty acids is included.

--A detailed discussion on the role of iodine and thyroid health--One of the newest additions to the Track Your Plaque menu of strategies is to achieve and maintain ideal thyroid health. This tips the scales in your favor for improved control over lipids/lipoproteins, weight, blood sugar, and coronary plaque.


The new guide, as well as our new Member kits that include the new Track Your Plaque Recipe Book, At-Home Lab Test kits, and nutritional supplements, are all available in the Track Your Plaque Marketplace.

Don't wet yourself

3. April 2011 William Davis (13)
While there is more to wheat's adverse effects on human health than celiac disease, studying celiac disease provides important insights into why and how wheat--the gluten component of wheat, in this case--is so destructive to human health.

Modern wheat, in particular, is capable of causing "celiac disease" without intestinal symptoms---no cramping or diarrhea--but instead shows itself as brain injury (ataxia, dementia), peripheral nervous system damage (peripheral neuropathy), joint and muscle inflammation (rheumatoid arthritis, polymyalgia rheumatica and others), and gastrointestinal cancers.

One neurological manifestation of wheat's effect on the human brain is a condition called cerebellar ataxia. This is a condition that can affect adults (average age 48 years) and children and consists of incoordination, falls, and incontinence.

Because brain tissue has limited capacity for healing and regeneration, symptoms of cerebellar ataxia usually improve slowly and modestly with meticulous elimination of wheat and other gluten sources.

Such observations are relevant even to people without celiac disease. Celiac disease sufferers are more susceptible to such extra-intestinal phenomena, but it can also happen in people without positive celiac antibodies.



Some references:

Neurological symptoms in patients with biopsy proven celiac disease

A total of 72 patients with biopsy proven celiac disease (CD) (mean age 51 +/- 15 years, mean disease duration 8 +/- 11 years) were recruited through advertisements. All participants adhered to a gluten-free diet. Patients were interviewed following a standard questionnaire and examined clinically for neurological symptoms. Medical history revealed neurological disorders such as migraine (28%), carpal tunnel syndrome (20%), vestibular dysfunction (8%), seizures (6%), and myelitis (3%). Interestingly, 35% of patients with CD reported of a history of psychiatric disease including depression, personality changes, or even psychosis. Physical examination yielded stance and gait problems in about one third of patients that could be attributed to afferent ataxia in 26%, vestibular dysfunction in 6%, and cerebellar ataxia in 6%. Other motor features such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus were infrequent. 35% of patients with CD showed deep sensory loss and reduced ankle reflexes in 14%. Gait disturbances in CD do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment.



Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics

Two hundred and twenty-four patients with various causes of ataxia from North Trent (59 familial and/or positive testing for spinocerebellar ataxias 1, 2, 3, 6 and 7, and Friedreich's ataxia, 132 sporadic idiopathic and 33 clinically probable cerebellar variant of multiple system atrophy MSA-C) and 44 patients with sporadic idiopathic ataxia from The Institute of Neurology, London, were screened for the presence of antigliadin antibodies. A total of 1200 volunteers were screened as normal controls. The prevalence of antigliadin antibodies in the familial group was eight out of 59 (14%), 54 out of 132 (41%) in the sporadic idiopathic group, five out of 33 (15%) in the MSA-C group and 149 out of 1200 (12%) in the normal controls. The prevalence in the sporadic idiopathic group from London was 14 out of 44 (32%). The difference in prevalence between the idiopathic sporadic groups and the other groups was highly significant (P < 0.0001 and P < 0.003, respectively). The clinical characteristics of 68 patients with gluten ataxia were as follows: the mean age at onset of the ataxia was 48 years (range 14-81 years) with a mean duration of the ataxia of 9.7 years (range 1-40 years). Ocular signs were observed in 84% and dysarthria in 66%. Upper limb ataxia was evident in 75%, lower limb ataxia in 90% and gait ataxia in 100% of patients. Gastrointestinal symptoms were present in only 13%. MRI revealed atrophy of the cerebellum in 79% and white matter hyperintensities in 19%. Forty-five percent of patients had neurophysiological evidence of a sensorimotor axonal neuropathy. Gluten-sensitive enteropathy was found in 24%. HLA DQ2 was present in 72% of patients. Gluten ataxia is therefore the single most common cause of sporadic idiopathic ataxia.
Magnesium and arrhythmia

