of cardiac arrhythmias using oral taurine with L-arginine with case histories:
hypothesis for nitric oxide stabilization of the sinus node
by George Eby, M.S.
George Eby Research
14909-C Fitzhugh Road
Austin, Texas 78736
email: george.eby at george-eby-research.com
William W. Halcomb, D.O.
William W. Halcomb Clinic
4323 E. Broadway, Suite 109
Mesa, Arizona 85206
See PDF of this published medical journal
Also, please consider large doses of Omega-3
Essential Fatty Acids.
We searched for nutrient deficiencies that
could cause cardiac arrhythmias [premature atrial
contractions (PACs), premature ventricular contractions (PVCs),
atrial fibrillation, and related sinus pauses], and
found literature support for deficiencies of taurine and L-arginine. Case
histories of people with very frequent arrhythmias are presented showing 10 to
20 grams taurine per day reduced PACs by 50 percent and prevented all PVCs but did not prevent pauses. Adding 4 to 6 grams of
L-arginine immediately terminated essentially remaining pauses and PACs,
maintaining normal cardiac rhythm with continued treatment. Effects of taurine
useful in preventing arrhythmias include regulating potassium, calcium and
sodium levels in the blood and tissues, regulating excitability of the
myocardium, and protecting against free radicals damage.
Taurine restored energy and endurance in one of the cases from a debilitated
status to normal. Arrhythmias may also respond to taurine because it dampens
activity of the sympathetic nervous system and dampens epinephrine release.
L-arginine may have anti-arrhythmic properties resulting from its role as a
nitric oxide (NO) precursor and from its ability to restore sinus rhythm
spontaneously. Endogenous production of taurine and L-arginine may decline in
aging perturbing cardiac rhythm, and these "conditional" essential
nutrients therefore become "essential" and require supplementation to
prevent morbidity and mortality. L-arginine is hypothesized to prevent cardiac
arrhythmias by NO stabilization of the sinus node. Cardiac arrhythmias having
no known cause in otherwise healthy people are hypothesized to be symptoms of
deficiencies of taurine and arginine.
contractions (PACs) and premature ventricular contractions (PVCs)
[ectopic heartbeats] are common disorders of cardiac rhythm particularly in
healthy older people. These arrhythmias are beats that occur early in either
the atria or the ventricle, causing the heart to beat out of synchronization
before the next regular heartbeat. In both cases the heart seems to pause or
hesitate until the next beat. Neither are usually
considered to be serious cardiac events, and patients may have experienced them
for many years with little cardiac distress, although they can be discomforting
and annoying. Sinus pauses occur when the sinus node fails to generate an
impulse for a few seconds, and long pauses require pacemakers.
Normally, the pacemaking
activity of the sinus node suppresses impulse production by other cardiac
cells, but if conductance to some other part of the heart muscle is blocked, or
if the heart is over stimulated, islands of cells may express their latent
impulse-production ability, resulting in extra or early beats.
Common causes of these ectopic heartbeats
among healthy persons are ingestion of caffeine, nicotine, alcohol, stress,
hyperthyroidism, electrolyte imbalances, candida albicans infection and some medications. Avoidance of, or
correction of, these initiators, and use of drugs such as beta-blockers and
calcium channel blockers have long been used to treat patients with these
ectopic beats with some success.
The literature was searched for natural
anti-arrhythmic agents, ones that were potentially insufficient in the diet or
insufficiently produced in the body, that might account for the occurrences of these cardiac arrhythmia when common causes had been ruled
out. Nutrient deficiencies capable of producing arrhythmias included acetyl-L-carnitine, calcium, CoQ10, magnesium, potassium, selenium, taurine,
thiamine, vitamin D3, vitamin E and zinc. For the individuals discussed below,
none of these nutrients in supplemental form, except taurine, had beneficial
effects in reducing their arrhythmias. The strong anti-arrhythmia effect of
taurine was first noted when one person switched from magnesium glycinate to
magnesium taurate, while using magnesium in an attempt to prevent arrhythmias.
