Low Sulphur Experiment is Successful

SULPHUR AS A SUSPECT. I have long suspected that sulphur (sulfur) might be the cause of my inflammation problems. Recently I finally found a list of foods evaluated for their sulphur content. I used that list as my guide in designing a low-sulphur diet.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1264524/pdf/biochemj01022-0143.pdf

A PROGRESSIVE EXPERIMENT. For six weeks, I have experimented with a low sulphur diet. At first I tried to eat only foods that contain less than 10 mg/100 g serving (about half a cup). Examples are celery (8 mg) and cherries (7 mg). Many fruits fit this category. Few vegetables fit it. No major starches, except pumpkin (9.5 mg) meet this requirement. I soon realized that I would have a lot of trouble getting enough protein. To do so, I raised my limit to 20 mg/100 g serving. Thus I was able to include sweet potatoes (yellow inside) and yams (orange inside), at 15 mg.

Since I had no problems with any food having up to 20 mg of sulphur, I lifted the bar again, to 30 mg. This expansion allowed me to add potatoes (22 mg), thus assuring me all the essential amino acids -- as well as a tasteful and filling meal.

I am now slowly and cautiously adding foods from an even higher level of sulphur. An example is asparagus (46 mg). So far I have had no adverse reaction.

SULPHUR VS. PRAL? Previously I used Potential Renal Acid Load as my guide for deciding which foods to eat. I avoided foods that tended to produce acidity in the kidneys after digestion; and I ate only foods that tended to produce an alkaline condition in the kidneys. The PRAL standard worked very well, reducing my inflammation problems by 99%. The low sulphur diet, however, is even more effective. It has wiped out the last 1% of the problems I have had intermittently for several years -- particularly the last of the eczema and occasional pain problems.

SULPHUR VS. SULPHUR-BEARING AMINO ACIDS? Have I actually identified sulphur, which is a natural chemical element, as the cause of my inflammation problems? I would say "no." Sulphur load might be only a proxy, confounder, or coincident indicator. The problem might be, not the element sulphur, but certain amino acids that contain a lot of sulphur, particularly cysteine and methionine. I do not know.

REMAINING PROBLEM. So far, I have been using only the amount of sulphur in each food as my guide. I have not been calculating the total amount of sulphur in a particular meal. I do not know which is more important. For the sake of simplicity, I will operate on the assumption that I should have only one higher-sulphur food per meal. That standard is easy to meet. I always eat fruit, which is very low in sulphur; I always eat roots or gourds, which are low in sulphur; and I always eat only about 1 C of vegetable, the one food I would consider at the higher sulphur levels. (I completely avoid all the highest sulphur foods: animal products and "seeds" of all kinds, such as grains, nuts, beans, peas, and especially seeds such as mustard, which has one of the highest sulphur ratings on the list.)

ACCEPTABLE FOODS. For an ever-growing list of acceptable, low-sulphur foods, see "What do I eat now?" -- originally posted on July 15, 2010. There is a link to it in the Key Posts list in the upper right corner of this page.

I will add to this post as I learn more.

Burgess Laughlin

Author, The Power and the Glory:The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith

Metoprolol

LAST UPDATED (Bottom) July 6, 2012

(This post is a diary. For a summary and overview of my tachycardia and arrhythmia experiences see the October 13, 2013 post here: http://www.anti-itisdiet.blogspot.com/2013/10/tachycardia-arrhythmia.html)

Cardio-version ended my second episode of atrial fibrillation, as described in the January 25, 2011 post here. My cardiologist recommended that I take 50 mg of time release Metoprolol every morning for the remainder of my life. The purpose of the Metoprolol is to suppress the heart rate. By preventing it from beating too fast (for example, under great stress), the Metoprolol helps prevent the sort of instability that might lead to atrial fibrillation.

My doctor expects the atrial fibrillation to return. (He said, "When, not if.") He said the most likely causes of reversion to afib are (1) alcohol (which I do not drink at all) and (2) general anesthesia (which I hope to avoid for many years).