Magnesium and arrhythmia

11. February 2010 William Davis (35)
Because magnesium is removed during municipal water treatment and is absent from most bottled water, deficiency of this crucial mineral is a growing problem.

Magnesium deficiency can manifest itself in a wide variety of ways, from muscle cramps (usually calves, toes, and fingers), erratic blood sugars, higher blood pressure, to heart rhythm problems. The abnormal heart rhythms that can arise due to magnesium deficiency include premature atrial contractions, premature ventricular contractions, multifocal atrial tachycardia, atrial fibrillation, and even ventricular tachycardia, fibrillation, and Torsade de Pointes (all potentially fatal). Magnesium is important!

Magnesium supplementation is therefore necessary for just about everybody to maintain normal tissue levels. (The exception is people with kidney disorders, who should not take magnesium without supervision, since they retain magnesium.)

Here is a Heart Scan Blog reader's dramatic rhythm-correcting response to magnesium supplementation:



Dr. Davis,

A few months ago, I contacted you inquiring if you had written any articles on arrhythmia. You were generous enough to answer and guide me to an LEF article you'd written in which you stressed fish oil and magnesium. I had been suffering with bad PVCs [premature ventricular contractions] for over 20 years, and they had gotten so bad recently that I was told my next options were ablation or pacemaker!

I was already on fish oil and had not seen any difference, and so I researched the magnesium you suggested more thoroughly and found a huge body of studies supportng its effect on arrhythmia. I also read many posts on heart forums with people having success with it. After getting advice from various bloggers, I tried magnesium taurate in the morning and Natural Calm (an ionized form of mag citrate) in the afternoon and evening. Within three days the PVCs were quite diminished and by 2 weeks totally gone! As long as I keep taking it, they never return---not even one irregular blip---even when I drink strong coffee! The magnesium also cleared up my restless leg syndrome, my eye twitching, and insomnia. (Apparently, I was the poster-girl for magnesium deficiency.)

I am so angry that after all these years of suffering, trying various medications, and seeing at least 4 different cardiologists that NOT ONE ever even mentioned trying magnesium. The generosity of the few minutes you took to answer my email and steer me in a helpful direction brought me total relief.

Thank you SO MUCH!

Warmly,
Catherine C.
Tags :

Comments (35) -

  • Emily

    2/11/2010 4:17:58 PM |

    are there not food sources of magnesium that are bio-available as well as the option of supplementing?

  • Mike

    2/11/2010 4:33:25 PM |

    I'll echo my thoughts on magnesium's anti-arrythmic properties; in my early 20's, I found I had intermittent episodes of frequent multi-focal PVC (premature ventricular contractions), exacerbated by stress and caffeine.  I saw a cardiologist for this, and had no subsequent treatment or follow up.

    In my 30's, I started supplementing with ZMA (zinc, magnesium and B6) to improve athletic recovery; I  noticed a nice, regular sinus rhythm on the cardiac monitor (I work as a firefighter/paramedic).  

    I have no doubt that a vast majority of people, especially athletes, are deficient in magnesium.  One of thee most important minerals!  Even with a solid diet, Mg is hard to come by, and excretion is enhanced through physical activity and sweating.  I like ZMA personally, but I have heard good things about Natural Calm.

  • davide

    2/11/2010 5:48:23 PM |

    ...three other very common results of magnesium deficiencies:

    1. Constipation
    2. Headaches
    3. Muscle tension/cramps


    I say this from first hand experience. I will not go a day without it. But it is important to use the right kind of magnesium. Magnesium oxide is the least preferred.