In 1969 Novelli et
al. first reported taurine as having
anti-arrhythmic effects. Since then there have been several dozen similar
reports of benefit to cardiac rhythm. Effects of taurine useful in managing
arrhythmias include regulating potassium, calcium and sodium levels in the
blood and tissues, and regulation of the excitability of the myocardium
possibly by modifying membrane permeability to potassium. Arrhythmias may
also respond to taurine because it dampens activity of the sympathetic nervous
system and dampens epinephrine release, relaxing the individual. In 2004,
Hanna et al. demonstrated the protective effect of taurine against free
radicals damage in the myocardium.
Regardless of these benefits, the effects
that were observed in treating PACs, PVCs, pauses and
occasional tachycardia showed taurine to be helpful but inadequate to prevent
all PACs and to completely restore normal sinus rhythm. Therefore, the search
for nutrients that had anti-arrhythmic activity was continued.
While experimenting with humming to induce
nasal nitric oxide (NO) production in the treatment of chronic rhinosinusitis,
it was observed that PACs could be prevented simply by strong humming for an
hour on each of four consecutive days and thereafter as needed. The observation suggested that L-arginine, known to be
a natural precursor of NO, might also have anti-arrhythmic properties. No
previous reports showing benefit of L-arginine in preventing or treating
arrhythmias was found, but we did find support for the notion that NO is a
modifier of human sinus node automaticity. Therefore, we hypothesized that
L-arginine would be effective in preventing cardiac arrhythmias by induction of
NO, thus stabilizing the sinus node.
L-arginine may be a natural anti-arrhythmic
agent upon consideration of its effect in restarting normal sinus rhythm at the
completion of heart surgery. For example, Kiziltepe
et al. used L-arginine for protection of acutely
ischemic myocardium during surgery (coronary artery bypass grafting) in a study
of forty patients. They showed that L-arginine treatment increased NO levels
and attenuated free O2 radical mediated myocardial injury relative to placebo.
Controlled reperfusion with L-arginine enriched non-cardioplegic
blood greatly diminished ischemia/reperfusion injury. Ninety percent of their
L-arginine treated group had spontaneous return of the sinus rhythm after
surgery, while 80% of the control patients required defibrillation (P<0.0001). In addition to significantly better hemodynamics, perioperative myocardial infarction incidence was significantly lower, and the length of intensive care unit and hospital stays were each significantly shorter in their L-arginine study group than in the placebo-treated group without any deaths in the L-arginine-treated group, but with one death in the control group. >
After explaining to the subjects some of the
promising benefits of NO, taurine and L-arginine in cardiovascular research,
the anecdotal humming for arrhythmia observations, the efficacy and safety of
taurine, and the potential for drug interactions with L-arginine, the following
treatments were conducted in otherwise healthy people.
Materials and Methods
A 64-year old male had suffered from very
frequent (25,000 per day) PACs for 6 years, occurring with nearly every fifth
beat. The PACs were accompanied by physical weakness (greatly reduced energy
and endurance not attributable to PACs or other cardiovascular disease) and
occasional paroxysmal tachycardia, rendering him debilitated. Propranolol was not successful. Taurine (5 grams with each
meal and at bedtime) was taken daily. L-arginine (1.5 grams) in gelatin
capsules was taken with each meal and at bedtime. No drugs or pacemakers were
used during amino acid therapy.
An 82-year old male had suffered from
documented (24-hour Holter) very frequent (21,000 per
day) PVCs for 5 years. He also had 650 bigeminal events, 90 couplets and sinus pauses
every sixth to tenth beat of about 2 seconds each with the longest being 2.2
seconds. His PVCs were responsive to verapamil, a calcium channel blocker, but it had no effect
on the incidences of pauses. Verapamil was tapered
off and taurine was substituted. He took 10 grams (2.5 grams with each meal and
at bedtime) of taurine and 4 grams (1 gram with each meal and at bedtime) of
L-arginine each day. No drugs or pacemakers were used during amino acid
A 60-year old man had cardiac arrhythmias
(PAC/PVCs) for 6 years. The symptoms included strong palpitation, very rapid heart beats of over 150 beats per
minutes, skipped beats, uneven heart rates, and some totally out of
synchronization beats. Daily skipped beats happened most frequently. Out of
sync heart beats awoke the man frequently at night. Holter
monitor tests for 24 hours, ultrasound, and stress test showed arrhythmias with
occasional atrial fibrillation. He did not use drugs
or a pacemaker to treat the arrhythmias. He began taking taurine with modest
change in his symptoms resulting, and later added L-arginine. He used 4 grams
of taurine and one gram of L-arginine three times a day with meals.
