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Wellness Wednesday for May 3, 2023

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

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Looking for some guidance on a wide swath of symptoms I’ve been experiencing.

Warning, wall of text. TLDR at the bottom. Throwaway for privacy.

I'm a male in my early 30s. Prior to the experience I'm about to describe, I was in fairly good shape, not overweight. I ran about 12 miles (about 20 km) a week and did light weight lifting. I don't drink, I don't smoke or take any kind of illegal drugs. I take daily meds for allergies.

Two years ago, while I was on my computer playing a game, I suddenly began to experience what I could only call a "headache". It felt like an intense strain just behind my forehead / eyes. It would last only about a few seconds, then fade briefly until another would come on, maybe 15-30 seconds later. These grew in intensity and I began feeling like I was going to faint, though I never did. I unsuccessfully tried to resolve the headaches by drinking orange juice because I thought I might have had low blood sugar, even though I had eaten a fair bit a couple hours before.

I went to the hospital but decided not to go in, as it felt that the headaches were decreasing in strength. They did eventually decrease but were still happening infrequently later in the night, so I decided to go back to the hospital. There, they did blood work and performed a brain scan, both normal. I had also complained of chills and shaking, so they thought I just had a random tremor and sent me home to get a good night's rest.

I wake up the next stay, still dealing with the intermittent headache. These continue for a week, though much less intense and eventually petered out. I would, however, continue to be plagued by other strange symptoms.

In the following weeks I would start to notice that my heart rate would increase much more than normal for doing even light walking around outside for a few minutes. After it increased, it would take much more time to decrease than normal. As I mentioned above, I used to run for a few miles every few days, and when I would stop, my heart rate would rapidly return to my base of ~70.

Other miscellaneous symptoms that appeared in the few months following this initial episode:

  • Heart palpitations. These were so strong they would keep me up at night. I saw cardiologist and after an EKG, Holter monitor, and echocardiogram they could see nothing wrong.

  • Awful acid reflux. I would later be diagnosed with GERD and a hiatal hernia.

  • Feeling my pulse all throughout my upper body. Laying on my side at night I could feel it in my ribs. If I got nervous, I could feel it in the middle of my stomach, down from where the sternum is.

  • I also felt like I had trouble breathing occasionally. It wasn't the case that I was gasping for air, it just felt like my diaphragm was weak and I couldn't get a full breath in. Saw a pulmonologist and my allergist, neither could find problems with my lungs or breathing power.

  • Spasms in my diaphragm, sometimes strong enough to make me gasp. They feel like a light punch to the stomach. One time it was so strong it felt like my whole stomach had dropped.

  • I would have very little appetite occasionally. This I believe has to do with me being nervous / excited, for example, when I would play a video game. Usually, getting in a nervous / excited state would flair all my symptoms. I would get diaphragm spasms and my heart rate would rise and take a while to come down. I felt like I was in fight or flight long after stopping playing.

  • Chills

  • Twitches all over my body, including thighs, hands, even my lips

  • Occasional pains in my chest, arms and legs that feels like a brief pin prick in the sense that feels like it's localized to a small area

  • General malaise

  • Overall weakness

Some of these dissipated to varying degrees as I basically cut all activity out of my life (exciting video games / working out / hanging out with friends). I've kept this up for the past two years, taking some opportunities to indulge in some of these normal activities. I found that doing so would cause some of my symptoms to flair. I tried resuming exercise but found that I would get headaches and dizziness later in the night or a day after working out.

Fast forward to a few weeks ago, after a day of walking around in the relatively high heat for the spring, I come home, go to sit down, and have a brief spasm in my diaphragm where it feels like I can't breathe. My heart starts to race (180bpm+) and doesn't stop even after 20 minutes. I'm taken to the hospital and they diagnose me with a Potassium deficiency. I wasn't vomiting and didn't have diarrhea. I was dehydrated though and I had been sweating a bit. I had a blood test a week later and my potassium was 3.9, within the sufficient range. Prior to the initial incident 2 years ago, I had a pretty strict diet and did intermittent fasting. I think I would have been lucky to get 100% of the daily intake of potassium. I wasn't eating many fruits or vegetables or other potassium rich foods.