  • TedHutchinson

    2/11/2010 6:02:55 PM |

    68% of USA adults don't reach the current RDA intake for magnesium and most people who understand the issue would say, like the RDA for Vitamin D, the current magnesium RDA is woefully inadequate.
    KRISPIN has a useful  
    Formula to Calculate Magnesium Daily Requirement-  5 to 10 milligrams per day per kilo of ideal body weight or 2.5 to 4.5 milligrams per day per pound of ideal body weight.  

    Example: 70 kilos or 150 pounds= 350 mg. to 700 mg. daily.  
    Magnesium is an incredibly safe mineral to supplement with and too much magnesium passes into the colon where it's hygroscopic properties means it attracts water and the result is loose stools. So you will be made aware when you have taken too much magnesium.
    Fellow misers may want to consider DEAD SEA SALTS magnesium chloride available in 25kg sacks from Equine  suppliers, Country Traders, suppliers to small farmers and livestock merchants. In the UK its pretty cheap £7ish a bag. Epsom Salts works as well if not better if you have arthritis. (Think Health Spa) but may be twice the price.Here's how to use it The advantage of having a soak in  magnesium rich bath water is your body won't absorb more than it needs transdermally.
    Do take note of the fact that magnesium calms nerves and relaxes muscle fibers.
    Soaking in a hot bath enriched with magnesium chloride (Dead Sea salts or magnesium sulphate (Epsom Salts) will leave you ready for bed and a good nights sleep. So later in the day, rather than morning.
    Lots of good magnesium info here MGWATER

    Don't try telling anyone on Diabetes forums of the relationship of magnesium to diabetes it's almost as provocative as trying to explain the Vitamin D Diabetes interrelation and will surely see you banned.

  • Anonymous

    2/11/2010 6:24:34 PM |

    The onset of PVC's in my mid-40's occurred about the same time as the onset of blindlingly painful nocturnal leg cramps of the calves and thighs.

    God only knows how many tests were ordered by the cardiologist I saw, or the other doctors that followed.  A lot of tests, not much to show for it except the threat of a statin prescription, a prescription for a "heart healthy" diet, a la the American Heart Association, and a pat on the head or two.

    Relief came several years later in the form of daily supplementation with magnesium glycinate ordered by a physician, whose practice is devoted to wellness... not sickness.

    madcook

  • DancinPete

    2/11/2010 8:46:11 PM |

    Is there an easy/cheap way to find out if you're magnesium deficient without getting a blood test?

  • TedHutchinson

    2/11/2010 11:25:51 PM |

    @ DancinPete
    Is there an easy/cheap way to find out if you're magnesium deficient without getting a blood test?
    Magnesium supplementation is so cheap and safe it's probably worth assuming you are deficient, take an effective amount, and if or when you start to get loose stools, back down a bit so you don't have that problem.

    Least well absorbed form is magnesium oxide.

    I use magnesium malate but magnesium citrate is fine for those who need the laxative properties.

  • Anonymous

    2/11/2010 11:40:11 PM |

    On a  very low-carb diet with little vegetables and no fruit, is it important to supplement potassium as well as magnesium?  If so, how much potassium?

  • polyhex

    2/12/2010 12:10:33 AM |

    I have seen the same thing in myself.  

    I had leg cramps in pregnancy which I stopped cold with magnesium.  An unanticipated side effect was the total resolution of a minor but persistent arrhythmia.  Recently I was lax in taking the supplements and my arrhythmia came back, exacerbated by exhaustion (new baby) and caffeine (new baby.)  I started the magnesium again and it's gone!

