#327 Does Stress Cause Atrial Fibrillation?

January 8th, 2022 by

Does Stress Cause Atrial Fibrillation?

How dangerous is stress for people suffering from atrial fibrillation? Will keeping stress levels in check help with your AFib? In this article, I’ll do my best to answer the question, does stress cause atrial fibrillation.

Evangelina’s Experience with Stress and AFib

Evangelina was 57 years old when she was diagnosed with atrial fibrillation. It had been two years since her husband passed away suddenly of a heart attack and, while she missed him desperately, life was finally starting to feel as though it was getting to a state of normalcy again. At the time, Evangelina had been working for nearly 20 years as a manager at a grocery store that had recently been taken over by a new corporate owner. With one child in college and another about to start, she was hopeful the new owner might be able to give her a raise—but that didn’t happen.

Evangelina began driving for Uber at nights and on the weekends to make some extra money. “I actually enjoyed getting to meet so many new people all the time,” she said, “but the traffic gets worse every day, and there is construction everywhere, and even though people are very nice, they’re also very concerned about getting where they need to be as fast as possible.”

Meanwhile, her youngest child had just started middle school and, like many children in that part of life, he was having a rough time navigating the complexities of social groups and avoiding bullies. His anxiety about school got so bad that, for a few weeks, he refused to go at all, and it took an all-hands-on-deck meeting involving Evangelina, the school counselor, the principal, and a private therapist to create the conditions that made the boy feel comfortable going back to school again. And as if all of that wasn’t enough, Evangelina had recently been told by her regular doctor that she was prediabetic and had hypertension.

“I guess it goes without saying that things were really stressful for me at that time,” Evangelina said. When Evangelina experienced her first episode of AFib, she panicked, thinking she was having a heart attack, just like her husband. Her thoughts immediately turned to her three children. When she learned at the hospital that what she actually had experienced was an arrhythmia, it came as a relief, at least at first. “Pretty soon, though, AFib just felt like one more stress in my life,” she said. But this wasn’t just another stressor. It was a stressor that was likely caused, at least in part, by the other stressors in her life—a real “double whammy.”

Are women more likely to have stress trigger an AFib attack?

Psychological stress has long been thought to be a possible trigger of atrial fibrillation and the association appears to be especially strong among women. But men aren’t immune. Neither are cardiologists—who it can be said to have one of the most stressful jobs in the world. That’s what Dr. Damien Legallois learned when he was just 28 years old.

Dr. Legallois’ Experience with Stress and AFib

“I was on call when a cardiac arrest call came from our cardiac intensive care unit, pulling me from my sleep,” he wrote of his experience in a letter to the International Journal of Cardiology. “It was a false alert and I went back to bed when I noticed some palpitations. My pulse was rapid and seemed irregular.” An electrocardiogram of Legallois’ heart showed atrial fibrillation with a ventricular rate of more than 180 beats per minute. And Legallois isn’t alone.

We have treated countless doctors over the years with AFib as well as innumerable CEOs, lawyers, accountants, politicians, athletes, celebrities and others who have come to see us for atrial fibrillation treatment due in large part to the enormous stresses they are under. If a stressful incident can push a young cardiologist with no history of heart problems—or any major medical issues for that matter—into atrial fibrillation, imagine what it can do to someone like Evangelina, who was already facing some health challenges and many other life stressors.

What do studies say about stress and AFib?

What kinds of challenges can create stress that triggers AFib?

1. A research group in Denmark concluded that the severely stressful experience of losing a partner increased the risk of atrial fibrillation for an entire year.

2. Another international group of researchers found that divorced men had a higher incidence of death associated with atrial fibrillation. And a group from Sweden revealed a potential dose-response relationship between work-related stress, like getting fired from a job, and atrial fibrillation. In fact, the Swedish researchers found, just the experience of having a job with high psychological demands and with little control over your work situation could increase your AFib risk by 50 percent.

3. When Yale University researcher and electrophysiologist Dr. Rachel Lampert correlated the way her patients were feeling emotionally to see if she could predict whether or not they would go into AFib that day, the results were absolutely startling. In a study published in the Journal of the American College of Cardiology in 2014, she noted that feelings of sadness, anger, stress, impatience, and anxiety increase the risk of an AFib attack up to 500 percent in the same day. Happiness, meanwhile, appears to be protective. If you are feeling happy you are 85 percent less likely to have your heart go out of rhythm today, according to Lampert’s research.

Physical Stress also Triggers AFib

But emotional stress isn’t the only thing that can send your body into a state of chaos. Researchers have connected AFib episodes to physical stressors caused by events like surgery, bad infections, and car crashes. In the case of irregular, singular events like those, there is a chance that after the stressor has passed, the AFib will go away. More likely, though, this is a harbinger of things to come. Our hearts are remarkably resilient, but if an incident of great stress pushed you into AFib, something else has likely been pushing you toward that precipice a long time before that incident occurred.

How I Manage Wintertime Stress

We all need a way to decompress from stress, especially those suffering from AFib. And this photo shows my favorite way to keep stress levels down. Every weekend in the winter our family goes skiing. No matter how stressful the workweek gets, I know there is always a mountain waiting for me just 30 minutes from our house in Salt Lake City, Utah.

I took this photo is from the 9990 chairlift at the Park City Mountain Resort this past week. The skiing has been amazing this year with recent snow levels well above average. If you’re planning a trip to Utah this year, and you suffer from AFib, come see me at St. Mark’s Hospital! Call my team at 801-266-3418 when you schedule your trip!

#326 How To Lose 100 Pounds

January 1st, 2022 by

How to lose 100 pounds

Have you ever wondered what happens to the “biggest losers” on reality TV shows? When the cameras stop rolling, do their incredible transformations stick? Not usually.

Researchers have found, in fact, that these contestants’ crash diets send their metabolism into a tailspin, making long-term weight maintenance nearly impossible. In most cases, the weight comes right back and, even six years later, their metabolism is slower than it was before they started filming.

This is what scientists call “metabolic adaptation” and is something you definitely want to avoid. That’s why, no matter how much weight you have to lose, and especially if it’s a lot, you need to take drastic actions that won’t crash your metabolism but will result in long-term sustainable loss, even if that loss amounts to just one pound a month.

In my case, I had 30 pounds to lose to get down to a healthy weight. Ten years later, I have still maintained this weight loss but it hasn’t been without effort. Every day, without ever a miss, I faithfully follow the 4-steps below.

You can do this as well by taking four big-but-doable actions—steps that will re-engineer your environment to make it far more conducive to weight loss. So, here is how to lose 100 pounds in 4-simple steps.

1. Eliminate All Temptations

First, you need to clean the cupboards and the refrigerator. Throw out the sugar and anything with added sugar. Then throw out the flour and anything made with flour. Finally, throw out anything that is processed—that’s basically anything in a can, box or bag that doesn’t still look like the ingredients from which it came. If it’s made by a company, rather than grown by a farmer, it needs to go—even if it “seems” healthy.

Like the famed organizing consultant Marie Kondo going through a cluttered home, you need to go through your kitchen with ruthlessness. As Kondo does to sentimental items, you may choose to thank those foods for their service or, if it pleases you, curse them instead. Either way, these foods need to be gone from your home. Once that is done, it’s off to the store to shop for veggies, fruits, intact whole grains and legumes, nuts and seeds. Your cupboards and refrigerator should now look like a miniature farmer’s market, stocked not with cans, boxes and frozen meals, but with single ingredients that can be eaten separately or mixed together for meals.

Maintaining a healthy weight loss is effortless if you can eliminate all temptations. But, depending on your family situation, this may not be possible. As I have 3 teenagers and a 5-year old, junk food always seems to enter our house. While I encourage the children to keep their junk food out of my sight, this rarely happens. Thus, maintaining my 30-pound weight loss becomes much more challenging as I have to battle temptations daily and rely heavily on steps 2 through 4 below.

The important thing here is to take action and eliminate temptations. In the process of eliminating temptations, you are banking willpower. You are creating a system in which you don’t have to go to war with yourself in your own home. Now, junk food binge eating is a lot harder. To do that, you’d have to leave your home—giving you precious time to let cooler heads prevail.

2. Eat As Many Non-Starchy Vegetables As You Can

Second, now that your kitchen is stocked with healthy foods, it’s time to eat. You can eat as many non-starchy vegetables as you want, as much as you possibly can. It’s almost impossible to eat too many vegetables. Whenever a vegetable runs out, replace it as soon as you can; in your home, eating something healthy should always be easier than eating something unhealthy.

Personally, I shoot for at least 10 servings of vegetables daily. And every day I fill up on at least one massive salad, one massive serving of broccoli, and one massive serving of cauliflower to go along with my other food choices for the day. If I can pack my stomach full of vegetables then it helps me from getting hungry and making poor food choices.

3. Track Your Food and Weight Daily

Third, you need to start tracking your food and weight and face some consequences for bad decisions. There are more things you’ll need to learn to track in the future—but these two things are vitally important. If you aren’t keeping track, you won’t make progress.

Since losing 30 pounds 10 years ago, on three separate occasions I thought I was strong enough to stop recording every bite of food I take every day. And on each of these three occasions, I quickly gained 10+ pounds within a month.

I learned the hard way that no tracking means no awareness. And this is why it’s also important to be accountable to someone, like a trainer or an accountability partner, or something, like an app. In my case, I use the free version of the Lose It app on my iPhone to record every late bite of food I take.

Tracking, or accountability to someone or something, is the “face the consequences” part of this program. For me, I’ll do almost anything to prevent a daily “bad score” on my Lose It app. For others, you may not want to let down your trainer or accountability partner.

There’s no reason for self-flagellation, but putting something on the line can offer a huge boost in willpower. An AFib patient named Heather, for instance, gave her trainer a crisp Benjamin Franklin and instructions to donate it to the election campaign of a politician she abhorred if she failed to make her goals twice in a row. One year down the road, the trainer put the $100 in a card and told Heather to buy herself something nice.

4. Exercise 1 Hour Every Day

Fourth, exercise. An hour a day. And this recommendation for an hour a day is based on research from the National Weight Control Registry. An hour of daily exercise helps to keep your metabolism running at a high level.

It seems that when I encourage my patients to work toward an hour daily of exercise, I usually get at least three excuses as to why they can’t exercise. Everyone can do something. Even my patients who are wheelchair-bound can still do daily arm exercises.

Remember, this is the step that helps you keep weight off. You cannot expect to see changes to your weight from exercise if you’re not also making changes to your diet. And yes, an hour each day is a big commitment—one that can be especially difficult for people who are taking drugs that sap them of their strength or for whom exercise is an AFib trigger. But it’s also a commitment that will help save your life. And it is for this reason that I never miss a daily workout.

If you already have a heart condition and would like to see one of the great cardiologists I work with every day, please call my team at 801-266-3418. My personal practice is 100% limited to patients suffering from documented arrhythmias. Sadly, telemedicine visits outside of the state of Utah are no longer possible due to government regulations following COVID. Also, if you liked the photo attached to this article, it is a painting my son created.

#325 Blood Thinners versus Watchman for Atrial Fibrillation: Which is Best?

December 27th, 2021 by

Blood Thinners versus Watchman for Atrial Fibrillation: Which is Best?

No one wants an stroke and most of my AFib patients at higher risk for stroke don’t want to take a blood thinner for life. Fortunately, AFib patients at low-risk for stroke don’t require blood thinners. But for those who have to take a blood thinner, are there any alternatives? In this article we’ll discuss AFib strokes, the role of the left atrial appendage, and whether blood thinners or Watchman is best for AFib.

What Causes Atrial Fibrillation Strokes?

Strokes are common in AFib patients because the complete electrical chaos in the atria leads to loss of pumping. The result is stagnant blood flow, and stagnant blood clots easily, especially in the left atrial appendage. The left atrial appendage is a dead end pouch in the left atrium where clots form when atrial fibrillation causes the upper chambers not to pump.

When these clots break off from the left atrial appendage and enter the bloodstream, they are like missiles that can go anywhere in the body and do incredible damage. Clots that go to your gut, kidneys, or leg can all leave a trail of destruction. But when clots go to the brain, resulting in a stroke, the effect is immediate, devastating, and often deadly.

What Happens During a Stroke?

During a stroke, the brain is starved of oxygen and nutrients, a situation that almost immediately begins to kill brain cells. You’ll also recall from previous posts that AFib is usually associated with high blood pressure. That’s a double disaster, since years of high blood pressure can damage the arteries in the brain long before the atrial fibrillation clot ever arrives. For all of these reasons, atrial fibrillation has been associated with a five-fold increase in the risk of stroke.

Those risks aren’t uniform, of course. They increase with age, and also with other complicating medical conditions. But even among AFib patients who are young and relatively healthy in other ways, no one with AFib is safe from stroke. Strokes in patients with atrial fibrillation that do not kill often result in greater disability compared to strokes caused from other reasons. Even “small” strokes over time can impair cognition and greatly increase the risk of dementia.

Why Are Blood Thinners Used for Atrial Fibrillation?

Because atrial fibrillation increases stroke risk, doctors are often keen to prescribe an anticoagulant. These medications, also called blood thinners, help prevent clots from forming inside your heart. And the less likely you are to form a blood clot in your left atrial appendage, which can happen when the upper chambers of the heart stop beating during AFib, the less likely it is that a clot will break off, cutting of the blood supply—and thus the oxygen—to the brain or other organs or structures.

Left Atrial Appendage Closure (Watchman or Amulet devices)

One way to get off blood thinners is having your left atrial appendage closed or removed. The two most popular non-surgical ways to close off the left atrial appendage are with the Watchman device from Boston Scientific or the Amulet device from Abbott Laboratories. Implanting either of these devices in the heart is a relatively simple outpatient procedure through an IV in a leg vein.

Intuitively, it seems this should be an enormously effective solution. After all, approximately 90 percent of all AFib strokes arise from blood clots forming in the left atrial appendage, a small sac in the muscle wall of the left atrium. Many doctors believe closing off this part of the heart, through the insertion of a closure device that plugs the sac’s opening, can keep clots from coming loose and heading toward the brain, where they can get stuck and cause a stroke.

4 Challenges with Left Atrial Appendage Closure (Watchman or Amulet)

But what seems intuitive and what happens in real life can, in some patients, be two different things. Studies show that a left atrial appendage closure device, along with a daily aspirin, offers a survival rate equivalent to blood thinners. However, with these left atrial appendage closure devices, like the Watchman or Amulet, there are some important things to consider.

1. You have a 1 in 50 of developing a blood clot on the device

This is intuitive, too, because any time you stick a foreign object into the circulatory system, the body wants to form a clot, so you may be trading one potential cause of stroke for another. And if you are that 1 in 50 then you may never get off blood thinners.

2. Your cardiologist may increase your stroke risk with a left atrial appendage leak

There is also a small chance that your cardiologist will leave you with a left atrial appendage leak after implanting the Watchman or Amulet devices which means blood can still get in and out of your appendage. This is not a good thing—a leak can dramatically increase your stroke risk even higher than it is right now.

3. Left atrial appendage closure does nothing for AFib

Closing off the left atrial appendage does nothing for your AFib. While it offers stroke protection, you will still have AFib and you will still be at an increased risk of premature death, dementia, and heart failure.

This is an important consideration as our studies have shown that with a successful ablation procedure your long-term stroke risk, as well as your risk of death or dementia, is no different than someone who has never had atrial fibrillation. In other words, based on our experience, a successful ablation could eliminate not only your AFib but all of the other increased risks with AFib as well.

4. Aspirin may be just as risky as a blood thinner

After you get through the healing process of left atrial appendage closure, your cardiologist will still keep you on aspirin daily. While aspirin may seem much safer than a “blood thinner,” studies show that there is no statistical difference in the bleeding risk of aspirin versus the safest blood thinner, Eliquis (apixaban).

Despite the Risks Patients Love the Watchman Procedure

Despite the 4 significant challenges with left atrial appendage closure with either the Watchman or Amulet devices, patients still love this procedure. Blood thinners frighten patients and many patients will do anything to get off these medications.

In my experience of caring for Watchman patients over the years, I have only had one patient who ever regretted having the procedure. And this regret only came after she developed a clot on the Watchman device which later broke free and shut off blood flow to her foot. Fortunately, a very talented vascular surgeon was able to remove the clot in time to save her foot. However, this event made it such that she can never come off her blood thinner.

If you want to learn more about atrial fibrillation, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418. Sorry, telemedicine visits outside of the state of Utah are no longer possible.

Also, if you liked the photo attached to this article, it was one of my mountain running trails until the deep snow came a month ago.

#324 How to Exercise without Getting Atrial Fibrillation (Podcast)

December 26th, 2021 by

Dear readers,

Recently I went on the Wise Athletes Podcast to discuss how to exercise without getting AFib. We covered all topics related to exercise, AFib, and why athletes seem to be particularly at risk for AFib. If you love to exercise as much as I do this is definitely a podcast you won’t want to miss!

Thanks for listening!


Wise Athletes Podcast episode website

#323 The 12 Best Ways to Fix Atrial Fibrillation with Sleep

December 11th, 2021 by

The 12 Best Ways to Fix Atrial Fibrillation with Sleep

Whenever people try to get healthier, and no matter what the underlying reason for that effort, they almost always start with diet and exercise. Those are two very important factors, but without addressing a third factor—sleep—they are almost assuredly doomed to fail in their efforts to eat better and exercise more. In this article, I’m going to give you my 11 best ways to fix atrial fibrillation with sleep.