Although I’ve increased my potassium intake to 100% daily recommendation almost every day, I still feel malaise, weakness., still get body twitches and diaphragm spasms. I think these spasms also trigger something akin to a panic attack in me. I feel like I’m not going to be able to breathe, my heart rate increases and my hands and feet get cold.

After 2 years without answers, I’m at my wits’ end. What could be causing this? I know some of this could be caused by my hiatal hernia. I also think some of it could be cause by low potassium, though after returning to normal levels, many of these symptoms keep reoccurring. My doctor wasn’t sure about any of the symptoms I’ve mentioned here. My blood work looks fine. The cardiologist saw nothing out of the ordinary.

TLDR: Male, early 30s. Got a strange, intense headache 2 years ago. Since then, I’ve experienced a variety of symptoms including heart rate that increases quickly but returns to resting rate slowly, heart palpitations, diaphragm spasms, body twitches, malaise, and weakness. Known issues include GERD, hiatal hernia, and at least one episode of low potassium, the root cause of which is unknown. Potassium has since returned to normal and blood work looks fine. Being nervous or exerting myself flairs symptoms.

Apologies for the rambling wall of text. I really want to feel normal again. So far, my doctor and the specialists I’ve seen have not given me any actionable advice on how to do that. I'd like to thank you for reading this and would appreciate any advice the members of this forum could offer.

Synopsis: One can make huge improvements in health issues, particularly those unfairly labeled as psychological, via nutrition. Definitely increase magnesium and potassium intake, experiment with increasing calcium intake if your current intake is below 2000mg, adjust sodium intake to 3-4000mg, supplement vitamin d until greater than 50ng/ml, supplement b12 if blood level is less than 500 pg/ml. Probably start with 250mg thiamine hcl, increase slowly up to 1000-2000mg daily. 4000 words justifying this below.

Obligatory, "I'm not a doctor" opening statement. Considering that doctors have failed to aid you entirely, maybe that's for the best. I'll mention I'm the same age as you, and experience about 80% of the same symptoms, which I've had some success in addressing.

I have to disagree with the users who say these are physical manifestations of psychological issues, and that's as someone who has tried using that approach for most of my life - SSRIs, tricyclics, SNRIs, 3+ hours of meditation a day, diazepam, cannabis, massage, somatic experiencing, and more besides. I think the paradigm is backwards - psychological issues are manifestations of physical problems.

I'm going to assume you're already using an app like Cronometer to track your potassium. If not, get an account now. It's free, you can use it in your browser if you prefer, and use a disposable email if you want some privacy. When inputting your food, be sure to select from NCCDB or USDA databases. Other databases, such as CRDB, may have the specific brand you've just eaten, but they only include data for 7 or 8 nutrients. It's better to put in something generic if it has tested the full range of vitamins and minerals.

Part one: Electrolytes

Let's start with electrolytes. How is your sodium intake, and do you recall how it was when you fell ill? Most people sweat more than a litre in an hour of vigorous exercise, although it can be as high as 3 litres depending on your individual biology. The average person's sweat has 900mg of sodium per litre, or 2.25grams of salt (and again, that can be significantly higher). If you did three hours of running and two hours of lifting a week, that could easily be 11g of a salt a week you were losing just through exercise, or 1.5g a day, which could create a deficit if you were only taking the RDA of salt, or even worse if you were on a "low sodium" diet.

The RDA is supposed to be high enough that it won't cause malnutrition in 97%. That's not as high a barrier as you might imagine, as it includes all adults, and older generations are usually shorter as well as slighter. The top 3% of all men is probably more like the top 10-20% of younger men, and you'll easily be in that cohort if you're fit, active and average height. As you mentioned you were deficient in potassium, you will need to be above the RDA to start repleting those stores rather than hitting the bare minimum for day to day life.

It's a good idea to treat the RDA for minerals and most water soluble vitamins as a minimum target, not a maximum - although obviously don't apply this to macronutrients, or toxic substances like mercury or lead . In the case of sodium, the Western RDA is based on addressing blood pressure issues in a population already eating an unhealthy diet. Compare this to South Korea where they have a higher intake of salt (10 grams a day!), but much lower rates of heart disease. I suspect this is because of their higher intakes of potassium and magnesium, both of which lower blood pressure. Electrolytes all interact with each other in every conceivable combination.