This post summarizes information about Metoprolol that I have gained through the help of an associate. As a layman, I think the information I cite is reliable, but each person must decide for himself.
WHAT IS METOPROLOL? According to drugs.com, Metoprolol is a beta blocker, that is, a drug designed to block heart receptors. The drug blocks chemicals in the blood that stimulate heart beat. Metoprolol thus reduces heart rate and thereby improves efficiency of pumping and reduces blood pressure.
IS METOPROLOL SAFE? Though I prefer taking no drugs at all, I think Metoprolol (also known as Toprol XL) is a safe drug, compared to many others. Coincidence and correlation are not causation. No proof shows that Metoprolol always or generally causes any particular adverse conditions. However, as always, some users report one or more adverse conditions while taking Metoprolol. For most adverse conditions reported, the number of reports is very small compared to the much larger number of individuals taking the drug. Partial exceptions are sleepiness (10% of users), depression (5%), and intestinal upset (diarrhea or nausea, 5% each). I experienced all of those at one time, but the effects faded after a few weeks.
WHEN SHOULD I TAKE IT AND HOW? I should take my Metoprolol tablet ("Extended Release") at the same time every day, in the morning, with breakfast. I need to swallow it whole so that this time-release tablet dissolves slowly during the following 24 hours. (Thus, I am receiving the lowest dose at the very time when I need Metoprolol the least, which is during deep sleep, when the heart is naturally beating most slowly.)
IS 50 MG A LARGE DOSE? I read literature from my pharmacist that said the range available is 50 to 200 mg. (My doctor originally recommended 150 mg.) If that is accurate, then I am taking the smallest dose available as a whole time-release tablet. I am considering cutting each one in half, a procedure which is acceptable as long as I do not crush it and thus destroy its time-release capability.
UPDATE, April 30, 2011: Last week both my eyes became bloodshot. The left eye's right side was becoming dark red. Alarmed, I went to an urgent care clinic on Saturday morning. While giving me a routine preliminary examination, the nurse noticed that my bloodpressure was acceptable (115/65) but my heart rate was disturbingly low (40 BPM). Metoprolol is the most likely cause of both problems -- the bloodshot eyes and the excessively low heart rate. On the next day, and thereafter, I took half a dose, 25 mg, at breakfast. My eyes began clearing within 24 hours. My heart rate is closer to 50 BPM now (at around 10 am). I will continue at the half-dose while I consider ending my use of Metoprolol.
UPDATE, May 21, 2011: I have extended my dosage experiment by reducing the dosage of Metoprolol to 12.5 mg (cutting the tablet twice). So far, my blood pressure (typically 120/65 at 9 am) and my resting heart rate (typically 45-55) have remained low, even with a 75% reduction in dosage. My medication symptoms (somewhat loose stools, drowsiness, slight nausea between meals) are gone. I may dispense with the Metroprolol altogether.
UPDATE, August 26, 2011: A few days after the May 21 update, I increased the daily time-release Metoprolol back up to 25 mg and kept it there until August 25, when I stopped the Metoprolol completely. Now, on my second day, I am seeing a more positive mood, somewhat faster transit of food through my intestine, less drowsiness after breakfast, no more dry eye.

