Medical mysteries intrigue me and bring out the detective part of my nature, fueled by a strong desire to relieve suffering. Merely quelling symptoms with potentially harmful pharmaceutical drugs offers much less gratification than searching for the underlying causes of the presenting symptoms.

Sometimes patients present with puzzling symptoms that require brainstorming for answers only found outside the box, in unlikely places.

James came to my practice as a last resort in the late 1990s after having been to four cardiologists, three of them outside of New Mexico. In his early 50s, James had developed a persistently rapid heart rate, called tachycardia. His heart rate went as high as 140 beats per minute, with episodic bouts of arrhythmia in which his heart beat without any consistent pattern. He had spent time in a few emergency rooms and even in the intensive care unit. His doctors plied him with medications, but they had no explanation for the cause of his arrhythmias except to say he had an electrical conduction defect in his heart.

The medications effectively slowed down James’ heart rate, but they made him lethargic with a low-grade feeling of malaise.

During our initial phone conversation, James asked if I could help him. “James, I would be a fool if I guaranteed I could help you solve this problem. The only thing I can guarantee you is my sincere commitment to help you find answers. You have to make the decision if you want to risk wasting your money.” James said he appreciated my honesty and wanted to go ahead and take the gamble.

During our initial appointment, James handed me a pile of papers with results of tests that had been done. The tests included a week of ambulatory heart monitoring with a continuous electrocardiogram, an ultra sound of the heart, angiography of his heart vessels, and comprehensive blood tests. The papers also included a list of all the medications James had tried but did not tolerate, especially the beta blockers which made him feel tired and unable to get an erection. He had been offered yet another medication for erectile dysfunction, but instead chose to stop the beta blocker. His other meds were for anxiety, insomnia, and acid reflux.

I took a complete history and found nothing that might shed light on the problem. I explained to him that something was causing his heart to be “irritable.” I asked about the usual culprits like too much caffeine consumption, excess alcohol, exposure to solvents and other toxic chemicals, low oxygen levels from sleep apnea, cigarette smoking, and high anxiety levels.

The question about anxiety led us down a different path, away from the heart. James said his work as founder of a startup company caused him a lot of stress, resulting in acid reflux.

For the past eight years his primary care physician had prescribed acid-blocking medications. Although the stress levels had diminished after his startup company was successfully launched, he could not get off the acid blockers. Each time he tried, he got tremendous esophageal pain under his breastbone that spread over his upper chest. He was resigned to taking the acid blockers for life.

As James talked about his acid reflux, I made the connection that blocking acid in the stomach means that minerals cannot be absorbed into the body, neither from the food we eat nor from the supplements we take. Acid-blocking medications—including the proton-pump inhibitors like Nexium—can lead to profound mineral deficiency over time.

The heart, for example, is very sensitive to insufficient magnesium levels in the blood. I sent James to get a special test for magnesium, called red blood cell magnesium that reveals how much magnesium is attached to the red blood cells. Since red blood cells live an average of three months, we can determine how much magnesium the patient has been averaging over that period. Mainstream doctors order serum magnesium that only tells the level of magnesium at the exact moment of drawing the blood, making the test not very useful.

James did indeed have low magnesium levels, along with low levels of most of his minerals. Mineral stores are slowly depleted over time by the use of acid-blocking medications. Symptoms develop only after months of continuous use have depleted the mineral reserves. The abnormal rate and rhythm of James’s heart appeared approximately one year after he began using the acid-blocking medication.

James was dubious that something as “insignificant” as a magnesium deficiency could be the root of his cardiac problems. In spite of his doubt, he agreed to wean himself slowly off his acid-blocking medication. We treated his rebound symptoms with one half teaspoon of baking soda in warm water each time he felt the acid burning his chest.

I asked James to put two tablespoons of apple cider vinegar in six ounces of water and sip it during each meal. This might sound counter-intuitive, yet acid taken with each meal can help lessen the symptoms of acid reflux in most people by supplying the acid needed for proper digestion.

The condition of acid reflux does NOT mean one makes too much acid—a common misperception by both patients and doctors. Overproduction of acid is a very rare condition. The problem comes from acid being in the wrong place. It only takes a miniscule amount of hydrochloric acid to burn the unprotected esophagus, resulting in esophagitis. And it only takes a tiny amount of hydrochloric acid to burn the stomach when the protective lining has been disrupted by irritants like pain meds, excess alcohol, and caffeine, resulting in gastritis.

We absolutely must have adequate acid in the stomach to digest our food properly. The acid acts as a solvent for extracting the minerals from the food and for breaking the protein bonds into the individual amino acids so they can be absorbed into the blood stream. When we take acid blockers, we still get the calories from the food we eat—given that most of those calories come from carbohydrates. But we don’t get all of the nutrients. Even obese people can be severely malnourished.

The number one cause of gastritis and esophagitis is the use of pain medications in the category of NSAIDs (non-steroidal anti-inflammatory drugs) such as Ibuprofen, Aleve, Celebrex, Indomethicin and so forth. Tylenol and opioid pain medications do not affect the stomach, but they produce their own set of problems in other areas of the body.

Below are some other common causes of acid reflux, referred to in medical parlance as gastro-esophageal reflux disease—or GERD.

• Alcohol
• Caffeine
• Cigarettes
• Unrelenting fear and anxiety
• Food sensitivities and food allergies
• Food irritants, like hot, spicy foods
• Eating a large volume of food at one time, causing stretching of the distal esophageal sphincter that allows the acid to reflux up into the esophagus where there is no protection against the caustic hydrochloric acid
• Lying down shortly after eating a large meal
• Hiatal hernias which occur when the esophageal sphincter is pulled up above the diaphragm. The diaphragm helps to keep the sphincter closed so that acid from the stomach cannot reflux up into the esophagus. Without that reinforcement of the diaphragm, the sphincter is more easily breeched.
• H. pylori, a bacteria that has been associated with gastritis, esophagitis, and ulcers. It tends to grow where there has been prior disruption of the mucosal lining of the stomach.

If you are in great distress from esophagitis, using the acid blocking medications for a month or less is acceptable and will not usually cause any major problems. At the same time, it’s important to work on eliminating the causes of the acid reflux.

If the esophagitis from the acid reflux persists over years, there is the risk of Barrett’s Esophagus, a precancerous condition that affects the cells lining the lower esophagus. The cells can become abnormal from constantly being bathed in hydrochloric acid. These abnormal cells have the potential to turn malignant over time.

James followed a gentle weaning program to get off his medications and took measures to heal the damaged esophagus using mastic gum (a resin from a plant in South America), chewable deglycyrrhized licorice root tablets, and slippery elm and chamomile tea. It took James about six weeks to get completely off the medication without having any residual pain.

James has been taking a food-based mineral supplement that contains all the necessary trace minerals. He also takes around 400 mg of magnesium glycinate every evening before bed. This particular form of magnesium is less likely to cause diarrhea and is better absorbed.

He religiously acidifies his stomach with each meal using either apple cider vinegar, lemons, or limes. He stopped drinking alcohol and reduced his coffee consumption to one cup a day. He follows all the other precautions mentioned above.

So, what happened to James’s heart problems, you might be wondering?

The arrhythmias disappeared completely. For nearly two decades now, James has been without any major symptoms. He takes his trace minerals and magnesium religiously. He has lots of energy and thoroughly enjoys his life. He currently is on no medications of any kind—and is proud of it.