Raising magnesium intake helps with bigeminy heartbeat

Dear Dr. Roach: Several months ago, I developed a case of a bigeminy heartbeat. My cardiologist prescribed metoprolol. At about the same time, I had reduced my intake of magnesium from about 50% of the daily value (DV) to 35%. (This may have preceded the bigeminy onset.)Quite by accident, I read an article recommending magnesium for a heart arrhythmia. Within a week or so of reading the article, I started magnesium gluconate at 100% of the DV. I have been taking this and metoprolol for about a month, and my condition has improved about 95%.The question is: How can we tell if the magnesium shorting down to 35% was actually the cause and increasing it to 100% was the cure? — L.R.Answer: Bigeminy, more precisely ventricular bigeminy, is a term most people probably haven't heard of, but most people have heard of a premature ventricular contraction (PVC). Ventricular bigeminy is when every other beat is a PVC and alternates with regular beats.While this rhythm can happen in people without any heart disease or risk factors, your cardiologist will have considered many underlying causes, such as excess alcohol use, anemia, low oxygen levels, and thyroid disease. A beta blocker like metoprolol is usually the first drug that is used as beta blockers reduce adrenalin levels, reduce the oxygen needs of the heart, and are proven to be effective at reducing the number of PVCs.A low magnesium level is another risk factor for PVCs and ventricular bigeminy, and there are case reports of the rhythm going away completely with magnesium. So, while we can't be sure whether your bigeminy was caused by a low magnesium level, the story is suggestive that it's a real possibility.I don't recommend taking magnesium except in people who have low levels, but 100% of the DV of magnesium is quite safe to take.Dear Dr. Roach: I am a 76-year-old female who weighs 112 pounds. I am 5 feet, 4 inches tall, and in good health. I walk 40 minutes to 1 hour over a very hilly course five days a week and do strength training two days a week. I was just diagnosed with osteoporosis, with my risk of a major osteoporosis fracture being 12.6% and my risk of a hip fracture being 3.8%, according to FRAX.I have Barrett's esophagus that is monitored every three years and take 20 mg of omeprazole for it. I also take 2,000 IU of vitamin D daily and try to eat a high-calcium diet. My only other medication is 50 mg of trazodone for sleep. I have no other medical problems.My primary doctor wants to put me on medication for osteoporosis. Given my situation, which medication would you recommend? — P.C.Answer: The FRAX score is a way of combining a person's measured bone density with clinical risk factors like age, sex and weight to provide an estimate of the fracture risk. Most authorities recommend treatment when the risk of a major osteoporotic fracture is greater than 20% or the risk of a hip fracture is greater than 3%. Your primary doctor is following the published literature. (I will note that a revised calculator called the FRAXplus includes additional risk factors and can be found at www.FRAXplus.org/calculation-tool/.)Omeprazole, the medicine you take for Barrett's, protects your esophagus but can cause poor absorption of calcium, which may be an additional risk factor for you. Because of your Barrett's, the normal first-line treatments (oral bisphosphonates) are not recommended. Instead, intravenous bisphosphonates such as zoledronic acid once a year are the standard recommendation.Denosumab is another option, but people need to stay on this medication long-term because, unlike bisphosphonates, bone loss occurs rapidly after stopping it.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.