How is your potassium intake now? Are you aiming for the more recent RDA of 4,700mg or the older one of 3,500mg? Certainly aim for 4,700mg at least. If you struggle to reach it, orange juice, dried fruits such as dates, figs or apricots, bananas, potatoes, red meat, oily fish, avocadoes. and even some vegetables such as broccoli are all excellent sources. Avoid spinach, and avoid supplementing potassium unless you're in dire straits. Remember you need to be above the RDA if you want to build back up the stores your body needs. Blood tests with minerals have a weird failure mode when they can pick up extreme deficiencies, but people can still be experiencing low levels of whatever mineral is in question while the tests show "low but within range." It's incredibly unlikely you can cause hyperkalemia from food intake. I've only heard of it happening to people with other issues, such as kidney function or medications that interact. There's a case here - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932298/ - of a woman who with psych issues who ate a pound of dried figs (that's 1200 calories and 3600mg of potassium) an experienced clinical hyperkalemia that was picked up by an incidental blood test. She had no other issues, was told to stop eating so much dried fruit, and her potassium levels were normal the next day - she returned three weeks later, and admitted she had done it again. As long as you don't eat a pound of dried fruit every day like a clinically certified lunatic, you will be fine.

How much magnesium do you get? Almost everyone is seriously deficient in it. The RDA says to aim for 400mg, but the RDA is too low. Dr Mildred Seelig, who was the specialist the FDA consulted to establish the RDA, initially recommended 5mg/kg of bodyweight, so 400mg for an 80kg man. However, only a few years later she increased her recommendation to 10mg/kg of bodyweight. The FDA said "that's great, or condolences for your loss, gotta admit tl;dr" and didn't make any changes. Her final view, for most of her career, was that a person needs 10mg of magnesium per kg of bodyweight when they're well, but this should be increased to 20mg/kg when recovering from illness, injury (including emotional or psychological trauma) or extreme exertion. Dr Carolyn Dean is an MD who also agrees with this. Interestingly, that's the same amount of magnesium as is given to most farm animals in their feed. Your ability to absorb magnesium decreases as your intake increases, so the jump from 5mg/kg to 20mg/kg isn't a fourfold increase within your body. A sufficiently high magnesium dose has completely removed my life long depression that otherwise had resisted all treatment, and massively reduced the anxiety that went with it.

It's difficult to get 10mg/kg from diet alone, and pretty much impossible to get 20mg/kg. This was probably different in the past. Spring water or mineral water can have magnesium contents as high as 100mg/litre, but it's almost entirely removed from tap water to avoid deposits building up and blocking the pipes. At the same time magnesium content in fruits and vegetables has fallen dramatically over the years because of a combination of agricultural methods and premature harvesting of crops, so it's almost impossible to get the same intake as the average peasant would have had 300 years ago.

Avoid magnesium oxide and magnesium citrate, the bioavailability is low so they will only act as laxatives. Magnesium malate, taurate, (bis)glycinate, l-threonate and chloride are all better bets. Threonate has a patent on it, so it's far too expensive unless you're quite wealthy, and people have had varied responses to malate and taurate. Glycinate works very well, but the glycine can have a paradoxical effect on some people. Most people find it makes them relax, but a minority will feel stressed and wired. Chloride is what I would recommend. It will certainly give you loose stools, but there will be no other negative side effects from it. Increase your dose slowly, to allow your body to build up tolerance. You can also apply it topically - mix approximately 2.5g magnesium chloride with 15ml water, rub it on yourself and allow it to dry. There's some debate as to how well it works, but your neck and throat area certainly absorb it well, and it should provide a sense of stress relief within a few minutes. Don't rub it on cuts, grazes, eczema, orifices, your eyes, or anywhere else common sense should hopefully discourage.

