7/2/2017 0 Comments Cyclocross Training Diet![]() A heart rhythm doctor’s approach. Here is an edited email I received from an athletic colleague: John,Quick question. He (or she, it doesn’t matter) has visited the doctor and an ECG shows PVCs, or premature ventricular contractions. ![]() ![]() ![]() Based in Massachusetts, he blogs about.
Otherwise the history, exam, ECG, ECHO and electrolytes are normal. What’s up with PVCs? Could they be 1) consequence of (chronic) exercise or 2) related in some way to overtraining. Any thoughts? PVCs are probably the second most common rhythm problem I see. Atrial arrhythmia, including AF and atrial flutter are the most common. ![]() ![]() This image shows PVCs (beats 2, 4, 6 etc) occurring in what we call a bigeminal pattern. Atrial or ventricular beats that appear in an every other beat pattern are referred to as bigeminy. ![]() ![]() Fisch called it “boom- boom- pause.”Here are six bullet points on PVCs: (No doubt, if you wanted to be an engineer about it, there would be many more. But then you might indeed get PVCs.)1. There is an old rule–it’s called the rule of bigeminy. Basically, the long- short intervals of PVCs tend to promote themselves. The following selection of testimonials consists of personal quotes and letters from people and health professionals that have been using our formulas for some time. The point is that PVCs often occur in a bigeminal pattern. It’s not unusual. Understanding PVCs is harder than understanding cyclists. If I had only one adjective for PVCs, I would use capricious. We can’t often find a reason why PVCs come, why they leave, or why they come back. It is worth quantifying facts about the PVCs: Response to exercise: PVCs that mostly occur at times of rest and suppress with exercise are usually benign. PVCs that worsen with exercise may be indicative of a heart under stress, say from a partial blockage of an artery or something else. A heart doctor should evaluate arrhythmia that gets worse with exercise. Quantity of PVCs: A 2. PVCs occur on a given day. The normal person has about 1. Patients with more than 2. PVCs per day are at risk for developing cardiomyopathy (weak heart). These patients should be referred to an electrophysiologist. In an overwhelming majority of patients, especially those with a structurally normal heart, PVCs are benign. The word benign means the extra beats do not indicate heart disease or predict sudden demise. Mandrola observations: PVCs might indicate training excess. I see this often in athletes. It might happen during a big training block or immediately afterwards. Of course, my theory is that PVCs associate with excess inflammation. The reason I see inflammation as the link is because PVCs often occur in patients who are exposed to stress. The middle- aged person going through a divorce, the doctor embroiled in a lawsuit, the minister who takes care of everyone but himself, the grad student during exams. The theme here is that PVCs tend to cluster at times of high inflammation–be it physical, mental or emotional. But not always. Recently, a cycling friend told me his PVCs had resolved almost as soon as he stopped training for races. He still rides, fast at times, but doesn’t . Ten treatment steps: The first step is to ask what company does the PVC keep? PVCs occurring in patients with a normal heart (by history, exam, ECG and ECHO) are almost always benign. Treatment steps 1- 4 are reassurance. It is important to understand the problem, and its benign nature. Removing fear is always a good first step. Steps 5- 8 include adjustment of lifestyle, both on a micro and macro style. This gets me back to the 4 legs of the table of health: good food, good exercise, good sleep and good attitude. Cutting back on caffeine and alcohol, looking critically at the dose of exercise, going to bed on time, and smiling are all great strategies for PVCs. Step 9 involves Buddhism. One must know that PVCs are impermanent. Right understanding of PVCs means knowing they will pass. Step 1. 0 involves medicine. I hate when it gets to this step. Beta- blockers are my first choice. These drugs block adrenaline. They sometimes lessen the thudding associated with the irregular beats. Beta- blockers are also good for as- needed use, say for bad days when the PVCs are acting up. And the best part of using beta- blockers: lack of harm. Rarely do I use an anti- arrhythmic drug, like Flecainide or Propafenone or Sotalol. Step 1. 0 (a): Please don’t beat me up on this one. Some patients report benefit from magnesium supplementation. I have found it helpful in my case of atrial premature beats. Let me repeat, I am not promoting supplements. Healthy patients with benign arrhythmia might try taking magnesium, especially at night. Don’t take magnesium if you have kidney disease. And if you take too much, watch out for diarrhea. Conclusions: Don’t try too hard to understand PVCs. A basic medical evaluation can exclude significant structural heart disease. Talk to your doctor. Come to a shared decision about what to do. I am sorry you have them. JMMP. S. Please don’t email me or comment with personal medical information. Arrhythmia cannot be treated on the Internet. This post, like all my posts on medical topics, are meant as general guides, not medical advice. Can they co- exist? Perhaps this can be said of all nutrition, which is a shame. Will I stay in this state in perpetuity? I have no idea, but for those interested, in the video of this post I made the case why I find NK appealing for my objectives. I love sushi (though I now mostly eat sashimi). And, over the last couple of years I’ve figured out how and when I can eat them to meet the following conditions: Stay in NK (except on a few occasions like my daughter’s birthday); Increase my anaerobic performance; Preserve most (but not all*) of the benefits I enjoyed when I was much more strict about my ketogenic diet (circa 2. How, you ask? By learning to calculate my glycogen deficit.(*) For me, the leanest body composition I achieved as an adult was in strict NK with no attempts to do what I’m about to describe below. I certainly don’t do this often, unless a lot is on the line (e. I like having this technique in my armamentarium. If you’ve watched the video in the post I linked to above, then you’re familiar with RQ. Because those carbohydrates are prioritized to replenish my glycogen stores AND I am highly insulin sensitive. Because my glycogen debt was not high. For the purpose of illustration I recorded everything I did and ate on the second day, which I rode a bit easier than the first day. The second ride took 6 hours and 5 minutes. Sure it was mostly water retention, both from the glycogen (small) and the fluid accumulating in the interstitial space (“thirds space” fluid losses, large) due to a systemic inflammatory response. Conversely, there are days I underestimate my glycogen depletion and wake up with very high BHB levels and very low glucose levels (i. BHB levels higher than glucose levels, when both measured in m. M). Final thoughts. I feel a bit like I’m in unchartered territory because the literature on nutritional ketosis hasn’t really (to my reading) explored this level of extreme activity. But, the key is knowing how much you need and when to take them. In my experience, working with athletes and non- athletes, most tend to make two errors (for lack of a better word): They over- estimate their carbohydrate requirement, and/or. They forget that no factor influences RQ – and therefore substrate requirement – more than dietary composition during lead up to event (or “life”, which is sort of the ultimate event). Know your engine, first.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
August 2017
Categories |