The PACs in the 64-year old male were
reduced by 50 percent with continued use of 20 grams of taurine a day. Although
the total number of ectopic beats per day was reduced, when they occurred they
occurred at every fifth beat. Incidences of occasional paroxysmal tachycardia
were reduced by half using taurine. Energy and endurance were restored to
normal by taurine. Addition of L-arginine to the taurine protocol almost immediately
stopped nearly all arrhythmias and prevented tachycardia for an observation
period of more than three months. Remaining PACs numbered less than 100 ectopic
beats per day. Missing doses of L-arginine usually precipitated arrhythmias.
The PVCs in the
82-year old male were completely prevented with continued use of 10 grams of
taurine per day, equal in effect to verapamil.
However, the pauses remained. Addition of L-arginine immediately and completely
terminated the pauses for the observation period of more than 3 months. Missing
doses of L-arginine precipitated pauses, and missing
doses of taurine precipitated PVCs.
The arrhythmias in the 60-year old male
decreased dramatically (95 to 100% reduction) with
elimination of heavy palpitations and atrial fibrillations
upon addition of L-arginine to his taurine treatment. He remained symptom-free
essentially all of the time. When he noticed arrhythmias, they were nearly
always skipped beating and not fibrillations.
These case histories are the first published
evidence of taurine with L-arginine to treat and prevent common, normally
benign, cardiac arrhythmias in other-wise healthy people. None of these
subjects had accepted deficiency symptoms of either taurine or L-arginine. Each
subject had tried many natural products, some drugs and life-style
modifications with varying degrees of success. However, only
the combination of taurine and L-arginine produced essentially complete
prevention of arrhythmias and fibrillations for more than a 3-month period.
Since each of these subjects had been using taurine for weeks to months prior
to starting L-arginine, it is unknown what residual effects resulted from
pre-conditioning with taurine.
Taurine is a conditionally-essential amino
acid which is not utilized in protein synthesis, but is found free or in simple
peptides. Taurine has been shown to be essential in certain aspects of
mammalian development, and in vitro studies in various species have
demonstrated that low levels of taurine are associated with various
pathological lesions, including cardiomyopathy,
retinal degeneration, and growth retardation. Metabolic actions of taurine
include: bile acid conjugation, detoxification, membrane stabilization, osmoregulation, and modulation of cellular calcium levels.
Taurine has been used in the treatment of: cardiovascular diseases,
hypercholesterolemia, epilepsy and other seizure disorders, macular
degeneration, Alzheimer's disease, hepatic disorders, alcoholism, and cystic
Some seafood (conch, inkfish,
blood clams, shellfish, crabs, sole) eaten by long-lived Okinawans
and other oceanic fishing communities are rich sources of taurine (2500 to 8500
mg/kg), while meats and other foods eaten by Western societies are much lower
As humans age, hepatic taurine synthesis can
be reduced or fail completely, resulting in low to no energy, cardiac,
digestive, and mental issues, and premature death. Since taurine has an
important role in formation of bile salts and digestion, perhaps it is required
in these larger amounts for the best absorption and utilization of L-arginine
in the aged population, helping to explain these results with low doses of
Under normal conditions, the 3.5 to 5 grams
per day of arginine found in the typical Western diet would be marginally
sufficient to maintain general health. Foods richest in arginine are often
fatty and include: peanuts, peanut butter, cashew nuts, pecans, walnuts,
almonds, chocolate, coconut, cereal grains, dairy products, gelatin, meat,
oats, soybeans, and edible seeds. Foods highest in arginine are often avoided
by the aged population sometimes on advice from physicians due to their fat
content, and deficiencies become possible, perhaps precipitating arrhythmias.