In my experience it's more effective than any antidepressant, and is an actual cure rather than simply numbing symptoms. Finally, magnesium absorption depends on acetylcholine, which in turn require choline and thiamine. I'll go into more detail on thiamine further down, but choline can be difficult to get from your diet. The only reliable way to get it is a lot of eggs. 5 eggs will get you your rda. 100g of wheat germ or 100g of beef liver will get you 80~% and 64% respectively, but you should avoid eating liver too frequently as it's very high in copper and retinol. I think in theory that high levels of copper can be balanced by high zinc, and high levels of retinol can be balanced with high vitamin e and vitamin d intake, but it's easier and safer to stick to one portion a week.

Finally it's important to think about calcium. What's your intake of that like? Are you supplementing vitamin K2? Vitamin k2 stops your body depositing calcium in soft tissue and encourages your body to bind it to the bones instead, which is great. But anecdotally, plenty of people report k2 supplementation giving them the symptoms of low calcium, which went away when they increased their calcium intake. This includes palpitations. Do you have a lot of spinach, or other foods rich in oxalates that would bind to calcium? I initially wrote oxalate off as not a serious threat until I read about a fellow who died from eating 500g of sorrel, a wild plant that has the same amount of oxalate per gram as spinach does. Your body can't absorb it, and needs to bind it to calcium to secrete it. This can often happen in the kidneys themselves, causing kidney stones. Magnesium intake helps, as oxalate binds more easily to that instead of calcium, and it passes out in your urine more easily, but it's still best to avoid large, daily portions of oxalate rich foods.

In my experience, the strength/severity/pounding nature of my palpitations was connected to calcium intake. As soon as I increased it, the ectopic beats simply felt like a beat in the wrong place, not like someone punching me from inside my own chest. It can be hard to get a high intake of calcium from regular food, so I supplement with ground eggshell powder. It's almost pure calcium carbonate, pretty bioavailable, and free as a benefit of eating eggs. I save my eggshells for a day or two, rinse and boil them, bake them for 30 minutes, and then grind them in a mortar and pestle. You can obviously get quite a lot of calcium from dairy produce, but the calories mount up. From what I've read it's ideal to keep your calcium intake slightly higher than your phosphorus intake - dairy increases both, so you can never get calcium above phosphorus. Again, avoid spinach. You will lose more calcium excreting the oxalate than you will get from the plant itself.

I can't give you any hard numbers, but I weigh 80kg and my own intake is (approximately, give or take ten percent) 1600mg magnesium, 2400mg calcium, 1800mg phosphorus, 5-6000mg potassium, and 3-4000mg sodium. This has massively reduced my stress, anxiety, depression, palpitations and fasciculations (random twitches, especially over broad areas like your whole thigh or upper arm).

Part two: Reflux and hiatal hernia.

I have only been experimenting with this a little recently. Have you tried doing the heel drops, or the associated abdominal massages? There's plenty on youtube which will be more helpful than text. Did they give you any benefit, or provide any relief?

I've seen hiatal hernias called the great pretender or the great mimicker because of the wide range of symptoms they can cause, making people worry they could have any number of serious illnesses. One that is relevant here is that it can cause immense stress to the vagus nerve. The stress can be made worse by stomach acid causing damage in the oesophagus, which won't cause any pain but will cause your body to respond like it's being injured (because it is being burnt by acid). This can make your body release adrenaline for no reason you can see, giving random bursts of panic, sudden increase in heart rate, palpitations and shortness of breath. I would guess this is why you have such bad symptoms when you are lying down, it is making the hernia aggravate the vagus nerve more and/or increasing the reflux. Is one side worse for it? I find lying on my left side immediately triggers palpitations.

My advice here is significantly more "fringe", but it might be worth experimenting with high doses of thiamine (vitamin b1). I have read several people suggesting that many digestion issues are related to it, including Elliot Overton here. I should point out, as interesting as Overton is, I don't believe he has traditional qualifications in medicine or nutrition.