  • Chloe

    2/12/2010 12:57:06 AM |

    On magnesium and calcium from my experience:  I increased my D3 supplementation (boosted 7 reading to 98, GrassRoots Health testing), but started to experience very high "fluttery" pulse, 140+ and I am in my 60s.  OMG how bad I felt.  Practically everywhere I searched said up the magnesium.  I did (magnesium taurate) but this problem continued.  I then changed on the following page and it has saved me:  
    http://www.ithyroid.com/ca_and_mg.htm

    Calcium citrate powder in water with a little bit of vitamin C powder (read calcium better absorbed in acidic environment) would bring my pulse and blood pressure down within 30 minutes.  

    Since I am without health insurance or the means to see a doctor anyway, I can only deal with the symptoms and not know the official diagnosis.

    My pulse was high, weak, and "fluttery."  Now that I supplement with 2000 mg of calcium citrate and 1000 mg of magnesium taurate my heart problems have disappeared.

  • Mike

    2/12/2010 3:27:33 AM |

    Nice posts, Ted.  And excellent blog!

  • Anonymous

    2/12/2010 4:44:22 AM |

    I take Natures Calm at night (makes me sleep like a baby) and pop a few mg citrates during the day.  If I take Natures Calm during the day I get way too relaxed.

    Heart palpitations and leg cramps seems to go hand in hand with me. Extra mg knocks out both.

    However, one time I ran out of my citrate tabs and grabbed a container of a mag/cal supplement.   That combination did nothing for me, no matter how much I took.  The ratio of calcium to mg was way off favoring calcium.  Also, I notice if I take in too much yogurt and cheese the effects of my mg seems to wane.

    My only theory is that its true that if your calcium intake exceeds your mg intake by too much it can block the benefits. So far that has been my experience. Not a psychosomatic response, since I knew nothing of it until I looked it up after the cal/mg  blend didn't help me. Wow.

  • Barkeater

    2/12/2010 7:09:40 PM |

    I looked into blood tests, but concluded that that was not a very practical or accurate way to assess magnesium deficiency.  

    I concur with those that say if you have symptoms that might be magnesium deficiency, go ahead and supplement because your probably are deficient and there is no harm in it.  I had a lifetime pattern of getting severe leg cramps any time I exercised hard (like playing soccer) for more than say 80 minutes.  That was a very good hint.

    But, I was not content to leave it at that.  I looked at my diet, the reported mg content of food in it, and the RDA for me of 420mg of magnesium per day.  It was totally obvious that, even with my pretty healthy diet, I must be below 300mg of mg per day.  IT IS SO EASY TO GUESTIMATE YOUR NUTRIENT INTAKE THIS WAY, but nobody seems to suggest it.  Instead you see mindless blather about eating a few other foods that are high in mg -- go ahead and do the math and you will see that you need to be really dedicated to make that work.

    This kind of a self-assessment of the nutrient content of your normal diet, in many cases, will show that you don't take in recommended levels of iodine, potassium, and selenium, either.  Like mg, these are involved in countless ways in our biology.  Potassium is the one of these that is trickier to supplement - that you probably need to correct by shifting salt use to mixed salts (or no-salt) that have potassium chloride.  It turns out that my cramping issue needs both mg and potassium to be kept at bay, but together they work.  (Getting salt-potassium in better balance is good for blood pressure, too.  My systolic and diastolic dropped 10 points each since joining TYP a year ago.)

    I supplement mg with mag water, per the TYP web site.  Cheap and absorbable, no side effects, easy to incorporate into your regimen, and nice not to take one more pill.

  • Dr. William Davis

    2/12/2010 7:41:41 PM |

    The only way to truly know your magnesium status, short of waiting for clear-cut evidence of deficiency (muscle cramps, heart rhythm disorders, etc) is to check a blood level, preferably an RBC level, not a serum level. The RBC level is a rough approximation of tissue levels.

  • DrStrange

    2/14/2010 6:49:56 PM |

    If you hunt around you can also get magnesium ascorbate which gives a nice two-fer.  I get mine from Intensive Nutrition, one tablet contains 100mg magnesium and 1000 mg vit C as ascorbate.  Also, NOW brand makes a powdered one and Source Naturals also...