Unfortunately, my blood pressure rose (up by c. 10/10 to c. 130/80, averaged throughout the day) and my heart rate rose (up about 10 bpm, to around 65). (I was alarmed when my BP spiked mid-afternoon at c. 133/96, but then it declined into the evening. I will continue monitoring. If they do not go higher, I will continue avoiding the Metoprolol.
UPDATE, October 16, 2011: After returning to a 25 mg dose, shortly after Aug. 26, I continued for about a month and then once again took 12.5 mg daily until yesterday. Today is my first day trying again to live without Metoprolol. (I am now taking only a daily probiotic capsule and a twice-weekly Vitamin B12 tablet, 500 micrograms each.) In the days ahead, if my blood pressure and heart rate do not rise alarmingly, I will continue avoiding Metoprolol.
UPDATE, October 30, 2011: My blood pressure did rise alarmingly. Here are readings in the late afternoon two days after stopping: 122/87, 68 bpm at 405 pm; 116/86, 70 bpm at 408 pm; 121/88, 67 bpm at 430 pm; 142/96, 60 bpm at 530 pm. I have returned to taking 25 mg of Metoprolol every morning, probably for the rest of my life, as my cardiologist had suggested. A typical recent reading is: 126/74, 50 bpm at 810 pm.
UPDATE, November 28, 2011. OFF METOPROLOL! At the recommendation of a Physician's Assistant, at a new general practice clinic, I halved my dosage of Metoprolol for a week and then stopped taking it. So far, five days later, the readings are acceptable: E.g., 116/71 at 58 bpm and 128/72 also at 58 bpm. I learned that, at least at the new clinic (which has no cardiologists), cardiologists generally have a reputation for seeking a much lower heart rate than most primary care physicians would seek. I am now free of pharmaceuticals.
UPDATE, March 30, 2012. BACK ON METOPROLOL. On March 10, when I woke up, I had a very irregular heart beat and a very fast heart rate. It did not subside, even with deep breathing. I went to the local hospital. Diagnosis: tachycardia (cause unknown, but no thyroid problems), a slight anemia (cause unknown), and dehydration. The arrhythmia corrected itself. I was treated with intravenous water, with no improvement, and then with Ativan (valium), with no improvement. My heart rate was c. 120 bpm and blood pressure c. 140/90. Two days later, on Monday, at my doctor's office, my doctor and I agreed that returning to metoprolol was the safest, most sensible next step. I will take 50 mg, daily (time release), measure the results for 2 weeks, and then take my blood pressure and heart rate log to my doctor. In retrospect, I should not have stopped taking the Metoprolol.

In another visit to my doctor, I found that I am in "atrial flutter." I am waiting now to talk to a cardiologist who visits this small town. We will decide whether to simply continue suppressing the heart rate with Metoprolol or plan for another cardioversion to try to reset the rate and rhythm.
UPDATE, July 6, 2012. BACK TO NORMAL; REDUCED DOSAGE. I talked to the local cardiologist, a moderately aggressive interventionist. I rejected his suggestion to prepare for cardioversion. I chose instead to stay with 50 mg of Metoprolol to suppress the heart rate, and live with it. Around June 15, I noticed that I was no longer aware of my own rapid and irregular heart rate. I measure it daily, at the same time, for two weeks. The average rate was about 48 bpm, with blood pressure of about 120/65. The skips and pauses were gone, judging from what I could feel with my finger tips. I cut my Metoprolol dosage in half, to 25 mg/day, time release. On July 5, an EKG at my doctor's office confirmed those numbers and the proper rhythm as well. I will continue to take 25 mg daily, time release.
What might have caused reversion to a regular, though rather low rate? Possibly one of these changes: (1) I had increased by supplementation with Vitamin B12 to 50 micrograms, 5 days per week and 500 micrograms twice weekly, thus more than doubling the dosage; (2) I had started using salt again, thus reintroducing more iodine; (3) I had started eating one Brazil nut per meal (for selenium); and (4) I had stopped eating avocados (to which I might be allergic). How long will this last? We will see.

Comments are welcome, especially about your own experiences with Metoprolol.

Burgess Laughlin

Author, The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith

BkRev: "Over-Diagnosed" by Dr. H. Gilbert Welch

H. Gilbert Welch, MD, Lisa Schwartz, MD, and Steven Woloshin, MD, Over-Diagnosed: Making People Sick in the Pursuit of Health, Boston, Beacon Press, 2011, 228 pages. http://www.amazon.com/dp/0807022004/

"So when I suggest," writes Dr. Gilbert Welch, "that we develop a healthy skepticism about early diagnosis, I am referring specifically to seeking diagnoses in the absence of symptoms, because that's when overdiagnosis can occur. ... I'm simply suggesting that we should be most cautious about early diagnosis in those who feel well" (p. 185).