I've been experimenting with this myself, initially to treat a chronic fatigue issue that has been plaguing me for a long time. I'm in the early stages so far and it's had a phenomenal impact not only on fatigue, but also on my digestion. I've been building up towards a higher dose, so I cannot confirm if it completely fixes my own reflux, but I am optimistic. I'll warn anyone reading this, though, it will trigger a "mild" form of refeeding syndrome. "Mild" in this case meaning "non fatal" compared to refeeding in anorexics, but otherwise completely crippling unless you keep your electrolyte intake very high, supplement with biotin and riboflavin, and increase thiamine in small increments. It's startlingly unpleasant. You cannot function in any way until you get your nutrition balanced so the symptoms recede.

Part three: other nutrition issues

Do you have any idea what your vitamin D levels are? It plays a big role in general health and sleep. The recommended blood levels are "the minimum amount to prevent rickets", which is better than having rickets I guess. All researchers who specialise in vitamin dD recommend a blood level of 35ng/ml, the vast majority of them recommend over 50ng/ml, and it's not uncommon to recommend 60 or even 80 as a minimum. I found this video a good starting point. It's important to make sure your vitamin d intake is daily, as well - some forms of it have a very short halflife as explained here. Monthly mega injections are not helpful. It would be ideal to get it from the sun if you can, and I suspect there are other benefits to sun exposure as well, such as helping set your circadian rhythm (you need to be exposed directly to the sun, not through glass, including spectacles). Increasing your vitamin d intake will also increase how much calcium you absorb, so in turn it's helpful to supplement vitamin K2 to help your body deal with that.

B vitamins in general are essential. As well as obtaining them from food they are naturally produced by bacteria in your gut. Which could mean that if your gut health is off, you might be significantly deficient in them even if your intake from food is ok (the fact they're produced by bacteria internally and also constantly - not as a single dose from food or a tablet - makes it difficult to know how much we need). A b complex can be very helpful, but it's difficult to find a reliable one. Many forms of vitamins (such a folate in the form of folic acid or b12 in the form of cyanocobalamin) are unhelpful at best and damaging at worst. Others, such as folate in the form methylfolate, can have a negative impact on some people (I believe due to methylation issues). If you want to experiment, it might be helpful to purchase them individually so you can tell which specific one is benefiting or harming you. From what I've read and experienced, these forms are least likely to have a negative effect:

  • b1 as thiamine hcl

  • b2 is always ok, I think.

  • b3 comes as niacin (also called nicotinic acid) and niacinamide (also called nicotinamide). Niacin in large doses can cause a "flush" reaction in large doses, which some people like for a reason I haven't been able to understand. Both should be fine.

  • b5 is pantothenic acid is easily available and fine

  • b6 is most bioavailable as p5p, from what I've read

  • b7 is biotin, I'm not aware of it being in different forms

  • b9 is less likely to cause issues as folinic acid, but methylfolate is fine if you don't have any side effects. I've been advised against the form folic acid

  • b12 is bioavailable as both methylcobalamin and adenosylcobalamin. Hydroxocobalamin is converted by your body to either form, depending on its needs. Cyanocobalamin should be avoided.

Finally, how is your sleep? A lack of restorative sleep would make these types of issues worse. I'd recommend looking at Dr Gominak's sleep protocol if you struggle with insomnia and regular suggestions like "go to bed early" or "exercise regularly" are more irritating than they are helpful. Her advice is to increase your vitamin d blood level to 60-80ng/ml, supplement with a b complex, supplement with b12 if your blood level is less than 500pg/ml, and stop the b complex after three months. It worked wonders for me, after struggling with insomnia from early childhood.

Part four: Pulling it together

Here's what I, a stranger on the internet with no qualifications in medicine, would advise.

Eat a diet of whole foods with the aim of getting 110% of the RDA at minimum. If you weigh more than 80kg, scale your targets up proportionately (eg, if you weigh 88kg, multiply the RDA value by 1.1). Make sure your vitamin a intake is in the form of retinol, rather than carotene, as carotene is converted into retinol by the body at around 8%. You can get this from either liver (I'd recommend whole, tinned cod livers - they don't taste bad and are much lower in copper than mammal liver, plus they include vitamin d - eat half a tin, approx. 55g on two consecutive days and that will get you just under a week's worth of vitamin a. Eat one tin a week, more if you have a good, educated reason to), or from a combination of eggs and butter. If you go with eggs and butter it will take a lot - around 6 eggs and 60g butter every day. Try to keep your zinc intake at 8x your copper intake at minimum, don't have more sodium than potassium, and experiment with increasing your calcium intake to see if it helps your palpitations. You will need more than the RDA of potassium to really build your body's stores back up. Blood tests can be very helpful, and also very misleading. You will not hurt yourself by eating bananas.