Most of Us Are Really Bad at Sleep

Let’s face it, most of us are really bad at sleeping. And as a global community, it would appear, we’re actually getting worse at it, even as the science that demonstrates its importance to our lives has gotten more and more compelling. The World Health Organization has raised the possibility that sleep problems are an emerging global epidemic. In the United States, 70 percent of adults report insufficient sleep at least once a month, and 11 percent report insufficient sleep every night.

For a while, it did seem like we were getting the message about the importance of sleep to our health. After a century of consistently diminishing sleep, researchers who study the way we slumber noticed something promising. From 2004 to 2012, the number of people who were getting less than six hours of sleep each night finally started to level out.

Maybe, some thought, we were finally getting the message. Or maybe, others argued, we’d simple hit rock bottom. Either way, it seemed, we could finally start working to move the needle in the other direction. But when demographic sociologist Connor Sheehan and his collaborators dove into the subject in the late 2010s, they were dismayed by what they found. Yes, there had been a leveling out starting in 2004, but between 2013 and 2017 there was a significant shift. Far more people were reporting far less sleep. We hadn’t hit rock bottom after all.

What changed? Among the most important factors are the devices we increasingly carry in our pockets, purses, and person. Closely coinciding with the quickly falling rate of adequate sleep was the rapidly rising rate of smartphone ownership, which went from 35 percent in 2011 to 77 percent in 2016.

“Americans now spend more time looking at a screen,” Sheenan and his collaborators wrote, “and, due to the mobile nature of these devices, technology has increasingly entered the bedroom.” This isn’t just happening in the United States. More than 5 billion people around the world now have mobile devices, and more than half of those devices are a smartphone. Leading the way in the adoption of tiny, glowing screens is South Korea, where 95 percent of adults have a smartphone and where, perhaps not coincidentally, adults get nearly 40 minutes less sleep each night, on average, than their global counterparts.

Because smartphones may be a cause of poor sleep, and also because these devices are increasingly equipped to detect the health consequences that result from poor sleep, it should come as no surprise atrial fibrillation diagnoses have skyrocketed in Korea in recent years.

Why is Sleep so Critical for Atrial Fibrillation?

The impact of poor sleep on AFib has been well documented. Even small interruptions of sleep quality and duration can increase the risk of atrial fibrillation by 18 percent, and people who experience insomnia are 30 to 40 percent more likely to develop atrial fibrillation. People who do not reach deep levels of sleep—the sort of sleep that is key to recovery—have an 18 percent increased risk of atrial fibrillation, and it worsens each time they wake up at night.

It’s even worse for people with sleep disorders such as sleep apnea; they have a 200 to 400 percent increased risk of AFib over individuals without a sleep breathing disorder. And the problem is compounded once AFib actually develops; the presence of an abnormal rhythm can increase the risk of poor sleep quality, or short sleep, by three to four times. It’s a vicious cycle.

That makes complete sense. In addition to the miserable experience of simply not feeling well-rested, sleep deprivation causes the release of excess cortisol and adrenaline. The former hormone causes you to retain water, lose potassium, have a high blood sugar, and have a higher blood pressure. The latter also increases your blood pressure, forcing your heart to work harder. In fact, when we want to trigger an atrial fibrillation episode during procedures intended to identify the trouble spots within a patient’s heart, we give our patients a form of intravenous adrenalin.

The 12 Best Ways to Fix Atrial Fibrillation with Sleep

Now that we know why sleep is so critical to maintaining normal sinus rhythm, below are my 11 best ways to fix atrial fibrillation with sleep.

1. Go to Bed at the Same Time Every Night

Studies show that just one night of bad sleep can increase your risk of an AFib attack the next day by more than three-fold! And the best way to get the sleep your heart needs is to actually put it on your calendar. Then, just like you do everything you can to avoid being late to work, you should do everything you can to avoid being late to bed.

This is a simple and powerful step: Studies show that the mere act of setting a bedtime, and sticking to it, results in an entire additional hour of sleep each night. And remember, seven hours is the target for actual sleep—not for time in bed. If it takes you 30 minutes to fall asleep and you typically have a middle-of-the night awakening to use the bathroom, get a drink of water, check the locks on the doors, or whatever, then you should probably schedule at least eight hours.

For me, I have a strict bedtime of 10 pm. And for most people suffering from AFib, studies now show that a 10 pm bedtime (or at least before 11 pm) is best to prevent AFib and other heart problems.

2. Wake Up at the Same Time Every Morning

At the same time you schedule going to bed in your calendar, you also should schedule the time you’ll get up in the morning—and rise no later than that time. This can be a tall order in a world in which more people than ever before are working remotely, with flexible hours and start-of-the-day times that are all-too-often aspirational rather than required.

That can make it seem like hitting the snooze button is a harmless choice. But, contrary to popular belief, getting a few extra minutes of sleep in this way doesn’t actually result in restorative sleep. In fact, waking, dozing off again, and abruptly waking again can result in sleep inertia—a period of up to four hours of lowered functionality.

This doesn’t mean that you should stay in bed if you have woken up and feel rested. If you wake up and are ready to go, there’s no reason not to greet the day. Conversely, if you need an alarm clock to wake up in the morning then you likely didn’t get enough sleep the night before. Our bodies are designed to wake once we’ve gotten the amount of sleep we need. So once you’ve figured out how much sleep your body truly needs, you can set your bedtime accordingly.

Alarm clocks should be like insurance policies; they are there to put our minds at ease just in case we oversleep but best when they are never really needed. Our bodies function best when we are able to wake up naturally, and that is most likely to happen when we schedule our bedtime and steadfastly adhere to that schedule.

In my experience, people can train their bodies when to fall asleep and when to rise. If your body learns, for example, that you go to bed every night at 10 pm and arise by 5 or 6 am then sleep can become effortless.

3. Create the Perfect Sleeping Room

Scheduling a bedtime is important, but once you get to bed, everything needs to be in order so that you can do what you’re supposed to be doing there. This includes maintaining a clean, quiet and cool room with plenty of fresh air. If little sounds awake you, consider some background “white noise” for better sleep.

It also means remembering the most important purpose for your bed: Sleep. Everything else can be done somewhere else, and most things should be done somewhere else.

To be very clear on this point: Our beds are not the right place for eating. They’re not the right place for working. And they’re absolutely not the right place for “screen time” of any sort.

4. Bright Natural Light in the Mornings and Dim Lights in the Evenings

Just as bright lights in the morning, especially bright natural light, is perfect to energize your day, keeping things dim in the evening can prepare you for sleep. And that is why electronic devices before bed can be especially problematic.

If you absolutely must use an electronic device as bedtime approaches, don’t do it in the bedroom, and make sure the blue light filtering feature is on. Most televisions don’t have a built-in blue light filtering option, so if you are going to watch a television program after dinner, do so while wearing glasses, which are designed to filter blue light. Indeed, most prescription eyeglasses now offer blue light filtering.

And for your bedroom, you want it dark. Really dark. The darker the better when it comes to restful sleep.

The reason why light timing is critical for sleep is that light works with natural melatonin production to set your circadian rhythm. Keeping your circadian rhythm in rhythm is the key to not only a great night of sleep but a long life free from cardiovascular disease as well.

5. Have a Caffeine Curfew

Most people are already aware that caffeine can impact sleep, but they tend to underestimate its effects. Caffeine isn’t just a mild stimulant; it’s a very powerful drug that can stay in your body for more than a day. For many people, the majority of the effects of this drug are gone in about five hours, but about 50 percent of people have a variant of a gene known as CYP1A2 that lowers the amount of a certain liver enzyme that causes their bodies to metabolize caffeine more slowly. From one person to the next, in fact, there can be as much as a 40-fold difference in the rate that caffeine metabolizes.

In most people—even those who are slow metabolizers—it’s generally safe to consume up to 100 milligrams of caffeine per day without adversely impacting sleep. But that’s not much caffeine; it’s the equivalent of one cup of coffee, two cups of tea, three servings of soda pop, or four ounces of dark chocolate. Start combining those sources, and you’ll quickly blow past the limit at which most people can consume caffeine without a significant impact to sleep.

Also, it should probably go without saying that so-called energy drinks, which are packed with lots of caffeine and other stimulants, will put you past the limit faster than you can say the words “Red Bull.” For most people, a “caffeine curfew” that comes six hours before bedtime is a good rule.

6. Avoid the Booze

If avoiding the booze doesn’t immediately make sense to you, you’re not alone. Alcohol, after all, is a central nervous system depressant, with an oppositional effect to caffeine. And yes, it’s true that a drink before bed can help some people fall asleep more quickly, but that initial benefit is offset by a reduction in the quality of sleep they get.

Research shows that people who drink alcohol before bed get less REM sleep, the sort of sleep that is characterized by rapid eye movements, dreaming and bodily movement, and which offers the biggest benefits in terms of health and restfulness. REM is also key to keeping our hearts in rhythm. One study, for instance, showed that people who have less REM sleep have higher rates of AFib, with the risk increasing as REM decreases.

A single glass of wine or beer during a dinner that comes several hours before bedtime is unlikely to be detrimental to most people’s sleep but, as is the case with caffeine, there are a lot of factors at play. Biological sex, race, weight, medications, experience with drinking, microbiome composition, and myriad genetic factors can impact how alcohol is metabolized in the body. And, since the hard truth is that even minimal alcohol consumption results in worse outcomes for people with AFib, the best possible amount of alcohol is none at all.

7. Time Your Workouts (Outdoors is best)

It’s a given, if you want to sleep better you need to be physically active throughout the day. For most people, a vigorous morning workout energizes them for the day and helps them sleep at night. And exercising outdoors is even better as bright natural light in the morning optimizes your circadian rhythm for sleeping soundly at night.

While it goes against everything you read on the internet, I’ve found that an evening workout usually works best for me. My mind is the clearest in the morning so I like to dedicate that time to work. As exercise is so relaxing for me, I like to save that time for the evening. Even better is that a vigorous workout makes me tired so I sleep better.

I’ve also found that the more activity I’ve logged on my Apple Watch during the day (steps, exercise time, calories burned, etc.), the easier I fall asleep and then stay asleep at night. In fact, I’ve now logged 134 consecutive days, without a miss, of hitting 1,000 calories burned each day according to my Apple Watch. And on the days I’ve burned more than 1,500 calories, I’m always asleep within 5 minutes of my head hitting the pillow and stay asleep the entire night.

8. Take a Warm Bath or Shower

People often turn to alcohol to unwind from a stressful day and relax. There are other ways to promote relaxation that can also have profound benefits on your sleep quality and duration. Taking a scheduled warm bath or shower can improve the time it takes you to get to sleep, your sleep quality and total sleep time, and how often you wake during the night.

Are you the type who needs a shower to get moving in the morning? Fair enough. Keep that habit, but build in an evening bath as well. This simple lifestyle change can be done with little disruption to your daily routine, after all, with a pretty significant payoff. In studies that have shown a significant benefit on sleep, the bath or shower can be as short as 10 minutes.

Personally, this is something I have started doing over the last year following my evening workouts as mentioned in number 6 above. A warm shower before bed has helped me sleep so much that I never go a night without a warm shower before bed.

9. Read Something Relaxing

Reading emails or social media before bed is a really bad idea unless you want to lie in bed for hours ruminating on what you just read. While reading something potentially stressful like emails or social media is bad before bed, reading a relaxing novel can be especially helpful to calm your mind or even put you to sleep. For me, I’ve found that reading something really boring in bed works best as I quickly start dozing off while reading.

10. Treat Your Sleep Apnea

Do you snore? Do you weigh a little more than you should? If you answered yes to both odds are you have sleep apnea.

The problem with sleep apnea is that all of the fatty tissue in your neck can choke off your airway while sleeping causing oxygen levels to plummet to dangerously low levels.

Sleep apnea is really bad for AFib. Indeed, studies show that sleep apnea quadruples your risk of AFib. In addition, sleep apnea makes you fatigued during the day, raises your blood pressure, and increases your risk of heart failure and an early death.

If you snore and weigh a few pounds more than you should tell your regular doctor and get tested for sleep apnea. Fortunately, most patients can make their sleep apnea go away with weight loss.

In addition, not sleeping on your back can also be curative for sleep apnea in some patients. For example, you can even buy stop snoring sleeping shirts on Amazon. By simply putting a tennis ball in the little pouch on the back of the shirt it will go a long way in helping to keep you off your back while sleeping.

11. Time Your Fluids

Unless you are feeling dehydrated, avoid drinking anything after dinner, and make sure to head to the restroom as your last stop before you go to bed. One of the main reasons people get up at night is to use the bathroom and, once up, those who have trouble sleeping in general are more likely to stay up.

If you’ve hydrated thoroughly throughout the day, a few hours without water before sleeping probably won’t hurt you. If you do have to use the restroom, it should be a direct to-and-from trip. Don’t take a lap around the house to make sure everything is shipshape.

Don’t get another drink of water (which will begin a vicious cycle.) And finally, do not go to the kitchen — especially not to open the refrigerator to get a blast of light that will signal your brain to start waking up.

12. Consider a Natural Sleep Aid

Even if you’ve scheduled your sleep, controlled your caffeine and alcohol intake, turned the lights out when you should, taken a warm bath before bed and, if needed, gotten treatment for your sleep apnea, slumber can be an elusive friend. And that can make pharmaceutical sleep aids and supplements very alluring.

Resist! Sleep drugs and supplements should only be used under a doctor’s supervision, and only as a last resort. Even something as “benign” as over-the-counter Benadryl (diphenhydramine) has been associated with dementia. And if something like Benadryl (diphenhydramine) increases your dementia risk, you can only imagine what a prescription-strength sleeping pill must do to your brain.

If supplements must be tried, studies show magnesium may not only help your AFib but your sleep as well. Likewise, melatonin is generally quite safe and may help with sleep. Personally, I take magnesium and melatonin every night to help with sleep.

I’ve also used L-Theanine and L-Tryptophan on the nights I knew sleep was going to be difficult. L-Theanine helps to calm my mind and just a tiny amount of L-Tryptophan seems to really put me to sleep. But as with any medications or supplements, please discuss with your healthcare provider first as serious complications could arise.

To see me or one of the other cardiologists specializing in AFib in our practice, please call my team at 801-266-3418. Sorry, telemedicine visits outside of the state of Utah are no longer possible due to post-COVID government regulations.

Also, if you liked the photo attached to this article, it is a picture my daughter took of my running shoes during one of our sunset runs on Laguna Beach over the Thanksgiving Day weekend.

#322 The 11 Worst Medications For Causing Atrial Fibrillation

November 28th, 2021 by

The 11 Worst Medications Causing Atrial Fibrillation

Could one of your medications actually be causing your AFib? Over the years I’ve seen a number of patients either significantly decrease their AFib episodes or even put their AFib into remission for a few years just by getting off an AFib causing medication. For those who needed a particular medication, catheter ablation was very helpful in eliminating the AFib so that they could continue to take their necessary medication. Below are my 11 worst medications causing atrial fibrillation.

1. Diuretics

With the exception of spironolactone (Aldactone) and triamterene, diuretics can be problematic for atrial fibrillation patients. The reason is that most diuretics are well-known to cause mineral depletion in the body. Depletion of those key minerals, especially potassium and magnesium, is often enough to trigger atrial fibrillation.


Non-steroid anti-inflammatory drugs, or NSAIDs, can also induce AFib. NSAIDs are relatively common drugs like ibuprofen and naproxen that are often used to fight pain. NSAIDs are particularly troublesome for AFib patients because they also increase the risk of heart and kidney failure. For those who are also on a blood thinner, NSAIDs increase the risk of an emergency room visit for a life-threatening gastrointestinal bleed.

3. Proton Pump Inhibitors

Proton pump inhibitors, which suppress stomach acid, can also atrial fibrillation by blocking magnesium absorption or possibly by changing a person’s gut microbiome. These drugs include omeprazole, lansoprazole and pantoprazole, which are often sold under the brand names Prilosec, Prevacid, and Nexium, respectively.

4. Steroids

Steroids, like prednisone and Solu-medrol, can cause atrial fibrillation, too, by raising blood glucose levels to very high levels and increasing blood pressure through fluid retention and weight gain. Over my career, I’ve even seen many cases of steroid injections triggering AFib.

5. Any Stimulant

Cardiac stimulant medications, like albuterol inhalers or theophylline for asthma, have long been associated with AFib. Even over-the-counter decongestants such as pseudoephedrine, which is sold as Sudafed, or medications for attention deficit hyperactivity disorder can trigger an AFib attack. The bottom line is that anything that revs up the cardiovascular system has a risk of causing AFib.

6. Digoxin, Diltiazem, Verapamil, and Beta-Blockers

Perhaps a bit counterintuitively, some if the classic drugs used to treat abnormal heart rhythms such as digoxin, calcium-channel blockers such as verapamil and diltiazem, and beta-blockers have all been associated with an increased risk of AFib. While the exact mechanisms whereby these drugs may increase the AFib risk aren’t entirely clear, plenty of cases have been documented in the medical literature. We’ve even seen beta-blockers, which are often used to treat AFib, linked to AFib episodes due to associated weight gain, particularly with women.