"Some," Dr. Welch continues, " may prefer to pursue health: to focus on feeling healthy and minimize medical contact while they are well. They accept a slightly higher chance of death or disability to minimize the chance of medicalization, overdiagnosis, and overtreatment now. They prefer to reserve medical care for problems that are obvious to them. Others may want to pursue disease: do everything they can to be healthy in the future and to decrease their chances of experiencing death or disability -- even with the knowledge that they are more likely to be diagnosed with disease, more likely to be frequently exposed to medical care, and more likely to suffer harm" (p. 185)

Those two basic choices -- primarily pursue health or primarily pursue disease -- are the alternatives the author of Over-Diagnosed offers at the end of his book. To reach that end, the author clearly but in considerable detail examines the potential benefits and dangers of premature diagnosis, that is, diagnosis formed before symptoms lead a patient to seek a solution to emerging problems.

The author explains the principles of diagnosis and overdiagnosis as he proceeds through a list of common diseases that most people -- and usually their doctors -- fear enough to be medically tested even before symptoms of disease appear. Those common diseases are: diabetes, osteoporosis, gallstones, damaged knee cartilage, bulging discs, abdominal aortic aneurysms, blood clots, defective pregnancies, prostate cancer, breast cancer, and other cancers. He also considers markers which are not themselves diseases but which might be harbingers of later disease: high blood pressure, high cholesterol, and genetic defects.

Welch meticulously shows the dangers of screening, that is, of automatically testing everyone -- or at least everyone of a certain category -- for the presence of a disease, even if they have no symptoms. The evidence for and against screening or other forms of premature diagnoses is mixed, which is why making a decision is difficult -- as much for physicians as for patients.

The time to read this thoroughly documented book is now, not when a physician tells you that you should be screened periodically for disease X or that you "might" have cancer or other frightening disease. Then you can make your choice about which approach you want to take.

Burgess Laughlin

Author, The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reasn vs. Faith, http://www.reasonversusmysticism.com/

My atrial fibrillation adventure

(This post is a diary. For a summary and overview of my tachycardia and arrhythmia experiences see the October 13, 2013 post here: http://www.anti-itisdiet.blogspot.com/2013/10/tachycardia-arrhythmia.html)

This post is my "journal" for my most recent medical adventure, chronic atrial fibrillation. I will revise the post as events unfold. I am not asking for specific medical advice. I welcome any suggestions for topics that I should consider or reconsider.

CHRONOLOGY

1997: EPISODE OF AFIB. After a large dinner, I walked, stopped, bent over to retie my shoe laces -- and my heart began beating irregularly and about 170 beats per minute (as I heard later from the emergency medical technicians who examined me). A doctor in the emergency room administered a chemical intravenously. It restored the regular rate. I walked home from the hospital.

2010, Dec. 19-23: CHRONIC AFIB. After a large dinner, I experience a rapid, strong, and irregular heart rate. It continued that way, with some variation, for four days. (I have learned to avoid rushing into medical treatments.) At the end of that period, I called 911 because I was worried about the rate. The emergency technicians said it was spiking at about 170 beats per minute.

Chronic atrial fibrillation, in some forms, is dangerous long-term because of the possibility of (1) eventual deterioration of the heart muscles, and (2) stroke resulting from a blood clot forming in the atrium, being expelled into an artery, and then blocking an artery somewhere in the body. Besides the danger, "afib" is very uncomfortable in some forms and very distracting. (My productivity for any kind of intellectual work plunged.)

2010, Dec. 23-25: ER AND HOSPITALIZATION. I went to a local hospital's emergency room. The doctor in charge administered, through an intravenous tube, a drug designed to regulate the heart rate. It did not work. The medication did improve the beat regularity somewhat and did lower the rate to about 130 BPM. (A safe rate is less than 90 and an ideal rate is about 60 BPM.)

I was admitted to the hospital from the ER. I had tests of my heart (electrocardiogram and echocardiogram [ultrasound]), thyroid (no problem), lungs (CAT scan, no embolism), "heart protein" (meaning unclear, but no problem), blood (no problem with either fat levels or vitamin or mineral deficiencies). I also had no kidney or liver or other organ problems. (That was good news I attribute to my diet.) No one asked me about what I eat except that the hospital dietician asked if there are foods to which I am allergic.

