# Simple Dietary Mistake STOPPED His HEART: Medical Mystery Solved ## Метаданные - **Канал:** Violin MD - **YouTube:** https://www.youtube.com/watch?v=g7VmqYwZu5E ## Содержание ### [0:00](https://www.youtube.com/watch?v=g7VmqYwZu5E) Segment 1 (00:00 - 05:00) meet Ryan a 34-year-old project manager who recently started a new demanding job at a tech startup Ryan had never been a big eater and stress only made it worse since starting his new job he would often fuel himself with coffee during the day and just have a single meal at night usually something simple like white rice chicken and boiled broccoli one day he noticed some tingling in his fingers he thought it might be from all the hours typing at work but then it started in his toes he didn't want to take time off of work to go see a doctor so we put his symptoms into chat GPT which told him that he probably had a vitamin B12 deficiency he figured that was easy enough to fix so he picked up a supplement and started taking it each day but despite the supplement his symptoms kept getting worse work stress was piling up and his appetite almost entirely disappeared even the thought of eating anything other than plain white rice made him feel nauseated Ryan's brother noticed that he was losing weight so one evening he stopped by to bring him some proper food Ryan seemed a bit weak but nothing too out of the ordinary then suddenly without warning he collapsed to the ground his brother rushed to his side and when he found Ryan unresponsive he called 911 by the time EMS arrived Ryan was awake and tried to tell them that he was fine but his brother insisted that he go to the hospital and get checked out in the emergency department the doctor asked Ryan to describe exactly what happened leading up to the moment he passed out Ryan explained that he remembers walking towards his desk and the next thing he knew he was waking up on the ground around he had no warning whatsoever it was like someone had just turned off a switch in his brain and he was unconscious that's a major red flag most of the time when people faint it's what doctors like to call vasovagal Syncopy which is basically when the body overreacts to certain triggers this causes the blood pressure to drop the heart rate to slow down and ultimately there's not enough blood flow to the brain in these cases there's a clear trigger like seeing blood or standing still for a prolonged period of time and people tend to get symptoms before like feeling woozy and light-headed before they pass out but that's not what happened to Ryan and when fainting happens all of a sudden without any warning that's when we start worrying about the heart so the doctor ordered blood work and an ECG to assess his heart rhythm so Syncopy is something that I see really frequently in the hospital and you might be surprised to know that despite extensive diagnostic testing we only get a definitive diagnosis and about 50% of patients it's actually really rare to make a diagnosis off the initial ECG but as you'll see Ryan's case is anything but ordinary all right let's look at Ryan's ECG together we're going to find something subtle but potentially fatal okay so let's take a second and go through the basics so that this doesn't just look like squiggles to you a normal ECG has three key Parts a p-wave a QRS complex and a t-wave and together they tell us how the heart's electrical system is functioning this little p-wave is where it all starts hearts a special group of cells in the heart act like a built-in timer firing an electrical impulse that causes the upper chambers of the heart to contract this forces blood into the ventricles which are the main pumping chambers of the heart the QRS complex shows the electrical impulse spreading through the ventricles as they contract to pump blood out of the heart into the rest of the body which brings us to the t-wave that shows the ventricles resetting in preparation for the next beat and this is where we see the abnormality in Ryan's e CG the distance between the qwave and the tve is way too long which tells us that Ryan's heart cells are taking too long to reset normally for a man this length should be less than 460 milliseconds Ryan's was a shocking 625 milliseconds and this is a major issue because if another electrical impulse moves through the heart before the cells have fully reset it can cause a chaotic potentially fatal arhythmia called torsade Deo French for twisting of PE and you can really see that here it almost looks like a ribbon flapping back and forth and this causes the heart to quiver rather than pumping properly which means less blood flow to the brain causing you to pass out this is almost certainly what happened to Ryan torsades is what we call a pre-arrest rhythm and it can go one of two ways if you're lucky it'll go away on its own but in many cases it can devolve into a fatal arhythmia called ventricular fibrillation and that's a cardiac arrest but there is one intervention that works really well for torsades and it's not some expensive medication it's actually plain old magnesium and get this even if a patient has normal magnesium levels giving IV magnesium can actually reduce the risk of torsades by stabilizing the heart cells so Ryan's nurses were preparing to hang a bag of magnesium when an alarm rang out in the nursing station and this is what they saw on the monitor rushing into the room they found Ryan unresponsive he had a pulse but it was extremely weak and fast at this ### [5:00](https://www.youtube.com/watch?v=g7VmqYwZu5E&t=300s) Segment 2 (05:00 - 10:00) point you're not just going to wait around and hope that he goes back into a normal heart rhythm his