#300 What is Happening to Your Heart with A-Fib? 3 Reasons Why You Got A-Fib

May 27th, 2019 by

What is Happening to Your Heart with A-Fib? 3 Big Reasons Why You Got A-Fib

Most patients I see every day want to know what is happening to their hearts and why they got A-Fib.  In this article, I discuss the 3 main why atrial fibrillation happens.

1.  Bad Genes (Familial A-Fib)

Over one hundred genes are associated with atrial fibrillation.  And new genes are identified every year.  These A-Fib genes may code for any one of the various electrical channels in your heart.  Alternatively, they may code for other parts of your heart cells like any number of proteins responsible for the contractile mechanism of a heart cell.  And whether these genes code for cardiac electrical channels or the building block proteins in heart cells, the result is electrical disruption within an individual cell.

Testing for some of the A-Fib genes can undoubtedly be done, but your insurance probably won’t pay for them and whether or not you have one or more A-Fib genes won’t change your treatment.  If you are interested in a low-cost way to screen for some of these atrial fibrillation genes, you could have your genes tested by 23andMe and then share the genetic data with a company called Promethease to get a full report. But before rushing to do the home genetic testing, please know that when I ran my 23andMe raw data through the Promethease database, I was only able to find out my status on a couple of the A-Fib genes.

How do bad genes cause A-Fib?

The first case of familial or “genetic” A-Fib was reported in 1943. While some people with familial A-Fib may only have one A-Fib gene, like KCNQ1, most patients with familial A-Fib have a combination of genes that puts them at risk for atrial fibrillation.

Just because you do have an A-Fib gene doesn’t mean you will get the disease.  Genes are like a seed.  For a seed to grow, it requires the right conditions.  And when it comes to any one of the atrial fibrillation genes, if you’re eating junk, not exercising, stressed out all the time, or not sleeping well at night then you dramatically increase the odds of that bad gene taking over your heart’s rhythm.  In contrast, by living an optimized healthy lifestyle, you have an excellent chance of forever silencing any A-Fib genes you may have.

Familial A-Fib Prognosis

So what can you expect if you have a family history of atrial fibrillation?  If you have a first degree relative with atrial fibrillation, you are 92% more likely to get A-Fib yourself.  However, before giving up hope, this same study showed that only 20% of the risk could be traced back to genes.  In other words, the biggest reason why family history is so crucial in determining atrial fibrillation risk isn’t because of your genes but rather because you probably have the same eating habits and other lifestyle factors.

In addition to a 92% increased risk of A-Fib, studies also show that those with a first degree relative with atrial fibrillation get A-Fib, on average, five years earlier.  And from this study, they are also more likely to experience symptoms.  However, the good news is that a family history of A-Fib doesn’t seem to put you at more risk of stroke, hospitalization, or premature death.

Putting it all in perspective, I have seen many young and healthy patients with familial atrial fibrillation (under age 50) who show no signs of any other heart problems.  Indeed, further evaluation of these patients often shows no signs of any fibrosis (cardiac scar tissue).  For these patients, their atrial fibrillation may be a purely electrical disease instead of too much scar tissue accumulation in the heart (like the traditional A-Fib patient).  For these patients with the purely electrical form of A-Fib, ablation generally results in what we would consider a “cure.”

2. An Out of Balance Autonomic Nervous System

The autonomic nervous system is something most people know little.  After all, it is an automatic process that happens in the background.  For example, you don’t have to consciously think about moving the food you just ate through your digestion system, regulating your heart rate, or remembering to breathe.  It is something that just happens–something that is on autopilot.  However, sometimes, the autopilot system breaks down.  And when the autonomic nervous goes haywire, A-Fib can be the result.

Sympathetic versus Parasympathetic Nervous System

To better understand how the autonomic nervous system may break down, let’s take a step back and briefly discuss the two aspects to the autonomic nervous system.  First, there is the sympathetic nervous system.  The sympathetic nervous system is known as the “fight or flight” nervous system.

When the sympathetic nervous system is activated, both your blood pressure and your heart rate quickly shoot up.  For example, I love to be in the mountains of my home in Park City, Utah.  During the summer, it is not unusual for me to come across a big moose stuck blocking a mountain trail.  These moose are huge animals, and when irritated are more than capable of maiming or killing a human.  From first-hand experience, I can tell you that in these situations, my sympathetic nervous system has my adrenalin pumping.  I’m ready to do whatever it takes to save my life.

In contrast, the parasympathetic nervous system is the “rest and digest” nervous system.  It lowers your blood pressure and slows your heart rate.  Sleep or a big meal stimulates this nervous system.

To keep A-Fib from happening, you need a healthy balance of the sympathetic and parasympathetic nervous system.  And when this balance is lost, the risk of A-Fib goes way up.

Sympathetic A-Fib

For the vast majority of my patients, the autonomic nervous system imbalance arises from chronic overaction of the sympathetic nervous system.  One big cause is our stress-filled modern lives.  Our sympathetic nervous system is designed to be turned on and then off as soon as the threat is gone.  The problem is that this perceived “threat” at work or in our home life never goes away, so the threat level consistently registers high. And the adrenalin is always pumping. Over time, the heart may give up the fight against atrial fibrillation.

Stress isn’t the only thing that overtaxes our sympathetic nervous system.  For example, sugar, processed foods, fast foods, etc. trigger inflammation, thereby activating the sympathetic nervous system.  Paradoxically, people who don’t exercise daily also require adrenalin with sympathetic nervous system activation to get them through their day.  And sleep deprivation from any cause also revs up adrenalin and the autonomic nervous system.

I have found that most of my A-Fib patients suffering from overstimulation of the sympathetic nervous system will have a resting heart rate in sinus rhythm of 80 beats per minute or faster.  Their heart rate variability, or SDNN, also tends to be below 70 ms.  While tracking your heart rate is easy to do, the best way to track an overactive sympathetic nervous system is with a smartwatch.  Most smartwatches will not only tell you your real-time heart rate but will also give you your heart rate variability.

As most of my A-Fib patients suffer from over-activation of the sympathetic nervous system, my goal is to calm it down if we want any hope of getting their A-Fib into remission.  And this means eating a clean diet, daily exercise, meditation/yoga, and sleep optimization.

Parasympathetic A-Fib: The Athletic Heart

In contrast to sympathetically driven A-Fib, you can have the opposite problem which is too little sympathetic activation or parasympathetic A-Fib. Thus, for some of my patients, a little more sympathetic stimulation (or calming the parasympathetic nervous system) is the goal.

The classic patient I see in my practice with an overactive parasympathetic nervous system is the world-class endurance athlete.

While the actual act of exercise stimulates the sympathetic nervous system, between workouts, there is a dramatic calming effect of the sympathetic nervous system, thereby allowing the parasympathetic nervous system to be firmly in control.  It is for this reason that world-class marathon runners or Tour de France riders may have a resting heart rate of 30 to 40 beats per minute. And unless they are beating up their bodies from overtraining, my well-trained endurance athletes also tend to have a heart rate variability number above 70 ms.

While 99% of my patients don’t get anywhere enough exercise, I do have a small subset of patients that push their physical training to the extreme.  These are usually my patients who regularly compete in marathons, long-distance bike races, Ironman World Championships, etc.  A resting heart rate below 50 beats per minute is an immediate clue that they may be exercising too much. These extreme levels of exercise overstimulate their parasympathetic nervous system thereby slowing down their heart rate.  And for these patients, if they can slightly dial back their training, the A-Fib usually goes into remission without medications or procedures.  However, as these patients are so committed to their exercise this is often something that most are incapable of doing.  And because their competition times are much slower with A-FIb or medications, we usually end up doing an ablation procedure so that they can still compete without A-Fib or medications.

Parasympathetic A-Fib: Gastrointestinal and Nocturnal A-Fib

Another group of patients that suffers from parasympathetic A-Fib are those with gastrointestinal challenges.  This is often called “vagal” atrial fibrillation.  The term “vagal” refers to atrial fibrillation arising from overactivation of the vagus nerve.  The vagus nerve is the nerve that connects the gut to the heart and the brain.  Thus, many people with vagal A-Fib report that eating a big meal, eating the wrong things, acid reflux, or even irritable bowel can then stimulate the vagus nerve to the point that an atrial fibrillation attack ensues.

The treatment for gastrointestinal or vagal A-Fib is relatively straightforward.  Calm the gut, and the heart usually follows.  Indeed, these patients may need temporary medications for their A-Fib until the gastrointestinal issues can be resolved.

The other commonly encountered form of vagal A-Fib is nocturnal A-Fib.  For these patients, sleep (which is when the parasympathetic nervous system dominates) triggers A-Fib attacks.  Often these patients will awake with an A-Fib episode.

When dealing with nocturnal A-Fib it is vital to rule out sleep apnea.  Once sleep apnea is excluded, there aren’t any specific treatments as we all have to sleep.  Thus, after reversing any biomarker or lifestyle factors which may be contributing to the A-Fib, these patients often require medications or an ablation.  Fortunately, ablation works just as well for the parasympathetically mediated forms of A-Fib as it does the more commonly encountered, sympathetically mediated A-Fib.

3. Age and Lifestyle-Related Fibrosis of the Heart

Of the three reasons why people get A-Fib, age, and lifestyle-related fibrosis of the heart is by far the number one reason I see every day.  Indeed, at least 90% of my patients develop A-Fib primarily from progressive scarring of the heart (fibrosis) rather than purely genetic or autonomic nervous system driven A-Fib.  Indeed, A-Fib didn’t just start. Instead, the fibrosis was accumulating decades before you ever had your first A-Fib attack.

Fibrosis, or cardiac scar tissue, damage electrical pathways in the heart leading to atrial fibrillation and other arrhythmias.  You need each heart cell as healthy as possible to keep your heart in normal rhythm.  Thus, the more fibrosis you pick up over time, the higher your risk of atrial fibrillation. Therefore, it should come as no surprise that the earlier you can be treated and make the necessary lifestyle changes to stop or even reverse the fibrosis, the better your chances of putting A-Fib into remission.

Studies show that as atrial fibrillation worsens over time, people correspondingly have more and more fibrosis in their heart.  This finding has led to the common saying that “A-Fib begets A-Fib.”  In other words, the more episodes of A-Fib you have, the more scarring takes place, and the more A-Fib attacks you can expect in the future.  This is something we discussed in a published manuscript.  Just 5 minutes of A-Fib is enough to start changing the way electricity is conducted within your heart.  And five weeks of A-Fib is enough to start laying down new scar tissue (fibrosis) in your heart.

What Causes Fibrosis?

If we want to stop fibrosis, we need to know what causes it in the first place.  Sadly, some degree of fibrosis happens from age-related changes.  And while we can’t stop how many birthday candles are on our cake, we can slow down the biological aging process.  Indeed, “old-appearing” 40-year-olds will often have more cardiac fibrosis than young appearing health conscientious 60 or 70-year-olds.

Rather than just looking at how old someone looks on the outside, you can measure this at the cellular level.  As we age, the telomeres on the ends of our chromosomes shorten.  Telomeres are like the caps on shoelaces.  When shoelace caps wear out, shoelaces unravel.  The same is true of our DNA.  We need these telomeres to protect our DNA.

As telomere shortening is a marker of biological aging, it should come as no surprise that research from our hospital has shown that short telomeres significantly increase your risk of A-Fib. And the key to slowing down the aging process is the same recipe for stopping A-Fib in the first place.  Eat a 100% clean diet, avoid weight gain, exercise daily, and optimize your sleep and stress levels.

In addition to aging, many other things cause cardiac scarring.  For example, eating the “Standard American Diet,” being overweight, not exercising, always stressing out, not getting enough sleep or sleep apnea, high blood pressure, diabetes, other heart problems including not getting enough blood flow, valve problems, or heart failure, etc. are all well-known causes of cardiac fibrosis.

How Can You Measure Fibrosis?

There are many tests you can do to determine how much fibrosis there is in your heart.  While a cardiac MRI is the most accurate way, you can also tell by the simple echocardiogram (ultrasound of the heart).  If your right or left atrium are enlarged, you probably have a fair amount of scar tissue.  Indeed, studies show that the size of the upper chambers in your heart is a powerful predictor of how well you will respond to treatment of your A-Fib.  And if your A-Fib ultimately requires an ablation, depending on what technology your electrophysiologist chooses to use, they may be able to tell you the degree of fibrosis you have.

A Window of Time to Stop the Fibrosis

It is a race against time if you are to stop atrial fibrillation.  At some point, if you develop too much fibrosis, you will no longer be able to maintain a normal rhythm.  Exactly how long you have before atrial fibrillation becomes permanent is unknown as it varies from person to person.  In a study of over 4,000 patients, we showed that the longer one waited from the time of atrial fibrillation diagnosis to an ablation procedure, the worse their long term freedom from atrial fibrillation.


While “bad genes” or an out-of-balance autonomic nervous system may certainly make atrial fibrillation worse, the primary driver is progressive cardiac fibrosis.  Thus, the key to beating A-Fib for most people is to stop the fibrosis before it is too late.  Fibrosis can be stopped, but it will probably require a lifetime commitment to healthy eating, daily exercise, optimizing stress levels and sleep, as well as a possible ablation for those wanting to avoid a lifetime of cardiac rhythm drugs.

#299 The 10 Most Important Atrial Fibrillation Lab Tests: How to Optimize Your Biomarkers

March 31st, 2019 by

The 10 Most Important Atrial Fibrillation Lab Tests

No one wants to suffer from heart failure, strokes, or premature death from atrial fibrillation.  Wouldn’t it be great if there were a few simple lab tests your doctor could order that would allow you to put your atrial fibrillation into remission?  In this article, I discuss the ten most important atrial fibrillation lab tests.

1.  C-Reactive Protein (CRP)

Of all the blood tests your doctor could order for atrial fibrillation, C-Reactive protein (CRP) is probably the simplest and most overlooked.  The reason why this test is so important is that it gives you a general sense of how much unnecessary inflammation is going on in your body.  And unless you are fighting off a cold or other illness, it is pretty accurate.

Years ago we published a study showing that CRP was a powerful predictor of who would get atrial fibrillation.  The reason for this is that unnecessary inflammation is associated with scarring in the heart.  And the more scarred up the heart is the more likely you will have disrupted electrical pathways with the end result of atrial fibrillation.

CRP is also a marker of left atrial enlargement.  And the left atrium of the heart is where most cases of atrial fibrillation originate.  Interestingly, CRP has been shown to go down over time with a successful atrial fibrillation ablation procedure.

If your CRP isn’t below 1.0 mg/L then you have some work to do to decrease your atrial fibrillation risk.  The single best thing you can do to lower your CRP is to get your waist size down to 35 inches (90 cm) if you’re a man and 32 inches (81 cm) for women.  The reason for this is that atrial fibrillation risk tracks waist size and waist size tracks visceral fat.

Visceral fat, especially fat surrounding the heart, releases cytokines which fire up intense inflammation.  Other ways to reduce unnecessary inflammation in your heart are to optimize your diet, daily exercise, sleep, and stress levels.  In rare cases, atrial fibrillation may be driven from chronic infections or other inflammatory reactions such as H. pylori infections in the gastrointestinal system, excessive mouth bacteria, or even a “leaky gut.”

2. Hemoglobin A1C

Along with CRP, hemoglobin A1C is another often neglected lab test for atrial fibrillation patients.  Indeed, it is unusual for me to see an atrial fibrillation patient with a CRP below 1.0 and a hemoglobin A1C below 5.7.

The hemoglobin A1C test simply measures how much glucose in your blood has been sticking to your red blood cells over the last two to three months. Obviously, the lower your average blood glucose the less of a sugar coating your red blood cells will have.  From a definition standpoint, a hemoglobin A1C of 5.7 indicates prediabetes and a level of 6.5 means full-blown diabetes.

Depending on which study you look at, diabetes increases your risk of atrial fibrillation by about 50%.  Other studies show that the higher your hemoglobin A1C, or the longer you have had diabetes, the more likely you are to also suffer from atrial fibrillation.  The reason why high blood glucose may damage the electrical system of the heart isn’t entirely clear but recent research suggests that blood glucose fluctuations may cause cardiac scarring through reactive oxygen species from upregulation of the Txnip protein.

If your hemoglobin A1C isn’t below 5.7, its time to get busy.  The single best way to get your hemoglobin A1C back to normal is to shoot for a waist size of 35 inches for men and 32 inches for women.  Additional strategies include religious daily exercise, no sugar, no flour, and no eating after 7 PM at night.

3. Thyroid Panel

Thyroid disease, especially from an overactive thyroid (hyperthyroidism), and atrial fibrillation go hand in hand.  Even our former US president, George Herbert Walker Bush, was struck with atrial fibrillation from hyperthyroidism while serving as president.

In my experience, at least 1% of my atrial fibrillation patients got there from an overactive thyroid.  Fortunately, this is something that is easily corrected.

Excessive thyroid hormone is a very potent stimulant.  So, just like any other stimulant, the more thyroid hormone you have the higher your risk of atrial fibrillation.  And it doesn’t matter if it is T3 or T4 that is elevated.  Indeed, any thyroid hormone elevation increases risk.  Even people with thyroid hormone levels in the upper range of normal are also at increased risk.

If your doctor has already prescribed thyroid hormone for you, and you have atrial fibrillation, get your thyroid hormone levels retested.  I can’t tell you how many atrial fibrillation cases I have seen from patients being prescribed too much thyroid hormone.

When it comes to atrial fibrillation risk from thyroid disease, it is generally because thyroid hormone levels are too high.  While studies have confirmed that an underactive thyroid is not generally a risk factor for atrial fibrillation, there are some reports that this may not always be the case.

4. Comprehensive Metabolic Panel (CMP)

A common blood test your doctor has probably already ordered for you is a comprehensive metabolic panel (CMP).  While what is contained within the CMP may vary from hospital to hospital, in general, it tests for electrolytes, kidney function, liver function, etc.

Depletion of certain electrolytes, like potassium and magnesium, is a clearly established atrial fibrillation risk factor.  Indeed, electrolyte optimization is critical to maintaining normal rhythm.  Fortunately, correcting electrolyte depletion is easy to do.  Simply, getting off diuretic medications, through weight loss, dietary optimization, and vigorous exercise works for many of my patients.  For those not on diuretics, boosting your intake of vegetables, fruit, legumes, nuts, and seeds usually corrects any electrolyte deficiency.  In rare cases, potassium or magnesium supplementation may be required.  Please don’t be tempted to correct electrolyte deficiencies with sports drinks as the sugar or artificial sweeteners are not worth the risk.

Poor kidney and liver function are also associated with atrial fibrillation.  Of course, with poor kidney or liver function, it is hard to know whether the kidneys or the liver caused the atrial fibrillation or the other way around. Regardless, if the goal is to beat atrial fibrillation, then both kidney and liver function needs to be optimized.  This may require consultation with a nephrologist (kidney specialist) or hepatologist (liver specialist).

5. Lipid Panel

Another test that has probably already been done for you is the lipid or cholesterol panel.  While your doctor likely ordered this blood test in the hopes of preventing atherosclerosis, abnormalities on this test may also predict your atrial fibrillation risk.

For example, studies show that high triglycerides predict atrial fibrillation. High triglycerides usually indicates that you are consuming too much sugar or flour (processed carbohydrates).  While your doctor will tell you that you want your triglycerides below 150 mg/dL, in my experience the lower your triglycerides the lower your atrial fibrillation risk.  Unless you have a genetic abnormality, a normal waist size, religious daily exercise, no sugar, no flour, and no eating after 7 PM should quickly get your triglycerides below 150.

In addition to triglycerides, a low HDL (good cholesterol) has also been associated with atrial fibrillation.  And if your HDL is low, follow The Atrial Fibrillation Diet, exercise daily, and get your waist size down to the normal range.

Your LDL, or “bad cholesterol,” is another important number for atrial fibrillation patients.  As strokes are the most feared atrial fibrillation risk, a recent study showed that an elevated LDL doubles your stroke risk.  And to keep your LDL as low as possible, strictly adhere to The Atrial Fibrillation Diet, never let a day go by without vigorous physical activity, and keep your body weight in the normal range.

6. Vitamin D

A low vitamin D level is associated with many chronic medical conditions–atrial fibrillation being no exception.  Indeed, a study of more than 27,000 people concluded that “low D” increases your atrial fibrillation risk by about 10%.

Now how exactly “low D” translates into an increased atrial fibrillation risk isn’t completely known.  However, studies suggest that it probably has something to do with increased inflammation through vitamin D receptors on cardiac cells, altered calcium metabolism, and fluid balance.

Of all the biomarkers to optimize, vitamin D has to be the easiest to correct.  Due to low vitamin D levels, I personally take 2000 IU daily when I don’t get a chance to get it naturally from the sun.  If your vitamin D levels indicate you also need to supplement, work with your physician to make sure you don’t take too much,  Indeed, our research suggests that too much vitamin D from supplements may also increase atrial fibrillation risk.

7. Anemia

From as far back as 1970, anemia has been recognized as an atrial fibrillation risk factor.  Anemia, or not enough red blood cells, not only is associated with atrial fibrillation but also indicates a potentially more dangerous case.   As with many of the other atrial fibrillation biomarkers in this article, your doctor has probably already tested for anemia.

When it comes to the causes of anemia, it generally comes down to one of two things.  Either you are losing blood somewhere in your body or your bone marrow can’t make enough red blood cells.  Anemia stresses your heart as your heart may not be able to get enough oxygen.  And any stress on the heart, physical or mental, increases the likelihood of atrial fibrillation.

Not only does anemia increase your atrial fibrillation risk but it also identifies an increased risk of something else bad happening like a heart attack, premature death, or stroke. If you have been diagnosed with both atrial fibrillation and anemia, be sure to work closely with your doctor to both correct the underlying cause of anemia and to minimize the risk of anything else bad happening.

8. Homocysteine

While a homocysteine blood test is easy for your doctor to order, it is rarely done.  Homocysteine is an amino acid and too much of this amino acid in your blood is associated with atrial fibrillation, strokesheart attacks, and dementia.

As with many of the other biomarkers covered in this article, the exact mechanism whereby too much homocysteine may trigger atrial fibrillation isn’t entirely clear.  Research has shown that high homocysteine levels may damage collagen in the heart thereby leading to cardiac scarring and enlargement of the left atrium.

So what should you do if your homocysteine levels are too high?  Like with vitamin D, optimizing this biomarker is surprisingly easy.  Just boost your vitamin B12 intake from fish, folate from green leafy vegetables and beans, and vitamin B6 from sweet potatoes, sunflower seeds, spinach, and bananas.  For those hoping to decrease homocysteine from taking supplements instead of eating real food, please note that many studies have shown that homocysteine-lowering vitamins don’t prevent bad things from happening to your heart.

9. BNP (B-type natriuretic peptide and N-terminal-pro-BNP)

There are two different ways your doctor can easily test for elevated levels of BNP.  And if you carefully review the medical literature there isn’t much difference between the B-type natriuretic peptide or the N-terminal-pro-BNP blood test.  As long as your doctor is testing for “BNP” it doesn’t really matter which test is chosen.

The bottom line is that BNP measures the physical stress your heart is experiencing.  BNP measures the degree of “heart failure” you have.  If your heart is pumping against high pressures, your body is retaining fluid, or heart inflammation is out of control your BNP will probably be high.  A “high BNP” is anything above 100 pg/mL for BNP  and anything above 125 pg/mL for NT-pro-BNP in people under age 75.

An elevated BNP is definitely something you don’t want.  A high BNP predicts an especially bad prognosis for atrial fibrillation as it is associated with heart failure, strokes, premature death, and recurrent atrial fibrillation.  If your BNP is up, you definitely need to see a cardiologist as soon as possible.  Medications will likely be needed until you can lower BNP naturally through weight loss, religious daily exercise, 100% clean eating, etc.

10. High Sensitivity Troponin (hs-Tn)

Having any troponin elevation in your bloodstream is a bad sign. Troponin is a heart muscle protein that signifies active heart muscle damage.

Indeed, an elevated troponin in someone with atrial fibrillation predicts a much higher risk of heart attack, heart failure, stroke, or premature death.  An elevated troponin also predicts that efforts to treat atrial fibrillation may not be as successful.

As with an elevated BNP, anyone with atrial fibrillation and an elevated troponin must be under the very close care of a cardiologist.  Fortunately, with prompt and aggressive therapy, including lifestyle optimization, BNP and troponin generally go down over time.

More Advanced Testing

In this article, we have covered the 10 most important atrial fibrillation blood tests that your doctor can easily order for you.  As you might imagine, these 10 tests are just the tip of the iceberg.

For example, you could be tested for chronic infections, food sensitivities, micronutrient deficiencies, hormonal imbalances, heavy metals, autoimmune diseases, vitamin deficiencies, etc. which all have been associated with atrial fibrillation in published studies.  However, to test beyond the 10 tests discussed above may require a functional medicine physician, naturopathic doctor, or other non-traditional health care providers with access to outside lab studies.


Lab testing is expensive and it isn’t always covered by insurance companies.  So it is best to check with your insurance company first before embarking on this path or you might get stuck with a big lab bill.



#298 The Atrial Fibrillation Diet: How to Beat A-Fib with Food

December 12th, 2018 by

The Atrial Fibrillation Diet: How to Beat A-Fib with Food

A lifetime of poor eating choices is one of the leading causes of atrial fibrillation that I see in my cardiology practice.  Wouldn’t it be great if there was an atrial fibrillation diet that could reverse atrial fibrillation without the need for drugs or procedures?  In this article, I’ll share the science behind the Atrial Fibrillation Diet and teach you everything you need to know to beat atrial fibrillation with food.

7 Ways What You Eat May Cause Atrial Fibrillation

1. Excessive Pericardial Fat

There are two main places where fat is stored in the body.  It can be stored under your skin or around your internal organs.  When it is stored internally, it is called visceral fat.  Of these two places where fat is stored, visceral fat is by far the most dangerous.  And of all the places where you could have visceral fat, fat encasing the heart or pericardial fat is the worst place for your long-term health and atrial fibrillation risk.

The pericardium is a thin membranous sack holding the heart.  Sometimes, the pericardial fat layer surrounding the heart can be more than an inch thick!

Fat cells, especially the visceral pericardial fat wrapping around the heart, release cytokines into the heart.  Cytokines are small proteins that activate the immune system.  And this immune system activation from cytokines leads to an intense inflammatory reaction which scars up the heart and may cause atrial fibrillation. Thus, the less pericardial fat you have encasing your heart, the less inflammation and scarring you will have going on inside of your heart.

So how do you know if you have too much visceral or pericardial fat?  While an MRI or CT scan could definitely tell you how thick your pericardial fat layer is, doing these tests probably isn’t the most practical option for most people.  Fortunately, there is an easier way.  Studies show that your waist circumference is an excellent predictor of how much visceral fat you have.  And to beat atrial fibrillation, research indicates that men want to get their waist size down to 35 inches.  For women, your goal waist size to prevent and reverse atrial fibrillation is 32 inches.

2. Insufficient Antioxidants

Oxidation is the same chemical reaction that causes iron to rust.  In the body, oxidation is one way in which the body ages.

Aging of the heart is one of the most powerful causes of atrial fibrillation.  This is why it is so common to see seventy or eighty-year-olds with atrial fibrillation.  Indeed, based on our research at Intermountain Medical Center, atrial fibrillation can be thought of as premature aging of the heart.  And to stop this oxidation aging process, you need more antioxidants from food.

Another mechanism whereby insufficient antioxidants may lead to atrial fibrillation is through excessive production of reactive oxidant species.  Indeed, these reactive oxidant species like myeloperoxidase, nicotinamide adenine dinucleotide phosphate oxidase, and uncoupled nitric oxide synthase enzymes have been shown to disrupt electrical pathways in the heart.  With enough antioxidants in the diet, overproduction of reactive oxidant species can be stopped.

Antioxidants are food compounds which block this oxidation aging process and reactive oxidant species.  For example, one study of 800 people showed that those who got the most antioxidants from vitamins like C, E, and carotenoids from vegetables and fruit were twice as likely to have their hearts go back to normal rhythm without drugs or procedures. Just to be clear, antioxidant dietary supplements have never been shown to prevent atrial fibrillation.  You can only get this antioxidant atrial fibrillation benefit by eating massive quantities of real food, especially vegetables.

3. Unnecessary Inflammation

Inflammation or activation of your immune system is definitely needed if you are injured or fighting an infection — however, low-level inflammation that is always present and never turned off damages your heart.  Indeed, anything that causes chronic low-level inflammation in your body may increase your risk of atrial fibrillation.  This is because unnecessary activation of your immune system causes the release of many inflammatory proteins, antibodies, etc. that damage heart cells and disrupt electrical pathways.

While cytokines from fat cells encasing the heart are one way that inflammation may damage the heart and cause atrial fibrillation, another way is through the diet.  The daily food choices we all must make determine whether or not there is a low-grade inflammation going on within your heart.

For example, studies show that anything triggering a blood glucose spike, like sugar or flour, may activate the immune system in a way that could increase the risk of atrial fibrillation. Likewise, anything in the modern diet like processed foods, fried foods, fast foods, etc. may also trigger this same inflammation-induced damage to your heart.

To protect yourself from the inflammation damage caused by anything in the standard American diet, you need as many vegetables and fruit as possible, especially vegetables. Indeed, studies show that the more vegetables and fruit you can eat the less of this unnecessary activation of the immune system (inflammation) you will have.  This, in turn, helps to prevent and reverse atrial fibrillation.

4. Micronutrient Deficiency

Micronutrient deficiency, especially that of potassium and magnesium, may also play a role in atrial fibrillation.  Indeed, one study of 4,059 people showed that inadequate potassium increased the risk of atrial fibrillation by up to four times.  Likewise, a study of 3,530 people showed that those with low magnesium levels were 52% more likely to develop atrial fibrillation.

The most likely reason why low potassium and magnesium levels increase the risk of atrial fibrillation is that they change the cell-to-cell electrical channels in the heart.  With these electrolyte disturbances, there is cellular hyperpolarity with increased resting potential and shortening of the action potential.  The bottom line is that these changes then render each cell more susceptible to electrical chaos or atrial fibrillation.

As most Americans favor processed and fast foods over vegetables, legumes, nuts, seeds, and fruit, it shouldn’t come as a surprise that most Americans don’t get enough potassium and magnesium in their diets. Surprisingly, when I talk with patients about getting more electrolytes in their diet, they often tell me that they will start drinking more Gatorade and other sports drinks.

This is absolutely the worst way to fight atrial fibrillation.  These sports drinks are nothing more than sugar and chemicals with a small dose of electrolytes.  Even though you can now buy these sports drinks without sugar, it still isn’t much more than artificial sweeteners and chemicals.

In addition to getting more potassium and magnesium in your diet from vegetables, legumes, nuts, seeds, and fruit, other micronutrients are also important.  For example, there are studies linking atrial fibrillation to elevated levels of homocysteine (often due to a B vitamin or folate deficiency) as well as insufficient vitamin D.

5. High Blood Glucose

Increasingly, more and more studies are pointing to the importance of controlling blood glucose to prevent atrial fibrillation.  For example, one study of 8,943 people showed that even if you have never been diagnosed with diabetes, but yet have an occasional borderline high glucose reading or hemoglobin A1C, you have a 33% increased risk of atrial fibrillation.  And if you have been diagnosed with diabetes, then that atrial fibrillation risk goes up to 50%!

But it isn’t just whether or not you have been diagnosed with diabetes that determines your atrial fibrillation risk.  For example, some studies suggest that the longer you have diabetes or the higher your hemoglobin A1C the greater your risk.

So, how does diabetes lead to atrial fibrillation?  Animal studies show that even minor glucose rises, like what happens after a big meal or eating sugar or flour, causes fibrosis (scarring) of heart cells by an increase in thioredoxin-interacting protein.

6. Unhealthy Gut Microbiome/Excessive TMAO

Just as we now know that any spike in blood glucose is bad for your health, so too is an unhealthy gut microbiome.  Scientists estimate that there are about 100 trillion bacterial cells living in your gut.  And depending on which bacteria you have there may determine your atrial fibrillation risk.

For example, having the wrong gut bacteria may lead to a spike in a cardiac toxic byproduct called TMAO (Trimethylamine N-oxide) which can get into your bloodstream.  And elevated levels of TMAO not only is linked to heart attacks but also significantly increases your risk of atrial fibrillation. Now, how TMAO damages the electrical system of the heart isn’t entirely clear but recent studies show that elevated levels of TMAO cause inflammation of the heart and damage the autonomic nervous system (the nerves controlling your heart rhythm).

If TMAO is bad for your heart, how do you stop your gut bacteria from making this stuff?  Studies show that the best way to reduce TMAO is to starve off the gut bacteria that make TMAO.  And to kill off these bad guys in your gut you need to limit meat, dairy, processed foods, and supplements/sports drinks containing choline and carnitine.

7. Unnecessary Enlargement of Your Heart

It has long been known that the more enlarged your atria are, the higher your risk of developing atrial fibrillation.  While some enlargement of the atria may happen with age, food choices play a much bigger role.

For example, sugar and flour promote weight gain, and studies show that weight gain is the number one cause of an enlarged heart leading to atrial fibrillation.  Also, high blood pressure from too much sugar and salt in the diet is another cause of unnecessary enlargement of your heart.  Lastly, salt alone from processed foods may cause heart enlargement independent of blood pressure changes.

4 Ways How You Eat May Cause Atrial Fibrillation

While eating right is absolutely essential to maintaining normal rhythm, meal timing may be equally important.  Below are 4 ways meal timing may prevent atrial fibrillation.

1.  Big Meals May Trigger Atrial Fibrillation

Studies show that vagus nerve stimulation, like what happens when you eat too big of a meal, may trigger atrial fibrillation.  For those who may have forgotten their anatomy, the vagus nerve is the tenth cranial nerve linking the gut to the heart and the brain.  Thus, overstimulation of this nerve with a big meal may be all that is needed for an atrial fibrillation attack.

While the exact mechanism whereby eating a big meal leads to an emergency room visit for atrial fibrillation isn’t entirely clear, studies show that intense vagus nerve stimulation from an overfilled belly may spike acetylcholine and adrenalin levels which then renders vulnerable heart cells near the pulmonary veins to electrically fire.  This abnormal electrical firing of cardiac cells near the pulmonary veins may then trigger an atrial fibrillation attack.

So how much should you eat?  We could take a great lesson from the Japanese who have some of the lowest rates of atrial fibrillation on this planet.  The Japanese, especially those living in Okinawa, practice “Hara Hachi Bu” which is a Confucian teaching to only eat until you are 80% full.  If you never fill your belly beyond 80%, then you won’t have to worry about excessive vagal stimulation from an overfilled belly.

2. Eating Fast May Worsen Atrial Fibrillation

Just as overeating may excessively stimulate your vagus nerve, so too can eating very fast.  Indeed, with fast eating, you get more stomach stretching and rapid blood glucose spikes both of which may cause an atrial fibrillation attack from vagus nerve stimulation.

Let’s face it, most of us probably eat too fast.  Some simple things I like to do to slow down my eating is to focus on high fiber foods.  Vegetables, especially when eaten raw, take more time to chew.  This extra “chew time” with vegetables can be invaluable in preventing overstimulation of the vagus nerve.

Other tricks I employ are eating left handed.  Not only will eating with your non-dominant hand slow your eating speed but it also strengthens the neural pathways in your brain by learning new skills.  I have found that eating my food with chopsticks at home can also accomplish the same results.  Lastly, you can always count how many times you chew your food or put your fork or spoon down between bites.

3. Cold Foods May Trigger an Atrial Fibrillation Attack

Just like overeating may trigger an atrial fibrillation attack via the vagus nerve, so too may eating cold foods.  For example, one study showed that the sensation of “brain freeze” which happens from eating cold foods like ice cream or drinking cold beverages might be a potent trigger for atrial fibrillation attacks.

Does this mean you can’t ever eat ice cream or drink a big glass of ice water?  Of course not.  However, if you are eating or drinking cold things, the key is to do it slowly to minimize any unnecessary stimulation of the vagus nerve.

4. Intermittent Fasting May Prevent Atrial Fibrillation

Intermittent fasting may represent an exciting way to prevent atrial fibrillation through food timing.  Indeed, intermittent fasting optimizes blood glucose fluctuations and vagus nerve excitability which may be quite helpful in controlling atrial fibrillation.

While there aren’t any published studies yet on using intermittent fasting to treat atrial fibrillation, when we have looked at the studies done at our hospital we are encouraged by the initial results.  In a small group of 329 people, we observed a statistical trend toward a 20% to 40% reduction in atrial fibrillation regardless of how we analyzed the data.  While certainly encouraging, further studies are needed to confirm if there is indeed a cause and effect relationship between intermittent fasting and atrial fibrillation.

Until further data are available, what should you do?  Unless told otherwise by their other doctors, I encourage all of my patients to go 12 hours each night without eating.  To accomplish this, I ask my patients not to eat after 7 PM.  The reason for this is that studies show late eating may spike glucose levels and blood pressure until very early in the morning (these changes alone could trigger an atrial fibrillation attack).  After “closing” the kitchen at 7 PM, they are then free to re-open the kitchen at 7 AM the next morning.

7 Ways to Beat A-Fib with the Atrial Fibrillation Diet

Now that we have discussed the science behind eating and the atrial fibrillation diet, what should you eat?  Below are what we know from studies.

1.  Lean Body Weight

Regardless of what you eat or how you eat it, staying a “healthy lean” may be the best protection you have against atrial fibrillation.  Indeed, our studies have shown that the leaner you are, the lower your risk of atrial fibrillation.  We have shown from our studies that even maintaining a five-pound weight loss can statistically reduce your long-term risk of atrial fibrillation.  The key is that you need to work with your physician to achieve this goal in a healthy and sustainable way.

2. Tripple Your Veggies

If there is one superfood you want to focus on to beat atrial fibrillation, it is veggies.  Many studies show that the more plant-based you can eat, the lower your risk of atrial fibrillation.  Make sure veggies are a big part of every meal you eat.

Fruit, especially berries, can also be helpful in maintaining normal rhythm.  Berries are your best bet as they pack the most micronutrients and are the least likely to spike blood glucose levels.

Vegetables and fruit are packed with antioxidants, magnesium, potassium, as well as the fact that they are also anti-inflammatory.  All of these properties make vegetables and fruit a great choice for those wishing to prevent or reverse atrial fibrillation.

3. Eat More Plant-Based Fats

When it comes to fat in the diet, the more healthy fats you can get the lower your risk of atrial fibrillation.  For example, olive oil, nuts, and dark chocolate have all been shown to decrease your risk of atrial fibrillation.

At first glance, eating more plant-based fats to prevent atrial fibrillation may seem counter-intuitive.  However, there are at least two good reasons why boosting plant-based fats may be beneficial.  The first is that plant-based fats, especially nuts, prevent weight gain.  The second is that if your diet contains a lot of healthy fats you probably won’t get much of an atrial fibrillation promoting blood glucose spike.

4. Tripple Your Fiber (think vegetables not supplements)

Just as I tell my patients to triple their veggies, I also want them to triple their fiber intake from real food sources.  Why fiber?  Because fiber may also prevent atrial fibrillation.

For example, in one study researchers were able to identify a statistical trend of up to a 36% reduced risk of atrial fibrillation with fiber.  Now this study was especially remarkable given that the best fiber eaters in this study (27 grams daily) couldn’t even achieve the bare minimum amounts recommended by USDA.

Getting more fiber from real food sources is easy to do.  I have been tracking my nutrient intake for years and have observed that unless I am traveling, getting more than 100 grams of fiber daily from real food (no fiber supplements) is surprisingly easy to do.

So how can fiber help to prevent atrial fibrillation?  Based on a review of 44 published studies, fiber increases your sense of feeling full by 39% which then correspondingly decreased caloric intake by 22%.  Basically, the more fiber you get, the less you will weigh.

Fiber not only optimizes your body weight but it also normalizes glucose metabolism.  For example, study after study has shown that blood glucose spikes can be minimized or even prevented with fiber.  The key point here is that if you can triple your non-starchy veggie intake, then your fiber intake will probably triple as well.

5. Eat Fish

If you like meat, then your best choice when it comes to atrial fibrillation is the low mercury high omega 3 fatty fish otherwise known by the acronym “SMASH.” SMASH stands for salmon, mackerel, anchovies, sardines, and herring.

Like vegetables, nuts, seeds, fruit, and olive oil, fish may also be protective.  For example, one study of 4,815 people showed that regular fish eaters had a 31% decreased risk of atrial fibrillation.  But before you make fish part of your daily food plan, not all studies show that fish helps.

For example, in a study of 44,720 women, no benefit from fish was found. Another study showed that while fish was helpful, eating it fried wasn’t.  A third study showed that eating fish in moderation was good but that eating too much of it was associated with more atrial fibrillation. And for those wishing to skip the fish and take a pill instead, fish oil isn’t helpful.

So how do you make sense of all these conflicting studies?  While it may not be the best approach for everyone, here is what works for me.  As fish is the healthiest meat, wild salmon is the only meat I eat.  Because I don’t want to consume too much, I eat about one ounce daily (two small bites) as part of my breakfast. For the rest of the day, I only eat plant-based foods.

6. Avoid Processed and Fast Foods

This section needs little explaining.  With processed and fast foods you are getting a massive dose of sugar, health-damaging fats, and salt.  Inflammation, glucose, and blood pressure all shoot up within minutes of your first bite.

One thing that is not well appreciated with processed and fast foods is the salt (sodium) load.  These “foods,” pack a megadose of sodium.  Sodium not only raises blood pressure but through fluid retention and its myriad of effects to the kidneys may be an important cause of left atrial enlargement and scarring of the heart thus leading to atrial fibrillation.  If you want to lower the sodium in your diet, you have to be willing to eat real food that doesn’t come in a box, can, jar, or fast food container.

When you consider the impact of sugar, harmful fats, and sodium it should come as no surprise that the US has the highest rates of atrial fibrillation in the world.  And it is probably the lack of processed and fast foods in remote areas of Asia that account for the 10 times higher risk of atrial fibrillation that we have in the U.S. compared to that of Asia.

7. Eat Less Animal Meat and Dairy

I realize this last point will probably be highly contentious so I saved it for last.  If you are are a believer in the research on TMAO production from the gut as a potential cause of atrial fibrillation, then the less animal meat and dairy you eat the better off you may be provided you are getting adequate amounts of vitamin B12, omega 3, calcium, etc. from other sources.

However, please note that elevated TMAO and atrial fibrillation have only been observed to coexist.  These studies certainly don’t prove that TMAO causes atrial fibrillation.  Also, we have to explain the paradox of how fish might decrease the risk of atrial fibrillation despite the fact that fish also increases TMAO production from gut bacteria.

What is an Example of the Atrial Fibrillation Diet?

Let’s face it; we live in a fast-paced modern world.  It can be almost impossible for most people to grow a garden, source locally grown organic food, and take the time to prepare fresh real food.  So how could you incorporate the Atrial Fibrillation Diet into your daily routine?


Breakfast really is the most important meal of the day but not for the reasons you usually hear.  I have found with my patients that how their breakfast goes usually determines how the rest of the day will go.

Smoothies are a great way to start the day.  As long as you aren’t adding any sugar, a smoothie loaded with green leafy vegetables, frozen berries, nuts, and seeds is a great way to protect your heart from atrial fibrillation.


Salads are great for lunch and should be a daily occurrence with the Atrial Fibrillation Diet.  As salad toppings can often undo any potential health-promoting effects of salads, I recommend never using commercially prepared salad dressings.  Making your salad dressing is surprisingly tasty and quick.  This is what we do in our home.  For ideas, please look through our family’s salad dressing recipes on this website.

If you are eating out, all is not lost.  Combining olive oil and balsamic vinegar makes for a great salad dressing on the go.  Likewise, nuts and seeds can substitute for salad dressings as well.  Personally, I try to avoid the salad dressing when eating out as you never know how much sugar, bad fats, or chemicals they have put in it.


For dinner, we love a stir-fry vegetable dish.  Sometimes some wild salmon will accompany the stir-fry.   Often we will mix in some lentils, garbanzo beans, or tofu.   Once again, if you are looking for ways to make lightly cooked vegetables taste delicious, here is my favorite.

If a dessert is desired, we love dark chocolate from Trader Joe’s or Whole Foods.  At these two stores, there are many dark chocolate options that both taste great and come without any sugar.

The Top 4 Atrial Fibrillation Diet Guidelines

When it comes to eating, some people like rules and others don’t.  Personally, I’m not one for a detailed list of “forbidden foods” or rules, rather I like general guidelines  And if you have to ask, can I eat this?  Then the answer is almost always no.

Eating should be an enjoyable thing that you share with friends and family.  So if you can just remember these four things, then you are 90% there for following the Atrial Fibrillation Diet.

1.  Triple Your Vegetable Intake

No further explanation needed here.  The more veggies you eat, the healthier you will be.

2. Avoid Sugar

Once again, we’ve covered this extensively in this article.  I can’t think of a single health benefit that comes from sugar.

3. Avoid Flour

Flour may come as a surprise to many readers.  The reason why I have listed flour isn’t due to gluten issues but rather because flour behaves exactly like sugar in the body.  Indeed, this explains why even so-called healthy whole wheat bread will spike your blood glucose faster than a Snicker’s bar!  If you can’t live without bread, like me, then learn to like bread made with almond flour or without flour (Ezekiel bread or Trader Joe’s flourless bread).

4. Don’t Eat After 7 PM

Eating late causes weight gain, fouls up your glucose metabolism, and spikes your blood pressure.  None of these things are good for people battling atrial fibrillation.  If you can learn to stop eating by 7 PM, then you’ll also be practicing a form of intermittent fasting with additional health benefits.

Is the Ketogenic Diet Safe with Atrial Fibrillation?

Perhaps you saw the worldwide news reports that the ketogenic diet wasn’t safe for atrial fibrillation?  In case you missed this media sensation, here is the most credible source to review this unpublished study.

While the headlines likely put fear in the hearts of any keto follower, the truth is that this study really doesn’t tell us much.  In fact, it really wasn’t even a study of the ketogenic diet.  Rather, they just looked at the atrial fibrillation risk based on a low (<45% of calories), moderate (45-52% of calories), or high carbohydrate diet (>52% of calories).

One strength of the study is that they had nearly 14,000 people with approximately 20 years of follow up.  However, the data quality is highly suspect as it was based on a food questionnaire where people tried to report what they remember eating over the years.  The bottom line is that the low carbohydrate group had a 16-18% increased risk of atrial fibrillation.

I suspect that the real reason why more atrial fibrillation was observed in the low carbohydrate group was that they probably had other unhealthy eating habits that increased their risk.  For example, were they eating more cheeseburgers, hot dogs, or other processed foods? Perhaps there was even more alcohol or smoking in the lower carbohydrate group.  Until the study is published, I can’t really comment more than this.

If the ketogenic diet is working for you, I wouldn’t stop it based on the preliminary results of this study.  Rather, the more plant-based you can make your ketogenic diet the healthier it will probably be for your heart.

Final Thoughts

As Hippocrates so famously said more than 2,000 years ago, let food be your medicine.  And when it comes to atrial fibrillation, I have seen first hand whether food suppresses or promotes arrhythmias.  While there is no one proven best diet for atrial fibrillation, provided you aren’t overweight and you have minimized sugar, flour, and other “modern foods,” in conjunction with copious amounts of vegetables, your risk of atrial fibrillation will likely be quite low. 

#297 Can You Exercise Too Much?

November 19th, 2018 by

Can You Exercise Too Much?

Most people would be thrilled to have their doctor tell them that they shouldn’t exercise too much.  Can you really exercise too much?  In this article, I’ll share the latest research findings on exercise with regards to lifespan, brain health, and arrhythmias.

Does Exercise Increase Longevity?

As we discussed in our best selling book, The Longevity Plan, at the cellular level studies show that exercise adds 10 years to your lifespan.  The great thing about these extra years is that these years gained from exercising are high-quality years.   In other words, the fitter you are the less likely you are to have poor health at the end of your life.

Indeed, this is what I see in my cardiology practice.  People who exercised faithfully throughout their mid-adult lives are often the same people who are still skiing, cycling, and going to the gym in their 80s, 90s, and beyond.  This finding fits well with the compression of morbidity hypothesis which states that proper maintenance care now may eliminate or minimize the sick years at the end of life.

Is There an Upper Limit to Exercise and Longevity?

While some people have argued that it is possible you can exercise too much, the most recent research suggests that you can’t exercise too much when it comes to longevity.  Indeed, in a recently published JAMA study on 122,007 people showed that the farther a middle age person can go on a treadmill at their doctor’s office the longer they will live.

To get the maximum life expectancy in this study you had to be in the 95th percentile of people your age for physical fitness.  And if you could achieve this 95th percentile, then you lived 80% longer.

What’s Worse, Smoking or Not Exercising?

While everyone knows that smoking is bad, few people quibble over missing a few workouts.  However, these missed workouts may actually be worse for you than smoking according to this same study.  The truth is that if you want a long life free of disease and heart problems, you have to do something for exercise every day.  No excuses.

How Do You Exercise with Bad Knees, a Bad Back, or Bad Whatever?

While most people are quick to come up with an excuse as to why they can’t exercise, Michele no longer believes these excuses.

Michele is a 78-year-old patient of mine with atrial fibrillation.  In addition to atrial fibrillation, Michele also has multiple sclerosis (MS) and is confined to a wheelchair.  Not only is she stuck in a wheelchair but MS left her so tired that she didn’t have any energy to exercise.  If anyone had an excuse not to exercise it was Michele.

When Michele and I discussed the importance of exercising to prevent her atrial fibrillation from worsening, she came to realize that not being able to exercise was really just an excuse she chose to believe.  Together we explored how she could exercise given her challenges.

With a few Google searches, she was quickly able to learn how to do wheelchair yoga and weightlifting.  She also invested in an upper body exercise bike that she could pedal with her arms while watching TV.  She made exercise a daily habit, which then led to healthier eating, natural weight loss, better sleep at night, and a whole new view of the stresses in her life.  The end result was that her atrial fibrillation went into remission and she no longer needed my help as a cardiologist.

The key point here is that everyone can do something for exercise.  If your knees or back hurt try cycling, water aerobics, or swimming.  And if these exercises don’t work for you then explore other ways to exercise daily.

What is the Best Exercise for Longevity?

When it comes to the best exercise my answer is always the one you like.  I answer this way because I know if you enjoy it then you will be more likely to stick with it.

Every once in a while someone fires back, “but I don’t like any type of exercise.”

To this I respond, “then find something you like.”  As there are thousands of different ways you can move your body I am confident you will find something you can learn to like.

However, if you want to take things to the next level, a recent study of 8,577 people showed that the more social interaction you get with exercise the longer you’ll live.  This finding makes sense and fits well with other research.  A leading researcher in the field of loneliness and longevity, Dr. Juliane Holt-Lundstad, has shown that social connection may be more important for longevity than how much you weigh or whether or not you smoke.

With my busy schedule at the hospital, it is hard for me to exercise with other people when I’m trying to get in a workout at four or five o’clock in the morning.  However, on the days I am off, I can choose to exercise with my family.  As a family, we love bike rides, hikes, and ski days together.

Can Exercise Prevent Dementia?

Exercise is fertilizer for your brain.  Indeed it is one of the most potent stimulators of brain-derived neurotrophic factor (BDNF), as I discussed in this article.  And the more of this BDNF you have the better brain you’ll have.

One interesting study showed that for middle age people if you can get into the top level of fitness for people your age you can drive your long-term dementia risk down close to zero (88% reduction).   Thus, as with longevity, research suggests that you also can’t exercise too much when it comes to dementia prevention.

Can Too Much Exercise Cause Arrhythmias?

Having made it this far in the article, it seems like there is no limit to the benefit you can get from exercise.  The one exception may be with arrhythmias.  Perhaps you can exercise too much when it comes to cardiac arrhythmias.

While 99% of my patients don’t have to worry about getting too much exercise, there is a small subset that does.  Indeed, many studies have confirmed that extreme levels of physical fitness, like training for the Ironman World Championship, elite ultramarathon runners, or Tour de France riders, may be at increased risk of atrial fibrillation.

Before you start dialing back your exercise, a study just published in JAMA showed that even among elite athletes atrial fibrillation was a rare occurrence.  Although the increased risk was low, older athletes who have competed for many years and who also have an enlarged left atrium seem to be the most at risk from this study.

As exercise is so critical for optimal brain function, health, and longevity, most of my elite athletes with atrial fibrillation usually opt to just get it fixed with a catheter ablation procedure.  For these people, they can’t compete on all the cardiac drugs so they are looking for non-pharmacologic solutions to their arrhythmias.

How Do You Make Exercise a Habit?

While everyone knows exercise is important, studies show that only 5% of Americans exercise regularly when you look at accelerometer studies.  Why is it that only one in every 20 Americans can make the daily exercise habit stick?

The problem is that in my experience they lack one or more of the following three things:

1. Purpose.

They need a reason to exercise.  Exercise isn’t easy and if you don’t have a compelling reason to exercise it makes it even harder.

For me, exercise is my daily antidepressant.  Without it I am miserable and no one enjoys being around me.

2. Environment.

If you are going to make exercise a daily habit you need the right environment.  You need friends that exercise.  And if you don’t have any exercising friends then find some at your local gym or community meet up.

Selling one of your cars is a fantastic way to change your environment to exercise more (not to mention the fact that you would also save a ton of money).  Less drastic measures could be setting out the right exercise gear before you go to bed at night.  If your workout clothes are all laid out before you then when you wake up in the morning the path of least resistance will be to exercise.

3. Accountability.

You have to be accountable to someone or something.  Perhaps it is your workout partner or a trainer at the gym.  It could even be an app on your phone.  In my case, I have recorded every workout in my iPhone for the last six years.  For me, it is the app on my phone that keeps me accountable.

How do You Prevent Exercise Injuries?

Once I hit age 40 I found that I had to cross train.  My body simply wouldn’t allow me to do the same exercise every day.  I have to mix it up or I get injured.

To prevent injuries, my advice is simple.  Mix it up.  If you go to the gym, attend many different workout classes.  If you exercise outside, like me, mix it up with cycling, hiking, running, skiing, paddle boarding, etc.

The Story Behind the Photo for this Article

Last month I finally cashed in the Delta Airlines frequent flyer miles and took my family on a free trip to the north shore of Oahu.  The best part about vacations for me is the opportunity to spend most of the day being physically active.  In this photo, I am running on the beach with my two-year-old son.  From the moment our children learn to walk, we try to keep them physically active every day.


While daily exercise is the right decision for more than 99.9% of my patients, there are rare situations where exercise may not be advisable.  Check in with your doctor first to make sure you don’t have any exercise restrictions that might put you at risk.



#296 17 Ways to Increase Your Heart Rate Variability and Life Expectancy

October 28th, 2018 by

17 Ways to Increase Your Heart Rate Variability and Life Expectancy

Your heart rate variability (HRV) number may be the single best predictor of your overall health, fitness, and longevity.  Your HRV number, and how far it strays from your baseline, can tell you how much mental or physical stress your heart is seeing.  In this article, I will teach you how to determine your HRV number in five minutes and then how to increase your heart rate variability.

For a background on what HRV is and why it matters, please read my previous post:  5 Reasons Why You Need to Know Your Heart Rate Variability Number.  The bottom line here is that if your HRV number is low, your risk of a heart attack, arrhythmias including atrial fibrillation, heart failure, strokes, dementia, etc. all increase significantly.

How to Determine Your HRV in 5 Minutes

Step 1: Follow this link to download the free Welltory app from iTunes or Google Play.

Step 2: Sign in to the app from your phone.

Step 3: Click on “measure now” at the top of the screen.

Step 4: Cover the camera and light on your phone with your finger and then watch your heart beats in real time as the app measures your heart rate variability (HRV).

The Best Way to Track Your HRV

The Welltory app is a great option for the first 5 days of the free trial period.  After 5 days, they block the most important data unless you agree to pay very high recurring fees to continue to get all of the information.

If you find HRV helpful, long-term I recommend the free Elite HRV app.  Please be aware that you can’t use your phone’s camera for the Elite HRV app.  While Elite HRV has no recurring fees, you will need to purchase either a chest strap or finger monitor for around $100 USD.  The details can all be found on the Elite HRV website.

Can you use your smartwatch to measure HRV?

Since so many of us now wear smartwatches to track our workouts, wouldn’t it be great if we could just take this HRV number from our smartwatch?  I tried doing this with my Apple Watch and my HRV number came back really low…

Even though smartwatches have built-in HRV measuring features, smartwatch HRV numbers are notoriously inaccurate.  It is just too hard for the watch to measure HRV from your wrist as you are moving around during the day.  If you really want to use your smartwatch to measure heart rate variability, then you need to do a manual measurement with your wrist as still as possible.  Fortunately, with a manual measurement, I was able to get a much better HRV number off my Apple Watch.

How do consumer HRV products compare to medical grade HRV equipment?

Of course, whatever consumer products you use probably won’t be as accurate as what your cardiologist can measure.  However, as consumer HRV products have continued to improve, studies show that these consumer HRV products do a pretty reasonable job as long as you are at rest.  If your goal is to see your exercise HRV then you will need to find a specialized lab that can measure this for you.  My personal opinion is that resting HRV is good enough to track your health.

What is your HRV goal number?

If you want to maximize your chances for a long and healthy life you need your SDNN heart rate variability number above 70.  If your number comes up below 70 then your risk of arrhythmias, heart failure, heart attacks, cancer, premature death, etc. all goes way up.

Please don’t get too caught up in trying to achieve this number.  The real goal is to take your baseline measurement and then try to improve this number over time with the 17 suggestions I provide in this article.

How do heart medications affect HRV?

Following my first article on HRV, I was flooded with many questions about how heart medications affect HRV.  In general, anything that slows your heart rate (also known as your pulse) will probably increase your HRV.  While this seems counterintuitive, let me explain.

With a slower heart rate, there is more time between each heartbeat.  Thus, there is more time for beat to beat variability.  In contrast, with a high heart rate, there is less time between each heartbeat so there are fewer opportunities for variability.

Thus, while HRV may decrease with a heart medication that slows your heart rate (pulse), no one knows what this really means.  If you are on heart meds which slow your heart rate (pulse), I would suggest measuring your baseline “medicated” HRV number and then work to decrease this number over time by the 17 things discussed later in this article.

Does HRV decrease with age?

Sadly, studies show that for most people heart rate variability decreases as part of the aging process.  Perhaps this helps to explain why cardiovascular disease also increases with age.  But it doesn’t have to be this way.

Our 5-year study of the people living in China’s Longevity Village, as described in our best-selling book The Longevity Plan, showed that aging doesn’t have to bring disease and disability.  Indeed, people living to 100 and beyond can still practice martial arts, hike mountains, and live independently.  And it probably wouldn’t surprise you to also learn that these people also had a much higher HRV number than people half their age living in the US.

What is the relationship between HRV and arrhythmias?

Provided your heart is in rhythm (HRV numbers aren’t so accurate if your heart is out of rhythm), your risk of arrhythmias go up on the days when your HRV is running low.  With regards to the most common arrhythmia, atrial fibrillation, when the body is under significant mental or physical stress the heart is much more likely to go out of rhythm.  Thus, as a low HRV is a marker for either high mental or physical stress, it only makes sense that a low HRV increases the atrial fibrillation risk.

17 Ways to Increase Your Heart Rate Variability and Life Expectancy

For those of you who desire better health and energy now, here are my 17 scientifically proven ways to increase your heart rate variability.  Are you ready to start optimizing your HRV?

1.  Bump up Your Exercise Time

Exercise has a profound beneficial effect on your autonomic nervous system.  Your autonomic nervous system is the part of your nervous system that controls bodily functions like heart rate (pulse), blood pressure, digestion, etc.  Indeed, studies show that regular daily exercise is probably the single best way to boost your HRV number.  And recent studies show that not exercising may even be worse for your health and longevity than smoking!

Interestingly, if you do a “killer” workout you will probably see an immediate drop in your HRV as your body recovers.  However, after the recovery period, your HRV then goes up over time.

World class athletes also use HRV in another way.  If their HRV is low for the day, they will dial back their exercise to prevent injuries.  Conversely, if HRV is high they will go “all out” on those high HRV days.

When it comes to making exercise a daily routine, the biggest challenge is self-discipline.  To help overcome all of the excuses as to why you can’t exercise consistently, please check out this article I wrote: The 10 Best Excuses Not to Exercise.

2. Yoga

Of all the ways to quiet your “fight or flight” sympathetic response, yoga has to be at the top of the list.  I have seen countless examples in my practice where yoga alone put arrhythmias into remission.  And when it comes to your HRV number, studies show that yoga can move your HRV number upward.

3. Intermittent Fasting

Fasting offers many health benefits.  When you are fasting your body goes into repair mode.

While fasting, the “rest and digest” or parasympathetic nervous system is in control.  In our stressed-out modern world, we need more parasympathetic influence to counterbalance the overly stimulated sympathetic nervous system.

As studies from our hospital have shown that intermittent fasting may decrease your risk of heart disease, it should come as no surprise that intermittent fasting has been shown to increase your HRV.

If you want to learn more about intermittent fasting, here is a great article I wrote on intermittent fasting and longevity.

4. Eat More Green Leafy Vegetables

Dietary advice can be so confusing.  What is clear though is that the more green leafy vegetables you eat, the better your health and longevity will be. Indeed, studies show that green leafy vegetable “superfoods” also boost your HRV.

5. Optimize Your Sleep

Optimizing sleep can be hard.  I know as I have struggled with insomnia now for the last 35 years.  What is clear from studies is that when sleep is optimized, HRV goes up.

Personally, I have found that if my HRV is running low at night from significant mental stress during the day, I find it hard to sleep.  Thus, a low HRV in the evening from a stressful day at work tells me that I need an evening workout for optimal sleep at night.  If you want to read more about what I have done to help optimize my sleep, here is a great article: 10 Things Great Sleepers Do.

6. Daily Meditation

In addition to yoga, meditation has a profound beneficial effect on your autonomic nervous system.  Meditation isn’t some new age “woo woo” thing.  Rather, it is merely a way of bringing your thoughts back and avoiding mental distractions.

For me, meditation is simply closing my eyes, clearing my mind, and taking slow deep abdominal breaths.  Most world class CEOs and athletes meditate for optimal performance.  And you can too if you want to boost HRV according to studies.

7. Slow Deep Breathing

If meditation isn’t your thing, then try regularly taking slow deep abdominal breaths.  If you wear an Apple Watch it will remind you to do this periodically during the day.

If you want to see what taking slow deep breaths can do, try watching your HRV in real time with the Welltory HRV app as you take these slow deep breaths.  When it comes to scientific studies, slow deep breathing improves HRV.

8. Decrease Commuting Time

According to many studies, long commutes to work is the number one thing that makes people unhappy.  And that unhappiness has a direct effect on HRV.  Thus, to improve HRV according to studies, you need to decrease the time you spend in your car or taking public transportation.

9. Eat More Omega 3 Foods

Perhaps because of the anti-inflammatory properties, eating more omega 3 foods may also increase your heart rate variability.  As a diet high in omega 3s has helped me, I eat a small piece of wild salmon on most mornings as well as a heaping amount of flax and chia seeds mixed in with my various nut and seed butters.

10. Practice Forgiveness

There is something magical that happens to our cardiovascular system when we let go of previous hurts.  Through the healing process of forgiveness, we can reprogram the impact of the autonomic nervous system on our cardiovascular system and boost our HRV.

11. Listen to Calming Music

Calming music has been shown to quiet the fight or flight response and increase HRV.  The key to this music benefit is that the fight or flight response (sympathetic nervous system) must be quieted so it can’t be pounding heavy metal or rap music.

12. Healthy Work Environment

Work for many is where we spend the majority of our day.  If work is stressful then it will take a toll on your autonomic nervous system and lower your heart rate variability.  However, if you have created a healthy work environment then studies show this may increase your heart rate variability.

13. Minimize any Overtime at Work

Even if you love your job, spending too much time at work takes a toll on your autonomic nervous system and lowers your HRV.  Indeed, studies show that by minimizing any overtime at work you may also increase your heart rate variability.

14. Avoid Shift Work

While we are on the topic of work and HRV, studies show that avoiding shift work is another way to increase your heart rate variability.  The reason for this is that shift work disrupts your circadian rhythm.  And anything that disrupts your circadian rhythm will have a negative impact on HRV.

As a cardiologist who is on call 24 hours straight at least six days a month, I can tell you that my HRV number is usually much lower than baseline levels when I am on call.  As doctors have to be on call for off-hour emergencies, it is especially important that I do every healing thing possible to increase my heart rate variability on the days when I am not on call.

15. Tai Chi

Like yoga, tai chi is a fantastic way to heal both the body and the mind.  And this healing increases your heart rate variability according to studies.  Thus, if yoga doesn’t work for you then try tai chi instead.

16. Spend More Time in Nature

Nature heals us.  There is something so wonderful that happens when we forget the stresses of the modern world and return back to nature.  This healing also has a tremendous benefit to your cardiovascular system that will likely increase your heart rate variability.

For me, my daily workout in nature is my antidepressant.  Indeed, right up there with my family, it is probably the one thing that helps keep me sane when stress levels are high.

17. Prayer

Prayer is a fantastic way to express our gratitude and turn our worries over to a supreme creator.  By practicing gratitude and outsourcing our worries, our hearts are not only healed but studies show that this may also increase your heart rate variability.



#295 5 Reasons Why You Need to Know Your Heart Rate Variability Number

October 8th, 2018 by

5 Reasons Why You Need to Know Your Heart Rate Variability Number

While knowing your blood pressure, cholesterol, and glucose numbers are all important, perhaps your most important health number is the one you probably have never heard about.  Indeed, heart rate variability (HRV) may be your best overall marker of health, fitness, and longevity.  HRV tells you how much mental or physical stress your heart is experiencing.   Fortunately, tracking this number is easy and will cost you next to nothing.  In this article, I’ll teach you everything you need to know about heart rate variability.

What is Heart Rate Variability?

Your heart beats about 100,000 times each day.  These 100,000 heartbeats aren’t perfectly timed.  And having a slight variation between the timing of your heartbeats is actually healthy.

Heart rate variability (HRV) is merely the beat to beat variation in timing.  For example, even though your heart rate is 60 beats per minute, which works out to an average of one beat per second, in reality, the timing between your next five heartbeats could be 0.98 seconds, 1.03 seconds, 0.99 seconds, 1.02 seconds, and then 0.98 seconds.

Why is There Heart Rate Variability?

The reason why there is heart rate variability is that there is a tug-a-war going on between the two opposing ends of your autonomic nervous system.  One one side you have the sympathetic response, which is the fight or flight response, that wants to rev up your cardiovascular system.  On the other side, you have the parasympathetic response, which is the rest and digest response, that wants to cool down your cardiovascular system.

Both responses are important.  For example, you need your sympathetic response when you are physically active during the day.  Likewise, you need your parasympathetic response at night when you are trying to sleep.

The key takeaway is that the sympathetic response makes the heart beat fast and the parasympathetic response slows it down.  When the heart is beating fast there is little beat-to-beat variation and heart rate variability is low.  In contrast, when the heart is beating slow there is a much wider beat-to-beat variability and heart rate variability is high.

If you’re stressed out and not exercising or eating optimally then your resting heart rate will be fast and your heart rate variability low.  This is because there is nothing to counterbalance an overactive sympathetic nervous system.  When the sympathetic nervous system is dominant at rest then the timing of your next five heartbeats might look something like 0.79 seconds, 0.79 seconds, 0.78 seconds, 0.78 seconds, and 0.79 seconds.  For optimal health, you need a healthy balance from both the sympathetic and parasympathetic components.

How Do You Measure Heart Rate Variability?

Fortunately, it is incredibly easy to measure your HRV at home.  While most smartwatches have built-in HRV tracking capabilities, I don’t recommend using smartwatches for this function.  The problem is that smartwatches aren’t reliable because they often can’t detect your wrist pulse.

The most accurate way to measure HRV is with a chest strap or finger monitor that communicates with your smartphone.  While the apps are free, the hardware will set you back around 100 US dollars.

A good way to test your HRV without having to buy a chest strap or finger monitor is to try out the free version of the Welltory HRV app. You can download this app for free on the AppStore or GooglePlay.  This app uses the camera feature of your phone to measure HRV so no extra equipment is needed.  For five days you will have full access.  After the five day trial period they hide the most important HRV data unless you pay a high recurring fee.

If you find HRV tracking helpful, I would suggest visiting the Elite HRV website as a long-term solution.  Just find a compatible chest strap or finger monitor from their website and the app is free with no recurring charges.

What Does a Low HRV Tell You?

Your HRV number tells you how much physical or emotional stress your body is under.  If your HRV is consistently running low, your body is probably getting crushed by excessive physical or emotional stress.  When HRV is low, you are much more likely to suffer from arrhythmias, heart attacks, illnesses, and injuries.  This is why world-class athletes will dial back their daily workout when HRV is low because they don’t want to get sick or get injured.

What is Your Goal HRV Number?

Regardless of which HRV system you choose, you will see lots of different numbers.  Of these various ways to measure your HRV, the best studied is SDNN.  SDNN represents the standard deviation of the beat-to-beat changes.  As long as your SDNN is consistently above 70 ms then the chances of you getting an arrhythmia, having a heart attack, or having anything bad happen to your body goes way down.  As long as your heart is in rhythm, meaning that you aren’t experiencing any arrhythmias, then the higher your HRV number the better.

How do arrhythmias affect HRV?

While you can still measure your HRV if you are having an arrhythmia (atrial fibrillation, PVCs, PACs, etc.), the HRV number while your heart is in an arrhythmia is meaningless.  This is because there are such extreme beat-to-beat fluctuations that you can’t make any sense of the data.  Thus, even though you will get a sky-high HRV number when your heart is out of rhythm, it isn’t the number you want.  Indeed, some studies have shown that when your HRV is too high from arrhythmias your risk of bad cardiovascular things happening to you is significantly increased.

The bottom line is that for an HRV measurement to be accurate, your heart has to be in rhythm.  Some variation in the beat-to-beat variation is healthy but too much, like from an arrhythmia, isn’t.

5 Reasons Why You Need to Know Your Heart Rate Variability Number

1.  A Suboptimal HRV Puts You at Risk of Atrial Fibrillation and Other Arrhythmias

Arrhythmias are often caused by an imbalance of the sympathetic and parasympathetic responses.  In other words, too much fight or flight (sympathetic) or too much rest and digest (parasympathetic) can trigger arrhythmias.  To minimize your risk of atrial fibrillation and any other arrhythmias, you need an optimal heart rate variability.

While an SDNN of less than 70 ms puts you at risk of arrhythmia, there are no clear numbers as to how high is too high.  Many of my patients have figured out what number on the high end puts them specifically at risk based on personal tracking.  As excessive premature beats often lead to atrial fibrillation, I suspect PACs are the reason why they get a sky-high HRV prior to their hearts going out of rhythm.

2. A Low HRV Puts You at Risk of a Heart Attack and Heart Failure

Countless studies over the last few decades have linked heart attacks and coronary artery disease with low HRV numbers.  Likewise, your risk of heart failure goes up three-fold with a low HRV. While higher is better when it comes to the SDNN HRV measurement (as long as you are not having an arrhythmia), the minimum number you want to hit is 70 ms.

3. A Low HRV Puts You at Risk of Premature Death

No one wants to die before their time.  However, if your HRV is consistently low there is a chance it could happen at any time without warning.  Indeed, many studies have shown that low HRV numbers and dying suddenly often go hand in hand.

4. A Low HRV Increases Your Risk of Cancer Death

Increasing your HRV doesn’t just protect your cardiovascular system but your entire body as well.  For example, an SDNN HRV level below 70 ms significantly increases your risk of cancer death.

5. A Low HRV Increases Your Risk of High Blood Pressure, Diabetes, Depression, etc.

The key takeaway here is that because most people living in modern societies are sympathetic dominant (low HRV), you can link low HRV numbers to most chronic medical conditions.  A low HRV doesn’t mean you will get any of these conditions.  Rather, a low HRV simply tells you that your life is out of rhythm.

The Big Picture

Most people living in modern societies are sympathetic dominant and thus have a low HRV.  While this would be helpful if we had to constantly defend our families from wild beasts, the truth is that most of us don’t have someone trying to kill them every day.

The reason why most people are sympathetic dominant is really quite simple.  We don’t get enough exercise, nutrition, and sleep but yet are under tremendous stress from sedentary jobs.  If your autonomic nervous system is out of rhythm then your health will also be out of balance.  The key is to have the right balance between the sympathetic and parasympathetic nervous system.  And tracking your HRV is the best way to see if you are in balance.


#294 9 Ways to Lower Your TMAO Afib and Heart Disease Risk

August 28th, 2018 by

9 Ways to Lower Your TMAO Afib and Heart Disease Risk

TMAO is a toxic byproduct from an unhealthy gut microbiome.  Having the right gut bacteria may help to prevent atrial fibrillation and just about every other form of cardiovascular disease.  In this article, I’ll share 9 ways to lower your TMAO Afib and heart disease risk.

What is TMAO?

Simply put, TMAO or trimethylamine N-oxide, is a waste byproduct from your gut bacteria.  As your gut microbiome tries to break down lecithin and carnitine from meat, eggs, dairy, processed foods, some energy drinks, some supplements, and soy TMAO is increased.

What’s the Proof of a TMAO Cardiovascular Risk?

If you do a simple search for “TMAO cardiovascular” on Pubmed website, you will quickly come up with 248 studies at the time of this writing.  Every study I reviewed reported a link between TMAO and a wide array of cardiovascular diseases.

And it isn’t just heart disease.  High TMAO levels have been reported with premature death, diabetes, strokes, cancer, high blood pressure, obesity, and kidney failure.

How may TMAO cause atrial fibrillation?

As just about every form of cardiovascular disease is associated with high TMAO levels, Afib is no exception.  For example, a Norwegian study of nearly 7,000 people showed that the higher your level of TMAO the more likely you were to get atrial fibrillation.  Indeed, this study showed that TMAO independently predicted susceptibility to atrial fibrillation outside of all the traditional Afib risk factors.

TMAO may also directly damage the electrical system of your heart.  In particular, studies show that that TMAO may rewire your heart’s electrical system by altering the autonomic nervous system or by directly damaging the heart cells through inflammation.

Is there a blood test for TMAO?

Yes, you can absolutely test for TMAO.  However, like countless other biomarkers of health, this isn’t a blood test your doctor will probably be able to do for you.  If you really want to know your TMAO level, you can do a quick Google search and find many companies willing to help you with this.  From a practical standpoint, if you can optimize around the 9 ways to lower your TMAO Afib and heart disease risk, then your TMAO levels will probably be undetectable even if you wanted to do TMAO testing.

9 Ways to Lower Your TMAO Afib and Heart Disease Risk

Based on hundreds of studies, we know that TMAO is definitely not something you want in your bloodstream.  Interestingly, antibiotics completely destroy TMAO producing bacteria.  However, given all of the other potentially harmful effects of antibiotics, this is not a viable option.   Below are the 9 best-proven ways I have found to lower your TMAO.

1. Eat a Mostly Plant-Based Diet

As TMAO is made by having the wrong gut bacteria, the quickest way to reduce TMAO is to eliminate the source.  Indeed, studies show that people who don’t eat meat, dairy, or eggs can virtually eliminate TMAO from their blood.  Once these bad gut bacteria have been eliminated, a vegan could even eat an occasional steak and not get a TMAO spike.

One unexplained paradox of TMAO is fish consumption.  For example, we know from countless studies that fish may protect against cardiovascular disease.  However, eating fish causes a big rise in TMAO levels.  One possible explanation for this paradox is that the TMAO produced from fish may be metabolized differently than TMAO from animal products.

If you like eggs and don’t want to increase TMAO levels, the cut off seems to be about two eggs per day.  As long as you stay under two eggs daily, one study shows that you can keep your TMAO levels in a reasonable range.

Likewise, dairy studies aren’t 100% entirely clear either.  For example, some studies show dairy shoots up TMAO levels whereas other studies say it doesn’t.

The bottom line is that if you choose to eat meat, make sure you also eat large amounts of vegetables to neutralize TMAO spikes.

2. Avoid Lecithin and Carnitine from Processed Foods, Energy Drinks, and Supplements

As the wrong gut microbiome will quickly turn any lecithin or carnitine from processed foods, energy drinks, or supplements into TMAO, the simplest way to lower TMAO levels is to avoid lecithin and carnitine.  If you consume these things, be sure to read the labels closely.

3. Optimize Sleep

Sleep is essential for just about everything, including keeping your TMAO levels in check.  Indeed, one study showed that going 24 hours without sleeping could boost TMAO levels.

4. Eat More Fiber

As with LDL cholesterol and many other potentially toxic substances, a high fiber diet dramatically drops TMAO levels.  This is because fiber is the best thing you can feed your healthy gut bacteria.  For example, one study showed that TMAO levels came down by 60% with fiber.

5. Probiotics

Right up there with fiber, probiotics also feed the good bacteria in your gut.  Many studies, but not all studies,  have shown that probiotics may also reduce TMAO.

6. Keep Your Fat Calories Below 55%

Too much fat in your diet may also raise TMAO levels.  While the amount of fat required to boost TMAO isn’t clear, one study has pegged the value at 55% of your calories coming from fat.  To do this study, research participants supplemented their diets with vast amounts of dairy and coconut milk.  Thus, it is impossible to know if it was the dairy, or the actual fat calories, that boosted TMAO levels.

7. Optimize B and D Vitamins

Micronutrient deficiency may be another cause of an elevated TMAO.  Indeed, one study showed that by optimizing vitamins B and D you could lower TMAO.

8. Eat Resveratrol Rich Foods

Resveratrol was once the darling longevity food.  While resveratrol has lost its longevity luster, it may reduce TMAO.  To get more resveratrol in your diet be sure to eat peanuts, berries, grapes, nuts, and dark chocolate.

9. Get More DMB from Balsamic Vinegar and Olive Oil

DMB, or 3,3-dimethyl-1-butanol which is a substance found in balsamic vinegar and olive oil, may lower TMAO levels.

The Big Picture

A healthy gut microbiome may be the secret to health and longevity.  And the more I read about TMAO, the more I am convinced that I don’t want this potentially toxic byproduct in my bloodstream.  If you’re going to lower your TMAO levels, be sure to discuss anything you read in this article with your physician first.

#293 Is there a Low Carb Diet Mortality Risk? New Study Results

August 19th, 2018 by

Is there a Low Carb Diet Mortality Risk?

Everyone seemed to think carbs were bad until this new study was published last week.  Is there a way to follow a low carb diet and still live a long life?  In this article, I’ll teach you how to optimize your carbs so that you can avoid the low carb diet mortality risk.

The Dietary Carbohydrate Intake and Mortality Study

In what has to be one of the biggest carbohydrate studies ever done, Harvard University researchers included a total of 447,607 people.  Of these 447,607 people, a total of 46,464 people passed away during the 25-year follow-up of this study.  These Harvard researchers then analyzed their mortality risk based on food questionnaires filled out over the years prior to their deaths.  Here are the results:

1.  If you ate a moderate amount of carbs (40-70% of your total calories) you lived the longest.

2. If you followed a low carb diet (less than 40% of your calories are carbs), you lost about 4 years of life.

3. If you followed a high carb diet (more than 70% of your calories are carbs), you lost around 1 year of life.

How do you explain these results?

As carbs have been blamed for the obesity crisis, diabetes, and just about every other health problem, how can these study results be explained?  The answer is really quite simple.  Just as there are good and bad carbs there are also good and bad proteins and fat.

In the case of this study, people eating the most carbs ate a lot of flour and other processed carbohydrates.  As a result, their lives were cut short.  This fits nicely from what we know from countless other studies.

For the low carb eaters in this study, the problem is that they replaced their carbs with animal proteins and fat.  Indeed, these lost years of life could have been avoided had plant-based proteins and fat replaced their carbs.  Once again, this finding is something that comes up in study after study.

While nutrition studies are hard to do and sometimes reach the wrong conclusion, the results of this study seem believable based on what we already know.  Personally, I really don’t think what percentage of carbs you eat matters provided you are eating a mostly real food plant-based diet.  In other words, if you choose to eat meat it is a very small portion of wild meat.  The bulk of what is on your plate is vegetables and you also have a healthy fat like nuts, seeds, avocado, etc.

How do you find out your carb percentage?

It is really easy to find out what percentage of your calories come from carbs.  Simply download the free version of either Lose It or Cronometer from iTunes or Google play to your smartphone.  If you still use a flip-phone, there is also a free desktop version to both of these apps.

Next, enter in everything you ate today.  Both of these apps will then automatically calculate what percentage of your calories came from carbs.

How to Eat Low Carb and Live a Long Life

Many of my patients swear by the ketogenic diet.  Some of the biggest celebrities in the world are also following the ketogenic diet.  Even my own carbohydrate intake this past week was 40%.  This 40% number was just 1% away from falling into the danger zone according to this new study.

Yes, you can eat low carb and still live a long life according to this study.  The way to do this is to replace your carbs with plant-based fat and protein.

For example, nuts, seeds, avocados, olives, and coconuts are all mostly fat.  Likewise, there is a lot of protein in beans, lentils, and other legumes.

The big take away for me from this study is that unless you want to eat more plant-based you should probably moderate your carbohydrate intake.  If you are trying to lose weight or reverse diabetes with the ketogenic diet, start embracing a much more plant-based way of eating.

Does that mean you have to give up meat and dairy if you want to eat low carb?  Of course not.  However, a 95% plant-based approach is probably optimal. You simply eat a ton of veggies, low-sugar fruit like berries, and replace your other carbs with nuts, seeds, beans, lentils, avocados, olives, and coconuts.  From a mortality perspective, this study argues that this approach is associated with a long life.

Are you trying to cut back on carbs?  Please leave your thoughts and comments below.

#292 8 Reasons Why I Like the New Blood Thinners More than Warfarin/Coumadin

August 18th, 2018 by

8 Reasons Why I Like the New Afib Blood Thinners More than Warfarin/Coumadin

No one wants to take a blood thinner.  But if you had a gun to your head with no other choice, should you go with one of the new Afib blood thinners or warfarin (also known as Coumadin)?  In this article, I share the 8 reasons why I like the new Afib blood thinners more than warfarin.

The FDA Approved New Blood Thinners

When I am referring to the new Afib blood thinners, I am referring to the FDA approved agents for treating atrial fibrillation.  These new blood thinners are as follows:

– Eliquis (apixaban)

– Pradaxa (dabigatran)

– Savaysa (edoxaban)

– Xarelto (rivaroxaban)

1.  Safer

Anyone on a blood thinner worries about bleeding.  While the lawyers advertising on TV would have you believe the new Afib blood thinners will cause you to bleed to death, the scientific literature doesn’t support this.  In fact, countless studies have shown that your risk of bleeding is much lower on one of the new Afib blood thinners when compared to warfarin.

For example, in the 18,140 patient Aristotle Study which got Eliquis FDA approved, the risk of major bleeding on Eliquis was 2.13% versus the 3.09% risk of major bleeding with warfarin. Of all the possible bleeding that could occur, the most feared is spontaneous bleeding inside your brain.

And the benefit isn’t just with Eliquis.  For example, in our study of 5,254 patients at our hospital, all of the new blood thinners had a much lower risk of bleeding than warfarin.

2. Lower Stroke Risk

If you do choose to take a blood thinner, you want it to do its job.  And to that end, the new Afib blood thinners do a much better job at preventing atrial fibrillation strokes than warfarin in our real-world experience.

3. Lower Dementia Risk

While preventing strokes and minimizing the risk of bleeding is definitely the goal, you don’t want to increase your long-term dementia risk in the process.  Once again, in our study of over 5,000 patients, your dementia risk is much lower with one of the new Afib blood thinners when compared to warfarin.

4. You May Live Longer

Statistically speaking, atrial fibrillation shortens your life expectancy.  Wouldn’t it be great if you could help to undo much of this premature mortality risk?  At least when it comes to blood thinners, the newer agents may offer a mortality benefit when compared to warfarin in our study.

5. More Time and Less Hassle

We all want more time.  And Warfarin just doesn’t work for busy people.

Even if your INR blood test is perfect, you still need to have it done at least once a month.  Unless you have your own home monitor, this means an extra doctor’s visit every month.  And if you are having troubles keeping your INR between two and three with warfarin, then it may be a weekly test.

6. You Can Eat All the Vegetables You Want

Brocolli is one of my favorite foods.  The only problem for people taking warfarin/Coumadin is that broccoli is also sky high in vitamin K.  As warfarin is a vitamin K blocker, one big serving of broccoli could completely neutralize the blood-thinning effects of warfarin.

But broccoli isn’t the only healthy food high in vitamin K.  The same goes for kale, spinach, or even the lowly romaine lettuce.  In fact, any green vegetable is packed with vitamin K.

Given how hard it is to manage warfarin, many clinics tell patients to avoid these superfoods.  The only trouble is that if most vegetables are off the table you are just inviting weight gain as well as a host of chronic medical problems.

One workaround is to eat the exact same amount of vitamin K each day.  If you can carefully manage your vitamin K dose from vegetables then your warfarin could be appropriately dosed.

7. Possibly Less Coronary Artery Calcification and Osteoporosis

Vitamin K2 is critical to your cardiovascular system and bone health.  And as warfarin/Coumadin is a vitamin K blocker, there may be unintended consequences that your doctor may not know about.

For example, if you take warfarin, many studies show that your risk of osteoporosis and fractures is increased.  Likewise, coronary artery calcification has also been shown in many studies to be significantly increased with warfarin.

8. There Are Now Antidotes

It used to be that people feared the new Afib blood thinners because there was no antidote.  Fortunately, that is no longer the case.

Pradaxa, which is a direct thrombin inhibitor, has an FDA approved antidote. Also, the factor Xa inhibitors, like Eliquis, Xarelto, and Savaysa, also have an FDA approved antidote.  Now whether or not the hospital you go to has the reversal agent at the time you need it is a completely different issue.

5 Reasons to Stay on Warfarin

Despite my strong bias to the newer blood thinners, many of my patients still take warfarin.  Years ago we thought that our Coumadin Clinic at Intermountain Medical Center would go away.  However, that never happened.  If anything, the number of patients we have enrolled in our Coumadin Clinic has only gone up.  While the reasons for this are diverse, here are the top five reasons why some of my patients are still taking warfarin.

1.  Finances are Tight

Of all the reasons to stay on warfarin/Coumadin, this is definitely top on the list.  For most of my patients, the newer blood thinners are too expensive.  For someone living on just their social security checks, it is next to impossible for them to pay up to $400 a month.

To get around the steep price tag, many of my patients borrow from family members, obtain samples from their doctor, or use coupons which allow them to take one of these drugs at a reasonable price for a year.  Indeed, many of my patients switch from one new blood thinner to another each year so that they can get another year of good drug prices.  Unfortunately, this can only be done once for each drug.  However, as generic versions of these drugs are probably only three or four years away, switching coupons could allow you to stay financially solvent until there is a generic available.

2. You Have a Mechanical Heart Valve or Mitral Stenosis

Anyone with a mechanical heart valve or mitral stenosis should stay away from one of the new Afib blood thinners.  However, even though the package label says that people with other significant heart valve histories should also stay away, many studies argue the opposite.  If you have a history of a heart valve problem, please discuss this possible risk with your cardiologist before starting one of the newer blood thinners.

3. Your INRs Have Been Perfect

Some people actually do well on warfarin.  Indeed, I have had a handful of patients with perfect INR blood tests for years.  If you are one of these rare patients, then the new blood thinners probably don’t add any safety benefit for you.

4. You Believe the Lawyer Advertisements

I get it. Those late night lawyer TV commercials do a good job in convincing you that they have your best interest at heart when they encourage you to sue the makers of the new Afib blood thinners.  And if you believe them, then warfarin is your only other proven blood thinner option.  Sadly, our new research shows that aspirin does not prevent Afib strokes but yet still increases your risk of bleeding.

5. You Worry About a Reversal Agent

While antidotes now exist for the new Afib blood thinners, you never know if the hospital will have it should you ever need it.  This is especially true if you live in a rural area or are traveling overseas.  As you might have guessed, these antidotes are expensive and don’t have a long shelf life.  Thus, it is possible it won’t be there when you need it.

In contrast, warfarin is easily reversed.  Also, there are many ways to reverse warfarin so something should always be available.

#291 Dr. Day’s Riced Cauliflower Fast Food

July 24th, 2018 by

Dr. Day’s Riced Cauliflower Fast Food

It often seems like there is no time to prepare healthy food.  Wouldn’t it be great if you could have great tasting healthy food in 5 minutes?  In this article, I’ll share my riced cauliflower fast food meal.  This dish is guaranteed to fill you up for hours!

My “No Cooking Skills” Disclaimer

I am not a chef. In fact, I am horrible in the kitchen.   While my wife is a fabulous cook, I’m not.  If your time and cooking skills are limited, like me, you may want to consider giving this recipe a try.

4 Ingredients from Trader Joe’s

We love Trader Joe’s.  For those of you outside of the US, Trader Joe’s is a popular and affordably priced health food store.  We have one between our home and my hospital.  While these four ingredients all came from Trader Joe’s, you could easily improvise with your local health food store.

1. Frozen Organic Riced Cauliflower

While you could buy fresh riced cauliflower, I like the frozen variety better.  It is always fresh and I never have to worry about it going bad.  Given that it was frozen immediately, you don’t get the loss of nutrients that often comes from long farm to plate transport times. I use the whole bag for this riced cauliflower fast food meal.

2. Frozen Melodious Blend

I love the frozen melodious blend from Trader Joe’s.  There are only six ingredients with no chemicals, preservatives, or any added sugars.  The six ingredients are cooked green lentils, cooked red lentils, cooked green garbanzo beans, tomatoes, extra virgin olive oil, and sea salt. This little-frozen concoction is a meal unto itself.  I just use half the bag for this riced cauliflower fast food dish.  If you don’t have a Trader Joe’s near you, I would suggest substituting in one cup of cooked lentils in light olive oil.

3. Can of Organic Diced Tomatoes

I like the 14.5 oz (411 g) can of organic tomatoes (diced and no salt added) from Trader Joes.  I use the whole can which works out to be 1.5 cups of diced tomatoes.

4. Salt or Garlic Salt to Taste

I can’t give you an amount because everyone’s tastes and health needs are different.  You can make this rice cauliflower fast food dish with or without added salt.

If you choose to skip the salt, it will be a little bland.  Personally, I like to use garlic salt.  I like the added flavor that comes from the garlic.

I would suggest adding in a little salt or garlic salt and see how it tastes.  If you want a stronger flavor, add more.

Combining the 4 Ingredients

Preparation is simple.  Use the whole bag of organic riced cauliflower (12 oz or 340 g).  Add in half the bag of the melodious blend (or 1 cup of cooked lentils in olive oil if you don’t live near a Trader Joe’s).  Mix in the entire small can of diced organic tomatoes (1.5 cups, 14.5 oz or 411 g).  Then add salt or garlic salt to taste.

Given that most of the dish comes frozen, you can heat it on the stove or in the microwave.  I often throw the frozen bags and can of tomatoes in my computer bag when I leave in the morning as it is so easy to prepare everything at my hospital.  The total preparation time for me, including warming it up, is 5 minutes.

The Nutrition Stats

I eat the entire dish and it fills me up for half the day.  You could easily share this meal with a couple of other people.  Assuming you eat the entire dish by yourself, here are the nutritional stats.


Cauliflower 80, melodious blend 200, and tomatoes 90 for a grand total of 370 calories.  No other 370 calorie meal fills me up as much as this one does.  When you see how much food is in this 370 calorie meal you will be amazed.  Be prepared to use a huge container for this meal as it probably won’t all fit on your plate.


Cauliflower 8 g, melodious blend 11 g, and tomatoes 3 g for a combined total of 22 grams.  Considering the average American only eats 15 g of fiber daily, this single dish of 22 grams of fiber crushes what most people can do in a day.  This big dose of fiber will fill you up for hours.


Cauliflower 8 g, melodious blend 12 g, tomatoes 3 g for a total of 23 g of protein.  This is a ton of protein especially considering that it has twice the protein of a McDonald’s hamburger and four-times the protein of an egg.  As with all the fiber, this big dose of protein will really keep you full.


If you’re not a fan of dairy, it can be hard to get enough calcium in your diet.  This riced cauliflower fast food dish will definitely boost your calcium intake.

Cauliflower 80 mg, melodious blend 40 mg, and tomatoes 60 mg for a total of 180 mg!  As the daily recommended amount of calcium is 1000 mg, you are 20% of the way there with this dish.

Vitamin C

If you’re looking to stay healthy and avoid colds then you’ll love all the vitamin C packed in this dish.  Here are the stats:

Cauliflower 280%, melodious blend 6%, tomatoes 105% for a total of 391% of your daily recommended amount of vitamin C!  This blows away what you would find in a multivitamin!


If you have ever tracked your nutrient intake, getting enough potassium can be hard.  Unless you suffer from kidney problems, getting enough potassium in your diet is absolutely critical for optimal health and normal blood pressure.  For potassium, here is what you will find:

Cauliflower 20%, melodious blend 15%, tomatoes 20% for a total of 55%!  Wow, more than half the optimal amount of potassium you need from this one dish.

Bad Ingredients

None.  No added sugar. No processed grains.  No unhealthy oils.  No cholesterol.

My Kids Love It…Give it a Try

If you are in a bind for time and want to eat healthily, give this dish a try.  All of my kids love this dish. Even my two-year-old son can’t get enough of it.

Please feel free to modify this recipe.  For example, I have substituted in some healthy marinara sauce in place of the tomatoes and salt.  Likewise, I have tried adding in a fifth ingredient, hummus, for a completely different taste.

I’d love to hear your thoughts.  Also, let me know how you have tweaked the recipe.

#290 4 Reasons Why Vacations Make You Live Longer

July 17th, 2018 by

4 Reasons Why Vacations Make You Live Longer

Wouldn’t it be great if the more vacations you took, the longer you lived?  Having just returned from a family trip I’d like to think that this week away added years to my life.  In a landmark study, researchers found that the more holidays you take, the longer you live.  In this article, I discuss four reasons why vacations make you live longer.

Vacation Longevity Study

In this study, researchers recruited 12,338 people who were at high risk for a heart attack.  Over the next nine years, they found something exciting.  If you want to live a long life, you need to take a lot of vacations.

Interestingly, the reason why these people lived longer was that vacations somehow protected them from heart problems.  Indeed, those taking the most vacations lived 17% longer and were 29% less likely to have serious heart troubles.

4 Reasons Why Vacations Make You Live Longer

To explain the life-extending benefits of vacations, these researchers came up with four possibilities.

1. Vacations Allow You to De-Stress

Really?  Perhaps this is because I have four strong-willed children.  In my experience, time away can be more stressful.  Everything from sleep deprivation to the various delays can make travel hard.

Perhaps the magic lies in the fact that it is a different kind of stress.  In my case, rather than the pressure of the operating room or being on call for hospital emergencies, it is now the stress of moving a large family from point A to point B and making sure my two-year-old doesn’t get lost or injured in the process.

When it comes to stress and the heart, I have learned that you can’t ever eliminate stress.  The only people without any stress have all passed away.  Whether or not stress causes you an arrhythmia or an early cardiac death all comes down to how you perceive your stressors.  Perhaps this helps to explain why any vacation related stress might be a good thing.

2. Vacations Increase Time with Family and Friends

Spending more time with friends and family may be one of the healthiest things we can do for our heart.  Indeed, studies show that your social life may be a better predictor of longevity than either smoking or obesity.  Sometimes it takes a vacation to wake us up to what is most important in this life.

3. Vacations Increase Physical Activity

Most people live their lives going from one chair to the next.  We sit for breakfast, sit in our cars, sit at work, sit in our cars again, and then sit to watch TV at night. Sometimes we need an enjoyable vacation to shake things up and get us a bit more active.

In my case, vacations offer the chance of a long workout.  And, as you know, long workouts can be challenging to come by during a typical workday. Physical activity from time away could be yet another reason why vacations make you live longer.

4. You’re Working Fewer Hours

If nothing else, getting away means you aren’t usually working.  And if taking a vacation makes it so that you avoid overtime then it may be good for your heart.  For example, many studies have shown that putting in more hours than the typical workweek significantly increases your risk of atrial fibrillation.  As a recovering workaholic, vacations help me remember the importance of creating memories that my children will remember for the rest of their lives.

How to Vacation Regularly on a Budget

Everyone’s idea of the perfect vacation is different.  Rather than just settle for one big annual family getaway, we try to spread out many budget-friendly mini-vacations over the course of a year.  Our goal is to try and do something, even if it is just a one-night getaway, on at least a monthly basis.

Staying a couple of nights with old friends or family members can be another budget-friendly vacation.  Our kids love packing their sleeping bags and hanging out with their cousins.

Even business-related travel can be a great excuse to take all or part of your family along with you.  My goal has always been to take my wife, or at least one child, with me whenever possible.

When it comes to financing trips, our philosophy is simple.  Other than the price of gas, an occasional budget hotel/Airbnb, or the food we would eat anyway, we never pay for travel.  We love cashing in on free flights from reward miles, high adventure activities within a few hundred miles, or just staying with family.

What if You Can’t Vacation Regularly?

Even if you can’t get away regularly, studies show that just having a vacation to look forward to can give you the same health benefits.  Thus, if you want the cardiac protection and longevity boost that comes from vacations, make sure you always have something on your calendar.  Even if it isn’t for a year or more, just looking forward to it will make your heart healthier.

The Big Picture

In my review of all the vacation studies, I have yet to find a study that says vacations are bad for you.  I also have never met a dying patient in the hospital who said they wished they had taken fewer vacations.

If you think you can’t afford more vacations, I challenge you to think creatively.  “Staycations” can be wonderful.  Likewise, budget travel can be the most enjoyable form of travel.  Even better, I have met many people who make money while traveling.  By simply putting their homes on Airbnb while away, they can collect US dollars while spending Mexican pesos.

If getting away is truly challenging for you, then the best “longevity hack” is to have a vacation to look forward to.  Heck, scheduling something 18 to 24 months out can be a tremendous boost to your heart health.

How has travel helped you to optimize your life experience?  Please leave your thoughts and questions below.  For questions, please be patient as it may take me a few weeks to respond.  Despite the wait, I do read and respond to everything left below.  In case you were wondering about the photo for this article, it was taken at one of our favorite family destinations, Lake Powell.



#289 13 Reasons Why CHADS-VASc May Not be the Best for Atrial Fibrillation Stroke Prevention

July 4th, 2018 by

13 Reasons Why CHADS-VASc May Not Be the Best for Atrial Fibrillation Stroke Prevention

Wouldn’t it be great if we could accurately predict who is most at risk for atrial fibrillation strokes?  Despite the aggressive use of blood thinners in the new CHADS-VASc guidelines, there is no proof yet that stroke rates have gone down.  In this article, I discuss 13 reasons why the CHADS-VASc scoring system may not be the best for atrial fibrillation stroke prevention.

What is CHADS-VASc?

For those readers who may be unfamiliar with the CHADS-VASc scoring system for atrial fibrillation stroke prevention, let me give you a quick primer.  CHADS-VASc is an acronym for some of the stroke risk factors.  Based on how many of these risk factors you have, you can calculate your score.  If your score is one or higher, you are a candidate for life-long blood thinners like warfarin (Coumadin), Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), or Savaysa (edoxaban).

To calculate your CHADS-VASc score, you get one point for congestive heart failure, high blood pressure, an age of 65 to 74, diabetes, vascular disease (history of a blockage in any artery), or sex (female gender).  If you have had a stroke or TIA, you get two points.  Likewise, if your age is 75 or older, you also get two points.

This CHADS-VASc scoring system has been the “Bible” for blood thinner use in Europe since 2012 and the US since 2014.  Since 2014, this new CHADS-VASc scoring system has had a huge impact on my atrial fibrillation practice.

How CHADS-VASc Has Changed my Practice

At least two-thirds of my cardiology practice is atrial fibrillation.  Other than the dramatic advances in the field of catheter ablation, the most significant change I have seen in atrial fibrillation management has been the CHADS-VASc scoring system for atrial fibrillation stroke prevention.

The reason why CHADS-VASc has had such a massive impact on my practice is that it requires most of my previously low-risk atrial fibrillation patients to now take blood thinners for the rest of their lives.  Despite all of the blood thinners now being prescribed, I’m not convinced things have improved.  As we have been less than impressed with the CHADS-VASc scoring system, our hospital has created a new scoring system which may be better than CHADS-VASc.

13 Reasons Why CHADS-VASc is Wrong for Atrial Fibrillation Stroke Prevention

The low threshold to start blood thinners with the CHADS-VASc scoring system never really made sense to me.  And here are 13 reasons why it may not be the best for atrial fibrillation stroke prevention.

1.  It Doesn’t Predict the Risk of Blood Clots in the Heart

Fully 90% of atrial fibrillation strokes arise from blood clots in the left atrial appendage of the heart.  Thus, if CHADS-VASc worked, you would expect this scoring system to predict the risk of developing a blood clot in the left atrial appendage of the heart.  Unfortunately, studies show that it doesn’t predict the risk of blood clots in the heart.

2. It Wrongly States that All Women Are Candidates for Blood Thinners

According to CHADS-VASc, all women are candidates for life-long blood thinners. Personally, I don’t think that the female gender should count as an atrial fibrillation stroke risk factor.  While there are some studies suggesting women might be at higher risk of stroke, I can find plenty of other studies arguing the opposite.

3. No Credit is Given for an Ablation

Even if a catheter ablation has eliminated your atrial fibrillation, CHADS-VASc gives you no credit.  Despite many studies showing that successful ablation patients have a very low risk of stroke, this scoring system ignores the evidence.

4. There is No Proof it is Better than the Old Scoring System

You would think that it would take compelling evidence to change a scoring system that determines whether or not you should swallow down a blood thinner for the rest of your life.  Sadly, that wasn’t the case.

This new CHADS-VASc scoring system was determined by retrospective database number crunching.  In other words, there was no definite proof that it was any better than the previous scoring system it replaced.  Even worse is that there are now studies showing that it is not as good as what we previously had.

5. No Credit is Given for the Motivated Patient

Regardless of the study, bad things are much more likely to happen to people who aren’t proactive about their health.  And when it comes to atrial fibrillation stroke prevention, the same holds true.

For the motivated patient who tracks their daily heart rhythm, it just doesn’t make sense to take a blood thinner every day when you may only have atrial fibrillation once or twice a year.  Indeed, at least three small studies (1, 2, 3) have shown that it is safe to only take a blood thinner on an as needed basis for people who are tracking their rhythms.  Despite this mounting evidence, CHADS-VASc gives no credit to the motivated patient.

6. It Ignores Reversible Causes of Atrial Fibrillation

Just because you have one episode of atrial fibrillation doesn’t mean that atrial fibrillation will be a lifelong problem for you.  Indeed, many cases of atrial fibrillation are completely reversible.

For example, drinking too much alcohol or getting pneumonia are both reversible causes of atrial fibrillation.  In other words, sobriety and staying healthy can put atrial fibrillation into remission.

Sadly, CHADS-VASc gives no credit to people with reversible causes of atrial fibrillation.  Even though studies show that blood thinners don’t work very well for reversible causes of atrial fibrillation, once again CHADS-VASc doesn’t consider this.

7. It Overlooks the Brain Microbleed Dementia Risk

I suspect that most cardiologists are unaware of brain microbleeds.  While most brain microbleeds don’t cause any symptoms, the more of them you get, the worse your brain functions.  Indeed, studies show that people on blood thinners may get more of these brain microbleeds than people not taking blood thinners.  And the more brain microbleeds you get, the higher your dementia risk.

8. It Assumes People Aren’t Taking Warfarin Anymore

One of the primary arguments of why everyone should take blood thinners for life with CHADS-VASc is that the new blood thinners are so much safer.  While the new blood thinners are much safer than warfarin, the problem is that warfarin use isn’t declining.

When the new blood thinners were released, we were sure that all of the Coumadin (warfarin) Clinics would go away.  In contrast, the number of patients on warfarin has only increased.

At least 99% of my patients on warfarin would love to take one of the new blood thinners. The only problem is that they can’t afford them. For people on a fixed income, there is no way they can afford the annual $5,000 price tag to take one of these drugs.   And if you can’t afford one of the new blood thinners, then the aggressive blood thinner use called for by the CHADS-VASc scoring system may not make sense.

9. Recommending Blood Thinners for a Score of 1 or Higher is Misguided

According to the CHADS-VASc scoring system, a score of one or higher is an indication for life-long blood thinners.  While some studies may suggest a benefit for the low score of one, others don’t.

For example, one study reports that blood thinners for a CHADS-VASc score of one is misguided.  Another highly credible study argues that the cut off for blood thinners should be at least a score of three.  The bottom line is that we really don’t know what the cut off for lifelong blood thinners should be.  In my mind, a cut off of “two” was an arbitrary decision.

10. It Disregards the Left Atrial Appendage

As 90% of atrial fibrillation strokes arise from the left atrial appendage, why does CHADS-VASc ignore this important structure in your heart?  For example, studies from our hospital show that the bigger your left atrial appendage, the higher your risk of stroke.

Also, the shape of your left atrial appendage matters when it comes to your risk of stroke.  In particular, the chicken wing pattern carries a very low stroke risk.  To find out the size or shape of your left atrial appendage, your cardiologist can quickly order a CT scan of your heart.

Lastly, the better your left atrial appendage contracts, the lower your stroke risk.  How well your left atrial appendage contracts is something that is best determined by a transesophageal echo (TEE).

11. It Dismisses the Type of Atrial Fibrillation You Have

Whether or not your atrial fibrillation is paroxysmal (starts and stops on its own) or persistent (doesn’t terminate on its own), determines your stroke risk.  For example, studies show that persistent atrial fibrillation has about twice the stroke risk of paroxysmal atrial fibrillation.  Sadly, CHADS-VASc completely dismisses this.  Regardless of your atrial fibrillation type, CHADS-VASc doesn’t care.

12. It Assumes Your Atrial Fibrillation Burden Doesn’t Matter

Common sense would tell you that when it comes to your atrial fibrillation stroke risk, being out of rhythm all the time is probably much riskier than only being out of rhythm less than 1% of the time.  And, as you might suspect, studies back this up.  CHADS-VASc, however, doesn’t care.  To the CHADS-VASc score, one brief minute of atrial fibrillation carries the same risk as one year of continuous atrial fibrillation.

13. It Rejects the Health of Your Left Atrium

When it comes to your atrial fibrillation stroke risk, the health of your left atrium also matters.  For example, the more dilated your left atrium, the higher your stroke risk.  Also, the more scar tissue you have in your left atrium also predicts your stroke risk. Once again, CHADS-VASc doesn’t care.  A perfectly healthy left atrium is treated the same way as a massively dilated and scarred up left atrium.

Are there Any Better Scoring Systems?

Given the limitations of the CHADS-VASc scoring system, is there anything else out there?  Yes, other scoring systems have been proposed.  For example, there is the ABC-Stroke system which uses blood tests to help determine your stroke risk.  Other scoring systems include GARFIELD-AF, ATRIA, and the Intermountain (my hospital) scoring system.  None of these alternative scoring systems are perfect either.  If nothing is perfect, what should you do?

The answer is to discuss this with your cardiologist.  Only you and your physician can determine if blood thinners are right for you or not.  And to make this decision, you have to take everything into consideration.

Avoid a Stroke…Read this Disclaimer

If you are on a blood thinner, don’t stop this drug based on anything you have read in this article.  Also, don’t let anything I discussed in this article influence your decision.  Strokes can happen and they usually happen in atrial fibrillation patients who are not taking blood thinners.

I have faith that you and your cardiologist can make the right decision for you.  Because taking a blood thinner is a big decision, look at stroke risk factors beyond those of “CHADS-VASc.”  And if you and your cardiologist do decide to hold off on blood thinners, then I would at least carefully check my pulse twice daily to make sure my heart was still in rhythm.  If my heart ever did go out of rhythm, I would immediately get on a blood thinner.



#288 4 Reasons Why Eating Nuts Prevent Atrial Fibrillation

July 1st, 2018 by

4 Reasons Why Eating Nuts Prevent Atrial Fibrillation

Wouldn’t it be great if a handful of nuts could prevent atrial fibrillation?  In this article, I’ll review the atrial fibrillation nut studies and share what I have learned from treating tens of thousands of atrial fibrillation patients over the last 23 years.

The Swedish Atrial Fibrillation Nut Study

If you are a nut lover, like me, then you’ll love this most recent study. In this Swedish atrial fibrillation nut study, researchers followed 61,364 people for 17 years.  After reviewing all of the data, they concluded that eating nuts decrease the risk of atrial fibrillation by 18%.

In order to get this 18% reduction in atrial fibrillation, the Swedes in this study had to eat nuts at least three times weekly for 17 years.  Sadly, they didn’t ask what kind of nuts they ate.  Thus, we have no idea if one nut is better than another for treating atrial fibrillation.

The most interesting part of this study was that the more nuts people ate, the less atrial fibrillation they had.  Unfortunately, the researchers only analyzed the data out to eating nuts three times weekly.  Based on the direction the graph was going, I suspect that daily nut eaters probably enjoyed even more atrial fibrillation protection.

While researchers did their best to make sense of the data, we can’t know for sure whether it was the nuts or the healthy habits of nut eaters that provided this protection.  To better understand whether nuts prevent atrial fibrillation, we need to look to other studies.

Two Other Atrial Fibrillation Nut Studies

In addition to the Swedish atrial fibrillation nut study, there have been two other significant studies looking at nut eaters and atrial fibrillation.  One of these studies showed that in male U.S. physicians, nuts offered no protection against atrial fibrillation.  The other study showed that while nuts, as part of an ancestral Mediterranean diet were helpful, they didn’t specifically prevent atrial fibrillation when compared to olive oil.

4 Reasons Why Nuts Could Prevent Atrial Fibrillation

I want to believe the Swedish atrial fibrillation nut study.  It only makes sense that nuts prevent atrial fibrillation.  Below are four reasons why it is possible that nuts prevent atrial fibrillation.

1. Nuts Are High in Magnesium and Potassium

Having optimal magnesium and potassium levels may be protective against atrial fibrillation.  As nuts are high in electrolytes, they could offer some protection.  Also, all of the other vitamins and micronutrients of nuts make a compelling argument as to why they might help.

2. Nuts Help You to Lose Weight

Despite all of the fat in nuts, studies show that these healthy fats help you to lose weight.  And as weight is so tightly linked to the risk of atrial fibrillation, it only makes sense that anything you can do to keep your weight in check would also help keep atrial fibrillation away.

3. Nuts Are Anti-Inflammatory

Our studies, as well as those from many other people, have shown that the higher your levels of inflammation, the greater your risk of atrial fibrillation.  As nuts help to reduce inflammation, you would expect that this would help your heart to stay in rhythm.

4. Nuts May Prevent Almost All Forms of Heart Disease

Depending on which study you look at, nuts have been shown to be protective against almost every form of cardiovascular disease.  Thus, given the incredible track record of nuts, you would expect that the same would be true for atrial fibrillation.

Nuts in My Atrial Fibrillation Practice

I wish I could tell you that all I have to do is prescribe a handful of almonds and atrial fibrillation goes away.  If the most potent antiarrhythmic drugs only have a fifty-fifty chance of keeping people in rhythm for even just a year, we can’t have too high of an expectation for any nut.

What I can tell you is that I have seen hundreds and hundreds of patients put their atrial fibrillation into remission with healthy living and weight loss.  And as part of this healthy living and weight loss, the vast majority of these patients ate nuts every day.  Nuts fill you up and help with insulin sensitivity.  While most liked almonds, peanuts, walnuts, and other nuts were also popular.

When it comes to using food as medicine, it is hard to isolate the beneficial effects of any one given food. Instead, it is the cumulative effect of nuts, seeds, vegetables, berries, etc.

Nuts Have Been Good to Me

Before my health turn around six years ago, I almost never ate nuts.  Since that time, I eat nuts every day.  It is part of my daily breakfast.

In addition to vegetables and berries, I eat various nut butters on Ezekiel (a flourless bread).  Instead of jam, I sprinkle lots of chia seeds and flax seeds on top of the nut butters for a crunchy texture.

As with my atrial fibrillation patients, I can’t say that nuts put my autoimmune disease, eosinophilic esophagitis, high blood pressure, or high cholesterol into remission without medications but it definitely played a role. I love the taste of nut butters, and I never let a day go by without partaking.

The Big Picture

While the experts may debate whether nuts prevent atrial fibrillation, in my mind, I see no significant downside for most people (unless you have a nut allergy).  Even if nuts don’t help your atrial fibrillation, your body will still thank you for eating this superfood.

Has optimizing your diet helped with atrial fibrillation?  Please leave your thoughts and questions below.  For questions, please be patient as it may take me a few weeks to get to all the questions.

Do you want to read more about the heart and longevity benefits of nuts?  Please be sure to check out my articles below:

Almonds vs. Walnuts: Which Nut Should You Eat?

Almonds vs. Peanuts: Which Should You Eat?

#287 Is Left or Right Side Sleeping Best for Your Heart?

June 30th, 2018 by

Is Left or Right Side Sleeping Best for Your Heart?

Most of my cardiac patients sleep better on their right side.  Is right side sleeping best for your heart?  In this article, I discuss the science of behind right versus left side sleeping.

Gravity and Left vs. Right Side Sleeping?

Gravity plays a role in where the heart goes during sleep.  For example, if you sleep on your left side, then gravity will pull your heart toward your chest wall.  In contrast, gravity pulls the heart toward the center of the chest with right side sleepers. This subtle change in where gravity pulls your heart may affect symptoms, cardiac output, or even your heart rate.

Why Back Sleeping is Probably Bad for the Heart

If you are carrying any extra weight, back sleeping is definitely bad for your heart.  This is because when you sleep on your back, the extra weight collapses your airway (sleep apnea).  And studies show that sleep apnea dramatically increases your risk of heart failure and atrial fibrillation.

Stomach sleeping is another possibility.  However, as I have learned personally, stomach sleeping is a perfect recipe for neck and back issues.

4 Reasons to Sleep on Your Right Side

If you suffer from heart issues, talk with your doctor about whether you should sleep on your right or left side.  Based on the science, here are four reasons why you may want to consider sleeping on the right.

1.  Less Shortness of Breath

As far back as 1937 doctors have noted that heart patients breath better sleeping on their right side.  Indeed, the worse the cardiac function, the more likely people are to sleep right side down.  While the reason for this isn’t entirely clear, it may have to do with a better venous return and lower pressures within the heart and lungs.

2. Better Cardiac Output

For the same reasons as number one above, cardiac output may be better with right side sleeping.  Once again, gravity pulling the heart toward the center of the chest may optimize cardiac performance.

3. Fewer Palpitations

No one likes the sensation that their heart isn’t beating correctly.  As the heart is in the center of your chest with right-sided sleeping, studies show that palpitations become much less noticeable.  In contrast, when you are on your left side, the heart is pulled to the chest wall, and you may feel every irregular beat of your heart.

While many atrial fibrillation patients have noted that they have fewer arrhythmias when sleeping on the right side, I could find no studies supporting this finding.  Thus, when it comes to sleeping and arrhythmias, I suggest sleeping in whatever position that seems to help.

4. Lower Heart Rate and Less Sympathetic Nervous Activity

The sympathetic nervous system is the fight or flight response.  This fight or flight response makes the heart rate and blood pressure go up.

For most of my patients, sympathetic nervous system stimulation makes their heart failure, chest pain, or arrhythmias worse.  And when it comes to sleeping and sympathetic stimulation, studies show that right-sided sleeping may be better.

3 Reasons to Sleep on Your Left Side

Not everyone does best with right side sleeping.  In fact, there are three distinct groups of people that may do worse.

1. Acid Reflux Sufferers

People suffering from acid reflux may sleep better on their left side.  This is because studies show that acid reflux may be worse with right side sleeping.  Thus, if your acid reflux is causing you more symptoms than your heart, you may want to consider sleeping on your left side.

2. Vagus Nerve Arrhythmias

The vagus nerve connects the heart, brain, and gut.  Because of this connection, vagus nerve activation may be an important cause of arrhythmias.

With vagus nerve stimulation, you get increased parasympathetic activity which is the exact opposite of the fight or flight response with sympathetic stimulation.  Thus, to quiet your vagus nerve at night, studies suggest that you may want to try sleeping on your left side.

3. Too Slow of a Heart Rate at Night (Bradycardia)

If you have ever worn a heart monitor, your doctor may have told you that your heart beats too slow at night.  If this is the case, sleeping on your left side could stimulate a sympathetic response and increase your heart rate.

Does it Really Matter Which Side You Sleep On?

For those of you who suffer from sleep issues, you may be asking does it matter which side is down?  I know for myself that I feel incredibly grateful for a great night of sleep regardless of which side is down.  Indeed, trying to force sleep on my right or left side would only intensify my insomnia.

Thus, I can’t definitively answer the question, is left or right side sleeping best for your heart.  The answer is a personal choice based on your specific situation and what feels best for you.

Do you prefer sleeping on the right or left side?  Please leave your thoughts and questions below.  For questions, please be patient as it may take me a few weeks to post a response.

Want to read more about sleep optimization?  Please check out this article I wrote called 10 Ways to Cure Insomnia without Medications.

#286 Is Weekend Catch Up Sleep Healthy?

June 5th, 2018 by

Is Weekend Catch Up Sleep Healthy?

Getting enough sleep during the workweek is hard.  Wouldn’t it be great if weekend catch up sleep could undo any damage from sleep deprivation?  In this study, I review a new study that goes against decades of sleep research.

The Longevity Plan

Ma Xue, one of the centenarians we came to love and know during our time in China’s Longevity Village, taught a timeless principle.

“My life is simple. Because of this, it is easy to know when something is out of balance.”

Sadly, our modern lives are usually a rhythmic mess. Indeed, when I see new patients whose hearts are out of rhythm, it is usually because their lives are also out of rhythm.  We’re generally not just out of rhythm in one way, but rather in multiple ways. And while we might be able to withstand a bit of disequilibrium in one part of our life, it’s hard to keep our balance when so many parts of our lives are so out of sync.

But starting quite simply, we can rebuild this balance piece by piece. And perhaps the best place is where almost all of us start each day, and where we end up each night.

Modern Life = Lack of Sleep?

Most of us wake up based on when we need to be somewhere, and from day to day that often changes. An early morning meeting can prompt a wake-up that is an hour or two earlier than usual. A late plane flight out of town can mean an extra few hours of slumber in the morning. And even if we keep a typical 9:00-to-5:00 workday, our five-days-on-two-days-off schedules promote sleeping timetables that are anything but routine.

Of course, very few of us are in a position to perfectly align our schedules to a sunrise-to-sunset existence. There are, however, things that almost all of us can do to bring a more consistent rhythm to our lives.  And while we work to bring our lives and our sleep into balance, fortunately, a new study just came out that offers hope.

Weekend Catch Up Sleep Study

I was amazed to read about a recent study looking at sleep duration and longevity.  After sifting through 13 years of records on 43,880 Swedes, they stumbled upon something that was rather interesting.

It should come as no surprise that these researchers found that those sleeping five or fewer hours each night increased their chances of dying early by 65%.  However, if these same sleep-deprived people could catch up by sleeping longer on the weekend, then their survival was as if they slept seven hours each night.  If this is true, it tells us that even if you have an incredibly demanding job, there is no longevity hit provided you can get some weekend catch up sleep.

I can’t even begin to tell you how this study contradicts decades of previous research.  And, quite frankly, I need to see some additional research to convince me that these findings are actually correct.

The Dangers of Acute Sleep Deprivation

To understand how bad sleep deprivation is for us, we have merely to look at the time of the year in which almost everyone is simultaneously thrown off kilter: when most folks across the United States “spring forward” an hour to accommodate for daylight saving time, effectively losing an hour of sleep. On the Monday following the spring daylight saving change, the incidence of heart attacks rises 24 percent, and the impact continues on Tuesday, when rates drop only slightly to 21 percent above the usual rate.

A lack of sleep impacts us right down to the genetic level, affecting the expression of more than 700 genes, which in turn dictate everything from our rates of metabolism, to the way our bodies deal with inflammation, to the antibodies created inside our cells to deal with infections or toxins. Pulling just one late-night work session or just staying up to watch a single TV show leads to the release of some of the same biomarkers that are increased with a concussion.

The Snooze Button

And we’re doing this damage en masse! Up to 70 million of us struggle with sleep according to the federal Centers for Disease Control and Prevention. If you regularly smack the snooze button in the morning, then chances are that you are part of this group. (And any rest you get after hitting the snooze doesn’t really even count; the sleep is so fragmented it doesn’t do anything for your body.)

My Sleep Challenges

Doctors belong to a culture that has long revered the idea of the sleepless physician selflessly putting patients’ needs above his or her own. And sure, the idea of a doctor turning in at 10:00 p.m. each night for a good night’s sleep might not be as dramatically alluring as that of a doctor who is staying up late reading through patient records in a heroic quest to save the day.

I firmly believe, though, that my commitment to a consistent bedtime when I am home has made me a better doctor for my patients. Indeed, a lack of sleep is the most significant predictor of clinical burnout, a combination of exhaustion and lack of interest in work that looks a lot like depression. You can’t help anyone when you’re burnt out.

Weekend Catch Up Sleep Didn’t Exist in The Longevity Village

For most of the past century in China’s Longevity Village, it has been a relatively simple task to be in sync with the sun, because electricity didn’t come to the village until just a few decades ago and, even once it did, there weren’t many televisions or computers until quite recently. After a long day of soaking up the sun while working in the fields and knowing that there was always another day just like it ahead, villagers had little reason to avoid getting the sleep their bodies need.

Is Weekend Catch Up Sleep Legit?

This study definitely offers hope for those who have demanding workday schedules.  Perhaps weekend catch up sleep may be a longevity hack for people with busy jobs.

Unfortunately, this is a possible longevity hack that doesn’t work for me.  The challenge I have is that I am no longer able to sleep later on weekends.  For me, my body always wakes up at the same time regardless of the day.

Regardless, I have a few concerns with weeekend catch up sleep…

1. We really don’t understand the potential risks of “yo-yo sleeping” over time.

2. Even though weekend catch up sleep may erase the longevity hit from acute sleep deprivation, what about your cognitive, behavioral, and metabolic health?

3. Are there irreparable biologic changes to your body even though you get weekend catch up sleep?

Weekend Catch Up Sleep May Fight Weight Gain

In defense of weekend catch up sleep, I did come across another interesting study.  As you know, sleep deprivation revs up your hunger hormones.  Indeed, it is well known that people who don’t sleep tend to gain weight.  However, this weight gain from sleep deprivation can be neutralized by weekend catch up sleep.

Make the Best of An Imperfect World

Not everyone can simply align their lives with the rotation of the globe. Shift workers. Traveling salespeople. Emergency workers. Graveyard convenience store clerks. Hospital staff members. As a cardiologist who is often called upon to care for patients with middle-of-the-night emergencies, this is a fact of life for me, too.

While weekend catch up sleep is certainly not ideal, it is probably less bad for you than sleep deprivation.  I just wish I could sleep in on the weekends…

Does weekend catch up sleep work for you?  Please leave your comments below.

#285 9 Things I Would Do To Prevent Atrial Fibrillation Strokes

June 4th, 2018 by

9 Things I Would Do To Prevent Atrial Fibrillation Strokes

Everyone fears an atrial fibrillation stroke.  Fortunately, most of these strokes are preventable.  As blood thinners are a scary prospect, patients always ask me what I would do.  In this article, I share the nine things I personally would do to prevent atrial fibrillation strokes.

Start Here

Before we jump in with the nine things I would do to prevent atrial fibrillation strokes, I need to confess that I don’t have atrial fibrillation.  While my grandmother had it, so far I have escaped it.

However, every week someone asks, would you take a blood thinner?  Based on a career of helping tens of thousands of patients prevent atrial fibrillation strokes, here is what I would do.

Please be warned, every case of atrial fibrillation is different.  What I would personally do may be completely different than what your doctor recommends (please listen to your doctor first).  My passion for extreme skiing and mountain biking doesn’t fit well with prescription blood thinners.  Thus, these are the nine things I would do to minimize my stroke risk and the need for daily pharmaceutical blood thinners.

This article is not medical advice.  I am not giving any recommendations.  As atrial fibrillation strokes can be catastrophic, please follow your doctor’s advice when it comes to atrial fibrillation stroke prevention.


To understand the nine things I would do to prevent atrial fibrillation strokes, you have to follow the CHADS-VASc scoring system.  CHADS-VASc is an acronym.  Each letter stands for a medical condition that increases your risk of an atrial fibrillation stroke.  The higher the score, the higher your stroke risk.

The essence of this scoring system is that if you have congestive heart failure, hypertension, an age of 65 to 74, diabetes, vascular disease, or are of the female sex you get one point.  If your age has reached 75, or you have had a stroke or TIA, you get two points.  Once you have hit a score of two, the atrial fibrillation guidelines then recommend life-long blood thinners.

As this scoring system can be confusing, here is an article I wrote that explains things in detail.

9 Things I Would Do To Prevent Atrial Fibrillation Strokes

Blood thinners don’t work for my lifestyle.  I ski or mountain bike almost every day of the year.  Usually, I am climbing the mountain alone in the dark before work as that is often the only time I can find to exercise.

Even though I do everything possible to mitigate risk, I have still had many bad crashes over the years.  Crashes that I’m sure, had I been on blood thinners, could have resulted in life-threatening internal bleeding.

So here are the nine things I would do to prevent atrial fibrillation strokes:

1.  Reverse Atrial Fibrillation

As the very best thing you can do to prevent atrial fibrillation strokes is to eliminate atrial fibrillation, I would do everything possible to fix it naturally.  Most of my patients are surprised to learn that optimizing your lifestyle has a fifty-fifty chance of putting your atrial fibrillation into remission without drugs or procedures.  This is a fifty-fifty chance that I would definitely take.

As my willpower weakens through the day, I would track my food, weight, workouts, sleep, etc. even more closely than what I am doing today.  Despite the best of intentions, I know that if I don’t have systems and rules in place, my willpower will never stand a chance.  If you want to read more on how to beat atrial fibrillation, here is an excellent article I wrote: How to Get Rid of Atrial Fibrillation Once and For All

2. Natural Blood Thinners for a CHADS-VASc Score of 0 to 1

Even though the atrial fibrillation stroke risk is low with a CHADS-VASc score of zero or one, I would still look for additional ways to possibly mitigate risk.  Personally, I am fascinated by the data on nattokinase.

While nattokinase is not a strong enough blood thinner for a CHADS-VASc score of two or higher, there may be a role for the CHADS-VASc zero to one person.  As I worry about the long-term safety of supplements, I would stick to eating natto to get my nattokinase.  To learn more, please read the following article I wrote:

Is Nattokinase the Safest Blood Thinner?

Other natural blood thinners include fish oil, turmeric, ginger, ginkgo, or vitamin E.  Sadly, aspirin is increasingly falling out of favor for atrial fibrillation stroke prevention.

I should point out that natural blood thinners have are totally unproven for atrial fibrillation.  Also, natural blood thinners should never be a substitute for the proven atrial fibrillation blood thinners like warfarin, Pradaxa, Xarelto, Eliquis, or Savaysa.  However, as blood thinners are not indicated for a CHADS-VASc score of zero, and are not mandatory for a CHADS-VASc score of one, there just might be a role for natural blood thinners in the CHADS-VASc 0 to 1 patient.

3. Hack My CHADS-VASc Score

If I couldn’t put my atrial fibrillation into remission naturally, I would “hack” my CHADS-VASc score to avoid pharmaceutical blood thinners.  By “hack,” I mean optimizing my lifestyle so that I could drop my CHADS-VASc score by up to four points.

If you can get your CHADS-VASc score below two, then your stroke risk is very low, and prescription blood thinners are no longer required.  To learn how to “hack” your CHADS-VASc score, here is an article I wrote on the topic:  4 Best Ways to Lower Your CHADS-VASc Score

4. Hack Virchow’s Triad

Dr. Virchow was a brilliant German physician who lived in the 1800s.  Even back in the 1800s, he correctly identified the three leading causes of blood clotting.  People still refer to this as Virchow’s Triad.  The three components of Virchow’s triad are hypercoagulability, stasis, and injury.

Hypercoagulability means that blood is more likely to clot.  Obesity, smoking or taking female hormone replacement therapy all make blood more prone to clotting.   Likewise, studies show that atrial fibrillation also causes a hypercoagulable state.  It is for this reason that I would explore natural blood thinners, even though they are completely unproven for atrial fibrillation, if my CHADS-VASc score was less than two.  For a CHADS-VASc score of two or higher, and there was no way to lower my score, I would have to consider a prescription blood thinner.

If blood isn’t moving, it is likely to clot.  Thus, to hack Virchow’s Triad, you have to avoid blood stasis.  And the best thing I can think of to avoid stasis is to keep your body moving.  By continually moving throughout the day, you can minimize any potential blood stasis.

The final component to Virchow’s Triad is vessel injury.  If atherosclerosis injures an artery, it is more likely to clot.  Fortunately, in at least 80% of people, atherosclerosis is entirely preventable.  By only eating the healthiest of foods, keeping your weight in check, exercising daily, and optimizing sleep and stress levels you can keep your arteries clean.

5. Track My Rhythm with a Smartphone EKG App

In addition to tracking my blood pressure, food, weight, workouts, sleep, stress, etc., I would also monitor my heart rhythm with a smartphone EKG app.  Twice a day I would confirm sinus rhythm.  If there ever were a question, I would quickly do my own EKG to verify the rhythm.

Personally, I like the FDA-approved Alivecor system.  Even though I don’t have atrial fibrillation, I still bought this device to track my heart rhythm.

6. Keep Any Atrial Fibrillation Episodes Under 24 Hours

No one knows how long it takes blood for blood to clot in atrial fibrillation.  However, based on a recent study, 24 hours may be the number.  Please note that in some people, atrial fibrillation clots could form in just a few minutes whereas for other people clots may never occur.

After confirming an atrial fibrillation attack with my smartphone EKG app, I would take a “pill-in-the-pocket” antiarrhythmic as soon as possible to minimize the time my heart was out of rhythm.  For those unfamiliar with a “pill-in-the-pocket,” antiarrhythmic approach, it is a heart rhythm medication that you only take if your heart goes out of rhythm.  If this didn’t do the trick, I would get a cardioversion (heart shock) before the 24-hour mark.

7. Pill-in-the-Pocket Blood Thinner

Taking a prescription blood thinner every day would require me to give up what I enjoy doing most (extreme skiing and mountain biking).  However, I would be open to taking a blood thinner on an as-needed basis.

While the pill-in-the-pocket blood thinner approach is unproven, small studies suggest that it might work.  Please be aware though that the people in this study all had their own smartphone EKG apps and were well-trained in monitoring for atrial fibrillation. Thus, if you aren’t prepared to learn how to read your own EKG, this probably isn’t the best option for you.

8. Have it Ablated

If you can’t tell, I’m not a medicine person.  I have been on many prescription medications in the past, and I didn’t like the way they made me feel.  Fortunately, I was able to reverse all of my chronic medical conditions by lifestyle optimization.  If you want to learn more about this journey, it was all described in our book, The Longevity Plan.

If I couldn’t reverse my atrial fibrillation naturally, like I did my other conditions, I would choose an ablation over life-long medications.  One possible benefit of ablation is that in our experience patients who have had an ablation had a lower stroke risk.

9. Consider Left Atrial Appendage Occlusion

In the event, an atrial fibrillation cure was impossible for me, and my CHADS-VASc score was two or higher, I would consider having my left atrial appendage occluded.  As approximately 90% of atrial fibrillation strokes arise from a little pouch in the heart, the left atrial appendage, it would be very tempting to get rid of this pouch.

Getting rid of the left atrial appendage is something that is easy to do. While most experts agree that left atrial appendage occlusion is an excellent option for people with a high stroke risk who can’t take blood thinners, it is still hotly debated for those people who don’t want to take pharmaceutical blood thinners.

The Big Picture

The bottom line is that the lifestyle I love isn’t in alignment with taking a daily pharmaceutical blood thinner.  Everything I shared is what I would do to avoid a stroke and blood thinners.  This approach isn’t appropriate for 99% of atrial fibrillation patients.

There is also no guarantee that what I would do to prevent atrial fibrillation strokes would even work.  However, in the 23 years since I graduated from medical school, I have yet to see an atrial fibrillation stroke in someone with a 100% optimized lifestyle who was also tracking their daily heart rhythm.

#284 4 Best Ways to Lower Your CHADS-VASc Score (How to Safely Get Off Afib Blood Thinners)

June 2nd, 2018 by

4 Best Ways to Lower Your CHADS-VASc Score (How to Safely Get Off Afib Blood Thinners)

No one wants to be on a blood thinner.  By optimizing your lifestyle, it is possible to get off your atrial fibrillation blood thinner.  In this article, I’ll share the four best ways to lower your CHADS-VASc score.


Strokes have to be one of the most devastating complications of atrial fibrillation.  Even if you have optimized all aspects of your lifestyle, you will never get your stroke risk to zero.  There is always a risk.

Stopping a blood thinner could cause a massive stroke.  Taking blood thinners may lead to life-threatening bleeding.

Because the consequences are so high, you have to be in close communication with your physician.  You can’t stop your blood thinner without discussing it first with your physician.

My Views of the CHADS-VASc Scoring System

One more disclaimer…I’m not a fan of the CHADS-VASc scoring system.  I personally think it is flawed as I discussed in this article.  However, if you want to “play by the rules,” here is the best way to “hack” the CHADS-VASc scoring system.

Brenda’s Experience

Brenda didn’t want a stroke.  She also didn’t want to suffer the same brain bleed that her mother did on Coumadin.  Brenda had a CHADS-VASc score of four which put her at high risk of a stroke.

“I’ll do anything to get off warfarin,” Brenda said.

“The only way we can safely avoid blood thinners is to get your CHADS-VASc score below two.  To drop your score from a four to one will require that we reverse your heart failure, high blood pressure, and diabetes.  I can’t stop your blood thinner now, but it may be possible over the next three to six months,” I said.

“I’m OK with taking a blood thinner for a few months as long as I know there is an end in sight,” she said.

What Are Your Odds of a Stroke? The CHADS-VASc Score

To lower your CHADS-VASc score, and safely get off blood thinners, you need to understand how this scoring system works.  To put it simply, CHADS-VASc is an acronym.  The lower your score, the lower your risk of a stroke.  The goal is to keep your score below two.

Below is how you calculate your CHADS-VASc score:


C: Congestive heart failure (1 point)

H: Hypertension (1 point)

A: Age (65 and older gets you 1 point)

D: Diabetes (1 point)

S: Stroke/TIA history (2 points)

V: Vascular disease (prior heart attack, blockage in your heart, or blockage in any other artery gets you 1 point)

A: Age (75 and older gets you a total of 2 points for age)

S: Sex (female gender gets you 1 point)


According to the atrial fibrillation treatment guidelines, here is your annual stroke risk based on your CHADS-VASc score:


CHADS-VASc 0:  0%

CHADS-VASc 1:  1.3%

CHADS-VASc 2:  2.2%

CHADS-VASc 3:  3.2%

CHADS-VASc 4:  4.0%

CHADS-VASc 5:  6.7%

CHADS-VASc 6 or higher:  ~10% up to as high as 15%


The Critical CHADS-VASc Score is 2

You don’t want a CHADS-VASc score of two or higher.  A CHADS-VASc score of two or higher means that blood thinners are recommended for the rest of your life.  While some aspects of the CHADS-VASc score can’t be reversed, others can.  If your score is two or higher, it is possible to lower your score by up to four points.

How to Lower Your CHADS-VASc Score by 4 Points

If you want to get your score into the safe zone (below 2) where blood thinners are no longer required, here are four ways you can do it.

1. Reverse Heart Failure (minus 1 point)

Not every case of heart failure is reversible.  However, you can drive many cases of acute heart failure into remission.

For example, heart failure caused by atrial fibrillation can usually be reversed by either maintaining sinus rhythm or by controlling the heart rate.  Dramatic weight loss may reverse heart failure in obese patients.  Correcting nutritional deficiencies, hormonal imbalances, or metabolic abnormalities may also reverse heart failure.

The key is to identify the cause of the heart failure.  If the underlying problem can be addressed, then acute heart failure may resolve naturally.

2. Reverse Hypertension (minus 1 point)

Unless you have had hypertension for years, most cases are reversible by optimizing your lifestyle.  For example, you usually don’t see high blood pressure in groups of people who have never been exposed to the modern diet or modern lifestyle.  In contrast, 90% of Americans will get hypertension.

When it comes to hacking your CHADS-VASc score, you can’t just take a pill.  Even if a drug controls your blood pressure, you still get one point for hypertension.  The only way to drop a point is to reverse this condition.  Basically, you optimize your lifestyle so that hypertension is no longer on your problem list.

If you want to get your blood pressure into the normal range fast, there are some simple things you can do.  First, lose weight.  Studies show that for every two pounds you lose your blood pressure will go down by about one point.

Second, eat a mostly plant-based real food diet.  The more whole plants you can work into your diet, the lower your numbers will be.  Also, get rid of all modern foods.  Eliminate sugar, processed carbohydrates, and everything else processed, pre-prepared, or packaged.

You’ll notice that I left out salt.  The reason is quite simple.  If you eliminate anything processed, then your sodium intake will naturally be low.

Last, exercise daily.  Physical activity lowers your blood pressure for up to 12 hours.  If you want to keep it low throughout the day, you could even consider exercising in the morning and evening.

To learn more about how to reverse blood pressure naturally, you need to read this article I wrote.

3. Reverse Diabetes (minus 1 point)

Just like with hypertension, diabetes is another easily reversible condition.  Even if your hemoglobin A1C score is in the normal range with medications, it still doesn’t count.  The only way to drop your CHADS-VASc score by one is to get diabetes off your problem list.

Fortunately, the same things that reverse hypertension are the same things that reverse diabetes.  Indeed, at least 80% of my patients can reverse diabetes by losing every extra pound, eliminating all sugar and processed carbohydrates, and exercising daily.

4. Reverse Vascular Disease (minus 1 point)

Of the four ways to lower your CHADS-VASc score, this one is the most challenging and controversial.  Most cardiologists don’t think this is possible.  However, not all cardiologists feel this way.

For example, President Bill Clinton’s cardiologist, Dr. Dean Ornish, thinks it is possible.  Based on his seminal 1990 publication, he showed it was possible without drugs or procedures.

Another believer is the Cleveland Clinic’s Caldwell Esselstyn.  He has also published studies showing that heart blockages are reversible.

The secret to Doctors Ornish and Esselstyn’s approach is a 100% low-fat plant-based diet, daily exercise, social interaction, and optimization of stress levels.  While I also believe it is possible to reverse vascular disease, I don’t buy the “low-fat” component.  For example, healthy fats, like nuts, seeds, and avocados have all been proven to be helpful in countless studies.

Brenda’s Story Revisited

In the end, Brenda was committed.  She lost 46 pounds, adopted a real food diet, and went to the gym every day.  Yoga, meditation, and regular social gatherings with friends and family members also became a habit.

Within six months, she got off her diabetes and high blood pressure medications.  And a follow-up echocardiogram showed that her ejection fraction had normalized with sinus rhythm.  With her optimized lifestyle, her CHADS-VASc score went from a four to a one, and she was also able to get off her blood thinner.

An Ablation Won’t Get You Off Blood Thinners

Contrary to popular belief, an ablation won’t get you off blood thinners.  Even if your a catheter ablation procedure eliminates your atrial fibrillation, according to the guidelines, you are still at risk.  Thus, the only safe way off blood thinners for atrial fibrillation is to lower your CHADS-VASc score.

The Big Picture

The key takeaway is that it is often possible to lower your CHADS-VASc score.  Acute heart failure, high blood pressure, diabetes, and vascular disease are all potentially reversible with an optimized lifestyle.   In our book, The Longevity Plan, we’ll show you how to eliminate most chronic medical conditions.

In the Longevity Plan, we uncover and deconstruct the secrets of China’s Longevity Village.  This village has the highest percentage of centenarians in the world.  It is also a place where people rarely, if ever, get atrial fibrillation, heart disease, or cancer.

#283 5 Best Ways to Fix Atrial Fibrillation Water Retention

May 29th, 2018 by

5 Best Ways to Fix Atrial Fibrillation Water Retention

No one wants swollen legs.  Besides the unsightly appearance, it often hurts.  With a few simple tweaks, fluid retention can be eliminated for most people.  In this article, I’ll share the five best ways to fix atrial fibrillation water retention.

Sarah’s Story

Sarah was 52 years old.  All her life her weight was a little higher than it should have been.  In addition to carrying the extra weight, she was also recently diagnosed with pre-diabetes and high blood pressure.  All told, she was on six prescription medications for her atrial fibrillation, hypertension, and pre-diabetes.

At the end of each day, her legs would swell up.  The swelling was terrible on the days she ate out or was on her feet a lot. However, nothing could compare to the days when her heart went out of rhythm.  On those days, the atrial fibrillation water retention was especially bad.

Her primary care physician wanted to put her on diuretics.  But given her family history of kidney problems, she didn’t want to take any medications that might harm the kidneys.  She came to see me for a second opinion.

Fortunately, we were able to quickly rule out heart failure, kidney failure, and liver failure as the cause of her fluid retention.  In her case, we had to optimize her lifestyle and keep her in sinus rhythm.

What Causes Leg Swelling?

While everyone immediately worries about the heart when the legs swell, fortunately, the heart is usually not the cause of the problem.  The primary cause of leg swelling is chronic venous insufficiency.  What this means is that the valves in the veins of the legs are not functioning properly.

If you think about it, these valves in the veins of the leg are asked to perform a difficult task.  They have to fight gravity in returning the blood from your big toe all the way back to your heart.  How they do this is that they have to open and close every time you move the muscles in your leg.

Conditions like obesity, physical inactivity, poor diet, history of blood clots, etc. can all cause chronic venous insufficiency.  While chronic venous insufficiency is the leading cause of leg swelling, sometimes leg swelling can be due to the heart.

Does Atrial Fibrillation Cause Leg Swelling?

When the heart goes into atrial fibrillation, the upper chambers of the heart stop pumping.  With the loss of the atrial contribution, you lose at least 20% of your cardiac performance.

If you are already prone to leg swelling from being overweight, eating a poor diet, or not exercising much, then atrial fibrillation could definitely make things worse.  Indeed, the older you get, the more likely atrial fibrillation water retention will be an issue for you.

5 Best Ways to Fix Atrial Fibrillation Water Retention

Besides keeping the heart in sinus rhythm, there are many things you can do to avoid leg swelling. Below are the five best ways to fix atrial fibrillation water retention.

1.  Eat High Fiber

Fiber helps to suck any extra water out of your body.  Fiber isn’t digested, and it pulls large amounts of water with it as it travels through your gut.

While our government recommends somewhere around 30 grams of fiber each day, this number can’t even begin to compare to what our ancestors used to eat.  Indeed, many experts peg hunter-gatherer diets close to 150 grams of fiber daily.

While 150 grams of fiber is out of reach for most modern people, my goal is to get 100 grams daily.  When it comes to fiber, health, and longevity the more, you get the better off you will be.  To read more about fiber, here is an excellent article I wrote.

2. Eliminate Sugar and Flour

Not only will sugar and flour mess up your metabolism and cause intense weight gain, but they also act as a magnet to water.  Indeed, it is for this reason that people drop water weight fast when they go on a low carb diet.

If you are like me and you can’t give up your sweet tooth, there are other options.  For example, I satisfy my sweet tooth with stevia-sweetened dark chocolate.  This delicious treat is very low carb and very heart healthy.  Instead of eating the traditional whole wheat bread, I like the Ezekiel flourless bread.  Because there is no flour, you don’t get the sugar spike.

3. Eliminate Processed Foods

Every doctor will tell you to limit the salt if you are retaining water.  And there is a good reason for this advice.  As with sugar and flour, sodium acts as a magnet for water.

When it comes to sodium, the problem isn’t the salt shaker. Instead, the problem is with processed foods, fast foods, and restaurant foods.  Processed foods, fast foods, and restaurant foods easily account for 80% of the sodium in the diet.

As strange as it may seem, I actually don’t mind my patients using the salt shaker provided they are not going crazy with the salt. The reason for this is because if they are using the salt shaker, then they are probably preparing their own foods at home.

4. Break a Sweat Every Day

When it comes to atrial fibrillation water retention, exercise is a must.  Vigorous physical activity causes you to lose both the excessive sodium and water in your body.  In addition to the salt and water loss, exercise also helps the valves in your veins get the fluid back to the heart where it can be put to good use.

How you exercise is really up to you.  The important thing is that you never let a day go by without breaking a sweat doing some form of physical activity.

5. Keep Your BMI Below 25

Even if you are eating right and exercising daily, studies show that if your body mass index (BMI) is over 25 you are prone to water retention.  The exception to this observation is the person who lifts for muscle bulk.  Indeed, in powerlifters, the BMI calculations may be completely inaccurate.

To find out your BMI, please click this link.  If your BMI is over 25, it can be easily corrected.  By simply following every item on this list, your BMI will be below 25 in no time at all.

Better yet, if you are physically fit with a BMI below 25, then you have an excellent chance of driving your atrial fibrillation into remission without drugs or procedures.  Nothing would fix atrial fibrillation water retention faster than putting your arrhythmia into remission!

Sarah’s Story Revisited

Fortunately for Sarah, she eagerly accepted the challenge of fixing the atrial fibrillation water retention problem naturally.  Within just six months of eating high fiber, eliminating sugar, flour, and processed foods, as well as exercising every day, she quickly dropped 50 pounds.

This 50-pound weight loss gave her a BMI of 23.8.  It also drove her fluid retention challenges, atrial fibrillation, high blood pressure, and pre-diabetes into remission.  No longer did she need the six prescription medications she was previously taking.

Practical Tips

You don’t need to suffer from atrial fibrillation water retention.  And you also probably don’t need to take diuretics to get the water off.  Unless fluid retention resulted from end-stage heart failure, kidney failure, or liver failure, in the 23 years since I graduated from medical school, I can’t think of a patient who required diuretics who faithfully followed all five things discussed in this article.


Please speak with your physician first before embarking on natural alternatives to diuretics.  For example, you may have an underlying medical condition which could make a high fiber diet or vigorous exercise dangerous for you.  Likewise, fluid retention may be the first sign of a life-threatening heart, kidney, or liver disease.  Use common sense and please be in close communication with your doctor.

#282 How Do You Diagnose Atrial Fibrillation?

May 29th, 2018 by

How Do You Diagnose Atrial Fibrillation?

If your heart isn’t beating right, you want it diagnosed quickly.  Sometimes it can take years before your doctor can make the correct diagnosis.  If you suspect that you might have atrial fibrillation, this article is for you.  In this article, I will teach you how to diagnose atrial fibrillation.

Melanie’s Experience

Every time Melanie’s heart raced uncontrollably, she rushed to the hospital.  She knew that if she could get to the hospital in time, her doctors could finally make the diagnosis. But they never could.

Instead, they merely diagnosed her with panic attacks.  Despite being labeled with panic attacks, Melanie still knew there had to be something wrong with her heart—something that her doctors couldn’t find.

Melanie isn’t alone.  Many people suffer from atrial fibrillation for years because it never seems to show up on an EKG.

Can an EKG Diagnose Atrial Fibrillation that Comes and Goes?

The problem with the standard EKG is that it is only about a 10-second snapshot of what your heart is doing.  If atrial fibrillation happens to be occurring during those exact 10 seconds, then the diagnosis is easy to make.  However, if you are like most of my patients, atrial fibrillation never seems to happen when the doctor’s EKG machine is running.

What is an Event Monitor?

The key to finally making Melanie’s diagnosis was a much longer EKG—an EKG that continued for an entire month.  This one month long EKG is also known as an event monitor.

An event monitor is a small electronic device that monitors your EKG for prolonged periods of time.  You wear it under your clothes.  You even wear it while you are sleeping.  The only time you take it off is when you shower or go swimming.

Event Monitor vs. Holter Monitor: Which is Best?

Perhaps you have heard of a Holter monitor.  The Holter monitor is usually much larger than an event monitor.  Also, the Holter monitor is taped to your chest for 24 to 48 hours.  During this period, you can’t even shower.

The benefit of a Holter monitor is that it is only 24 to 48 hours.  If your atrial fibrillation happens during this short period, then you are golden.  If, however, nothing happens then it was a waste of time and money.  This is why I generally prefer the event monitor over the Holter monitor.

Besides being stuck with the monitor for a month, the only other drawback of the event monitor is the cost.  Event monitors generally cost much more than a Holter monitor.

If cost is an issue, talk with your doctor about using the Alivecor system described below.  While the Alivecor system probably isn’t covered by your insurance, the $99 you’ll pay is likely much less than the co-pay on an event monitor.

What if the Event Monitor Doesn’t Show Anything?

For some of my patients, a month-long EKG may still not be a long enough period to detect atrial fibrillation.  For these people, more advanced technologies are needed.  Two such possibilities include an implantable loop recorder or a smartphone EKG app.

What is an Implantable Loop Recorder?

An implantable loop recorder is a small chip that cardiologists inject under the skin on your chest.  This chip continuously monitors your EKG for the life of its battery which is generally about three years.

This technology is especially helpful in that any episodes of atrial fibrillation you may be having, even if you are asleep, are automatically recorded and sent to your physician.  All of this happens without you having to do a thing.

The implantable loop recorder automatically communicates with your transmitter at home once a day.  If you are having symptoms, you can do a manual transmission of your EKG to your doctor’s office.

One thing to remember is that while the implantable loop recorder goes in quickly, there is usually a bigger scar getting it out three years later.  Thus, if you don’t want a half inch scar on your chest, then this technology is not for you.

What is a Smartphone ECG app?

The second approach to prolonged EKG monitoring is to turn your smartphone into an EKG machine. This is done through Bluetooth enabled electrodes and a smartphone app.  The best-studied device is the FDA-approved Alivecor system.

If you really want to go high tech on this, you can get it on your Apple Watch.  Hundreds of my patients have used this system with excellent results.  Indeed, studies show that the Alivecor system is one of the best ways to diagnose atrial fibrillation.

Practical Tips

If you think you may be suffering from atrial fibrillation, you need to get it diagnosed.  And you need an EKG to diagnose atrial fibrillation.  Only then can you be appropriately treated.  Knowledge is power, and you have to capture your symptoms on an EKG.

How you do the EKG doesn’t matter.  The key is to document the rhythm.

Of course, don’t try to diagnose atrial fibrillation without the help of your doctor.  Unless you are an EKG master, there will be mistakes. As the stakes are high with heart issues, work with your doctor to correctly diagnose atrial fibrillation.

#281 How Do You Know If You Are in Atrial Fibrillation?

May 29th, 2018 by

How Do You Know If You Are in Atrial Fibrillation?

Sometimes it is hard to know what your heart is doing.  Fortunately, with a few simple tricks, you can tell with 99% accuracy if your heart is out of rhythm.  In this article, I’ll teach you how to know if you are in atrial fibrillation.

Kim’s Experience

Kim was never quite sure when she was in atrial fibrillation.  She didn’t get the palpitations that her sister and neighbor got when they had an atrial fibrillation attack.

All she knew was that sometimes she just felt tired.  That was it.  No palpitations, no shortness of breath, no chest pain, and no dizziness.  Just fatigue.

“How come I can’t feel my atrial fibrillation,” Kim asked.

“Many people can’t feel their hearts beating irregularly,” I said.

“Then how do you know if you are in atrial fibrillation?” she asked.

“Check your pulse,” I said.

“I think I can feel my pulse,” she said.

“Good.  If your pulse is regular and is beating about once a second, then you are likely in sinus rhythm.  If the pulse is irregular and fast then you are probably in atrial fibrillation,” I said.

How do you know if it is atrial fibrillation or just your heart skipping beats? She asked.

“If it is an occasional missed beat, and all the other beats are perfectly timed, then it is probably just a premature beat,” I said.

How Do You Check Your Pulse?

Checking your pulse to see if you are in atrial fibrillation is simple.  Indeed, most of my patients can learn to tell within 10 seconds.  All you have to do is find your pulse.

How you check your pulse doesn’t matter.  It can be on your wrist, neck, the temple of your head, or just about anywhere else you can feel your pulse.

If you feel your pulse about once per second, and it is regular, then you are probably in sinus rhythm. Atrial fibrillation typically has a fast and chaotic pulse.  The heart rate is often faster than 100 beats per minute at rest, and every heartbeat is irregular.

What Should Your Heart Rate Be?

Most people have a resting heart rate of 50 to 90 beats per minute.  If your heart goes into atrial fibrillation, it will likely be at least 10 to 20 beats per minute faster.

Of course, there are no hard and fast rules.  Sometimes the heart rate slows with atrial fibrillation.  It is for this reason that you can’t rely on the heart rate alone to tell if you are in atrial fibrillation.  You also have to check your pulse to know if the heartbeat is regular or not.

If you want to learn more about what your heart rate should be, here is an excellent article I have written on this topic:

What Should Your Resting Heart Rate Be?

How Often Should You Check Your Pulse

For my patients with atrial fibrillation, I recommend that they check their pulse twice daily.  The reason for a twice daily check is to minimize their risk of stroke.  Knowing your rhythm is especially important for those people not taking a blood thinner.

The reason for the twice-daily check is because studies show that the risk of a stroke starts going up somewhere around 24 hours of uninterrupted atrial fibrillation.  If you are checking your pulse twice daily, then you will be able to detect atrial fibrillation before this 24 hour time point.

What Should You Do if You Can’t Feel Your Pulse?

As many of my older patients struggle to feel their pulse, there are other ways to tell if you are in atrial fibrillation.  Here are some different ways to check your pulse if you can’t feel it on your wrist or neck.

1.  Have Your Spouse Put Their Ear to Your Chest

If your spouse puts their ear on your chest, it is almost like using a stethoscope.  When your heart is in rhythm, they should hear a regular heartbeat at about once per second.  If, however, you are in atrial fibrillation then they should hear faster and irregular heartbeats.

2. Buy a Stethoscope

Stethoscopes are cheap.  For example, Amazon’s choice for stethoscopes will only set you back $25.48 at the time of this writing.  As with #1 above, if you are in atrial fibrillation the “lub dubs” should be fast and irregular.

3. Buy a Blood Pressure Monitor that Detects an Irregular Pulse

Every home needs a blood pressure monitor.  As high blood pressure is one of the leading causes of heart disease, knowing your numbers could save your life.

When shopping for a blood pressure monitor, look for one that will also detect an irregular pulse.  Usually, these monitors will have a heart icon on the screen.  Whether or not the heart icon is lit up or not will tell you if your pulse is regular or irregular.  The only challenge with these devices is that the blood pressure machine can’t know the difference between atrial fibrillation and skipped heartbeats.

4. Buy a Pulse Oximeter

Pulse oximeters are also cheap.  The best selling model on Amazon was only $18.95 on my last check.  While most people buy a pulse oximeter to see what their oxygen saturation is, it can also be used to monitor for atrial fibrillation.

As with a blood pressure machine, you can’t just focus in on the actual pulse number.  You need to carefully look at the flashing or blinking lights on the pulse oximeter.  Every time the pulse oximeter detects a heartbeat, it will flash or blink.  If you are in atrial fibrillation, the flashing or blinking will be fast and irregular.

5. Turn Your Smartphone into an EKG Machine

For $99 you can turn your smartphone into an EKG machine with the Alivecor system.  Hundreds of my patients have used this device with excellent results.

With the Alivecor system, you put your thumbs on the small Bluetooth electrodes.  The electrodes then transmit the data to your phone.  With the app, you can see your actual EKG.  While the app can give you a reasonably accurate EKG interpretation, you’ll want to show it to your doctor for confirmation.

Practical Tips

It really doesn’t matter how you check your pulse.  The key is to be consistent.  With a little training, most of my patients can tell if they are in atrial fibrillation with 99% accuracy.

#280 Harvard Scientists Reveal 5 Life Extending Hacks: Your Best Lifestyle for Longevity

May 28th, 2018 by

Harvard Scientists Reveal 5 Life Extending Hacks: Your Best Lifestyle for Longevity

Wouldn’t you like to know the real secret to a long and healthy life?  Based on the latest longevity study, Harvard researchers found five easy life-extending hacks that could get you to age 93.  In this article, I’ll share the very best lifestyle for longevity.

What Does it Take to Get to Age 90?

The human body is genetically programmed to make it to 90.  As long as we don’t screw it up, 90 is within reach for most people.  If you can get a few simple, healthy lifestyle habits down, then the odds are that you will thwart a fatal cancer or heart condition.  Indeed, if you can stave off heart disease and cancer then cruising past 90 should be a breeze.

The Latest Longevity Study

In search of life’s Holy Grail, Harvard researchers recently revealed five simple life-extending health hacks. These five hacks are all you need to know to find your best lifestyle for longevity.

As part of this new study, Harvard researchers painstakingly dissected the medical records of 123,219 people. With an average of 34 years of medical records at their disposal, they were able to deconstruct the five secrets to a life free of heart problems, cancer, or a premature death.

When it comes to beating heart disease, these five health hacks will slash your heart disease risk by 72%!  If a 72% reduction of death from heart disease isn’t compelling enough, these five hacks will also drop your cancer risk by 52%!

As you will likely be free of heart disease and cancer, this study shows that for women you will get 14 bonus years of life allowing you to reach 93.  For men, these same five health hacks predict 12 bonus years of life achieving an age of 88.

5 Life-Extending Hacks

Without keeping you in suspense any longer, here are the five longevity hacks to find your best lifestyle for longevity.

1.  Breathe Clean Air

Okay, nothing new here. While this study specifically looked at smoking, countless other studies have linked any form of air pollution to heart disease, cancer, and a shortened life.  The message is simple.  Make clean breathing a must.

In addition to not smoking, you also don’t allow anyone to smoke around you.  The same goes for electronic cigarettes.

Besides smoking, air pollution can be a huge problem.  Indeed, studies show that air pollution may rob you of up to 5.5 years of life!  And when it comes to air pollution, indoor air quality is generally much worse than anything you may encounter outside of your home.   For indoor air pollution, studies show that even breathing the stench of smoke on the clothes of smokers puts you at risk.

What can you do?  Besides banning cigarettes in your home, don’t go anywhere near where people are smoking.  If air pollution is bad, then don’t exercise outside.  For your home, invest in many indoor plants and be sure to also buy a HEPA filter.  These filters are cheap and can be very effective at scrubbing the indoor air of pollutants.

2. Keep Your BMI Between 19 and 25

I’m guessing that if you are like most people, this will be the most challenging longevity hack.  Food manufacturers have scientifically designed their fake foods to get you hooked, steal your money, and make you gain weight.

Not quite sure what your body mass index (BMI) is?  Here is the link to find out. If you are like most people, you are probably in shock as to how high your BMI is.  The natural inclination is to say the BMI system is wrong, bogus, or a terrible measure of health.

Yes, there are limitations.  No system is perfect.  For example, it doesn’t account for excessive muscle mass.  Thus, if you are faithfully doing hardcore strength training, your BMI measurement won’t be accurate.

Despite the limitations, BMI is a proven predictor of longevity within a population of people.  And when it comes to living a long life, studies show that the BMI sweet spot seems to be 20 to 25.

Even if you have battled weight all your life, it is easy for most people to maintain a BMI below 25. In fact, after working with thousands of patients, you only need to remember three things when it comes to optimizing your weight – No sugar, no flour, and nothing after 7 PM.

No sugar and no flour are really just the same things.  Flour, whether it comes from wheat, rice, corn, etc. turns instantly to sugar minutes after swallowing it down.  Sugar and flour will throw off your metabolism, mess up your insulin sensitivity, and keep you hungry all day long.  Unless you are exercising for hours and hours every day, you can’t eat this stuff long-term and expect to stay lean.

Likewise, late night eating is another sure fire way to thwart your body’s natural metabolism.  To optimize metabolism and insulin sensitivity, you need a period of time without food.  And the easiest way to accomplish this goal is to stop eating by 7 PM assuming that you don’t work nights.

3. At Least 30 Minutes of Exercise Every Day

With regards to this Harvard study, they don’t give you any days off. You have to be active every day. No excuses.

What you do for exercise doesn’t matter. My only rule is that you enjoy doing it because if you don’t, it will never stick. That daily dose of physical activity can be anything provided you break a sweat and get your heart rate up.

A quick disclaimer…if you haven’t been exercising regularly, please speak with your physician first before adopting this longevity hack or, for that matter, any other hack mentioned in this article.

4. Keep Alcohol Intake in Check

In this study, Harvard researchers only looked at those with moderate levels of alcohol intake.  Interestingly, those who drank the least seemed to live the longest.

Alcohol and longevity is a difficult question to answer.  On one hand, you have some studies that claim moderate alcohol consumption has life-extending properties.  However, other studies claim this research is bogus because they didn’t account for the abstainer bias.

And then you have the American Institute for cancer research which claims that there is no safe level of alcohol that can be consumed.  Even for the heart condition, atrial fibrillation, studies also show that there is no safe level of alcohol.

If you chose to drink, my advice would be to look for the minimally effective dose that you need.  If your BMI runs high, minimizing alcohol intake will help you to optimize your weight as alcohol packs a big sugar punch.

5. Eat a Healthy Diet

Despite evidence to the contrary, 75% of Americans think they are eating a healthy diet.  Just so there is no confusion, eating a healthy diet is really quite simple.  Eat real food.

If there is an ingredient list, it probably isn’t real food.  Likewise, if it comes in a box, can, or jar it also probably isn’t real food.  Real food looks like something you would grow in your garden or bring back from a hunt.

If you can just do these three things, then you are 90% of the way to a healthy diet.

1.  Don’t eat sugar. (This includes fruit juice, honey, maple syrup, etc.)

2. Don’t eat flour.  (Flour, whether it be from wheat, rice, corn, or potatoes, is still just sugar)

3. Eat vegetables with every meal. (And by every meal I also mean breakfast!)

Of course, I am not saying that vegetables should be the only thing in your diet.  Far from it.  It is just that people struggle with vegetables.  If you can get the vegetable thing right then the rest of the diet usually falls in line.

The Big Picture

If you want a life free of heart disease, cancer, and an early death it comes down to five simple health hacks.  Breathe the clean air, keep your BMI between 19 and 25, exercise daily, minimize alcohol, and eat real food.  Simply put, this is the best lifestyle for longevity!

What are your tips and tricks for optimizing these five health hacks? Please leave your thoughts and questions below. This comment section will be open for 30 days during which time I will respond to every question posted.

#279 6 Reasons Why There is an Atrial Fibrillation Dementia Link

May 28th, 2018 by

6 Reasons Why There is an Atrial Fibrillation Dementia Link

Besides not feeling well, maintaining brain function is one of the main concerns of people suffering from atrial fibrillation.  Fortunately, studies show that driving atrial fibrillation into remission and optimizing your daily health decisions may preserve long-term cognitive performance.  In this article, I share six reasons why there is an atrial fibrillation dementia link. And I’ll also teach you what you can do to optimize brain function even if you have atrial fibrillation.

Does Atrial Fibrillation Affect Brain Function?

Things Exercise Does To Your Brain

Before we ever get to the atrial fibrillation dementia link, the first question is does atrial fibrillation affect brain function? In a worrisome study, researchers from Italy showed that when the heart is out of rhythm, blood flow to the brain is compromised and cognitive function drops.

Sadly, all aspects of brain functions suffered in atrial fibrillation.  And, as atrial fibrillation progresses from paroxysmal to persistent, brain function gets even worse.

Indeed, my lawyer, physician, and CEO patients tell me their thinking isn’t sharp when their heart is out of rhythm.  This “brain fog” then affects them negatively in the courtroom, boardroom, or operating room.

We First Showed the Atrial Fibrillation Alzheimer’s Link

In the early part of my career, I saw many atrial fibrillation patients develop Alzheimer’s disease.  Based on these observations, Dr. Jared Bunch and I decided to see if an atrial fibrillation dementia association existed.

To better understand if an atrial fibrillation dementia link existed, we looked at nearly 40,000 patients.  To be sure that it was Alzheimer’s disease, we required both a brain MRI and neurologist evaluation confirming this diagnosis. We then went back through their medical history to see what role atrial fibrillation played.

In the final analysis, our study showed that atrial fibrillation roughly doubles the risk of Alzheimer’s as well as all other forms of dementia.  Probably the scariest finding was that this dementia risk was highest in our younger patients with atrial fibrillation.

6 Possible Links Between Atrial Fibrillation and Dementia

So what is the mechanism to the atrial fibrillation dementia link?  While we don’t have all the answers yet, there are some clues.  Below are my six best explanations of how atrial fibrillation may cause dementia.

1.  Macro and Micro Thromboembolism (Blood Clots)

While most doctors and patients worry about the big clots, the little ones are all of concern.  Indeed, with a transesophageal echocardiogram (TEE), you can see these micro-clots when the heart is out of rhythm.

These micro-clots, also known as spontaneous echo contrast, occur when blood isn’t moving.  As the upper chambers of the heart aren’t beating with atrial fibrillation, clots may quickly form.

Preventing strokes is critical to eliminating the atrial fibrillation dementia link. And If you want to treat the underlying cause of atrial fibrillation strokes, you have to keep the heart in rhythm and eliminate every atrial fibrillation stroke risk factor possible.   Because, as you will see below, blood thinners are not a risk-free option.

2. Macro and Micro Brain Bleeds

The top concern of every atrial fibrillation patient taking a blood thinner is bleeding.  This concern is top of mind in the U.S. where lawyers encourage anyone who has ever been on a blood thinner to sue drug maker.

No doubt about it, blood thinners are especially effective at preventing atrial fibrillation clots.  The only problem is that they also significantly increase the bleeding risk.  By bleeding risk, I’m not just talking about bleeding if you get hurt.  I’m talking about spontaneous internal bleeding.

Spontaneously internal bleeding could take the form of gastrointestinal bleeding or even a brain bleed.  And the brain bleeds can be the big ones that everyone fears or the microbleeds that develop over time.

Microbleeds don’t cause any immediate symptoms.  However, studies show that these microbleeds may lead to progressive brain injury and dementia.  Sadly, blood thinners, especially warfarin/Coumadin, may increase this risk.

If you have to be on a blood thinner, then the best option would be a “NOAC.”  The “NOAC” blood thinners are Pradaxa, Xarelto, Eliquis, or Savaysa.  When compared to warfarin/Coumadin, our studies show that these blood thinners have a much lower risk of brain bleeding and dementia.

3. Cerebral Blood Flow

The key to optimizing brain performance is to maximize blood flow.  Unfortunately, atrial fibrillation decreases blood flow to the brain. How this occurs isn’t entirely clear, but three obvious reasons arise.

First, with atrial fibrillation, you lose the pumping ability of the right and left atria.  This loss of “atrial kick” decreases cardiac performance by about 20%.  Any loss of cardiac performance is linked to dereduced blood flow to the brain.

The second possible explanation is the irregularity of the pulse with atrial fibrillation.  Indeed, studies show that even if the heart is in atrial fibrillation, if you can normalize the pulse with a pacemaker then you can also normalize blood flow to the brain.  This study argues that it is the irregularity, not the loss of atrial function, that decreases blood flow to the brain.

Lastly, either too slow or too fast of a heart rate with atrial fibrillation could impact cerebral blood flow.  In another study (see abstract PO06-103) from our hospital, we have observed that the optimal atrial fibrillation heart rate to preserve brain blood flow is probably somewhere around 100 beats per minute.  Of course, sinus rhythm would be preferable but if you have to be in atrial fibrillation, then a higher heart rate may be necessary to preserve blood flow to the brain.

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4. Systemic Inflammation

Keeping inflammation as low as possible may be the secret to living to 1oo and beyond without any significant medical problems.  Indeed, studies of semi-supercentenarians, or those older than 105, have shown that the secret to their health is keeping inflammation barely detectable.

Years ago we published a study showing that inflammation levels, as measured by C-reactive protein, are much higher in people with atrial fibrillation.  Likewise, elevated inflammation levels have also been seen with dementia.  Thus, it is quite possible that the same inflammatory factors causing atrial fibrillation are also causing dementia.

5. Other Medical Problems

Atrial fibrillation doesn’t usually occur in isolation.  Generally, the same people with atrial fibrillation are also the same people suffering from obesity, high blood pressure, diabetes, sleep apnea, etc.  As all of these conditions also increase the risk of dementia, it is hard to know the exact atrial fibrillation dementia link.

The bottom line is that if you want to minimize your risk of atrial fibrillation, you can’t ignore your other medical challenges.  In other words, you can’t just focus on maintaining sinus rhythm while not also addressing the obesity, high blood pressure, diabetes, sleep apnea, etc.

This is where lifestyle optimization becomes so important.  Fortunately, most of these conditions can all be reversed by eating real food, keeping your body mass index below 25, exercising daily, and optimizing your sleep and stress levels.

6. Genetic Factors

reverse aging

Despite every effort at optimizing your lifestyle, genetics always play a role.  Fortunately, studies show that only about 25% of your health and longevity is determined by your genes.  The good news here is that the other 75% is completely up to you.

Interestingly, the Nigerians have the highest rates of the the Alzheimer’s gene.  Despite having the worst genes in the world, the Nigerians living in Nigeria rarely get dementia.  However, if they give up their healthy ancestral ways and migrate to the US then they lose these protective effects.

If you want to know whether your genes code for atrial fibrillation or dementia, there is a simple test you can do to find out. 23andMe offers a simple genetic analysis with a saliva sample at a cost of $199 USD.  While the FDA limits what 23andMe can share with you, by allowing Promethease access to your 23andMe raw data, you can unlock everything that is currently known about your genes for an additional $10 USD.

Atrial Fibrillation and Dementia in China’s Longevity Village

The Longevity Plan

In our book, The Longevity Plan, we deconstructed the secrets of China’s Longevity Village.  In this village, which has the highest percentage of centenarians in the world, atrial fibrillation and dementia are almost non-existent.  Indeed, during our five years of research, we couldn’t find any cases of atrial fibrillation or dementia.

Initially, my assumption was that the only way these people could live to 100 and beyond without atrial fibrillation or dementia had to be due to their genes.  However, when we analyzed the genes of these centenarians, we found nothing special.  As with us, they also had genes that predicted heart disease and dementia.  Clearly, it was something else that protected them.

After five years of research, the protective factor was that they had unknowingly optimized all aspects of the their daily health decisions.  Indeed, this book showed just what kind of heath and longevity is possible if you can optimize all of your health decisions.

How Do You Protect the Brain from Atrial Fibrillation?

Foods That Reverse Brain Aging

For those who are unable to reverse their atrial fibrillation with lifestyle changes, in 2011 we published a follow-up study  of 37,908 people showing that if you could eliminate atrial fibrillation with an ablation, then the increased dementia risk was completely gone.  Indeed, we have learned that the two key factors to preventing dementia are to maintain sinus rhythm and optimize your lifestyle.

For those in whom sinus rhythm is no longer possible, all is not lost.  When it comes to maintaining long-term brain function, the most important thing is to optimize your daily health decisions. Study after study has confirmed that healthy lifestyles trump genes and just about everything else.

Practical Tips

The key message is that despite the atrial fibrillation dementia risk, you can preserve long-term brain function by maintaining sinus rhythm and optimizing your health.  Do everything possible to keep your heart in rhythm.  Keep your weight in check.  Include vegetables with every meal and stay as far away from sugar, flour, and processed foods.  Never miss your daily workout and always look for ways to optimize your sleep and stress levels.

#277 Can Atrial Fibrillation Cause a Heart Attack?

May 20th, 2018 by

Can Atrial Fibrillation Cause a Heart Attack?

One of the biggest concerns people have during an arrhythmia is can atrial fibrillation cause a heart attack?  Fortunately, with the right lifestyle and proper treatment, the answer is usually no.  In this article, I’ll discuss how you can minimize the risk of a heart attack with atrial fibrillation.

Mark’s Experience

Mark was afraid to exercise. He was sure he was going to have a heart attack if he did anything that was physically active. The biggest thing on Mark’s mind was, can atrial fibrillation cause a heart attack?

Mark worried that when his heart rate hit 160 beats per minute in atrial fibrillation that he must be doing damage to his heart.  He kind of felt like he was “redlining” his heart much the same way you might “redline” your car from running the engine faster than it was designed to go.

Since his diagnosis of atrial fibrillation a month previously, Mark had stopped exercising. He had even stopped playing with his kids outside. He mostly just sat in a chair for fear that any activity might trigger atrial fibrillation or a heart attack.

With our initial visit I scheduled him for a stress echocardiogram and lab work to make sure that with the exception of his atrial fibrillation, the rest of his heart was healthy. Fortunately, his stress echocardiogram and lab work didn’t indicate any problems.

With a normal stress echocardiogram, I then got Mark on the lifestyle I described in our best selling book, The Longevity Plan. By optimizing his lifestyle in every way, and by providing him with some flecainide and metoprolol to be used only in the possibility of another atrial fibrillation attack, we had effectively dropped his heart attack risk as close to zero as possible.

Fortunately for Mark, optimizing his lifestyle was all that was needed to get his atrial fibrillation under control.  While he has kept a dose of flecainide and metoprolol in his wallet at all times for an emergency, he has not had to take either of these medications yet…

Heart Attack Risk from Atrial Fibrillation

It is easy to see why many people confuse heart attack symptoms with atrial fibrillation symptoms.  For example, both atrial fibrillation and a heart attack can cause shortness of breath and chest discomfort.


Based on a study we published many years ago, atrial fibrillation does indeed increase your risk of a heart attack. The good news though is that our studies also show that once the atrial fibrillation is properly treated, this increased risk goes away.

What is the Best Stress Test for Atrial Fibrillation?

When it comes to stress testing, my favorite is the stress echocardiogram. I like this test because it involves no radiation, no IV, and it provides the most information about the heart in a simple and cost-effective test.

For those patients who are unable to walk on a treadmill, I usually stress their hearts with a medication. The main downside is that these “chemical stress tests” generally involve radiation.  In addition, the information you get from a chemical stress test is rather limited.  Thus, I usually combine a chemical stress test with a resting echocardiogram.  This way I can make the valves and other aspects of the heart are also functioning properly.

The Very Best Way to Prevent a Heart Attack

Heart attacks are largely a phenomenon of living a modern lifestyle.  Indeed, heart attacks are very rare in cultures that have maintained their ancestral ways.

For example, in our book, The Longevity Plan, people living in and or around China’s Longevity Village didn’t get heart disease.  Even among the centenarians, only 4% had heart disease.  Atrial fibrillation was likewise rare in this group of people.

How these people were effectively able to avoid all of the medical conditions that afflicted those of us living in the modern world were spelled out in this book.  The bottom line is that only eating real food (no sugar or processed carbs/foods, etc.), maintaining a lean weight, exercising every day, connecting with friends and family on a daily basis and optimizing sleep and stress levels can prevent at least 90% of all heart conditions.

Practical Tips

The take-home message is that with a healthy lifestyle, like the one we described in our book The Longevity Plan, a normal stress echocardiogram, and being under the care of a cardiologist specializing in arrhythmias (electrophysiologist), the chances of atrial fibrillation triggering a heart attack are incredibly low.  Of course, if you are experiencing chest discomfort, or any other symptom possibly related to your heart, please let your doctor know immediately.

#275 9 Key Findings of the CABANA Study

May 12th, 2018 by

9 Key Findings of the CABANA Study

No one wants to be on drugs for the rest of their life to treat a heart arrhythmia called atrial fibrillation (Afib).  In a perfect world, you would have a safe and simple procedure that would make it all go away.  In this article, I’m going to share the results of the most important study that has ever been done for atrial fibrillation, the CABANA Study.

Why the CABANA Study Needed to Be Done

Gently placing a small catheter into the heart to treat the areas that are misfiring is a procedure that cardiologists have done regularly for nearly 20 years.  Those of us who have taken care of patients with atrial fibrillation have all seen miracle results.  Patients doomed to a life of atrial fibrillation are suddenly free from this affliction.

In fact, the results have been so striking that we even published our results of 37,908 patients in a 2011 study.  In this study, we showed that the procedure was safe and that it could significantly reduce the risk of premature death, stroke, and dementia from atrial fibrillation.  The only problem was that this study was never randomized.  And because it was never randomized it can’t be considered as “proof” that patients live longer and healthier lives with ablation.

In other words, were these findings in our study because catheter ablation works or did healthier patients somehow opt for ablation more than drugs?  No matter how we looked at the data, the only difference we could find in the ablation patients was that people with atrial fibrillation symptoms were more likely to get an ablation.  Which raises an interesting question…are atrial fibrillation patients with symptoms somehow “healthier” than atrial fibrillation patients without symptoms?

We needed proof from other hospitals that catheter ablation works.  Which is the precise reason why the CABANA Study is so important.  And while we thought we were going to get that proof, instead we just got more questions and more controversy.

Perhaps things will be a bit clearer when the study is finally published.  All we know so far is what was shared from a 15 minute presentation at a recent medical conference…

It Was Hard to Enroll CABANA Study Patients

Before we get to the actual results, the CABANA Study was a hard study to do.  As it is well known from many prior studies that ablation is better at keeping people in rhythm and reducing symptoms, it was hard enroll patients to participate in this study.  I personally met with hundreds and hundreds of atrial fibrillation patients who were not interested in participating in this study because they didn’t want to take drugs.

Thus, enrollment in the CABANA Study was slow and it took much longer to complete that what was previously anticipated.  For anyone who has done clinical research, motivated patients always have the best outcomes.

Right from the start, motivated patients generally were not included in this study.  Or at least that was the case from our hospital which was the number one enrolling hospital in this study.  Pretty much the only people we could enroll were those rare patients who had either never heard about ablation before or were ambivalent about how they wanted to treat their atrial fibrillation.

Cabana Study Results: Intention to Treat

To the scientific purists, you can only analyze a study based on the intent to treat.  For 99% of the studies out there, this approach works.

However, the CABANA Study was different than most other studies.  Hence, the controversy.

Nine percent of the people assigned to an ablation never actually had the procedure.  Nine percent is a big number.  That means more than 100 patients in this study of 2,204 people never got the therapy they were supposed to get.  So, if you are interpreting the results, how do you account for the 9% who were assigned to ablation but didn’t get an ablation?

But that was just the tip of the iceberg.  Of those assigned to take drugs, 28% couldn’t do it.  The CABANA Study required these patients to stick with drugs for five years.

If so many patients didn’t get the treatment they were supposed to get, it makes interpreting the study really difficult.  If you use the “intention to treat” method then you have to ignore the fact that too many patients in the CABANA Study never received the therapy they were supposed to receive.

Per Protocol Analysis: The CABANA Study

Just like you probably wouldn’t give your kids credit for doing the dishes unless they actually do the dishes, do you analyze the results of the CABANA Study in a way where you give credit for a treatment they never received?  If you only believe in giving credit where credit is due, then you probably want to interpret this study based on a per-protocol analysis.

According to the per protocol analysis, you simply see what happened to the people who actually completed the protocol.  In other words, if you had an ablation then it was counted as an ablation.  Likewise, if you took drugs it was counted as taking drugs.

9 Key Findings of the CABANA Study

As I have thought more about how the CABANA Study, I have decided to take myself out of the intention to treat versus per-protocol analysis debate.  Rather, I will show you the results both ways and then let you decide whether you subscribe to the intention to treat or the per-protocol way of interpreting the study.

If you are an intention to treat person, then I’ll give you the results based on how the patients were randomized and we’ll ignore what therapy they actually received.  An if you are a per-protocol person, then I’ll share with you what happened to the 1,307 patients who had an ablation compared to the 897 who were able to stick with the drugs.

1. Ablation Patients Are More Likely to Stay in Rhythm

If your goal is to eliminate atrial fibrillation, then ablation was the clear winner.  Regardless of how you analyze the CABANA Study, there is no controversy when it comes to maintaining rhythm.  Even by handicapping drugs and using an intention to treat analysis, your chances of remaining in normal or sinus rhythm is increased by 47% with an ablation (HR 0.53, CI 0.46-0.61, p<0.0001).

2. The Mortality Benefit Depends on How You Analyze the Data

If you choose the intention to treat methodology, then there was no difference in survival between drugs and ablation.  However, if you choose the per-protocol methodology then the numbers are radically different.

Of those who actually received an ablation, their risk of dying during the study was 40% lower (4.4% vs 7.5%, HR 0.60, P=0.005).  This is a huge mortality reduction and it is right in line with our 2011 study showing the exact same thing.  But then again it begs the question I raised earlier in this article, are atrial fibrillation patients with symptoms somehow healthier than those without symptoms?  Unfortunately, this is a question that has yet to be answered.

3. The Composite End point of Death, Strokes, Bleeding, and Cardiac Arrests Also Depends on How You Analyze the Data

As with the mortality question above, the combined end point of death, strokes, bleeding, and cardiac arrests in the CABANA Study also depends on how you interpret the results.  If you choose intention to treat then there was no meaningful difference.

On the other hand, the primary end point of death, strokes, bleeding, and cardiac arrests of this study was dramatically lowered with ablation.  In fact, those patients who actually got an ablation in this study experienced a 33% lower risk of death, strokes, bleeding, or cardiac arrest (HR 0.67, CI 0.50-0.89, p=0.006).   Once again, these finings are right in line with our 37,000 patient study.

4. Ablations Kept Patients from Getting Hospitalized for Atrial Fibrillation

Regardless of how you interpret the results, the finding was the same.  Ablation did a much better job at keeping atrial fibrillation patients from winding up in the hospital.  And even if you use the intention to treat analysis thereby handicapping ablation, drug patients were 17% more likely to end up in the hospital (HR 0.83, P=0.002).

5. Ablation Patients Had a Better Quality of Life

Although the numbers haven’t been presented yet, the lead investigator of this study, Dr. Doug Packer, shared that ablation patients enjoyed a better quality of life.  This finding came as no surprise and is right in line with just about every other study that has been done.

6. Heart Failure Patients Really Benefited from Ablation

For the sickest patients in this study, those with not only atrial fibrillation but who also had heart failure, did exceptionally well with ablation.  In fact, their risk of death, stroke, bleeding, or cardiac arrest plummeted by 49%!

Of course, to those who follow the latest atrial fibrillation research, this came as no surprise.  A recent study in the prestigious New England Journal of Medicine by Dr. Nassir Marrouche came to the same exact conclusion.

7. Ablation Procedures Are Safe

For me, probably the biggest surprise was how safe ablations have now become.  It should be noted that the CABANA Study was only done in the most experienced centers in the world.  Thus, these results are not applicable to every hospital in the world performing catheter ablation procedures.  However, in the most experienced hands, there were only three strokes, eight tamponades, a couple of vascular events, and no atrial esophageal fistulas in the ablation patients.  As our hospital was the top enrolling site in the US, I can tell you that I personally saw more drug complications than ablation complications in this study.

8. Younger People Did Exceptionally Well with Ablation

As I have said many times on this blog, young and active people like sinus rhythm.  They like using all four chambers of their heart.  Young and active people don’t like the way they feel when their hearts are out of rhythm.

Thus, it should come as no surprise that people under age 65 were much less likely to suffer from death, strokes, bleeding, or cardiac arrests with ablation.  And, based on the results of the CABANA Study, you could make an argument that younger patients should now be offered an ablation as first line treatment for their atrial fibrillation.

9. Minorities Fared Better with Ablation

This is a finding from the CABANA Study that I’m not sure what it means.  For some reason, minority groups fared better with ablation.  Perhaps future studies will shed light on this finding.

Who Shouldn’t Have an Ablation?

Despite the positive findings of ablation in the CABANA Study, there was one group that didn’t do so well with ablation.  For those age 75 and older, medications seem to be the best option (HR 1.54).

Perhaps this group, on average, wasn’t so active.  Thus, sinus rhythm may not have had that much of a benefit.  I suspect that if the CABANA Study could have separated out the active versus sedentary people, they may have found a different result.

How Can You Further Optimize Ablation Results?

For those who want even better ablation results than those reported in the CABANA Study, lifestyle optimization is the answer.  Even though this study didn’t look at lifestyle optimization, countless studies by Dr. Prash Sanders, as well as our own studies, have shown that you can at least double the positive effect of ablation with lifestyle optimization.

By lifestyle optimization, I’m talking about losing any extra weight, exercising daily, optimizing your nutrition, optimizing sleep, optimizing stress levels, etc. Indeed, when it comes to long-term freedom from atrial fibrillation, nothing works better than lifestyle optimization.

In fact, studies show that you can eliminate drugs or procedures in about half of everyone diagnosed with atrial fibrillation just by optimizing your lifestyle.  Thus, before you even consider drugs or procedures, the most critical question to ask is can I reverse this condition naturally?

The Big Picture

In my opinion, the big take away from the CABANA Study is that ablation performed remarkably well.  It is especially an attractive option for the patient with atrial fibrillation symptoms that don’t respond to medications.

Should everyone get an ablation?  Of course not.  If you can’t reverse atrial fibrillation with an optimized lifestyle then it may be a reasonable option.  For those in whom drugs don’t work or cause side effects, then ablation is definitely a logical choice.

#272 Can You Live a Normal Life with Atrial Fibrillation?

May 10th, 2018 by

Can You Live a Normal Life with Atrial Fibrillation?

No one with atrial fibrillation wants to feel like their life is over.  They still want to be able to do everything they did in their 30s, 40s, or 50s. With the right treatment plan, you can absolutely live a normal life with atrial fibrillation. The purpose of this article is to open your eyes to just how much is really possible.

Maria’s Experience

Maria was sure her life was over. In her mind, atrial fibrillation meant no more sex, traveling, hot tubs, or rollercoasters. Still, she wanted to believe she could do the same things as everyone else.

Even though she was only 52, she felt like she was still 32.  Her friends and family members all told her that she needed to be careful with atrial fibrillation.  Her primary care doctor wanted her to stop exercising for fear of a heart attack.

She didn’t want to be a cardiac cripple for the rest of her life.  And she definitely didn’t want to live like someone who was old.  She wanted to know if a normal life with atrial fibrillation was possible.

What holds people back with atrial fibrillation?

In my experience, the main two things that keep people from resuming normal activity with atrial fibrillation is the sometimes rapid heart rate and medication side effects. Indeed, until your atrial fibrillation heart rate is under control, you will probably become very winded and lightheaded with any activity.

The second main thing holding people with atrial fibrillation back from living a normal life is all of the new medications. These medications often turn high-energy people into zombies.

There is no reason why you should be on a medication that makes you tired, dizzy, or causes weight gain. If you don’t feel better on atrial fibrillation medications, then you either need a different drug or a new approach to treating your atrial fibrillation.

And if your cardiologist isn’t open to non-drug alternatives, then you may want to get a second opinion. The thing to remember about atrial fibrillation is that if the drugs don’t work, there is always an option that doesn’t involve medications.

Is sex OK with atrial fibrillation?

Sex, even among the more adventurous in this arena, is generally considered to be a moderate form of exercise. As such, studies show that as long as you can sustain a moderate level of  physical activity without symptoms, and you are in a stable monogamous relationship, then sex with any heart condition should pose little risk.

The reason why a stable monogamous relationship is important when it comes to having sex with a heart condition is that studies show that the vast majority of cardiovascular deaths during sex occur during an extramarital affair. While some may claim this is karma, it may just be that the sexual stress from infidelity may be too great for someone with a heart abnormality.

Can you drive your car in atrial fibrillation?

I know it seems strange, but I can’t tell you how many times I have been asked this question.  Yes, you can absolutely drive your car in atrial fibrillation.  Assuming, of course, that you could drive a car before atrial fibrillation…

Unless you are on the brink of passing out or otherwise distracted from the craziness of your atrial fibrillation heart rate, then you are safe to drive a car.  Believe it or not, my home state of Utah requires me to “sign off” on every one of my atrial fibrillation patients who wants to maintain a driver’s license.  As long as their arrhythmias have been under control, this has never been a problem.

Can you be active with atrial fibrillation?

Absolutely! The goal with all of my atrial fibrillation patients is to help them be as active as they possibly can. Indeed, studies show that the more physically active you are, the better you feel, the less atrial fibrillation you will have, and the less you will weigh.

Of course, until your atrial fibrillation is under control, your doctor may not want you to be that active. The reason for this is that until things are under control, your heart might go dangerously fast with atrial fibrillation. However, with the right treatment, you should be back to full activity within a few weeks.

Can you travel with atrial fibrillation?

Yes, you can still travel with atrial fibrillation. However, as with physical activity, your physician may want you to hold back until your atrial fibrillation is under control.

Even though airplane cabins are pressurized, at typical cruising altitudes this is the equivalent of being at an elevation of six to eight thousand feet (1,800 to 2,400 m) above sea level. Since higher elevations mean there is less oxygen, an uncontrollably fast atrial fibrillation heart rate could get you into trouble.

One other consideration for traveling is that you don’t want to wind up in the emergency room of some third world country. Once again, close partnership with your cardiologist should allow you a backup plan should an atrial fibrillation problem arise.

Can you ride a rollercoaster with atrial fibrillation?

The thrill of rollercoasters causes a massive adrenalin release. This adrenalin release then causes your blood pressure and heart rate to shoot up.

If your heart is already beating too fast with atrial fibrillation, then this adrenalin rush only makes matters worse. If, however, your atrial fibrillation is adequately treated then you should still be able to enjoy your favorite rollercoaster.

Can atrial fibrillation patients get in a hot tub?

Hot water causes your blood vessels to dilate. As your blood vessels dilate, your blood pressure may drop.

As this is often a dose-related effect, the longer you are in the hot tub, the lower your blood pressure may go. In fact, your blood pressure may go so low that you pass out either in the hot tub or while you are trying to get out of the hot tub.

For people not on medications, this usually isn’t a problem as the body generally compensates. However, if your doctor has you on atrial fibrillation medications that lower your blood pressure, like beta-blockers, diltiazem, or an antiarrhythmic, this could be a problem.

Another theoretical concern is for the person on a blood thinner. If you were to cut yourself somehow getting into the hot tub, the hot water could result in more bleeding.

The bottom line is that if you are on any prescription medications; please speak with your doctor before getting into a hot tub. It is possible that with the right precautions like hydrating first or limiting your time in the hot tub, you may still be able to enjoy this activity.

Can you skydive or scuba dive with atrial fibrillation?

When it comes to skydiving, I put the cardiovascular risk on par with riding a roller coaster. While both activities are not that physically demanding in most cases, the adrenalin release may be massive.

Thus, this adrenalin release could trigger an atrial fibrillation episode. If, however, your heart is already out of rhythm, then the adrenalin spike may cause your heart to beat extremely fast. As with all of the other activities discussed, if your atrial fibrillation is under good control, then skydiving should pose little risk.

Scuba diving, in contrast, may seem like it would be much more gentle on the heart. Indeed, you probably won’t get that same adrenalin rush unless you had a shark coming at you.

However, because of unexpected currents, wind, and water temperature, this sport could quickly tax your cardiovascular system. It is for this reason that I make my atrial fibrillation patients pass a full-exertion stress test before embarking on their scuba diving trip.

Practical Tips

The key to living a normal life with atrial fibrillation is to find an open-minded cardiologist who listens to your needs and can work with you to regain your normal life. For some people, medications allow them to resume full activities. For others, it may require a drug-free solution, like losing weight or a catheter ablation procedure, to get back to their previous life. As everyone’s condition, needs, and desires are different; this will require a tailored approach between you and your cardiologist.

Of course, nothing in this article should be taken as medical advice.  Make sure you are in close communication with your physician when it comes to engaging in any physical activity with atrial fibrillation.  Poorly controlled atrial fibrillation is a high risk situation that requires prompt treatment.

#271 Mindfulness vs. Tracking: Can you ever stop tracking?

April 15th, 2018 by

Mindfulness vs. Tracking: Can you ever stop tracking?

We all know what to do.  The problem is doing it.  When it comes to losing weight and exercising daily, can you ever stop tracking?  In this article, I share the reasons behind my recent 10 pound weight gain and discuss mindfulness vs. tracking when it comes to maintaining healthy behaviors.

Why I Started Tracking

As those of you who have read our bestselling book, The Longevity Plan, know, that when I hit my health crisis a number of years ago I had to drop 30 pounds.  Fortunately, the weight loss happened effortlessly.

I didn’t even have to track.  I could be mindful.

The reason why weight loss was effortless and I didn’t have to track was because there were no temptations.  But upon returning to the US, tracking was the only thing that helped me to maintain the health I found in the Longevity Village.

Thus, to maintain my health and weight loss, I became a tracker.  I tracked everything. However, a few months ago, something changed…

My 10 Pound Weight Gain This Winter

I grew tired of tracking every piece of food I ate.  Getting on a scale everyday also wasn’t any fun.  No longer did I want to count my daily steps or record every workout.

After more than four years of tracking everything, I needed a break.  Given the healthy routines I had built over the years, as well as the lessons I learned in China’s Longevity Village, I was sure that I could make the right intentional decisions and practice mindfulness when it came to diet and exercise.

Instead of tracking every morsel of food, I let mindfulness guide my food intake.  I tried to listen to my internal food cues to know when I was hungry.  Every bite was chewed thoroughly to extract each flavor.  I ate slowly.  And I was grateful for the food I had.  With this mindfulness approach, I reasoned that moderation in all things is good and a little bit can’t hurt…

By the time spring arrived, I got out the scale.  I had expected to see the same weight I have maintained for more than four years.  To my horror, the scale read 10 pounds heavier!  I was sure the scale was wrong.  Sadly, other scales confirmed the 10 pound winter weight gain was indeed real…

During my 4+ years of tracking everything, my weight never varied by more than two to three pounds.  Now, after just taking a month or two off from tracking, my weight shot up 10 pounds!  How can this be?

What Went Wrong?

Like most Americans, I had lost my internal cues of feeling full. I needed environmental cues.

By tracking, my iPhone app told me when I was supposed to feel full.  And with this environmental cue removed, I ate more than my body needed.  I also cheated a little bit in what I ate…

Of course, it didn’t help that I have two copies of the “Fat Gene” (FTO variant gene).  The vast majority of people in the US with just one copy of the “Fat Gene” are doomed to a life of being overweight.  For those of us with two copies, our obesity fate is almost sealed…

I should have know better.  Study after study has shown that if you don’t track your food it is next to impossible to maintain your weight loss.  I wanted to believe that being intentional and mindful would work for me in the US.  But it didn’t…

I clearly knew my purpose for maintaining my weight loss.  I wanted maximal energy.  I didn’t want to take medications again.  And I wanted to silence my Alzheimer’s gene (ApoE4).  So how did this 10 pound weight gain happen so fast?

The Problem Was that Tracking Was No Longer Fun

After analyzing my failure, the problem came from changing the tracking app I use on my iPhone.  For more than four years I have used the “Lose It” app.

My favorite part of the Lose It app are the lifetime statistics.  For example, I love to see how many calories I have burned over the years skiing, mountain biking, or running.  It is like a contest to see which sport will win.

The reason why I switched is that Lose It doesn’t track the micronutrients of foods.  I wanted to make sure that I was getting enough calcium, zinc, potassium and other essential micronutrients from my plant-based diet.  Because Lose It can’t tell me about the micronutrients of the foods I eat, I switched to the Cronometer app.

Cronometer gives you far more nutritional information than Lose It.  Because it is so good, I even opted for the paid version.

While Cronometer is a much better food and nutrition tracking app, it lacks the lifetime calorie burn from different workouts.  And because this one little component was missing, tracking was no longer fun.  When tracking was no longer fun, I thought I could rely on mindfulness…

Keystone Habits

In one of my favorite books, The Power of Habit, Charles Duhigg writes about keystone habits.  Leveraging your keystone habit is what makes behavior change possible.  The keystone habit is your key domino.  If you can do this one thing right, everything else will fall into place.

For me, my keystone habit is exercise.  Fortunately, I became addicted to exercise at age 22.

Exercising outside is my daily antidepressant. Indeed, studies show that about 15 minutes of daily exercise has the same beneficial effect on depression as taking an antidepressant.  If I even go a day without exercising outside I become very depressed.  No one wants to be around me if I miss a day of exercising outside.

The reason why I gained 10 pounds this winter is that I failed to leverage my keystone habit.  I love the sense of accomplishment of seeing my lifetime exercise statistics.

The reason why the Lose It tracking app worked for me is because I could see my lifetime workout statistics.  This reward helped me to also record my daily food intake.  When the reward was gone, it was too much of a burden to track my food.  So I stopped tracking.

I Gained Weight Even Though I Was Exercising

Whenever I talk with patients about losing weight, nine times out of ten they tell me why they can’t exercise.  For some strange reason, most people think that exercise is the key to weight loss.

Surprisingly, the medical literature doesn’t support this at all.  Indeed, study after study has confirmed that exercise alone doesn’t cause weight loss.  Weight loss is primarily determined by food choices.  What we eat, when we eat, and how much we eat.

During my mindfulness experiment in the US, I was actually exercising more.  I know it seems counterintuitive but even though I was exercising more my weight went up!

My favorite time of the year to exercise is winter.  So every day this past winter I either cross country skied or climbed snow covered mountains to ski.  Both of these activities have incredible calorie burns.  But despite these massive calorie burns, I still gained weight…

My Steps Dropped Off

When I stopped tracking my food I also stopped tracking my daily step count.  Even though I thought I was no longer tracking my steps, my Apple Watch was still tracking them in the background.

Because taking steps isn’t fun for me, my daily step count did drop when I stopped tracking.  However, in doing the math, this slight drop in steps could only explain perhaps a pound or two at most of my 10 pound weight gain.

This observation brings up another interesting point of why people don’t lose weight with exercise.  Humans, like every other animal, conserve energy.  In fact, studies show that we are hard wired to be as lazy as possible.

Indeed, countless studies show that when people or animals are exercised, they subconsciously become less active throughout the rest of the day to conserve energy.  This happened to me as well with my mindfulness experiment in the US.

When I stopped tracking my steps, I didn’t take any more steps than I needed to.  As sitting is now the “new smoking” when it comes to cancer, heart disease, and premature death risk we all need every possible advantage to avoid our prewired nature to sit.  It is for this reason that I recommend not only 30 minutes of daily exercise for my patients but also at least 10,000 steps as well.

We have to move throughout the day.  A single killer workout simply isn’t enough.

The 3 Easy Steps to Behavior Change

Behavior change is never easy.  Based on reviewing every study I could find, and from working with thousands of patients, here are the three things you need to do for successful behavior change.

1.  Have a Purpose

You need a strong purpose.  If your reason for behavior change is to fit into your bathing suit again this summer your purpose probably isn’t strong enough.  Choosing health is not easy in a life full of temptations.

Studies show that a medical crisis, like a cancer or heart disease diagnosis, can be powerful motivators.  For me it really comes down to feeling young, avoiding medications, and silencing my Alzheimer’s gene.

2. Create the Right Environment

Creating the right environment was the secret to the people living in China’s Longevity Village.  In fact, this was all they had when it came to behavior change.  And if done right, this may be the strongest of the three steps.

Historically, there were no temptations in the Longevity Village.  If you never saw sugar, processed carbohydrates, or fast food then you would never be tempted.  And if you were never tempted, then you would never miss these foods or feel deprived.

Likewise, if people ate vegetables as part of their breakfast, lunch, and dinner then you would have no choice but to learn to like vegetables.  Also, if everyone did hand farming all day, everyday, then you would never be tempted to sit.

Indeed, I found that when I lived in China’s Longevity Village I could stop tracking.  Because there were no temptations, I could be mindful.  And every time I returned from the Longevity Village, I found that I had effortlessly lost weight.

When it comes to creating the right environment you need to eliminate every temptation that you can.  For the temptations you can’t eliminate, you need to make it very difficult to get to those temptations.

For example, if you never bring junk food into your home then you will never be tempted to eat junk at home.  If, however, you have a spouse or child that insists on eating junk food then you can ask them to keep their junk food hidden from you.  This way, unless you spend hours searching your home, you will never find the junk food.

3. Accountability

For behavior change to stick you have to be accountable to someone or something.  For me, it was being accountable to an app on my iPhone.

As long as I was “having fun” tracking, I stuck with it.  However, when I changed apps and it was no longer “fun” to track, I stopped tracking.

Many of my patients have also found success being accountable to another person.  For example, having a trainer at their gym holding them accountable has been the secret to their success.

At the end of the day it really doesn’t matter if you track with an app, or a trainer holds you accountable. Accountability is key to preventing self sabotage.  For me, this accountability piece also has to be fun.

Is there a role for mindfulness?

I hope I haven’t discouraged you from practicing mindfulness with this article.  While mindfulness hasn’t been able to replace tracking for me in the US, that doesn’t mean it can’t work for you.  In fact, the real goal is that mindfulness can someday replace tracking for me.

I still remember fondly my time in China’s Longevity Village when I didn’t have to track.  Because there were no temptations, mindfulness worked for me.

However, life in the US is different.  It is hard to find great tasting vegetables when you are hungry.  There are just too many great tasting foods all around me.

For my wife, even in the US mindfulness works.  I also have many patients that can rely on mindfulness to help them eat right, keep their weight in check, and stay physically active.  However, for every one patient I have that can successfully be mindful, I have 99 who, like me, can’t.

Thus, if you are part of that 1% who can stay healthy from being mindful, keep going.  You have developed a gift.  I strive to someday reach your ranks.  However, for the 99% of us who must track, the key lesson I learned is that tracking must be fun.

Make Tracking Fun

Because I will probably never be able to stop tracking if I want to eat right, maintain my weight loss, and not sit too much, I have to make it fun.  For me, I like seeing my lifetime achievement awards on Lose It.

Sadly, the Lose It app only displays 10 years of data.  In a little more than five more years I will no longer be able to see my lifetime achievements.  Thus, I will need to come up with a new way to “gamify” tracking.

For me, the virtual medals that these apps give out don’t motivate me.  Comparing my results to others also isn’t motivating.  For me, I like to see which exercise “wins” when it comes to my lifetime exercise stats.  And by leveraging this “reward,” I can tack on other healthy behaviors like food tracking.

In case you wanted to see my results for the last 4+ years, here you go..


I know this seems stupid, but this one feature of Lose It is what keeps me tracking everyday.  My goal is to have my lifetime calories burned from skiing beat out the calories I get from walking everyday.  As snow skiing is a seasonal sport, my off-season goal is to have my total calories burned from mountain biking also beat out walking.

The key to tracking is to make it fun.  If you can make it like a video game where you achieve new levels then it can help to make the healthy behavior change stick.  The reason why I stopped tracking with Cronometer, even though it gives you so much more information than Lose It, is because it wasn’t fun for me.

Practical Tips

While mindfulness is the ultimate goal, if you are like me you may never reach this level of enlightenment.  Thus, short of permanently moving to China’s Longevity Village, I need to track.

Through my recent 10 pound weight gain I have learned that I probably can never stop tracking as long as I am living in the US.  And the way to make tracking a habit is to make it fun.

Since switching back to Lose It a week ago, I have now lost two pounds.  I have eight more pounds to lose before summer in order to get back to my ideal healthy weight…

What has helped you maintain healthy habits?  Please leave your experiences below.  The comment section will be open for the next 30 days.

If you enjoyed this article, please be sure to sign up for our free weekly newsletter, subscribe to my podcast, or read our bestselling book, The Longevity Plan.

#270 Will Atrial Fibrillation Kill You?

April 12th, 2018 by

Will Atrial Fibrillation Kill You?

Heart problems are scary, and everyone sooner or later asks will atrial fibrillation kill you?  In this article, I’ll teach you what you need to do to add extra years to your life even if you have atrial fibrillation.

Jeff’s Story

“Will atrial fibrillation kill you?” Jeff asked me on the day we met. The interesting thing is that he was only 65 and had just finished a half marathon. Somehow he figured that if something was wrong with your heart, then death was imminent.

Other than his atrial fibrillation, Jeff was a picture of health. He ate right and took nature walks daily  to keep stress levels in check.  He was asleep every night by 10 pm and got at least seven hours of good sleep.

Jeff filled his days with a part-time consulting business and running. He and his wife Margie would travel the world looking for the next race to run. It was their way of exploring each new city.

Given how well he felt, he was in a state of shock when atrial fibrillation seemed to strike out of nowhere.  He loved his family, and he loved living.  He came to see me because he didn’t want atrial fibrillation to shorten his life.

Does atrial fibrillation shorten your life?

Based on our research, people with atrial fibrillation don’t live as long as those without atrial fibrillation. What we don’t know is whether this shorter life expectancy is from atrial fibrillation or the many other medical issues that often accompany atrial fibrillation.

For example, it is rare for me to see a patient, like Jeff, whose only medical issue is atrial fibrillation. In general, most of the people I see every day with atrial fibrillation have not optimized their lifestyle.  Most are overweight, aren’t exercising every day, and they eat the Standard American Diet (SAD).  In addition to a suboptimal lifestyle, they often have high blood pressure, sleep apnea, or other lifestyle-related conditions.

What we really don’t know is will atrial fibrillation still shorten your life even if you have optimized your lifestyle?  My personal opinion is that the longevity risks of atrial fibrillation are minimal provided you are doing everything else right.

Will keeping your heart in rhythm extend your life?

The simple answer to this question is it depends. For example, if keeping your heart in rhythm means a cardioversion and antiarrhythmic medications, then the answer is no.

Indeed, many studies comparing living out of rhythm versus taking an antiarrhythmic and having your heart shocked have shown no difference in survival. The reason for this is likely due to whatever survival benefit you may get from a normal heart rhythm is completely offset by the toxicities of the drugs used to get you there.

In contrast, our studies involving close to 40,000 patients have shown that a catheter ablation procedure to treat atrial fibrillation may extend your life. Once again, while normal rhythm likely gives you a longevity boost, the life extension benefit probably seen in our studies is also due to living a healthier lifestyle. Indeed, it is pretty difficult to get out of our clinic without also being encouraged to make healthier lifestyle choices.

Do your genes determine how long you live?

Most people assume that your genes determine how long you live.  While genes do play a role, it is much less than what people think.

For example, even with identical twins who share the same DNA, studies show that genes only account for 25% of how long they will live.  Thus, 75% of their life expectancy is determined by their daily lifestyle choices.

What do atrial fibrillation patients die from?

So what happens in the end?  How do people with atrial fibrillation die?

To answer this question, French researchers looked at the cause of death of every atrial fibrillation patient in a 2012 study. And what they found will likely surprise you.

Death from anything heart related ultimately claimed the lives of only a third of all French people with atrial fibrillation. However, fully two-thirds of the deaths occurred from other medical conditions.

The findings of this study come as a complete surprise to most physicians taking care of people with atrial fibrillation as well. Indeed, the real risk isn’t the atrial fibrillation but rather all of the other medical conditions that go along with atrial fibrillation.

The Top 5 Things That Shorten Your Life

Instead of thinking, “will atrial fibrillation kill you” the real focus should be on reversing lifestyle-related medical conditions.  These lifestyle-related medical conditions will rob you of far more years than atrial fibrillation.

For example, studies show that smoking, weighing more than you should, not exercising, stress, and diabetes all take approximately ten years off your life. Even if you live the rest of your life in atrial fibrillation, reversing just one of these five conditions will give you back far more years than atrial fibrillation might take. Indeed, when put in proper perspective, the risk of atrial fibrillation can’t even begin to compare to the premature death risk of smoking, weighing more than you should, not exercising, stress, or diabetes.

Jeff’s Story Revisited

Because Jeff had already optimized his health, there wasn’t anything we could do to reverse his atrial fibrillation naturally.  Interestingly, his 23andMe home genetic test showed that the cause of his atrial fibrillation was probably genetic.

As the atrial fibrillation drugs slowed his running times, Jeff was looking for a permanent solution to his atrial fibrillation that didn’t involve taking medications.  He was ready for an ablation.

While it ultimately took two ablation procedures, his atrial fibrillation is totally gone now.  And to ensure he never goes out of rhythm again, he tracks his heart rate and EKG with the new Apple Watch Kardiaband.

Practical Tips

If your goal is a long and healthy life, focus on optimizing your overall health rather than worrying about atrial fibrillation. In the big picture, atrial fibrillation can’t even come close to affecting your lifespan the way healthy living can.  And if you can optimize your overall health, then there is a good chance your atrial fibrillation may go away on its own without drugs or procedures.

#269 The 5 Best Ways to Diagnose Atrial Fibrillation

April 8th, 2018 by

The 5 Best Ways to Diagnose Atrial Fibrillation

Isn’t it frustrating when doctors can’t seem to figure out what is going wrong?  It can be that way with atrial fibrillation that comes and goes.  Atrial fibrillation never seems to happen in the doctor’s office.  In this article, I’ll teach you the five very best ways to diagnose atrial fibrillation.

Mary’s Experience

Mary’s heart never did its thing in the doctor’s office.  For years, she had palpitations and a rapid heart beat.  But it always behaved in the doctor’s office.

During the many years she suffered from palpitations and a rapid heartbeat, her doctors had ordered many tests.  These tests included electrocardiograms (EKGs) and even a 48-hour heart monitor.  And everything always came back normal.

Because her doctors could never find anything wrong with her heart, they diagnosed her with panic attacks. Under this assumption, her doctors then prescribed anxiety medications.  Despite this, she knew something was wrong with her heart even though her doctors didn’t believe her.

Does Atrial Fibrillation Come and Go?

The problem was that Mary had the kind of atrial fibrillation that comes and goes.  The medical term for this kind of atrial fibrillation is paroxysmal atrial fibrillation.

With paroxysmal atrial fibrillation, the heart periodically goes out of rhythm and then will self-correct.  For some strange reason, people suffering from paroxysmal atrial fibrillation always seem to be in normal rhythm when they are at the doctor’s office.

Finally, after years of suffering, the diagnosis was made.  Sadly, it took a stroke that left her unable to speak before the EKG finally showed atrial fibrillation.  Fortunately for Mary, she got to the emergency room in time so that they could quickly dissolve the atrial fibrillation blood clot and allow her to speak again.  While it can be hard to diagnose atrial fibrillation, it doesn’t have to be this way.

How do you know if you are having atrial fibrillation?

Mary knew she was experiencing some form of an arrhythmia.  Her heart would suddenly take off racing.  Then, it would abruptly stop.

Probably the main reason why it took so long to diagnose atrial fibrillation is that she never learned to check her pulse.  If she could have communicated to her doctors that her pulse was periodically fast and irregular, the diagnosis could have been made years earlier.

And that is how you know you are in atrial fibrillation.  Your pulse is fast and irregular.  While this method isn’t 100% accurate, in my practice it works 99% of the time.

The 5 Best Ways to Diagnose Atrial Fibrillation

To cut the possible diagnosis time of atrial fibrillation from years to days, here are my five best ways to diagnose atrial fibrillation.

1.  A Fast and Irregular Pulse

As mentioned above, all atrial fibrillation patients need to learn to track their pulse.  The easiest way is to just feel your pulse.

Your pulse should be regular.  Occasionally you might “skip” a beat, this is normal.  If every beat is irregular then it is probably atrial fibrillation.

Next, count the number of beats you have in 15 seconds and multiple by four.  This is your pulse.  Unless you are on medications to slow your heart down, most cases of atrial fibrillation have a heart rate faster than 100 beats per minute.

What should you do if you can’t feel your pulse?  If you can’t feel your pulse you could listen to your heart beats to see if it is fast and irregular with a five dollar stethoscope you can buy on Amazon.

If your hearing isn’t any good either, then you can buy a twenty dollar pulse oximeter on Amazon.  With a pulse oximeter you look at the blinking light to see if it is fast and irregular.

2. Do an EKG While Your Heart is Fibrillating

While detecting a fast and irregular pulse will get you 99% of the way to the diagnosis, to confirm things you will need an EKG.  The easiest way to do this is to get an EKG done while your heart is in atrial fibrillation.

To expedite this process, I often write a prescription for an EKG and give it to my patients.   This way, whenever the atrial fibrillation attacks, they can quickly run to the hospital, bypassing the emergency room, and getting an EKG done.

If your doctor hasn’t yet written you a prescription for an EKG, you could run to the nearest urgent care clinic or the emergency room.  If you tell them your pulse is fast and irregular they will quickly do an EKG for you.

3. Have Your Doctor Order an Event Monitor

For those people who have atrial fibrillation attacks that don’t occur frequently, and don’t last very long, an event monitor is a great way to go.  An event monitor is a heart monitor that you use at home.  Most models have several electrodes that you stick to your skin.

In my practice, I typically prescribe an event monitor for one month.  Also, the event monitor is continuously transmitting, like a cell phone, as people experience atrial fibrillation.  Thus, it may not take long to nail down the diagnosis.

4. Turn Your Smartphone into an EKG Machine

For those who don’t get atrial fibrillation attacks every month, turning your iPhone or Android phone into an EKG machine may be the way to go.  For this approach, you pay a one time $99 fee on the Alivecor website to buy some electrodes that bluetooth in to your phone.

With the KardiaMobile system, you can now email or text the EKGs from your phone.  These EKGs are no different from what you might get at the hospital so the diagnosis is usually pretty straightforward.

Unfortunately, the free “EKG apps” available for smartphone users are usually worthless when it comes to making the diagnosis.  These apps rely on the flash component of your phone to try and diagnose atrial fibrillation.  If you want to use your phone, then pay the $99 and get a high quality system.

5. Turn Your Apple Watch into an EKG Machine

If money is not an issue, and you want the coolest way to diagnose and track your atrial fibrillation, then go with the KardiaBand.  For $199, on top of the cost of buying the latest Apple Watch, as well as ten dollars a month in recurring expenses you can turn your Apple Watch into an EKG machine.  As with the smartphone version described above, you get a high quality EKG for your doctor.

Practical Tips

No one should have to wait years before atrial fibrillation is finally diagnosed.  Because atrial fibrillation can cause strokes, you don’t want any delay in making the correct diagnosis.

Of all the ways to diagnose atrial fibrillation, taking you pulse has to be the easiest.  If your pulse is fast (usually above 100 beats per minute if you aren’t on any heart medications) and irregular then you probably have atrial fibrillation.

To confirm the diagnosis, you will need an EKG.  Whether that EKG comes from the doctor’s office, an event monitor, your smart phone, or even your Apple Watch it really doesn’t matter.

#268 The Top 9 Atrial Fibrillation Symptoms

April 6th, 2018 by

What Are the Atrial Fibrillation Symptoms?

Many people wonder if they might have atrial fibrillation.  Short of doing an EKG, recognizing the symptoms can help you to determine if it is atrial fibrillation or not.  In this article, I’ll cover the key atrial fibrillation symptoms to look out for.

Bob’s Story

At 56, Bob thought he was getting old. While he never was the “exercising type,” he always prided himself on being able to do a hard day of work. Bob was a carpenter. He liked his work so much that he often joked that he wanted to keep hammering nails right up until one was nailed in his own coffin.

“Doc, I just don’t know what’s wrong with me. I can’t even make it through a day of work anymore. I’m just so tired and short of breath if I try to do anything. Is this old age?” He asked.

“You are too young to be tired and short of breath. I think it’s the atrial fibrillation,” I said.

“What can we do about it?” Bob asked.

“Let’s get your heart back in rhythm and see if you feel better,” I said.

With that, I had my nurse schedule him for an electrical cardioversion to shock his heart back into rhythm later that day. When he came back a month later, he looked a lot younger than his previous self.

“Doc, I feel young again,” he said.

“That’s sinus rhythm,” I said.

The Top 9 Atrial Fibrillation Symptoms

Having seen tens of thousands of patients with atrial fibrillation over my career, I think I have heard about every possible symptom there is.  Based on this experience, below are the top nine atrial fibrillation symptoms I hear from patients, in order.

1. No symptoms

Yes, you read this correctly.  No symptoms.

Indeed, if you ask an older or an inactive person with atrial fibrillation to describe their atrial fibrillation symptoms, they will probably tell you, “I don’t feel a thing.”

The reason for this is that if you aren’t regularly using your heart, then you probably won’t notice if your heart goes out of rhythm.  Even in people who swear they can tell the second they go out of rhythm, if you monitor them long enough you will discover they often have short atrial fibrillation attacks that they can’t feel.

Basically, the more you use your heart, the more likely you will be to notice that something isn’t right if your heart goes out of rhythm.

2. Fatigue

Of all the atrial fibrillation symptoms I hear, the most common is fatigue. Like Bob, many people don’t feel the palpitations or the rapid heartbeat.  Rather, they just are tired.  Many, like Bob, think that this fatigue is just a sign that they are getting old.

Remarkably, most patients feel much younger once we get their hearts back into normal rhythm. It’s almost like a switched was flipped.

There are so many reasons why atrial fibrillation patients feel tired.  To understand the five main reasons why people with atrial fibrillation feel so tired, here is a link to an article I wrote on this topic.

3. Shortness of Breath

After fatigue, the next most common atrial fibrillation symptom is shortness of breath.  The shortness of breath that comes from atrial fibrillation isn’t usually noticeable at rest.  Instead, it is a shortness of breath that comes from exertion.