7. Fish Oil

As many readers know, there is prescription-strength fish oil, like Lovaza, as well as the over-the-counter fish oil. Prescription-strength fish oil is used to treat high triglycerides whereas the over-the-counter version is used to treat a myriad of complaints. Regardless of which form it is, fish oil has now been implicated as a potential cause of AFib.

If fish oil has been particularly helpful for you, try keeping the dose under 1 gram per day to minimize the risk of AFib. Or, alternatively, you can do what I’ve done and go back to eating wild-caught fish high in omega 3s instead of taking a supplement. Interestingly, since stopping fish oil for myself, I’ve noticed a lot fewer palpitations.

8. Antiarrhythmics like Amiodarone, Flecainide, and Propafenone

Another surprise to many readers is that the antiarrhythmic drugs, the ones that are supposed to prevent AFib, have been linked to AFib. For example, amiodarone is well-known to cause hyperthyroidism which can then result in AFib. Flecainide and propafenone both slow the sodium electrical channels in the heart which, in some cases, may trigger AFib. It is also well known that these 3 antiarrhythmics may also increase the risk of atrial flutter which could be even worse than the original AFib.

9. Antidepressants

If depression wasn’t bad enough, one study showed a 3-fold increased risk of atrial fibrillation when starting an antidepressant. Fortunately, much of this risk goes away after you have been on the antidepressant for more than a month and then declines even further after you have been on the antidepressant for a year. Like many of the other drugs on this list, antidepressants alter the electrical conduction channels of the heart.

10. Opiates

As if it weren’t bad enough that so many people are dying from opioid pain killers, the AFib risk has been reported to be up to 4-times higher in people taking these drugs. And just as opiates change the electrical properties of the heart to cause long QT and cardiac arrest, they can also rewire your heart to trigger AFib.

11. Too Much Vitamin D

When you do talk to your doctor, make sure that you don’t forget to mention any supplements you are taking; people don’t always think of vitamins and supplements as drugs, but just like any form of therapy, these substances should only be taken for the right reasons and at the right doses. One of our studies, for example, found that the risk of developing atrial fibrillation was two and a half times greater among individuals who were taking excessive amounts of vitamin D.

Should You Panic if One of Your Medications is on this List?

Just because a medication you take might be associated with AFib doesn’t mean it shouldn’t be taken. All medications have potential side effects, after all. The best way to make decisions about the medications you have been prescribed is in consultation with your doctor.

Under no circumstances should you come off a drug you have been prescribed on your own volition; you should always do so in consultation with a physician. If you have an atrial fibrillation diagnosis or if you have concerns that AFib might be on your horizon, you should immediately engage in a conversation with your doctor about all of the medications you are taking, both regular prescriptions and once-in-a-while over-the-counters.

You don’t have to wait for an appointment to start gathering the information you need, though. The common and less frequently known side effects of all medications are available from a variety of reputable sources, including the U.S. FDA, and a simple internet search for “AFib” and the name of the drug you are taking can tell you whether there is a possible connection.

Consider an Ablation

If there is a particular medication on this list that is very helpful for you, catheter ablation can be a very effective way to get rid of the AFib problem. Indeed, catheter ablation in conjunction with a healthy lifestyle, including weight control, is often curative for our patients as we described in our book, The AFib Cure.

The procedures take less than 2 hours to perform and patients are usually able to go home 3 hours later. There is no cutting and no stitches with the procedure. Five days later most of our patients are able to return to full exercise at the gym.

To see me or one of the other cardiologists specializing in AFib in our practice, please call my team at 801-266-3418. Sorry, telemedicine visits outside of the state of Utah are no longer possible due to post-COVID government regulations.

Also, if you liked the photo attached to this article, it is a picture my daughter took of my running shoes during one of our sunset runs on Laguna Beach over the Thanksgiving Day weekend.

#321 The 7 Most Important AFib Triggers to Avoid

November 20th, 2021 by

The 7 Most Important AFib Triggers to Avoid

A new study was just published identifying the most important AFib triggers to avoid. Avoiding AFib triggers is incredibly important for AFib patients and something we covered in our best-selling book, The AFib Cure. In this article, I discuss the 7 most important AFib triggers to avoid based on published medical studies and my 30 years of experience caring for AFib patients.

What are your AFib triggers?

While most of my patients can identify at least one specific AFib trigger, many cannot. For some of my patients, AFib attacks are 100% random events so they don’t have any clearly identifiable triggers. If you can identify one or more AFib triggers, then avoiding these triggers can be a very effective way of putting your AFib into remission naturally.

1. Alcohol

At the top of every published study of AFib triggers is alcohol. Sadly, there is no safe dose of alcohol for AFib patients. And that shouldn’t come as a big surprise as any emergency room doctor can share many stories of high school or college students who have presented with AFib after binge drinking.

2. Exercise

Exercise is the most natural way in the world to shift our hearts into a higher gear, so it’s no shock that, if your heart is already prone to beating erratically, a quick burst of exercise could push it over the edge. But avoiding exercise is simply not an option as not exercising at all dramatically increases your risk of AFib and an early death.

For those suffering from exercise-induced AFib, many of my patients have found that simply decreasing the intensity or duration of their exercise can help tremendously. For others, they can still exercise vigorously without AFib provided they have slept well, are well hydrated, and have their electrolytes in check.

When nothing prevents exercise-induced AFib, it is time to consider an ablation. Indeed, I have countless patients, including elite world-class athletes, who have all successfully returned to high levels of exercise free of AFib with an ablation procedure.

3. Dehydration/Electrolyte Depletion

It always amazes me how so many of my patients’ AFib attacks come from when they aren’t drinking enough water. Indeed, many of my patients fail to realize that their fatigue, dry skin, headaches, muscle cramps, urinary tract infections, constipation, dizziness, brain fog, or their AFib all happen because they aren’t drinking enough water. And proper hydration is especially important for AFib patients before exercising.

In addition to adequate hydration, optimization of electrolytes is also necessary to keep the heart beating right in sinus rhythm. For example, potassium and magnesium depletion are well documented AFib triggers in the medical literature. Fortunately, both can easily be replenished with a diet high in vegetables, fruit, nuts, seeds, legumes, etc. Indeed, many of my patients report that magnesium supplementation has been essential to keeping their AFib in remission.

When it comes to optimizing your electrolytes, please don’t turn to sports drinks. Sport drinks are nothing more than sugar water or artificial sweetener water with chemical dyes and a trace amount of electrolytes. If your goal is to optimize for sinus rhythm and longevity, get all the electrolytes your body needs from natural food sources like vegetables, fruit, nuts, seeds, legumes, etc.

4. Poor Sleep

A bad night of sleep is another big AFib trigger. Bad sleep could be from sleep deprivation or sleep apnea. Indeed, studies show that a bad night of sleep increases your risk of AFib 3x the next day and sleep apnea quadruples your AFib risk. Make restorative sleep a priority!

While sleeping on your left side is often uncomfortable for AFib patients, a recent study did not show an increased risk. So, while you may feel more palpitations when sleeping on the left side from gravity pulling your heart toward your chest wall, it probably won’t cause an AFib attack.

5. Stress/Anxiety

When you’re stressed your blood pressure is up and adrenalin is pounding through your veins. So it should come as no surprise that on the days you wake up stressed or anxious studies show your risk of AFib on these days is 5 times higher!

If you suffer from AFib, find ways to manage your stress. Good sleep, sunlight, and a great workout in the mountains always cures me of any stress. For others, prayer, meditation, yoga, or spending time with a friend can also be incredibly helpful. Find what works for you and optimizes your stress levels.

6. Unhealthy Foods, Over Eating, and Cold Foods/Drinks

Stuffing your belly full of food or eating junk may also trigger an AFib attack. Why would food be a trigger? Perhaps the high salt and sugar load of processed or fast foods trigger the attack from a blood pressure spike or fluid retention. Or perhaps it is because specific foods may irritate gastrointestinal problems. And GI problems are known to stimulate the vagus nerve, which connects your gut, brain, and heart.

We don’t understand this vagus nerve connection in-depth, but our research has shown that gastrointestinal diseases are associated with atrial fibrillation. Also, when those gastrointestinal issues have been resolved, the AFib usually settles down as well. And cold foods and cold drinks are well known to stimulate the vagus nerve in ways that might put you at risk for an AFib attack.

As I often tell my patients, in my 30 years of caring for AFib patients I’ve yet to meet a patient who reported that broccoli triggered an AFib attack!

 7. Energy Drinks

While most of my patients are convinced that caffeine is an AFib trigger, the studies simply don’t support this. While I’m sure some of my patients are truly caffeine sensitive, most are not. If you are caffeine sensitive then it is best to avoid it.

However, there is one form of caffeine that is particularly problematic for all of my patients. And that is energy drinks. There is something bad about combining a bunch of chemicals with sugar/artificial sweeteners and massive doses of caffeine that send hearts into AFib.


If your goal is to beat AFib, you’ll need to avoid your AFib triggers. Even if you have had a successful ablation, you still should avoid your triggers. As alcohol can cause a perfectly normal teenagers’ heart to go into AFib, why should it be any different if you are 50 and have had an ablation?

If you want to learn more about stopping AFib, be sure to check out our best-selling book, The AFib Cure. To see one of the EP’s in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

Also, if you liked the photo attached to this article, it is another picture of an evening run I just went on with my daughter. We are standing on the old pipeline remnants of the Pipeline Trail up Millcreek Canyon overlooking Salt Lake City, Utah.

#320 Is Caloric Density the Secret to Eating as Much as You Want without Gaining Weight?

November 14th, 2021 by

Is Caloric Density the Secret to Eating as Much as You Want without Gaining Weight?

By Kate Clemens with John Day

Is there a way to never feel hungry again and not gain weight? One answer is to mostly eat only those foods with the absolute lowest caloric density. In other words, a low caloric density means you want the most food you can get on your plate with the least amount of calories. And in this article, we’ll teach you everything you need to know about the low caloric density eating approach.

Dr. Day’s Experience with Low Caloric Density Eating

Focussing primarily on foods with the lowest caloric density has been something Dr. Day has done for the last 10 years to maintain his 30-pound weight loss. For him, pilling up his plate high with food not only fills his belly but also psychologically convinces his brain that he is full.

As vegetables have the lowest caloric density this is what fills up most of his plate. And because oils have the highest caloric density, he avoids them whenever possible. For example, when making a salad he puts berries, beans, nuts, and seeds on his salad, rather than salad dressing, because berries, beans, nuts, and seeds have a much lower caloric density (see chart).

In general, Dr. Day keeps his caloric density below 780 calories per pound unless he is eating nuts, seeds, or some very dark chocolate (>70% cacao and usually stevia-sweetened). Of note, his wild salmon measures in at about 780 calories per pound. On rare occasions, he will just put a small taste of salad dressing on a fork (he never puts the dressing on the salad) if berries, beans, nuts, or seeds are not available to flavor his salad.

Caloric Density Works

Caloric density is a straightforward approach to weight management that works. The idea is to increase the amount of food on your plate while decreasing your total caloric intake. You do this by paying attention to the calories per pound in the food you choose to eat. The best part of it is that you eat for satiety and optimize the amount of nutrients you take in at each meal.

5 Key Findings from Weight Loss and Caloric Density Research

What does research tell us about the caloric density eating approach? Below is a summary of the best studies:

1. People can eat freely foods that are about 300 calories per pound or less and not gain weight.

2. People can consume relatively large portions of foods that are between 400 and 800 calories per pound and still lose or maintain their weight depending on their individual activity levels and metabolism.

3. Foods with a calorie density of 800-1,800 should be limited as these can contribute to weight gain and interfere with efforts to lose weight.

4. Foods over 1,800 calories per pound should be extremely limited as these foods can very easily contribute to weight gain and obesity and can also greatly interfere with efforts to lose weight.

5. In 2007, the American Cancer Institute and the World Cancer Research Fund published a report which recommended the average calorie density of the American diet be lowered to 567 calories per pound. This can easily be achieved if one eats freely of unrefined, unprocessed fruits, veggies, starchy veggies, and intact whole grains and legumes. It is important to note that this means without the addition of salt, sugar and/or fat/oil to them.

Never Diet Again by Following the Caloric Density Eating Approach

Using the caloric density approach is one that is truly simple and based on common sense. Better yet, it is easy to stick with which allows you to manage your weight for the rest of your life without dieting. Because you essentially end up eating more food with fewer calories, you will feel satiated and happy.

In a nutshell, by having a rough idea of how many calories there are in a given weight of food, one can enjoy a larger amount of food without increasing their total daily caloric intake. Foods that fall in this category tend to be whole, natural foods that leave us satiated for longer. Also, while low in caloric density, they are high in nutrient density. So it’s a win-win.

Kate’s 6 Tips to Healthy Eating

1. Get in tune with hunger and satiety:

Eat only when you are hungry, and avoid eating past the point of satiety. Remember to eat slowly and chew your food well.

2. Order matters:

Start all meals with foods that are lower on the calorie density scale. This will help increase satiety and ensure you are eating nutrient-dense foods that will optimize your health.

3. Form matters:

Solid foods fill you up more than liquids of equal calories. Be mindful of your beverage choices and avoid any drinks with added sugars.

4. Dilution Solution:

Minimize the caloric density of your meals and increase the nutrient density with the 50/50 visual. Half of your plate by visual volume should be filled with non-starchy veggies.

5. Facts on Fats:

We need healthy fats to survive. No need to completely eliminate fats. However, keep in mind that even small amounts of healthy fats will greatly increase the caloric density of your meals. Be mindful of serving size when you are using avocados and olive oil, etc.

6. Less High Dense:

When you incorporate high calorically dense foods into your meals make sure the meal is already made up mainly of low calorically dense foods. The real goal is to keep your average caloric density as low as possible.

If you already have a heart condition and would like to see one of the great cardiologists I work with every day, please call my team at 801-266-3418. Dr. Day’s practice is 100% limited to patients suffering from documented arrhythmias. Sadly, telemedicine visits outside of the state of Utah are no longer possible due to government regulations following COVID.

Also, if you liked the photo attached to this article, it is a picture I took this week on a night run in the mountains with my daughter overlooking the Salt Lake City valley.

#319 Dr. Day’s 8 Scientifically Proven Ways to Lower Your Blood Pressure Naturally

November 6th, 2021 by

8 Scientifically Proven Ways to Lower Your Blood Pressure Naturally

Studies show that up to 90% of all Americans will have high blood pressure by age 50! But yet isolated groups of people cut off from our modern lifestyles have normal blood pressures in the range of 110/70 mmHg throughout their lives without the need for medications.

If your goal is to optimize for normal sinus rhythm, a heart free of disease, and a long healthy life, you have to maintain a healthy blood pressure throughout your life. In this article, I will share my 8 scientifically proven ways to lower your blood pressure naturally.

My Struggle with High Blood Pressure

Ten years ago my blood pressure typically ran 140/90 mmHg. And as a cardiologist knowing of the cardiac dangers of high blood pressure, I put myself on a blood pressure-lowering medication.

However, as I lived among the centenarians in the remote Longevity Village area of China, my goal was to naturally reverse all of my medical conditions, including high blood pressure. And by adopting a 99% natural plant-based diet, including a 30-pound weight loss, in conjunction with regular daily exercise, time with my family, and optimization of my sleep and stress levels, my unmedicated blood pressures now consistently run 110/90 mmHg!

Below are the 8 scientifically proven ways I lowered my blood pressure. But if you are currently taking high blood pressure medications, please speak with your doctor first before trying anything in this article.

My concern is that on one hand stopping blood pressure medications could be life-threatening. But yet, on the other hand, getting super healthy while taking blood pressure medications could drop your blood pressure to dangerously low levels. If your goal is to get off blood pressure medications, it will take exceedingly close monitoring while at the same time working with your doctor as you wean off medications.

1. Cut the Sodium

First, you’re going to need to eat a low-sodium diet. This can offer a 4-point reduction in your systolic blood pressure, an effect equivalent to about half a typical blood pressure-lowering medication.

2. Eliminate any Added Sugars

Second, you’ll need to eliminate any added sugars. That’s generally worth a 7-point reduction.

3. Commit to a Daily Workout

Next, it’s time to commit to a daily workout for a 6 to 7 point reduction.

4. Drop Some Weight

The fourth thing is really hard to do by itself, but a ton easier if you’ve done the first three things: You’ve got to drop some weight. How much? Broadly speaking, for every 2 pounds you lose you could expect a 1 point reduction. So, dropping 20 pounds could get you a 10 point reduction.

5. Embrace a High Fiber Diet

Next, you’ll want to embrace a high-fiber diet. And to get there you’ll need to eat a lot of vegetables, legumes, and high fiber fruit like berries. My personal goal is 100 grams of fiber daily but something much less than that could still be worth another 6 point reduction.

6. Learn to Eat Plant-Based

Sixth, eating a mostly natural plant-based diet that is high in potassium and magnesium with limited saturated fats has been shown to drop your blood pressure by 6 points.

7. Get More Nitric Oxide from Greens and Root Vegetables

Next, you need to get some more nitric oxide from greens and root vegetables. Eat enough of that molecule, the intake of which causes blood vessels to relax and dilate, and you could enjoy a 5 point reduction in your systolic blood pressure.

8. Lower the Stress Levels

Finally, you’ve got to do something about your stress, which you already know is a key driver of high blood pressure. That can help drive a 5 point reduction in your systolic blood pressure.

If your goal is to maintain a healthy blood pressure, work with your physician to help decide what approach would be best for you. To see one of the cardiologists or in our practice specializing in blood pressure management, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations). Also, if you liked the photo attached to this article, it is a picture I took this week on a run with my daughter overlooking the Salt Lake City valley.

#318 Dr. Day’s 13 Simple Weight Loss Tips That Actually Work

November 2nd, 2021 by

13 Simple Weight Loss Tips That Actually Work

Authored by Kate Clemens with Dr. John Day

As Dr. Day revealed in his book, The Longevity Plan, he has struggled to maintain a healthy weight since high school. Indeed, 84% of all Americans report that they have tried to lose weight. Below are our 13 simple weight loss tips that actually work for us and our patients.

1. Diets Don’t Work, Lifestyles Do

You go on a diet and then you go off the diet–Diets were never meant to be long-term solutions.

The goal is to find a way of eating that you can maintain for the rest of your life. So the next time you commit to “eating healthy,” ask yourself can I eat like this for the rest of my life? If the answer is “no,” then you’re doomed to fail. You need a lifestyle or way of eating that you can easily maintain until you turn 100.

2. Faithfully Follow Dr. Day’s 3 Rules to Eating

As there is so much confusion as to what is healthy eating, Dr. Day’s approach is to give his patients 3 simple rules to follow. And if you can just follow these 3 easy rules to eating, then you are 90% of the way there to healthy eating.

First, minimize or avoid any added sugars. We do not need these! Real whole fruits are naturally occurring sugars, these do not count.

Second, minimize or avoid processed foods. If it comes from a box, can, package, fast food window, etc. it is processed. You do not need these “foods.” The more natural you eat the better.

Third, eat as many non-starchy vegetables as you can. The more variety in the color of your vegetables the better.

3. Find What Works for You

There is no one perfect diet for everyone. Just because “keto” worked for your friend doesn’t mean it will work for you.

For example, everyone says exercising first thing in the morning is best as it will help you to eat healthy all day long. Dr. Day found that exercising in the morning just made him hungry all day long. So for Dr. Day, he can control his eating by exercising late in the afternoon or after dinner.

You are so wonderfully individual. While there are certainly a lot of health “guidelines” out there, these guidelines may or may not help you. Have fun, experiment, and be true to yourself. Remember the ONLY person you should ever compare yourself to is the person you were yesterday.

4. Crash Diets Crash Your Metabolism

Have you ever wondered what happens to the “biggest losers” on reality TV shows? When the cameras stop rolling, do their incredible transformations stick? Not usually. Researchers have found, in fact, that these contestants’ crash diets send their metabolism into a tailspin, making long-term weight maintenance nearly impossible.

In most cases, the weight comes right back and, even six years later, their metabolism is slower than it was before they
started filming. This is what scientists call “metabolic adaptation” and is something you definitely want to avoid.

No matter where you are in all facets of your life, getting to where you want to be is not supposed to happen overnight. After all, you probably put the weight on at a pace of 1 to 2 pounds a year. Do not be afraid of achieving your goals slowly and mindfully, just be sure you are moving forward! We are aiming for progress, not perfection.

5. Have a Daily Plan

We do not plan to fail, we fail to plan. This is a well-known quote for a good reason.

Set yourself up for success! Figure out 5-minute ‘planning window’ either each Sunday or the night before to sketch out what your food week or food day will look like.

For example, as Dr. Day is surrounded by unlimited free treats at every nurse station or the doctor’s dining lounge in the hospital, he has to plan out a daily “healthy treat.” Without a prepared “healthy treat” in his laptop bag, he’ll feel deprived and devour the unhealthy ones at his hospital.

Prioritize self-care as much as you prioritize work. Believe me, it will make you that much more efficient!

6. Schedule at least a 12-Hour Daily Fast

A daily 12-hour fast is an easy health habit if you simply use the hours you sleep. For instance, if you finish eating dinner at 7 pm then don’t eat anything more until your 7 am breakfast. Intermittent fasting is very beneficial for our health. It aids in weight management, boosts mitochondrial health, reduces inflammation, and enhances the body’s natural detoxification process.

Dr. Day reports that just last week he met with an atrial fibrillation patient who started daily 14-hour fasts with her husband 5 months ago. She shared that without any changes in her food choices, she was able to lose 12 pounds and her husband lost 17 pounds from intermittent fasting. The best part was that just this 12-pound weight loss from daily 14-hour fasts was enough to put her atrial fibrillation into remission and get off her flecainide!

7. Dairy is Personal Decision

There is no scientific proof that your bones will be brittle if you don’t eat your 3 daily servings of dairy. In fact, cultures with the lowest risk of fractures eat little to no dairy at all.

The goal is to find what works for you as dairy’s effects on people vary greatly. You shouldn’t feel like you have to eliminate dairy from your diet if you can tolerate it well and enjoy it. On the other hand, dairy is not essential to our diet.

For instance, while one of milk’s claim to fame is its calcium content, 1 cup of cooked spinach provides almost the exact same
amount of calcium as 1 cup of milk. If you do choose dairy, opt for sources as natural as possible with no added sugar and ideally fermented.

Dr. Day’s decision to eliminate almost all dairy came from his dairy-induced high LDL, acid reflux, and eosinophilic esophagitis. In carefully tracking his calcium intake from eating massive quantities of broccoli, kale, lettuces, etc. he easily achieved his daily recommended allowance of calcium from plant-based sources.

8. Keep Your Meat Wild

As with dairy, meat is also a personal decision. If you do choose to eat meat, make it wild. Since wild animals feed on natural vegetation, their meat contains more omega-3 fatty acids and less saturated fat than grain-fed, factory-farmed animals. They are considered a source of “lean meat” which means they are low in fat, high in protein, and have a low-calorie content ratio.

And when it comes to fish, wild-caught is also best. In general, wild-caught fish is healthier, leaner, and less polluted. And it is for this reason that Dr. Day periodically enjoys wild-caught Alaskan salmon.

Indeed research shows that a mostly plant-based diet with wild meat can be incredibly healthy. For example, the Tsimane people living in the Bolivian rainforests don’t get cardiovascular disease and don’t get atrial fibrillation likely in part from their wild meat and vegetable diet. To learn more about the Tsimane people, please check out this article from Dr. Day.

9. The More Fiber the Better

Fiber is a key nutrient that keeps our blood sugar stable and our appetite in control by regulating the way our body processes sugar. It is unique as it cannot be broken down into sugar molecules for digestion like other carbohydrates can.

Instead, fiber remains undigested as it passes through our digestive tract. And it is for this reason that science tells us that the more fiber you consume the lighter you’ll probably be. In the past century, the amount of fiber we eat has decreased by about 90%! In fact, most Americans are only getting about 15g of fiber per day when Dr. Day argues the goal should be somewhere near 100 grams daily. To learn more about how fiber can help you to maintain a healthy weight, please check out this article from Dr. Day.

10. Be Accountable for Your Food Choices

Whether you are a numbers person like Dr. Day or take a mindful approach with no counting like Kate, you need some way of keeping yourself honest! This may mean resorting to a tracking app such as Lose It!, a trainer at the gym, learning to become a mindful eater, or finding another way to hold yourself accountable. To learn more about Kate’s approach to mindful eating, follow this link.

As the mindful eating approach hasn’t worked so well for Dr. Day, his approach is to “gamify” his “food stats” using various charts and apps. For him, it is all about maintaining a daily high score with his food choices.

11. Eat the Right Carbs

Carbohydrates are vital for many functions in our body, but it is important to make sure we are smart when selecting our carbs. Don’t believe for a minute the reports you may see on the internet that all carbs are bad. After all there is a big difference between a slice of white bread and raw broccoli.

Low glycemic index, complex carbohydrates, like most vegetables and berries, will give your body a slow release of energy and keep you feeling fuller for longer. Indeed, all of the healthiest and longest-lived groups of people around the world have thrived on eating the right carbs.

While many of Dr. Day’s patients have reported that poor food choices have triggered an atrial fibrillation attack, Dr. Day is fond of saying that he has yet to see a patient go into atrial fibrillation from eating too much broccoli.

Still not sure what carbs are best? Here is a document Kate has prepared with some excellent carbohydrate options.

12. Use Breathing Techniques to Help with Stress Eating

In modern-day society, we tend to get stuck in fight or flight mode (sympathetic state). This leads to unnecessary stress and also takes away from our digestive power.

A free tool we have 24/7 to slide back into rest and digest mode is our breath. Check out this document from Kate to learn how to use this powerful tool to your advantage. Be sure to always aim to eat when you are in a parasympathetic state! (rest and digest mode).

13. Relationships May Be More Important than Food Choices

In The Longevity Plan, Dr. Day shares the following: “Confucius once said, we should “not, even for the space of a single meal, act contrary to virtue.” When I learned this I was devastated. I figured it was impossible. I might eat lots of veggies, fruits, and legumes. I might never again have another Diet Coke. But what if my friends were to invite me out to pizza? What if I wanted to share an ice cream sundae with my daughter? Would that be acting contrary to virtue?

Perhaps it is this “virtue” that explains why some studies have shown that loneliness is a bigger risk factor for cardiovascular disease and a shortened life than obesity.

I’ve since come to believe, isn’t just what we eat. It’s how we eat. It’s who we eat it with. It’s our relationship with where our
food comes from. It’s the decisions we make about how to prepare it. It’s our determination to honor the energy it gives us in positive ways.”


If your goal is to maintain a healthy weight, don’t take our word for it but rather work with your physician to help decide what approach would be best for you.

To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations). Also, if you liked the photo attached to this article, it is a picture I took last week during our fall break trip to Miami Beach.

#317 Can You Exercise with AFib?

October 16th, 2021 by

Can You Exercise with AFib?

Can you exercise with AFib? And if so, how high can your heart rate go before it is unsafe? We all know that exercise is good for you but does that still hold if you’re in AFib? If you or a loved one has AFib, read on to learn more.

Can Exercise Cause AFib?

Most of my patients are shocked to learn that people who run marathons, competitively cycle, or do Ironman triathlons are five times more likely to develop AFib! What is particularly perplexing, however, is that studies have not tended to show higher rates of arrhythmias in athletes who participate in other strenuous forms of exercise, such as boxing, wrestling and weight-lifting.

There is something particular about endurance sports that increases the risk of AFib. One exception to this may be football. Among former NFL athletes, the risk of AFib is six times higher, although this may be due to the use of performance-enhancing substances or the weight these athletes put on to compete at a professional level.

Also, it bears noting that while aggressively competing in endurance sports might put you at a greater risk of AFib, participation in these activities certainly does not guarantee you’ll get AFib. It is reassuring to note that non-competitive recreational participation in endurance sports, even if it is a marathon or triathlon, doesn’t seem to put you at risk of AFib.

I have found over the years that almost all of my athletes with AFib have opted for an early ablation. They simply can’t or don’t want to exercise with the usual cocktail of AFib drugs that are prescribed. And fortunately for athletes, we typically get excellent results as studies show that the AFib ablation success rates are up to 3 times higher with athletes!

Can Not Exercising Cause AFib?

Regular exercise in general isn’t risky at all. In fact, for 99.9% of my patients it’s exceptionally protective. To put things into perspective, for every thousand patients I see with atrial fibrillation, perhaps one may be at risk due to overexercising. The biggest problem, by far, is that most patients aren’t exercising enough.

There is far greater risk to not exercising enough than to exercising too much. People who live sedentary lifestyles are at significant risk of AFib, not to mention all of the other health consequences of not getting enough exercise. Indeed, one study showed that not exercising at all increased your risk of AFib by more than four times!

A big problem for many of my AFib patients is that they want to exercise but either the AFib or their medications make them so tired that they simply can’t exercise. And for those people who can’t exercise with AFib, we typically end up treating them with an ablation as the health benefits of exercising are too great to ignore.

How High Can Your Heart Rate Go when Exercising in AFib?

As exercise drives the heart rate up, how high can you let the heart rate go when exercising in AFib? For the vast majority of my patients, they are perfectly okay driving their heart rates up to their maximally predicted heart rate. And your maximally predicted heart rate is 220 minus your age.

So if you are 40 years old, I would expect you to hit a heart rate of 180 with high levels of exercise. Of course, if you get chest discomfort or shortness of breath with exercise then you need to notify your cardiologist immediately as your life could be at risk.

How Hard Can You Push Your Heart with Exercise and AFib?

While I don’t have AFib, I love to run long distances every day that I can. And the thought of whether or not I am putting my heart at risk for AFib has certainly crossed my mind on many occasions.

If you love endurance sports, it is perfectly fine to participate as long as your cardiologist is in agreement and your heart feels great during exercise. And if you want to be safe running that marathon, try slowing your running pace. Indeed, among my “plodder” patients, or those who exercise at slow non-competitive speeds, I rarely see AFib.

Dr. Day’s 3 Thoughts on Exercise and AFib

1. The health benefits that come from exercise are too great to ignore. Everyone should exercise every day. If AFib gets in the way of your exercise then you need to get it treated immediately.

2. Ultra-endurance athletic competitions are problematic for my AFib patients. And, in general, the only way my endurance athletes can get around this is by getting the AFib “fixed” with an ablation.

3. Non-exercisers are also at high risk for AFib. Regular daily moderate levels of exercise are incredibly protective against AFib.

If you want to learn more about exercise and AFib, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418. Sorry, telemedicine visits outside of the state of Utah are no longer possible due to post-COVID government regulations.

Also, if you liked the photo attached to this article, it is a picture I took today running the Pipeline Trail with my 14 year-old daughter. From the Pipeline Trail up Millcreek Canyon, you can get a spectacular view of downtown Salt Lake City, Utah.

#316 The 4 Best Reasons Why Intermittent Fasting May Prevent Atrial Fibrillation (and an early death)

October 9th, 2021 by

The 4 Best Reasons Why Intermittent Fasting May Prevent AFib

Fasting has been shown to slow aging and help most chronic medical conditions but can intermittent fasting also prevent atrial fibrillation? In this article, I’ll share everything you need to know about intermittent fasting’s role in atrial fibrillation prevention.

Why Did I Write this Article?

My long-term readers know I’ve always been impressed by the strong data supporting intermittent fasting for longevity and cardiovascular health. Indeed, both of our books, The Longevity Plan and The AFib Cure, had a section on intermittent fasting. The reason why I chose to cover this topic again came from a recent podcast interview I heard with Dr. David Sinclair.

For those not familiar with Dr. David Sinclair, he is a Harvard University longevity researcher. And interestingly, the person who helped him write his New York Times best-seller, Lifespan, was the same person who helped me write The Longevity Plan and The AFib Cure.

In this podcast, Dr. David Sinclair reported that he doesn’t snack and only eats one meal a day. As someone who has always struggled with fasting, my goal is that writing again on the topic of intermittent fasting will help me to redouble my efforts to fast regularly. And to help you redouble your efforts, below are my 4 best reasons why intermittent fasting may prevent AFib.

1. Fasting May Slow Aging

Researchers have long known that caloric restriction, or eating the absolute minimum number of calories to keep the body functioning, makes animals of all types live longer. Indeed, if you’re a rat you’ll live 80% longer with caloric restriction. But while caloric restriction works great for animals in a controlled experiment, it is almost impossible for humans to maintain caloric restriction long-term.

The beautiful thing is that humans may not need to calorically restrict themselves to achieve this longevity boost. Indeed, intermittent fasting activates the same genes that caloric restriction does.

How does this happen? Studies show that periodic fasting activates an energy-sensing protein called AMP-activated protein kinase (AMPK), which then keeps the energy center of the cell, the mitochondria, in a “youthful” state.

With regards to AFib, as age-related fibrosis (or scarring) of the left atrium is a significant driver of AFib, anything that slows the aging process would be expected to also slow the development of AFib. Indeed, based on a study we were involved with at Intermountain Medical Center, shorter telomeres, which is a marker of premature aging, was associated with atrial fibrillation.

2. Fasting May Lower Blood Pressure 10 mmHg

When we fast, blood sugar levels are less likely to spike high. The research is pretty clear, the more time we can give our bodies a break from food the better our insulin sensitivity, the slower our body “rusts” with aging, and the lower our blood pressure runs.

And when it comes to AFib, lower is usually better. Indeed, studies show that high blood pressure doubles the risk of AFib. So if you suffer from AFib, the goal is to keep your blood pressure always below 130/80 mmHg. But if your goal is to maximize longevity, then the research suggests a blood pressure in the range of 110/70 mmHg, without the help of blood pressure medications, is where you probably need to be.

3. Fasting is Good for a 9 Pound Weight Loss

If you’re looking for a quick 9-pound weight loss, then the science suggests you may want to try intermittent fasting. For example, I have found that when I skip dinner I eat approximately 500 fewer calories for the day. And these 500 fewer calories are maintained even after accounting for any “make-up” calories I may consume on the following days.

While most people practice intermittent fasting by skipping breakfast, medical science argues the opposite. Studies show that if you’re going to skip a meal, skipping dinner is best. To optimize health and longevity, you want your calories earlier in the day rather than right before bed.

If you eat late your glucose spikes late. Perhaps this is a reason why the Japanese have long known that the best way to fatten up a sumo wrestler is to give them a big meal just before bed.

With regards to AFib, the research is pretty clear. The less you weigh the lower your risk of AFib. Even for those who have already undergone an AFib ablation procedure, our research shows that just a 5-pound weight loss will statistically increase your long-term success rate of that procedure.

 4. Fasting May Fix Diabetes

If you suffer from type 2 diabetes or pre-diabetes, intermittent fasting may be one strategy to reverse this conduction. As discussed above, fasting improves insulin sensitivity, optimizes glucose metabolism, and drops your weight. Indeed, one study in the prestigious British Medical Journal showed that periodic fasting resulted in a 22-pound weight loss and was an alternative to having to take insulin.

But before you dive headfirst into fasting to fix your diabetes, my long-time friends at Intermountain Medical Center have argued in the medical literature that you have to be very cautious with fasting as a diabetic. For example, fasting while at the same time taking diabetes medications or insulin could drop your blood sugars so low it could put your life at risk.

The bottom line is that if you suffer from diabetes and want to try fasting, you’ll need continuous monitoring of blood sugar levels and very close communication with your physician to know what to do with your diabetes medications and insulin while you are fasting.

If your goal is to get rid of AFib then anything you can do to get your diabetes under control will help. Indeed, studies show that diabetes increases your AFib risk by 40-60%. And studies also show that the higher your hemoglobin A1C or the longer you have suffered from diabetes the more likely you are to also suffer from AFib.

How to Fast?

So how should you fast? Should you only eat during a 1-2 hour time frame like Dr. David Sinclair? Or should you fast for 12-14 hours every day like the centenarians we studied in our best-selling book, The Longevity Plan?
While you could easily find 100 ways to fast on the Internet, here is how I fast. First, my goal is to fast at least 12-hours every day. So if I stop eating at 6 pm the night before then I wait to have my breakfast the next day until after 6 am. Second, I try to minimize or avoid any snacking during the day. Third, I do my best to follow my faith’s monthly 24-hour fast.
As diabetes runs in my family, I’m trying my best to keep my weight down and rest my pancreas as much as possible by intermittent fasting and minimizing or avoiding any added sugars and flour.

Will Fasting Cure AFib?

So the million-dollar question here is will fasting fix AFib? While fixing AFib is never that easy, the only study published on intermittent fasting as a way to treat AFib is the one we published in our best-selling book, The AFib Cure. In our book, we reported on our unpublished data from when we were at Intermountain Medical Center.
In the 329 patients who fasted for 24 hours monthly as part of their faith, a 20% non-statistically significant reduction in AFib was seen over a 10-year follow-up. So while fasting may not be the magic bullet to cure AFib, it just may help through the 4 ways we discussed in this article.
Of course, if you want to try fasting, please check with your physician first. For those on blood pressure or diabetes medications, fasting could lead to a dramatic reduction in blood pressure and glucose levels which could result in fainting or a worse outcome.

To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations). Also, if you liked the photo attached to this article, it is a picture I took during one of our regular trips to Lake Powell at sunset along the Utah Arizona border.

#315 The 7 Best Ways to Stop an AFib Attack

September 25th, 2021 by

The 7 Best Ways to Stop an AFib Attack

If you find yourself experiencing a very occasional incident of AFib, you need not panic provided you aren’t about to pass out, you’re experiencing chest discomfort, or you’re short of breath. Of course, if AFib is happening repeatedly then you need to see your cardiac electrophysiologist or “EP” as soon as possible. An EP is a cardiologist who has had two additional years of training in arrhythmias following their cardiology board certification.

And the off chance that such an attack might happen in a very inconvenient time—like when you’re on a long international flight, taking a cruise, or in a very remote area of the world—absolutely shouldn’t stop you from living your life.

Lots of people travel with a first aid kit. That doesn’t mean they intend to use it—it simply means they are ready in case something happens. No matter how long your AFib has been in remission from massive lifestyle changes or an ablation, I suggest having a plan of response ready to go, especially when you know you’re going to be away from a hospital or doctor for a while. As the Boy Scout motto goes: “Be prepared.”

1. “Pill-in-the-Pocket”

First, keep an antiarrhythmic medication, like flecainide, on hand for an emergency. Sometimes, my patients may also have a medication to also slow down their heart and a blood thinner in addition to the flecainide on hand for an emergency.

Even though many of our patients haven’t had an AFib episode in years following an ablation, many still keep an antiarrhythmic in their wallet, purse, or car just in case their heart ever starts fibrillating again. If nothing else, it gives them peace of mind and a sense of control should anything ever change.

2. Rehydrate

Next, always be ready to rehydrate. As dehydration is a big AFib trigger, many of our patients report that they are able to quickly get back to sinus rhythm simply by rehydrating. Always travel with clean water at arm’s reach.

3. Optimize Your Electrolytes

Third, keep your electrolytes up. Low levels of magnesium and potassium are another common AFib trigger. A quick boost through electrolyte-heavy foods, or drinks like tomato juice or low-sodium vegetable juices, is always a good bet. But if you’re going to be away from a place where you can access these foods and drinks, supplements are a good idea, especially in the case of magnesium.

4. Exercise Away Your AFib Attack

Fourth, exercise. While it may seem very counterintuitive, many of my patients report that all they need to do is to overtake their AFib heart rate with an elevated exercise heart rate to get back in normal sinus rhythm. When their heart slows after the exercise, their normal sinus rhythm is restored.

Of course, if your heart rate runs especially fast with an AFib attack then driving the heart rate up even higher with exercise wouldn’t be a good idea. For those whose hearts break speed records with AFib, option number 5 below may be a much better choice.

5. Lie Down

Fifth, lie down. If an exercise-induced increased heart rate doesn’t work for you, the opposite might do the trick. Many of my patients report that taking a nap or going to bed early when they are in AFib is the trick to getting back in rhythm.

6. Stimulate Your Vagus Nerve

Sixth, stimulate your vagus nerve. Sometimes autonomic nervous system imbalances can trigger AFib. One way to quickly correct this is through vagal maneuvers, like slow deep breathing, bearing down like you are trying to have a bowel movement, tightening your abdominal muscles, inverting your body by raising your legs or standing on your head, coughing, or taking a cold shower.

7. Get a Quick Cardioversion

Finally, if all else fails, it’s time to visit an ER during off-hours or your cardiologist/EP’s office for a quick cardioversion to restore normal sinus rhythm. For example, our practice provides same-day cardioversions during normal business hours provided you are fasting. While a cardioversion doesn’t fix the underlying AFib problem, it can provide temporary relief until your AFib is fixed either through lifestyle changes, including weight loss, or an ablation.

Concluding Thoughts

Having a plan in place to stop an AFib attack isn’t admitting defeat. Sometimes life just throws us a curveball. Let bad experiences become good data that can help you prevent another such experience. After all, for some this can be a lifetime fight.

Even people who have been “cured” from their AFib with an ablation may have that rare one-off AFib attack and then go decades without another AFib attack. Sometimes this once-in-a-blue-moon AFib attack can come from a major life stressor like a death in the family, divorce, etc., or even a massive infection.

As long as AFib is a very rare event, the symptoms aren’t worrisome, and the proper stroke prevention measures are in place then it shouldn’t cause too much concern. If, however, AFib attacks are repeatedly happening then you need a new treatment plan with your EP.

If you want to learn more about how to stop an AFib attack, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

Also, if you liked the photo attached to this article, it is a picture I took this week running out of Neff’s Canyon just after sunset in the mountains overlooking Salt Lake City.

#314 Is Fish Oil Still Good for the Heart and Longevity?

September 24th, 2021 by

Is Fish Oil Still Good for the Heart and Longevity?

Is fish oil still good for the heart? Ten or 20 years ago I would have said most definitely for the heart and possibly for longevity. Now, I’m not so sure. But before we jump into this article, let me share with you 6 reasons why I have taken fish oil in the past.

Six Reasons Why I’ve Taken Fish Oil

1. Fish Oil May Lower Blood Pressure 1-2 Points

Studies show that fish oil may have a slight blood pressure-lowering effect in the range of 1-2 mmHg. And as my long-time readers know, the goal blood pressure to prevent heart disease and to optimize for longevity seems to be about 110/70 mmHg. To put this blood pressure-lowering effect of fish oil into perspective, you could get this same 1-2 mmHg blood pressure reduction from losing just 2-4 pounds.

2. Fish Oil Lowers Triglycerides

High levels of triglycerides in the blood can cause all sorts of damage to your vascular system. And fish oil has long been proven to lower triglycerides. However, whatever benefit you may gain in triglyceride-lowering from fish oil, simply eliminating all added sugars and flour may lower your triglycerides even more!

3. Fish Oil May Keep Inflammation Levels Lower

Once again, long-term readers know that keeping inflammation levels low may be the secret to avoiding cardiovascular disease, including atrial fibrillation, and optimizing for longevity. And science suggests that fish oil may help to reduce inflammation levels. As my personal goal is to have a C-reactive protein (CRP) lab value of zero despite having a history of an autoimmune condition, this provided an additional reason for me to take fish oil. For those not familiar with the CRP blood test, a CRP reading of zero indicates no significant inflammation going on anywhere in the body.

4. Fish Oil May Promote Longevity

Although the data is weak, some studies report a longevity benefit from fish oil. For example, in this study, fish oil helps to prevent the telomere shortening that comes with aging. While many studies report that higher blood levels of omega-3’s are associated with an increased lifespan, it isn’t clear to me if this is from fish oil or from eating real fish.

5. Fish Oil May Help with Weight Loss

Once again, the data here is weak but yes, there are studies reporting that fish oil helps with weight loss. Indeed, some studies report that fish oil may reduce hunger and enhance metabolism. As one who has struggled to keep my weight in check, I was eager for any help I could get. Sadly, I didn’t notice any reduction in my hunger or an increased calorie burn with fish oil.

6. Fish Oil May Help with Dry Eyes and Dry Skin

Yes, fish oil has been shown to help with dry eyes and dry skin. And given that I live in the very dry state of Utah, my hope was that fish oil would help me better tolerate contact lenses and help to moisturize my skin. But with many of the other possible fish oil benefits, it didn’t really seem to help my dry eyes or my dry skin.

Fish Oil Doesn’t Seem to Prevent Heart Disease and Cancer

With all of the above reasons to take fish oil, one would hope that fish oil prevents heart disease and cancer. So in the biggest and most rigorous study to date, the recently completed VITAL Trial randomized nearly 26,000 patients to approximately 1 gram/day of fish oil or placebo for over 5 years. Sadly, faithfully taking fish oil for over 5 years didn’t prevent heart disease nor did it prevent cancer.

Fish Oil May Increase Your Risk of Atrial Fibrillation

While fish oil didn’t seem to impact heart disease risk, a just-published sub-study of the VITAL Trial showed a non-statistical trend toward an increased risk of atrial fibrillation from taking 1 gram/day of fish oil. To put this finding in perspective, a study using 2 grams/day of fish oil also showed a non-statistically significant increased risk of atrial fibrillation. And at the high dose of 4 grams/day of fish oil, two studies showed a statistically significant risk of atrial fibrillation. Taken together, these studies raise the possibility that there just might be an atrial fibrillation risk from taking fish oil and this potential risk may be dose-related.

Does Fish Oil Increase Your Bleeding Risk?

One area of controversy is whether or not fish oil increases your bleeding risk. Indeed, there are many studies reporting that fish oil increases your bleeding risk, especially when combined with other blood thinners, whereas other studies say there is no increased risk.

The bottom line is if you have been prescribed a blood thinner, please discuss the possibility of an even higher bleeding risk with your cardiologist or EP should you choose to take fish oil. Also, please remember that fish oil has never been proven to prevent AFib strokes.

Fish Oil in China’s Longevity Village

As you know from our best-selling book, The Longevity Plan, the centenarians we studied in China’s Longevity Village didn’t take fish oil supplements. Rather, they kept their omega 3 levels high from eating small oily fish that they caught from the river running through the village one to two times a week. And eating small oily fish is ideal for maximizing the benefit of omega 3’s to the mercury and PCBs. In general, the smaller the fish the lower the mercury/PCB dose.

Is Dr. Day Still Taking Fish Oil?

Rather than keep you in suspense any longer, let me answer this question. While I am still taking fish oil for the 6 reasons I’ve listed above, I have decreased my dosage from half that listed on the bottle to a quarter of the dose on the bottle.

My general rule of thumb to minimize supplement risks is to only take half the dose if it is a safe supplement and a quarter the dose if it is a high-risk supplement. And after reviewing the possible link of fish oil to an increased risk of AFib, I now place fish oil in the high-risk supplement category. Thus, my quarter dose represents 0.5 grams/day of fish oil which is well below the potential dosage associated with an increased AFib risk.

And while I can’t share with you which brand I buy, my second rule of thumb for buying supplements is to only buy the “Amazon Choice” options. Why Amazon Choice? The logic is simple. Amazon Choice represents the highest rated products with the lowest return rate. And while sellers may artificially raise their score through fake reviews, they can’t control which customers return the product. In my line of reasoning, if a particular supplement is making everyone sick then the return rate to Amazon is probably going to be higher.

Dr. Day’s 5 Thoughts on Whether Fish Oil is Still Good for the Heart

1. Based on my review of the medical literature, I still believe that fish oil may help lower triglycerides, inflammation, and possibly blood pressure.

2. The data for fish oil promoting longevity and weight loss is so weak that I don’t feel there is much of a benefit in these two categories.

3. While fish oil may lower your triglycerides, inflammation, and blood pressure, it probably won’t prevent a heart attack, heart failure, etc.

4. Fish oil may increase your atrial fibrillation risk which is why I’ve significantly reduced the dose of fish oil that I take.

5. Based on the potential AFib risk, it may be better to get your omega 3’s naturally from wild fish low in mercury/PCBs or from plant-based sources like flax seeds, chia seeds, or walnuts.

Given all the recent updates on fish oil and the heart, if you still want to take this supplement please discuss it with your doctor. As with everything in life, you have to carefully weigh the potential benefits versus the risks. While I shared what I am doing, my situation is probably different from what you are experiencing.

If you want to learn more about fish oil and the heart, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

Also, if you liked the photo attached to this article, it is a picture we took on one of our daily runs at 10,000 feet overlooking beautiful Park City, Utah.

#313 Get Out of AFib as soon as Possible

September 21st, 2021 by

Get Out of AFib as soon as Possible

A recent study reported that your risk of cardiac death, stroke, or hospitalization could be decreased by 22% if you can get out of AFib as soon as possible. If you’re feeling okay, is there really a rush to get your heart back in rhythm? In this article we discuss the research behind the title of this article–get out of AFib as soon as possible.


The EAST-AF Study was the recent study reporting 22% fewer cardiac deaths, strokes, or hospitalizations with an early rhythm control strategy for AFib. This study was a well-designed randomized controlled multi-center study published in the most prestigious medical journal in the world.

Indeed, of the 2,791 patients followed for over 5 years, the EAST-AF researchers found that all of the bad things mentioned above (cardiac death, stroke, or hospitalization) could be significantly reduced if patients could get out of Afib within 12 months.  I could only imagine how much more successful the results of this study would have been if they had gotten their patients back in rhythm within a day, like we do in our practice, rather than wait up to a year!

“Get Out of AFib” also Benefits Heart Failure Patients

In a follow-up to the EAST-AF Study discussed above, a new sub-study just looking at heart failure patients with AFib was published. As AFib patients with heart failure are the highest risk AFib patients, it makes sense to see whether early rhythm control also benefits the sickest of the AFib patients.

As you might expect, the 798 patients with heart failure patients with AFib in this sub-study also benefited significantly from a strategy to get out of AFib. Taken together, these two studies provide a very convincing message that people do best when their hearts are beating in normal sinus rhythm.

How Long Do You Have to Get Out of AFib?

The real question from the EAST-AF main study, as well as the sub-study, is how long do you have to get out of AFib? We certainly know that the longer you are in AFib the harder it is to correct. This is because people that have been out of rhythm too long start to have enlargement of the upper chambers of their heart from too much scar tissue.

Indeed, my co-author on the best-selling book, The AFib Cure, Dr. Jared Bunch, and I wrote an article a few years back discussing the “AFib tipping point.” The AFib tipping point is when you have been out of rhythm so long that normal sinus rhythm is no longer possible. Based on the best research available, electrical degenerative changes to the heart can start to develop within as little as 5 hours of AFib. Even more worrisome is that new scar tissue can develop within 5 weeks of uninterrupted AFib.

This AFib tipping point varies from patient to patient but in general the older you are the faster the tipping point comes. Obviously, if your goal is normal sinus rhythm then the sooner you can get out of AFib the better.

The Longer You Wait for an Ablation the Lower the Success Rate

The AFib tipping point also plays a factor when looking at ablation success rates. Indeed, in our study of 4,535 atrial fibrillation ablation patients, the sooner they could go from AFib diagnosis to ablation the better their long-term freedom from AFib. And this only makes sense as AFib causes degenerative changes to the heart so the sooner you can get out of AFib the better.