Struggling against the standard hospital over-treatment, I rejected some of the drugs which hospitals automatically prescribe for every heart patient: stool softener (I eat a high-fiber diet!), antacid (I have had no acid reflux since adopting my "anti-itis" diet six years ago), pain reliever (I have had no chest pain), two of the three anticoagulants (I accepted only an aspirin daily). I did accept Metoprolol (which suppresses the rapid heart rate to a safe level) in the lowest dosage (12.5 mg, 2x daily). The official diagnosis was atrial fibrillation, with no identified cause. I was discharged on Dec. 25 with instructions to take Coumadin (Warfarin, an anticoagulant designed to reduce the chance of a blod clot forming in the atria).

2010, Dec. 26 - 2011, Jan. 1st week: OUT OF THE HOSPITAL: PHARMACEUTICALS. For about five days, I experienced oscillating mild chill and fever, but it faded away. I researched online for the nature and effects of Coumadin (Warfarin). I decided not to take it.

I was examined briefly by my new primary care physician, Dr. C, and he gave me a short list of local cardiologists. I found Dr. K, a non-intervention specialist. He prescribed a higher dose of Metoprolol, a beta-blocker, 35 mg, taken once daily in the morning with breakfast. (The lower dose that I had requested in the hospital, as a start, wasn't working when I was under stress -- e.g., in a doctor's office.) My Metoprolol is now a time-release medication; it works for 24 hours and is weakest at precisely the time of day when my heart rate is naturally lowest, thus avoiding the danger of over-medicating and slowing the heart rate too much.

Dr. K discontinued my aspirin. He prescribed Digoxin, another beta-blocker designed to suppress heart beat. Dr. K also prescribed a drug newly "approved" in the USA, Pradaxa, an anti-coagulant. He gave me enough free drug samples of the Pradaxa (normally about $250/month), to last me until a stress test in his office. At that point, Dr. K said, he might be able to offer a more definitive diagnosis and recommend either a treatment program (possibly continuing the Pradaxa) or acceptance that I will need to live with the problem and continue taking Metoprolol and Digoxin to suppress the racing heart.

Dr. K confirmed what I had read about risk. The hospital doctors told me that I was at "high risk" of stroke, but I found later (and confirmed by my cardiologist) that the actual risk of stroke for a 66 year old man with afib, without medication, is, say, only about a 2% chance per year. With medication, it drops to about 1% per year. (The exact numbers are unclear to me.) So, relatively there is a much higher risk (100%) of stroke with not taking an anticoagulant, but the absolute level of risk is fairly small. On the "CHADS" scoring system (0 for the lowest risk, 6 for the highest risk), I am in the 0 category. As usual, the hospital doctors were being (over) cautious, perhaps for legal or regulatory reasons as well as training.

The pharmaceuticals I am taking now (Metoprolol, Digoxin, and Pradaxa) caused diarrhea in the first week. That problem lessened after about five days and then ceased when I began adding a probiotic (over the counter, chewable tablet, one per meal, containing Lactobacillus Acidophilus and L. Bifidus). I take all medications in the middle of meals, but spaced apart.

I am taking at meals two nutraceuticals -- nonprescription nutritional supplements designed to address specific problems -- recommended by two cardio physicians whose books I have read (with serious doubts, in one case): cod liver oil (1 teaspoon/meal), Vitamin B12 (50 mcg, 2 x week), and magnesium oxide/gluconate (1/day, 250 mg, which is about 63% of the Recommended Daily Allowance). The largest sources of magnesium are animal products and "seeds" (grains, and so forth). I can eat no animal products (except fats) or "seeds" without bringing my "-itis" problems back. (See "Key Posts" in the upper right corner.)

Three circumstances now accelerate my heart rate disturbingly: sitting up or standing up too quickly; compression (for exmple, bending over to tie my shoelaces); and mental stress (for example, reading the news). Mental stress is the strongest cause and the most difficult for me to control, but I am learning. My quality of life might depend on it.