doctors hooked him up to a defibrillator and shocked him okay so it's charging and then everyone's all clear from the bed chalk hold it this basically resets the electrical activity of the heart and fortunately Ryan's heart went back into a normal Rhythm and he woke up Ryan was stable for the time being but he wasn't out of the woods yet there's no way of knowing when his heart would flip back into torsades again so what's causing his Long QT and how do we fix it when I see someone like this with a Long QT on their ECG I immediately think about the top two causes medications and electrolytes now there's a whole long list of meds that can cause this but I like to think of the antis antibiotics antiemetics antis psychotics anti-ar rhythmics and so on but Ryan didn't take any medications and as for electrolytes the classic triggers are low potassium low magnes magnesium or low calcium and those were all normal on Ryan's blood work so his cardiologist did some more blood work and an echocardiogram which is an ultrasound of the heart but again those were all normal too out of ideas Ryan's cardiologists came to the conclusion that there was no reversible cause of his Long QT and that he figured it was probably genetic so the only thing left to do was to implant a defibrilator into Ryan's chest icds are a really cool life-saving technology it doesn't actually fix the Long QT but this small device will constantly monitor your heart rhythm and if it detects a dangerous heart rhythm it'll deliver an electrical shock which will reset the heart just like they did with Ryan in the hospital so with this Safety Net in place Ryan was discharged home Ryan was frustrated he now had a defibrillator in his chest a bunch of doctor's appointments and he was falling further behind at work and of course none of this addressed the fact that he was feeling awful he was exhausted his fingers and toes were constantly tingling and he was so nauseated that he could barely eat anything over the next week the numbness and tingling slowly crept up his arms and legs at first he tried to ignore it but soon he could barely feel his feet and he was struggling to walk at that point he knew he had no choice he had to go back to the hospital in the emergency department the focus now shifted away from his heart as his doctor did a detailed neurological exam and the findings were quite concerning not only did he have reduced sensation to his knees and elbows but his reflexes were completely absent in his legs now when it comes to reflexes you'll find there's some variation between people some people it's really easy to find their reflexes and others it can be a bit harder but when it's impossible to get any response it tells me that there's an issue with the peripheral nerves meaning the nerves that connect the brain and spinal cord to the rest of the body so Ryan's doctors consulted the neurologist on call to help with making the diagnosis the neurologist carefully reviewed his chart and then ordered a few key blood tests which confirmed that Ryan was suffering from thomine deficiency and his levels weren't just low they were undetectable thiamine is also known as Vitamin B1 you know I'm not quite sure why thine doesn't get as much attention as other B vitamins like B12 or folate but as you'll soon find out it's just as important the active form of thomine is a key player in the citric acid cycle and without it your cells struggle to produce enough ATP the energy that powers nearly every function in your body and when thyine levels remain low for too long your body goes into an energy crisis which leads to your brain nerves and heart quite literally breaking down historically we've classified thyine deficiency based on the organ that's affected and it has its own special name although we now know that this all exists on a spectrum which is why Ryan had multiple organs involved let's start with the brain uses about 20% of the body's ATP which is pretty impressive and without a constant source of energy the brain starts to degenerate and we can actually see that on MRI imaging when thyine deficiency predominantly affects the brain we call it Waki corov syndrome usually this happens in the context of heavy alcohol use and if it's left untreated the damage is permanent and it's more common than you might think in fact almost anyone who comes into the hospital with an alcohol addiction will get started on IV thyine to try and prevent this from happening but it's not just the brain the peripheral nerves that run down the arms and legs can also be affected this causes is numbness and weakness in the extremities like Ryan experienced early on when the nerves are primarily affected we historically call this condition dry berry and I'll tell you why later on in the video in a similar way the heart also starts to fail when it doesn't get enough ATP this can cause the body to hold on to extra water causing swelling in the legs and more concerningly fluid buildup in the lungs all of the fluid buildup is how this condition got the name wet berry now here's something interesting about the way your heart uses energy only 60 to 70% of the energy is used for ### [10:00](https://www.youtube.com/watch?v=g7VmqYwZu5E&t=600s) Segment 3 (10:00 - 15:00) the physical pumping the rest of it is used to maintain the electrical system which we talked about earlier and that's what caused Ryan's Long QT clearly this is an important nutrient so how do you get enough thyine in your diet fortunately you can find thyine in all sorts of foods like pork seeds particularly sunflower seeds nutritional yeast whole grains and fish and thanks to fortified Breads and cereals which have vitamin B1 added into them most people in developed countries get plenty of it without even trying but here's the issue your body can't store much thomine instead it relies on a steady supply from your food to maintain its level and if you're not getting thyine from your food it only takes about 4 weeks until your body is completely depleted so to understand what happened to Ryan we need to take a closer look at his diet his first mistake was choosing white rice over brown rice made by removing its outer layer which contain important nutrients like thiamine there are some Rices that are naturally white like Basmati and Jasmine rice but similarly they only have a fraction of the thyine found in brown rice his next mistake was boiling the vegetables because the thymine molecule gets damaged at high temperatures think of thyine like a delicate paper structure it holds its shape under normal conditions but if you expose it to high heat or harsh chemicals it breaks apart and loses its function plus thyine is water soluble so much of it leaks out into the water you're boiling and then it's not in the vegetables that you're eating Ryan did eat chicken which contains some thyine but he wasn't eating enough of it to meet his daily requirements so if we tally up one of Ryan's typical dinners that would include about 2 cups of white rice chicken breast and some boiled broccoli he was getting roughly 0. 35 mg of thomine and that's likely generous because it doesn't take into consideration the thiamine that was broken down in the cooking process even still that's less than a third of his daily requirement now remember how much coffee Ryan was drinking well coffee contains multiple compounds that reduce thyine absorption for most of us who are eating a very diet with plenty of thyine in it this won't have a big impact but for Ryan who already had so little thyine in his diet this probably made matters worse one other thing to note was that vicious cycle of nausea that Ryan experienced nausea is actually an early sign of thyine deficiency and in response Ryan restricted his diet even further and started just eating white rice he would have needed to eat at least 30 cups of cooked white rice to get enough thyine that way over the course of a few weeks his body was completely depleted of thyine and that's when his symptoms progressed rapidly now thyine deficiency has been around a long time but the origin story of how it was discovered is really quite interesting and it involves a flock of chickens if you love this kind of information and you want your questions answered in a monthly live stream then click this link up here to become a channel member back in the 19th century industrial Milling transformed form diets across Asia brown rice was replaced with polished white rice a status symbol with a longer shelf life and as white rice spread so did some unusual symptoms and this condition became known as berry Legend has it that when Afflicted patients in sh Lanka were asked to move they would cry out berry meaning I cannot the disease hit hardest in areas with restricted diets that relied primarily on white rice like prisons naval ships and poor communities then came Christian ikan a Dutch doctor studying berry in Indonesia one day he noticed something odd chickens at the military Hospital started having symptoms similar to the ones he was studying in humans and he made the observation that they had recently changed the chicken feed from brown rice to white rice and when he had them change the diet back the chickens made a full recovery ikan had unknowingly discovered a missing nutrient he didn't know what it was vitamins weren't even a concept yet but his work led to the discovery of vitamin B1 and he later earned a Nobel Prize eventually countries around the world started supplementing foods with thyine to prevent berry but whether your white rice is supplemented with thiamine greatly depends on where you live for Ryan here in Canada manufacturers are not required to fortify white rice in contrast in the United States all white rice is fortified unless it's explicitly labeled so it's strange to think that this may not have happened to Ryan if he lived in the United States unless he had chosen to by unfortified white rice so let's get back to Ryan's case after he was diagnosed with thyine deficiency treatment was started right away he was given IV thyine immediately and then later transitioned over to a pill supplement he also participated in a rehab program to regain his strength since returning home Ryan has Diversified his diet he swapped out white rice for brown rice and he still takes his thyine supplement just for good measure after a year of physical rehab Ryan is finally prioritizing his health and actually making time to do things he loves outside of work and now ### [15:00](https://www.youtube.com/watch?v=g7VmqYwZu5E&t=900s) Segment 4 (15:00 - 15:00) he's in conversations with his cardiologist about removing that defibrillator since his Long QT has completely normalized and he stayed in a normal heart rhythm for over a year so the moral of the story is maintain Variety in your diet while routines can be great when life gets busy having Variety in your diet is really important because it can protect you against nutritional deficiencies that you may not even know exist if you enjoyed this video check out this one next it's a real case of a woman whose choice of snack caused her kidneys to start shutting down stay curious stay healthy and I'll see you in the next one so bye for now a big thanks to neural Academy for use of the heart animation in this video --- *Источник: https://ekstraktznaniy.ru/video/41551*