  • Anonymous

    2/16/2010 7:23:15 AM |

    Magnesium is one of the essential components necessary for the body to function normally. It is not just necessary for human; rather, it is essential for all living organisms as magnesium ions are a part of the nucleic acid chemistry of all living cells and things. Because it is so vital, you can imagine what should happen if someone were to be magnesium deficient. It is not a pretty picture, indeed.

    More Info: Sign and Symptoms of Magnesium

  • chris

    2/16/2010 4:56:50 PM |

    Theres no need to supplement if you are eating several servings of legumes and nuts every day.

    I have replaced most grain use in recipes with legumes, and nuts are a good food on the go.

  • Mike

    2/16/2010 11:55:59 PM |

    "Several serving s of legumes and nuts" will effectively increase your intake of inflammatory lectins and omega-6s.

    I'll stick to supplementing.

  • Anonymous

    2/24/2010 11:47:52 PM |

    My leg cramps were also resolved by magnesium supplementation. Many people don't realize that eating grains will severely inhibit the absorption of minerals, due to their phytate content (an "anti-nutrient") and will therefore contribute to magnesium and other mineral deficiencies. The phytates in grains can be mostly eliminated by soaking and/or sprouting them before consumption.

  • L. Cramp

    3/16/2010 7:52:39 PM |

    I have always been fascinated by the question ,why some people can and others cant. I spent years trying to figure this out. At first it was mainly for myself. I remember growing up with little confidence and under the impression that others were more capable than I was. The fact was that this impression was true. It was true because i believed it.

  • Helena

    4/15/2010 6:54:29 PM |

    Hi Dr Davis,

    I just had my first experience, at least I think so, of arrhythmia on Tuesday night... My heart was beating really, really fast for about a minute or two and then it all just stopped and went back to normal.

    I try to take 150 mg of magnesium every day (on Tuesday I forgot to take all my supplements). What is your recommendation on how much I should take each day? Does it matter what kind, should I spread it out over the day or is once a day dose ok?

    The whole experience was a bit overwhelming for me and I want to make sure it does not happen again! If it however does, should I go to a doctor? What can I requests as far as 'safe' tests?

    My experiences with tests are usually pretty bad as I always end up in the 'normal' range... whatever that means. And I get the "You are just a crazy hypochondriac, go home" look from the doctors.

    Appreciate your comment on this. Thank you.

  • TedHutchinson

    4/16/2010 9:25:42 AM |

    @ Helena
    150mg magnesium daily probably isn't sufficient.
    Krispin's formula suggests someone 70 kilos = 150 pounds should have a  total intake between 350mg to 700mg daily.
    The current magnesium RDA of 420mg/men, 320mg/(non-pregnant) women but average US female intake is just 228mg/daily.

    You also do not state the form of magnesium supplement you take.
    Many of the magnesium blends available include magnesium oxide. It's likely, where percentages are not stated, this cheapest (least effective) form constitutes the bulk present. Only 4% of magnesium oxide is absorbed.

    Magnesium is best absorbed (like calcium) from small amounts, through the day, with meals. I find it easier to take magnesium with each meal of the day and before bed.

    Does a higher ratio of serum calcium to magnesium increase the risk for postmenopausal breast cancer?
    This paper hypothesizes that low levels of magnesium  increase calcium retention, higher calcium levels further depress magnesium absorption and the resulting cellular imbalance leads to cancer initiation. Magnesium intake is an extremely important aspect of Vitamin D supplementation that is often overlooked.

  • Dave, RN

    5/14/2010 4:25:51 AM |

    TEedHutchison, I've been there with the diabetes forum. When I suggested a  paleo very low carb diet to a confused person who was just diagnosed, I was called a "dangerous extremest" by who I believe was the moderator. All of my suggestions about magnesium and D3 were poo-pood by him, and besides an extremest, I was brushed of as "one of those people who occasionally shows up here".