If you want to eat raw eggs, make sure you supplement biotin. Raw egg white contains avidin, which binds to biotin and stops you using it. Each raw egg white will bind approximately 90mcg of biotin. This means if you want to go full Gaston and have a dozen each day, you'd need to supplement more than 1000mcg of biotin just to avoid deficiency.

Avoid all the things that are sensible to avoid. Cut out sugar, syrup, alcohol, caffeine, artificial sweeteners, any recreational drugs, . Consider avoiding gluten or sticking to a FODMAP diet as best you can, which will involve cutting out pulses and many grains. In the long term you should be able to return to eating these foods, but in the short term avoiding them might improve your health by 10%, and it's a 10% that you could really benefit from right now.

Supplement magnesium, and experiment slowly increasing your intake to 20mg/kg of bodyweight, or even a little higher if you're still experiencing benefit. Initially try magnesium chloride, as it's the most reliable, but be aware that it will loosen your stools or even cause some diarrhoea. Make sure your other electrolytes are sufficiently high while doing this, or you'll feel quite unwell. Try applying magnesium topically on your neck for immediate effect, and it should give you some indication of whether or not it will be helpful for you.

If you find yourself having compulsive, negative thoughts and actions from them - things like skin picking, hair pulling, self harming, or other addictive and destructive behaviour - a supplement called inositol can be very helpful. It's a sugar, both made by your body and available from food. Experiments have used up to 18g of it without serious side effects, although I try to stay under 12g myself, and only use it when I feel I need to. It has a powerful anti anxiety effect for a certain "type" of anxious feeling, and zero addictive properties or side effects beyond mild flatulence.

Make sure you get regular vitamin D, ideally from the sun (an app called dminder is very helpful for measuring the actual amount of vitamin d you’re synthesising, particularly if you have a light sensor on your phone), and increasing b12 plus a b-complex alongside this as recommended by Dr Gominak can really help with insomnia. 4-8000iu of vitamin d is probably sufficient if you're supplementing a decent amount of magnesium, higher if not.

After establishing everything above, consider starting with a low dose of thiamine and increasing up to 1000mg-2000mg depending on your body type, size, and individual response. I would recommend thiamine hcl. More expensive forms such as TTFD might be more bioavailable but they're also more likely to cause other issues, such as mentioned here. If you start to feel truly awful on higher dose thiamine, it's not an allergy or negative response, it's refeeding syndrome. Depending on what you diet has been that day, eat 2g of salt, eat 100g of dried fruit for potassium, drink a pint of water with 2.5g of magnesium chloride dissolved in it, supplement 30mg of riboflavin (despite some much bigger supplements, your body doesn't absorb more than that at one time - feel free to supplement again later in the day though) and make sure you're already taking a biotin supplement above 1000mcg. MAKE SURE YOU HAVE THIS AVAILABLE BEFORE YOU START SUPPLEMENTING THIAMINE! You don't want to experience refeeding syndrome at 3 in the morning, or 40 miles from the nearest shop, and not have the resources to hand.

If you struggle with getting everything you need from the diet, a good starting point is 4 eggs, 40g of cheese, 150-200g potato, 1/4-1/2lb of red meat and 1/4-1/2lb of low mercury oily fish. Low mercury oil fish is unsalted anchovies, sardines, mackerel, herring, salmon or trout. Salmon and trout are usually farmed if you're in Europe, and farmed fish are exposed to antibiotics as well as being much higher in parasites. Wild salmon may have higher levels of mercury depending on the species, as do different species of mackerel, but searching the name of the specific type should give you clear results. Fill up the rest of your diet with fruit, vegetables, orange juice, potatoes, rice, cold pressed oils and butter, always aiming to hit nutritional surplus before filling up on carbs or fats. Fish/meat weights are raw values, so cooked weight will be about 15% lighter - in practice, a 90g tin of fish is the same as 1/4lb fresh. Almond oil and styrian pumpkin seed oil are both good sources of vitamin e if you're struggling to get enough. Probiotics such as kefir or kimchi could prove helpful, especially if you've had antibiotics. Homemade is vastly superior to store bought, especially as some companies make the insane move of pasteurising their product before putting it on the shelves.