GENERAL OUTLOOK: As of Jan. 25, a month after leaving the hospital, I have fully recovered my strong appetite, energy level, and exercise schedule (light weights, stretching, and walking 2 hours/day). Although I don't expect to live as long as I had originally hoped (85), I am cautiously hopeful that I can continue to live well for more years without yet starting to slide down the pharmaceutical spiral of ever-more drugs that treat the destructive effects of earlier drugs. I have no fear of death or of dying. I hate the idea of becoming progressively sicker because of pharmaceuticals.

UPDATE, 2011, Jan. 31, 10 am stress test: I took the stress test and enjoyed it. The main conclusions Dr. K reached are: (1) I have no heart problems other than the atrial fibrillation, and even that is not major; my heart efficiency is low but not dangerously so. (2) The Metoprolol and Digoxin are indeed suppressing my heart rate. (3) I need to continue the anti-coagulant Pradaxa until I can make a decision (after one more tests in three weeks) whether to have cardioversion or continue with some combination of drugs. (4) I probably will be able to replace the Pradaxa with a daily aspirin, eventually. (5) I am still in the bottom, least-risk category of the ranking for stroke risk. (That is why an aspirin will be sufficient, long-term.)

The details are, so far, unclear, but apparently the next step is to begin an additional drug for a few weeks, and then I will have another EKG. Apparently the new drug is a mild form of cardio-version (turning the irregular heart beat back to normal) that is safe for outpatient use. (More serious electrical, chemical, or surgical cardio-version would require hospitalization because of the doctors' fear of a stroke from a blood clot released during the cardio-version process. Apparently, when I begin the new drug, I will continue taking the Digoxin and Metoprolol but at reduced levels. I may have more details after February 2.

UPDATE, Jan. 31, 5 pm and 11 pm: While preparing dinner, I injured one finger with a tiny cut. It bled a small amount, but continuously for 30 minutes, despite soaking in cold water and wrapping it in tissue.

UPDATE, Feb. 4: Today I received my new instructions, via my doctor's medical assistant/nurse. I will continue taking Metoprolol (1/day, but now at 25 mg, half the previous daily dose), for rate control, and Pradaxa (2/day), for anticoagulation. Replacing the Digoxin will be Multaq (dranedarone), 400 mg/tablet (2/day), for rhythm control, as a sort of out-patient cardioversion, apparently. I am also continuing my nutraceuticals: probiotic (1/2 per meal), magnesium (250 mg, 1/day), cod liver oil (1 t, 3/day), and B12 (50 mg, 2/week). I am scheduled for an EKG in my doctor's office on Feb. 17.

I have a growing list of questions about the drugs, especially the Multaq: what are its advantages over its competitors? Safer? More effective? Only one governmentally approved for outpatient cardioversion (as my doctor had suggested in the past)?

UPDATE, Feb. 17: An EKG in my doctor's office revealed that I do indeed still have atrial fibrillation and my heart rate, even under medication, remains high (78 bpm). The chemical treatment (Metoprolol, Multaq), which is therapy stage 1, failed to reset my heart rhythm or lower the rate enough.

I agree with my doctor that trying the next stage of therapy, stage 2, is worthwhile, though it is expensive and has a success rate of only about 65% of the cases. This stage 2 is "cardioversion," in which I will be sedated at the hospital and then given a painless shock to my heart. The purpose is mainly to restore proper rhythm, apparently. I don't know whether lowering the rate is also a goal of cardioversion. The brochure I received from my doctor speaks only of rhythm restoration. My understanding though is that if the rhythm is proper, the rate will follow naturally. (I will need to double-check that.)

If the treatment does not work, or if it works only for a few months, I will not repeat it. (The success rate of repeated treatment is very low.) Instead, I will use only one drug, Metoprolol (plus an aspirin as the anti-coagulant), to fully control the heart rate and thereby make the heart more efficient. This approach is similar to the one Dr. McDougall describes in his newsletter article on Coumadin: Suppress the high heart rate (which functionally is the key problem) and live with it.

