My first question would be why you are taking magnesium supplements in the presence of propanolol. It's very important to realize what's happening when you combine pharmaceutical medications with over-the-counter supplements. While most supplements are safe to use, they can offer complications when taken with certain medications because of an antagonistic effect.

Propanolol works by reducing cardiac force, which in turn lowers blood pressure and the amount of work the heart must do. An artificial threshold is achieved with drugs like beta blockers that is experienced when undergoing exertion. When cells need oxygen, the heart is called upon to increase rate and force to help produce faster gas exchange of blood circulating through the body. Since beta blockers reduce cardiac force, they capitate how much the heart can work to provide sufficient oxygenated blood to the tissues and cells. This is why you're only achieving the rates mentioned in your posting. Blood pressure is also increased as a consequence of increased force.

So when you're taking propanolol, you need to realize that you must limit the degree of exertion you place on your body because the heart is unable to work to achieve maximum potential. It's perfectly fine to exercise, but you have to take into consideration the limitations imposed by the medication and how it can effect you.

Magnesium is not required in large amounts by the body and to date, I've never observed a single person to have a magnesium deficiency. I will tell you that taken in sufficient amounts, it can ultimately have a considerable effect upon blood pressure because of its actions on heart rate. Although relatively harmless by itself, the combination of beta blockers and magnesium can produce symptoms associated with hypotension, which is what I believe you are experiencing.

The body's main directive is to maintain perfusion to the brain, which as you know drives everything else and without consciousness, the remainder of activities are pretty much a useless point. Whenever perfusion is decreased to a certain extent, the brain sends signals to increase cardiac force and increase pressure at vessels to accommodate the change needed. This is why you get a sudden rush and pressure sensation. In additon to that, if you happen to experience a benign palpitation, pressure is affected as well so the response is even more dramatic.

My suggestion to you here is to stop taking the magnesium supplements unless specifically directed by your doctor. The propanolol is quite sufficient to reduce the symptomatic effects associated with benign palpitations and you also need to determine what your blood pressure is while at rest.

Again, I am not an advocate of supplements except in the rare occasion where a deficiency has been noted in laboratory tests.

As for the abdominal distension you describe, it is highly likely the consequence of trapped air, which can be caused by production of methane within the intestines or aerophagia (swallowing air), sometimes even a combination. Care must be taken to avoid offending foods or beverages and the amount eaten at any one sitting is also very critical. A reduction in GI symptoms is highly relative to the frequency of vagal stimulated palpitations.

If your symptoms persist, then you should alert your primary care physician. I would also stay clear of supplements that can produce a synergistic effect upon your prescribed medications.

Best regards and Good Health  

Firstly Stu, let me say here that there's no need to plead ignorance or stupidity with regard to your healthcare endeavors. Many people try to do their level best to take care of themselves and do what's proper.

My job as a physician is to clarify what works and what doesn't and how you can avoid problems. Otherwise, there are many things you can do to improve and/or maintain good health.

What I mean by synergistic effects is that if you're taking a prescribed medication that has chemical properties capable of lowering your blood pressure and you also introduce a compound that can intensify or add to those capabilities, you are in essence over-dosing on the prescribed medication. Dose-related prescriptions must be relative to any other drug that may have a compounding effect. See what I mean now? And by all means, the combination of beta blockers with sufficient quantities of magnesium can create hypotension and dysregulation. Stick to your prescription.

Vitamins, while good for you in limited quantities, can be extremely caustic on the GI tract and particularly so when taken in high doses. A very potent source for your bloating is highly suspect for fish oil capsules combined with all the vitamins. Realize that these are concentrates and react poorly on the lining of the GI tract in many people. Now I don't know if you're a tea drinker or not, but you can really set yourself up for trouble by washing down things like fish oil and B complex with a strong English tea, coffee and similar beverage. That's a hard combination and one that doesn't bode well for folks with stress-affected GI conditions. Also remember that when the GI tract becomes unstable due to chronic ingestion of disagreeable substances, it takes time for the epithelial tissues and mucosal lining to settle down again, sometimes several days.