  • Helena

    5/27/2010 3:05:03 PM |

    Thank you Ted.
    I will look at what type of Mg I am taking... and also increase the dose. If not I will order the magnesium you suggested. I have not had an event since that one time but I have had some slight feelings of dizziness and fluctuations in pulse. This is all due to coming off of a birth control pill that was killing me I am sure, it just takes time getting to know your body once again after years on synthetic hormones. Thank you again.

  • Anonymous

    5/28/2010 3:54:24 PM |

    Just want to say what a great blog you got here!
    I've been around for quite a lot of time, but finally decided to show my appreciation of your work!

    Thumbs up, and keep it going!

    Cheers
    Christian, iwspo.net

  • Anonymous

    6/7/2010 2:49:32 AM |

    Dr. Davis, I stumbled across The Heart Scan Blog after months and months of being frustrated with a heart arrhythmia that appeared out of the blue after a period of high stress and anxiety attacks late last fall.  I was feeling a lot of "skipped heartbeats" and immediately went to a cardiologist who ordered a stress echo and 24 hr holter monitor.  He told me it was a benign premature heartbeat which I was relieved about but after months of getting 20-30 a day, it was all I could think about.  Reading your blog and the discussion regarding magnesium has given me hope.  A few weeks ago, due to ease, I  was eating large quantities of quinoa which is rich in magnesium and noticed that the skipped beats subsided a bit to 5x a day.  I didnt know if there was a link but I am hopeful that there is a link and willing to give magnesium a try.  I've already purchased the magnesium taurate - what do you recommend in dosage? Please note, I am always worried about taking any supplements....are there negative side effects. Could it make my heart arrhythmia worse?  Thanks so much!! I am desperate to get back to a life where the skipped beats are not on my mind 24/7.

  • Phyllis

    6/9/2010 5:37:37 PM |

    I have had an annoying arrythmia for a very long time. Its worse at times, better at times. I have seen a cardiologist. He did an ekg which said that I had had a heart attack. Echo was done and Doc said I had not had a heart attack, but have PAC's and a leaky tri-cuspid valve. He also did a 24 hour holter monitor. Basically he said there wasn't anything bad wrong, but he put me on sotalol to try and clear up the palpitations and rapid-ish heart rate. Also, my BP was in the 100's range for the lower number.
    I have not noticed much difference as far as the palpitations go, after over a year on the sotalol.
    I have however gotten my eating/health under control, with low carb, I have lost around 45 pounds and am within 10 pounds of my goal weight. My blood pressure is running around 117/75 most mornings, I feel like a new person, now if these annoying palpitations would just go away...
    To that end, after reading this post I have just recieved my bottle of magnesium taurate and plan on adding it to me list of supplements which includes 5000 units of vitamin D per day for about the last 6 months.
    My reason for posting this here is I hope to be posting soon that the palpitations have cleared up.
    LOVE this blog, its one of the very few that I have discovered and gone back and read many of the older posts.
    God Bless you, Doc, for taking the time to really help people!

  • Tiza

    8/30/2010 6:37:32 PM |

    Nice blog. Basically, I couldn't do without my magnesium malate. If it wasn't for the magnesium, I probably would not be able to walk, or at least not very good because of my back.

    I noticed that someone asked about having their magnesium tested. First, blood tests are really worthless for testing magnesium. I've never had mine tested, but there is a test that Dr. Dean talks about.  It's here at this link, and it's a non-evasive test:

    http://www.exatest.com/

  • blogblog

    10/31/2010 8:42:09 AM |

    The cheapest and simplest magnesium supplement is Epsom Salts (magnesium sulphate). It only costs about $1/year. It is also extremely safe and is widely used in medicine. About 1/10th of a teaspoon dissolved in 1L water will do the trick. It is also an extraordinarily effective laxative in higher doses.

  • buy jeans

    11/2/2010 8:41:18 PM |

    Magnesium supplementation is therefore necessary for just about everybody to maintain normal tissue levels. (The exception is people with kidney disorders, who should not take magnesium without supervision, since they retain magnesium.)

  • Drew

    1/6/2011 7:04:43 PM |

    Magnesium truly is the body's "master mineral." Without it, so many other minerals cannot be properly used in the body.

    Most people have a hard time with taking oral magnesium supplements and don't get the results their body needs.

    I was fortunate enough to come across "Transdermal Magnesium" or better know to me now as "Magnesium Oil."

    Magnesium Oil is simply a magnesium rich mineral solution that has been sourced from some body of salt water.

    Since the minerals in sea water are constantly being subjected to sunlight, it in turn makes the minerals ionic (ready for the body to use).

    It is as simple as spraying the solution on your skin and the body absorbs it directly into the cell. No digesting needed!!

    There are some concerns to be aware of however. Where are they sourcing their raw materials from? Is it clean of pollution and heavy metals?

    I have researched about every brand out there and a lot of them can be misleading.

    My favorite, by far, is Magnesoothe! They can be found at https://magnesoothe.com/index.html They handle there product in the very best manor from start to finish. They have the most helpful customer service. And their source goes unsurpassed!

    Their source is the Dead Sea and there is no other body of salt water like it on the  face of the planet! You can read more on the Dead Sea here at https://magnesoothe.com/dead-sea-facts.htm

    If you want to know more on the purity of Magnesoothe, you can read that here at https://magnesoothe.com/purity-cleanliness-clarity-magnesoothe.htm

    I hope that my 2 cent will be helpful to someone.

    Best of Health!
    The Magnesium Man

  • Hal

    4/26/2011 8:51:32 PM |

    About 1 1/2 years ago I started having arrhythmia issues which were diagnosed as atrial fibrillation.  I had my atenolol increased and this did help some but I was still having (mostly short) episodes on an almost daily basis a month later.  Looking around the net I found a paper that talked about how using preoperative Mg for open heart surgery reduced the incidence of AFib after surgery.  So I decided to try Mg.

    I started taking it to tolerance (IE. increased dose until I had loose stools and then back off a little) and in about a week the AFib episodes had gone away.  Now I only have AFib episodes if I forget taking Mg for a few weeks and it goes away in a few days if I start taking Mg again.

    What I find most distressing about this is that none of my doctors even considered recommending giving Mg a try as far as I can tell.   Why wouldn't it be one of the first things they try if there is no other apparent cause (like high/low potassium, for example).  In those cases where I told the doctor that Mg had helped their reaction was mostly along the lines of Mg can't cause too many issues so go ahead and take it.  But nothing about how it should be considered for treating arrhythmia.

  • kend

    11/21/2011 2:57:24 AM |

    A few yrs. back, I read a very interesting article written by a cardiologist concerning his having successfully treated a patient with arrythmia  with an intravenous solution of magnesium.

  • Ray

    2/9/2012 8:30:57 PM |

    I have had arrythmia for a few years now, I have been to two different consultants and both say "it''s benign and won''t do any harm" I however could not stand the horrible fluttery feeling when it happened so they put me on 2.5mg  of bisopronol. I found this was making me dizzy and so after getting the all clear from my angiogram with the doctors ok stopped taking them. I had read about the successful results of taking mangnesium and so at the start of this new year started taking 1000 mg a day and started a diary of taking my blood pressure and heart rate three times a day (I have a good home blood pressure meter that shows up arrythmia as well)  So far it seems to have cleared the arrythmia apart from the odd reading.
    I forgot to mention that where I differ from everyone elses posts is that I have a very slow pulse, 40-45 sitting and only 65 when I fast walk to work but it will go up to 120 if I do a hard session on the treadmill.  I am 61 and did have a slow heart rate when I did long distance jogging up to the age of forty.
    I would be interested to hear from anyone else that has a slow pulse.

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