3) Magnesium Sulfate Injections
Magnesium blocks the production of nitric oxide by calcium channel blockade. [Many patients benefit from magnesium injections, which are virtually painless with the addition of taurine. The Magnesium used by most is Magnesium Sulfate, standard 50% solution, ½ cc drawn into the syringe first, followed by 1 ½ cc’s of Taurine. The Taurine is compounded at 50 mg/cc. The taurine makes the injection virtually painless and the ratio eliminates the hard knots many are familiar with. The injection is intramuscular, given in upper, outer quadrant of either buttock. Both require scripts from a doctor.]
Numerous other treatments are used by Dr. Cheney as appropriate with certain patients. Some of the more common ones are zinc and selenium supplements that help block mercury. [Zinc Picolinate, 50 mg, once a day; Liquid Selenium, 1 tsp a day.]
CoQ10 and/or Idebenone. Idebenone comes in 40 or 45 mg capsules, and one such capsule is roughly equivalent to 200 mg of CoQ10. [600 mg of CoQ10, or an equivalent combination of the two, is highly recommended. There is a lot of poor quality CoQ10 on the market – the cheaper products may not be worth your money. Kirkman Labs sells Idebenone, kirkmanlabs.com. It’s available at some local health food stores – 20% off on the first Tuesday of each month at Sunflower Shoppe in Fort Worth and Healthy Approach in Colleyville if you live in Texas.]
Proanthocyanidins or bioflavonoids. The most powerful of these antioxidants are in Grape Skins or Pycnogenol®. It makes good sense to supplement with these.
Essential Fatty Acids, such as Fish Oil, Evening Primrose Oil and Borage Oil. “I tend to recommend Fish Oil only. It has certain advantages over the others.”
PHYSIOLOGY: PRE-LOAD and AFTER-LOAD
Turning to physiology, how does a cardiologist treat this? He uses the Frank-Starling Curve. [Dr. Cheney drew a curve for his other patient that I don’t have.] [See www.nda.ox.ac.uk/wfsa/html/u10/u1002_02.htm for sample curves. The diagram has a vertical line on the left that connects to a horizontal line at the bottom. There are several curves on the graph. The vertical axis is labeled “Stroke Volume”. The horizontal axis is labeled “Ventricular End-Diastolic Volume”.]
[To understand this diagram and the rest of this section, the following somewhat simplified definitions may be helpful. Stroke Volume (SV) is the amount of blood pumped by one contraction of the heart. Cardiac Output is the volume pumped out in one minute: SV x heart rate. The ventricle is a lower chamber of the heart. Oxygenated blood is ejected from the left ventricle to the body; and unoxygenated blood from the right ventricle to the lungs.
Preload is the amount of blood in the left ventricle waiting to be pumped out to the body, or, as on the diagram, the volume in the ventricle at the end of diastole. It’s mainly dependent on the venous return of blood from the body. Diastole is when the muscles relax and a chamber of the heart expands and fills with blood, compared with Systole when the muscles contract and expel blood from the chamber. Afterload is the resistance the blood encounters when ejected from the heart – remember how arteries constrict like nozzles?]
[The diagram could be seen as plotting the amount of blood waiting in the ventricle to go to the body (horizontal axis) against the amount of blood that is actually ejected from the ventricle (vertical axis). Four curves are shown, the highest two (A and B) being healthy hearts with good cardiac output during exercise and at rest.
The lower two curves (C and D) indicate diseased hearts that cannot produce sufficient cardiac output. While they have lower cardiac output, they also have greater ventricular volume – there is more blood in the heart, but the heart muscle isn’t strong enough to pump as much out. There are also three dotted horizontal lines at increasing heights indicating the necessary cardiac output for rest, walking and maximal activity.]
Dr. Cheney states, “This is the normal Starling Curve.” [Presumably something like Curve B.] This curve is where most CFIDS patients are. [I suspect CFIDS curves are between B and C.] Obviously the point at the top of that curve is the sweet spot. That would give you the most cardiac out output and thus the greatest tissue perfusion, and that would be the best. On either side of that peak, the cardiac output goes down. Most CFIDS patients sit right here. [Probably somewhere on the left side of the curve.]