UPDATE, Feb. 24: Today I had the cardioversion therapy. It worked! My heart is now back in a normal rhythm and rate range. The procedure was painless, thanks to the intravenous sedation. If you have the procedure done, don't drive or make any important decisions afterward! I could barely form a complete sentence. I came home and slept for three hours.

My doctor convinced me that, on the short-term, I need to continue the drugs in order to keep my heart in a narrow range of rate (Metoprolol) and rhythm (Multaq), as well as to protect myself from a clot expelled by my now more effective heart (Pradaxa).

UPDATE, March 8: I consulted with my cardiologist today. Here is the plan: (1) Stop taking Pradaxa, the anticoagulant. (Drop from two doses daily to 1 dose daily, for 3 days, then stop altogether.) (2) For the rest of my life, take an 81 mg aspirin tablet daily as an anticoagulant. (3) Stop taking the Multaq after one more week. (4) For the rest of my life, take Metoprolol, 50 mg, time release, every morning, to keep the heart beating in a low range, thus avoiding a higher range that might send it into fibrillation again. The two usual causes of returning to afib are: drinking alcohol and general anesthesia for surgery.

I have hired a nurse-researcher to help me gather information about metoprolol: What are the risks of long-term usage? (My doctor says there are no established cumulative adverse effects.)

UPDATE, March 19: I have returned to normal, almost. I am walking as quickly (3 mph) and as far (5-6 miles/day) now as I did before the afib episode. I have stopped taking the daily aspirin. I do not need any anti-coagulant, either in general or in particular for the former afib problem. Now I am taking only the Metoprolol, 50 mg, a low dosage, but one high enough to make me drowsy two hours after swallowing it with breakfast. I am considering experimenting with a half-dose. I am continuing to take 1 teaspoon of cod liver oil per meal, one magnesium tablet (250 mg, 60% of RDA) per day, and two 50 microgram Vit. B12 tablets per week. The oil and magnesium are recommended by some cardiologists, though in much higher doses than I am taking. I am also continuing to take half a probiotic wafer per meal.

UPDATE, May 5: I now take 25 mg of Metoprolol. (I am cutting the regular tablets in half.) I take no other medications: no aspirin, no magnesium, and no cod liver oil. I continue to take a probiotic and a Vitamin B12 tablet (50 micrograms twice weekly).

UPDATE, August 26: Yesterday I stopped taking the Metoprolol. My mood is more positive; food transit time is a little faster; and I am much less drowsy. My blood pressure and heart rate have risen (about 10/10 and 10, respectively). That increase -- if it goes no higher -- is not alarming, but it is worth watching.

UPDATE, April 24, 2012: In March, 2012, I went back into afib. The cardioversion worked for one year. I do not know what caused recurrence. In a local emergency room, the physician said I was dehydrated and "moderately low" anemic. The hospital found no other possible causes (as in the previous episode). I never noticed being particularly thirsty. Now I am wrestling again with trying to decide what to do: Continue with medication (Metoprolol, 50 mg) to control the rate (about 130 bpm without medication, about 80 with medication) and blood pressure (about 125/80 with, 150/90 without)? Or try cardioversion again, and if that doesn't work, try more invasive procedures? This time, I may choose to take the medication and just live (or die) with it. I will write more after I resolve some of the many issues.

UPDATE, September 15, 2012: After taking 50 mg of Metoprolol daily April-July, and after refusing a second cardioversion, my heart has returned to normal sinus rhythm. My physician confirmed that a few days ago, while I was taking 25 mg of Metoprolol. (Because my heart rate has been dropping as low as the 40s, I have begun taking 12.5 mg, half a 25 mg tablet.) I probably will continue the Metoprolol. I am monitoring my heart rate and blood pressure. I have discussed the possibility of substituting digoxin, but my physician and I have not yet made a decision. Possible causes of a return to normal rhythm are: (1) an increased dosage of Vitamin B12 (from c. 250 to 1250 micrograms/week) in the two weeks before; and (2) resumption of using salt (containing iodine). The afib has disappeared as "spontaneously" as it had appeared.

Burgess Laughlin
Author of The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith