Dr. John Day, Cardiologist

Can You Stop Blood Thinners After a Successful AFib Ablation?

At St. Mark’s, we’ve now treated nearly 1,000 patients with the new pulsed field ablation (PFA) technology. PFA is not only faster and safer than traditional methods, but we’re also seeing higher success rates and a much lower need for repeat ablation procedures. Because of these improvements, many of our patients are now asking:

Do I still need to take blood thinners for the rest of my life?

This is a great question—one that many doctors and researchers are also trying to answer. Two major studies (one recently published from Japan that included 1,821 patients and one that we published in 2013 based on 4,212 patients who had undergone AFib ablation) give us helpful insights. And I’ll also walk you through some important tools that can help you and your doctor make the safest decision together as to whether you can stop blood thinners after a successful AFib ablation.

Two Big Studies, One Clear Message

The Japanese Study

This recently published study followed 1,821 people who had successful AFib ablations. Their ablation had been done a year before the study, and they had remained completely AFib-free during that time. In other words, they didn’t even consider stopping their blood thinner until they had maintained a full year of normal rhythm with no recurrence of AFib. At that point, half of the patients continued taking blood thinners, while the other half stopped. Here’s what the researchers found:

1. People who stopped taking blood thinners had a slightly higher risk of stroke—especially if they had a weak heart (low ejection fraction), an enlarged left atrium, or no symptoms of AFib. Not having symptoms can make it harder to know if the AFib has come back. Fortunately, new technology like home ECG devices and smartwatches (such as the Apple Watch) can help. These tools let many patients check for AFib at home, even if they can’t feel it. It’s also important to remember that sometimes an ablation doesn’t fully stop AFib—it may just make it harder to notice. So even if you feel better, AFib could still be happening without you knowing.

2. However, the overall risk of stroke was still very low after stopping blood thinners—less than 1 out of 100 people per year. But it’s important to remember that this study only included AFib patients who were already at relatively low risk for stroke.

3. People who stayed on blood thinners had more bleeding problems, especially if they had a high HAS-BLED score—a tool doctors use to estimate bleeding risk (we’ll explain this score later in the article).

Our 2013 Study

Our published study looked at over 4,000 people who had a procedure called an AFib ablation. We compared them to two other groups:

1. People of the same age and the same risk factors for stroke who had AFib but didn’t get an ablation. Instead, they chose to stay on medications.

2. People who never had AFib at all but yet were the same age and had the same risk factors for stroke such as high blood pressure, diabetes, heart failure, prior TIA, or prior strokes.

What did the study find?

1. Our patients that chose to have an AFib ablation had a much lower risk of stroke compared to those who had AFib but chose to stay on their medications.

2. In fact, the stroke risk for our patients who had an ablation was about the same as people who never had AFib—just 1.4% per year.

The people who stayed on medicine (instead of getting the ablation) were about the same age and had similar health problems—like high blood pressure, diabetes, heart failure, or past strokes—as those who had an ablation or never had AFib.

It’s important to know that AFib only causes about 25% of all strokes. Most strokes actually happen because of plaque buildup in the arteries—either in the brain or in the arteries that bring blood to the brain.

Key Takeaways for AFib Patients

Does ablation reduce the stroke risk?

While many studies—including ours—suggest that ablation may reduce stroke risk, we’re still waiting on definitive answers. The multicenter, randomized OCEAN Study is designed to conclusively address this question and is expected to be completed later this year.

This trial is comparing two common post-ablation options: the blood thinner Xarelto (rivaroxaban) versus a baby aspirin. It will assess not only stroke risk, but also “silent” or hidden strokes detected by MRI.

The results of the OCEAN Study are expected to provide doctors with more solid guidance on whether more patients can safely stop blood thinners after a successful ablation.

Can some people safely stop blood thinners?

Maybe—especially if they are low-risk and haven’t had any AFib come back after their ablation. But this is a decision that should be made with your cardiologist. It depends on how successful your ablation was, your personal risk of stroke, and your risk of bleeding.

Can you ever get your stroke risk to zero?

Unfortunately, no—there’s no way to reduce stroke risk to zero. In our study, even people without AFib had a 1.4% annual risk of stroke. As mentioned earlier, only about 25% of strokes are caused by AFib. The majority are due to plaque buildup in the arteries of the brain or in the vessels that supply blood to the brain. Other causes include bleeding strokes, which are more likely to occur in people taking blood thinners.

What Do the AFib Guidelines Actually Say?

Many people are surprised to learn that there are no studies proving that lifelong blood thinners are necessary after a successful ablation. Current AFib guidelines recommend continuing blood thinners based on expert opinion—not hard data.

In fact, the guidelines state that if your stroke risk is low, you may not need lifelong blood thinners after ablation:

• Men with a CHA₂DS₂-VASc score of 0–1

• Women with a score of 0–2

In these cases, blood thinners are prescribed for a short period following the ablation, but if everything goes well, lower-risk patients are often able to stop them. Of course, your cardiac electrophysiologist (EP) will guide you based on your individual case.

Know Your Numbers: These Tests Can Help

There are simple heart tests that can help your doctor decide whether you should stay on blood thinners. These were the same tests used in the Japanese study mentioned earlier:

1. Ejection Fraction (EF) measures how well your heart pumps blood. A normal EF ranges from 52% to 70%. According to the Japanese study, AFib patients with a normal EF have a lower risk of stroke.

2. Left Atrial Size (LA size) shows whether the upper left chamber of your heart is enlarged. This is the area where most AFib begins—and where most AFib-related strokes originate. The study found that patients with a normal LA size had a lower stroke risk, while those with an enlarged LA faced a higher risk.

The good news? You probably already have this information. These numbers are typically included in the results from your last echocardiogram (heart ultrasound). Just ask your doctor for a copy, and review them together.

What If I Don’t Feel My AFib?

Some people have asymptomatic AFib—they don’t feel any symptoms, even though AFib is still occurring. This is one reason doctors may be cautious about stopping blood thinners. In fact, after an ablation, it’s possible that your AFib becomes silent, meaning it’s harder (or impossible) to feel when it’s happening.

Here’s the good news: home ECG tools like the Apple Watch, KardiaMobile, or Fitbit can help you monitor your heart rhythm. Learning to use one of these devices regularly can give both you and your doctor valuable information—helping detect any AFib recurrence, even if you don’t feel it.

Understanding Your CHA₂DS₂-VASc Score

This scoring system helps estimate your risk of stroke. The higher your score, the greater your risk. Here’s how the score is calculated:

A CHA₂DS₂-VASc score of 0–1 in men or 0–2 in women is considered low risk.

According to current guidelines:

-Men with a score of 2 or higher

-Women with a score of 3 or higher

should strongly consider lifelong blood thinners, even if their ablation was 100% successful in eliminating AFib.

Understanding Your HAS-BLED Score

This score helps predict your risk of bleeding if you take blood thinners. Here’s how it’s calculated:

A score of 2 or more means a higher risk of bleeding.

What Should You Do Next?

1. Talk to your cardiologist about your AFib stroke risk and risk for bleeding if you take a blood thinner.

2. Ask for your echocardiogram report if you haven’t seen it to know your EF and left atrial size.

3. Track your heart rhythm using a smartwatch or mobile ECG device.

4. Work together with your care team to decide whether staying on blood thinners makes sense for you.

Combining PFA with Watchman: A New Option for High-Risk Patients

For patients who have a higher risk of stroke and bleeding, there’s a newer approach worth discussing. At St. Mark’s, we offer a concomitant procedure that combines pulsed field ablation (PFA)with a left atrial appendage occlusion (LAAO) using the Watchman device.

Medicare and most insurance companies now cover this combined procedure for eligible patients (both the pulsed field ablation and the Watchman are done during the same procedure).

Here’s how it works:

1. After the Watchman is placed, patients will still take blood thinners for a short time.

2. A follow-up transesophageal echocardiogram (TEE) is done a few weeks later to check that no clots have formed on the Watchman device and that the Watchman has fully sealed off the left atrial appendage.

If both conditions are met, patients can stop blood thinners and switch to baby aspirin instead. This approach can be a good option for patients at high risk of stroke and bleeding after ablation.

Final Thoughts

If your AFib is well-controlled after ablation—and your stroke risk is low—you may not need to stay on blood thinners forever.

Our published research suggests that ablation can significantly reduce stroke risk. The Japanese study also found that for many patients, stopping blood thinners after ablation is safe. Still, we’re awaiting conclusive results from the OCEAN Study, expected later this year to see if more patients can come off their blood thinners following a successful ablation.

That said, stroke risk is never zero. Even people without AFib had a 1.4% annual risk of stroke in our study. That’s because strokes can also be caused by plaque buildup in the brain’s arteries, or bleeding strokes, which are more likely in people taking blood thinners.

If you’ve already had a TIA or stroke, or if you’re at high risk of stroke and also at high risk for bleeding, a Watchman procedure may be worth discussing with your cardiac electrophysiologist (“EP”).

The bottom line: partner with your cardiologist/cardiac EP to create a plan tailored to your stroke risk, your heart, and your lifestyle.

Disclaimer:

This article is for informational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Always talk to your doctor or a qualified healthcare provider before making any changes to your medications, treatment plan, or lifestyle. Do not stop taking blood thinners or other prescribed medications without medical supervision.

About the Photo:

Snow-covered 9990 in Park City—my favorite mountain to ski. I took this photo at sunset following a great day of skiing while writing this article. Sadly, it’s the last weekend the lift is open this season, even though the snow is still deep enough to keep going for another month. But even after the lifts stop, I’ll keep hiking 9990 to squeeze in a few more ski turns before the snow melts.

Slow Aging with Vitamin D, Omega-3s, and Exercise: Science-Backed Strategies

Aging is inevitable, but what if you could slow it down? New research from the DO-HEALTH trial suggests that three simple lifestyle habits—taking vitamin D, consuming omega-3s, and doing regular exercise—can help slow biological aging. These findings could mean more energy, fewer illnesses, and a longer, healthier life. Let’s break down the science and how you can apply it to your daily routine.

The Science Behind “Slow Aging”

Aging isn’t just about wrinkles and gray hair—it’s happening deep inside your cells. Scientists measure biological aging using DNA methylation (DNAm) clocks, which track changes in DNA that influence aging. The DO-HEALTH trial studied how vitamin D, omega-3s, and exercise affected these aging markers in 777 healthy 70 year olds over three years.

What They Found:

1. Omega-3s slowed biological aging across multiple DNAm clocks.

2. Vitamin D and exercise had additional benefits, especially when combined with omega-3s.

3. The combined effect of all three interventions was the strongest, showing a clear advantage in slowing aging and reducing disease risk.

How Much Can You Slow Aging?

In the study, participants who followed these interventions experienced a biological aging slowdown of about 2.9 to 3.8 months over three years. This may seem small, but when combined with other healthy habits, the effects can accumulate, potentially adding years of quality life.

Beyond slowing aging, the study also found that:

1. Omega-3s reduced infections by 13% and falls by 10%.

2. The combination of all three interventions cut the risk of frailty by 39%.

3. They also reduced invasive cancer risk by a staggering 61%!

How to Apply These Anti-Aging Strategies

The best part? These interventions are easy, affordable, and completely natural. Here’s how you can incorporate them into your life today.

1. Get Enough Vitamin D

Vitamin D is crucial for immune function, bone health, and reducing inflammation—all factors that influence aging. The study participants took 2,000 IU daily, which is a safe and effective dose for most adults.

How to Get It 2000 IU of vitamin D daily:

1. Sunlight exposure in a “sun safe” way to avoid any burning (15–30 minutes daily on bare skin)

2. Vitamin D supplements (especially if you live in a colder climate or have had blood tests showing low vitamin D levels)

3. Foods like salmon, fortified dairy, and eggs

Vitamin D deficiency is widespread, especially among those who spend a lot of time indoors. If you’re unsure about your levels, consider getting tested and adjusting your intake accordingly.

2. Eat Omega-3-Rich Foods

Omega-3 fatty acids, particularly EPA and DHA, are powerful anti-aging nutrients that support brain health, heart health, and reduce inflammation.

How to Get 1 Gram of Omega-3s Daily:

– 1 ounce (28g) of wild salmon

– 7 walnut halves

– 1.5 teaspoons of flaxseeds

– ½ teaspoon of chia seeds

I personally get my omega-3s from wild salmon, chia seeds, and flaxseeds. While I used to take fish oil, I stopped due to concerns about atrial fibrillation (Afib), as some studies suggest a potential link. Instead, I get my omega-3s naturally through whole foods.

Another great way to incorporate omega-3s into your diet is by adding walnuts, flaxseeds, or chia seeds to smoothies, yogurt, or oatmeal. They provide fiber, protein, and essential fatty acids, making them an excellent addition to a healthy diet.

While both fish and plant-based sources like walnuts, chia seeds, and flaxseeds provide omega-3 fatty acids, they are not identical in form or function. Fish contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), the two most bioavailable and beneficial forms of omega-3s for heart, brain, and cellular health. In contrast, plant-based sources provide ALA (alpha-linolenic acid), which the body must convert to EPA and DHA, though this conversion is inefficient—only about 5-15% of ALA is converted. While plant-based omega-3s still offer benefits, especially for those on a vegetarian or vegan diet, consuming fatty fish like salmon ensures direct access to the most potent forms of omega-3s with superior anti-inflammatory and cognitive support properties.

3. Strength Training 30 Minutes, 3 Times Per Week

The study participants followed a strength-training exercise program for 30 minutes, three times per week. This type of workout improves muscle strength, balance, and metabolic health—all key for longevity.

How to get 30 minutes of strength training, 3 times per week:

Strength training can take many forms and doesn’t require a gym membership. For example, Everyday activities like carrying groceries, gardening, or climbing stairs also count as functional strength training. No matter your fitness level, incorporating strength training at least three times a week—whether at home, in a gym, or through activities you enjoy—can make a profound difference in slowing the aging process and maintaining overall health.

Bodyweight exercises such as squats, push-ups, lunges, and planks provide resistance and build strength without any equipment. Resistance bands add variety and challenge with exercises like lateral band walks and seated rows.

Free weights, like dumbbells or kettlebells, allow for functional strength training with movements like deadlifts, shoulder presses, and bent-over rows. Machines at the gym offer controlled resistance exercises, such as leg presses and lat pulldowns, while TRX suspension training uses body weight for full-body resistance.

Consistency is key! Even small amounts of regular movement can have profound effects on aging and overall well-being. If you’re new to exercise, start with a routine you enjoy and build from there. Walking is an excellent starting point, and as you gain strength, adding resistance training will further support longevity.

Additional Benefits Beyond Slow Aging

Aside from slowing aging, these interventions provide a host of other health benefits. Vitamin D has been shown to boost mood and immune function, while omega-3s support cognitive health, reducing the risk of neurodegenerative diseases like Alzheimer’s. Exercise not only improves physical strength but also enhances mental health by reducing stress and anxiety.

Research shows that a combination of these interventions contributes to a lower risk of chronic diseases such as diabetes, heart disease, and osteoporosis. By taking proactive steps today, you can improve your quality of life well into your later years.

Why This Matters for You

The DO-HEALTH trial provides compelling evidence that you can take control of your biological aging. By making small, consistent changes, you may not only slow aging but also lower your risk of infections, falls, frailty, and even cancer.

These findings align with what I’ve personally practiced for the past 13 years since our first visit to China’s Longevity Village, which became the foundation of our bestselling book, The Longevity Plan. I take 2,000 IU of vitamin D daily, eat 1 ounce of wild salmon, and include chia and flaxseeds in my diet every day. In addition, I make time for at least one hour of exercise daily, prioritizing both strength training and cardiovascular fitness. This commitment to daily movement has been a game-changer for my own health, and I encourage my patients to adopt similar habits for a longer, healthier life.

Final Thoughts

Slowing aging doesn’t require fancy supplements or extreme diets. The key is simplicity and consistency. A few small daily habits—taking vitamin D, eating omega-3-rich foods, and exercising—can make a meaningful difference in how you age.

Remember, it’s never too late to start. Whether you’re in your 30s, 50s, or beyond, making these changes today can lead to a healthier, more vibrant future. Start with one small step—whether it’s adding a few extra minutes of sunlight exposure, swapping in omega-3-rich foods, or doing a quick strength-training session. Your future self will thank you!

Disclaimer

This blog post is for informational purposes only and is not intended as medical advice. Always consult with your healthcare provider before making any changes to your diet, supplement regimen, or exercise routine, especially if you have underlying health conditions or are taking medications.

About the Photo

The photo accompanying this article was taken by my wife during a recent day at Park City Mountain Resort. She has a deep appreciation for nature and especially loves capturing the beauty of her favorite trees—aspen trees—while skiing through the scenic mountain landscape.

When is the Right Time for an Atrial Fibrillation Ablation?

If you or a loved one has been diagnosed with atrial fibrillation (AFib), you may be wondering about the best treatment approach. A growing body of research suggests that the earlier you seek treatment—especially with catheter ablation—the better your long-term health outcomes will be. Thanks to advancements like pulsed field ablation (PFA), in our experience procedures are now faster, safer, and more effective than ever before.

Why Early Treatment Matters

AFib is an irregular heart rhythm that, if left untreated, can lead to serious complications such as stroke, heart failure, and a reduced quality of life. While medications and lifestyle changes can help manage AFib, catheter ablation has emerged as the most effective treatment for restoring and maintaining a normal heart rhythm. But timing is everything!

A recently published study in Europace by Lawin et al. examined the impact of early versus late ablation for AFib. This real-world study analyzed data from 3,447 patients across 37 countries and found that early ablation—performed within 12 months of AFib diagnosis—resulted in a 33% lower risk of arrhythmic recurrence compared to those who underwent ablation later. Additionally, early ablation was linked to fewer complications and better overall cardiovascular health.

Supporting Evidence for Early Ablation

The findings from this study are consistent with previous research. For instance, the EAST-AFNET 4 trial demonstrated that initiating rhythm control therapy within 12 months of AFib diagnosis significantly improves cardiovascular outcomes compared to standard treatment with rate control medications. This means that acting early can not only prevent recurrent AFib episodes but also protect your heart from long-term damage.

Our own research further supports the benefits of early ablation. A study conducted within the Intermountain Healthcare system analyzed nearly 10,000 patients who underwent AFib ablation and found that delays in treatment were associated with significantly higher risks of death, heart failure hospitalization, stroke, and AFib recurrence. The longer patients waited, the worse their outcomes became. For example, those that quickly went to ablation were able to cut their stroke and AFib recurrence risk in half when compared to those who waited to have their ablation done. And those who received ablation more than five years after diagnosis had up to a 4.39 times higher risk of premature death compared to those treated within the first six months!

The Role of Lifestyle Optimization

While early ablation is critical, optimizing your lifestyle before and after treatment can greatly improve outcomes. The recently published study in Europace that I referenced above suggests that patients ideally undergo ablation within 12 months of diagnosis, which allows time to make meaningful lifestyle changes.

Healthy eating, maintaining an healthy weight, daily exercise, restorative sleep, and managing stress are all essential for AFib prevention. Additionally, controlling hypertension, diabetes, and sleep apnea can significantly reduce AFib burden. In our experience, those who are significantly overweight—often by 50 pounds or more—stand the best chance of reversing their AFib naturally if they can achieve and maintain a healthy weight. In fact, when patients successfully lose excess weight and sustain it long-term, their AFib, high blood pressure, diabetes, and sleep apnea often improve or even resolve entirely.

However, for patients who are already at a relatively healthy weight, or for those whose AFib prevents them from exercising without triggering an episode, catheter ablation is usually the best next step. For these individuals, delaying AFib ablation treatment could mean prolonged symptoms and increased health risks.

The Game-Changer: Pulsed Field Ablation (PFA)

Ablation technology has come a long way, and the latest advancement—Pulsed Field Ablation (PFA)—is transforming the way we treat AFib. PFA is a cutting-edge technique that uses controlled electrical pulses to target abnormal heart tissue with unmatched precision. Unlike traditional heat-based methods (radiofrequency) or the cryoballoon, PFA minimizes damage to surrounding healthy tissue, significantly reducing the risk of complications and making the procedure faster, safer, and more effective.

At our practice, we have seen incredible results with PFA. Overall, our patients experience shorter procedure times, faster recoveries, and improved long-term success rates. This means that not only is early ablation beneficial, but it is now also much safer and far more efficient than ever before. Notably, the outstanding results from our first 604 PFA-treated AFib ablation patients have been submitted for presentation at the upcoming annual scientific sessions of the Heart Rhythm Society on April 24-27, 2025. Once these results are published, I will share them with you. This milestone highlights the significant advancements and promising outcomes associated with PFA technology.

Take Action Early for Better Heart Health

If you or someone you know has been diagnosed with AFib, don’t wait! The evidence is increasingly becoming more clear: the sooner you receive ablation treatment and optimize your lifestyle, the better your chances of preventing long-term complications and maintaining a healthy heart. With advancements like PFA, we can now offer a safer, more effective solution to help you regain control of your heart rhythm and improve your quality of life.

Talk to your cardiologist today about whether an ablation is right for your AFib. Your heart will thank you!

If you found this article helpful, please share it with friends or family who may benefit from this information. For more insights on heart health, stay tuned for our upcoming blogs!

Disclaimer

This article is for informational purposes only and should not be considered medical advice. While catheter ablation, including Pulsed Field Ablation (PFA), has shown promising results, no medical procedure is without risks. Potential complications may include, but are not limited to, bleeding, infection, stroke, heart damage, or, in rare cases, death. Individual results may vary, and treatment decisions should always be made in consultation with a qualified healthcare provider. If you have any concerns about AFib or treatment options, please speak with your doctor to determine the best approach for your specific condition.

About the Blog Photo

Attached is a photo of the breathtaking Dutch Draw slope, a location notorious for fatal avalanches over the years, just beyond the ski boundary of the Park City ski resort. If you examine the image closely, you’ll notice numerous ski tracks from individuals who have ducked the ropes to access the untouched powder just outside the resort’s boundary off the 9990 chairlift. You can also see evidence of a recent avalanche.

My daughter and I had just skied off the 9990 chairlift last weekend when we witnessed three skiers trigger an avalanche measuring 2 feet deep and 200 feet wide. One skier was completely buried but was fortunately rescued without injury. If you are interested in learning more about this particular avalanche (including much better photos of the avalanche), you can find a detailed assessment from the Utah Avalanche Center at this link.

Is Your Risk of an Atrial Fibrillation Stroke Going Down?

If you have atrial fibrillation (AFib), you may have heard about the CHADS-VASc score. It’s a scoring system doctors use to estimate your risk of having a stroke due to an atrial fibrillation blood clot. Each risk factor—such as congestive heart failure, high blood pressure, diabetes, or past strokes/TIAs—adds points to your score. Age is also a factor, with people over 65 getting one point and those over 75 getting two. Being female automatically adds one point.

According to current guidelines, men with a score of 2 or higher and women with a score of 3 or higher are recommended to take blood thinners for life. But does this really make sense? If women are already given an extra point just for their gender, why does their threshold for needing blood thinners also have to be higher? Wouldn’t it be simpler to just remove gender from the equation altogether and make it the same for men and women?

A new study of 129,789 people with newly diagnosed atrial fibrillation from Finland might help answer that question. Researchers looked at all AFib cases in Finland from 2007 to 2018 to determine whether the declining risk of AFib-related strokes was due to the increasing use of blood thinners or something else entirely. What they found was surprising.

Key Findings

Even after adjusting for blood thinner use, stroke rates in people with AFib decreased significantly over the 11-year study period—especially in women. Here’s what they found:

1. Women saw a 32% decrease in stroke risk that was independent of blood thinner use.

2. Men, on the other hand, had only a 7% decrease, which wasn’t statistically significant.

3. The biggest drop in stroke risk happened in those with higher CHADS-VASc scores. For example, patients with a score of 3 saw a 26% overall decrease in stroke risk. In patients with a CHADS-VASc score of 4, the overall incidence of a blood clot Afib stroke declined by 20%.

4. Age also played a role. In patients over 80, stroke rates dropped by 29% overall, with a 33% decrease in women and a 15% decrease in men.

What Does This All Mean?

While this is just one study, it’s an important piece of the puzzle. Scientific conclusions become much stronger when multiple studies all point in the same direction.

The findings suggest that AFib-related stroke risk may be decreasing over time, even as the population ages and accumulates more risk factors. This challenges the idea that women and older people with AFib inherently have a much higher stroke when it comes to AFib.

Could it be that previous studies overestimated the stroke risk in women and older people with AFib? Or is something else at play? With smartwatches and better awareness, many people are getting diagnosed with AFib earlier than ever before. Advancements in early detection and treatment may be reducing stroke risk across the board, making AFib less dangerous than it was two decades ago.

What’s Next?

A straightforward first step would be to remove gender from the atrial fibrillation risk assessment. The older studies that identified female gender as a higher stroke risk factor were likely flawed, and it may be time to discard this criterion. Simplifying the CHADS-VASc scoring system to CHADS-VA (by eliminating the “S” for sex so there is no distinction between men and women), with a universal cutoff score of 2 for lifelong blood thinners for both men and women, would make the process more consistent and easier to apply.

Secondly, is a score of 2 really the right threshold for a possible updated CHADS-VA system to determine when lifelong blood thinners are needed? Should the cutoff be 3 or even 4? This recent Finnish study certainly seems to suggest that the Afib stroke risk for people with higher CHADS-VA scores is also declining over time. Further studies are needed to determine whether the threshold should be adjusted to ensure that patients receive the optimal treatment.

Thirdly, should we still be giving people 2 points in the CHADS-VASc scoring system if their age is over 75? Given the findings of this study that older people with AFib may not be at as high a stroke risk as previously thought (or at least the stroke risks of older people with Afib may be declining over time), should the scoring system assign only 1 point for age over 75 instead of the current 2?

AFib, Strokes, and Blood Thinners

This Finnish new study is just one piece of the puzzle, and further research is necessary to validate these findings. But it does raise an important question: Should the way we determine who needs blood thinners in AFib be reconsidered? Personally, I believe this is the case but these things move very slowly. So, it could be years before we see any meaningful revisions to the Afib blood thinner guidelines.

For now, if you have AFib, you should continue following your doctor’s recommendations regarding stroke prevention and blood thinners. Additionally, future studies should reassess whether the criteria for lifelong blood thinners should be more flexible, as further research may help refine the appropriate cutoff.

While this study is just one piece of the puzzle, it highlights the need to continually reassess medical guidelines based on new evidence. Future research should refine stroke prevention strategies to ensure that recommendations are both effective and evidence-based.

Disclaimer

The information provided in this article is for educational and informational purposes only and is not intended as medical advice. Readers should not use this article as a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician or a qualified healthcare provider before making any changes to your treatment plan, medications, or health regimen. The views expressed in this article are based on current studies and expert opinions but should not be interpreted as definitive medical guidance.

About the Blog Photo

This photo was taken today during our family’s amazing ski trip over the President’s Day weekend at Park City Mountain Resort in Park City, Utah. After a major snowstorm, we were treated to an epic powder day, making for unforgettable skiing conditions. The untouched snow beyond the resort’s boundary, just on the other side of the rope, was especially tempting to all the skiers enjoying the fresh powder.

Could Heart Rate Recovery Be the Secret to a Longer Life?

Your heart is more than just a muscle—it’s a key predictor of your overall health and longevity. One of the simplest yet most powerful ways to measure heart health is through Heart Rate Recovery (HRR). But what exactly is HRR, and what does it reveal about your future well-being?

What Is Heart Rate Recovery?

Heart Rate Recovery refers to how quickly your heart rate slows down after exercise. A faster recovery means your heart and nervous system are working efficiently, while a slower recovery may signal potential health risks.

What Does the Most Recent Research on HRR Tell Us?

A recent study published in the European Journal of Preventive Cardiology explored how well the heart recovers after exercise and what it can tell us about long-term health. Here’s what the study found and why it matters for you.

Researchers looked at nearly 10,000 people, ages 18 to 85, who performed a cycling exercise test. They measured how quickly their heart rates dropped in the first and second minutes after stopping exercise—this is called Heart Rate Recovery (HRR). They also looked at overall heart rate response to exercise and tracked participants for about 8.6 yearsto see how HRR was related to health and longevity.

What Did This Heart Rate Recovery Study Find?

1. A slower heart rate recovery (HRR) after exercise was linked to a higher risk of death from all causes, including heart disease (about 2X increased risk of premature death).

2. Even people who were physically fit were at increased risk of premature death if they had a slow heart rate recovery.

3. The risk was highest for those whose HRR was the slowest compared to others in their age group.

What HRR Number Is Good for Longevity?

A healthy HRR is generally considered to be a drop of at least 20 beats per minute (bpm) within the first minute after stopping exercise. Ideally, an HRR of 25 bpm or more is linked to better heart health and a longer lifespan. However, if your heart rate drops by less than 12 bpm in that first minute, it may indicate poor heart function and a higher risk of heart disease and early mortality. If you consistently have a low HRR, it may be worth discussing with your doctor.

There is no specific heart rate recovery value that will indicate optimal health in everyone. However, one study examined data from almost 800 physically active men and found that the average HRR one minute after exercise was around 15 bpm. A more recent study on 274 younger male athletes found that the average HRR at one minute was 30 bpm. However, it is important to note that this study focused on elite younger athletes, meaning their heart rate recovery may not be a realistic target for the general population.

What’s a Normal HRR for Different Ages?

While there is no strict cutoff, studies show that younger individuals tend to have a faster HRR compared to older adults. For example:

-A healthy young adult may see a 25–30 bpm drop in the first minute after exercise.

-In middle-aged adults, HRR may slow slightly, often around 15–25 bpm.

-In older adults (60+ years), HRR may decline further, with values under 15 bpm potentially indicating reduced cardiovascular health.

How to Measure Your Own HRR

Tracking your HRR is simple and can give you valuable insights into your cardiovascular health: Here are the 5 steps to checking your heart rate recovery without any fancy technology.

1. Exercise: Engage in any workout that elevates your heart rate, such as walking, cycling, or jogging.

2. Measure Peak Heart Rate: Immediately after stopping, check your pulse for 15 seconds and multiply by four to get beats per minute (bpm).

3. Rest for One Minute: Sit down and relax.

4. Measure Again: After one minute, check your heart rate again.

5. Calculate HRR: Subtract your second heart rate from the first. A higher number is better.

Note: Your HRR may vary depending on how intense your workout was. Higher-intensity exercise tends to result in a greater heart rate drop in the first minute compared to lower-intensity workouts. For meaningful tracking, try to measure HRR under similar workout conditions each time.

How the Apple Watch and Other Smartwatches Automatically Track HRR

If you use an Apple Watch, tracking your HRR is even easier because it is automatically happening with every workout your record. After completing an exercise session, open the Fitness app on your iPhone. Tap on your workout session, then scroll down to the Heart Rate section. By clicking on Show More, you’ll be able to see your Heart Rate Recovery at one minute after exercise. This feature allows you to monitor trends over time and gives you valuable insights into your heart health without the need for manual calculations.

Other smartwatches also provide HRR tracking. These devices automatically measure your heart rate throughout workouts and recovery, offering similar insights into your cardiovascular fitness. While the exact method for viewing HRR may vary by device, most fitness-focused smartwatches include this valuable metric in their health tracking features. If you’re using a different smartwatch, check your device’s health app or manual to find out how to access your HRR data.

How to Improve Your Heart Rate Recovery

The good news is that HRR is not fixed—you can improve it through these 5 healthy lifestyle changes!

1. Regular Exercise: Cardiovascular activities like brisk walking, running, swimming, or cycling can improve your heart’s efficiency.

2. Strength Training: Lifting weights or doing bodyweight exercises supports heart health by improving circulation and endurance.

3. Managing Stress: Meditation, deep breathing, and yoga can help lower your resting heart rate and improve HRR.

4. Getting Enough Sleep: Quality sleep helps regulate your nervous system, which plays a role in heart rate recovery.

5. Healthy Eating: A diet rich in whole foods, lean proteins, and healthy fats can support heart function.

When HRR May Not Be Accurate

While HRR is a great tool for assessing heart health, certain factors can affect its accuracy. If you’re dehydrated, stressed, or lacking sleep, your HRR may be lower than usual. Additionally, some medications—like beta-blockers, calcium channel blockers, and certain anti-arrhythmic drugs—can slow down heart rate and make HRR appear artificially low. If you’re on any of these medications, be sure to consult your doctor about interpreting your HRR results.

Take Control of Your Heart Health

Your HRR is a simple but powerful indicator of your heart’s ability to recover. The faster your heart rate drops after exercise, the healthier and more resilient your cardiovascular system is. The best part? You have the power to improve it. By staying active, managing stress, and prioritizing heart health, you can work toward a longer, healthier life.

So, could heart rate recovery really be the secret to longevity? Science suggests the answer is a resounding yes! Start tracking your HRR today and take the first step toward a healthier future.

Disclaimer

The information in this blog is for educational purposes only and is not intended to replace professional medical advice. Always consult your healthcare provider before making any changes to your health routine, especially if you have underlying medical conditions or are taking medication.

About the Photo

Our outdoor adventure-loving older Labrador retriever, pictured after conquering a 10,000-foot snow-covered summit in Park City, Utah—proof that staying active is the key to endurance, resilience, and heart health at any age!

Six Simple Lab Tests that Predict Whether You’ll Live to 100

Imagine celebrating your 100th birthday with family and friends, full of energy and vitality. Sounds like a dream, doesn’t it? A recent study has shed light on how optimizing six simple lab tests could predict whether you’ll live to 100. These tests are likely already part of your annual check-up with your primary care physician. As you read this article, it might be helpful to review your own lab results so you can follow along and see where you stand.

Let’s dive into what this study found and what you can do to tilt the odds in your favor.

What Did this New Study Discover?

Researchers compared lab test results of individuals who lived to 100 years or more (“centenarians”) with those of their shorter-lived peers. By analyzing biomarker profiles—measurements of various substances in the blood—they found that centenarians consistently had healthier values in several areas as early as age 65. This means that the road to exceptional longevity might begin decades before reaching the century mark.

Here are some of the key findings:

1. Optimized Levels of Total Cholesterol: While high cholesterol is often viewed negatively, not all cholesterol is bad. The type and distribution of cholesterol—such as higher HDL (“good” cholesterol) versus LDL (“bad” cholesterol)—may be more important than the total number. Cholesterol is essential for building cell membranes and producing hormones, and having the right balance supports overall health. For younger and middle aged people, lower levels of total cholesterol are associated with better cardiovascular function and longevity. However, in those age 85 or older, higher levels of total cholesterol while still keeping LDL low may be best. Work closely with your physician to optimize your cholesterol numbers for longevity.

2. Higher Levels of Iron and Total Iron-Binding Capacity: Iron is vital for carrying oxygen in the blood and supporting energy levels. Adequate iron levels prevent anemia, which is common in aging populations and can lead to fatigue, weakness, and impaired cognitive function. Having sufficient iron supports longevity by ensuring that tissues and organs receive the oxygen they need to function optimally. Total iron-binding capacity (TIBC) reflects your body’s ability to transport and regulate iron, ensuring levels are neither too high nor too low.

3. Lower Levels of Glucose: Elevated blood sugar levels can damage blood vessels and lead to chronic diseases.

4. Lower Levels of Creatinine: Creatinine is a waste product filtered by the kidneys. Lower levels indicate that your kidneys are functioning efficiently, which is crucial for removing toxins from the body and maintaining overall health.

5. Lower Levels of Uric Acid: Uric acid is another metabolic byproduct that, in excess, can lead to conditions like gout or kidney stones. More importantly, uric acid serves as a marker of inflammation and is a powerful predictor of your likelihood of suffering a heart attack, atrial fibrillation (AFib), or heart failure. Maintaining lower levels is protective for your cardiovascular health.

6. Lower Levels of Liver Enzymes: Markers like aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) were lower in centenarians, pointing to healthier liver function.

What Do These Lab Tests Mean?

Understanding your lab tests is the first step toward taking control of your health. Here’s what some of these biomarkers indicate:

1. Cholesterol: While too much LDL (“bad cholesterol”) can clog arteries, HDL (“good cholesterol”) helps clear it away. A balanced cholesterol profile supports heart health.

2. Iron and Total Iron-Binding Capacity (TIBC): These markers assess iron status and reflect your body’s ability to maintain an adequate supply of red blood cells to deliver oxygen throughout the body. Both deficiency and overload can harm your health, so balance is key. For example, too much iron increases the risk of oxidative stress and cardiovascular disease, while too little can lead to anemia and fatigue. Longevity studies suggest that maintaining low-normal iron levels may be optimal for reducing oxidative damage and promoting long-term health. Iron is a more significant issue for women, particularly during their menstruating years, when blood loss increases the risk of deficiency.

3. Glucose: High glucose levels may signal prediabetes or diabetes, conditions that accelerate aging by damaging blood vessels and nerves.

4. Creatinine: This waste product reflects kidney function. Lower levels suggest kidneys are filtering blood efficiently.

5. Uric Acid: Excess uric acid can lead to gout and kidney stones. Keeping it in check supports joint and kidney health.

6. Liver Enzymes (AST, GGT): Elevated levels can indicate liver stress or damage. Lower values often reflect a well-functioning liver.

How Can You Improve Your Numbers?

The great news is that you have the power to influence many of these biomarkers through lifestyle changes. Here are some actionable steps you can take:

1. Nourish Your Body

Eat a Balanced Diet: Focus on whole, minimally processed foods. Incorporate fruits, vegetables, legumes, whole grains, lean proteins, and healthy fats like nuts, seeds, or olive oil.

Mind Your Cholesterol: Increase your intake of foods rich in omega-3 fatty acids (like salmon and walnuts) and soluble fiber (like vegetables and beans) to boost HDL and lower LDL cholesterol.

Control Blood Sugar: Reduce refined carbohydrates and added sugars. Opt for low-glycemic foods like leafy greens, legumes, and nuts.

Balance Your Iron: Eat iron-rich foods like spinach, legumes, and lean meats alongside vitamin C-rich foods (like lemon, broccoli, citrus fruits, etc.) to enhance absorption. Most men should avoid iron supplementation altogether unless prescribed by their physician. For menstruating women, avoid excess supplementation unless directed by your doctor.

2. Stay Active

Move Daily: Regular physical activity improves nearly every biomarker mentioned in the study. Aim for a mix of aerobic exercise (like walking or cycling) and strength training.

Be Consistent: Even moderate activity, like a daily 30-minute brisk walk, can have profound effects on your health.

3. Protect Your Liver

Limit Alcohol: Excessive drinking can raise liver enzyme levels and damage organs over time.

Optimize Your Weight: Excessive weight is now the number one cause of fatty liver and liver failure in the US.

Avoid Unnecessary Medications: Overuse of certain medications, like acetaminophen, can strain the liver.

Avoid Excessive Supplementation: Common supplements like excessive iron, turmeric, green tea extract, niacin, and vitamin A can all be toxic to the liver when taken in high doses or over long periods. Always consult your physician.

4. Protect Your Kidneys

Stay Hydrated: Drinking enough water supports kidney function and helps flush out waste products.

Minimize Kidney-Toxic Medications: Work with your physician to reduce or manage the use of certain medications that can harm the kidneys, such as specific antibiotics, excessive diuretics, and proton pump inhibitors. Regular monitoring can help mitigate these risks.

4. Reduce Inflammation

Eat Anti-Inflammatory Foods: Include foods like berries, leafy greens, nuts, seeds, and olive oil that fight inflammation.

Manage Stress: Chronic stress increases inflammation. Practice mindfulness, yoga, or other stress-relief techniques.

Get Quality Sleep: Aim for 7-8 hours of restorative sleep each night.

5. Monitor Your Health

Regular Check-Ups: Annual lab tests can help track your progress and catch potential issues early.

Know Your Numbers: Understanding your biomarkers empowers you to make informed decisions.

How Could These Changes Prolong Your Life?

Maintaining optimal biomarker levels can help you avoid chronic diseases, such as heart disease, diabetes, and kidney failure—all of which shorten life expectancy. Here’s how healthier numbers might add years to your life:

Better Heart Health: Balanced cholesterol and lower glucose levels reduce the risk of heart attacks and strokes.

Improved Metabolism: Lower uric acid and glucose levels support healthier cells and less oxidative stress.

Stronger Organs: Healthy liver and kidney function means your body can detoxify and regulate nutrients effectively.

Reduced Inflammation: Chronic inflammation accelerates aging and damages tissues. Keeping it in check can slow aging.

Your Journey to 100 Starts Today

Living to 100 might sound like a lofty goal, but the foundation for exceptional longevity begins with small, consistent choices. You don’t need perfect genes to extend your life. By taking control of your health—through diet, exercise, and regular check-ups—you can influence your biomarkers and create a healthier future.

Your lab results aren’t just numbers on a page. They’re a window into your body’s inner workings and a guide to living your best life. Start making changes today, and who knows? You might just find yourself blowing out 100 candles someday.

Disclaimer

The information provided in this article is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Reliance on any information provided herein is solely at your own risk.

Can Vigorous Daily Exercise Guarantee that You’ll Never Get Dementia?

Imagine if you could reduce your risk of dementia by 88% and, even in the rare case you developed it, delay its onset by a 10 years!  This isn’t just wishful thinking – it’s a scientifically proven possibility, as revealed in the groundbreaking study, “Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women,” published in the scientific medical journal Neurology.

In this inspiring research, women with the highest cardiovascular fitness levels in midlife were shown to have an 88% lower risk of developing dementia compared to their moderately fit peers. Those who did develop dementia experienced onset 10 years later. These findings highlight the profound power of exercise in protecting the brain. Let’s dive into the study’s key insights and explore practical ways you can apply its lessons to your daily life.

What Did the Study Find?

The Swedish researchers followed a group of women for 44 years, assessing their cardiovascular fitness in midlife using a demanding cycling test. Participants were divided into three categories: high, medium, and low fitness.

High fitness group: Had an 88% reduced risk of dementia compared to the medium fitness group.

Delayed onset: For the rare cases in the high fitness group who developed dementia, symptoms appeared almost a decade later compared to less-fit participants.

The study underscores that maintaining high cardiovascular fitness isn’t just about living longer; it’s about living better, with a sharper mind well into old age.

How Can You Achieve an 88% Reduction in Dementia Risk?

Achieving the high fitness levels described in the study requires consistent effort, but the rewards are monumental. Here’s how to chart your path:

1. Commit to Aerobic Exercise

What they did: The women in the high-fitness group achieved their fitness levels through rigorous aerobic activities that challenged their cardiovascular systems. While the study doesn’t specify exact routines, exercises such as brisk walking, jogging, cycling, swimming, or rowing can help you achieve similar results.

Daily target: Aim for 60 minutes of moderate to vigorous aerobic exercise every day.

2. Measure Your Fitness Level

The participants underwent a maximal cycling test, which measures cardiovascular fitness. While you don’t need a clinical test, you can monitor your progress with wearable fitness trackers or periodic VO2 max assessments at a gym or health facility. In my case, I can use my Apple Watch to track my VO2 max to make sure I am in the high fitness group for my age.

3. Make Exercise Non-Negotiable

Consistency is key. In the study, high fitness wasn’t a result of sporadic efforts but of sustained, long-term habits. Treat your daily workout as an essential appointment for your brain health.

4. Add Variety

Combine aerobic activities with strength training, balance exercises, and stretching. This holistic approach enhances overall fitness and reduces the risk of injuries that might disrupt your routine. I’ve found that this is especially important for me. For example, I can do high-intensity downhill skiing every day from sunup to sundown for days on end and never get an overuse injury. In contrast, just one or two long runs, or even running on a treadmill two or three days in a row, can give me so many overuse injuries it can make it hard to even exercise for a few weeks.

5. Adopt a Heart-Healthy Lifestyle

Nutrition: Fuel your body with a traditional Mediterranean or Asian-style diet of mostly vegetables, complemented by fruits, legumes, lean proteins, nuts, seeds, and limited amounts of whole grains.

Sleep: Prioritize 7-8 hours of quality sleep each night.

Stress management: Practice mindfulness, meditation, or other relaxation techniques to keep your mind and body in sync.

For the 12% that Still Get Dementia: Delaying Dementia by 10 Years!

For the small percentage of highly fit individuals who develop dementia, the study found a significant delay in onset. Here’s how fitness likely contributes:

Improved brain circulation: Regular exercise increases blood flow to the brain, supporting neuroplasticity and reducing brain cell death.

Lower inflammation: Physical activity decreases inflammation and oxidative stress, both linked to cognitive decline.

Better metabolic health: Exercise reduces the risk of diabetes and hypertension, major contributors to dementia.

Even if the risk isn’t eliminated entirely, maintaining high fitness levels ensures you maximize your cognitive reserve and enjoy more vibrant years.

A Daily Pathway Toward an 88% Reduction

To align with the study’s findings, here’s a suggested daily schedule:

Morning: Begin your day with 30-45 minutes of aerobic exercise such as brisk walking, jogging, cycling, swimming, or whatever you enjoy. Consider a high-intensity interval session twice a week for maximum cardiovascular benefit. Be sure to rotate your exercise each day to prevent overuse injuries.

Afternoon or Evening: Incorporate strength training for 20-30 minutes, focusing on major muscle groups. Add balance exercises if you’re over 50. Wind down with gentle yoga or stretching to enhance flexibility and relaxation.

Why This Study Offers Hope

Dementia is a condition that many fear, but this study provides a roadmap for dramatically reducing its risk. While genetics and other factors play a role, cardiovascular fitness is something you can control. By investing in your fitness today, you’re investing in a sharper, healthier future.

Your path to an 88% reduction starts with a single step – so lace up your sneakers, and let’s go!

About the Photo

I was fortunate to have my family come with me on a recent atrial fibrillation conference I spoke at in Washington DC. Following the conference, my daughter and I took an 8-mile run visiting the sites in Washington DC. Here you can see our selfie in front of the Washington Monument on our run.

Disclaimer

This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new exercise or diet regimen, especially if you have pre-existing conditions or concerns. Individual results may vary, and the strategies discussed may not be suitable for everyone. The findings of the referenced study are specific to its participants and should not be generalized without consideration of personal health factors.

My Apple Watch Detected AFib

When Mick bought the first FDA-approved EKG smartwatch, the Apple Watch 4, he didn’t do it for the atrial fibrillation (AFib) and EKG features. He just happened to be a really big fan of Apple products. Smartwatches, including the Apple Watch, commonly use the term ‘ECG’ to refer to ‘EKG,’ both of which mean the same thing.

But thank goodness he was, because in the year before he made that purchase, he had noticed that occasionally it was getting harder to exercise and that he felt tired more often. “I just figured that was just what happens when you get older,” he said. “You have some good days and some bad days, right?”

He did think the smartwatch would help him get back in shape through apps that track exercise and steps. But soon after his purchase, his Apple Watch detected AFib. Although he ignored the first few AFib alerts, Mick eventually reached out to his family doctor, who referred him to a local cardiologist. After an EKG and a stress test, the doctor confirmed that Mick had AFib, prescribed the usual meds consisting of a beta-blocker (metoprolol) to slow his heart down and a blood thinner (Eliquis), and sent him on his way.

The AFib Alerts Kept Coming

But Mick’s Apple Watch detected AFib again and again. “And this time I took it more serious,” he said. “The watch was right the first time—it alerted me to AFib and, sure enough, that’s what the doctor confirmed. So now that it was basically saying that the meds weren’t keeping my heart in rhythm any more than it had been before, I was pretty concerned.”

When Mick returned to his local cardiologist with that information in hand, the doctor agreed it was time to get him in to see us.

Could an Apple Watch Save Your Life?

Just think about this: because Mick’s symptoms were so subtle and intermittent, he would likely have not known he had atrial fibrillation for many months, if not years, if he had not had the watch. Fortunately, with his early smartwatch diagnosis, his AFib was easily treated—long before any significant problems developed. So, it isn’t hyperbole to say that Mick’s watch might have saved him from a devastating AFib stroke.

How Reliable is Your Apple Watch’s Detection of AFib?

The Apple Watch has become a popular tool for heart rhythm monitoring, but its reliability in detecting atrial fibrillation (AFib) has notable limitations. According to the Apple Heart Study, which involved an impressive 419,297 participants, only 34% of AFib detections by the Apple Watch were confirmed as true AFib upon further testing. This means that approximately two-thirds of these alerts were false alarms.

It’s important to note that this study was conducted using an early generation of the Apple Watch, and its accuracy has improved over the years. However, due to lingering reliability issues, we advise all of our patients to immediately record an ECG on their Apple Watch as soon as they receive an AFib alert. This step provides a clearer picture of their heart rhythm at the time of the notification.

In our experience, false positives are most often caused by premature beats, such as premature ventricular contractions (PVCs) or premature atrial contractions (PACs), or by poor-quality ECG recordings due to movement artifacts. Many of our motivated Apple Watch users have learned to distinguish true AFib from these other patterns on their own ECG recordings, gaining confidence in their ability to interpret the results.

Rather than panicking, users should promptly share the ECG recorded immediately after receiving an AFib alert with their healthcare provider. This ensures an accurate assessment to determine whether the notification represents true AFib or a false alarm. Taking this step promotes appropriate care while reducing unnecessary stress. To further support you in understanding these notifications and avoiding unnecessary worry, this article will also teach you some basics of reading an Apple Watch ECG. Of course, always share these ECGs with your provider to confirm the correct diagnosis as your life may depend on this diagnosis being accurate.

Can You Skip the Watch and Rely on Your Symptoms to Detect AFib?

Now, some people don’t think they need an AFib-detecting watch. They think they can feel every episode. Studies clearly show, however, that many people with AFib experience episodes that they can’t feel. What’s more, waiting until an episode is strong enough that it can be felt may mean you’ve waited too long. Complicating matters even further, studies also show that symptoms perceived to be AFib are something else at least 50 percent of the time. And, to make things even more challenging, if you’ve have had an AFib ablation, many of the cardiac nerves that once helped you perceive your AFib symptoms may have also been treated as part of the procedure, so all bets are off as to whether your symptoms will still reliably flag future episodes of AFib.

What Other Arrhythmias Can Fool an Apple Watch?

Unfortunately, the Apple Watch’s ability to detect AFib is far from perfect. In fact, at least 50% of the EKGs patients send us for AFib analysis turn out not to be AFib at all!

This is why it’s crucial not only to rely on your Apple Watch for detecting AFib but also to recognize when it might be a false alarm. To do that, you’ll need some basic EKG reading skills, as the technology in these devices still has a long way to go before you can fully trust their interpretations. Of course, you’ll always want to show these EKGs to your physician to verify the correct diagnosis. .

AFib typically presents as a fast and irregular rhythm—so irregular that you won’t be able to detect a consistent pattern in the beats. However, that’s not always the case. We’ve seen numerous instances where people with AFib have a very slow heart rate, so don’t dismiss the possibility of AFib just because your heart isn’t racing.

On the other hand, atrial flutter is usually fast and regular, with a consistent, patterned beat. And this is why atrial flutter often triggers a high heart rate alert from the Apple Watch. Yet, as with AFib, there are exceptions. Atrial flutter can sometimes occur with a slower heart rate or even appear irregular, though this is less common.

Premature beats—such as premature atrial contractions (PACs) or premature ventricular contractions (PVCs)—usually result in a normal or slightly slower heart rate but with a detectable pattern to the irregularity. For example, you might notice a few normal beats followed by one that’s out of sync.

Lastly, motion artifact is another common cause of false alarm AFib detections on the Apple Watch. If both your elbows and hands aren’t resting firmly on a flat surface, even minor movements can create jagged EKG lines, misleading the device. And for individuals with significant tremors, the motion artifact might make it impossible to obtain an accurate reading.

What Does an Inconclusive Reading Mean?

Besides smartwatches often not being able to tell the difference between excessive movement while taking the EKG, atrial fibrillation, and sinus rhythm with a lot of premature beats, our smartwatch-wearing patients are also bothered when their watch can’t “figure out” their rhythm. When this happens, the watch calls the EKG “inconclusive.” Usually, inconclusive means that you were moving too much during the EKG and this movement made your EKG uninterpretable. However, it could also mean that your heart rate is too high or too low, that there are too many premature beats, or your heart is in some other rhythm.

What Do All the “Squiggles” on the ECG Mean?

With all that in mind, let’s look at some charts, starting with with what normal sinus rhythm looks like.

On this smartwatch-recorded EKG, the watch correctly diagnosed its owner as being in normal sinus rhythm at ninety beats per minute. This is a high-quality recording; the watch’s owner was sitting perfectly still when it was taken. Each beat is perfectly timed and the heart rate is within the normal range.

My Apple Watch Detected AFib: Question 1

Let’s put your skills to the test: Can you interpret an Apple Watch EKG? Did the watch correctly diagnose this individual with AFib? What specific features of the EKG or heart rate support your conclusion? The answers are provided below—take a look after making your assessment!

In this tracing, you’ll notice that this individual’s resting heart rate is elevated at 113 bpm, and that the distance between every beat is completely different. We call this being “irregularly irregular” and, once again, the watch has made the correct diagnosis: She is in AFib.

My Apple Watch Detected AFib: Question 2

There are some limitations to these Apple Watch devices, of course. Take this tracing below for instance. In this case, the user knew she was out of rhythm. Indeed, her resting heart rate was 143 bpm and her pulse was very irregular. However, because her resting heart rate is above 120 bpm, this watch wouldn’t even venture a “guess” as to whether she was in AFib. Needless to say, she was rather frustrated with her Apple Watch. What’s your diagnosis?

As an astute observer of AFib, you can easily make the call. Once again, we see that the rhythm is fast and the distance between every heartbeat is “irregularly irregular.”  This is another episode of AFib.

My Apple Watch Detected AFib: Question 3

Now, how about a  challenge? What’s your diagnosis on this ECG? With all of the jagged lines on this ECG do you agree with the Apple Watch’s diagnosis?

In this case, the rhythm is mostly regular. The heart rate is not elevated. But there are lots of jagged lines between each heartbeat. What’s happening?

Well, in this situation, the watch is correct. This is normal sinus rhythm. The distance between each beat is mostly constant. But what are tall those jagged likes? Those are from “movement artifact,” which happens when the electrodes aren’t making stable contact with the skin.

My Apple Watch Detected AFib: Question 4

Some of our patients have even been able to catch EKGs like this one. The Apple Watch computer in this ECG below is saying “sinus rhythm” and “this ECG does not show signs of atrial fibrillation” but is this really the case? How would you interpret the ECG below?

Even though the computer called this EKG “sinus rhythm” it missed the fast atrial fibrillation at the beginning of the EKG. The other interesting thing about this EKG is that after the rapid AFib at the beginning of the EKG terminated there is a long pause with no heart beat until sinus rhythm kicked in. If these pauses last too long when AFib terminates it can cause people to pass out.

Apple Watch versus Other Home ECG Devices

Now, all smartwatches are not created equal. Technology will change over time. But if you have AFib, or if you are at risk of developing AFib, there’s really no better investment than a watch that will, at a minimum, be able to detect AFib with reliability and record an EKG. Watches that just record your heart rate, or try to record a “artificial EKG” through the light sensor based on the regularity of your pulse on your smartphone, are not as accurate for detecting AFib.

And watches aren’t the only tech that can help you track your AFib. Many of our patients use less expensive Bluetooth-enabled electrodes that work with many different types of smartphones. Still others use a pulse oximeter, stethoscope and blood pressure machine with built in rhythm checks. Outside of an implanted heart monitor, though, we have found that for many of our patients, wearing a watch is the most reliable method to keep a constant vigil for AFib events.

Now, these devices are are not continuous monitors, so they can miss short events. In most cases, what you get from a smartwatch is a “fingerprint” of what your heart rate is supposed to look like. Then, by tracking the graphs each day, you can quickly identify when things change. Even still, your doctor may not think that the symptoms you describe are from AFib unless you provide a real EKG for them to review. And that’s not a bad thing; you don’t want your doctor prescribing new medications or ordering up procedures unless they are 100 percent certain that you are indeed experiencing AFib.

But just because smartwatches aren’t perfect doesn’t mean they can’t be a tremendously important tool for catching early incidents of AFib, tracking incidents over time, and alerting pill-in-the-pocket patients to potential incidents that might warrant the use of medications.

Can Smartwatches Help You Beat AFib?

If we only use smartwatches as AFib warning or EKG devices, we’re missing out on their full potential. These devices often collect detailed daily heart rhythm data that can be easily shared with your cardiologist. This data is incredibly valuable, offering insights into how your daily, weekly, and monthly habits affect your heart rhythm.

In the near future, smartwatches will likely evolve to accurately monitor blood pressure and other biomarkers, further enhancing their role in disease prevention and management. For now, however, they already offer impressive capabilities: tracking your sleep, monitoring for sleep apnea, measuring exercise, and even assessing stress levels.

In our practice, we strongly encourage all patients to invest in a smartwatch. For those who cannot afford one, we recommend more affordable alternatives, such as the Kardia Mobile device, to monitor heart rhythms. If your goal is to put AFib into remission, having access to even basic home ECG monitoring technology is essential.

Disclaimer (Never Trust the Computer’s Diagnosis or Your Own ECG Interpretation)

The information in this article is for educational purposes only and should not be considered medical advice. While wearable devices and home ECG monitors can provide valuable insights into your heart health, they are not a substitute for professional medical evaluation. Do not attempt to independently interpret your ECG results or use them to make medical decisions without consulting your physician. Additionally, be cautious of the computer-generated interpretations provided by home ECG devices, as these automated diagnoses are often inaccurate. Always share your ECG data and any concerns with your healthcare provider to ensure accurate diagnosis and appropriate treatment.

New Research in Atrial Fibrillation: Further Evidence of Why Pulsed Field Ablation Is a Game Changer

Atrial fibrillation (AFib) is a common heart condition where the heart beats irregularly and often too fast. It can lead to serious health problems like stroke, dementia, and heart failure. To treat AFib, doctors sometimes use a procedure called ablation, which targets the malfunctioning heart tissue to stop the irregular beats. There are different ways to perform ablation: pulsed field ablation (PFA), radiofrequency ablation (RF), and cryoablation (cryo). All of these ablation types are minimally invasive outpatient procedures done through an IV in the femoral vein, allowing the patient to go home the same day without any incisions or stitches. Let’s explore these methods and find out which one might be the best.

The Basics of Ablation

1. Radiofrequency Ablation (RF): This method uses heat to treat the defective heart tissue causing the irregular beats. The heat is generated by high-frequency electrical currents.

2. Cryoablation (Cryo): This technique uses extreme cold to freeze the problematic heart tissue. It effectively stops the irregular signals by creating a scar.

3. Pulsed Field Ablation (PFA): PFA is a newer method that uses electric fields to treat the faulty heart tissue causing AFib. Unlike RF and Cryo, which rely on thermal (heat or cold) energy, PFA uses non-thermal energy.

Comparing the Methods

Recent studies have compared these three methods to see which is the most effective and safest. The most important study in the field, the ADVENT Study, randomized patients to either PFA or thermal ablation with RF or cryo. Of note, I served on the data safety monitoring board for the ADVENT Study which means I was one of the three “referees” for the study to make sure PFA met all of the safety criteria with this study. Here’s what we found:

Methods

In the ADVENT study, patients with symptomatic paroxysmal AF (PAF) that did not respond well to medications were randomly assigned to undergo either PFA or thermal ablation with RF or cryo. Here’s how the study was conducted:

1. Monitoring: After the ablation procedure, patients had their heart rhythms monitored with ECG recordings every week or whenever they had symptoms. They also wore 72-hour Holter monitors at 6 and 12 months after the procedure to check for any AFib recurrences.

2. Atrial Arrhythmia Burden Calculation: The percentage of time patients experienced atrial arrhythmias (AA) was calculated from the data collected from the ECGs and Holter monitors.

3. Quality-of-Life Assessments: Patients’ quality of life was assessed at the beginning of the study and again at 12 months.

Results

1. Participants: The study included 593 patients, with 299 randomized to PFA and 294 receiving thermal ablation with either RF or cryo based on physician choice.

2. Atrial Arrhythmia (AA) Burden and Quality of Life: It was found that having an AA burden exceeding 0.1% was linked to a significantly lower quality of life and more clinical interventions, such as redo ablations, cardioversions (procedures to restore normal heart rhythm), and hospitalizations.

3. Effectiveness of PFA: More patients who underwent PFA had a residual AA burden of less than 0.1% compared to those who had thermal ablation. This indicates that PFA was more effective in keeping patients in normal rhythm. The odds ratio (OR) for this was 1.5, meaning PFA patients were 1.5 times more likely to have a low AA burden (meaning a successful procedure) than those who had thermal ablation with RF or cryo.

Key Takeaways from the ADVENT Study

1. Lower AF Burden with PFA: PFA was linked to a lower AF burden compared with thermal ablation at 1 year.

2. Quality of Life: Atrial arrhythmia burden less than 0.1% was linked to maximal quality of life and fewer returns to the hospital.

3. Superiority of PFA: PFA lowered the odds of high residual atrial arrhythmia burden compared with thermal ablation for patients with atrial fibrillation at 1 year. This means patients were 1.5 times more likely to have had a successful ablation with PFA, achieving an AA burden of less than 0.1%. In other words, their hearts were in rhythm more than 99.9% of the time.

As presented at the annual scientific sessions of the Heart Rhythm Society (Heart Rhythm 2024), the results showed that PFA not only matched but exceeded thermal ablation (RF or cryo) in both effectiveness and safety. PFA procedures were faster and had fewer complications, leading to an overall better outcome for patients.

Dr. Day’s Views on this Study

Having served as one of the three physicians on the data safety monitoring board of the ADVENT Study, I reviewed the data submitted by every hospital involved. While I was impressed with the safety, effectiveness, and speed at which atrial fibrillation ablation procedures were performed using PFA in the study, it does not compare to the results we are currently seeing in our practice at St. Mark’s Hospital in Salt Lake City, Utah.

With further modifications to the PFA technology used in the ADVENT Study (the specific type of PFA we are using at St. Mark’s Hospital), we are seeing an even safer procedure with improved success rates compared to those reported in the study. Although there is still a risk of bleeding from the catheter entry at the femoral vein or the heart, and a stroke risk, many of the complications we previously worried about—such as pulmonary vein stenosis, esophageal injury, permanent phrenic nerve injury, stiff left atrial syndrome, pericarditis, and acute congestive heart failure—seem to have disappeared with PFA. Even our most challenging cases, which couldn’t be treated successfully with older technologies like RF, can usually be effectively treated with PFA.

In my 25 years of performing AFib ablations, I have never seen a technology perform as well as the PFA we are now using. Indeed, this PFA works so well that I now use it for every AFib ablation procedure.

Conclusion

Ablation is a crucial treatment for atrial fibrillation, and choosing the right method can make a big difference. Pulsed field ablation (PFA) stands out as a faster, safer, and more effective option compared to traditional thermal methods like RF and Cryo. If you or a loved one is considering ablation for AF, it’s worth discussing PFA with your doctor to see if it’s the right choice for you.

Disclosure

The information provided in this blog is intended for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider or a qualified medical professional before making any decisions regarding medical treatments or procedures. The results and findings discussed, including those from the ADVENT study, reflect current research and clinical practices as of the date of publication. Individual patient outcomes may vary, and the choice of treatment should be tailored to each patient’s specific condition and needs. The author of this blog receives an hourly reimbursement for time spent from three different manufacturers of pulsed field ablation (PFA) devices to assist with PFA studies, consulting, and educating physicians on this new technology.

About the Photo

The photo attached to this article was taken today from the Salt Lake City lookout portion of the Desolation Trail in Millcreek Canyon. The weather was perfect this morning, and my 16-year-old daughter and I thoroughly enjoyed our 4.8-mile hike/run with a 1,237-foot vertical gain.

Can a Mediterranean Diet Prevent Atrial Fibrillation from Coming Back After an Ablation?

Atrial fibrillation (AFib) is a common heart rhythm problem. After a procedure called AFib ablation, which aims to fix this issue, AFib can still come back in some patients. However, there might be a way to reduce this risk with the help of a Mediterranean diet. Let’s explore what a Mediterranean diet is, what a recent study says about it, and how it might help patients with AFib.

What is the Mediterranean Diet?

The Mediterranean diet is a way of eating inspired by the traditional foods of countries around the Mediterranean Sea, like Italy and Greece. This diet includes:

-Fruits and Vegetables: Fresh and colorful fruits and vegetables make up a large part of this diet.

-Whole Grains: Foods like whole wheat bread, brown rice, and oats.

-Healthy Fats: Mainly from olive oil, nuts, and seeds.

-Lean Proteins: Fish, especially those rich in omega-3 fatty acids like salmon, as well as poultry and legumes.

-Limited Red Meat: Red meat is eaten less often and in smaller amounts.

-Dairy: Usually in the form of cheese and yogurt, but in moderation.

-Herbs and Spices: Used to flavor food instead of salt.

The PREDIMAR Study

The PREDIMAR trial studied whether a Mediterranean diet could help prevent AFib from coming back after an ablation procedure. In this study, patients were divided into two groups:

1. Mediterranean Diet Group: Patients followed the Mediterranean diet and received extra-virgin olive oil (EVOO) for free. They also got support through phone calls and a website.

2. Control Group: Patients continued with their usual diet without specific guidance.

Results of the Study

The study involved 720 patients. Here’s what the researchers found:

1. Overall Recurrence: AFib came back in 34.8% of patients in the Mediterranean diet group and 37.5% in the control group. While this difference wasn’t statistically significant, it showed a trend towards fewer recurrences in the diet group.

2. Patients with Paroxysmal AFib: For patients who had AFib that comes and goes on its own (paroxysmal AFib), the Mediterranean diet significantly reduced the recurrence of AFib. Only 25.2% of these patients had AFib return, compared to 34.7% in the control group.

4 Possible Reasons How the Mediterranean Diet May Help AFib

While the exact reasons are still being studied, here are some possible ways the Mediterranean diet might benefit AFib patients:

1. Anti-Inflammatory Properties: The diet is rich in anti-inflammatory foods like fruits, vegetables, and fish. Inflammation is a known factor in AFib, so reducing inflammation could help prevent it.

2. Heart Health: Foods like olive oil and fish contain healthy fats that improve heart health, possibly making the heart less prone to AFib.

3. Weight Management: There is a clear link between being overweight and atrial fibrillation (AFib). The Mediterranean Diet can help maintain a healthy weight, which reduces the strain on the heart and decreases the risk of AFib. However, it’s important to note that the Mediterranean Diet didn’t lead to any weight loss in this study. To achieve weight loss with the Mediterranean Diet, you should focus on cutting calories by cutting out the empty calories of alcohol, replacing whole grains with more vegetables, and substituting legumes, like garbanzo beans, for meat and dairy.

4. Blood Pressure: While the Mediterranean diet has been shown to help lower blood pressure, which is a major risk factor for AFib, no blood pressure reduction was seen in this study. Once again, if they had designed the study to also result in weight loss, they would have seen a significant drop in blood pressure.

Dr. Day’s Take on this Mediterranean Diet Study to Treat AFib

Dr. Maria T. Barrio-Lopez and her colleagues from Spain deserve recognition for successfully conducting a multicenter randomized dietary study on AFib. Getting 720 people to follow a specific diet for 18 months is a significant accomplishment!

The primary goal of their study was to reduce AFib progression in all patients. Unfortunately, this goal was not fully met. Here is a published report of what this study was designed to accomplish before they enrolled their first patient.

While there was a trend suggesting that the Mediterranean Diet might benefit all AFib ablation patients, it didn’t reach statistical significance. However, the study did find that patients with the less severe form of AFib, known as paroxysmal AFib, appeared to benefit from the Mediterranean Diet. Specifically, these patients experienced a 31% reduced risk of their AFib returning.

I believe the benefits of the Mediterranean Diet for preventing AFib recurrence after an ablation could have been greater if alcohol consumption had been limited, as alcohol is a major trigger for AFib, and if the diet had been adjusted to promote weight loss. In my experience, many of my overweight patients have been able to put their AFib into remission through significant weight loss with the Mediterranean Diet by replacing grains with vegetables and substituting much of their meat and dairy with natural plant-based proteins like legumes.

Conclusion

The Mediterranean diet, enriched with extra-virgin olive oil, shows promise in reducing the recurrence of AFib after an ablation procedure, especially for those with paroxysmal AFib. Incorporating this diet into your lifestyle could be a beneficial step towards maintaining a healthy heart and preventing AFib from coming back if you are already at a healthy weight. For those who are overweight, our research has consistently shown that losing weight after an ablation helps to keep AFib from ever coming back. Always consult with your doctor or a nutritionist before making significant changes to your diet.

Disclaimer

The information provided in this blog article is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or dietary changes. Do not disregard professional medical advice or delay in seeking it because of something you have read in this article. Individual results may vary, and it is important to consult with your healthcare provider before starting any new diet or health program.

About the Photo

This photo was taken during one of my recent evening mountain bike rides after work. I love riding the trails above Salt Lake City in the spring and late fall when the mountains are still covered with snow.

Taking the Stairs Prevents Heart Disease and Extends Your Life

Have you ever thought about how the simple act of taking the stairs can change your life? Research has shown that something as ordinary as climbing stairs can significantly reduce your risk of heart disease and even increase your lifespan. A recently presented meta-analysis study of 9 studies involving 480,520 people concluded that choosing the stairs instead of the elevator decreases your risk of heart disease killing you by 39% and also lowers your risk of a premature death from any cause by 24%! Let’s dive into how this easy habit can have extraordinary benefits for your health.

Why Stairs are so Good for Your Heart

Climbing stairs is more than just a way to get from one floor to another; it’s a powerful exercise that can boost your heart health. This study included people aged 35 to 84, both healthy individuals and those who already had a heart condition, demonstrating that taking the stairs whenever possible can help anyone combat heart disease and reduce the risk of early death.

Indeed, regularly taking the stairs can decrease your chances of dying from heart disease by 39% and lower your risk of dying early from any cause by 24%. Additionally, it was associated with a lower risk of having a heart attack, heart failure, and stroke. That’s a huge impact for such a small daily decision of choosing the stairs over an elevator!

6 Ways Taking the Stairs Strengthens Your Heart

1. Cardiovascular Workout

Climbing stairs is a vigorous aerobic exercise that gets your heart pumping. This increased heart rate strengthens the heart muscle, improving its efficiency and endurance. A stronger heart can pump more blood with each beat, reducing the overall workload on the heart and decreasing the risk of heart disease.

2. Improved Blood Circulation

As you climb stairs, your body requires more oxygen, which in turn increases blood flow. Enhanced circulation helps prevent the buildup of plaque in your arteries, a leading cause of heart attacks and strokes. Good circulation also ensures that your organs and tissues receive adequate oxygen and nutrients, promoting overall health.

3. Lower Blood Pressure

Regular physical activity, such as stair climbing, helps to lower blood pressure by making your heart stronger and more efficient at pumping blood. This reduces the force on your arteries, decreasing the risk of damage and plaque buildup. Lower blood pressure is directly linked to a reduced risk of heart disease and stroke.

4. Weight Management

Stair climbing burns calories and helps in weight management. Maintaining a healthy weight is crucial for heart health because excess body fat, especially around the abdomen, is a significant risk factor for cardiovascular disease. Reducing weight decreases the strain on the heart and lowers the risk of developing high blood pressure, diabetes, and high cholesterol.

5. Cholesterol Levels

Engaging in regular stair climbing can improve your cholesterol profile by increasing levels of high-density lipoprotein (HDL) or “good” cholesterol and decreasing levels of low-density lipoprotein (LDL) or “bad” cholesterol. A better cholesterol ratio reduces the risk of plaque formation in the arteries, thus preventing heart attacks and strokes.

6. Stress Reduction

Physical activity, including stair climbing, releases endorphins, which are natural mood lifters. Reducing stress and anxiety levels has a positive impact on heart health, as chronic stress is known to increase the risk of cardiovascular diseases by raising blood pressure and causing harmful habits like smoking or overeating.

By integrating stair climbing into your daily routine, you harness these benefits, making a significant impact on your cardiovascular health. This simple yet effective exercise strengthens your heart, improves circulation, helps maintain a healthy weight, balances cholesterol levels, and reduces stress—all contributing to a lower risk of heart disease and a longer, healthier life.

Start Small, Think Big

You don’t need to climb hundreds of stairs to see benefits. Start with small goals, like taking the stairs instead of the elevator at work or at home. Over time, you can increase the number of stairs you climb and see even greater health benefits.

Look for opportunities to take the stairs throughout your day. Whether it’s at the mall, at work, or even at a friend’s apartment, choose the stairs whenever you can. These small changes can add up to significant health benefits over time.

My Personal “Never Take an Elevator” Policy

With the exception of perhaps a high-rise hotel where they don’t let you take the stairs, you’ll never see me in an elevator. My policy for the last 39 years is simple—never take an elevator.

In fact, if you ever come to my hospital, St. Mark’s Hospital in Salt Lake City, Utah, there’s a good chance you might catch me running the stairs between surgeries. For me, it’s not just about getting from one floor to another. Climbing stairs keeps my mind and body sharp and my energy levels high, enabling me to perform at my very best. This personal commitment to stair climbing reflects my belief in the power of this simple exercise to enhance overall health.

As someone dedicated to inspiring healthier lifestyles, I believe in practicing what I preach. My daily routine of running the stairs is a testament to the benefits of regular physical activity. By incorporating stair climbing into my day at the hospital, I not only stay fit but also set an example for my patients and colleagues. This small habit makes a big difference in my ability to stay focused and energized throughout the day.

Conclusion

Choosing the stairs over the elevator is a simple yet powerful way to improve your heart health and extend your life. The research is clear: climbing stairs can significantly reduce your risk of heart disease and overall mortality. So, next time you’re faced with the choice, take the stairs and step up to a healthier heart!

Incorporating stair climbing into your daily routine is an achievable and effective way to boost your health. It’s a small change that can lead to big benefits. Let’s take the first step together and make stair climbing a part of our lives for a healthier future. Embrace the power of the stairs, and inspire others to do the same. Your heart will thank you!

Disclaimer

The information provided in this blog article is for educational and informational purposes only and is not intended as health or medical advice. Always consult with a qualified healthcare provider before starting any new exercise regimen, especially if you have a pre-existing medical condition, have poor balance, or are experiencing symptoms that may require medical attention. While climbing stairs can offer significant health benefits, it is important to ensure that this form of exercise is safe and appropriate for your individual health circumstances.

About the Photo

The attached photo shows my 8-year-old son and me at the top of the Snowbird tram, enjoying the last weekend of skiing over Memorial Day. It was the closing weekend at Snowbird, so we made sure to get our final turns in before the end of the season. I love spring skiing in the sun with my family.

Is Diltiazem Dangerous to Use with Eliquis or Xarelto?

A recent study involving 204,155 Americans with atrial fibrillation just concluded that using ditiazem with either Eliquis (apixaban) or Xarelto (rivaroxaban) was potentially dangerous due to increased bleeding risks. Is this really the case? And if it is, what steps should you take if you have been prescribed these medications? Keep reading to find out more.

What is Diltiazem?

The cardiac medication diltiazem also goes by the brand names of Cardizem, Tiazac, Cartia, Dilacor, Matzim, Taztia, and Dilt-XR.  Diltiazem is the second most commonly prescribed medication in the US to slow the atrial fibrillation (AFib) heart rate, right after metoprolol. Apart from regulating the AFib heart rate, diltiazem also helps in lowering blood pressure. For those with AFib, diltiazem can greatly reduce symptoms and may also lower the risk of heart failure when the heart beats too fast from AFib.

What are Eliquis and Xarelto?

Eliquis and Xarelto are the top two blood thinners for AFib in the US. Both Eliquis and Xarelto are factor Xa inhibitors. They’re popular because they’re safe, easy to use, and don’t require a lot of monitoring or check-ups.

What is the Drug Interaction Between Diltiazem and Eliquis/Xarelto?

The interaction between diltiazem and Eliquis or Xarelto revolves around the enzyme system called cytochrome P450. Diltiazem can inhibit certain cytochrome P450 enzymes, particularly CYP3A4, which are responsible for metabolizing Eliquis and Xarelto in the liver.

As a result, diltiazem slows down the breakdown of Eliquis and Xarelto, leading to elevated levels of these blood thinners in the body. This heightened concentration increases the risk of bleeding complications associated with Eliquis and Xarelto. Therefore, caution is necessary when combining diltiazem with Eliquis or Xarelto.

How Much Does Diltiazem Raise Drug Levels of Eliquis and Xarelto?

Given the p450 enzyme interaction of diltiazem with Eliquis and Xarelto, it slows the breakdown of Eliquis and Xarelto thereby leading to higher drug levels. For example, one study reported that diltiazem increases drug levels of Eliquis by 31% and Xarelto by 40% (I haven’t seen these numbers validated in other studies nor is it clear to me that this is the same reaction for everyone so please take these numbers with “a grain of salt.”)

If you’ve had bleeding issues with these medications, then this drug interaction could be significant. On the other hand, if you’re prone to blood clots, strokes, mini-strokes (TIA), or have a family history of strokes, you and your doctor might be fine with this drug interaction.

What is the Latest Study on Combining Diltiazem with Eliquis or Xarelto?

The research that got my attention involved 204,155 Medicare patients with atrial fibrillation, with a median age of 77 years. Among them, 53,275 individuals were prescribed diltiazem, while 150,880 were using metoprolol to regulate their atrial fibrillation heart rate.

Among those using diltiazem, the risk of hospitalization due to bleeding was found to be 22% higher compared to those using metoprolol for controlling their atrial fibrillation heart rate. Interestingly, for patients on the lowest dose of the extended-release version of diltiazem (120 mg once daily), their risk of bleeding was only 13% higher.

Because patients were not randomized in this study, it’s uncertain if there were underlying factors influencing why one rate-controlling medication was prescribed over another. This lack of randomization could have introduced unintended biases to the study.

For instance, considering the reported higher risk of falls in elderly individuals using beta-blockers like metoprolol, it’s conceivable that physicians may have prescribed diltiazem to patients who were perceived as being more frail. Therefore, the observed increased bleeding risk associated with diltiazem, when combined with Eliquis or Xarelto, might be attributed to factors such as frailty and not the potential drug interaction.

What Do Other Studies Say About Combining Diltiazem with Eliquis or Xarelto?

Given the known cytochrome P450 enzyme interactions when combining medications, a number of studies have looked at the interaction of diltiazem with either Eliquis or Xarelto. Surprisingly, while many studies have called out an increased of bleeding when combining these medications, many have not. For example, in another large study of 91,330 people in Taiwan taking these blood thinners, diltiazem did not increase the risk of bleeding when combined with Eliquis or Xarelto.

Dr. Day’s Take on This Study

Managing drug interactions can be challenging since it seems like almost every medication can interact with something. When it comes to combining diltiazem with Eliquis or Xarelto and the risk of bleeding, it’s still not entirely clear. Some studies suggest there might be a higher risk of bleeding, while others don’t show this. Even the guidelines for treating atrial fibrillation (AFib) don’t give any specific advice on using diltiazem with Eliquis or Xarelto.

In my practice, I haven’t noticed a higher risk of bleeding with diltiazem compared to metoprolol. However, since severe bleeding events with Eliquis and Xarelto are quite rare, I would probably need to see 200,000 or more older patients on these medications, like the number of patients in this study, to see any noticeable differences.

Also, this study included patients with a median age of 77 years. Is this potential bleeding risk of diltiazem, when combined with Eliquis or Xarelto, even significant in younger patients? As of now we still don’t know.

Following the results of this most recent study, I’m discussing alternatives to diltiazem with my AFib patients on these blood thinners. And after these conversations, some are deciding to stick with diltiazem because they’ve done very well without any bleeding issues, while others are switching to different medications. Some are even choosing to steer completely clear of medications altogether and are exploring options such as atrial fibrillation pulsed field ablation or the Watchman procedure.

What Other Medications Can Be Used to Slow the AFib Heart Rate?

For my patients choosing to replace diltiazem with a different medication, most are opting for metoprolol, which is my favorite beta-blocker medication. While metoprolol doesn’t have the same interaction with the p450 enzyme, it does have different side effects to consider. For example, some studies show an increased risk of falls with metoprolol in older patients (other studies refute this), and falls may also increase the risk of bleeding.

Other than calcium channel blockers like diltiazem or beta-blockers like metoprolol, there is only one other medication option for slowing the AFib heart rate, and that is digoxin. While digoxin has been used safely for more than a hundred years, it has lately fallen out of favor due to other non-randomized studies like these which suggest an increased risk of death and hospitalization with this medication. However, it’s important to approach non-randomized studies like these cautiously because they can often be inaccurate in their study findings.

Can You Stay on Diltiazem and Switch to a Different Blood Thinner?

While Eliquis, in my opinion, is the best overall blood thinner to prevent strokes and minimize the risk of bleeding, there are certainly other blood thinners that can be tried so that people can stay on diltiazem. For example, warfarin (also known as Coumadin) doesn’t interact with diltiazem this way. However, warfarin requires a very strict diet and frequent blood tests. Also, unless warfarin is perfectly controlled, it may not be as effective or safe as Eliquis or Xarelto.

Another option is Savaysa (endoxaban), which is in the same factor Xa inhibitor family as Eliquis and Xarelto but has less of a drug interaction with diltiazem. Lastly, Pradaxa (dabigatran) could be tried for people without kidney disease. However, even though Pradaxa is in a different blood thinner family than Eliquis, Xarelto, or Savaysa, one study showed a significant increased risk of bleeding when combining this drug with diltiazem.

What Should You Do?

The key takeaway from this study is that combining diltiazem with Eliquis or Xarelto might increase your risk of bleeding. Therefore, my suggestion would be that if you are on diltiazem with either Eliquis or Xarelto, you schedule an appointment with your prescribing physician to discuss this drug interaction and whether or not it makes sense for you to switch medications or explore other alternatives.

Disclaimer

The information provided in this article is intended for educational purposes only and should not be interpreted as medical advice. It is not a substitute for professional medical guidance or treatment. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized recommendations regarding your medical condition. Additionally, never stop a medication on your own without first discussing with your prescribing physician.

About the Photo

Captured the vibrant spring bloom in Salt Lake City, with the majestic Mount Olympus providing a breathtaking backdrop. Snapped this moment while strolling down our neighborhood street with my children and our furry companion.

What’s Better for Your Heart: Plant-Based Meats or Animal Meats?

Is Practicing Daily Forgiveness and Gratitude Better for Blood Pressure than a Medication?

Does your blood pressure occasionally run higher than 120/80? And do you subconsciously keep reaching for your smartphone? Well, here’s some news that might just make you feel better about it!

A recent study presented this week at our annual American College of Cardiology meetings in Atlanta explored this topic. Could something as simple as reading a daily text message encouraging you to practice daily gratitude and forgiveness keep your blood pressure in check?

Let’s break down what this study, known as the FEEL study, found and what it means for you. The full name of this new study is as follows: “A Clinical Trial to Evaluate the Influence of a Spirituality Intervention on Blood Pressure Control, Central Hemodynamics and Endothelial Function – The Feel Study.”

What Was the Study About?

The FEEL study, conducted in Brazil, focused on adults with stage 1 and 2 hypertension. Stage 1 hypertension is when your blood pressure runs somewhere between 130/80 and 139/89. And stage 2 hypertension is when your blood pressure is above 140/90.

Hypertension, or high blood pressure, is a common condition that can lead to serious health issues if left untreated. For example, high blood pressure increases your risk of atrial fibrillation by about 50%. Also, untreated high blood pressure can take many years off your life in addition to an increased risk of heart attacks, strokes, blindness, kidney failure, etc.

The researchers in the FEEL study wanted to see if a simple daily text message encouraging gratitude and forgiveness could help manage high blood pressure and improve overall heart health.

What Did the Intervention Involve?

The 100 participants in the study were randomly divided into two groups: one receiving usual care for hypertension, and the other receiving usual care along with daily smartphone messages aimed at promoting spirituality and reflection. These messages encouraged participants to reflect on topics like optimism, gratitude, and forgiveness. They also included occasional tasks, such as writing messages of gratitude.

What Were the Results?

After 12 weeks, the researchers found some promising results. Participants who received the daily smartphone messages showed a significant reduction in systolic blood pressure (the top number in a blood pressure reading) compared to those who received usual care alone. Specifically, the group that got the text messages saw a bigger drop in their blood pressure, about 7.6 points, while the other group only saw a tiny drop of about 0.55 points.

A 7.6 point reduction in their systolic blood pressure (the top number on a blood pressure reading) is a big deal! In fact a 7.6 point reduction in the systolic blood pressure is more than what we see with a typical blood pressure lowering medication!

Additionally, the study looked at a measure called flow-mediated dilation (FMD), which is a marker of blood vessel health. The group receiving the smartphone messages showed a 4% improvement in their FMD, while those being treated the usual way for high blood pressure saw a 3% decrease in their FMD.

How Does Practicing Daily Gratitude and Forgiveness Help Blood Pressure?

Daily gratitude and forgiveness can potentially decrease blood pressure in hypertensive individuals through various mechanisms. Firstly, practicing gratitude and forgiveness may reduce stress levels by promoting positive emotions and reducing negative ones like anger and resentment. Lower stress levels can lead to a decrease in the production of stress hormones such as cortisol and adrenaline, which are known to elevate blood pressure.

Additionally, gratitude and forgiveness can improve overall mental well-being, which in turn may positively impact physical health.

Furthermore, engaging in these practices may foster healthier lifestyle habits, such as regular exercise and better dietary choices, which are known to contribute to lower blood pressure. Overall, the combination of reduced stress, improved mental health, and healthier lifestyle behaviors may collectively contribute to the observed decrease in blood pressure among hypertensive individuals who practice daily gratitude and forgiveness.

What Does This Study Mean for You?

These findings suggest that practicing daily gratitude and forgiveness can help to keep your blood pressure down and your arteries healthy. And as we often say in the cardiology world, “you are only as old as your arteries.” So, the healthier you can keep your arteries the longer you’ll live, the healthier your brain will be, and the more likely you will be to avoid heart problems.

For me, yet another daily text message is highly stressful. Thus, instead of signing up for a daily spiritual reminder on my phone, I listen to two daily spiritual podcasts while driving to the hospital or during my daily exercise. As a physician for almost three decades, I’ve noticed significant cardiovascular benefits in my patients from incorporating some form of daily spirituality.

Disclaimer

The information provided on this blog is intended for general informational purposes only and should not be construed as medical advice or a substitute for professional medical expertise or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment plan. If you have high blood pressure work with your healthcare provider to get it under control as soon as possible.

About the Photo

Absorbing the spring warmth of Salt Lake City during my inaugural mountain bike excursion of the year this past week. This sun-drenched trail, providing a panoramic vista of the city skyline against the backdrop of lingering mountain snow, offers a captivating sight. These mountain bike outings afford ample opportunities for me to listen to spiritual podcasts, fostering gratitude, forgiveness, and in maintaining optimal blood pressure readings.

Intermittent Fasting: Miracle Diet or Hazardous to Your Heart?

A recent study involving more than 20,000 adults discovered that people who adhered to an 8-hour time-restricted eating plan, a form of intermittent fasting, were 91% more likely to face a higher risk of dying from heart problems. How could this be? Isn’t intermittent fasting supposed to be heart-healthy, as I’ve previously reported in our 2 best-selling books The Longevity Plan and The AFib Cure? Read on to learn more…

The 91% Higher Risk of Heart Death Intermittent Fasting Study

In this study, scientists looked into how sticking to an 8-hour time-restricted eating plan (a 16 hour fast each day) could affect your health. They reviewed self-reported data about what time people ate each day from 2003 to 2018 in the National Health and Nutrition Examination Surveys (NHANES). Then, they compared it to which people died in the U.S. from 2003 to December 2019, using data from the Centers for Disease Control and Prevention’s National Death Index database.

The people in the study were then followed for 8 years on average, with some being followed for as long as 17 years. And over the 8-year follow-up period those who fasted for at least 16 hours daily were 91% more likely to die from cardiovascular disease.

It is important to know that this study has not yet gone through the peer-review process nor has it been published. It was just an abstract that was presented at an American Heart Association (AHA) meeting on March 18, 2024.

So, why am I discussing a study that hasn’t been published yet? Well, these initial study findings were shared with the press, sparking discussions worldwide. If you’re interested in seeing the complete data presented at this AHA meeting, you can click on this link.

3 Reasons Why This Presentation Was Totally Flawed

1. The study relied only on 20,000 people trying to remember how long they fasted every day for 8 years (at least 16 hours). Personally, I can barely recall how long I fasted from dinner last night until breakfast this morning, let alone my fasting time every day for the past 8 years!

2. The researchers didn’t mention what people were eating during this 8-year period. If their intermittent fasting method was to eat cheeseburgers and fries every night for dinner, that might explain the 91% higher risk of dying from heart disease.

3. This study wasn’t randomized, meaning it’s probable that the people who opted for intermittent fasting were quite different from those who didn’t. For instance, it’s entirely possible that individuals with more health issues decided to try intermittent fasting in this study.

The 1 Big New Finding from This Study

Despite the flaws in this study, it does make me wonder about something significant. Many studies over the years have warned that skipping breakfast isn’t good for your heart or your overall health. For example, in a recent study of 199,634 Americans, regularly skipping breakfast resulted in a 32% increased risk of dying prematurely.

Could it be that the 91% higher risk of dying from heart disease in this study was linked to people skipping breakfast? Is there something crucial in your body’s internal clock that benefits from starting the day with breakfast?

While we’re still lacking solid research on the long-term mortality risks of intermittent fasting, we can turn to existing longevity studies for insights. For instance, in our study of centenarians in China that we covered in our book, “The Longevity Plan,” all of them fasted for at least 12 hours each day. They typically had an early dinner around 6 pm and then didn’t eat until breakfast the next day at around 6 am. Could the key to a longer life be following this pattern: having an early dinner and then fasting for 12 hours until breakfast the next morning?

What Does the Science Really Tell Us About Intermittent Fasting?

Can Exercise Triple Your AFib Ablation Success Rate?

Regular physical activity has long been recognized as a cornerstone of optimal cardiovascular health. Exercise strengthens the heart muscle, improves blood flow, lowers blood pressure, and reduces the risk of obesity and diabetes – all factors that contribute to atrial fibrillation (AFib).

In a recent study conducted by my friend Dr. Oussama Wazni and his colleagues at the renowned Cleveland Clinic, the role of exercise in enhancing success rates for atrial fibrillation (AFib) was examined. The study aimed to explore whether individuals with higher baseline cardiac fitness, as assessed through a stress test prior to the procedure, predicted better outcomes following AFib ablation.

The findings of this study are remarkable and should grab the attention of anyone with atrial fibrillation contemplating an ablation procedure. Specifically, the study revealed that individuals who were in the best physical condition prior to the procedure experienced a staggering three-fold increase in the likelihood of a successful outcome. If you’re living with AFib, it’s crucial to continue reading to discover how you can significantly enhance your chances of a successful ablation.

The Study on Exercise Improves AFib Ablation Success Rates

In this study, the Cleveland Clinic researchers looked at 591 patients who had undergone a stress test within a year prior to their AFib ablation. They divided these patients into three groups based on their level of cardiovascular fitness: low, adequate, and high.

They then followed these patients for an average of 32 months after the procedure to see how often AFib returned and other related outcomes occurred. With regards to their AFib ablation success rates over the following 2-3 years they found the following:

-Low Cardiovascular Fitness: 21% success rate (30% for paroxysmal AFib patients)

-Adequate Cardiovascular Fitness: 46% success rate (55% for paroxysmal AFib patients)

-High Cardiovascular Fitness: 73% success rate (82% for paroxysmal AFib patients)

Additionally, patients with higher cardiovascular fitness levels were less likely to need to go back to the hospital for AFib-related issues or need more procedures to control their heart rhythm. Moreover, patients with higher cardiovascular fitness levels had a lower risk of death compared to those with lower fitness levels. Overall, the study suggests that being more physically fit before undergoing AFib treatment may lead to better outcomes and a reduced risk of AFib returning.

How Did They Define a Successful Ablation in this Study?

In this study, they checked on patients closely after their ablation procedure to see if it worked. Patients had to wear heart monitors afterward. If they had 30 seconds or more of AFib at any time, either seen on an ECG, heart monitor, home ECG, or any implanted device, the procedure wasn’t considered successful.

Dr. Day’s Take on this Study

Firstly, it’s essential to carefully assess how well the ablation worked. In this study, even if someone had AFib all the time before the procedure, finding just one short episode of AFib afterward, like 30 seconds during sleep, meant the procedure wasn’t seen as successful. A better way to measure success would be to look at how much AFib someone had before and after the procedure. From our experience, most of our patients who get an ablation see a big drop in their AFib burden and symptoms.

Secondly, I was surprised by the relatively low success rates seen in this study. One possible explanation could be the differences in the health status of the AFib patients we treat in Salt Lake City compared to those in Cleveland. Generally, it’s widely acknowledged that healthier patients tend to achieve more favorable outcomes with AFib ablation.

For example, Utah boasts notably low rates of smoking and alcohol abuse, both of which are recognized to complicate the elimination of AFib. Additionally, individuals in Utah tend to maintain higher levels of physical activity, facilitating the elimination of AFib. It’s worth noting that in our practice, we seldom encounter procedure failures among our physically fit and healthy AFib patients, particularly when allowing for a touch-up procedure.

Lastly, I’ve seen many patients over the years who decided to get healthier after not getting the ablation result they had hoped for. For instance, after still having some occasional AFib after a second procedure, they then lost weight and committed to going to the gym every day. Quite remarkably, I’ve then seen the AFib often go away completely.

How Does Exercise Help Treat AFib?

Exercise could very well be the best AFib medicine we have as it tackles several key factors that contribute to the condition. Firstly, it helps to lower blood pressure, which is a big risk factor for AFib. When you exercise regularly, it improves your heart health and helps keep your blood pressure in check.

Secondly, exercise can prevent and manage diabetes, another condition linked to AFib. By helping you maintain a healthy weight and better manage your blood sugar levels, exercise lowers your risk of developing diabetes and, in turn, reduces the chance of AFib.

Thirdly, regular exercise can prevent sleep apnea, a common sleep disorder associated with AFib. By keeping your weight in check many cases of obstructive sleep apnea go away.

Lastly, exercise is known to improve mental health by reducing symptoms of depression and anxiety, which are often seen in AFib patients. When you exercise, your body releases feel-good chemicals called endorphins, which can boost your mood and reduce stress. Overall, by addressing these different aspects of health, exercise becomes a valuable tool in treating and managing atrial fibrillation.

How to Start Getting Active?

Getting started with exercise can feel daunting, but it’s essential for managing atrial fibrillation and promoting overall heart health. Start by choosing activities you enjoy, whether it’s walking, swimming, cycling, or dancing. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.

Remember to start slowly and gradually increase the duration and intensity of your workouts. Listen to your body and take breaks as needed. Don’t forget to warm up before exercising and cool down afterward to prevent injury.

Consider finding a workout buddy or joining a fitness class to stay motivated and accountable. And most importantly, be consistent – even small amounts of exercise can make a big difference in your heart health over time.

Always consult with your healthcare provider before starting any new exercise program, especially if you have underlying health conditions or concerns. They can offer personalized recommendations and guidance based on your individual needs and medical history.

Disclaimer

The information provided in this blog article is intended for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

About the Photo

The accompanying photo captures a serene moment from yesterday, showcasing our family’s ski trail descending from the mountain after sunset. It reflects the joyous memories of a delightful day spent skiing on the majestic 9990 mountain, identifiable as the snow-covered peak in the center of the background, nestled in Park City, Utah.

Do You Really Need 10 Servings of Vegetables and Fruit Daily for Optimal Health?

The 2020–2025 Dietary Guidelines for Americans advocate for consuming 3.5 to 5 servings of vegetables and fruit daily. However, for those aiming to minimize the risk of heart disease, strokes, and cancer, this may not be enough. Based on an extensive study I’ve examined, achieving the goal of avoiding these diseases requires a more substantial intake. In fact, this study suggests that optimal protection against heart disease, strokes, and cancer is attained with a daily consumption of up to 10 servings of vegetables and fruit.

The 10 Servings Daily Study

This study, led by a group of scientists from Imperial College London, looked at data from 95 studies involving over 2 million people. They discovered that sticking to the recommended servings of veggies and fruits did help somewhat in the prevention of heart disease, strokes, and cancer. But when people bumped up their intake to 10 servings a day, the protection against these diseases got much better. They defined one serving as 80 grams, and found the best disease protection when people ate 800 grams of veggies and fruits each day (10 servings).

How Much Disease Prevention Can You Get with 10 Servings Daily?

What rewards await those who increase their daily intake of vegetables and fruits to 10 servings? This study outlines significant benefits:

-A 28% reduction in the risk of cardiovascular disease

-A 33% decrease in the risk of a stroke

-A 13% lower risk of cancers

-A 31% decreased chance of premature death

Which Vegetables Offered the Most Protection in this Study?

Among the standout veggies in this study are green leafy vegetables like spinach, kale, and lettuce, as well as cruciferous vegetables such as broccoli, cauliflower, and Brussels sprouts. These powerhouse vegetables have been shown to have a profound impact on cardiovascular health and cancer protection. In addition, including green-yellow vegetables like bell peppers and carrots also offered significant protection in this study. By incorporating these nutrient-rich vegetables into your meals regularly, you’re taking proactive steps toward promoting your overall health and well-being.

Which Fruits Offered the Most Protection?

In the realm of fruits, the findings of this study highlight apples, pears, and citrus fruits as potent guardians against heart disease, strokes, and cancer. Moreover, tomatoes emerge as a noteworthy contender, offering substantial protection specifically against heart disease. Interestingly, although berries showed protection against disease in this study, they didn’t provide as much benefit as apples, pears, and citrus fruits did.

How Do Vegetables and Fruit Protect Against Disease?

Research indicates that fruits and vegetables play a crucial role in promoting overall health and well-being by reducing cholesterol levels, lowering blood pressure, and enhancing the health of our blood vessels and immune system. This is largely attributed to their rich array of nutrients, including vitamins, minerals, fiber, and antioxidants.

These essential components work together to support various bodily functions, such as regulating cholesterol and blood sugar levels, promoting digestive health, and combating harmful free radicals that can lead to cancer development. The antioxidants found in fruits and vegetables have the potential to minimize DNA damage, thereby lowering the risk of cancer. Overall, the complex network of nutrients found in these foods underscores their significance in preventing chronic diseases like heart disease, strokes, and cancer.

Why Are Cruciferous Vegetables the Best Cancer Fighting Vegetables?

Cruciferous vegetables like broccoli, cauliflower, kale, and Brussels sprouts are known for their ability to fight cancer. They contain special compounds called glucosinolates that break down into substances like sulforaphane. These substances can help stop cancer cells from growing and encourage them to self-destruct. Additionally, cruciferous veggies are packed with antioxidants and other plant chemicals that protect cells from damage and inflammation, which are key factors in preventing cancer. Eating these vegetables regularly can significantly lower your risk of developing cancer, making them an important part of a healthy diet.

How Do You Get 10 Servings in Daily?

Increasing fruit and vegetable intake to 10 servings daily may seem daunting, but there are practical strategies to incorporate more of these nutritious foods into your diet. Start by aiming to include fruits and vegetables in every meal and snack. Fill half of your plate with vegetables at lunch and dinner, and incorporate fruits into your breakfast or as a mid-morning or afternoon snack.

Experiment with different cooking methods such as roasting, grilling, steaming, or stir-frying vegetables to enhance flavor and variety. Consider adding fruits and vegetables to smoothies, salads, soups, and sandwiches for a quick and easy boost of nutrients.

Keep a variety of fresh, frozen, and canned fruits and vegetables on hand for convenience and versatility. Get creative with your meals by trying new recipes and exploring different types of fruits and vegetables to keep things interesting. Finally, involve your family or friends in meal planning and preparation to make healthy eating a fun and enjoyable experience for everyone. By incorporating these practical strategies into your daily routine, you can gradually increase your fruit and vegetable intake and reap the numerous health benefits they provide.

Disclaimer

The information provided in this blog is intended for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or dietary changes.

About the Photo

Yesterday, my son and I shredded the slopes under the bright sun at Park City’s 9990 chairlift. In this snapshot, you can spot the chairlift’s peak reflected in our goggles. Skiing together on a balmy spring day is our ultimate joy—nothing beats the thrill of bonding as a family while enjoying the great outdoors and staying active!

Does the Mediterranean Diet Prevent Atrial Fibrillation?

While researchers associate the Mediterranean diet with a lower risk of heart attacks and strokes, they continue to research its direct impact on preventing atrial fibrillation (AFib). In this article I review the latest study on how the Mediterranean Diet may prevent atrial fibrillation.

The PREDIMAR Study

Researchers conducted a study involving 199 patients from the PREDIMAR trial (PREvención con DIeta Mediterránea de Arritmias Recurrentes). The study aimed to explore the relationship between adherence to the Mediterranean diet and epicardial adipose tissue (EAT) in people with atrial fibrillation. EAT refers to the layer of fat surrounding the heart. They also investigated how EAT and MedDiet adherence correlated with AF recurrence after ablation.

How May the Layer of Fat Surrounding the Heart Cause AFib?

Now, you might wonder how this fat can cause atrial fibrillation. Well, researchers have found that when there’s too much fat around the heart, it can lead to inflammation. This inflammation can affect the electrical signals that control the heartbeat. When these signals become disrupted, they can cause the heart to beat irregularly, which characterizes what we see with atrial fibrillation.

Epicardial adipose tissue (EAT) is a type of fat that wraps around the heart, sitting between the heart muscle and its outer layer. It works like a cushion, protecting the heart. EAT is also active in the body’s metabolism, which means it can release hormones and substances that cause inflammation, potentially affecting heart health.

So, in simple terms, having too much epicardial adipose tissue (EAT) can lead to inflammation around the heart, which in turn can disrupt the heart’s normal rhythm and cause atrial fibrillation. That’s why it’s important to keep a healthy balance of fat around the heart to help maintain a regular heartbeat.

How May the Mediterranean Diet Decrease the Fat Layer Around the Heart?

The Mediterranean diet might help decrease epicardial adipose tissue (EAT) because it’s rich in foods that are good for the heart. Eating a mostly plant-based diet, rich in vegetables, fruit, and legumes, along with whole grains and lean proteins like fish in moderation, can have a positive effect on your body. Avoiding health-harming foods like sugar, processed foods, or fast foods is essential. This healthy eating pattern can benefit your overall health, including potentially shrinking the fat layer around the heart.

5 Ways that the Mediterranean Diet May Decrease Fat Around the Heart

1. Healthy Fats: The Mediterranean diet includes sources of healthy fats like olive oil, nuts, and fatty fish. We know that these fats have anti-inflammatory properties, which can help reduce inflammation in the body, including around the heart where EAT is located.

2. Vegetables, Fruits, and Legumes: The Mediterranean diet is packed with veggies, fruits, and legumes, which are rich in antioxidants and other nutrients. These nutrients can help protect the heart and reduce the risk of inflammation, which in turn may help decrease EAT levels.

3. Fiber: Plant-based natural foods like veggies, fruits, and legumes are packed with fiber. And a high fiber diet fills you up so you don’t need to snack between meals. Fiber is also good for heart health as it helps regulate blood sugar and cholesterol levels. And these blood sugar and cholesterol levels are factors that can influence EAT accumulation.

4. Lean Proteins: Lean proteins like fish and poultry in moderation are lower in saturated fats compared to red meat, which can help keep cholesterol levels lower and reduce the risk of excess fat and inflammation around the heart.

5. Overall Healthy Eating Pattern: The Mediterranean diet isn’t just about individual foods—it’s a lifestyle approach to eating. By following this pattern of eating, you’re less likely to consume processed foods, sugary drinks, and unhealthy fats, which can contribute to inflammation and EAT accumulation.

How Does the Fat Layer Around the Heart Correlate with Belly Fat?

Epicardial adipose tissue (EAT) and belly fat, also known as visceral adipose tissue (VAT), both constitute types of fat in the body, yet they reside in distinct areas and perform different functions.

EAT is the fat that surrounds the heart, located between the heart muscle and the outer layer of the heart. It acts as a protective cushion for the heart and is metabolically active, meaning it can release hormones and inflammatory substances that can affect heart health.

On the other hand, belly fat or VAT refers to the fat that accumulates around the abdominal organs, such as the liver, pancreas, and intestines. This type of fat associates with metabolic syndrome, insulin resistance, and an increased risk of cardiovascular disease.

Both EAT and belly fat can lead to health problems, but they aren’t directly linked. However, they can share some common risk factors, such as obesity, poor diet, sedentary lifestyle, and genetics. Individuals who have excess belly fat are more likely to have higher levels of EAT, but the relationship between the two can vary among individuals.

It’s important to note that reducing belly fat through lifestyle changes like healthy eating and daily exercise will likely also lead to a reduction in EAT.

How Do You Check Your Fat Layer Around the Heart?

The best way we can measure epicardial adipose tissue (EAT) is with directly imaging the heart. For example, an MRI or CT scan of the heart can readily identify the amount of epicardial adipose tissue (EAT). Unfortunately, physicians traditionally haven’t been taught about the link between the fat layer around the heart and the risk of atrial fibrillation, so you’ll rarely see the amount of EAT reported on an MRI or CT scan.

4 Main Findings of the Latest Study on the Mediterranean Diet and Atrial Fibrillation

The 4 main findings of this latest study on the Mediterranean Diet and atrial fibrillation can be summarized below:

1. The Mediterranean Diet is Associated with Less Epicardial Adipose Tissue (EAT): This research shows that adhering to the Mediterranean diet is linked to reduced levels of epicardial adipose tissue in individuals undergoing ablation for atrial fibrillation. This suggests that adopting a Mediterranean diet may help prevent the accumulation of EAT, which is associated with heart rhythm disturbances.

2. EAT is Associated with Persistent Atrial Fibrillation: Higher levels of epicardial adipose tissue are significantly associated with persistent atrial fibrillation, a more aggressive and challenging type of atrial fibrillation to treat. This underscores the importance of addressing EAT levels in individuals with atrial fibrillation, as it may impact the pattern and severity of the condition. In other words, the more EAT you have the harder it is to keep your heart in rhythm.

3. EAT Increases the Risk AFib After Ablation: The study suggests that a larger amount of epicardial adipose tissue may increase the risk of arrhythmic recurrence after ablation. This highlights the potential role of EAT in predicting the likelihood of recurrent episodes of atrial fibrillation post-treatment.

4. Mediterranean Diet Adherence May Help to Prevent AFib: While adherence to the Mediterranean diet shows a trend towards reducing the risk of arrhythmic recurrences after ablation, this association did not achieve statistical significance. However, in my experience, incorporating the Mediterranean dietary principles still offers many other benefits that are very helpful in managing atrial fibrillation.

Disclaimer

The information provided in this article is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional before making any changes to your diet, exercise routine, or medical treatment plan.

About the Photo

Family fun in the sun! Enjoying a peaceful moment at the summit of the 9990 Chairlift at Park City Mountain Resort last weekend.

Latest Research Confirms Tomatoes Lower Blood Pressure

In the quest for better health, we often overlook the humble tomato, considering it merely a tasty addition to salads or sandwiches. However, science reveals that tomatoes offer much more than just flavor – they could be the key to reducing high blood pressure. Let’s delve into the latest scientific study reporting the benefits of tomatoes in lowering blood pressure, which can help prevent atrial fibrillation and other heart problems, potentially extending your life.

Latest Tomato Study

The study, conducted within the PREDIMED (Prevención con Dieta Mediterránea) trial, involved 7,056 participants, the majority of whom were already dealing with high blood pressure. Researchers set out to investigate whether consuming tomatoes was linked to changes in both systolic and diastolic blood pressure, as well as the risk of developing hypertension over a three-year period.

Participants’ tomato consumption from all tomato products was meticulously measured using a validated Food Frequency Questionnaire and divided into four groups based on daily intake: lowest (<44 grams or 1/4 of a large tomato daily), intermediate (44–82 grams or 1/2 of a large tomato daily), upper-intermediate (82–110 grams or 3/4 of a large tomato daily), and highest (>110 grams or one large tomato daily).

Researchers then closely tracked the blood pressure of these 7,065 people over three years to see if daily tomato consumption from all tomato products helped to prevent or treat high blood pressure.

Results of the Latest Tomato Study

In this study, those people eating the equivalence of one large tomato daily (>110 grams) were able to reduce their blood pressure by three points. And for those who had not yet been diagnosed with high blood pressure, eating the equivalence of one large tomato daily reduced their chances of developing high blood pressure by 36%.

The authors of this study concluded that “Tomato consumption, including tomato-based products, is beneficial in preventing and managing hypertension.” This study fits nicely with other tomato studies showing that tomato consumption does indeed help to prevent and treat high blood pressure.

How do Tomatoes Lower Blood Pressure?

Tomatoes contain a powerful combination of nutrients and bioactive compounds that work synergistically to lower blood pressure. One key component is lycopene, a potent antioxidant responsible for the vibrant red color of tomatoes. Lycopene has been shown to improve blood vessel function, promoting better circulation and reducing the force against artery walls. Additionally, tomatoes are rich in potassium, a mineral known for its ability to counteract the effects of sodium, thus helping to regulate blood pressure levels. Moreover, the high fiber content in tomatoes can contribute to lower blood pressure readings by helping to promote a healthy body weight.

What Other Nutrients are Tomatoes High In?

In addition to lycopene, potassium, and fiber, tomatoes are also rich in several other essential nutrients that contribute to overall health. They are a great source of vitamin C, an antioxidant that supports immune function and promotes healthy skin. Tomatoes also contain vitamin K, which is important for bone health and blood clotting. Furthermore, they provide folate, which is crucial for cell division and DNA synthesis, as well as vitamin A, known for its role in vision and immune function. Additionally, tomatoes are a good source of several B vitamins, including thiamine (B1), niacin (B3), and vitamin B6, which play key roles in energy metabolism and nervous system function. Moreover, tomatoes contain minerals such as manganese and magnesium, which are important for various bodily functions, including bone health and muscle function. With this rich nutrient profile, tomatoes are not only delicious but also offer a wide array of health benefits.

How Do You Incorporate More Tomatoes In Your Diet?

Now that we understand the scientific benefits of tomatoes for lowering blood pressure, let’s discuss how to incorporate them into your diet:

1. Fresh Tomatoes: Enjoy sliced tomatoes in salads, sandwiches, or as a side dish with your meals.

2. Tomato-based sauces: Use tomato sauce or paste as a base for pasta dishes, soups, and stews.

3. Salsa: Whip up a batch of fresh salsa with tomatoes, onions, peppers, and cilantro to accompany your favorite dishes.

4. Smoothies. Start your day with a glass of tomato juice from a blended tomato or add a tomato to your favorite smoothie for a refreshing boost of nutrients.

5. My favorite way to boost my tomato consumption, especially, is by adding a can of diced tomatoes to cooked riced cauliflower. To enhance the flavor, I include a seasoning blend of sesame seeds, poppy seeds, dried garlic, dried onion, and sea salt flakes.

Conclusion

Incorporating more tomatoes into your diet can be a delicious and effective way to lower blood pressure and improve overall cardiovascular health. Whether enjoyed fresh, cooked, or blended in a drink, the nutrients and bioactive compounds found in tomatoes offer numerous health benefits. So, why not add a little more red to your plate and reap the rewards of this humble yet powerful fruit? Your heart will thank you for it!

Disclaimer

The information provided in this blog article is intended for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding high blood pressure or any other medical condition. For people suffering from kidney failure, increasing your tomato consumption could result in life-threatening high levels of potassium.

About the Photo

In this heartwarming photo, you’ll see our family, minus our 18-year-old son Jacob, relishing a sunny day of skiing on the 9990 chairlift at Park City Mountain Resort last weekend. Despite Jacob’s absence as he serves on a church mission with the Chinese immigrant community in New York City, we seized the chance to strengthen our bonds and forge lasting memories together. This snapshot perfectly captures the joy and togetherness we share while enjoying outdoor activities as a family.

Does Losing Weight Help Atrial Fibrillation?

Being overweight is directly linked to your chances of developing atrial fibrillation (AFib). Additionally, carrying extra weight makes AFib more likely to worsen over time. This is because the excess weight may cause scarring to the heart muscle resulting in damage to the electrical system of the heart.

Furthermore, weighing more than you should may lead to other health conditions such as high blood pressure, sleep apnea, or diabetes, all of which also contribute to AFib. Even if you have had a successful ablation, our research has shown that without getting your weight in check, there is a higher chance that AFib will come back.

In this article, I’ll share the good news about optimizing your weight in the treatment of AFib. I’ll also provide the latest weight loss recommendations for AFib based on the atrial fibrillation treatment guidelines.

How Powerful is Weight Loss for AFib?

The good news is that shedding the extra weight can have profound effects on your heart, as well as on other conditions like high blood pressure, sleep apnea, or diabetes. My good friend, Dr. Prash Sanders, has shown in his research that for patients who are overweight with a BMI of 27 or higher, dropping 10% of their weight could lead to a 6-fold decrease in their AFib episodes! To put this in perspective, it means that someone overweight at 200 pounds would need a 20-pound weight loss to reduce their AFib attacks by six times.

Not sure about your BMI? Here is a link to an online BMI calculator to check if your BMI is 27 or higher.

Losing Weight with AFib is Hard

I know from firsthand experience that losing weight is hard. As described in our best-selling book, “The Longevity Plan,” I was overweight and had many medical problems that all started in my early forties. As part of our experiment for this book, 12 years ago, I lost 30 pounds to get my weight where it needed to be.

To achieve this weight loss, I had to track every bite of food and every workout. Over the last 12 years, I have tried multiple times to stop tracking every bite and every workout. Sadly, every time I stop, I quickly regain about 10 pounds in a month. Even to this day, after tracking my food and workouts so carefully for 12 years, I still regained 7 pounds of the 30 I lost.

For my AFib patients, it can be even worse. Many cannot drop the weight because they feel so poorly from their AFib. For others, every time they exercise, their hearts will go back into AFib. And for these patients who can’t seem to get anywhere with their AFib, catheter ablation of their AFib has often allowed them to get their lives back.

The Latest AFib Guidelines on Weight Loss

Based on the compelling research by my friend, Dr. Sanders, the AFib Guidelines now recommend that people with AFib and a BMI of 27 or higher should lose 10% of their body weight if possible. So, for a 300-pound person with AFib, they should lose 10% of 300 pounds, which would be a 30-pound weight loss. Also, this weight loss should be maintained, as our experience has shown that yo-yo dieting can often make AFib worse. For individuals with AFib whose BMI is below 27, there is currently no clear evidence that losing weight will help with their AFib.

How Do You Lose the Weight and Keep it Off?

As everyone is different, there is no one right path for everyone. For some, programs such as Weight Watchers can be incredibly helpful. The key is that it can’t be a diet because diets don’t work in the long run. It has to be lifestyle changes that you can maintain for the rest of your life to keep the weight off forever. For those looking to learn more, here are two articles I have written: How to Lose 100 Pounds.  The 5 Easiest Ways to Lose Weight.

About the Photo

Over the past weekend, my daughter participated in a gymnastics competition in San Diego. During our stay, we took the opportunity to go on several extended runs along the beach. Here is a photo captured during one of our runs at Solana Beach.

Disclaimer

The information provided in this blog article is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of information presented in this article. The author and the website assume no responsibility for any actions taken or not taken based on the content of this article.

Is Optimizing Your Creatinine, Glucose, and Uric Acid Levels the Secret to Longevity?

In a new study, researchers examined 1,224 Swedish people who lived to 100 to help identify the cause of their exceptional longevity. The secret to why some hit 100 while others don’t might be hidden in the routine blood tests of these longest-living individuals. This study discovered that those who reached 100 tended to have lower levels of creatinine, glucose, and uric acid (all simple lab tests your primary care physician can order for you) when compared to those who never made it to 100.

In this article we’ll review this latest study on longevity and explore why these three routine lab tests are important for living a longer life. We’ll also discuss what you can do right now to make sure your creatinine, glucose, and uric acid levels are optimized for a long and healthy life.

The Latest Longevity Study

This study enrolled 44,000 Swedes who had regular health checkups from ages 64 to 99In the pursuit of a longer and healthier life, emerging research sheds light on the significance of maintaining low serum creatinine levels. Creatinine, a waste product generated by muscle metabolism, is typically filtered by the kidneys and expelled through urine. Interestingly, studies suggest that individuals with lower serum creatinine levels tend to exhibit improved kidney function and overall health. This is particularly noteworthy in the context of longevity, as optimal kidney function is closely linked to the body’s ability to rid itself of toxins and maintain a balanced internal environment. By understanding the role of low serum creatinine in promoting longevity, we gain valuable insights into potential lifestyle adjustments and health practices that could contribute to a prolonged and vibrant lifespan.. They were tracked for up to 35 years, and out of them, 1,224, or 2.7%, lived to reach 100. Like many studies on living longer, most of the people who reached 100 (85%) were women.

This study then focused on 12 common blood tests that check for inflammation, metabolism, liver and kidney function, malnutrition, and anemia. Previously published studies have linked these 12 routine blood tests to longevity.

Among the various biomarkers examined in 12 routine blood tests, researchers identified creatinine, glucose, and uric acid levels as the most crucial for longevity.

Why is a Low Serum Creatinine Critical for Longevity?

In the pursuit of a longer and healthier life, emerging research sheds light on the significance of maintaining low serum creatinine levels. Creatinine, a waste product generated by muscle metabolism, is typically filtered by the kidneys and expelled through urine. Thus, people with lower serum creatinine levels tend to to have healthier kidneys.

Healthy kidney function is particularly noteworthy in the context of longevity, as optimal kidney function is closely linked to the body’s ability to rid itself of toxins and maintain a balanced internal environment.

9 Scientifically Proven Ways to Optimize Serum Creatinine for Longevity

If your aim is to enjoy a prolonged and healthy life, it’s essential to enhance your kidney function. Luckily, many individuals undergo an annual check of their serum creatinine levels through their primary care physicians, providing a valuable baseline. To ensure your serum creatinine lab tests remain at optimal levels, consider implementing these ten evidence-based strategies to enhance your kidney function.

1. Stay Hydrated: Adequate water intake is crucial for kidney health. Drink enough water throughout the day to help flush out toxins and support optimal kidney function.

2. Maintain a Healthy Diet: A healthy diet that includes a variety of fruits, vegetables, nuts, seeds, intact whole grains and lean proteins without processed foods or added sugars contributes to better kidney health.

3. Control Blood Pressure: As high blood pressure can damage the kidneys, make sure blood pressures are always well controlled.

4. Manage Blood Sugar: As high blood sugar can also harm the kidneys, always keep blood sugar levels in the normal range.

5. Limit Alcohol and Avoid Smoking: Too much alcohol and smoking both negatively impact kidney function.

6. Exercise Regularly: Regular physical activity promotes overall health and can help maintain a healthy weight. Activities like walking, jogging, or cycling can be beneficial for optimal kidney function.

7. Avoid Overuse of Painkillers: Frequent use of certain over-the-counter pain relievers, such as NSAIDs like ibuprofen, can harm the kidneys.

8. Get Adequate Sleep: Quality sleep is crucial for overall health, including kidney function.

9. Manage Stress: Chronic stress can have negative effects on various aspects of health, including kidney function.

Why is a Low Blood Sugar Critical for Longevity?

Aiming for a low blood sugar level is critical for longevity due to its multifaceted impact on overall health. Elevated blood sugar levels are linked to a higher risk of chronic diseases, including diabetes and cardiovascular issues, which can significantly reduce lifespan.

Beyond disease prevention, maintaining optimal blood sugar levels supports cellular health by minimizing oxidative stress and inflammation. Lower blood sugar is also associated with improved insulin sensitivity, reducing the risk of type 2 diabetes and supporting energy metabolism. Furthermore, it plays a pivotal role in preserving brain health, as high blood sugar is linked to cognitive decline and neurodegenerative diseases.

By prioritizing a balanced blood sugar level, individuals can promote cardiovascular health, enhance energy metabolism, and contribute to a healthier, more resilient aging process, ultimately increasing the likelihood of a longer and more vibrant life.

12 Scientifically Proven Ways to Keep Your Blood Glucose Levels Normal

Maintaining normal blood glucose levels is crucial for overall health and well-being. Here are 12 scientifically proven ways to help keep blood glucose levels in the normal range:

1. Healthy Diet: Follow a diet high in unprocessed whole foods, including fruits, vegetables, intact whole grains, nuts, seeds, and lean proteins. Limit or avoid processed foods, added sugars, and snack foods.

2. Portion Control: Watch portion sizes to avoid overeating, as excess food intake can lead to spikes in blood sugar levels. Pay attention to serving sizes and choose nutrient-dense foods.

3. Regular Physical Activity: Engage in regular exercise, including both aerobic activities (e.g., walking, jogging) and strength training. Exercise helps improve insulin sensitivity and regulates blood sugar levels.

4. Weight Management: Maintain a healthy weight through a combination of a balanced diet and regular physical activity. Weight management is crucial for preventing insulin resistance and maintaining normal blood glucose levels.

5. Fiber-Rich Foods: Include high-fiber foods in your diet, such as whole grains, legumes, fruits, and vegetables. Fiber slows down the absorption of sugar, helping to regulate blood glucose levels.

6. Healthy Fats: Choose sources of healthy fats, such as avocados, nuts, seeds, and olive oil. These fats have a minimal impact on blood sugar levels.

7. Hydration: Stay well-hydrated, as dehydration can affect blood sugar concentrations. Water is the best choice for hydration.

8. Regular Meal Timing: Establish regular meal times. Consistent eating patterns can help regulate blood sugar levels throughout the day.

9. Avoid Sugary Beverages: Reduce or eliminate the consumption of sugary beverages, as they can lead to rapid spikes in blood sugar levels. Also, minimize or avoid added sugars in any foods.

10. Manage Stress: Chronic stress can impact blood sugar levels. Practice stress-reducing techniques such as mindfulness, meditation, and deep breathing.

11. Adequate Sleep: Ensure you get enough quality sleep each night. Lack of sleep can affect insulin sensitivity and contribute to imbalances in blood sugar.

12. Regular Blood Glucose Monitoring: Regularly monitor blood glucose levels, especially if you have diabetes or are at risk of developing it. This allows for timely adjustments to lifestyle and medication, if necessary.

Why is a Normal Uric Acid Level Critical for Longevity?

Maintaining a normal uric acid level is critical for longevity. Elevated uric acid levels are linked to conditions such as gout, kidney stones, and hypertension, all of which can negatively impact overall health and potentially shorten lifespan. High uric acid levels have also been linked to inflammation and oxidative stress, contributing to the development of chronic diseases.

By keeping uric acid within a normal range, individuals may reduce the risk of these health complications, promoting optimal organ function and cardiovascular health. Additionally, maintaining a healthy uric acid level is essential for preventing conditions that could compromise the quality of life, ultimately supporting a longer and more robust lifespan.

8 Scientifically Proven Ways to Lower Uric Acid Levels

Lowering uric acid levels can be achieved through various scientifically proven methods. Here are some evidence-based strategies:

1. Hydration: Drinking an ample amount of water helps to flush out excess uric acid through urine. Aim for at least 8 glasses of water a day.

2. Dietary Changes: Adopting a low-purine diet can be effective. Limit or avoid high-purine foods such as organ meats, red meat, seafood, and certain vegetables like asparagus and spinach.

3. Cherry Consumption: Some studies suggest that consuming cherries may help lower uric acid levels.

4. Vitamin C Supplementation: Vitamin C has been associated with lower uric acid levels. Consider incorporating vitamin C-rich foods into your diet like broccoli, strawberries, citrus fruits, and tomatoes.

5. Limit Alcohol Consumption: Excessive alcohol intake can elevate uric acid levels. Moderation or abstinence is advisable if your goal is to lower uric acid levels.

6. Weight Management: Losing weight, if overweight, can contribute to lowering uric acid levels. However, rapid weight loss or extreme dieting should be avoided, as it can temporarily increase uric acid levels.

7. Limit Fructose Intake: High intake of fructose, particularly from sugary beverages, has been linked to elevated uric acid levels. Reduce the consumption of sugary drinks and foods.

8. Regular Exercise: Engaging in regular physical activity helps with weight management and improves insulin sensitivity, which may contribute to lower uric acid levels.

Creatinine, Glucose, and Uric Acid Levels in Our Longevity Plan Study

As you may infer from the findings presented in our bestselling book, The Longevity Plan, our group of centenarians exhibited low levels of serum creatinine, blood glucose, and uric acid, aligning with their distinctive lifestyle. Of course, optimizing your lifespan is much more involved than just three simple lab tests.

Their routine, characterized by a predominantly natural, plant-based diet complemented by wild fish, an active physical routine, minimal mental stress, restful sleep, and strong social bonds, naturally played a role in maintaining optimal levels of serum creatinine, glucose, and uric acid.

Conclusion

In closing, let us embrace the inspiring journey toward longevity with the wisdom gleaned from centenarians and the insights shared here. By nurturing a mindful lifestyle, grounded in a nourishing diet, regular exercise, restorative sleep, and meaningful connections, we pave the way for a future filled with vitality and joy. Each positive choice we make contributes to our well-being.

Disclaimer

The information provided in this blog article is for general informational purposes only and should not be considered as professional advice. The content is based on research and insights available up to the date of publication. Individual health needs and circumstances vary, and it is crucial to consult with qualified healthcare professionals for personalized advice and recommendations. Any actions taken based on the information provided in this article are at the reader’s own risk.

About the Photo

Captured at the breathtaking summit of a 10,000-foot mountain in Utah on New Year’s Day, this captivating photograph unveils the serene beauty of Scofield Reservoir draped in a pristine blanket of snow. The tranquil expanse of the reservoir, nestled within the awe-inspiring winter landscape, reflects not only the splendor of nature but also the spirit of adventure and shared moments. The climb to this snowy pinnacle with my wife symbolizes the resilience and determination we bring into the new year, facing challenges with our loved ones by our side.

Does Aspirin Prevent Atrial Fibrillation Strokes?

Unless you or someone close to you has experienced an atrial fibrillation stroke, the idea of taking a blood thinner might not be appealing. Many people are understandably worried about the risk of bleeding, and the financial aspect adds another layer of concern. For individuals without good drug coverage, popular blood thinners, like Eliquis or Xarelto, can cost a staggering $600 per month in the US, often surpassing the expense of a typical monthly car payment.

Considering these factors, it’s not surprising that I often get asked this question in my clinic: Can aspirin stop strokes caused by atrial fibrillation? Even though I wish the answer was yes, unfortunately, it’s probably not. In this article, we’ll explore the risk of strokes related to atrial fibrillation and look into the data about whether aspirin can actually prevent these strokes.

How Do Blood Thinners Prevent AFib Stokes?

Since atrial fibrillation raises the chance of having a stroke, doctors frequently recommend anticoagulants. These drugs, also known as blood thinners, aid in averting the formation of clots within your heart. The lower the risk of developing a blood clot in the left atrial appendage, a situation that may occur when the upper heart chambers stop beating during AFib, the less chance there is for a clot to dislodge and block the blood supply, leading to a lack of oxygen to the brain or other parts of your body.

Our Aspirin AFib Study

For a long time, aspirin was thought to be protective against stroke. It turns out, though, that this cheap and common remedy is actually not all that helpful. While it would be nice to think that lowering the risk of stroke was as easy as “an aspirin a day,” a study we did a few years ago demonstrated that aspirin, even in people at lower risk of stroke, simply doesn’t work very well for this purpose and, instead, puts AFib patients at risk in other ways by increasing their risk of bleeding both in the brain and elsewhere. So, In these 4,124 patients we studied, we found that not only did aspirin not help prevent strokes caused by AFib, but it also increased the chance of serious bleeding that could be life-threatening.

What Do the 2023 AFib Treatment Guidelines Say About Aspirin?

In the latest AFib treatment guidelines, the authors didn’t even give aspirin the time of the day. In fact, the wording was quite strong: “In patients patients with AF who are candidates for anticoagulation (blood thinners), aspirin as an alternative to anticoagulation (blood thinners) is not recommended to reduce stroke risk.”

Put simply, if you have enough risk factors for stroke due to AFib (CHADS-VASc score of 2 or higher), don’t even consider using aspirin as a replacement for your prescribed blood thinner. If you’re unsure on whether you should take a blood thinner or not for your AFib you can quickly CHADS-VASc Score.

Congestive heart failure: 1 point

High blood pressure: 1 point

Age 65 or higher: 1 point

Diabetes: 1 point

Stroke or TIA history: 2 point

Vascular disease (blockage in any artery): 1 point

Age 75 or higher: 2 points

Sex (female gender): 1 point

The goal with the CHADS-VASc scoring system is to keep your score as low as possible. If your score is zero blood thinners are not recommended. If your total score is 1 then blood thinners are optional. And if your CHADS-VASc score is 2 or higher the guidelines recommend blood thinners.

Aspirin is Still Important for Other Medical Conditions

While aspirin may not be especially helpful for preventing Afib strokes, it is still used for other conditions. For example, if you have had a stent placed in one of your arteries, then chances are that your physician wants you to take aspirin for the rest of your life. Likewise, if you have had a heart attack or a left atrial appendage occluding device to help prevent AFib strokes, like Watchman, your cardiologist will also probably want you to take aspirin for the rest of your life.

Putting it All Together

The take home message is that aspirin may not prevent AFib strokes but this medication is still used for other reasons. If your CHADS-VASc score is 2 or higher and you can’t take prescription blood thinners for whatever reason, talk to your cardiologist about other options.

Disclaimer

The information provided is for general informational purposes only. It is not intended as medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

About the Photo

The image included in this blog post captures a moment from a recent run I undertook. This stunning run unfolded on a snow-covered trail situated high above Soldier Summit in Utah during the enchanting sunset hours.

Does Testosterone Increase the Risk of Atrial Fibrillation?

In our best-selling book, The Atrial Fibrillation Cure, we noticed something missing back then – solid info on how testosterone supplements might affect the risk of atrial fibrillation. But fast forward today and we now have new studies hinting that taking testosterone might actually raise the chances of getting Afib. So, in this article, we’re going to discuss why so many men take testosterone, the possible heart-related risks it brings, and what you should think about if you’re dealing with cardiac issues and are considering testosterone therapy.

Why Do So Many Men Take Testosterone?

Numerous medical studies suggest that testosterone plays a pivotal role in various aspects of men’s health. Research indicates that adequate testosterone levels contribute to muscle development, bone density, and overall vitality. Moreover, testosterone is associated with improved muscle strength, sex drive, cognitive functions, including enhanced mood and cognitive performance. Indeed, some have even claimed that testosterone might be the “Fountain of Youth” for aging men. But with all of these positive effects from testosterone, some studies suggested that testosterone may have a dark side when it comes to the heart.

Does Testosterone Supplementation Cause Heart Disease?

Given that studies were unclear on the cardiovascular effects of testosterone supplementation in men, the Food and Drug Administration (FDA) mandated that manufacturers of testosterone products conduct clinical trials. In response to this FDA mandate, the TRAVERSE Study was just completed and published in the prestigious New England Journal of Medicine.

The TRAVERSE Study

The TRAVERSE Study was a multi-center study involving 5,246 men aged 45 to 80. These men all had symptoms of low testosterone levels below 300 ng/dL and either pre-existing cardiovascular disease or were at a high risk of cardiovascular disease. They were then randomized to receive testosterone supplementation or a placebo and were followed for a mean of 33 months to assess cardiovascular safety.

Findings of the TRAVERSE Study

Below are the key findings of this study:

1. There was no statistical difference between testosterone supplementation and placebo with regards to cardiovascular death, heart attacks or stroke, or requirement for coronary after bypass surgery or coronary stenting.

2. There was no statistical difference in the risk of prostate cancer between the two groups.

2. The risk of developing atrial fibrillation was 45% higher in the testosterone group (p=.02).

3. Twice as many people in the testosterone group had a pulmonary embolus (blood clot traveling to the lungs) when compared to placebo.

4. The risk of kidney damage was 53% higher in the testosterone group (p=.04).

Dr. Day’s Take on the Testosterone AFib Risk

This study, along with other studies, suggest a higher risk of atrial fibrillation linked to testosterone supplementation. Considering that a low testosterone level isn’t an immediate threat to life, the discovery of an increased atrial fibrillation risk is concerning.

For my patients dealing with significant discomfort due to low testosterone symptoms, we might think about trying out testosterone, keeping a close eye on their heart health. Ideally, everyone would have a home ECG device and check their heart’s rhythm daily. But, for some, monitoring at home isn’t possible. In those cases, I may recommend a 30-day heart monitor while starting testosterone to watch out for atrial fibrillation.

The main point is, if testosterone makes their atrial fibrillation worse, I suggest stopping the supplementation. But if it doesn’t make things worse, they can keep using testosterone safely.

Disclaimer

The information provided in this blog is intended for general informational purposes only and should not be considered as medical advice. The content is not a substitute for professional medical expertise, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding any medical concerns, conditions, or treatment options.

About the Photo

The image included in this blog post captures a moment of me skiing alongside my daughter during the Christmas holiday, braving a wind chill temperature of 5 degrees below zero. Despite the bitterly cold weather, our commitment to spending quality time together on the slopes remains unwavering, ensuring that we never miss a skiing day whenever I have time off from work.

How Many Hours of Sleep Does Your Heart Need?

While everyone knows that not getting enough sleep is bad for your heart and for your lifespan, is there a risk associated with getting to much sleep? Also, for those who struggle to sleep at night, is there anything you can do to erase the risks of not getting enough sleep? Read on to learn the answers to these questions.

The Goldilocks Zone of Sleep

Getting the right amount of sleep is crucial for a healthy heart and a longer life. The study, involving 92,221 participants who were followed for 7 years, found that sleeping 6 to 8 hours a night was considered optimal. This study used an accelerometer to accurately determine when people were exercising and when they were sleeping.

Those who slept less than 6 hours faced a 34% increased risk of dying over 7 years, with a striking 56% higher risk of heart disease-related deaths. Surprisingly, sleeping more than 8 hours also increased the risk, but not as much as insufficient sleep. Striking a balance, around 7 hours of sleep, emerged as the sweet spot for heart protection and reducing the risk of premature death.

Exercise Erases Any Bad Sleep in this Study

After examining the charts and tables, it seemed that getting just a bit more than 7 hours of sleep each day was the healthiest for shielding your heart and reducing the chances of dying from heart disease or any cause. For those snoozing only 3 hours a day, their risk of heart disease or any other fatal issue was incredibly high, off the charts, to be exact. Surprisingly, even people sleeping over 10 hours daily faced a significantly elevated risk of heart disease or death.

Now, the most fascinating part of the study emerges. If you’re someone really into exercise, you can wipe out the higher risks associated with both too little and too much sleep. Surprisingly, even those catching less than 3 hours of sleep each night saw their increased risks of heart disease and death virtually disappear with intense levels of exercise. The same went for those sleeping more than 10 hours – their heightened risks seemed to almost vanish with more than ample exercise.

The individuals with the lowest rates of heart disease and death in the study were the ones getting the usual amount of sleep (6-8 hours daily) and going beyond the recommended exercise levels (more than 150 minutes per week of intense exercise that gets your heart pumping and makes you break a sweat). On the flip side, those with the highest risks of heart disease and death were the ones doing less than 150 minutes per week of exercise and sleeping either less than 6 hours or more than 8 hours daily.

Cancer Risks Based on Sleep and Exercise Duration

Similarly, the study revealed that the correlation between sleep duration, exercise, and health risks extended to cancer as well. To achieve the utmost protection against both heart disease and cancer, it’s imperative to engage in more than 150 minutes of moderate to vigorous physical exercise per week while ensuring a consistent sleep routine of 6 to 8 hours each night.

Straying from these optimal ranges significantly elevates the risks of cancer and heart disease. Thus, maintaining a balance by meeting these recommended guidelines emerges as a powerful strategy for minimizing health risks and promoting overall well-being.

Why is this study so important?

This study is super important for a few big reasons. First off, it’s the first one I’ve seen that connects how much we move, measured by fancy gadgets called accelerometers, to how we sleep and how that affects our chances of getting heart disease, cancer, or even dying. This new way of looking at things gives us a better, more detailed understanding of how exercise, sleep, and our health are all interconnected.

Second, it gives us hope if you’re someone who either doesn’t get enough sleep or sleeps too much, you can basically cancel out those risks by doing more exercise than the usual advice suggests. And get this – there’s no such thing as too much exercise in this case; the more, the better.

Lastly, this study outshines the ones before it because it uses accelerometers to keep track of how much people move and how long they really sleep. This high-tech method makes the study’s findings much more reliable, making it way more trustworthy when it comes to understanding how sleep, exercise, and health are all interconnected.

How could exercise help those who don’t get enough sleep or sleep too much?

I think exercise might lower the risk of dying linked to both short and long sleep through different ways. When it comes to not getting enough sleep, there are a bunch of health problems tied to it, like your nervous system going into overdrive, insulin levels not well controlled, problems with your blood vessels, and inflammation.

Not sleeping enough also makes you eat too much, leading to gaining too much weight. Exercise does good things for your heart as it fights off inflammation, and helps your body handle sugar better. It can even fix some of the issues with blood vessels caused by lack of sleep. The various good things that exercise does for your health could be the reason it lessens the risk of dying from not sleeping enough.

On the other hand, when you sleep a lot, it might not be because of the sleep itself but a sign of other health problems. But in this study, the risk of dying went down more for people who slept a lot when they started exercising more. This might mean that the problems connected to sleeping too much could be balanced out by spending more time exercising.

Since both sleep and exercise need time, super long sleep might get in the way of doing enough exercise. These discoveries hint that exercising more could help offset the risks tied to sleeping too much and might be a key part of staying healthy.

Exercise: The Ultimate Equalizer

Even if you find yourself on the extremes of the sleep spectrum – either sleeping less than 6 hours or more than 8 hours – regular exercise can be your superhero. The study revealed that getting more than the recommended amount of exercise (more than 150 minutes per week of moderate to vigorous exercise) completely erased the increased risk associated with too little or too much sleep.

Whether you’re a short sleeper or enjoy longer nights, engaging in more than the recommended amount of exercise eliminated the heightened risks. The magic combination for the lowest heart disease and death risk? Sleeping 6 to 8 hours daily and exceeding the recommended 150 minutes of moderate to vigorous exercise each week.

Practical Tips for Optimal Sleep

Improving your sleep doesn’t have to be complicated. Establish a consistent sleep schedule by going to bed and waking up at the same time every day. Create an ideal sleep environment – a dark, cool room with minimal noise. Say goodbye to electronic devices before bedtime, and consider relaxing activities like a warm shower. As someone who battled insomnia, I’ve found that exercising for at least 2 hours a day, sticking to my 10 pm bedtime, and enjoying a warm shower before bed guarantee me an excellent night of sleep.

Make Exercise Enjoyable and Sustainable

Making exercise a regular part of your routine doesn’t have to be a chore. Find an activity you genuinely enjoy, mix it up to prevent overuse injuries, and consider group workouts for added motivation.

Personally, I love outdoor activities like mountain biking, trail running, and hiking, especially with my family during the warmer months. In winter, I hit the slopes for skiing with my wife or my children. On busy days at the hospital, I turn to our home’s indoor bike or elliptical machine. And whenever I’m sitting at my desk working I’m peddling a bike. Consistency is key – find what you love, and make it a daily commitment.

Take Control of Your Heart Health and Longevity

In conclusion, this groundbreaking study highlights the interconnectedness of sleep and exercise in influencing mortality risks. By optimizing both, you can significantly enhance your chances of a longer, healthier life (and avoid cancer as well). Strive for that sweet spot of 6 to 8 hours of sleep and exceed the recommended exercise guidelines. Your heart will thank you, and you’ll be on the path to a more vibrant, fulfilling life.

About the Photo

In the captivating image featured in my blog article, our family is joyously conquering the heights of a majestic mountain, blending the thrill of mountain climbing with the exhilaration of skiing down the mountain. Although only the beginner ski runs are officially open, the allure of untouched terrain beckons those willing to embark on a challenging hike. The sheer beauty of the snowy landscape, coupled with the physical exertion of climbing the mountain without the help of a chairlift, adds a unique dimension to the adventure.

Disclaimer

The information provided in this blog is intended for general informational purposes only and should not be considered as professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Never disregard professional medical advice or delay in seeking it because of something you have read on this blog. Reliance on any information provided by this blog is solely at your own risk. The author shall not be held responsible for any inaccuracies, errors, or omissions in the content or for any actions taken based on the information provided here.

Is There Really a Link Between Atrial Fibrillation Onset Age and Future Dementia?

A study published this past week found that people who develop atrial fibrillation at a younger age are at increased risk of getting dementia later in life. Our research has shown that AFib doubles the risk of dementia but this is the first study to show that the earlier you get AFib the worse your dementia prognosis. Is this really the case and what can you do to protect your brain now?

The New Study: Age at Diagnosis of Atrial Fibrillation and Incident Dementia

This study, which looked at a large group of people over many years, used information from the UK Biobank, a public database in the UK. They collected baseline information from 2006 to 2010.

In their main analysis, they included 433,746 participants who didn’t have dementia or atrial fibrillation at baseline. They then followed these people for an average of 12.6 years to see who developed dementia and atrial fibrillation.

The study showed that being diagnosed with AFib at a younger age was directly linked to a greater chance of developing dementia. This risk was most significant for people diagnosed with AFib before turning 65 years old. The dementia risk was somewhat lower for those diagnosed with AFib between the ages of 65-74. And for those diagnosed with AFib at 75 or older, the dementia risk was the lowest.

Why Are AFib Patients at Increased Risk of Dementia?

The connection between atrial fibrillation and a higher risk of dementia is not completely clear, but there are several factors that seem to contribute:

1. Cerebral Microembolism:

AFib can cause blood clots in the heart, and these clots might travel to the brain, causing small blockages in blood vessels. These tiny blockages, or microemboli, can lead to small strokes, which may contribute to cognitive decline and a greater risk of dementia.

2. Reduced Blood Flow:

The irregular heartbeat in AFib can result in less efficient blood pumping, leading to lower blood flow to the brain. This reduced blood supply over time might contribute to the development of dementia.

3. Inflammation and Oxidative Stress:

AFib is associated with inflammation and oxidative stress, processes that can harm brain cells and contribute to neurodegeneration, which is linked to dementia.

4. Shared Risk Factors:

AFib and dementia share common risk factors like getting older, having high blood pressure, gaining weight, diabetes, and plaque build up in arteries. When these factors are present, it can increase the chances of both conditions happening at the same time.

5. Brain Changes:

AFib might be connected to changes in the structure of the brain, like the development of white matter lesions which can be seen on brain MRI studies. White matter lesions tend to occur in people with plaque build up in their arteries, high blood pressure, inflammation, poor lifestyles, or aging. In simpler terms, white matter lesions are like glitches in the brain’s communication network.

Why Might Younger AFib Patients Be at Higher Risk of Dementia?

While this study suggests that younger AFIb patients might be at higher risk for dementia, this is not yet proven. Younger individuals may have a longer time frame for the cumulative impact of risk factors associated with both AFib and dementia, such as high blood pressure, obesity, diabetes, and vascular diseases (plaque build up in the arteries). The combined effect of these risk factors over an extended period may increase the likelihood of developing dementia.

On the flip side, it could result directly from atrial fibrillation. Over time, the formation of tiny blood clots, or microclotting, may occur with AFib. The consistently irregular and rapid heart rate might of AFib might harm vulnerable brains over the decades. Another possibility is that it stems from reduced blood flow to the brain when in atrial fibrillation.

6 Ways to Protect the Brain from Atrial Fibrillation

Atrial fibrillation, the most common heart rhythm disorder, not only poses challenges to cardiovascular health but can also impact brain function. Here are 6 ways to protect the brain from AFib.

1. Maintain Normal Sinus Rhythm if Possible:

Whenever possible, normal sinus rhythm should be the goal. Treating atrial fibrillation (AFib) early increases the chances of putting it into remission. Sadly, a lot of our patients have been dealing with AFib for years before coming to us. In these cases, getting back to a normal heart rhythm might be difficult because the AFib has been happening for too long.

2. Take a Blood Thinner if Indicated:

Given that strokes, mini-strokes, or even asymptomatic microclotting can harm the brain over time in individuals with AFib, it’s crucial to consistently take any prescribed blood thinners. If you have AFib, discuss with your doctor to determine whether a blood thinner is recommended for you.

3. Religiously Adhere to a Heart Healthy Lifestyle:

Studies suggest that the majority of cases involving AFib and dementia can be averted by consistently adopting a heart-healthy lifestyle. This involves adhering strictly to a predominantly plant-based, unprocessed diet, maintaining a healthy weight, engaging in daily exercise to heal the brain, prioritizing adequate sleep, addressing sleep apnea if present, managing stress, giving importance to quality time with family and friends, and avoiding tobacco and alcohol.

4. Manage Risk Factors:

This involves monitoring your heart rhythm daily with a home ECG device for any indications of AFib, checking your blood pressure daily to ensure it remains at or below 120/80, tracking blood sugars regularly for those with diabetes to maintain normal levels, and consistently weighing yourself to sustain a healthy weight.

5. Mentally Stimulate Your Brain Daily:

To safeguard your brain from dementia, it’s essential to actively engage and stimulate it on a daily basis. The age-old saying “use it or lose it” rings true in this context. Participate in meaningful activities regularly that challenge and stimulate your brain, such as learning a new language or musical instrument. Maintain social connections to stay mentally active. Incorporate daily exercise into your routine to enhance blood flow and promote healing in the brain. Embrace the learning of new technologies to keep your mind sharp and adaptable.

6. Never Miss a Workout:

The importance of daily exercise cannot be overstated if your goal is to overcome AFib and reduce the risk of dementia. Physical activity boosts blood flow to the brain and elevates BDNF (brain-derived neurotrophic factors), encouraging the brain to heal and establish new electrical connections. Think of BDNF as fertilizer for your brain. Therefore, keep a record of your daily workouts, and if you’re using a smartwatch like the Apple Watch, set a goal to consistently complete your “exercise rings” each day.

The Good News from this Study

Although younger individuals with AFib seem to face an increased risk of dementia, the positive side is that treating AFib in younger patients is more straightforward. In fact, the younger you are, the higher the probability that our treatments will effectively maintain a normal sinus rhythm in your heart. Additionally, at a younger age, your body is more resilient, healing more rapidly from any damage that AFib may have already caused.

About the Photo

Accompanying this article is a snapshot from one of my routine mountain runs, a cherished activity shared with my daughter. Taken during a breathtaking fall run in Neff’s Canyon, outside of Salt Lake City, the photo captures the essence of our 100% commitment to daily exercise. This serene backdrop serves as a reminder of the positive impact that daily physical activity can have on our lives. The trails we traverse not only strengthen our bodies but also symbolize the proactive steps we take to reduce the risks of AFib and dementia.

Disclaimer

The information provided in this article is for educational and informational purposes only and is not intended as medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. Reliance on any information provided in this article is solely at your own risk.

How Many Steps a Day Do You Need to Cheat Death and Avoid Heart Disease?

Everyone knows that walking is healthy, but have you ever wondered just how many steps it takes to cheat death and steer clear of heart disease? In a world where the pursuit of longevity is a common goal, a recent meta-analysis of 17 studies, involving nearly 227,000 participants followed for 7. 1 years, unveils a captivating connection between the simple act of walking and the potential to extend life while fortifying the heart. This groundbreaking exploration brings forth a message of hope: each step you take is a stride towards a longer, healthier life, challenging preconceived notions and opening the door to a personalized path to well-being.

Your Risk of Dying in the Next 7.1 Years Based on Your Step Count

After looking at the graphs and tables in the study, it turns out that how much you walk each day can affect your chances of living longer. So here is my very rough estimate from the graphs in this study of how many steps you need each day to still be alive 7.1 years from now.

If you make an effort to walk around 5,000 steps every day, the chances of living longer become 50% better compared to someone who only walks 1,000 steps daily. If you want to get the most out of your efforts, increasing your daily step count from 1,000 to 5,000 gives you the highest rewards. So, according to what I learned from this study, it’s a good idea for everyone to do their best to reach at least the 5,000 steps daily goal. Remember, every step you take is a step toward a healthier and longer life, and it’s something achievable that can make a big difference if you still want to be around in 7.1 years.

If you go up to 10,000 steps every day, the benefit is even bigger – your chance of dying is about 80% less than someone doing only 1,000 steps a day. But here’s the catch: once you go beyond 10000 steps daily, the benefits start to slow down.

For example, taking 15,000 steps daily only decreases your risk of dying by 90%, and going all the way up to 20,000 steps daily only decreases your risk by 95%, compared to someone who only moves 1,000 steps daily. So, it’s not just about walking more; finding the right balance that fits your abilities is key, and even a small increase in daily steps can make a big difference in how long you live.

How Should You Track Your Steps?

When it comes to keeping tabs on your daily steps and overall heart health, investing in a smartwatch is a wise move, especially for those under my care as a cardiologist specializing in cardiac arrhythmias.

For  my patients that are iPhone users, I highly recommend the Apple Watch series 4 or later (or any of the Ultra models), which not only monitors your heart rhythms and conducts ECGs but also effortlessly tracks your daily steps.

On the Android front, my preference leans towards the Samsung Galaxy Watch or one of the Fitbit watches that can also track heart rhythms and ECGs in additions to steps. Equipping yourself with a smartwatch tailored to your phone not only ensures accurate step tracking but also provides valuable insights into your heart health, empowering you to take proactive measures for a healthier lifestyle.

If investing in a smartwatch is not within your budget, there are free pedometer apps available for both iPhones and Android phones. These pedometer apps allow you to monitor your daily steps without the need for any additional expenses. While these smartphone apps don’t offer ECG capabilities, there are more affordable ECG devices, such as the Kardia monitor, priced between $70 to $80 on Amazon.

A Message of Hope

In conclusion, this comprehensive meta-analysis study offers a resounding message of hope: every step you take is a step toward a healthier heart and a longer life. Regardless of age, gender, or location, the benefits of walking are universal and attainable. The study not only reaffirms the importance of physical activity but also encourages a personalized approach to health, highlighting that every step counts.

Once you have received approval from your physician to boost your physical activity, aim to add at least one more step to your daily count compared to yesterday. Gradually increase your step count, taking small, manageable steps toward a more active and healthier lifestyle.

So, lace up your walking shoes and embark on a journey towards improved cardiovascular health. Whether it’s a leisurely stroll or an ambitious walk, your heart will thank you for every step you take. Remember, the power to enhance your well-being is right beneath your feet!

Disclaimer

Prior to making any significant changes to your physical activity, especially in relation to step count, it is crucial to consult with your physician or healthcare professional. Increasing your step count should be done gradually and under the guidance of a healthcare provider to ensure it aligns with your individual health needs and conditions. This article provides general information and encouragement, but individual health considerations should always take precedence, with professional advice sought for personalized guidance.

The 4 Secrets Why the Tsimane People Don’t Get Heart Disease, AFib, or Dementia

Tucked away in the secluded corners of the Bolivian Amazon, there’s a community that’s a source of fascination for researchers and health enthusiasts—the Tsimane people. Surrounded by the rich and diverse Amazon rainforest, the Tsimane live a life far removed from the advancements of modern society. Across generations, they’ve thrived by relying on the resources of the land while upholding a distinct social structure that greatly contributes to their exceptional health and overall well-being. In this article, we’ll delve into the four secrets as to why the Tsimane people don’t get heart disease, atrial fibrillation, or dementia.

Life in a Tsimane Village

In the villages lining the Amazon River in Bolivia, you’ll find about 16,000 Tsimane people. Their homes are built using natural materials such as wood, palm leaves, and thatch. What’s striking about their community is how closely-knit it is, fostering a strong sense of shared responsibility and support among its members.

The Tsimane way of life revolves around sustaining themselves from the land. They hunt, fish, and farm to meet their daily needs. Hunting provides meat, while fishing adds fish to their diet. Their farming includes growing crops like plantains, maize, and manioc. They also gather wild fruits, nuts, and other edible plants from the forest, which are crucial parts of what they eat.

Living in Tsimane villages means living with limited access to modern conveniences like electricity, running water, or high-tech gadgets. Their lifestyle is far removed from the complexities of the modern world.

Their community’s structure is based on family ties and social connections. Decisions are often made by reaching a consensus within the community, and the elders are highly respected for their wisdom and experience.

The Tsimane Don’t Get Heart Disease Study

For many years, Dr. Hillard Kaplan and his team from the National Institute on Aging and St. Luke’s Hospital of Kansas City have been amazed by the Tsimane people living deep in the Amazon jungle. These indigenous folks show an incredible resistance to heart disease. Recently, the results of their extensive research have grabbed global attention in the media.

The research team dived into a thorough study, visiting 85 Tsimane villages to closely check how common heart disease was among this community. They used CT scans on every adult Tsimane they could find for the study, a total of 705 participants. These scans were super important in looking at heart health, checking things like coronary artery calcification, blood pressure, cholesterol levels, and signs of inflammation linked to heart disease.

For those not familiar with medical tests, a CT scan that looks at coronary artery calcification is a powerful way to find blockages or heart problems. And as we know, how we live greatly impacts whether we might get clogged arteries. Plus, the level of artery hardening often connects to how long a person might live. And if you’re interested in what you own coronary calcium score might be, for a fee of just $69, you can undergo this test at our hospital.

The research revealed something amazing: out of the 705 Tsimane adults studied, a huge 85% had no signs of any heart artery plaque. This gave them a perfect score of zero on this test, showing their hearts were in great shape. What’s even more incredible is that 65% of Tsimane folks over 75 years old had no heart plaque at all.

To put this in perspective, nearly all people over 75 in the United States have some heart artery plaque. What the Tsimane people showed in this study about their low heart disease risk is unlike anything seen before, showing just how resistant they are to heart issues compared to most people in the world.

Even though the Tsimane people face a lot of inflammation from dealing with many infections, they have the least amount of heart disease ever recorded compared to any other group. This study tells us that most people can prevent heart artery problems by having low cholesterol, keeping their blood pressure and sugar levels low, having a healthy weight, not smoking, and staying physically active throughout their lives.

The Tsimane Don’t Get Atrial Fibrillation Study

Is it Your Genes or Your Lifestyle that Determines How Long You’ll Live?

Many of my patients believe that their fate in terms of heart disease and early mortality is solely written in their genes. They often tell me things like, “My grandma and mom both had atrial fibrillation, so it was no surprise when I was diagnosed with it.” But it’s essential to consider whether they shared the same genes or simply shared a similar lifestyle. In other words, their shared lifestyle choices might have contributed to their same health issues, like fitting into the same-sized jeans and experiencing Afib.

A New Study on Genes vs Lifestyle:

A recent study involving 5,446 women with an average age of 78.2 years shed light on this subject. Researchers examined their key longevity-related genes and monitored their physical activity by strapping accelerometers onto them. After six years of observation, 1,022 of these women had passed away.

The findings were clear: Irrespective of your genetic makeup, the more physically active you are, the longer you tend to live. Similarly, sitting less correlates with an extended lifespan. When it comes to longevity, the influence of physical activity significantly outweighs the genetic hand you’ve been dealt.

These results align with a wealth of other studies, all pointing to the same adage: “Move it or lose it.” If you stop moving, you risk losing the ability to move as you age. Additionally, reduced physical activity makes it increasingly difficult to maintain mobility in later life. As the saying goes, “motion is lotion,” and it holds true – if we don’t move, we may eventually lose the ability to move.

What do other study say on genes versus lifestyle?

A second study focused on the lives of nearly 3,000 identical and fraternal twins from Denmark, taking into account both genetic and environmental factors. So, while these individuals shared nearly identical genetic backgrounds, they displayed a wide range of medical conditions and lifespans. Their conclusion was enlightening – “longevity seems to be only moderately heritable.” For women, they estimated that approximately 26 percent of longevity was influenced by heredity, and for men, it was about 23 percent. The rest, they affirmed, is within our control.

In a third study, researchers analyzed 54 million family trees utilizing data from Ancestry.com. Astonishingly, they found that only 7 percent of a person’s lifespan can be attributed to their genes.

Our Research Findings on Genes versus Lifestyle

In our bestselling book, “The Longevity Plan,” we embarked on an incredible journey to unravel the mysteries of long and healthy lives. Our destination: China, where we conducted a remarkable five-year study of centenarians, individuals who had reached the extraordinary age of 100 and beyond. What we discovered was truly astonishing.

At first glance, it appeared that these centenarians possessed genes that, by all predictions, should have made them vulnerable to heart disease, dementia, and early mortality. But here’s the incredible twist: these remarkable individuals had not fallen victim to these grim predictions. Instead, they were living vibrant, healthy lives well into their 100s. How did they manage this seemingly miraculous feat? The answer, we found, lay not in their genes, but in their lifestyle.

You see, it’s not just about the genes you inherit; it’s about how you influence them through the way you live your life. This concept can be summed up in one word: epigenetics. Think of your genes as the instructions for your body’s functions. Epigenetics, in essence, is like the conductor of an orchestra, telling the genes which notes to play and when to play them.

The centenarians we studied had genes that could have played a rather unpleasant tune—heart disease, dementia, and early demise. However, their extraordinary longevity was a result of their lifestyle choices. These choices effectively “reprogrammed” their genes, like a skilled conductor guiding an orchestra toward a beautiful symphony.

So, what can we learn from these remarkable individuals? Your genes might set the stage, but you hold the conductor’s baton. With a healthy lifestyle, you can lead your genes toward harmony, ensuring that they play a melody of long-lasting health and vitality, instead of a tune of illness and aging. It’s a powerful reminder that the choices you make today can pave the way for a long and vibrant life tomorrow.

Your DNA is Not Your Destiny

These four studies collectively emphasize one essential truth: your DNA is not your destiny. Even if your ancestors suffered from heart disease or early mortality, it doesn’t mean you are fated to the same outcome. Ultimately, it’s not your genes but your lifestyle choices that predominantly determine your susceptibility to health issues in this lifetime.

What do I tell my heart patients?

So, what’s the daily prescription I give to my patients for a long, joyful, and healthy life? It’s genuinely straightforward: prioritize a diet rich in natural, plant-based foods to maintain a healthy weight. Dedicate an hour each day to exercise. Ensure you get at least seven hours of restful sleep every night, and seek treatment if you have sleep apnea. Incorporate daily stress-reduction practices. Lastly, make ample time for friends, family, neighbors, and the community – these connections are invaluable to a long and fulfilling life. Your destiny is in your hands, not in your genes.

About the Photo

Incorporating the captivating essence of our blog post’s photo, it captures the idyllic scene of sheep leisurely grazing against the stunning backdrop of the Park City ski resort, set under the golden hues of a late October afternoon. This particular day was not just about the breathtaking landscape, but also a tale of adventure and exploration. My son and I were embarking on a remarkable 26-mile, 3.5-hour mountain bike journey that wound its way through a dynamic terrain, seamlessly connecting the mid-mountain and Wasatch Crest trails. As we traversed these scenic routes, the sheep’s serene presence served as a reminder of the tranquility that can be found in the heart of the wilderness.

Disclaimer

The information provided in this blog article is intended for general informational purposes only. It should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this blog.

10 Reasons Why You Might Be So Tired

In the clinic this past week, many of you shared your struggles with fatigue and a desire to understand why you’re feeling so tired. Drawing from my years of research and clinical experience, I want to shed light on the 10 common reasons why you might be experiencing low energy levels.

1. Your Sleep Might Be Off

Quality sleep is the foundation of boundless energy. Sleep apnea, nighttime awakenings, and even nocturia (frequent urination at night) can disrupt your rest. If you snore or suspect sleep apnea, seek evaluation. Sleep apnea dramatically increases your risk of atrial fibrillation and may even shorten your life.

Also, consider the timing of diuretic medications, and if necessary, consult a urologist for urinary issues. For my patients taking “water pills,” I encourage them to take these medications in the morning so that the effects are gone by bedtime.

Maintain a consistent sleep schedule to promote better sleep quality. If you can train your body to go to bed and awake at roughly the same time each day your energy levels should increase.

2. You May Not Be Exercising Enough

Believe it or not, exercise is a potent energy booster. Regular physical activity enhances mood, aids in weight management, and significantly improves sleep. Indeed, the very best “energy pill” I can offer my patients is regular daily exercise.

I encourage my patients to gradually increase their activity levels, aiming for 10,000 daily steps and at least one hour of moderate-intensity exercise. And for my patients who can achieve these exercise goals they all sleep better at night.

Everyone can do something for regular daily exercise. Even my elderly patients confined to a wheelchair can still do wheelchair aerobics, yoga, or workout with arm weights.

3. You Might Be Eating the Wrong Foods

Your diet plays a crucial role in energy levels. Processed foods, prepared foods, eating out, sugary snacks, and refined carbohydrates can zap your vitality.

Fuel your body with energy-rich foods, with a special focus on vegetables and avoiding sugary and highly processed items. To optimize your energy levels, eat as naturally and clean as you possibly can and avoid any foods that spike your blood glucose levels like bread, pastries, or snack foods.

4. You May Not Be Drinking Enough Water

Dehydration can leave you feeling tired. Aim to drink enough water daily until your urine has a slight yellow tinge. Many find that sipping water throughout the day helps combat fatigue.

5. You Might Be Too Stressed

Stress is an energy thief. If you’re juggling multiple responsibilities, look for ways to reduce stress. Explore stress-relief techniques such as yoga, meditation, prayer, nature walks, or regular exercise to find what works best for you.

6. You Might Be on too Many Medications

Certain medications, especially beta-blockers, can cause fatigue. Review your medication list with your physician to identify any potential culprits and explore alternatives.

While you should never stop a medication on your own, there may be natural approaches to get you off some of your pills. For example, many of my patients have found that by losing 10 to 20 pounds they may be able to get off their blood pressure or diabetes medications. Likewise, for my patients suffering from atrial fibrillation, an ablation procedure may allow they to get off their beta-blockers and other fatigue inducing antiarrhythmic medications.

7. You May Have a Medical Condition that isn’t Being Optimally Treated

Atrial fibrillation, heart failure, thyroid problems, anemia, depression, etc. can all contribute to fatigue. Consult your doctor for testing and appropriate treatment to regain your energy.

For my patients suffering from AFib, many find that if we can keep their hearts in normal sinus rhythm their energy levels improve. And for those who may have been out of rhythm for too long to get back into normal sinus rhythm, often just controlling their atrial fibrillation heart rate significantly improves energy levels.

8. You Might Be Carrying Too Much Weight

Excess weight can weigh you down, both physically and energetically. Many of my patients have experienced a surge in energy as they shed those extra pounds. Also, many of your health conditions or medications may go away if you can drop a few pounds.

9. You’re Smoking or Might Be Drinking Too Much Alcohol

Both smoking and excessive alcohol consumption can drain your energy and hinder sleep quality. Seek guidance from your healthcare provider if you’re looking to quit or reduce these habits.

10. You May Have a Caffeine Problem

While caffeine can provide a temporary energy boost, excessive or late-day consumption can disrupt sleep patterns. Be mindful of your caffeine intake and aim to limit it, especially in the hours leading up to bedtime.

Conclusion

Your energy levels are a valuable asset, and it’s within your power to rejuvenate them. By addressing these ten common factors, you can take proactive steps toward a more energized, vibrant, and fulfilling life.

About the Blog Photo

When our family needs a recharge, Lake Powell is our sanctuary for exercise, de-stressing, and quality family time. The real magic? In most spots, there’s no cell signal, giving us a much-needed technology ‘detox.’

Disclaimer

The information in this blog article is for educational purposes and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding any medical concerns, and never disregard or delay seeking medical advice based on information in this article.

Too Busy to Exercise? New Study Shows Weekend Warrior Exercisers Get the Same Benefit

In our fast-paced lives, finding the time for daily exercise can be a challenge. But here’s some fantastic news that might just make your day: a groundbreaking study conducted by Harvard Medical School, led by Dr. Patrick Elenor, who was my former Stanford medical student and current chief of cardiology at Harvard, reveals that you can enjoy the same health benefits with concentrated weekend workouts as you would with daily exercise.

The Importance of Physical Activity:

Guidelines have long recommended at least 150 minutes of moderate to vigorous physical activity per week for overall health benefits. However, the big question has always been whether it’s better to spread your exercise evenly throughout the week or concentrate it into just a couple of days.

The Study:

To answer this question, the study examined data from the UK Biobank cohort, which included 89,573 individuals. These participants wore accelerometers to track their physical activity levels between June 8, 2013, and December 30, 2015.

The researchers compared three exercise patterns: the “active weekend warrior” (achieving at least 150 minutes with more than 50% of total exercise over 1-2 days), “active regular” (achieving at least 150 minutes spread out fairly evenly throughout the week), and “inactive” (achieving less than 150 minutes).

The Positive Findings:

The results of the study are incredibly encouraging. Both the ‘active weekend warrior’ and ‘active regular’ groups showed similarly lower risks of heart disease.

Atrial Fibrillation Episodes: Active weekend warriors saw 22% fewer AFib episodes, and active regular exercisers saw 19% fewer AFib episodes when compared to inactive people.

Heart Attacks: For heart attacks, the active weekend warriors enjoyed a 27% lower risk, while the daily exercisers enjoyed a 35% lower risk than couch potatoes.

Heart Failure Risk: When it came to heart failure risks, the results were similar. Weekend warrior exercisers had a 38% lower risk, and the daily exercisers had a 36% lower risk when compared to couch potatoes.

Stroke Risk: For the dreaded risk of a stroke, once again, weekend warrior exercisers experienced 21% fewer strokes, and the daily exercisers experienced a 17% lower risk.

Hard-Core Exercisers Had the Same Positive Benefits:

Interestingly, when Dr. Patrick Elenor and his team examined the ‘hard-core’ exercisers, those who engaged in 230 minutes or more of exercise each week, they discovered a similar outcome. Both the weekend warriors and the daily exercisers experienced significantly fewer instances of atrial fibrillation, heart attacks, or heart failure when compared to couch potatoes.

Conclusion:

The study’s conclusion is clear: you don’t need to exercise every day to reap the rewards of physical activity. Concentrating your exercise efforts within 1-2 days can provide the same health benefits as spreading it out throughout the week. So, if your schedule is hectic and you find it challenging to work out daily, don’t be discouraged. Embrace the role of a weekend warrior, and you’ll still be on track to a healthier, happier you.

Remember, the most important thing is to find an exercise routine that fits your lifestyle and is sustainable in the long run. So, get out there, make the most of your weekends, and enjoy the many benefits that come with being a weekend warrior! Your health will thank you for it.

About the Photo:

This photo captures a memorable weekend adventure that perfectly complements the uplifting message of the article. In the image, you’ll see the fall colors adorning the Brighton Ski resort from a 10,000 foot view.

Together with my two teenagers, we embarked on an exhilarating mountain bike ride along the scenic Wasatch Crest Trail this past Saturday. This photo embodies the spirit of seizing weekends for fulfilling and health-boosting activities, even amidst our busy lives.

Disclosure:

Before embarking on any new exercise program or making significant changes to your current routine, it’s essential to prioritize your health and safety. Please consult with your healthcare provider or a qualified medical professional before starting a new exercise program. They can assess your individual health status, provide valuable guidance, and tailor an exercise plan that is safe and suitable for your unique needs and circumstances.

How to Double the Longevity Benefit of Exercise

In the pursuit of a healthier and longer life, regular exercise has long been regarded as a fundamental component. But is it possible to double the longevity benefit of exercise?

We have all heard about the importance of meeting the federally recommended amount of physical activity to reduce the risk of premature death. However, recent research conducted by Harvard’s School of Public Health reveals a fascinating new twist. According to their study, individuals who go above and beyond the minimum guidelines can enjoy even greater benefits, significantly lengthening their lifespan. In this article, we explore the intriguing findings that suggest exercising more than recommended could be the key to a longer and healthier life.

The Study

The study, published in the prestigious journal Circulation, involved an extensive analysis of 30 years’ worth of medical records and mortality data from over 100,000 adults enrolled in the renowned Nurses’ Health Study and the Health Professionals Follow-Up Study. The study aimed to investigate the relationship between physical activity and its impact on life expectancy.

Recommended Exercise Guidelines

Before delving into the study’s findings, let’s review the federally recommended physical activity guidelines. For optimal health benefits, adults are advised to engage in either:

150 to 300 minutes per week of moderate-intensity activity, or

75 to 150 minutes per week of vigorous-intensity activity.

Basically, Americans are asked to exercise 21 to 43 minutes daily of moderate-intensity activity or, if they want to reduce their exercise time by doing vigorous-intensity activity, they could cut this time in half to 11 to 21 minutes each day.

The Impact of Meeting the Minimum Guidelines

The researchers found that individuals who adhered to the minimum recommended guidelines enjoyed a considerable 21% reduction in their risk of early death. These statistics alone confirm the importance of regular physical activity in enhancing overall health and longevity.

Exceeding the Recommendations

However, the study’s most intriguing revelation came when investigating the effects of surpassing the minimum guidelines. Participants who exercised two to four times more than the recommended amount experienced an astonishing 31% reduction in their risk of early mortality. This significant improvement in life expectancy demonstrates that there might be additional benefits to pushing the boundaries of our physical activity routines.

Can You Stop the Progression of AFib with a Catheter Ablation?

The Natural Progression of Atrial fibrillation (AFib) can start with sporadic episodes, where the heart’s rhythm is irregular but self-terminates. This stage where AFib terminates on its own is known as paroxysmal AFib. Paroxysmal AFib may not cause significant harm to the heart initially, and some individuals may not even be aware of the condition.

Unfortunately, if left untreated, the progression of AFib ultimately may lead from the self-terminating paroxysmal form to the persistent or permanent stages. During the persistent phase, the episodes often become more frequent and may no longer self-terminate. Indeed, medical intervention, like an electrical cardioversion or “shock,” may be required to restore normal sinus rhythm. If AFib remains untreated, AFib may eventually evolve into a permanent state, where any efforts to restore normal sinus rhythm may be futile.

In this article, I share the results of a new study comparing antiarrhythmic medications versus a catheter ablation procedure to stop the natural progression of AFIb.

Why is AFib so Dangerous?

Atrial fibrillation or “AFib,” for short is often described as an irregular and rapid heartbeat, affects millions of people worldwide. Left unchecked, this condition can progress from occasional episodes (paroxysmal) to more frequent and sustained occurrences (persistent) and ultimately to a chronic and irreversible state (permanent). The repercussions can be severe, leading to fatigue, shortness of breath, strokes, and heart failure.

However, there is hope. Advances in medical science have introduced effective interventions that can halt AFib’s progression and even send it into remission particularly if coupled with healthy lifestyle changes. Among these, catheter ablation stands out as a game-changer. But before we explore the remarkable power of this procedure, let’s understand the natural progression of AFib if left untreated.

Breaking the Chain: Interventions that Make a Difference

The good news is that the progression of AFib is not set in stone. Early detection and appropriate measures can significantly alter the course of this condition. Making lifestyle changes, such as weight loss and adopting other heart-healthy habits, can provide a positive impact.

Additionally, antiarrhythmic medications may be prescribed to control the irregular heart rhythm and prevent further complications. While these interventions can be beneficial for some patients, many patients cannot tolerate these medications or these medications don’t work for them. And for those patients in whom the drugs don’t work or they don’t want to be stuck on these drugs for the rest of their lives, the answer is often a catheter ablation procedure.

What is a Catheter Ablation?

Catheter ablation for atrial fibrillation (Afib) is a minimally invasive medical procedure designed to restore the heart’s normal rhythm by targeting and eliminating the abnormal electrical signals responsible for the irregular heartbeats. It is an outpatient procedure which doesn’t involve any cutting or stitches.

During the procedure, thin, flexible catheters are threaded through an IV in the leg and guided to the heart. Once in position, the catheters deliver controlled energy, such as radiofrequency or cryotherapy, to target the misfiring heart cells causing the AFib. Catheter ablation has emerged as a highly effective treatment option to restore normal sinus rhythm without the need for lifelong antiarrhythmics.

The Power of Timely Treatment: Results of a New Study

In a groundbreaking study recently published in the New England Journal of Medicine, researchers from Canada compared the effectiveness of catheter ablation to antiarrhythmic drugs in slowing AFib’s progression.

The study involved 303 patients who were followed for 3 years. One group was randomized to ablation and the other group was randomized to antiarrhythmic drugs. Over a 3-year follow-up, the ablation group experienced significantly better outcomes. Only 1.9% of patients in the ablation group had persistent AFib episodes, compared to 7.4% in the drug therapy group.

The ablation group also had less overall AFib episodes and 3-times less hospitalizations due to Afib-related issues. Also, serious adverse events were twice as likely with the antiarrhythmic drugs when compared to catheter ablation. Thus, not only was catheter ablation much better at stopping the progression of AFib but was also much safer than the antiarrhythmic drugs.

Beyond the Study: Insights from Our Experience:

Drawing from our extensive experience in treating tens of thousands of Afib patients, we can attest to the transformative effects of catheter ablation. For many of our patients, this procedure, especially when coupled with healthy lifestyle changes including weight loss, has resulted in significant improvements and generally complete remission of Afib without the need for antiarrhythmic drugs.

Remember, you don’t have to face Afib alone. Reach out to a cardiac electrophysiologist or “EP” (a cardiologist specializing in atrial fibrillation) near you to explore treatment options, and make lifestyle changes that support your heart’s well-being.

The Blog Photo

Feast your eyes on the breathtaking beauty of the Wasatch Crest Trail, a mountain biking and running trail that stands as one of the most scenic and awe-inspiring trails in the US! Stretching from Big Cottonwood Canyon to Millcreek Canyon, this epic path at about the 10,000 foot level offers a mesmerizing panorama of the majestic mountains overlooking Salt Lake City and Park City. For the last 2 days, my daily exercise has been to ride this trail on my mountain bike. And if you look closely you can still see a few patches of snow that haven’t yet melted…

Disclaimer

The information provided in this blog article is for general informational purposes only and should not be considered as medical advice or a substitute for professional medical consultation, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding a medical condition.

Dr. Day’s 10 Food Suggestions for Longevity and Cardiovascular Health

Building and maintaining a healthy diet is a cornerstone for longevity and cardiovascular health. The choices we make about what we eat and drink can have a profound impact on our well-being, energy levels, and long-term health. In this article, I will share my 10 food suggestions for longevity and cardiovascular health.

For those readers looking for a deeper dive on nutrition for longevity and cardiovascular health, please check out my books The Longevity Plan and The AFib Cure. In each of these books I provide a chapter on how to optimize nutrition, including meal suggestions, for longevity and cardiac health.

1. Be Careful with Grains

While there has been a recent wave of books and websites vilifying grains, the scientific literature doesn’t support this belief. It is processed grains that should be a cause for concern, as they are essentially sugary products responsible for the obesity crisis and the prevalence of conditions like atrial fibrillation, diabetes, and a premature death.

When it comes to grains, moderation is key. While they can certainly be a part of a balanced diet, it’s important to consume them in appropriate quantities. For individuals aiming to lose weight, temporarily eliminating grains from their diet until they reach their target weight may be worth considering. This allows for better control over calorie intake and can help with weight management.

When incorporating grains into your diet, opt for whole or intact grains rather than processed ones. Whole grains retain their nutrient-rich bran and germ, providing essential vitamins, minerals, and fiber. Processed grains, on the other hand, have been stripped of these valuable components, leaving behind little more than refined starch.

Flourless bread, such as Ezekiel bread, can be a healthier alternative for those seeking a grain option that won’t cause a rapid spike in glucose levels. Without the finely ground flour, the release of glucose into the bloodstream is more gradual, providing sustained energy and reducing the risk of blood sugar imbalances.

Another option to consider is sourdough bread. The fermentation process involved in making sourdough lowers the glycemic response of the bread, meaning it causes a slower rise in blood sugar levels compared to conventional bread.

Remember, everyone’s nutritional needs and sensitivities are different, so it’s important to listen to your body and make choices that work best for you.

2. Nuts and Seeds Daily in Moderation

When it comes to nuts and seeds, they are nutritional powerhouses that offer a wide range of health benefits. While some popular health books and websites may have demonized peanuts, it’s important to look at the scientific evidence. From a scientific standpoint, peanuts provide similar health benefits as other nuts. So, if you enjoy them, there’s no need to exclude them from your diet.

Incorporating a variety of nuts and seeds into your eating routine is beneficial. Each type brings its unique combination of nutrients, including healthy fats, protein, fiber, vitamins, and minerals. The wider the variety, the better, as different nuts and seeds offer varying profiles of beneficial compounds.

While I recommends nuts and seeds daily, it’s important to consume nuts and seeds in moderation. They are energy-dense foods, meaning they contain a high number of calories. Keeping portion sizes in check is key to avoid excessive calorie intake. The good news is that nuts and seeds can actually help with feelings of satiety due to their high fiber and protein content so you don’t always feel so hungry.

When enjoying nuts and seeds, be mindful of added flavors, coatings, or salt. Opt for raw or lightly roasted varieties whenever possible to maximize their nutritional value and avoid unnecessary additives.

Consuming nuts and seeds regularly has been associated with numerous positive outcomes for overall health. They have been linked to a reduced risk of heart disease, improved cholesterol levels, and better blood sugar control. Incorporating a variety of nuts and seeds into your diet can support brain function, lower inflammation, and contribute to healthy aging.

Remember, individual nutritional needs may vary, so it’s important to listen to your body and choose the nuts and seeds that you enjoy and suit your dietary preferences.

3. Fruits and Vegetables: 9 Servings Daily

When it comes to fruits and vegetables, they are the foundation of a healthy diet. Aim to include a generous amount of these nutrient-packed foods in your daily meals. I recommend consuming a total of 9 servings of fruits and vegetables per day, with the majority of those servings coming from vegetables.

Eating a wide range of fruits and vegetables is important to ensure you receive a diverse array of vitamins, minerals, antioxidants, and phytochemicals. Each fruit and vegetable offers unique nutritional benefits, so incorporating a variety is key to obtaining a well-rounded nutrient intake.

When preparing vegetables, it’s best to avoid drowning them in cheese sauces or dressings that can add unnecessary calories, saturated fat, and sodium. Instead, opt for healthier cooking methods such as steaming, roasting, or sautéing with minimal oil. This allows the natural flavors and nutrients of the vegetables to shine.

One group of vegetables that deserves special attention is cruciferous vegetables. These vegetables are known for their exceptional health benefits. Examples of cruciferous vegetables include broccoli, cauliflower, Brussels sprouts, cabbage, kale, and bok choy. These vegetables are rich in vitamins, minerals, fiber, and various bioactive compounds that have been associated with reduced cancer and cardiovascular risk and improved overall health.

When it comes to fruits, berries stand out as a particularly nutritious choice. Berries such as blueberries, strawberries, raspberries, and blackberries are packed with vitamins, antioxidants, and fiber. They have a low glycemic response, meaning they have a minimal impact on blood sugar levels. The high fiber content in berries further supports satiety and digestive health.

Remember, these recommendations are general guidelines, and individual nutritional needs may vary. It’s important to choose fruits and vegetables that you enjoy and suit your dietary preferences. By focusing on a variety of vegetables, with an emphasis on cruciferous vegetables, and incorporating nutrient-rich berries into your fruit intake, you can maximize the nutritional benefits of these plant-based foods.

4. Legumes Daily

Legumes are an incredibly nutritious and versatile food group that often gets overlooked. Including legumes in your diet is highly beneficial, and I recommend incorporating them into your meals on a daily basis.

Legumes encompass a wide range of plant-based foods, including beans, lentils, chickpeas, peas, and Edamame or soybeans. These humble yet powerful legumes offer an abundance of nutrients, including protein, fiber, complex carbohydrates, vitamins, minerals, and antioxidants. They are also typically low in fat and cholesterol-free.

It’s worth noting that soybeans, a type of legume, have faced some criticism in popular literature and websites. However, when it comes to unprocessed whole soybeans, the scientific data tells a different story. The demonization of soybeans stems mainly from concerns about their phytoestrogen content. However, extensive research indicates that consuming unprocessed whole soybeans have been associated with various health benefits, including improved heart health, reduced risk of certain cancers, and better bone health. It’s important to distinguish between whole soybeans and heavily processed soy products when considering their impact on health. Incorporating whole soybeans into your diet, such as edamame, can be a nutritious and beneficial choice.

Including legumes in your daily meals has numerous health benefits. They contribute to heart health by reducing cholesterol levels, supporting weight management due to their high fiber content and ability to promote satiety, and aiding in blood sugar control. Legumes also provide essential nutrients for overall well-being, such as potassium, magnesium, and folate.

To incorporate legumes into your diet, try adding them to salads, soups, stews, or as a base for vegetarian dishes. You can also enjoy them in spreads like hummus or as a filling for tacos and burritos. The possibilities are endless!

Remember, legumes are a fantastic addition to a balanced and nutritious diet. Aim to include them in your meals on a daily basis to reap their many health benefits and enjoy their delicious flavors.”

5. Dairy is a Personal Choice

The 2-Minute Workout to Prevent AFib and Extend Your Healthy Lifespan

Everyone knows daily exercise is at the heart of a long and healthy life. However, it is disheartening to observe that two-thirds of my patients, and most people in the US, don’t exercise consistently. In light of this, I would like to share a revolutionary approach inspired by the work of James Clear from his book, Atomic Habits, that can help everyone incorporate exercise into their daily routine.

The 5 Easiest Ways to Effortless Weight Loss: Insights from Over 25 Years of Patient Experiences

Are you tired of the exhausting struggle to lose weight? Countless diets, intense workouts, and endless sacrifices can leave you feeling discouraged and overwhelmed. But what if I told you there’s a better way?

After decades of working closely with my cardiac arrhythmia patients on their weight loss journeys, I’ve uncovered 5 simple strategies that consistently yield remarkable results for my patients. Whether your goal is to prevent atrial fibrillation attacks, live longer, or simply feel better, these five proven strategies from my clinical practice can work for you.

In this article, I’ll share 5 effortless weight loss strategies successfully used by my patients. This is not some fancy new study. These are real world observations from my patients over the last 25 years who have lost the weight and kept it off over the years.

You only need to implement one of the 5 strategies to see results. Just pick the strategy that seems easiest to try for you. Get ready to unleash your full potential and achieve lasting results that will leave you feeling motivated, energized, and ready to conquer any challenge that comes your way!

Unlock Effortless Weight Loss: Choose Your Winning Strategy

In the pursuit of weight loss, it’s easy to feel overwhelmed by the myriad of advice, diets, and strategies available. But what if I told you that you don’t have to do it all? Based on my experience as a cardiologist and the invaluable insights gained from my patients over the past 25 years, I have discovered a remarkable truth: success lies in choosing just one of these five effortless weight loss strategies.

Imagine the power of selecting a single approach, focusing your energy and intention on mastering it, and witnessing the transformation unfold before your eyes. Whether your goal is to prevent health issues like atrial fibrillation, extend your lifespan, or simply feel better in your own skin, you have the power to make a significant change by implementing just one of these strategies.

Throughout my years of practice, I have made it a point to ask my successful weight loss patients about the secret to their achievement. To my surprise, the majority of them credit their remarkable results to a single strategy. They wholeheartedly committed to one approach and experienced extraordinary outcomes.

So, as you embark on your own weight loss journey, I invite you to choose your winning strategy from the following five options: make your home a junk food free zone, close the kitchen at 6 pm, eliminate all added sugars, embrace zero calorie hydration, or make 90% of your plate vegetables. Each strategy holds immense potential for transformation, and it’s up to you to select the one that resonates with your aspirations and aligns with your lifestyle.

So, which strategy will you choose? The path to effortless weight loss awaits, and it starts with a single decision. Harness your determination, embrace the power within you, and embark on a journey that will shape not only your physical appearance but also your overall well-being and sense of empowerment. Your success story is waiting to be written, and it begins with the transformative power of a single strategy.

1. Make Your Home a Junk Food Free Zone (if you can’t see it you won’t eat it)

“To put it bluntly, I have never seen someone consistently stick to positive habits in a negative environment.” These powerful words from New York Times bestselling author and habit guru, James Clear, perfectly encapsulate the essence of our first strategy for effortless weight loss. As a practicing cardiologist with over 25 years of experience, I can wholeheartedly echo this sentiment.

Almost uniformly, in a moment of weakness, my patients will eat whatever junk food has been dragged into their house. However, by consciously removing these triggers from your home, you empower yourself to make better choices even in moments of vulnerability.

Creating a positive environment is crucial for cultivating lasting habits and achieving your weight loss goals. By removing junk food from your home, you eliminate the constant temptation that can derail your progress. Imagine walking into your kitchen and being greeted by shelves filled with fresh produce, wholesome ingredients, and nourishing snacks. With every glance, you are reminded of your commitment to a healthier lifestyle and the empowering choices that await you.

In our own household, I have discovered a strategy that empowers both me and my children to make healthier choices. I encourage my kids to hide their junk food, and I make it clear that if I find it, it will be thrown in the trash. This approach not only safeguards me from temptation but also fosters a sense of ownership and responsibility in my children. They become active participants in supporting my journey towards a healthier lifestyle.

This solution may seem unconventional, but it embodies the essence of taking charge of our environment and our choices. By implementing this practice in your own home, you create a dynamic where everyone is invested in maintaining a haven of health. Encourage open communication with your loved ones and make them aware of your commitment to effortless weight loss. Together, you can find creative ways to ensure that tempting junk food remains hidden, allowing your entire family to embrace a more nutritious and fulfilling way of life.

Remember, true transformation begins with inspired action. By creating an environment that supports your goals and involving your loved ones in the process, you forge a powerful alliance. Let your home be a sanctuary where healthy choices thrive, where your family rallies around a shared vision of vitality and well-being. As Tony Robbins often says, “It is in your moments of decision that your destiny is shaped.” So, decide today to craft a supportive environment and inspire those around you to join you on this incredible journey towards effortless weight loss.

2. Close the Kitchen at 6 pm (to harness the power of intermittent fasting)

Imagine a transformative strategy that could not only help you shed pounds but also put ailments like high blood pressure, diabetes, and atrial fibrillation into remission without relying on drugs or invasive procedures. The remarkable story of Mark, one of my patients, serves as a shining example of the extraordinary results that can be achieved by simply implementing the practice of not eating after 6 PM. Mark had lost 42 pounds over the course of year just by not having a midnight snack before bed. Not only did this make his high blood pressure, diabetes, and atrial fibrillation all go away without drugs or procedures but also allowed him to feel several decades younger.

This strategy, rooted in the principles of intermittent fasting, has been backed by numerous studies showcasing its ability to facilitate remarkable weight loss for many people. Get ready to tap into the power of time-restricted eating and unlock a world of possibilities for your own health and well-being.

Intermittent fasting, by closing the kitchen at 6 PM and abstaining from food until breakfast the next morning, provides your body with an extended period of rest and rejuvenation. During this time, your body can efficiently process and utilize stored energy, promoting fat burning and optimizing metabolic function. It’s a powerful approach that taps into your body’s innate ability to heal and restore itself.

Embrace the opportunity to transform your mealtimes into a structured, empowering practice. By implementing a 6 PM kitchen closure, you create a clear boundary that supports your weight loss goals and promotes vibrant health. The process of intermittent fasting not only aids in shedding excess weight but also offers a range of benefits, from improved digestion and increased energy levels to enhanced mental clarity and focus.

3. Eliminate all Added Sugars (free yourself of this compulsive addiction)

In the pursuit of vibrant health and effortless weight loss, there is a powerful step that can yield remarkable results: eliminating all added sugars from your diet. The truth is, sugar provides no nutritional benefit and can have detrimental effects on our well-being. By breaking free from its grasp, you open the door to a healthier, more fulfilling lifestyle.

Numerous studies have shed light on the addictive nature of sugar and its impact on our brains. One particularly notable unpublished study conducted by Connecticut College captured attention when it revealed that sugar can be more addicting than cocaine, triggering obsessive-compulsive behaviors within the brain. In this experiment, rats were offered sugar, and the astonishing findings showed that sugar activated the same neuroreceptors as cocaine, with an unexpectedly stronger response.

For my patients who have successfully chosen to eliminate sugar entirely from their lives, the results have been nothing short of extraordinary. They have witnessed dramatic and effortless weight loss, experiencing the transformative power of freeing themselves from the clutches of this addictive substance. By severing ties with sugar, they have taken a crucial step towards reclaiming their vitality and achieving their weight loss goals.

Personally, I have embarked on a journey of eliminating added sugars from my diet for many years. The impact on my health and overall well-being has been nothing short of transformative. While I have now allowed myself the indulgence of very dark chocolate with minimal sugar, the awareness of the detrimental effects of excessive sugar consumption remains ingrained in me.

I invite you to join me on a 30-day challenge, perhaps with a loved one or a friend, where we collectively commit to saying no to added sugars. It’s important to clarify that we are targeting added sugars specifically, as whole fruits, with their natural sugars, are not included in this restriction. Let’s see how this 30-day journey unlocks new levels of vitality and empowers us to make healthier choices that nourish our bodies and minds. Together, we can break free from the grip of this addictive substance and embrace the sweet abundance of a life fueled by wholesome, unprocessed foods.

4. Zero Calorie Hydration (don’t waste your calories on things that won’t fill you up)

One crucial key to effortless weight loss lies in a simple yet profound decision: don’t drink any calories. The science behind this strategy reveals a fundamental truth – liquid calories fail to provide the satiety we need to feel satisfied and full. By eliminating or minimizing beverages like chocolate milk, sugary drinks, and alcohol from your daily intake, you open the door to a world of effortless weight loss and renewed vitality.

Research supports the notion that liquid calories do not satiate us in the same way that solid foods do. Our bodies have evolved to respond differently to the act of eating compared to drinking. When we consume calories in liquid form, our brains may not register them as effectively, leading us to consume more overall. By shifting our focus to zero-calorie hydration from water, we create space for healthy, fulfilling foods that truly nourish us.

Personally, I have lived by this principle for over a decade, abstaining from drinking any calories. The impact on my well-being has been remarkable. Water has been my drink of choice, refreshing and invigorating me throughout the day. If water alone doesn’t appeal to you, consider adding a twist of lemon, strawberry, or another fruit to infuse natural flavor and enhance your hydration experience.

It is important to note that while I advocate for eliminating liquid calories, I am a strong supporter of smoothies. Smoothies, when prepared with nutritious ingredients like nut butter, spinach, kale, and berries, offer a powerhouse of vitamins, minerals, and fiber. My wife prepares a daily breakfast smoothie for our children, providing them with a delicious and wholesome start to their day.

Embrace the power of zero-calorie hydration and experience the liberating effects it has on your weight loss journey. By choosing water as your primary beverage and exploring the vibrant flavors nature has to offer, you create a foundation of health and vitality. As Tony Robbins often reminds us, “It’s not what we do once in a while that shapes our lives, but what we do consistently.” Make the consistent choice to prioritize zero-calorie hydration and witness the effortless weight loss and lasting satisfaction it brings to your life.

Raise your glass – filled with refreshing, zero-calorie goodness of water – to a future where nourishing your body is a celebration, and where every sip brings you closer to the vibrant, healthy life you deserve.

5. Make 90% of Your Plate Veggies (fill up on the healthiest foods)

Imagine a simple yet powerful strategy that allows you to fill up on nutrient-dense, low-calorie foods while minimizing those that may contribute to weight gain. Strategy #5 is all about making 90% of your plate a vibrant array of vegetables. By embracing this approach, you tap into the natural wonders of fiber and water content that vegetables offer, filling yourself up with nourishment and vitality.

For over a decade, I have wholeheartedly embraced the power of making 90% of my plate vegetables. This unwavering commitment has been the cornerstone of my success in maintaining a remarkable 30-pound weight loss for more than ten years. The impact has been profound, not just on my physical appearance, but on my overall well-being and vitality.

The magic lies in the incredible benefits that vegetables bring to the table. Packed with essential nutrients, vitamins, and minerals, they offer a spectrum of vibrant flavors and textures that ignite your taste buds and energize your body. The fiber and water content in vegetables work harmoniously to create a sense of satiety and fullness, ensuring that you feel satisfied while consuming fewer calories.

By making vegetables the star of your plate, you create a symphony of health and well-being. Their colorful presence not only delights your senses but also fuels your body with the vital nutrients it craves. Imagine savoring the crispness of fresh greens, the earthy sweetness of roasted root vegetables, or the vibrant crunch of bell peppers. Each bite takes you closer to your weight loss goals, all while reveling in a world of culinary delights.

Embrace this strategy as a transformative journey of exploration and discovery. Allow the allure of vegetables to captivate your imagination and inspire your taste buds. As Tony Robbins famously says, “It’s what you practice in private that you will be rewarded for in public.” Practice the art of making vegetables the heart and soul of your meals, and witness the remarkable changes it brings to your body, mind, and spirit.

Remember, the goal is not about depriving yourself or eliminating entire food groups. It’s about making conscious choices and finding balance. While grains and other foods have their place, the emphasis here is on the overwhelming presence of vegetables, letting their nutritional prowess take center stage. Let them light up your plate and fuel your journey towards effortless weight loss and vibrant health.

So, dive into the world of veggies, explore their incredible variety, and revel in the abundance they offer. Fill your plate with their vibrant colors, and watch as your body transforms, your energy soars, and your well-being flourishes. With each meal, you are nourishing not only your body but also your aspirations and dreams for a healthier, more fulfilling life.

Disclaimer

The information provided in this article is for educational and informational purposes only. It is not intended as medical advice or a substitute for professional medical guidance, diagnosis, or treatment. Always consult with your healthcare provider before starting any weight loss program or making significant changes to your diet or exercise routine.

Every individual is unique, and what works for one person may not work for another. Your healthcare provider is the best resource to evaluate your specific health conditions, assess any potential risks, and provide personalized recommendations tailored to your needs. They can consider factors such as your medical history, current medications, and individual circumstances to guide you on a weight loss approach that is safe and suitable for you.

The Blog Photo

In closing, I would like to invite you to reflect on the captivating photo attached to this article. Taken by my wife during our recent visit to the French Quarters in New Orleans, it captures the beauty and serenity of the basilica of Saint Louis King of France. As we embarked on evening walks amidst the scientific sessions of the Heart Rhythm Society, this photo serves as a reminder of the importance of balance and harmony in our lives. Just as the basilica stands tall and majestic, so too can we find strength and resilience within ourselves as we embark on our weight loss journey. Let it inspire you to embrace the effortless strategies shared in this article and unlock a world of transformation and well-being. May you find the inner peace and radiance that accompany a healthy body, mind, and spirit as you pursue your path to a vibrant and fulfilling life.

What’s Worse for Living a Long Life—Loneliness or Eating a Bad Diet?

If you want to live a longer, healthier, and happier life, it’s every bit as important to be socially connected as it is to what you eat. In fact, it now seems clear from the research that being socially connected is an even more important factor in our current and long-term health than what we eat.

Being socially connected can be with your family. It can be your friends. It can be your neighbors. It can be people with similar interests with whom you maintain a connection. And, especially in the digital age, it doesn’t necessarily have to be geographically located; it can be people you feel connected to, via social media, even if you have never met each other in person.

However, you chose to define it, though, one thing is clear: When we strengthen our social connections, we strengthen ourselves.

Should You Give Your Parents a Coffin at Age 60?

There is a tradition in the Longevity Village, the mountainous area of Southwest China that has the highest percentage of centenarians in the world, that we studied in our bestselling book, The Longevity Plan, in which children build a coffin for their parents when they reach the age of sixty. That might seem morbid, but I’ve come to learn that it is not in any way because the children believe their parents are close to death. Much to the contrary, the practice is intended to let aging parents know that everything has been taken care of, and they do not have to worry that their deaths might be a burden upon their kin.

As Masongmou, age 107 at the time, shared with me, “My son has already prepared three coffins for me,” she said. “The first two became old, molded, and fell apart.”

That, I learned, was quite common. The wooden coffins tended to last ten or twenty years before they began to rot and fall apart.

Masongmou wasn’t eager to die, but when the time came, she said, she would be ready and content. And the way she saw it, death would give her a special opportunity to give back to her community.

Does Worshiping Your Ancestors Promote Longevity?

As is the case throughout most of China, each home in the village has a shrine. Ancestor worship—jìzǔ, in Mandarin—is deeply ingrained in Chinese culture and rooted in Confucian philosophy. Many Chinese believe the deceased have a special ability to do favors for the living, and can even shower their living descendants with blessings and fortune. That’s one of the reasons they make offerings to their ancestors, even burning paper money to make sure departed loved ones have plenty of cash to spend in the spirit world.

There’s a powerful social effect to this belief system. For in addition to whatever heartfelt familial obligations children feel they have to their elders, the constant presence of an ancestral shrine in people’s homes is a persistent reminder that the way parents are treated in this life won’t be forgotten when they pass on. This certainly isn’t to say that the Chinese wouldn’t be devoted to their parents anyway; the Chinese take elder care quite seriously.

Indeed, China is the only nation in the world I know of where children can be prosecuted for not visiting their parents often enough. But the spiritual coupling of familial responsibility and self-interest turns out to be a powerful motivator that helps keep the elderly engaged in the lives of their families in ways we sometimes fail at here in the United States.

What results from this belief is an understanding of mutual need that lasts until a person’s very last breath. Nearly every home in Longevity Village is inhabited by three or more generations from the same family. Each generation relies on the others for emotional, educational, social, and economic support. Children are expected to give grandparents and great grandparents love and companionship. Elders, in turn, are expected to help children learn to be good scholars and good people, and to help out with cooking and cleaning as much as they are able. Everyone is important in a meaningful way. That’s what social connection is all about.

How Dangerous is Loneliness?

It would be very hard to overstate the health benefits of feeling capable and connected to others in this way. Regardless of age, people who feel as though their communities don’t need them are at increased risk of depression and high blood pressure, and have been shown to be more susceptible to all sorts of other ailments. Disconnection is the beginning of loneliness, and that is even worse for our long-term health: Research suggests people who feel lonely are more than twice as likely to suffer from Alzheimer’s disease.

The indelible feeling of capability and connection I saw in the people of Longevity Village isn’t always present in the lives of my patients. And that’s a real problem, because loneliness and social isolation can actually be more dangerous to your health than smoking or even being an alcoholic, and perhaps twice as dangerous as being obese.

Yet even as our nation spends hundreds of millions of dollars on antismoking campaigns, billions treating alcoholism, and hundreds of billions battling the health consequences of obesity, we haven’t treated social connectedness as the public health priority it should be.

Does Modern Life Make Us Lonely?

Perhaps it’s no wonder that between 1985 and 2004—years that saw an explosion of cable television channels, a proliferation of angry talk radio shows and, of course, the emersion of the Internet from relative academic obscurity to the predominant media force of our time—the number of Americans who don’t have a single person with which to discuss matters that are important in their lives nearly tripled.

The trappings of our modern society can leave us helpless, frustrated, isolated, and sick. But these parts of our lives can also be tools we use to strengthen our connections with friends and families, and build our communities in ways that will help us feel stronger, more important and healthier than we’ve ever been.

Masongmou is the perfect example of this. When I next returned to the village, her wheelchair was nowhere to be seen. “My family and friends told me that I’d been in it long enough,” she explained. “They said, ‘you need to start walking again’ and so I did.”

Rosemary’s Loneliness

Recently, while seeing a patient who was suffering from a heart arrhythmia, I inquired about who she considered to be part of her support network.

“Oh, Rosemary,” she said with a sly smile.

“Is that your daughter?” I asked.

“No, my cat,” she laughed. “The best friend a woman could have!”

We both got a good chuckle out of this, but I did want to know that she also had some human support. Did she have regular visitors? Did she ever feel lonely?

“How could I feel lonely?” she asked. “I have three wonderful kids and seven beautiful grandchildren. Someone is over at my place almost every weekend.”

“And the weekdays?”

“Oh, well,” she said. “Those days can get pretty lonely. But I wouldn’t want to complain.”

I assured her that it was perfectly reasonable to feel lonely after four or five days spent with her cat as her only companion. We discussed the health implications of loneliness, and some strategies for addressing it.

Is Social Isolation More Dangerous than Smoking, Alcoholism, or Obesity?

In one of the biggest studies ever done to explore the role of friends and family on longevity, Dr. Julianne Holt-Lunstad from Brigham Young University (BYU), published a study of 308,849 people.  In this study she found that of all the common longevity factors, such as exercise, maintaining a healthy weight, or not smoking, that being socially connected was the most important.  Indeed, her study showed that people who were socially connected lived 50% longer!

With regards to mortality, here are the 3 key findings of this study:

          1. Social isolation is more dangerous than smoking 15 cigarettes a day

          2. Social isolation is more dangerous than becoming an alcoholic

          3. Social isolation is twice as dangerous as obesity

Do People Hide Their Loneliness?

I’ve definitely noticed in my patients a tendency to downplay or deny feelings of loneliness. The deeper we get in conversation, though, the more it’s clear that this is a problem that impacts a lot of their lives, sometimes without them ever realizing it. And that’s increasingly problematic in a world in which isolation is increasingly the status quo.

Elders are far from the only people who get lonely. Loneliness is actually one of the most common emotions among Americans of every age, so much so that many people don’t even realize that they are, in fact, chronically lonely. That feeling isn’t something to be ashamed of; it’s simply our body’s way of telling us that we need to work a bit harder toward the goal of connecting with our community.

How do we do that? I often tell my patients that the best way to cure their loneliness is to cure someone else’s. After all, when two isolated people are together, they’re no longer isolated.

On occasion I’ve asked patients who appear to suffer from loneliness to do a bit of “homework,” using the Internet to research recreational sports teams, interest groups, political organizations, book clubs, volunteer organizations, and lifelong learning classes that they might be interested in joining. All of these avenues are great ways to meet new people, and the mere act of looking into these opportunities is often enough to get people to try them out.

14 Reasons Why You Got AFib

So, why did you get atrial fibrillation? There are a lot of possible substrate causes—some of which you can control and some of which you cannot. Below is a list of the 14 most common reasons why our patients have developed AFib.

1. You Inherited the Wrong Gene

Some people inherit a genetic predisposition that makes AFib more likely. Up to a third of all people who have atrial fibrillation without another identified cause have a familial history of the condition.

At least fifteen different “potassium channel” mutations have been linked to AFib and at least seven “sodium channel” mutations are associated with AFib. Potassium and sodium ions are atoms that carry electric charges and thus are essential to the signaling system that tells parts of the heart to contract in rhythm. But a lot of non–ion-channel mutations have been linked to AFib, too. These include mutations in a protein-coding gene called NUP155; a gene linked to many heart disorders known as LMNA; a gene called NPPA that encodes a vital hormone created in the heart; and a set of genes known as GATA4, GATA5, and GATA6 that are key to the development of new heart tissue.

Those aren’t the only genes that have been linked to AFib, though—there are actually more than one hundred. Even if we were to create an exhaustive list, it would soon be outdated. Emerging research is revealing other “candidate genes” that may have links to AFib. For now, however, there isn’t a test that can scan all of the known and potential “AFib genes.”

While over-the-counter commercial DNA tests can scan for some, you’re really just scratching the surface with these products. What’s important to note is that while it can be very helpful to know whether you’ve inherited a genetic predisposition to AFib, there’s nothing we can do about the genes we were dealt.

However, it is equally important to understand that research conducted over the past few decades in the field of epigenetics has conclusively demonstrated that we do have the power to influence which genes are “expressed” and which genes are “silenced” based on the hundreds of little health decisions we make every day. Indeed, health outcomes among the individuals who have inherited any of these genes vary greatly based on factors that extend far beyond that inheritance.

2. You Have Another Heart Problem

If you were to round up all of the people with AFib in the world, you would find that somewhere close to half of them have also been diagnosed with another cardiovascular condition. Of these, the three most common culprits are heart failure, cardiac valve problems, and coronary artery disease.

3. You’ve Got a Few Years Under Your Belt

Margaret had been a picture of health for most of her life. She had followed a mostly plant-based diet free of fried, processed, and fast foods. She didn’t eat sugar. She’d never been overweight. She did aerobics every day at the gym and attended a yoga class three times a week. She practiced deep-breathing exercises whenever stress levels were getting too high. She slept well at night. She even volunteered as a crosswalk guard at the elementary school across the street from her house. And since no one in her family had ever been diagnosed with AFib, she was more than a little irritated when her doctor told her she had that arrhythmia.

But here’s the thing: Margaret was ninety-four years old. And the truth is that even if your genes are perfect and you do just about everything right, you can still get AFib as a result of age. Just as your skin will wrinkle over the years, the simple act of living life will put some wear and tear on your heart cells over time.

But there’s a big difference between being ninety-four and fifty-four—between AFib that results from natural aging and AFib that comes about due to premature aging. Most of the AFib cases we see are due to the latter kind of aging. And while there is nothing we can do to stop how many candles are on our birthday cakes—that’s chronological age—there is plenty we can do to slow the process of biological aging.

4. Your Blood Pressure Is Too High

Hypertension occurs when the force of a person’s blood against the walls of their arteries is high enough that it puts a person at risk of health problems. Within the heart, this means that, with every heartbeat, the organ is working harder to pump blood through more restrictive arteries. And all of this strain on the heart can cause its muscle to thicken and enlarge, disrupting electrical pathways and causing AFib. Indeed, of all of the factors that have been associated with atrial fibrillation, none may be stronger than hypertension. High blood pressure is the most commonly encountered condition in AFib patients, and research has shown that it nearly doubles the risk of developing atrial fibrillation.

Studies show that 90 percent of Americans are hypertensive by age fifty-five, so it’s little wonder why AFib is so common. It doesn’t have to be this way. Only 4 percent of the centenarians living in southern China’s famed “Longevity Village” of Bapan, the people we studied in our best-selling book The Longevity Plan, had high blood pressure. That finding is similar to studies of hunter-gatherers living in the Amazon rainforest or elsewhere in the world consistently showing a natural blood pressure of about 110/70 that doesn’t increase much, if any, with age.

Indeed, it appears from many studies that our genes are designed to keep our blood pressure naturally in this 110/70 range without medication as long as we don’t mess things up with our modern lifestyle. Low body weight, a mostly plant-based diet devoid of sugar and processed foods, daily physical exercise, rejuvenating sleep, and low perceived stress levels protected these people from the scourge of hypertension. It might seem like it’s impossible in a modern context to live as these people do, and that’s true. But the lessons we can draw from these elders are virtually endless, and your ability to apply these lessons to your own life are limited only by your imagination.

5. It’s One of these 11 Medications You Are On

6. Too Much Exercise

Over the years, we explained, we have noticed a particularly increased risk of atrial fibrillation in patients who regularly compete in ultra-endurance events, including running, biking, and cross-country skiing. Most of our patients are shocked when they learn that people who run marathons, competitively cycle, or do Ironman Triathlons are five times more likely to develop atrial fibrillation.

Also, it bears noting that while aggressively competing in endurance sports might put you at a greater risk of AFib, participation in these activities certainly does not guarantee you’ll get AFib. It is reassuring to note that recreational participation in endurance sports, even if it is a marathon or triathlon, doesn’t seem to increase this risk.

7. You’re Not Getting Enough Exercise

And regular exercise in general isn’t risky at all—in fact, it’s exceptionally protective. To put things into perspective, for every thousand patients we see with atrial fibrillation, perhaps one may be at risk for atrial fibrillation due to overexercising. The biggest problem, by far, is that most patients aren’t exercising enough. There is far greater risk from not exercising enough than from exercising too much. People who live sedentary lifestyles are at significant risk of AFib, not to mention all of the other health consequences of not getting enough exercise.

8. You’re Overweight

Nearly three-quarters of American men and nearly two-thirds of American women are overweight, if not obese. Today more than two billion people worldwide are overweight or obese In fact, the scientific data connecting weight and AFib are so compelling that many electrophysiologists (EPs) specializing in heart rhythm disorders feel that carrying extra weight is a primary cause of AFib.

Our research has shown that even a few extra pounds can make a big difference in a person’s AFib risk and how they respond to treatments. Other studies have shown that carrying too much weight is the main cause of an enlarged left atrium and premature heart aging—two critical components in the development of AFib.

Even if it’s only by a few extra pounds, being overweight can significantly raise your risk of AFib as we showed in one of our studies. And maybe it’s not just a few pounds. Perhaps you are obese. That word has a lot of negative baggage attached to it, which may be one of the reasons why people are reluctant to even step on the scale. Consciously or subconsciously, they simply don’t want to know. But when people do check, many are surprised to learn that they might indeed be obese, which substantially increases the risk of atrial fibrillation.

9. You Have Diabetes or Pre-Diabetes

Just about everyone knows that obesity puts people at risk of lots of other health challenges, especially diabetes. And it stands to reason that diabetes and obesity have been shown to be associated with an elevated risk of AFib, too.

Not only is your risk of AFib substantially increased with diabetes or pre-diabetes but your experience with that disease is likely to be a lot worse, as people with diabetes have worse AFib symptoms, report a lower quality of life, are more likely to spend time in a hospital, and experience higher mortality rates. There is good news in this regard, though: type 2 diabetes (also known as adult-onset diabetes, although children are increasingly affected) is usually reversible through weight control and processed carbohydrate reduction/elimination. That makes it manageable.

Manageable doesn’t mean “easy.” We live in a world that is constantly conspiring against us when it comes to the food choices that drive so many of our metabolic challenges. It’s also a world in which we’re constantly being told there are shortcuts to just about everything. But we’ll go to battle against those forces very soon. And we’ll do it together. It is something that even we, as cardiologists, have to battle every day. But, again, the important thing, at this moment, is to understand if this is one of the challenges you are facing. If so, the first step is to acknowledge that challenge, and accept its connection to AFib.

10. You’re Not Eating the Right Foods

Food is good medicine. A diet that respects what our bodies need to thrive might be the best way to prevent atrial fibrillation, or to beat it back once it starts.

A bad diet does the exact opposite. In fact, there isn’t much that is worse for you, when it comes to AFib, than eating foods loaded with sugar and other simple/processed carbohydrates. The Standard American Diet (the acronym “SAD” is tragically telling) has way more sugar than anyone needs, and it’s a veritable mass-delivery system for other simple carbs, which your body breaks down to create fast energy.

Most people know that if they’re trying to eat healthy, they should avoid sugar-filled foods like pastries, confections, and candies, along with sugary sodas. What many people fail to recognize is that many of the foods we often think of as “healthy” are also packed with sugar. Even “healthy natural sugars,” like honey, still cause our bodies to respond in roughly the same way: a sudden shockwave of sugar courses through our blood, and these bloodsugar fluctuations may cause cardiac scarring, which, over time, can cause atrial fibrillation.

Another bulk supplier of simple carbs in many people’s diets are refined grains like white flour and white rice, which have been stripped of most of their natural nutrients and fibers. The more processed a grain is, the faster it will be digested to sugar. That has the added consequence of making these foods less filling, so when you eat a white rice dish or a piece of white toast, you’re bound to be hungry again very soon. Sadly, even whole wheat bread isn’t much better. A single slice can spike your blood glucose higher than a Snickers bar.

The key is making sure that, to the greatest extent possible, the carbohydrates you’re getting are complex carbs, including fruits and especially vegetables. For now, though, it’s important to do a realistic assessment of your habits related to sugars and processed carbs. Anyone who isn’t actively avoiding foods with any and all types of added sugar, and limiting their processed or simple carbohydrate intake to those foods that are packed with complex carbohydrates (think vegetables and fruit), may be at an increased risk of AFib.

11. Your Thyroid Hormone Levels Are Off

Thyroxine is the main hormone created by the thyroid gland, and people suffering from hyperthyroidism have bodies that make way too much of it. That’s a big problem because thyroxine is a potent cardiac stimulant. In a way, having hyperthyroidism is like having a little energy-drink factory in your neck. So, you can see why people who have hyperthyroidism might experience increased heart rates, palpitations, and arrhythmias such as atrial fibrillation.

The scary thing is it doesn’t take full-blown hyperthyroidism to increase the risk of AFib. For example, our research showed that when people had thyroid hormone levels in the higher end of normal, they were 40 percent more likely to develop AFib.

Are you motivated to beat your AFib? If so, give my office in Salt Lake City, Utah a call to set up a consultation. Sorry, initial consultations all have to be in-person.

If you liked the photo with this article it was a picture I took this past week mountain biking with my teenage son overlooking Jupiter Bowl at the Park City Mountain Resort.