Synthesis of arginine occurs principally via
the intestinal-renal axis. Consequently, impairment of small bowel or renal
function in aging or disease can reduce endogenous arginine synthesis, thereby
increasing dietary requirements to prevent arrhythmias and maintain cardiovascular
L-arginine may have interactions with
anticoagulants, antiplatelet and blood pressure drugs
and it may change electrolytes in the blood. People taking coumadin
may require less or none while taking L-arginine to prevent excessive blood thinning
and bleeding. Arginine may significantly raise blood sugar levels in diabetes
requiring changes to medication. Larger doses have been implicated in
recurrence of latent herpes infections, a disease for which topical ionic zinc
treatment is effective. Many drug interactions are
possible since arginine has many functions for which drugs are currently
substituted. People with liver or kidney disease may be especially sensitive to
these interactions and they should avoid using L-arginine except under medical
Large doses of arginine worsen inflammation
in the lungs and can contribute to asthma and allergy symptoms. Taurine may
impair the production of adrenaline, thus asthma symptoms may be increased.
Magnesium throat lozenges (100 mg magnesium) are useful as preventative and as
a rescue treatment for asthma, and also provide additional cardiovascular
support. There may be similar benefits in preventing arrhythmias from taurine
with resveratrol or other NO inducers, which might be
useful in case of side effects from L-arginine.
Arginine is a precursor of nitric oxide,
which causes blood vessel relaxation (vasodilation).
Arginine is also useful in the treatment of medical conditions that are
improved by vasodilation, including angina, atherosclerosis,
coronary artery disease, erectile dysfunction, heart failure, intermittent claudication/peripheral vascular disease, and vascular
headache. Arginine also stimulates protein synthesis and has been used in wound
healing, bodybuilding, enhancement of sperm production, and prevention of
wasting in people with critical illness.
People having had heart attacks who were
receiving "standard postinfarction
therapies" had an increased incidence of death when L-arginine was added
to the protocol. Blood levels of L-arginine in both treatment and placebo
groups remained normal, and they did not increase or differ from those
receiving identical treatments without arginine. Added arginine did not improve
vascular stiffness or left ventricular function. We
were unable to ascertain from this article drugs used with L-arginine to
discuss any possible interactions.
Caffeine and the drugs digoxin
and isoproterenol, suspected or proven arrhythmia
inducers, can greatly reduce the arginine content of cytosol
in both ventricular and atrial heart muscles of
animals. Experimental dosing of rats with toxic doses of caffeine (15
mg/kg/min) led to ectopic beats and lethal fibrillation, which responded
somewhat by treatment with propranolol or verapamil. We suggest that these observations support
our hypothesis that L-arginine is vital in maintaining normal sinus rhythm.
Nitric oxide (NO) is derived from oxidation
of L-arginine by NO synthases. NO is an agent with
wide-spread functions including maintenance of vascular tone, neurotransmitter
function in both the central and peripheral nervous systems, mediation of
cellular defense, cellular respiration, generation of reactive oxygen species,
inhibition of platelet aggregation and adhesion, and modulation of smooth
muscle cell proliferation. NO has been implicated in a number of cardiovascular
diseases. Virtually every risk factor for cardiovascular diseases appears to be
associated with a reduction in endothelial generation of NO. Reduced basal NO
synthesis or action leads to vasoconstriction, elevated blood pressure and
thrombus formation. By contrast, overproduction of NO leads to vasodilatation,
hypotension, vascular leakage, and disruption of cell metabolism. There is
also an inverse relationship between arginine intake and C-reactive protein,
further suggesting increased NO generation. However, NO has not been
reported previously to have anti-arrhythmic properties. Enhanced NO production
occurs during magnesium deficiency which lowers red blood cell glutathione.
This may explain why one severely magnesium deficient man believed that
magnesium supplements worsened his arrhythmias.
With the discovery that caloric restriction,
a promising means of life extension, induces NO production,
interest in nitric oxide and its precursors will likely increase. Consequently,
interest in oral use L-arginine with the intent of producing cardioprotective benefits and life extension will likely
If the biosynthesis of taurine and
L-arginine becomes inadequate in aging, they become essential nutrients rather
than "conditional" essential nutrients. Unnecessary morbidity, such
as cardiac arrhythmias, and mortality result if they are not supplemented in
sufficient amounts. Drugs should not be substituted
for nutrients. It is hypothesized that doses of taurine in the 10 to 20 grams
per day range combined with L-arginine in doses of 3 to 6 grams per day, will
be found effective in the prevention of cardiac arrhythmias in clinical trials,
and such trials are highly recommended. We hypothesize that cardiac arrhythmias
not having a specific cause in otherwise healthy people are symptoms of
nutrient deficiencies of taurine and L-arginine.