Now, here is a Congestive Heart Failure curve. [Curve C] Those patients are treated with Lasix to make them pee out the extra volume, and then they are able to move up the curve and improve their cardiac output. “Most of you, on the other hand, need volume, and as we give you more volume you will come up onto the peak and will maximize your cardiac output. But if we overshoot, you’re going to go down the other side and you actually lose volume. And if you keep going down you’ll actually go into heart failure.” It’s critical to understand the Frank-Starling Curve of Cardiac Output, where you are and how you manipulate it.
[Notice that the healthy hearts in the diagram (curves A & B) have little to no drop after their peak!]
Preload – Lying Down
How do you augment preload, that is blood volume, to improve cardiac output? You lie down. When you lie down you augment the cardiac output a whopping 2 liters per minute. Don’t sit, don’t recline – lie down. Some patients need to lie down and augment volume anytime, all the time.
But what if you’re one of the ones right near the top of the curve and you increase your volume (preload) 2 liters by lying down? You could actually go over the peak and down the other side. Do you know what that means clinically? Some patients can’t lie down! Some tell me, “When I lay down I cannot rest well or sleep.” They went right over the top and dropped their cardiac output by lying down!
Preload Chronobiology: Daytime vs Bedtime
There is a chronobiology to this curve: the time of day affects it. In the daytime patients need to increase blood volume by taking in fluids. That allows them to be up more. But some can over treat by drinking fluids and lying down in the daytime. [Some with this problem who can’t be up find a semi-recumbent position helpful. Use pillows to raise your torso.]
But at nighttime, the opposite happens. The chronobiology drops your cortisol and aldosterone so you don’t hold fluids as well, and all that combines to allow this type of patient to lay down without this problem. Patients with this problem (lying down makes them feel worse) should only expand volume in the first six or seven hours of their day with the Gookinaid or Home Brew mentioned below, then switch to water. And if they lie down while over expanding volume with Home Brew or other supplements or drugs, they’ll get creamed. These patients should not use the Home Brew during the six or seven hours before bedtime. If they do, they may not be able to sleep.
Preload – Gookinaid / HomeBrew
“Volume loading using appropriate volume expanders can be quite helpful. This can be done in a variety of ways, but falls best under the term of isotonic volume expansion. Gookinaid is a well-documented isotonic volume expander and is used in athletic events such as marathon running.” [Gookinaid.com] “It has an advantage of rapid absorption and is maintained in the intravascular volume far longer than hypotonic drinks such as water itself. The disadvantage to Gookinaid is that it has sugar in it in the form of glucose.”
“Another option would be a Home Brew mixture of sea salt and “No Salt”. [Home Brew: one cup of filtered or spring water, 1/8 teaspoon of Sea Salt, and 1/8 teaspoon of “No Salt” salt substitute (potassium). Add lime juice or an herbal teabag as well as stevia for taste.] Four to eight glasses of Gookinaid or Home Brew is recommended.
Why is potassium in these drinks? Potassium induces Aldosterone, a hormone that significantly increases blood volume.
Preload – Cortisol as Licorice Root
For those with low blood pressure, and most CFIDS patients have low blood pressure, cortisol could also be useful and can be augmented adaptogenically using Licorice Root Extract at 1 to 2 tsp every other day. [I take licorice root capsules. Only the type with glycyrrhizin works for this purpose.]
Afterload Reduction – Magnesium
The second thing you need to do after increasing your Preload, is reduce your Afterload. This means reducing the resistance the blood encounters. The best Afterload reducing agent I know of is Magnesium, an adaptogenic vasodilator. [Opens up /relaxes the blood vessels as needed.] Magnesium and taurine injections have been very effective for many patients. [See details on these injections in the section on how to block Nitric Oxide.] You could also use oral Magnesium Glycinate capsules in the form of Magnesium Glycinate Forte 300 to 500 mg at bedtime. [I use both the oral and the injectible forms.]
Will implementing these treatment measures cure you? Absolutely not, because none of this is getting at the primary issue. It is directed at what is most dysfunctional about this disease. If we’re trying to get you functional, this is where we start.
[NOTE FROM CAROL SIEVERLING: This concludes the information on CFS and Cardiac Issues. Dr. Cheney spoke on this topic on June 18 in Irving, TX. His presentation included new information on CFS and Dyastolic Cardiomyopathy. See www.virtualhometown.com/dfwcfids for details about the seminar and information on ordering a videotape.]