In episode #46, Paul talks with consultant cardiologist Dr Sanjay Guptaon a supplement that he’s found to be beneficial for cardiac patients who experience ectopics and palpitations.
And that supplement is Magnesium and in this episode Dr Gupta takes us through what ectopics and palpitations are and why he recommends taking magnesium for them. He talks about the various types of magnesium available and which ones to buy and which ones to avoid.
There’s lots of great help if you are experiencing ectopics or palpitations or just want to know a little more about what goes on in your heart. Another essential listen from this popular YouTube cardiologist.
#046 Magnesium for ectopics and palpitations with Dr Sanjay Gupta
Paul Swindell: [00:00:10] Hello and welcome to another episode of the life after cardiac arrest podcast with me, your host, Paul Swindell. And today I'm joined by Dr Sanjay Gupta, who is a consultant cardiologist at the York teaching hospital and has a specialist interest in cardiac imaging.
And he has a popular social media presence and can often be seen doing YouTube and Facebook videos on cardiac related matters.
And he's also got a fantastic collection of shirts, which I'm very jealous of actually.
He's done a number of videos and all sorts of cardiac issues like palpitations, anxiety, ectopics, AFib, but his most popular one is on magnesium, which has got over one and a half million views on, and that post had 7,000 comments on.
And this is the subject we're going to be talking about today.
So welcome again, Dr Gupta.
Dr Sanjay Gupta: [00:01:05] Thank you for having me Paul.
Paul Swindell: [00:01:07] It's great to speak with you again.
So can you tell me why you did a video on magnesium? Cause it doesn't immediately spring to mind as being a cardiac subject?
Dr Sanjay Gupta: [00:01:17] Yeah. I think it all started because I was interested in talking about heart palpitations. And in particular, one of the commonest, Heart rhythm disorder causing heart palpitations is something called ectopic heartbeats. These are transient extra beats that tend to occur virtually in everyone, but tend to be very much noticed by those people who carry a degree of anxiety.
And when they happen, they can be really, really scary.
The problem well, with these is that, although we recognize them not to be dangerous. They are incredibly scary for patients. When the patient comes to the doctor, the doctor will say, Oh, you've just got a few a topic beads. They're not dangerous. Don't worry about it.
Because the patient can't understand this. He can't understand. He only knows what it feels like. There's very, there was very little support for such patients. You know? No one really talked about ectopics because they were not dangerous. So, in some way they were not important to the medical field because they were not dangerous.
But for patients, and particularly those patients who, who tend to be anxious about their health anyway, it was really something very big, so I felt that I could explain ectopics in a way that made sense to me, and because I did that, I did a video on ectopic heartbeats. A lot of people responded very favourably to that video.
They really felt that I was providing them with information that they hadn't been provided by their own healthcare practitioners. Many of them had been suffering from ectopic beats for 20-30 years. They developed chronic health anxiety as a result.
Really, really terrible stories when you heard them.
As I started doing more videos around ectopic heartbeats, I came across a bunch of people who talked about the fact that magnesium had helped their ectopic heartbeats.
No one had really talked about it on a big scale. These were just anecdotal reports from people who said, well, I took some magnesium and it's really made a big difference. And I thought, well, it'd be interesting to look into this to see whether it really works.
Does it really work?
And do you know?
And if it does, maybe I should talk about it.
I then went and did some reading around the subject and as a doctor, you want to feel like you have some kind of scientific evidence to back up your recommendations.
And I found a very, very small study in Brazil where they used magnesium. They gave magnesium to patients with ectopic heartbeats and they got some really good results and they describe 80 to 90% of patients feeling better.
And although it was a really tiny study and it was in an obscure journal, it gave me enough to be able to feel like I could talk about it.
And I said, well, you know, there is this and here is a study which talked about it. The problem is, the minute you mentioned something like this, people say, well, we want proper studies. We want bigger studies.
Those bigger studies will never be done because magnesium is never going to make money for anyone. And, therefore. Here was something that did have some kind of evidence base. The next step was to try and just recommend it to people, because to my mind, I was confident that it was a safe supplement to use.
So, I thought to myself, well, why dont I talk about it with two people and say, look, there was a small study which suggested it was beneficial. You could try it. It's not dangerous. If suddenly you find that things are better than it's worked for you, and if you don't feel any better then it's maybe not for you.
And on the basis of that video, a lot of people started using magnesium. And I got a ton, a ton of replies, a ton of comments saying, well, you know, when I started taking the magnesium, my palpitations got better. I spoke to my colleagues at work about this and they said, well, how can you recommend this?
There's no really big evidence. And I said to myself, well, do I really need the evidence? Because if the person in front of me who comes to me with a complaint says his problem is better after taking it. Then that's all the evidence I need. We are prescribing this or we are recommending this to improve a person's quality of life, and quality of life is a very individual thing and it has to be measured by that individual's own yardstick.
And so. I started recommending it, and a lot of people responded amazingly to it because they felt, gosh, no one has talked to us about these supplements. when you look, The FDA, the, everywhere. We are chronically depleted of magnesium. This is well-published. It's a well-recognized that three quarters of the population are deficient in magnesium, so it made sense.
When I started recommending it, people said they slept better.
People said that they felt calmer.
People felt that their ectopics got less.
Some people found that their other heart rhythm disturbances, like atrial fibrillation got less anecdotes, that these are not big studies, but how many anecdotes do you need to feel convinced that it's worth trying out?
And that's what's happened with magnesium and me.
Paul Swindell: [00:06:20] Can we just, go over what is exactly a palpitation and what is an ectopic? What is actually going on in our hearts when we, we feel those? I'm I don't think I've ever really had palpitations so much, but after my, cardiac arrest. I was very much aware of what I called missed beats.
Is that what our an ectopic is?
Dr Sanjay Gupta: [00:06:43] The missed beats where you describe a skipping or a fluttering or a miss beat followed by a big thud, those are ectopic beats. So, palpitation is a symptom. Okay. Any time the patient says, my heart feels like it's doing something it shouldn't be doing or it feels odd, that's a palpitation.
Different heart rhythm disturbances can cause palpitations. So, you you may even get palpitation when your heart is not doing anything funny, but it just feels like your heart's doing something funny.
So, for example, if someone comes and scares you, you know, from behind your heart will beat really hard and really fast and that would be a palpitation.
But at that time your heart's not doing anything odd. It's just responding to all the adrenaline that's suddenly been produced in your body. Then you have other heart rhythm disturbances, which may manifest as palpitation, and the commonest by far are ectopic heartbeats. Where what tends to happen there is that your heart will beat and then it relaxes for a certain amount of time.
When it relaxes for a certain, let's say it relaxes for a second and then it beats, so it'll fill up with a seconds worth of blood whilst it's relaxing, and then it will contract and push out that seconds worth of blood. Then it will start relaxing. Now if before it reaches that second of relaxation, let's say after half a second, an extra beat comes in from somewhere.
Then this time. The heart is only pumped out half a seconds worth of blood because the extra beat came in after half a second so it only had half a second. So that will feel like a missed beat. Then to compensate, the normal beat comes in later after one and a half seconds, and now the heart has had to fill up with one and a half seconds worth of blood, which it pumps out, and that then feels like a big thud.
So that's traditionally what ectopics feel like.
They feel like boom, boom, boom, boom, boom.
Paul Swindell: [00:08:35] Yeah.
I've definitely had those.
You said several times that they're not considered dangerous, why is that? Because it sounds like it could be a problem or could it not lead into a, further arrhythmia?
Dr Sanjay Gupta: [00:08:47] Well, we, the reason they're not dangerous usually is because they're non-sustained ectopics by definition, tend to be followed by normal beats.
Paul Swindell: [00:08:59] So what you just get them in isolation.
Dr Sanjay Gupta: [00:09:02] Yeah, definitely. So you'll get that extra beat. And then after a little while you get that big thud, which is the normal beat.
So, because the heart is a pump and when you have an ectopic, any heart rhythm disturbance, means one thing and one thing only. It means that the heart is a pump is not as as efficient. Okay?
So, the efficiency of the heart is compromised during that heart rhythm disturbance.
So, if you've got something which is only going on for a second, followed by normal beats, the inefficiency is non-sustained inefficiency.
It's followed by normal beats, the heart becomes efficient again.
Sustained heart rhythm disturbances are where you get one abnormal beat, followed by another abnormal beat, followed by another abnormal beat for, let's say, you know, 10 minutes there, you've got 10 minutes worth of inefficiency.
So that's why ectopics in general are not dangerous because they represent a non-sustained heart rhythm disturbance as opposed to things like atrial fibrillation, ventricular tachycardia, which are sustained.
Paul Swindell: [00:10:03] I see.
So are ectopics a symptom of an underlying problem, whether that be in the heart muscle or elsewhere in the body?
Dr Sanjay Gupta: [00:10:11] Sure. I mean, I think the first thing to say is that ectopics happen.
So if you take a hundred people off the street and do a 24 hour monitor on them, you will find that on their monitor, 60 out of the hundred, will have some ectopics in a 24 hour period. So they're very, very common. These are people who don't feel a thing.
They're just getting about their own, their lives. Normally they have no symptoms, but if you do a monitor, you'll see some ectopics. So they occur normally. It is true to say that if you have a diseased heart, if you have a structural problem with your heart, let's say you have a cardiomyopathy, let's say you have scar in your heart.
Let's say you have weaker heart, then the heart is more likely to be more irritable and therefore you may get even more ectopics. Significantly more ectopics, and that is why the first thing we do when we have a person who is getting ectopics is to make sure that the heart is structurally normal. We do that by doing an ECG and doing an echocardiogram, a heart scan, and if those are fine, then we turn around and say, we think you have a structurally normal heart.
Therefore, your ectopics are not, a symptom of a diseased heart. The next question then is, if they're not a symptom of a diseased heart, what else could they be?
And the answer is that there was some interesting studies done, the where they took a bunch of people who suffered from health related anxiety and they strapped them to a monitor and they proceeded to make them more anxious.
And as these people got more anxious, they got more ectopics on their monitor. So yes, you know, it's interesting. For example, you mentioned that you know, after, after you were unwell, you got some missed beats. That can simply, of course, it could be due to the fact that if you had a cardiomyopathy or something like that, you may get ectopics as a result of that, but more likely because of the trauma and the stress and anxiety that this whole thing may have caused you.
Paul Swindell: [00:12:05] I see. I see. Yeah, that makes sense. Because, they have dissipated over time and, I've become more relaxed and chilled about what happened as it were.
Dr Sanjay Gupta: [00:12:16] Yeah .
Paul Swindell: [00:12:17] Okay. So, can we look at the actual magnesium?
What is magnesium and why is it important to the body and the heart?
Dr Sanjay Gupta: [00:12:25] Okay, so, magnesium is a essential mineral.
It's a mineral and an electrolyte. It's, I think the fourth most abundant mineral in the body. It's necessary for electrical activity in the heart and the brain. It's a cofactor in more than 300 reactions within the body.
The daily recommended daily allowances, 400 to 420 milligrams for men and 310 to 360 milligrams for women.
But our daily intake is far less than this, most people take between 240 and 370 milligrams at most, and therefore, 75% of the population in the Western world takes in less magnesium than is recommended.
Once we have ingested the magnesium, 30 to 40% is absorbed from our gut and our bowel and some is excreted through our kidneys, but then our kidneys try and reabsorb it when we're deficient.
The other thing to say about magnesium, which is really, really important, is that the blood tests we have for it or not very accurate, and they don't give a true reflection of how much to total body magnesium we have. And that is why a lot of people will come to me and say, well, I've had my magnesium levels checked.
They're okay and I say to them, well, it's still worth trying a magnesium supplement because you can't rely on the blood test. And we are magnesium deficient because we now take in less than we should.
This is because of modern farming methods, which just serve to deplete the magnesium in soil, processing of food depletes magnesium further, we absorb less of it from our stomach because, you know, a lot of patients, for example, are on proton pump inhibitors, for their stomach, and, that reduces acid production and acid is necessary for absorption of magnesium.
And so by far and away, the commonest medication that is prescribed these days are PPIs, Losec, Metrazole, that kind of stuff.
And, they reduce magnesium absorption.
Carbonated beverages, reduce the absorption of magnesium and can make the problem worse.
We're using up a lot more magnesium than we were.
So, things like sugar, a lot more sugar in our foods, and magnesium is required to break the sugar down.
So, we're using a lot more magnesium that way. Stress, sleep disturbance, we'll all get rid of magnesium from the body. And, things like coffee, tea will make us excrete more magnesium in our urine. So, there's loads of reasons why so many of us are deficient in magnesium.
Paul Swindell: [00:14:57] You mentioned about, the food that we eat and the farming methods, depleting the amount of magnesium in our food, but what, what foods should we be looking for?
Because obviously I'll guess food is the best way of getting magnesium into your body, rather than necessarily taking a supplement.
Dr Sanjay Gupta: [00:15:14] I think greens are an important way to get magnesium.
Nuts are an important way to get magnesium in our body, you know, so almonds, spinach, cashew nuts, peanuts.
Trying to eat organically grown foods, whatever, you know, whether you can rely on what is organic or not is another matter, but avoiding processed foods and eating as far as you're aware, organically grown foods from local growers is a good way to get the magnesium into the body, but to my mind, most people benefit from taking a supplement as well.
Paul Swindell: [00:15:46] You mentioned that a blood test is not a good way of telling whether you are deficient is, is there any other way of telling if you're deficient?
Are there any obvious signs?
Dr Sanjay Gupta: [00:15:57] You know, the reality is, it's one of those deficiencies, which isn't reflected in outwardly major, major issues. But, there are some tests that are more accurate, so you can measure something called the red cell magnesium content, but very few places offer that test.
So most places they just do a blood test, and if you go to, you know, local doctors, et cetera, they'll just do the blood test for magnesium, which has no good at all.
I think it's one of those things where the symptoms of a deficiency of very kind of nonspecific, and this is only once you start taking a supplement, if you suddenly find out, gosh, you know, I'm feeling calmer and I'm sleeping better, and a lot of people will say that they get cramps in their legs at night and that they take a magnesium supplement, the cramps go away.
Paul Swindell: [00:16:44] What confused me when I was looking is that there are so many different types of magnesium. are you able to run through sort of some of the main types and the ones that perhaps, heart patients should be looking for in particular?
Dr Sanjay Gupta: [00:16:57] Yeah, there were a lot of different preparations. The common preparation you will come across as something called magnesium oxide and magnesium oxide is is not a good preparation to take because the bioavailability is only 4%.
So, what you take in you only absorb about 4% of what you're taking in, and it has a propensity to cause a loose stomach.
And so, one of the side effects of taking magnesium is loose stool.
So, magnesium oxide is one that I recommend against taking, but there are other preparations like magnesium citrate, magnesium glycinate, magnesium taurate. Any other form of magnesium is fine. You can, you don't actually have to take it orally.
You can take it topically, so you can have oil and rub oil into your skin, and it can be absorbed trans dermally as well.
In my experience, I recommend magnesium citrate or magnesium taurate as a really good supplement for heart palpitations.
Paul Swindell: [00:17:53] Is there any price difference in those products or those types of magnesium?
Dr Sanjay Gupta: [00:17:58] The way it started with me was a lot of people came to me and said, well, can you recommend a preparation?
And the preparation that was studied in the study from Brazil is no longer in production. So, no one seems to be producing that, particular, preparation. So, I decided to recommend magnesium taurate, and a lot of people came back to me and said, you know. That magnesium taurate it's done me a lot of good, I feel better. So, I said, look, that's the one to go for.
Unfortunately, then I discovered that the, company that was making it to raise their prices greatly, and I started recommending magnesium citrate. In the UK we have a health food store called Holland and Barrett, and you can buy magnesium citrate and it's about five or six pounds, something like that.
So, it's not too expensive at all. And, and that seems to work as well as any other preparation.
Paul Swindell: [00:18:48] But what form would that come in, is that a tablet or a powder?
Dr Sanjay Gupta: [00:18:52] I think it's a, I think it's a capsule.
Paul Swindell: [00:18:55] And for people who don't like taking tablets or have got a handful of tablets to take anyway, do you know, are there any other ways to ingest?
Dr Sanjay Gupta: [00:19:03] You can buy magnesium aspartet sachets so that you can mix them in water. And that�s a reasonable way to do it. You can open the capsules and put the powder in and mix it with water and that's another way to do it. Or topical magnesium, magnesium oil.
Paul Swindell: [00:19:21] And what sort of dosage should people will be taking of this? Would it be one size fits all or does it depend on your symptoms?
Dr Sanjay Gupta: [00:19:30] I generally say start with the recommended dose on the tin.