For example, Bob’s breathing was fine when he was with me in the clinic.  However, as soon as he tried to do any physical work he felt breathless.

4. Palpitations

When most of my patients think about atrial fibrillation symptoms, palpitations immediately comes to mind.  But this isn’t the case.  In fact, many of my patients are amazed that they don’t feel anything in their chest when their heart is out of rhythm.  In Bob’s situation, because he never felt the palpitations, he didn’t think it could be his heart.

For those who can feel their atrial fibrillation symptoms, palpitations are the sensation that their heart is flopping around like a fish inside their chest. Sometimes, people may even describe “hard” or “pounding” beats with atrial fibrillation.

5. Chest Pain

Chest pain is an especially troublesome symptom to diagnose. With chest discomfort, it can be hard to tell if it is from atrial fibrillation or a heart attack.  Heck, it could even be one of a hundred other different causes.

One way that can help to determine if the cause is from atrial fibrillation has to do with the timing of the symptoms.  If you only have chest pain when your heart is in atrial fibrillation, then it is probably from the atrial fibrillation.  Indeed, if your chest pain instantaneously goes away the exact second your heart goes back to a normal rhythm then this is usually the case.

If, however, the chest pain doesn’t 100% correlate to your atrial fibrillation then it is likely a different cause.  Regardless of the cause, chest pain can be a life-threatening symptom so call for help immediately.

6. Dizziness or Lightheadedness

With the rapid heartbeat that accompanies most cases of atrial fibrillation, many people feel dizzy or lightheaded.  Dizziness and lightheadedness can also come from atrial fibrillation dropping your blood pressure.

As with chest pain, there are a million different causes of dizziness and lightheadedness.  Thus, to correctly determine if dizziness and lightheadedness come from your atrial fibrillation then these symptoms should 100% correlate to your pulse.

7. Leg Swelling

In older or heavier people, leg swelling can be a symptom of atrial fibrillation. As people get older, particularly if they have been overweight or have had high blood pressure, the heart can get very stiff. Just like when you are trying to blow up a balloon at a birthday party, a stiff heart is hard to fill with blood.

When the heart doesn’t fill properly, fluid backs up and swelling occurs. This situation is worse when the heart goes out of rhythm. Thus, many of my older, overweight, or hypertensive patients know they are out of rhythm based on how much swelling they are getting in their legs.

8. Fainting

In rare cases, atrial fibrillation can cause fainting in older people.  This happens either from the heart going so fast that the blood pressure drops or from the heart briefly flat-lining when the atrial fibrillation stops and sinus rhythm returns.

9. Other Seemingly Unrelated Symptoms

With atrial fibrillation, just about any symptom is possible. For example, some of my patients report excessive urination when they are out of rhythm. Others describe digestive issues or abdominal discomfort when their hearts are out of rhythm.  The bottom line is that atrial fibrillation can cause many other seemingly unrelated symptoms.

Practical Tips

Regardless of your symptoms, make sure your cardiologist is aware of your symptoms. Whether or not you and your cardiologist decide to treat atrial fibrillation aggressively largely comes down to your symptoms.

Also, don’t rely on symptoms to tell you that you are in atrial fibrillation.  I have seen far too many patients in my career suffer strokes because they relied on their atrial fibrillation symptoms to tell them if they were in rhythm or not. Symptoms are never 100% reliable.

Learn to check your pulse every day.  If your pulse is fast or irregular, then you just might be in atrial fibrillation.

#267 5 Ways to Lose Weight with Pasta

April 4th, 2018 by

5 Ways to Lose Weight with Pasta

Everyone knows pasta causes weight gain.  Would you be surprised to learn that scientific studies show the opposite?  In this article, I cover the latest pasta study and share five ways to lose weight with pasta.

The Latest Pasta Study

In a study published this week in the prestigious British Medical Journal, researchers from Canada pooled together the results of 32 studies looking at 2,448 people.  And what they found goes against what you read in all of the popular health books…

When carefully analyzing the results of 32 different studies of 2,448 pasta eating people, these researchers found that eating pasta, as part of an otherwise healthy diet, doesn’t cause weight gain.  In fact, those eating pasta every day actually lost about one pound provided pasta was part of a healthy diet.

How Can this Study Be True?

This study must be wrong.  Everyone knows pasta makes you gain weight.  Let me give you four reasons why this study may be right.

1.  Pasta is relatively low on the glycemic index.

The glycemic index measures how fast food is converted to sugar in the body.  Foods high on the list, like bread, are instantly converted to sugar.

White bread has a glycemic index in the high 70s.  Even “healthy” whole wheat bread also has a glycemic index score in the high 70s.  These high glycemic scores tell us that the standard store-bought bread is little more than just sugar.

At the opposite end of the spectrum, you have foods like nuts which have almost no sugar response in the body.  With nuts, the glycemic index will typically be under 20.

Pasta, surprisingly, has a relatively low glycemic index score in the 40s.  Thus, it is somewhere between bread and nuts when it comes to how fast it is converted to sugar in the body.  Foods with a low glycemic index are generally healthier and promote weight loss as they are much more filling and don’t throw off your metabolism.

2. Pasta Portion Sizes were Controlled.

While the portion sizes of pasta varied in these 32 studies, in general, a reasonable portion size is about the size of your fist.  These studies didn’t include the massive pasta bowls that you might see in a typical U.S. restaurant.

3. What You Put on the Pasta Matters

It should come as no surprise that a lot of the 32 studies came from Italy and other Mediterranean countries.  Thus, pasta sauce using tomatoes, vegetables, and olive oil were common.  It wasn’t a big bowl of cheesy pasta like you might see at the Olive Garden restaurant.

4. It Matters What the Rest of Your Diet Looks Like

As mentioned, only those who ate an otherwise healthy diet didn’t gain weight with pasta.  If the rest of your diet is healthy, pasta won’t cause weight gain.

5 Ways to Lose Weight with Pasta

Depending on where your current diet is at, let me suggest five ways to lose weight with pasta.  I have listed these in order of their nutritional value and the likelihood that you will lose weight with pasta.

1.  Use Vegetable Noodles

Using fresh vegetables as your noodles is clearly the healthiest option.  Zucchini, carrots, squash, cucumbers, or sweet potatoes can easily be cut into spirals with a machine to create incredibly healthy pasta.

While vegetable noodles are off the charts nutritionally, there are a few downsides.  First, you need a vegetable noodle maker.  For about $15 you can get one of these at Walmart or on Amazon.  For those of you who don’t want to use a machine to cut up your veggies into noodle strips, Whole Foods always has fresh vegetable noodles available, but you will definitely pay for this convenience.

Second, vegetable pasta doesn’t taste like regular pasta.  It is for this reason that I struggle with vegetable noodles.

Don’t be fooled by a little spinach in your typical pasta.  That little bit of spinach doesn’t do anything to the nutritional aspect of your pasta.  If you want the best pasta when it comes to nutrition, it has to be all vegetables.

2. Bean Pasta

The second healthiest way to eat pasta is to use a bean pasta.  Fortunately, bean pasta comes much closer to the taste and texture of traditional pasta.

Almost any bean can be made into pasta.  With bean pasta, you are going to get an even lower glycemic index number.  Also, with a bean pasta, you will get a ton of protein and fiber as well to fill you up.

If you want to give bean pasta a try, Amazon has many choices.  Also, health food stores, like Whole Foods, has many bean pasta options.

3. Quinoa Pasta

Down one level from bean pasta is quinoa pasta.  While you won’t get as much protein and fiber as with a bean pasta, it is still probably better for you than wheat pasta.  Also, for those wishing to avoid gluten, this is another option.

4. Turn Regular Pasta into a Resistant Starch

Number four on the list is to take your regular pasta and turn it into a resistant starch.  While this doesn’t boost the nutritional content, it does put the pasta even lower on the glycemic index.

With a resistant starch, you are making the pasta even harder for your body to convert to sugar.  This slow-burning carb helps to keep you full and won’t lead to a sugar/insulin crash.

To convert your pasta to a resistant starch, simply put your cooked pasta in the fridge overnight.  The process of cooking, cooling, and then cooking again converts it to a resistant starch.

5. Replace Bread with Pasta

Last on the list if you want to lose weight with pasta is to simply replace bread with regular pasta.  Nutritionally they are about the same.  However, because even regular pasta is so much lower from a glycemic standpoint than bread, you are much less likely to mess up your metabolism.

The Big Picture

Pasta can be incredibly healthy if eaten right.  Even the standard pasta is probably “less bad” for you than eating bread.  Of course this also depends on what you put on your pasta…a big portion size or that cheesy sauce could completely undo any possible benefit.

When it comes to optimizing your metabolism, you want all of your foods to be at least less than 50 on the glycemic index.  To learn where your favorite foods fall on the glycemic index, here is a great chart from Harvard University.

Do you have any “pasta hacks” to make pasta healthy?  Please leave your tips below.

#266 How to Bulletproof Your Brain

March 25th, 2018 by

How to Bulletproof Your Brain

I want to share a message of hope for those of you with a family history of dementia.  According to a new study, one simple habit can cut your risk of dementia by 90%!  In this article, I will teach you how to bulletproof your brain.

The Swedish Dementia Study

Researchers from Sweden just published a study that rocked the neurology/dementia world.  After following the people in this study for 44 years, researchers found that for those who are in the top 5% of their age group for physical fitness, then the risk of dementia dropped by 90%! And in those incredibly rare cases where a very physically fit person did develop dementia, it didn’t happen until after age 90.

No other intervention has ever been shown to have such a profound effect on protecting the brain. Of course, to make it to the top 5% for physical fitness in your age group will also require that you are eating right, optimizing sleep, etc.

How does exercise bulletproof your brain?

Studies show that exercise helps clear the dementia debris that piles up in the brain as we age. Also, physical activity is the most potent stimulator of brain-derived neurotrophic factor (BDNF), which causes the growth and development of brain cells.

Other studies have shown that people cut back on physical activity about ten years before developing dementia. Thus, if you have had no drop off in your daily exercise, then these studies suggest your brain will stay sharp for at least ten more years.

As dementia scares me to death, since reading this study I have significantly bumped up my daily exercise regimen.  I’m banking on the fact that because my physical fitness continues to improve that I can bulletproof my brain.

Key Takeaway

The message here is clear. If you want to bulletproof your brain it is going to require a very high level of physical fitness.  Walking around the block just isn’t going to cut it according to this study.

In addition to a high level of physical fitness, you also need to cut out the sugar and dramatically boost the veggies.  At least seven hours of sleep, embracing stress, and learning new things daily will also help to bulletproof your brain.

Of course, If you haven’t done much more than walking, now is the time to work with your physician on finding the right way to increase your stamina.  Don’t boost your daily exercise without speaking to your physician first.

#265 Low Carb or Low Fat: Which is Best?

March 25th, 2018 by

Low Carb or Low Fat: Which is Best?

Should you go low carb or low fat for weight loss? I’m guessing you would pick low carbs. However, if I had asked you this same question 20 years ago, the answer would likely have been different.  Would you believe me if I told you that it probably doesn’t matter based on a big new study from Stanford University?

The Best Low Carb vs. Low Fat Study

In this new study, Stanford researchers recruited 609 adults who were willing to eat either low carb or or low fat for a year based on the “flip of a coin.” A year later, the low-fat group lost about 13 pounds and the low-carb group also lost about 13 pounds.

When they looked at glucose and insulin metabolism, they also saw no meaningful difference. Where things really got interesting was when they looked at the genes of everyone in this study. Even if your genes predicted you would do better eating low fat or low carb, the study results showed that it just didn’t matter.

The 3 Success Factors to Losing Weight

Interestingly, when these Stanford researchers analyzed those who lost the most weight in the study, they found three factors.

1. Those losing the most weight avoided sugar.
2. Those losing the most weight avoided flour.
3. Those losing the most weigh ate a lot of vegetables.


Number one on this list, avoiding sugar, should come as a surprise to no one.  Almost everyone loses weight if they can give up the sugar addiction.

Likewise, number three, eating a lot of vegetables, is another no brainer.  If you fill up on vegetables you’ll lose weight and feel so much healthier.

Number two, avoiding flour, however may come as a surprise to many. The reason for this is that when a grain is pulverized to a dust-like form, the body absorbs it so fast that it raises blood glucose almost as much as eating straight sugar. Thus, to keep your metabolism in check, if you choose to eat grains only eat intact grains.

What does this study tell us?

Even though it may seem counter intuitive, this study fits nicely with what we know about diets and nutrition. The bottom line is that low carb or low fat can be healthy provided you avoid sugar, including flour, processed foods, and eat a ton of vegetables. Basically, you need to find what works for you and then stick with it.

#264 Does Atrial Fibrillation Make You Tired?

March 25th, 2018 by

Does atrial fibrillation make you tired?

No one wants to feel tired all the time.  Yet, that is what most people suffering from atrial fibrillation endure every day.  While the answer to the question, does atrial fibrillation make you tired is obviously yes, in this article I’ll explain why it makes you fatigued and how you can fix this problem.

Why does atrial fibrillation cause fatigue?

Having spent the last 30 years of my career caring for people with atrial fibrillation, the number one symptom I hear is fatigue.  Indeed, studies have confirmed that feeling tired is a hallmark symptom of atrial fibrillation.

As most of my patients with atrial fibrillation struggle with fatigue, here the top 5 reasons I have found as to why atrial fibrillation makes you so tired.

1. Losing 20-30% of Your Heart Function Can Make You Tired

When your heart is out of rhythm, the upper chambers of the heart are no longer pumping. Thus, you lose 20-30% of your overall cardiac function as the bottom two chambers are doing all of the work. And this 20 to 30% loss of cardiac performance is more than enough reason to make anyone feel tired.

2. A Rapidly Beating Heart Causes Fatigue

When most people go out of rhythm, their heart rate suddenly jumps up. Indeed, many people have a resting pulse of 100 beats per minute or faster when they are out of rhythm. With this fast of a heart rate, it is almost as if they are always running on a treadmill and their heart never gets a chance to rest.

3. An Irregular Pulse Makes You Tired

Another possibility is that the irregularity of your pulse with atrial fibrillation makes you tired. While there isn’t a lot of research in this area, we do know that there are many nerve endings in your heart tissue. It is possible that activation of the vagus nerve, which connects your heart and brain, causes you to feel tired when your heart is out of rhythm.

4. Atrial Fibrillation Medications Cause Fatigue

Most atrial fibrillation patients are on a lot of medications.  Putting all of these chemicals into your body can have side effects.  And if you don’t know what these side effects are then my guess is that you just haven’t discovered it yet.

To help illustrate this point, let me challenge you to read the package insert of any atrial fibrillation drug you have been prescribed.  I’ll bet that fatigue is somewhere on the list of possible side effects.

Why are atrial fibrillation drugs notorious for causing fatigue?  This is because these medicines often slow the heart and drop the blood pressure. Too slow of a heart rate or too low of a blood pressure can definitely cause fatigue.

If you can pin your fatigue down to one medication, then work with your doctor to see if this medication can be eliminated or changed.  However, if all of the atrial fibrillation drugs make you tired, then you will likely be looking at a catheter ablation procedure unless you can put your atrial fibrillation into remission with a 100% commitment to healthy living for the rest of your life.

5. Underlying Problems Are Making You Tired

Most cases of atrial fibrillation didn’t happen by chance.  There is usually an underlying problem that contributed to the wear and tear on the heart that ultimately caused the atrial fibrillation.

In my practice, at least 80% of atrial fibrillation cases can be at least partially traced back to being overweight, too much sugar or processed carbohydrates, not enough vegetables, a lack of physical activity, excessive stress, or sleep deprivation. Sadly, not only can these conditions cause atrial fibrillation but they can also make you very tired as well. Fortunately, correcting these underlying causes of atrial fibrillation may not only help you to reverse this condition but also energize you in the process.

Practical Tips

Atrial fibrillation causes most of my patients to feel tired.  Unless you can live with this atrial fibrillation fatigue for the rest of your life, then you need to proactively work with your cardiologist/electrophysiologist to make sure your heart never goes out of rhythm again.

The bottom line is that atrial fibrillation can make you very fatigued. While getting your heart back in rhythm helps tremendously with fatigue, to experience the full energy your body was designed to have will likely require you to treat the underlying causes of your atrial fibrillation. Besides a normal heart rhythm, nothing will cure your fatigue faster than getting back to a healthy weight, eating real foods, making physical activity a part of every day, embracing stress, and optimizing your sleep.

#262 Is Nattokinase the Safest Blood Thinner?

March 24th, 2018 by

Is Nattokinase the Safest Blood Thinner?

Most of my heart patients are scared to death of blood thinners.  No one wants a blood clot, but yet no one wants to bleed to death either. Nattokinase may just be the safest blood thinner you have never heard of.  In this article, I’ll teach you everything you need to know about this natural blood thinner.

Why I Eat Natto for Breakfast

Since my health turn around nearly seven years ago, natto has been a part of my daily breakfast.  This is a practice I described in our best selling book, The Longevity Plan.  And if you haven’t read it yet, pick up your copy now to find out why this best selling book has consistently maintained a 4.9-star rating on Amazon!

When I first tried natto, I’ll admit I was grossed out.  Even though it smells like a dead rat what bothers me the most is how slimy and sticky it is.

The reason why it is sticky and slimy is that it is a probiotic.  In other words, the helpful bacteria from this probiotic make it slimy and sticky.

While the Japanese eat it every morning over rice with mustard, soy sauce, or other flavorings, I just eat it plain. I scoop up a big tablespoon of the stuff and quickly swallow it down.

It doesn’t taste good but knowing how good it is for me makes it tolerable.  Of note, my wife and two-year-old son also eat natto with me.  My older three children won’t go near the stuff.

One Reason Why the Japanese Rarely Get Heart Disease

For decades researchers have tried to figure out why the Japanese rarely get heart disease and why they live so long.  Despite high rates of smoking among men, the Japanese are somehow still protected.

One possible explanation may be natto.  Natto, or fermented soybeans, is their equivalent for cereal in the morning.  Natto contains nattokinase, a natural blood thinner, and is also off the charts in vitamin K2. For those not familiar with vitamin K2, vitamin K2 helps to keep calcium out of your arteries and into your bones where it belongs.

Indeed, studies show that Japanese eating the most natto have the lowest rates of heart disease and strokes.  They also live the longest.  Interestingly, some studies show that it is only fermented soy that offers any of these benefits.

What is nattokinase?

Nattokinase is a food enzyme found in natto.  Natto,  in turn, is made from fermenting soybeans with the helpful bacteria called Bacillus natto.  Thus, to get nattokinase, you can either get it naturally from eating natto or in a supplement extract form called nattokinase.

Natto vs. Nattokinase: Which is Best?

In choosing between eating natto or taking a nattokinase supplement, I have always gone with natto.  The reason for this is really quite simple.  Natto is so much better for you than taking a nattokinase supplement.  To visualize what natto is doing for you just think of natto as nattokinase plus vitamin K2 in a probiotic form.

When you take a nattokinase supplement, you don’t get the probiotics and you don’t get vitamin K2 either.  And when it comes to vitamin K2, no other food on this planet comes anywhere close to natto.  As I described in a previous article, vitamin K2 may be one of the best ways to protect your heart and bones from the aging process.

I also worry about the purity of any supplement.  With supplements, you really never know what you are getting.  As supplements are totally unregulated, the blood thinning effects you get from bottle to bottle may not be the same.

My philosophy on supplements is that a supplement should be a supplement.  In other words, you should only consider a supplement when you can’t get it naturally from food.  Given that natto can be easily purchased at your local Asian grocery store, or shipped over ice from an online source, most people should have no problem obtaining natto.

How does nattokinase thin the blood?

Whether you get nattokinase from eating natto or from taking a supplement, nattokinase thins your blood many different ways.  For example, one study showed that nattokinase decreases plasma levels of fibrinogen, factor VII, and factor VIII.  For those of you not familiar with fibrinogen, factor VII, or factor VIII, let me explain.

Fibrinogen is a protein that causes blood to clot.  Naturally, if you decrease fibrinogen levels, your blood will be much less likely to clot.

Factors VII and VIII are also blood clotting proteins.  Once again, if plasma levels of factors VII and VIII are reduced, clotting is less likely to occur.

In addition to fibrinogen and factors VII and VIII, another study showed that nattokinase also works on platelets.  Platelets can clump together in your blood which can be the start of a blood clot.  Two common anti-platelet drugs are aspirin and Plavix (clopidogrel).

Will nattokinase make you live longer?

As the Japanese are the longest-lived people on this planet, could it be the natto?  To find out, researchers gave nattokinase to worms in a study.   If you are a worm, nattokinase will help you live an extra six days.  This extra six days translates into a 16% longer life expectancy.

For humans, we really don’t know if nattokinase increases longevity or not.  Until a nattokinase longevity study is done, the best data we have are from the natto eating Japanese population.

Does nattokinase cause bleeding?

Fortunately, studies show that when it comes to bleeding, natto and nattokinase are very safe.  Indeed, of the studies I reviewed in writing this article, I could find no significant bleeding risk from natto or nattokinase.

I should point out that theoretically nattokinase probably has a higher bleeding risk than natto.  This is because natto contains both nattokinase and vitamin K2.  Vitamin K2 has an anti-bleeding effect.

Thus, the vitamin K2 and nattokinase in natto likely cancel each other out when it comes to the risk of bleeding.  Because I want to keep my body in a state of “natural balance,” this is another reason why I prefer natto over the nattokinase supplement.

However, for those of you already on a blood thinner, nattokinase could increase your bleeding risk.  Thus, if you have had a problem with bleeding in the past, or are currently taking a blood thinner, do not eat natto or take a nattokinase supplement without talking to your doctor first.

Does nattokinase help with inflammation?

When it comes to staying young and healthy, you want to keep inflammation levels as low as possible. One additional way to do this may be with nattokinase. While there aren’t a lot of studies on nattokinase and inflammation levels, of the studies that do exist nattokinase may function as a natural anti-inflammatory agent.

Nattokinase Prevents Blood Clots When Flying

I’m guessing that you have probably heard that sitting too long in the car, or on an airplane, may cause blood clots.  And it is for this reason that most doctors recommend that you frequently get up and walk around when traveling.

As long airplane flights are known to cause blood clots, scientists wanted to see if nattokinase could prevent clots from forming in a study of 300 people scheduled for a long flight.  Based on ultrasound imaging after their long airplane flight, none of the people taking nattokinase suffered a blood clot.  In contrast, five people not taking nattokinase developed a blood clot.

Nattokinase vs. Aspirin: Which is Best?

As we have covered in this article, nattokinase and aspirin both help to prevent platelets from clumping together.  In fact, it is platelets clumping together that causes many heart attacks and blood clots.

In one study, researchers wanted to find out how nattokinase and aspirin compared.  To sort this out, they gave various doses and measured the effect in rabbits.

What they found is that it took mega doses of nattokinase (500 mg of nattokinase for every kilogram of body weight) to have the same effect as 30 mg of aspirin.  For reference, a “baby aspirin” has just 81 mg of aspirin.

Thus, if it takes megadoses of nattokinase to have the same blood thinning effect as less than a half of a baby aspirin, this probably explains why I couldn’t find any significant reports from nattokinase in the studies I reviewed.

Does nattokinase work for atrial fibrillation?

Atrial fibrillation is the most common heart rhythm abnormality.  Indeed, one in four adults will experience atrial fibrillation at some point during their lives.

Of all the bad things that atrial fibrillation can cause, strokes have to be at the top of the list.  It is for this reason that most people with atrial fibrillation take a blood thinner.

The problem with atrial fibrillation strokes is that it takes a powerful blood thinner to prevent them.  This is why aspirin is largely ineffective against atrial fibrillation strokes.  And, as we have discussed, it takes a megadose of nattokinase even to be comparable to less than half of a baby aspirin.

While most of my atrial fibrillation patients would love to take nattokinase rather than their blood thinner, there are no studies showing that nattokinase works for atrial fibrillation.  Anecdotally, I have seen a stroke in one of my atrial fibrillation patients who faithfully took her nattokinase.  Even though I recommended a stronger prescription blood thinner in this patient, she was confident that nattokinase would protect her. Since her stroke, she now reluctantly takes a proven atrial fibrillation blood thinner.

Does nattokinase prevent heart attacks?

As heart disease remains the number one killer in the Western world, anything that could decrease this risk would be highly welcomed.  While nattokinase will never prevent every case of heart disease, some interesting research in rabbits shows that nattokinase can help to repair damaged arteries.  As with all of the other animal studies I have covered in this article, it is never clear whether the findings in animals will eventually translate to humans.

Does nattokinase treat high blood pressure?

If you live in America, studies show that you have a 90% chance of getting high blood pressure by age 55.  High blood pressure is a major medical problem as it leads to heart attacks, strokes, kidney failure, blindness, and dementia.

In a study of 79 North Americans, half were given a placebo and the other half 100 mg of nattokinase daily for eight weeks.  By the end of the eight weeks, nattokinase lowered the systolic blood pressure by four points and the diastolic blood pressure by three points.  Surprisingly, this blood pressure reduction from nattokinase seemed to be better for men.

While a four-point reduction in the systolic blood pressure and a three-point lowering of the diastolic blood pressure may not seem like much, this is the equivalence of about a half dose of your typical blood pressure medication.

Does nattokinase treat high cholesterol?

As with high blood pressure, most Americans also have high cholesterol.  One study from China found that nattokinase seemed to work just as well as a statin for cholesterol lowering.

However, before you throw out your statin drug for nattokinase, please note that there were only 82 people in this study.  Also, I could only find one study specifically looking at the effects of nattokinase on cholesterol.  Thus, we really don’t have adequate proof yet that nattokinase lowers cholesterol.

Where do you buy natto?

Every time I mention natto in a blog article or on my podcast, I get a flood of emails asking me where I buy natto.  Thus, to stop my email inbox from filling up, I thought I would answer the question here.

I now buy my natto from a local Asian grocery store.  Most Asian grocery stores carry fresh natto.  If not, they can order some for you.

In the past, I purchased natto online from a company out of California.  This online natto was shipped over ice.  The reason why I now buy it from a local Asian grocery store is that by the time online natto arrived at my house the ice was always melted and they charge more than my local Asian grocery store.

If there are no Asian grocery stores near your home, here is the link if you want to try this company.  Please note that I have no relationship whatsoever with this company.

Final Points

Based on the research available, nattokinase probably is the safest blood thinner.  Side effects seem to be minimal and the wide range of positive effects most impressive.

However, nattokinase is a relatively weak blood thinner.  Thus, nattokinase isn’t strong enough for atrial fibrillation stroke prevention.

In choosing how to obtain nattokinase, my preference is to get it naturally from food (natto) rather than from a pill.  Letting food be your medicine always seems to work better than tablets or capsules.  It is for this reason that I will continue to gulp down a heaping spoonful of natto for breakfast.

It goes without mention that you shouldn’t stop your current blood thinner based on what you have read in this article.  Also, if you have a history of bleeding, or currently take a blood thinner, don’t even think about taking nattokinase from any source without speaking to your doctor first.  Blood clots and bleeding may cause serious disability or even death.  Always speak with your doctor first before ever considering a natural blood thinner.

#261 Does Atrial Fibrillation Get Worse Over Time?

March 18th, 2018 by

Does Atrial Fibrillation Get Worse Over Time?

With the diagnosis of atrial fibrillation, most people want to know does atrial fibrillation get worse over time? While atrial fibrillation is a progressive condition in most people, it doesn’t have to be this way.  In this article, I’ll teach you what you need to do to stop the disease progression and hopefully make your atrial fibrillation go away.

Carrie’s Atrial Fibrillation

Like 99% of my patients, Carrie wanted to know, does atrial fibrillation get worse over time?

“That depends,” I said.

“Depends on what?” Carrie asked.

“It depends on whether you can stop the heart from scarring further or not. If you can stop the scarring, then you can prevent atrial fibrillation from getting worse. The key is to identify what caused your heart to scar up and disrupt electrical pathways in the first place. If you can identify the cause and correct it, then your heart will have a chance to heal. Otherwise, atrial fibrillation gets worse over time,” I said.

I then went on to share with Carrie what I am going to share with you now…

Premature Heart Aging, Heart Scarring, and Atrial Fibrillation

For most people, atrial fibrillation represents premature aging of your heart. The thousands of little health decisions you make every day determine whether your heart ages fast or slow.

With each episode of atrial fibrillation, more scarring is possibly happening to your heart. This is because heart scarring, or fibrosis, can occur with each atrial fibrillation attack.

Also, other medical conditions such as high blood pressure, sleep apnea, obesity, diabetes, anxiety, etc. may also cause heart scarring.  The key is to stop the scarring if you don’t want atrial fibrillation to get worse over time.

In my experience, if patients can lose the necessary weight to get back to a normal weight, keep their blood pressure in the normal range, eat right, exercise daily, optimize sleep and stress levels then not only does atrial fibrillation not progress but it also may go away on its own

Is there an atrial fibrillation tipping point?

As more heart scarring occurs, you will likely have more frequent and more prolonged episodes of atrial fibrillation. Eventually, the heart may be out of rhythm all of the time.

This phenomenon is what my colleague, Dr. Jared Bunch, and I described as the “Atrial Fibrillation Tipping Point” in an article we recently published in a prominent heart rhythm medical journal. Basically, this AFib tipping point means that once enough scar tissue is laid down within the heart, the heart will no longer hold rhythm on its own.

Can You Reverse Atrial Fibrillation?

Yes, you can absolutely reverse atrial fibrillation!  I have seen this countless times in my cardiology practice.

The key is to stop the progressive scarring through healthy living and then reduce the strain on the heart so that future episodes don’t occur.  For a primer on how to do this, please read this article I wrote called, How to Get Rid of Atrial Fibrillation Once and For All.

Carrie’s Outcome

Carrie was motivated.  Her diagnosis of atrial fibrillation was a wake-up call.

She always knew she needed to get rid of the sugar and processed foods.  She also knew that she needed to exercise every day, get more sleep at night, and stress less.  However, with the stress of a full-time job and teenage kids at home, there never seemed to be enough time for self-care.

Atrial fibrillation was a game changer.  It forced her to confront her own mortality.  She had to be there for her kids.  It was her body’s way of telling her that she was aging way too fast.

With the fear of another atrial fibrillation attack, Carrie never missed a day.  Eating real food, daily exercise, and optimizing sleep and stress levels was a top priority for her.

She also lost weight, a lot of weight, without even dieting.  A year later her weight was down 40 pounds and the atrial fibrillation gone.  After several years without an attack, I have now moved her visits to the atrial fibrillation clinic to an “as needed” basis.

To ensure that her bad habits never come back, Carrie keeps her emergency room EKG of her heart in atrial fibrillation taped to her refrigerator.  This daily reminder is all she needs to stay strong.

Carrie is living proof that atrial fibrillation doesn’t have to be a progressive condition.  Despite what your doctor may tell you, atrial fibrillation doesn’t have to get worse over time.  Her experience also highlights that if your incentive for behavior change is strong enough, then anything is possible.

Practical Tips

To prevent the atrial fibrillation tipping point from happening, the most important thing you can do is to live the healthiest life possible. You have to stop the scarring today if you want to stop or even reverse the progression of atrial fibrillation going forward. Resolve today to slow the aging process of your heart.