ETA: While all of this should help, it will be massively limited if you are still fighting other stresses in your life. If you going through a divorce, grieving a recently departed loved on, or feuding with your local drug dealer, you will be less able to benefit from this. Similarly, if you are staying up late staring at computer screens, not getting to bed before 10pm, not getting fresh air and daylight, spending an unreasonable amount of energy arguing with strangers on the internet, or any number of other stressors that are obvious when you think about it, you'll be hindering your ability to recover. Doing the small, healthy obligations of life might only get you a 10% benefit, but again it's a 10% you need right now, and could you push you from "spiraling downwards" into "finally recovering."

Wow. First off thank you for such thorough write up. I'm thankful for my doctors but none have given me this thorough of an examination of my problems.

I don't know why but it really hadn't occurred to me to question whether the RDAs were accurate/appropriate for me.

I have started using Cronometer since the beginning of this year, which would be after I changed my diet to start eating a wider variety of foods. Inputting my old diet in which I skipped breakfast and had the same lunch everyday, I was really low on a lot of vitamins and minerals depending on my dinner.

Back when this first happened, my salt intake was probably low considering my exercise level. My diet wasn't intentionally low salt but in practice it most likely was.

For the potassium RDA, I had been using whatever RDA is in Cronometer, which was 3400mg. I'll update this manually so I start using it in the future. The easiest food for me is milk. OJ and some fruits are hard because of GERD. Since learning that I had low potassium, I began drinking a bunch of milk.

I had started taking magnesium supplements before I had tried restoring my potassium. I was worried about taking too much so I eventually stopped. I think I noticed I had soft stools and assumed I must be taking too much. But on Cronometer I am getting about 50-60% of the 400mg that is recommended there, which would be an even smaller percentage of the even higher RDA numbers you stated. After looking up low magnesium, I see it causes low potassium. You would think a doctor would have mentioned that at one point. Do you have a brand of magnesium that you recommend?

My calcium intake should be good after I started having multiple cups of milk a day. I'm not supplementing K2.

Part 2:

I initially started heel drops before I had been diagnosed with a hiatal hernia but felt like it really didn't accomplish anything. I'll look into these massages further though.

Now that you mention it, I recall it being impossible for me to sleep on my left side when my symptoms were at their worst. I could feel my pulse through my left ribs.

I'll probably hold off on high doses of thiamine and maybe try as a last resort.

Part 3:

My vitamin d levels should be good. I did discover how important vitamin d was when I was initially feeling bad. Since then, I've made it a priority to get out in the sun each day for 15-20 minutes at solar noon and as much as I can handle on the weekends (I have been using dminder for a while and love it). I live in a northern latitude so the winter is limiting for vitamin D but I get a lot in the summer.

For B vitamins, I take a multivitamin that has multiple B vitamins that has worked pretty well for me I think.

My sleep is okay. I have been getting to be too late and sometimes I wake up early and can't fall back to sleep. I average around 7 hours.

I like your diet suggestion. I appreciate the point about holding off on carbs until I hit my nutrition markers. I thought for a while I had maybe just been eating too low of calories and that's why I didn't feel good so I started including some more carbs, but they were mostly empty nutrition.

There is so much to digest here. I'll be coming back to this post often. Thanks again for all your help.

You're very welcome, I only hope it's of some use to you. I'm glad to hear you're using Cronometer already. It's both intimidating and liberating to realise you have to take your health into your own hands.

