Dear Dr. Roach: I have a suggestion for the lady who complained of heart palpitations without any apparent underlying causes. My late uncle, when staying in our house, always requested a big glass of water by his bed in case heart palpitations awoke him. He said that drinking water stopped palpitations each time.
It also works for me and others who follow my advice. It could be a placebo effect; being convinced one can stop the palpitation by drinking water gives one a sense of control.
— J.G.
Dear J.G: While I try never to underestimate the power of the placebo response, there are physiological reasons that drinking water can stop palpitations. Many palpitations are coming from the top chambers of the heart — called supraventricular tachycardias — and these can sometimes be stopped by stimulating the vagus nerve. It partially controls heart rate.
One powerful stimulant to the vagus nerve is splashing cold water on the face. Drinking water is also a stimulus to the vagus nerve, and may immediately stop a run of supraventricular tachycardia.
Not having enough fluid (what people think of as “dehydration”) is another stimulus for fast heart rates, so some additional fluid is a second reason that water may help, though not instantly.
Dear Dr. Roach: We hear about how bad “low intensity chronic inflammation” is. Does low-dosage aspirin stop that inflammation from happening? Other than preventing the leaky gut via diet, are there any other measures one can take to prevent that kind of inflammation?
— K.S.
Dear K.S.: Chronic inflammation is both a problem in itself (ongoing joint disease in rheumatoid arthritis, for example), and strongly associated with vascular disease. People with chronic inflammatory conditions have increased risk of developing heart attacks. This is not only the case with severe inflammatory diseases such as RA, but there is good evidence that less inflammation, as measured by even modestly elevated levels of inflammatory markers such as the C-reactive protein, leads to an increase in heart disease risk on the same order of magnitude as high cholesterol.
Aspirin probably has less benefit than statin drugs, which certainly have an anti-inflammatory effect, which may explain part of their benefit. But aspirin remains appropriate as a preventive for people at high risk of heart disease, potentially including people with inflammatory conditions.
“Leaky gut” may be a complication of inflammatory bowel disease such as Crohn’s disease, and celiac disease, but the term is sometimes used as a catch-all phrase for abdominal symptoms without evidence that there really is a leaky gut. It is not a diagnosis in itself. Persistent abdominal symptoms do call for additional investigation, or at least a trial of treatment such as dietary modification.
Evidence of chronic inflammation — such as very high levels of CRP or the erythrocyte sedimentation rate, another marker of inflammation in the blood — may be signs of serious disease, whether rheumatologic, infectious, malignant or traumatic. However, modest elevations are more likely due to obesity or insulin resistance than to a hidden underlying cause. In cases where there is minimal evidence of chronic inflammation, a healthy plant-based diet, regular exercise, tobacco cessation and stress reduction are more likely to improve health than an extensive medical workup.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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