You know, so the preparation you buy, take the recommended dose because we know that at that dose that's going to be safe.
Now, the reality is with magnesium, you know, it has a, you can take a higher doses and not come to harm as opposed to something like potassium, for example.
With potassium, potassium has a very narrow, kind of normal range in the body.
If you go very high, it can be dangerous.
If you go low, it can be very dangerous.
But magnesium has a much wider scope.
So, I normally start off by magnesium citrate, 200 milligrams daily. Magnesium taurate 125 milligrams twice a day.
But any of the preparations, if you take the recommended dose on the box, then that's great place to start.
Paul Swindell: [00:20:23] You mentioned with magnesium oxide that you could get loose stools. Are there any other sort of side effects that you might get from some of the other types of magnesium?
Dr Sanjay Gupta: [00:20:33] I haven't come across any, is the truth. It is just the loose stool that I've come across. Obviously, people who have kidney damage or you know, in those people, you want to be a little bit more careful because they're not treating as well as they should.
But it is mainly the loose stools that have come across as a problem. Having said that, most people tolerate the other forms of magnesium really well. Magnesium glycinate is probably the easiest on the stomach.
Paul Swindell: [00:21:00] As I mentioned earlier, people are probably taking a handful of medications already if they've had a serious heart issue, are there any contra-indictions that it shouldn't be taken with any of these tablets. And should they be going to their, GP or cardiologist before starting on something like this?
Dr Sanjay Gupta: [00:21:21] It's always a good idea for everyone , to get the consent of their, healthcare provider before starting anything. Because everyone's different. And, you know, when I sort of make a recommendation, it's impossible to know the specifics for every person who may be thinking about it.
So, I would always say, you know, there's no harm in trying it. But just make sure that your doctor's happy with you trying it. I have not really found a major contraindication. My patients take all sorts of medications and they can take a magnesium supplement. And I've not really come across anyone, who has suffered, adversely as a result of taking the magnesium.
Some people worry that it has a slight, a very tiny anticoagulant effect. And if you're taking anticoagulants, people worry about that. But again, a lot of my patients do, and they've not come to any harm.
But again, as you know, I would always reiterate that before taking any kind of supplements, make sure your doctor is happy with you doing so.
Paul Swindell: [00:22:19] So have you got anything else to sort of, to sum up
Dr Sanjay Gupta: [00:22:22] Yeah, I think so.
I think the reason I recommend magnesium is for quality of life.
I don't know whether, you know, I don't recommend it because I think, Oh, this will make you live longer, I don't know.
There is no evidence, we don't know, but, I think that try and get out and seeing if your quality of life improves in some way.
And if it does, then that is what you were taking it for.
And if it doesn't, then maybe it's not for you.
But you know as again, you know, if, if for example, you don't sleep well and you start taking a magnesium supplement and you sleep better, well that just is good for you.
It improves your quality of life, it makes you a healthier person.
If you're getting ectopic beats and you take some magnesium supplements and the ectopics get less, well, that's just improved your quality of life.
So, in that sense, I think it's worth trying, and if you feel better, then great.
You know, the problem is very few people are going to go out and say, oh, take magnesium. You know, we are sort of a largely pharma driven industry now.
And, so it is all the, kind of the newest and most expensive medications, and the research and the kind of evidence base that we all crave for, will never, be accumulated for things like magnesium because there's no money.
Paul Swindell: [00:23:41] Okay, my final question would be, if someone starts taking it, how soon would they notice any effect if there is going to be some for them?
Dr Sanjay Gupta: [00:23:50] Usually, you know, within a week or two weeks, a lot of people come back and say, look, that's worked. I definitely think that's helped. So one to two weeks.
Paul Swindell: [00:24:00] And what's the sort of maximum time they should take it for? And if they haven't seen any, effect, and then?
Dr Sanjay Gupta: [00:24:07] Four weeks,
Paul Swindell: [00:24:09] Four weeks.
Dr Sanjay Gupta: [00:24:10] If you've not noticed a benefit in four weeks, and I don't think it's working for you then.
Paul Swindell: [00:24:16] Okay.
That's an absolutely brilliant session on magnesium Dr Gupta, thank you for that. And I'll speak to you next time.
Dr Sanjay Gupta: [00:24:24] Thank you.
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Presented and edited by Paul Swindell.
Recorded March 2020.