Maybe Cronometer is using a European RDA for potassium. The American FDA increased theirs to 4700mg in 2016, partly because the average American was so much heavier than when they set the original RDA. Cronometer also set an incredibly high target for protein by default, something like 1.8g per kg of body weight. If it works for you that's great, but I think that's a target for athletes rather than the everyman. Reflux is a pain like that - I found sticking to the fodmap diet reduced the symptoms, and as you reintroduce food it helps you pinpoint which are giving you trouble. For example I've found I tolerate dried figs, apricots and dates well, but apples, pears and raisins still cause discomfort. It's worth experimenting if you're struggling to get the potassium, but obviously you know your own body best. Never try and ignore obvious pain just because someone thinks it shouldn't happen, whether that’s a medical doctor or some anonymous poster online.

I understand the worry when supplementing. I suspect if you're the kind of person who spends time on here you will be ok - the fact you're worried means that you're also researching this and you’re bright enough to do so successfully. There are certainly studies showing high dose magnesium (up to 1500mg supplemented) was effective in rapidly reversing treatment resistant depression, but I don't know enough to vouch for how strong those studies are. There are also plenty of testimonies online from people who have taken high doses for a variety of ailments, usually attached to warnings not to take it if you have kidney issues. If you're worried you can always discuss it with a doctor, but it's possible they won't be open to the idea. There are plenty of articles like this online, with doctors lamenting how little they are taught about nutrition. That's probably why no doctor you visited has mentioned it, nutritional approaches are not a major part of their tool kit despite how useful it can be. I buy magnesium from a brand called Heiltropfen, but I don't have any particular loyalty to them - they were the only company I could find selling magnesium chloride flakes that were listed as food grade. The cheaper versions marketed as bathing salts are probably fine, but I didn't feel the need to risk it at that price.

If you find the loose stools too unpleasant to deal with, Magnesium Glycinate, Taurate, Malate, and L Threonate should not have that particular side effect (although they may have others instead). The most important thing when taking high magnesium is to keep calcium/phosphorus/sodium/potassium at least as high as the RDA.

In terms of calcium, I was taking around 1500mg when the ectopic beats felt like they were pounding in my chest, but once I increased it to 2,400mg the beats only felt out of rhythm, not worryingly forceful. I think my situation is unusual, the high dose thiamine I'm currently taking means I need a higher calcium intake for now. In your situation it could be the relation between any of the electrolytes being too high or too low, but I think that is worth investigating.

I'm not so experienced with the heel drops, but it's worth looking through youtube to see the variety (and other exercises). Some people say that having your arms raised when you do them makes a huge difference, and there's probably other tricks. I hope you can find something else that helps there, though, and hey, it’s free.

Did the symptoms get worse when you were on your left side, or did they just become more noticeable? If it definitely gets worse then that indicates it could be related to the vagus nerve becoming irritated by the posture, or alternatively because it's changing the position of your heart - but this also something I've only just started reading about, so take this as an avenue to explore rather than something that is definitely the problem. Like so many other things, there are arguments for sleeping on either side. Sleeping on the right side avoids stimulating the vagus nerve but it's worse for acid reflux, so I don't see a good option there. But it might be useful information to narrow down what's affecting you.

Vitamin D can be tested privately and cheaply, if your doctor isn't willing to do it themself. The test can be ordered by post with the kit to take a tiny blood sample and return it. Your ability to synthesise vitamin d depends on a lot of nutritional factors. Bruce Hollis, the researcher I mentioned in the earlier post, says that when he started supplementing magnesium (I think it was 400mg, it definitely wasn't a huge dose) he saw his vitamin d level rise by 10ng/ml in his blood work, from something like 50 to 60 ng/ml. Sorry, it's late here and I haven't got the time to pinpoint it, but it was in one of those two videos. On the other hand, too much vitamin d can cause issues too, usually from absorbing too much calcium. I think that's mainly in people taking huge doses, or life guards who have really high sun exposure. It sounds like you've got a lot of this under control already, so I think it's unlikely to be an issue, but testing lets you know for certain instead of guessing.

And maybe I was too harsh on carbohydrates! We need them too, and there's a big difference between a healthy diet that involves decent portions of rice/potatoes/pasta, and a diet of purely hyper processed carbohydrates like pizza. It sounds like you're doing a lot better with your diet now compared to when you initially fell ill. I really hope you find some relief soon.