By the way, you're going to make 40. You'll even make it through the 50s, 60s, 70s and if you've got good genes, into the 80s or beyond. I say this because your constellation of symptoms are not associated with any attenuation of life-span by any means. I think you're overly concerned that all these symptoms are bearing down heavily to the degree that it spells a physical calamity at some point. Not the case, so take a deep breath and relax.

Look Stu. Here's my suggestion. Look through the multitude of vitamins and supplements you are presently taking. You can get Omega 3 fatty acids from many sources besides fish or oil capsules, so look a little further. The other important factor is to always try to consume your daily requirements through natural sources as much as possible. The body takes in nutrients from natural sources far better than artificial ones and in the right quantities will produce better overall health benefits. Another thing to realize about certain vitamins is that if taken in sufficient quantities, it can overstimulate production of erythropoetin used to make red blood cells and cases of polycythemia have been observed(over-production of red blood cells that turns your blood into a thick, viscous liquid medium). The problem is that it can produce extreme hypertension and other problems. It's rare, but does occur. So my example is merely to point out that vitamins and supplements are necessary, but should be obtained from natural sources.

Here's more scoop on the vitamin issue. The only folks we ever really recommend vitamin supplements to are either children or old folks. It is important in children because their diets at an early age are not necessarily filled with all the nutritional requirements for a growing individual. With regard to older folks, 60 and beyond, the stomach begins to decrease its production of stomach acid and along with it, something called intrinsic factor, a vital substance necessary to metabolize Vitamin B and therefore any intake in the absence of sufficient intrinsic factor will pass through the body largely unmetabolized, very often producing a vitamin B deficiency.

The vitamin business is a multi-billion dollar industry and one based upon the fact that most people don't realize their physilogical status associated with vitamins and minerals. They're given the facts as portrayed by the vitamin industry and often told that you're in a constant state of deficiency or that vitamins will cure anything up to and including the common cold. Nothing could be futher from the truth.

For a fellow at your age, you have none of those worries and all of your vitamin and supplements can be obtained naturally. It will be a lot less caustic on your stomach and GI tract as well. I recommend working to stabilize your GI discomfort by filling it with natural substances rather than artificial ones. You're already exercising, so that's wonderful. Check your blood pressure once a day at the same time each day, after you've been sitting comfortably for 20 minutes or so. Once you have a record of your average blood pressure, you and your doctor can determine whether adjustments need to be made to your propanolol.

Above all, relax. Don't throw things down your spout to maintain your health because they're known to be good for you. Make a very careful assessment of what you need to reach maximum health and stick with it, using natural sources.

You're going to be just fine. Again, if the symptoms persist, contact your doctor. Things should begin to settle down and you can better assess your needs.

Best regards and Good Health

Hi Stu
Hope you are well.
Just read your posting re your concerns about ensuring you are getting the right balance of nutrients.
I think that RLR is right in that if you can get the nutrients in food form rather than vitamin tablets it is better. They are better absorbed for one thing. So I was thinking of recommending you a book called The Food Doctor - Healing Foods for Body and Mind - it is written by a nutrition expert and goes through in detail which foods are high in what vitamins.

here's the amazon link...
http://www.amazon.co.uk/Food-Doctor-Healing-Foods-Mind/dp/1843401878/ref=sr_1_2?ie=UTF8&s=books&qid=1207571286&sr=8-2

There is info on foods that might be more relevant for some people depending on their particular ailment. It might be interesting for you. I have used it myself when my anxiety was worse because they say that having severe anxiety makes you more needy of B vits and so on, so I tried eating more foods including those. And also eating foods that had calming effects - eg. turkey, walnuts, wholefoods. There's nothing cranky in there - it's all sensible stuff.

bead x

PS. I hit 40 this year, so I am feeling your concerns too!