But just getting back in rhythm quickly with an AFib ablation is only half the story. The other key finding of our study was that with an early ablation our patients could also cut their death rate in this study by 2.5x as well as cut their hospitalization risk by 1.7x! Once again, when the heart is out of rhythm bad things are more likely to happen.

Dr. Day’s 5 Thoughts on Early Rhythm Control for AFib

1. The sooner you can get back in rhythm the better. As we’ve covered in this article, the longer you are in AFib the greater the chance of degenerative changes to your heart and the higher risk you put yourself in for premature death, strokes, or hospitalizations.

2. If your goal is normal sinus rhythm then why wait? If you know you don’t want to live the rest of your life out of rhythm then it only makes sense to get treatment earlier rather than later.

3. Every patient’s AFib tipping point is different. You really don’t know how long your heart can be in AFib before permanent degenerative changes occur. For some, it could be weeks to months before the AFib becomes permanent while for others it could be many years.

4. Be proactive in getting the care you need. If you are suffering from fatigue, shortness of breath, or “brain fog” from AFib then advocate for normal sinus rhythm. Sadly, I’ve seen many second opinion patients left in AFib for years all because they didn’t complain loudly enough about their AFib symptoms to their original cardiologist.

5. Discuss your AFib case with a cardiac electrophysiologist. Every AFib case is different. And because it is impossible to know what AFib treatment is right for you or when your AFib will no longer be treatable, get in to see a cardiac electrophysiologist or “EP.” EP’s are cardiologists who specialize in arrhythmias like AFib. To find an EP near you, please follow this link.

If you want to learn more and about the importance of getting your AFib treated as soon as possible, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

Also, if you liked the photo attached to this article, it is a picture my daughter took of me on one of our regular trail runs overlooking the Salt Lake City valley.

#312 Is Vitamin D Good for the Heart, Longevity, and Atrial Fibrillation?

September 10th, 2021 by

Is Vitamin D Good for the Heart, Longevity, and Atrial Fibrillation?

My answer to is vitamin D good for the heart, longevity, and atrial fibrillation is changing based on the most recent studies. While low vitamin D levels are definitely associated with heart attacks, heart failure, atrial fibrillation, longevity, cancer, infections, premature death, dementia, etc. it is becoming increasingly clear that taking a vitamin D supplement may not decrease the risk of any of these bad things happening. So what do the latest studies say and should we still take a vitamin D supplement for low vitamin D levels? Read on to learn more.

The Vital Trial

The main findings of the Vital Trial were published in 2019. This was a randomized controlled trial (RCT) which is the highest
quality study you can do. It was also published in the most prestigious medical journal, The New England Journal of Medicine.

The Vital Trial enrolled 12,987 patients and through a complex randomization process specifically evaluated whether taking 2,000 IU of vitamin D or a placebo could prevent cancer, heart attacks, strokes, or a cardiac death. To get into the Vital Trial you had to be age 50 or older if male and 55 or older if female. The reason why they picked an older age group is that at these ages the risk of heart disease and cancer start really going up.

As you might suspect, for those randomized to 2,000 IU of vitamin D, their 25-hydroxyvitamin D levels did somewhat increase from 29.8 ng/mL to 41.8 ng/mL. For those not familiar with 25-hydroxyvitamin D levels, normal is 30 to 100 ng/mL. With this in mind, you can see that the people studied didn’t really have that low of vitamin D levels, to begin with. Regardless, researchers then following these 12,987 patients for the next 5.3 years to see if this slight increase in vitamin D levels could prevent cancer, heart attacks, strokes, or a cardiac death.

Sadly, 2,000 IU of vitamin D daily did none of the above. There was no statistical difference in the number of cancers, heart attacks, strokes, or cardiac deaths between the vitamin D supplement group and the placebo group. And a just-published sub-study from the Vital Trial also showed that a 2,000 IU vitamin D supplement did nothing to prevent atrial fibrillation. Surprisingly, even in the group with super low vitamin D levels (less than 20 ng/mL) a daily vitamin D supplement still didn’t prevent atrial fibrillation.

Vital Trial and Atrial Fibrillation Risk

So what did all these millions of dollars spent on this study really teach us? Well, we learned that even though low vitamin D levels have been shown to be associated with an increased risk of atrial fibrillation, a supplement doesn’t seem to fix anything.

Of course, one could argue that only increasing 25-hydroxyvitamin D levels from 29.8 to 41.8 ng/mL is simply not enough to make a difference in arrhythmias. And it’s certainly possible that many episodes of atrial fibrillation during the 5 plus years of follow-up were probably missed as these people were not continuously monitored for arrhythmias. And given that the mean age of this study was 67, one could also argue that the results may not apply to younger patients.

Our 2011 Vitamin D Atrial Fibrillation Study

When trying to assess the results of the atrial fibrillation Vital Trial, I have to put in a plug for our 2011 vitamin D atrial fibrillation study. In this study, we looked at the impact of vitamin D on 132,000 patients within the Intermountain Healthcare system in Utah and Idaho.

In our study, the average age was 52 and 71% of the patients were women (as opposed to the 50/50 male-female mix in the Vital Trial). One finding of our study was that there was a trend toward low vitamin D levels being associated with atrial fibrillation (14% increased risk that didn’t quite reach statistical significance). However, the key finding of our study was that over-supplementation with vitamin D, driving 25-hydroxyvitamin D levels above 100 ng/mL, was associated with a statistically significant 2.5x increased risk of atrial fibrillation.

Dr. Day’s 7 Thoughts on Vitamin D

1. Vitamin D supplements probably won’t help you avoid heart problems or cancer. Vitamin D supplements also probably won’t make you live any longer.

2. Vitamin D supplements aren’t benign as we showed in our study above. Driving 25-hydroxyvitamin D levels above the normal range could result in atrial fibrillation, hypercalcemia (too much calcium in your blood), kidney failure, bone loss, and hardening of your heart and arteries.

3. While vitamin D supplements don’t protect the heart, studies suggest that natural sunlight and spending time outside regularly may protect your heart. Of course, if you’re going to get vitamin D naturally then do it in a sun-smart way so that you don’t get skin cancer in the process.

4. While low vitamin D levels are associated with just about every bad medical condition in the book, we still don’t know if low vitamin D causes these conditions or rather these if these medical conditions cause vitamin D levels to drop.

5. I personally still take 2,000 IU of vitamin D each day. The reason is that I have had my vitamin D levels tested and my levels consistently run low without supplementation. One reason for my low vitamin D levels could be due to the minimal dairy and fish I consume. It could also be due to the fact that living in the Salt Lake City area, I can only get vitamin D naturally about half of the year.

6. Even though vitamin D supplements don’t seem to help the heart or cancer prevention, low vitamin D levels can result in frequent infections, fatigue, bone or back pain, depression, poor wound healing, bone loss, hair loss, or muscle pain. Anecdotally, I noticed that since I started supplementing with vitamin D about 10 years ago, I never get sick. Of course, not ever getting sick could also be due to all of the positive lifestyle changes I made in my life at about the same time that we described in our book, The Longevity Plan.

7. If you choose to supplement with vitamin D, only do so under the direction of a healthcare provider. Vitamin D levels must be tracked if you supplement to prevent complications.

Is Natural Vitamin D Best?

Given that vitamin D supplements don’t seem to help the heart or cancer, could it be that the Vital Trial studied the wrong way to boost vitamin D levels? Indeed, given all of the studies reporting better heart health and longevity from the natural forms of vitamin D, like spending time outdoors, we need a big randomized clinical trial looking at the natural vitamin D supplements.

In our best-selling book, The Longevity Plan, we reported the results of our 5-year study of  the centenarians living in China’s longevity belt in the rural mountainous areas near the Vietnam border. While these centenarians did not take any supplements or consume any dairy, they did eat some fish and spent most of the day outside. Indeed, they enjoyed year-round vitamin D while they hand farmed every day.

Interestingly, while some centenarian studies have reported that centenarians enjoyed high normal levels of vitamin D, many of the centenarians in rural China had low vitamin D levels. Contradictory results like these tell us that we still have a lot to learn when it comes to vitamin D and longevity.

If you want to learn more and about vitamin D and your risk of atrial fibrillation, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists in our practice, please call my team at 801-266-3418 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

Also, if you liked the photo attached to this article, it is a picture I took of a moose just outside of my office window in Park City, Utah.

Is Vitamin D Good for the Heart?

#311 Ablation or Drugs First for Atrial Fibrillation?

September 10th, 2021 by

Ablation or Drugs First for Atrial Fibrillation?

Should you do ablation or drugs first for atrial fibrillation? Technically, I would argue neither as studies show that with aggressive lifestyle changes, including weight loss, up to 50% of atrial fibrillation cases can be put into remission without drugs or procedures! Assuming you have already tried lifestyle changes, let’s discuss next options–ablation or drugs first for atrial fibrillation based on three recently published meta-analysis studies.

Background Information

If you’re not sure what an ablation is, or what drugs are used for atrial fibrillation, then this section is for you. For advanced readers, feel free to skip down to the next section.

Catheter ablation is an outpatient procedure whereby a cardiologist specializing in arrhythmia treatment (cardiac electrophysiologist or “EP”) inserts catheters into the heart through a vein in the leg. And then while the patient is asleep, the “EP” will cauterize or freeze those areas of the heart that are misfiring. And the goal of catheter ablation is no more AFib and no more anti-arrhythmic medications.

Anti-arrhythmic drugs have traditionally been used first to keep hearts beating in rhythm. Under the old treatment paradigm, ablations were only recommended when drugs failed. Mechanistically, anti-arrhythmic medications change the electrical connections between cells in the heart. If everything goes as hoped then the drug keeps your heart in rhythm and you don’t have any side effects.

1. JAMA Cardiology: Ablation or Drugs First

In this recently published JAMA Cardiology meta-analysis study, researchers pooled the results from 6 randomized clinical trials (RCT’s). I should point out here that RCT’s are considered the most accurate clinical studies as by randomizing the patients to say treatment “A” vs “B” it minimizes the risk of selection bias. And selection bias can change the results of a study if researchers subconsciously recommend one treatment over another based on how “sick” the patient may be.

With 1,212 patients from 6 RCT’s available to study, these researchers came up with the following 3 conclusions:

1. Ablation is better at maintaining normal sinus rhythm.

2. Ablation results in less hospitalizations.

3. Ablation is every bit as safe as medications.

When I’ve shared the results of studies like these with patients, many have been surprised to learn that the safety profile of an ablation is similar to that of medications. And probably the reason why ablations are just as safe as drugs probably stem from the fact that we really don’t have any good medications available to keep hearts beating in rhythm. All of the anti-arrhythmic drugs can change the electrical connections within the heart thereby ever so slightly increasing the risk of a cardiac arrest. Indeed, based on my 26 years of clinical experience since medical school, I’ve personally seen far more serious complications from AFib medications than complications from catheter ablations.

2. British Medical Journal Heart: Ablation or Drugs First

Interestingly, in this recently published meta-analysis researchers used the same 6 RCT’s and the same 1,212 patients. Fortunately, when analyzing these same 6 studies, the researchers came to the same conclusion that ablations are best for keeping hearts in rhythm, keeping patients from being hospitalized, and from a safety standpoint there was no difference between the two therapies. In this world where everyone seems to interpret “the facts” differently, it is very reassuring that two different research groups came to the exact same conclusion.

3. Circulation Arrhythmia and Electrophysiology: Ablation or Drugs First

And in the third meta-analysis study published this year, the researchers writing this report only included 5 studies of 997 patients. Now why they dropped one study isn’t entirely clear. Regardless, even with only pooling the results of 5 RCT’s, this third group of researchers still came to the same conclusion. If your goal is no atrial fibrillation then ablation is your best option. And if you don’t want to get hospitalized then once again ablation is your best choice. Finally, safety was the same whether you choose ablation or drugs first.

Dr. Day’s 7 Thoughts on Ablations vs. Drugs First for AFib

1. It’s critical to remember that up to half of all patients can maintain normal sinus rhythm without drugs or procedures provided they quickly adopt aggressive lifestyle changes including weight loss. The key here is that lifestyle changes need to happen fast like the second you are diagnosed with atrial fibrillation. The longer your heart is out of rhythm the harder it is to correct. And for those patients who are already at a lean body weight, atrial fibrillation may not be reversible unless there are significant stressors or other obvious medical conditions that need to be treated.

2. While the “average” patient can only expect one to two years of normal sinus rhythm with an anti-arrhythmic medication, I’ve certainly seen patients go one or two decades with perfect rhythm control and no side effects. While these patients are definitely outliers, it is still possible to have excellent results from medications. And the patients that seem to do best with medications are those patients who use medications only temporarily until they can drop 20 or 30 pounds, get their sleep apnea treated, bring their blood pressure under control, etc. so that they can then maintain normal rhythm naturally without the aid of drugs.

3. For those patients in whom it is impossible to maintain normal sinus rhythm with lifestyle changes alone, and do not want to be stuck on medications for the rest of their lives, ablation is an excellent choice. Indeed, I have countless patients who have combined healthy living with an ablation and have been living without AFib for many, many years.

4. The 3 meta-analysis studies discussed in this article are very reassuring from a safety standpoint. As the technology has improved over the years, so too has the safety profile of this procedure. And with the new technologies currently being studied, like pulsed field ablation, my prediction is that in the next few years ablation will be much safer than anti-arrhythmic medications.

5. For my young and athletic patients there is no question that the vast majority do better with ablation. For most younger patients, like anyone under age 65, they don’t like taking medications and they definitely don’t like the way most of our anti-arrhythmics make them feel. Likewise, our athletic patients generally can’t compete with these drugs holding their hearts back. And for this reason, I generally recommend an early ablation for my young and athletic patients when lifestyle changes either don’t work or are not possible.

6. While ablation is usually the answer for the young and athletic, in an older patient anti-arrhythmics may be recommended first. And by older I mean over 80 years old. Why this number? Based on our studies, while we can successfully get our 80 year olds safely through an ablation procedure, the success rates of maintaining normal sinus rhythm are not as high as what we see in our younger patients. Here are the links to our published studies on ablations in 80 year olds: 1st study. 2nd study.

7. At the end of the day the answer to whether ablation or drugs first for atrial fibrillation is a question best left to a personal discussion between you and your “EP.” Each patient is different and no two cases are the same. Find a cardiologist specializing in atrial fibrillation ablation and have a “heart-to-heart” discussion as to what is best for you.

Ablation or drugs first for atrial fibrillation?

If you want to learn more, be sure to check out our best selling book, The AFib Cure. Or if you would like to meet with me, and you can make it to our clinic in Salt Lake City, Utah, to discuss ablation or drugs first for atrial fibrillation, please call my team at 801-266-3418 (sorry tele-med visits outside of the state of Utah are no longer possible due to government regulations).

Also, if you liked the photo attached to this article, it came from my daughter’s iPhone on our mountain bike ride this week. She took the photo from the Wasatch Crest Trail near Park City, Utah overlooking Desolation Lake at sunset. At an elevation of approximately 10,000 feet above sea level, the Wasatch Crest Trail is my favorite trail in the world to run or mountain bike.

#310 10 Tools To Combat Sugar Cravings

April 10th, 2021 by

10 Tools To Combat Sugar Cravings

By Kate Clemens

Added sugars in the diet is one of the leading causes of weight gain. And as you know, keeping those extra pounds off is critical to avoiding heart disease – especially atrial fibrillation. Below are 10 tools to combat sugar cravings.

1. Hydrate

Often sugar cravings are a sign of dehydration.  Before you give in to that sweet tooth because to quench your thirst.  You may just find that craving loses its grip on you.   I love to add a tiny pinch of sea salt and squirt of lemon to my room temp water.  Because of its mineral content, sea salt is a great source of electrolytes and lemon is the king of citrus when it comes to those electrolytes!

 2. Eat Naturally Sweet Foods

Sweet is one of the five basic tastes that our taste buds perceive and guess what? Nature has provided plenty of sweetness for our satisfaction.  To avoid craving artificial sweets (which have no nutritional value!) be sure to incorporate plenty of naturally sweet foods into your diet.   Sweet potatoes, butternut squash, strawberries, yams and cinnamon are my favorites.

3. Sleep

When we are sleep deprived our bodies look to a quick fix for energy and we are vulnerable to those sugar cravings.   If you find yourself constantly fatigued it is time to analyze your sleep habits.  Of course we are not going to always be able to get that idealized 8 hours of sleep.  A great trick to combat fatigue is a simple 5 minute eyes closed reset when that feeling of utter exhaustion hits you.

4. Kick the caffeine to the curb

The highs and lows of this stimulant include blood sugar swings, dehydration and mineral depletion.  All of which will increase your cravings for the white stuff.

5. Use Gentle Sweeteners (if sweeteners are even needed)

If you are going to use sweeteners, opt for the gentle ones.  These include maple  syrup,  brown  rice  syrup,  raw honey, dates, blackstrap molasses,  coconut  sugar, stevia and monk fruit.

6. Move Daily

Whether this is walking, jogging, swimming, dancing, gardening – get that beautiful body in motion!  Even just 15 minutes a day will help balance your blood sugar levels and reduce tension.

7. Forget about Fat-Free

Typically when makers remove the fat, they add in sugar to compensate.  Plus, fat free processed foods are far from satiating and will leave you hungry.  Which of course leads to sugar cravings.

8. Get Enough Protein

Take inventory of how much protein you are eating. Adequate protein intake is a sure way to stabilize blood sugar levels and stave off sugar cravings.  Be sure to choose high-quality whole food sources like lean meats, fish, chicken, nuts, and legumes.  To figure out your daily requirements, it is wise to run the calculations based on your age, weight, activity level and health goals.   Here is a great free calculator from bodybuilding’s website: https://www.bodybuilding.com/fun/calpro.htm

9. Add Some Spice to Your Life

Spices naturally sweeten your food and satisfy your sweet tooth.  My favorite is cinnamon which has also been shown in research studies to lower blood sugar levels.   Other sweet spices to experiment with are nutmeg, cloves, cardamom and coriander.

10. Make Life Sweeter

Enjoy extra time with and hugs from family – soon enough you can add friends to that hug list too I hope (post pandemic).  While your body can survive with zero processed sugar, we all know that it needs connection to thrive.   Be good to yourself and practice self love and care.   Warms baths, walks in nature, meditation, stretching, massage and breathing exercises are all easy ways to give yourself a little TLC.

Kate Clemens Bio

Kate Clemens is a licensed Health Coach, personal trainer, nutritionist and yoga instructor.  She is currently in her clinical year of PA school through the Yale School of Medicine online and just finished a month long preceptorship with Dr. John Day.

Kate has worked in the wellness industry for over 15 years now.  Her passion for guiding people to their optimal health was ignited in 2003 when she was designated Command Fitness Leader at the Pentagon as a young naval officer.  What she has learned from working with hundreds of diverse clients is that 90% of people want to and attempt to change, but fail.  Significant research studies have proven that behavior change strategies are essential to helping people obtain the new habits they need to reach their goals.  As a wellness professional, Kate’s mission is to provide specific support, a specific plan and personalized reinforcement to those she works with.

Today, Kate resides in Santa Cruz, CA and works with clients both in person and online.   Contact her today to get started!


(415) 676 0353


#309 10 Bad Conditions Linked to Low Magnesium

April 10th, 2021 by

10 Bad Conditions Linked to Low Magnesium

By Kate Clemens

Low magnesium levels have been linked to the following 10 bad conditions:  atrial fibrillation, heart attacks, cardiac arrests, Alzheimer’s disease, diabetes, high blood pressure, osteoporosis, headaches, osteoporosis, and cancer.  Clearly, no one wants any of these conditions. 

Scientific literature shows that magnesium intake has decreased over the years especially in the Western world.  Deficiency is not uncommon among the general population and prominent cardiologists have even called magnesium deficiency a principal driver of cardiovascular disease and a public health crisis.

Since less than 1% of our total Mg is in our blood serum (50-60% is in our bones and then the rest is in our soft tissue), it can be difficult to measure our levels.  However, we can easily assess whether or not we have symptoms of magnesium deficiency.  Are you deficient?

Magnesium: What is it?

Magnesium is a mineral found in the sea, plants, the earth,humans and animals.   In fact every cell in your body contains it and needs it to function!  

As the second most abundant intracellular cation after potassium, it is a cofactor in more than 300 enzyme systems that manage various biochemical reactions in the body. To name a few of its important roles, magnesium is required for muscle contraction and relaxation, ATP metabolism (which is vital to energy production), bone formation, blood pressure, heart rhythm and normal neurological function.

The great news is that  this mighty mineral is plentiful in so many delicious and healthy foods.  While using Food as medicine to intake our nutrition is the ideal way to go, fortunately there are many quality magnesium supplements out there today.   More information to follow at the end of this article.  

15 Mighty Magnesium Rich Foods


SPINACH (BOILED)   1C   157 mg 
SWISS CHARD (BOILED)   1C   150 mg

(75-80% CACAO)

  1 OZ   64.6 mg
CASHEWS   1 OZ   74 mg
MACKEREL   3.5 OZ   75.4 mg
FLAXSEED (WHOLE)   1 TB   40.4 mg
ALMOND BUTTER   2 TBS   89.3 mg
PUMPKIN SEEDS   1 TB   47.7 mg
AMARANTH   1 C   159.9 mg
BLACK BEANS (BOILED)   1 C   120 mg
AVOCADO    50 G (⅓ of whole)   20 mg
QUINOA (COOKED)   1C   118 mg
EDAMAME (SHELLED)   1C   99.6 mg
MUNG BEANS (COOKED)   1C   97 mg
BANANAS (RAW)   1 medium    32 mg

A Mighty Magnesium Breakfast


1 Ezekiel Sprouted Grain Tortilla  (48 mg Mg)

1 medium banana (32 mg Mg)

2 TBs almond butter (89.3 mg Mg)

1 TB Flaxseed (40.4 mg Mg)

½ c strawberries (9 mg Mg)

½ blueberries (5 mg Mg)

Cinnamon (to stabilize blood sugar!!)


1.  Warm up your tortilla in the toaster

2. Spread your almond butter in the center of the tortilla

3. Lay your banana on top of the almond butter

4. Sprinkle on your flaxseed seed and cinnamon

5. Rinse and dry your berries and add them as a side dish.

Bon Appetit!

Should You Supplement?

When making a decision on whether or not to supplement, it is vital to know your numbers and consider certain factors.  Keep in mind that the recommended daily intake (RDI) includes mg from the foods we eat as well as supplements we ingest.  Also, please discuss with your physician whether or not supplementing is right for you. Some factors for consideration:

1. What is my intake? 

Your magnesium needs are based on your age and sex.  Compare your intake to the Recommended Daily Intake (RDI) from the National Institutes of Health’s table below.

Not sure if you are getting enough magnesium? Try using the free smartphone app, Cronometer app, to record everything you eat for a week to see where you end up.

2. What medications do I take that may be interfering with magnesium absorption?

The most common medications blocking magnesium absorption include the proton pump inhibitors such as such as Prilosec (omeprazole) or Prevacid (lansoprazole), diuretics, and metformin.  

3. Do I have other medical conditions like kidney disease?

4. Do I drink more than one alcoholic drink per day?

5. Do I experience restless sleep and wake frequently during the night? 

Which Magnesium Supplement is Best?

1. Magnesium Glycinate — This type is considered ideal when trying to correct a deficiency because it is in a form that is easily absorbed.  It also has less tendency to cause loose stools.  It is most helpful for inflammatory conditions, insomnia, stress and anxiety. 

2. Magnesium Chelate — This form is in a similar state as the food we eat and as well is easily absorbed by our body.  “Chelated” simply means the mineral is bound to a chelating agent, such as an amino acid, to improve absorption. 

3. Magnesium Citrate — Only use this form if your purpose is to increase bowel movements.  It is a saline laxative that increases fluid in the small intestine.  

4. Magnesium Threonate — This is considered the only type of mg that can easily cross the blood-brain barrier and penetrate cell membranes.  It is used for its potential brain benefits. 

Do Magnesium Supplements Cause Diarrhea?

Approximately 20% of people who take Mg supplements can experience diarrhea and loose stools when taking 600mg or more per day.   It is best to stay closer to the 300mg range or less.

Low Magnesium: A Very Preventable Condition

Fortunately, low magnesium is something that is easily correctable for most people. Of course, by getting your magnesium levels where they need to be is no guarantee that you can avoid any of the 10 bad conditions associated with low magnesium levels in medical studies (atrial fibrillation, heart attacks, cardiac arrests, Alzheimer’s disease, diabetes, high blood pressure, osteoporosis, headaches, osteoporosis, and cancer). However, if you can minimize or avoid added sugars and processed foods, while at the same time eating enough magnesium rich foods to top off your magnesium levels by diet alone then you are probably eating in a way that will significantly minimize your chances of developing any of these 10 bad conditions. 

Kate Clemens Bio

Kate Clemens is a licensed Health Coach, personal trainer, nutritionist and yoga instructor.  She is currently in her clinical year of PA school through the Yale School of Medicine online and just finished a month long preceptorship with Dr. John Day.

Kate has worked in the wellness industry for over 15 years now.  Her passion for guiding people to their optimal health was ignited in 2003 when she was designated Command Fitness Leader at the Pentagon as a young naval officer.  What she has learned from working with hundreds of diverse clients is that 90% of people want to and attempt to change, but fail.  Significant research studies have proven that behavior change strategies are essential to helping people obtain the new habits they need to reach their goals.  As a wellness professional, Kate’s mission is to provide specific support, a specific plan and personalized reinforcement to those she works with.

Today, Kate resides in Santa Cruz, CA and works with clients both in person and online.   Contact her today to get started!


(415) 676 0353


#308 9 Signs You Aren’t Getting Enough Potassium

April 10th, 2021 by

9 Signs You Aren’t Getting Enough Potassium

By Kate Clemens

I was surprised to hear from Dr. John Day, the author of “The Longevity Plan” and “The AFib Cure”, that most patients in his practice aren’t getting enough potassium in their diet.  He even tracked his own potassium intake with the Cronometer app and learned how hard it is to get the recommended daily amount – which will be noted later in this article. 

It makes one wonder, could the potassium deficiency in our diets account for the 90% chance of becoming hypertensive by age 55?  This shocking statistic stems from the Framingham Heart study investigators who concluded that the residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%. Even more alarming is a study that shows low potassium may increase your risk for atrial fibrillation, a heart arrhythmia, fourfold.   Let’s delve a bit deeper into this chemical element that is oh so important for our well being! 

Potassium: What is it?

Potassium is the primary cation (positive ion) within your cells – in fact this is where more than 90% of your total body stores reside.  So many enzymatic reactions are activated by potassium.  

Sufficient potassium is essential in maintaining a healthy blood pressure. It is not surprising that this vital electrolyte has many other essential roles. Potassium is a key player in the transmission of nerve impulses, kidney function, gastric secretion, and the contraction of all types of muscle tissue. 

It’s worth pointing out that potassium plays a critical role in the transmission of electrical impulses in the heart. Thus, potassium levels have to be carefully monitored as hypokalemia (low potassium levels) or hyperkalemia (high potassium levels) may cause life-threatening arrhythmias.

The 9 Signs You Aren’t Getting Enough Potassium

1. Heart palpitations

2. Atrial fibrillation

3. High blood pressure

4. Muscle cramps and spasms

5. Weakness and fatigue

6. Tingling and numbness

7. Breathing difficulties

8. Mood changes

9. Digestive problems

What Causes Low Potassium?

It is important to keep in mind the above symptoms will generally only be present with significantly low levels of potassium in the blood – which is known as hypokalemia.   While possible this could definitely occur from too little potassium in your diet, most often hypokalemia (low potassium levels) occurs from taking a diuretic. Other common causes of hypokalemia include the following: vomiting, excessive sweating, low magnesium levels, alcoholism, adrenal gland disorder, asthma medications like albuterol, laxatives, high levels of ketones in your blood like with diabetic ketoacidosis, and antibiotics such as penicillin or ampicillin.

What Causes High Potassium?

The number one cause of hyperkalemia or high potassium levels is kidney dysfunction. Next in line is taking too much potassium supplements or potassium sparing diuretics, such as spironolactone or aldactone. Other causes include dehydration, beta-blockers, and the commonly prescribed blood pressure medications ACE inhibitors or angiotensin receptor blockers.

Where Should Your Potassium Levels Be?

Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L).   However, with regard to atrial fibrillation risk, you will want to keep your levels as close to 4 mmol/L as possible.  

How Much Potassium Should You Eat Each Day?

Like any nutrient, recommended daily intake levels for potassium are based on age and gender.   Here are the most recent adult recommendations determined by the National Academies of Sciences, Engineering and Medicine: 3,400 milligrams/day for males and 2,600 milligrams/day for females. However, for women who are pregnant or breastfeeding the recommendation increases to 2,800–2,900 milligrams/day.

How Do You Know How Much Potassium You’re Getting?

Are you curious whether or not your potassium intake is adequate for your needs? Why not devote a few days to tracking for free!  www.cronometer.com is a great resource that will allow you to do this easily and at no cost.  You simply need to provide a valid email address and create an account, which takes only 1 minute.  Go for it!

Whether you decide to track your potassium or not, below is a table with foods that surely pack a potassium punch.  

13 Potassium Packed Foods


                FOOD    SERVING SIZE     Potassium CONTENT
SPINACH (BOILED)   1C   839 mg 
SWISS CHARD (BOILED)   1C   96 1mg
SWEET POTATO   1 large   855 mg
BEET GREENS (BOILED)   1C   1309 mg
DRIED APRICOTS   1/2C   755 mg
COCONUT WATER   1C   600 mg
ACORN SQUASH   1C   896 mg
PINTO BEANS (BOILED)   1C   746 mg
AVOCADO    50G (⅓ of whole)   357 mg
LIMA BEANS (COOKED)   1C   955 mg
BANANAS (RAW)   1 large   487 mg

Should You Supplement? 

Potassium supplementation should be under the direction of a physician as the consequences of hypokalemia or hyperkalemia could be cardiac arrest. This is why all over-the-counter potassium supplements come in an incredibly low dose. Keep in mind that you can get far more potassium from food sources than an over-the-counter potassium supplement!  Meaningful potassium supplements can only be obtained with a prescription and these prescription potassium supplements are usually only needed for people who are on diuretics or who have specific potassium wasting medical conditions. Thus, for you  health conscious people without these medical conditions your goal should be to focus on potassium rich foods with special awareness that you may need more of these foods if you are an avid exerciser or exercise in the heat.






Kate Clemens Bio

Kate Clemens is a licensed Health Coach, personal trainer, nutritionist and yoga instructor.  She is currently in her clinical year of PA school through the Yale School of Medicine online and just finished a month long preceptorship with Dr. John Day.  

Kate has worked in the wellness industry for over 15 years now.  Her passion for guiding people to their optimal health was ignited in 2003 when she was designated Command Fitness Leader at the Pentagon as a young naval officer.  What she has learned from working with hundreds of diverse clients is that 90% of people want to and attempt to change, but fail.  Significant research studies have proven that behavior change strategies are essential to helping people obtain the new habits they need to reach their goals.  As a wellness professional, Kate’s mission is to provide specific support, a specific plan and personalized reinforcement to those she works with.  

Today, Kate resides in Santa Cruz, CA and works with clients both in person and online.   Contact her today to get started!  


(415) 676 0353



#307 The Promise of The Atrial Fibrillation Cure

February 16th, 2021 by

The Promise of The Atrial Fibrillation Cure

Our latest book, The Atrial Fibrillation Cure, comes out today! For the week leading up to the release, The Atrial Fibrillation Cure has maintained a Number 1 New Release status on Amazon. This book is the ultimate source for anyone suffering from this condition. And let me share with you the “promise” of The Atrial Fibrillation Cure which is what you’ll read in the first 11 pages of the book.


Much of what you’ve heard about AFib is true. Much isn’t. Here’s the real story.

The first time you experience atrial fibrillation is likely to be the scariest moment of your life.

Everything is fine. And then, just like that, it’s not. All of a sudden your heart is pounding away.

One hundred and forty beats a minute.

Then one hundred and sixty.

Then one hundred and eighty.

That’s two or three times faster than it should be going. Just like that, something you’ve taken for granted for your entire life instantly becomes the only thing that matters. You can feel it throbbing in your neck. You can hear it pounding in your ears. Your chest hurts. You become lightheaded.

If you’re standing, you sit down. If you’re sitting, you lie down. You think you’re dying.

What is going on?

Oh no, I’m having a heart attack,” you think, and the sound of that thought seems to be screaming in your head.

You reach for the phone. The numbers seem so small. Your hands are shaking.

“It’s just three numbers, for goodness sake, why can’t I dial three simple numbers!?”

It feels like it’s taking forever. And it feels like, at any second now, it might be too late.

Finally, the call connects.

“911, what’s your emergency?”

“I… don’t know… my heart… it’s… out of control.”

“Stay calm,” the emergency dispatcher says. “Help is on its way.”

The dispatcher stays on the line and tries to collect some additional information from you. Your name. Your address. Your location inside your home. You’re having trouble answering basic questions. Your thoughts turn to your family.

“Will I ever see them again?”

If you’re a praying person, this is when you pray. And sometimes even if you’re not a praying person, this is when you pray.

The operator asks if you can make it to the front door. You say that you’ll try. Everything seems like it’s happening in slow motion. Everything, that is, except your heart; it seems like it’s beating even faster now.

“How is that even possible!?”

You make it to the door. You unlock the deadbolt. Somehow, that simple act feels like a victory. You slide to the floor. There’s nothing to do, now, but wait.

If you live in an urban area, you might wait for about six minutes; that’s the average wait time, for instance, in the U.S. state of Illinois. If you live in a more rural area, it might be 35 minutes or more before someone comes to help you; that’s how long it takes, on average, in Wyoming.[i] Either way, these are likely to be the longest minutes of your life.

Who Gets AFib?

If you’ve had an experience like this, or know someone who has, you’re certainly not alone. Atrial fibrillation is a condition characterized by unpredictable episodes of chaotic electrical activity in the heart’s upper chambers, causing rapid and irregular heartbeats that just gets worse with time if not treated. It is the most commonly diagnosed arrhythmia (a condition in which the heart beats abnormally) in the world. U.S. presidents George H.W. Bush and Richard Nixon both had it. So did vice presidents Joe Biden and Dick Cheney. So did singers Barry Manilow and Elton John. So did comedians Ellen Degeneres and Howie Mandel. So did basketball hall of famers Larry Bird and Bill Bradley. The list goes on and on.

One in four American adults will suffer from atrial fibrillation at some point in their lives,[ii] and some studies suggest that, for some groups in the United States, the risk of developing AFib might be as high as one in three.[iii] All told, more than 60 million adult Americans are likely to suffer at least one AFib episode in their lives. And that’s just in the United States; the global population is also growing, it is also aging, and the incidence of AFib appears to be increasing. Worldwide, 65 million people over the age of 35 have already been diagnosed with AFib.[iv] Many, many more simply haven’t been diagnosed yet.

These people do not suffer from this condition alone. Their partners suffer, too. So do their parents, siblings, children and friends. And because the average cost for treating atrial fibrillation hovers around $20,000—and is often much more than that,[v] even people who are fortunate to not have had a personal experience with AFib are indirectly impacted by higher insurance rates that support others in the pool, or higher taxes to support those who are uninsured, under-insured, or insured through government programs. That’s not to mention the costs attributed to lost productivity.[vi]

If you’re reading this book, though, chances are that you have had a direct experience like the one described above, or you know someone who has. Usually, these are frightening experiences that impact older people, but that is changing.

AFib Now Strikes the Young

We’ve seen those changes first-hand. What we are going to cover in the rest of this book represents more than 20 years of our research and clinical experience in treating thousands of AFib patients around the world.

Cardiologists who specialize in arrhythmias are called electrophysiologists, or EPs for short. Back in the 1990s, a newly minted EP, fresh out of residency, would likely have been very surprised to have met an AFib patient under the age of 50. Just a few decades later, though, the patient demographic landscape has changed. Now, doctors regularly see patients who are seeking treatment for AFib in their 40s, their 30s, and sometimes even their 20s. That’s in no small part because of our dreadfully poor diet and exercise habits, ever increasing waistlines, lack of restorative sleep, and over-stressed lives—a perfect storm for premature aging and AFib (as we’ll come to see quite well in Chapter 1.) Indeed, AFib may be a warning sign that you are aging too fast and that you may be wearing out your heart long before its time.

And, in fact, you may be wearing down everything, right down to your chromosomes. For example, our study of more than 3,500 patients demonstrated that people with atrial fibrillation tend to have shorter telomeres—the deterioration-protective caps at the ends of each chromosome—which is a sign of premature aging.[vii] So, if you have been diagnosed with AFib, it’s not just your heart that is at risk; your whole body may be aging faster.

Another reason why we are seeing so many more young people with AFib is a positive one. We now have a myriad of consumer technologies that can detect AFib easier and earlier than ever before. Many smartwatches can now detect signs of potential AFib even before an arrythmia episode occurs. As tech giants eagerly promote consumer “wearables” that can easily diagnose this condition without the help of a doctor, what was once a rarely talked about heart condition now is a common topic in consumer technology spaces. These devices are a big part of the reason why more than 2 million Americans who are under age 65 will be diagnosed with atrial fibrillation in the coming year alone.[viii]

Gavrilo’s Journey

And there is another reason for the increase in people seeking information about atrial fibrillation—a reason exemplified by the experience of a 27-year-old patient named Gavrilo.[ix] His story begins during the holidays.

“For Christmas, my fiancée offered to pay for a pretty extensive DNA test for both of us, and I was excited for several reasons, both of which were related to the fact that I am adopted,” the software engineer from San Francisco explained. “First, I really wanted to better understand where my family came from. I’d always been told that part of my family came from Serbia, but I didn’t know anything more than that. Second, because I don’t know my birth parents, I can’t ask them about my family health history. Does cancer run in our family? Does heart disease? I have no idea. So, I wanted to know as much as I can to fill in all those blank spots.”

Gavrilo’s DNA test showed he had inherited one copy of each of the two atrial fibrillation SNPs (which stands for single nucleotide polymorphisms and is pronounced “snips.”) This genetic abnormality upped his lifetime risk of AFib to nearly 1 in 2.

“Honestly, up until that point, I don’t think I’d ever even heard of atrial fibrillation,” he said, “but the test sent me into ‘research mode,’ and I was pretty surprised to learn how common it actually is.”

He was also surprised to learn how much it could impact his life, if it wasn’t addressed. Not only were his chances of getting AFib higher, but so was his risk of blood clots and strokes.

“I was about to be married,” he said. “We were already talking about having children, and obviously I wanted to make sure I would be around for all that, but also that I would be able to do all of the things I never got to do with my own birth father—wrestling around, playing soccer, going on hikes, all that sort of stuff.”

Gavrilo had never had an episode of AFib, and he was determined to do everything he could to make sure he never would—thus his scramble for answers about what he could do to prevent this condition from ruining his life. In doing so, Gavrilo joined other “proactive preventers” who have seen the destruction AFib has brought into the lives of their parents, grandparents, or siblings, and are committed to keeping it from striking them in the way it did their loved ones.

Although it is exceptionally common, AFib doesn’t get much attention in the media. It’s not a well-known disease. Like Gavrilo, most people hadn’t even heard of it until they have been diagnosed with it, had a loved one who had it, or learned they had a genetic predisposition for it. But once a diagnosis is made—whether in the emergency room, prompted by an EKG-enabled smartwatch, or precipitated by a genetic test, everyone wants to know as much as they can.

That’s probably why you’re here. You’ve been looking for answers. And, if you’re like many people, much if not most of what you’ve learned so far is likely quite disheartening.

You might, for instance, have already run across the statistic that 14 percent of people diagnosed with AFib will pass away within one month of diagnosis.[x] That’s a research-backed estimate, although it’s also important to put this stat into context: the vast majority of people diagnosed are over 65. Even still, 65 is hardly “old.” Or it shouldn’t be, at least. Today, our mid-60s are a time in which most people should be able to live a healthy and active life, confident that they have decades more to come.

You’ve probably also learned—either by experience, from a doctor, or by doing your own research—that this arrhythmia often comes with palpitations, rapid heart rates, dizziness, chest pain, shortness of breath, lightheadedness and, sometimes, fainting spells. You’ve also likely discovered that the drug options for treatment come with a long list of side effects, increased risks for other debilitating conditions, and a substantially reduced quality of life. You may have found out that AFib drastically increases the risk of strokes, heart failure, cognitive decline, and dementia. In fact, every time a person’s heart shifts into AFib, the blood flow to their brain is compromised, meaning their brains are constantly being starved of oxygen.[xi] As a result, their brain may actually shrink, potentially putting them at risk of suffering from decreased memory, difficulties in language use, challenges in how their brains processes visual images, and trouble paying attention.[xii] In fact, our research team has discovered that many of the same biomarkers of brain injury that are elevated after a concussion are also chronically high in atrial fibrillation patients—a reflection of the chronic insult of the abnormal heart rhythm on the brain.[xiii] Indeed, one study showed that fully 40 percent of people with AFib have visible brain damage on a MRI, even if they have no prior neurologic symptoms.[xiv] And all of these brain changes may help to explain why so many people whose have always felt quite intelligent and “high functioning” come to us for help; their brains are no longer capable of functioning at high levels when their heart is out of rhythm.

Indeed, the outlook sure seems bleak. So it is no wonder that researchers have found that people who have been diagnosed with AFib are more likely to report declines in their satisfaction at work and home, a decrease in enjoyment of leisure time, a reduction of social activities, and a drop in their satisfaction with their sex lives.

But it’s time for a change in perspective.

AFib can be the worst thing that ever happens to you—but it can also be the best.

No, really.

AFib is a canary in the coalmine when it comes to many other diseases—a literal heart-felt warning that something is amiss and even more is likely to go wrong, very soon. Because of this, the health optimization strategies offered in this book won’t just help you prevent and reduce the occurrence of dangerous arrhythmias; these strategies will help you live longer, healthier and happier lives in every way.

And so…

… if you don’t want to take handfuls upon handfuls of medications for the rest of your life…

… if you don’t want to go from one doctor to the next…

… if you don’t want to be a prisoner to your condition…

… if you don’t want “the healthy part” of your life to be over…

… if you don’t just want hope, but direction…

… and if, indeed, you’d like to start working toward a life that is better than it was before the words “atrial fibrillation” were part of your vocabulary…

… then this book is for you.

Feeling a bit skeptical?

Maybe a lot skeptical? That’s good. We live in a world in which it’s often far easier to find snake oil than real science, and where people throw words like “cure” around without regard for the damage that can be done to people who get their hopes up, only to have those hopes dashed on the rocks of reality. In this journey, your skepticism will serve you well.

But skepticism and optimism are not mutually exclusive ideas. And the science suggests that there’s plenty of room for people with AFib to feel hopeful and confident about the future, especially if those people are willing to ask questions and seek answers.

And at this point, you probably have a lot of questions related to the path we will explain in this book. Some of the common ones include:

Do I have to quit my doctor?

Do you like your doctor? And does your doctor want you to be well? If so, then you should very much keep that doctor on your team. And, to be clear, this book is absolutely NOT a replacement for a doctor. (This book is intended to help educate you about AFib. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment!) And, in fact, if you don’t have a doctor, what you’re going to learn in this book is that you really need to find one. In particular, you need to find a great electrophysiologist—a doctor who specializes in arrhythmia care and can help you understand your heart by helping you understand what it’s trying to tell you. (More on that later.)

Do I have to be a risk taker? 

Absolutely not. The risks are greater—so much greater—for those who stick to the status quo of a lifetime of medications and increasingly debilitating symptoms. Studies show that not only can the lessons in this book extend your life, but following the guidelines offered here will likely, and quite dramatically, improve the quality of your life.

Is this something only for young people?

By young do you mean 80? Patients in their late 80s have used the lessons in this book to beat back their AFib by taking advantage of transformational procedures, giving up blood thinners and heart rate controllers, and making lifestyle choices that help them optimize their lives.

Do I have to be into technology?

No, but you should be willing to collect some very basic data about your life—tracking your meals and workouts—as well as wear an EKG-enabled smartwatch. If you’re tech-savvy, all the better, but the basic tech that makes The AFib Cure possible is so simple a toddler could use it.

This isn’t speculative. It’s true that the idea of a “cure” for atrial fibrillation doesn’t align to the traditional view of this condition and can still, for now, rightly be called an “alternative” course of treatment, but it’s also a course of treatment that is backed by published medical studies—lots of them.

It’s also backed by a lot of people’s experiences. There’s a quickly growing group of people who have resolved to reject the traditional view that atrial fibrillation is best treated with daily handfuls of medications and that, even then, it always gets worse over time.

And here’s the really good news: The AFib Cure can work for anyone.

That doesn’t make it right for everyone, though, for there’s a big difference between people who can succeed on this plan and those who would be better off just sticking to the traditional way of dealing with this condition.

The traditional treatment regimen is good for people who:

1.  Accept atrial fibrillation as a lifelong medical problem.

2. Don’t mind taking medications for the rest of their lives.

3. Believe that feeling bad is just part of getting older.

The AFib Cure requires people who are:

1.  100 percent committed to seeing an immediate improvement in their lives.

2. Believe it’s important to do everything they can to put AFib into remission by prioritizing natural interventions.

3. believe that age doesn’t need to be an indicator of health.

There are a lot of people in that latter group. In this book, you’re going to meet some of them. Their stories are inspiring. More importantly, their experiences provide a roadmap for those who want to slow, stop and even reverse their AFib.

To do that, though, we can’t just give you a “do this” and “don’t do that” checklist. To take full advantage of the transformative power of this guide, you’ll need to develop a better understanding of the mysteries of this condition. Indeed, you’re going to need to understand what’s happening in your heart and in your body, and why. You don’t need to go to medical school to “get it” though. Once it’s been explained in the right way, anyone can learn what they need to know to mount a sophisticated attack on their atrial fibrillation.

Are you ready for that? If so, there is absolutely no time to lose.

That’s what the family of a 55-year-old police officer named Carl recently learned.

Like a lot of people who are first diagnosed with atrial fibrillation, Carl was almost immediately put on a very commonly prescribed antiarrhythmic medication, flecainide, which was intended to decrease the amount of time his heart spent out of rhythm.

Pills are the direction most patients go. Indeed, that’s the direction most doctors advise them to go. It’s the easy road, after all—or at least it looks that way on the surface.

Pop a few pills, and your heart will stop going crazy all the time. No invasive procedures are needed. No big changes in your life are required. That’s what patients are often told, at least. And even when they’re not told that directly, it’s often what they come to tell themselves.

But the side effects of flecainide can be awful. There’s fatigue, brain fog, weakness, dizziness, tremors and headaches. Weight gain, anxiety and depression are common. Vision problems. Nausea. Diarrhea. And even though this medication can substantially reduce a patient’s risk of another AFib episode, some research has suggested that it might increase the risk of sudden cardiac death by 50 to 60 percent.[xv]

And notwithstanding the serious side effects of medications like flecainide, they don’t actually work very well. With the exception of amiodarone, your chances of an antiarrhythmic keeping your heart out of AFib for a whole year is 50-50 at best.[xvi]

After a few months of taking flecainide, Carl hadn’t had any more AFib attacks and he wasn’t aware of any side effects, but he knew he didn’t want to be on this or any other AFib medications for the rest of his life. That’s why he came to see us for a second opinion. He wanted to talk about other options that didn’t include more medications.

Carl was often stressed at work and rarely exercised. He knew he needed to start eating better and get his weight and blood pressure under control, too. “You’re going to need to make some pretty big decisions about the way you live your life,” we told him. “You’ve got so much to live for, but we need to get your life back into rhythm.” And because there was a chance that optimizing his lifestyle wouldn’t be enough to get him off the medications and keep his heart in rhythm, we also talked about the possibility of a procedure called an ablation, an important step for many people who wish to cure their AFib.

“OK,” he said. “I think I’m ready for that, but let me give it some thought.”

He went home to think over the various options. That night there was a big snowstorm, and the next morning he went out to shovel his yard. When he didn’t come in, after a while, his wife went out to check on him and found him lying face down in the snow. He had gone into cardiac arrest.

Was flecainide to blame? We can’t know for sure. When he arrived at the hospital there was no sign of heart failure or any serious arterial blockages in his heart, but it had to have been something. Even if it wasn’t the flecainide, though, we know that people recently diagnosed with AFib are nearly five times more likely to go into cardiac arrest.[xvii]

The paramedics were able to resuscitate him and, once they got him to the hospital, doctors put him on life support, but permanent damage to his brain had developed. Carl was surrounded by his family when they took him off life support.

None of us knows how much time we have left on this planet.

But those with an AFib diagnosis can be assured that, if they’re not willing to make some pretty big changes to their lives, their time is even more limited. But even if AFib doesn’t kill you, if you don’t address it, and soon, it is only the start of your problems.

That’s certainly not the most cheerful way to begin a book about fighting AFib, is it? But this is the reality of the disease we’re fighting, and of the world in which we live. It’s important that we talk openly and honestly about what atrial fibrillation is, and what it can take from us. It’s important that we don’t talk about this like its no big deal.

This isn’t a condition that simply makes life harder, more painful, or more frustrating. This is a disease that can do all of that and takes lives, too. And it can take them in tragic ways.

That’s the bad news.

But there’s also good news. And it’s really good news.

All over the world, people are learning that it’s possible to fight this disease. They’re learning that they can change its impact on their lives. Some have beaten it into complete remission and will never be impacted by it again.

Indeed, they’ve cured their AFib.



[i] Snibbe, Kurt. (June 7, 2018). 50 years of calling 911: How many still call and how fast (or not) is the response time. San Jose Mercury News.

[ii] Lloyd-Jones, D., Wang, T., Leip, E., et al. (2004). Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation.

[iii] Mou, L., Norby, F., Chen, L., et al. (2018) Lifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status: ARIC Study (Atherosclerosis Risk in Communities). Circulation: Arrhythmia and Electrophysiology.

[iv] Chugh, S., Havmoeller, R., Narayanan, K., et al. (2014). Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation.

[v] Delaney, J., Yin, X., Fontes, J., et al. (2018). Hospital and clinical care costs associated with atrial fibrillation for Medicare beneficiaries in the Cardiovascular Health Study and the Framingham Heart Study. SAGE Open Medicine.

[vi] Stewart S., Murphy N., Murphy N., et. al. (2004). Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart.

[vii] Carlquist, J., Knight, S., Cawthon, R., Bunch, T. et al. (2016). Shortened telomere length is associated with paroxysmal atrial fibrillation among cardiovascular patients enrolled in the Intermountain Heart Collaborative Study. Heart Rhythm.

[viii] Benjamin, E., Virani, S., Callaway, C., et al. (2018). Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation.

[ix] The stories in this book are based on interactions and treatments with diagnosed AFib sufferers; in some cases names and other biographical details have been changed to protect the confidentiality of patients and their families. The life circumstances and outcomes these example patients have experienced, though, are absolutely representative of patients seen by Dr. Day and Dr. Bunch.

[x] Bassand, J., Virdone, S., Goldhaber, S., et al. (2019) Early risks of death, stroke/systemic embolism, and major bleeding in patients with newly diagnosed atrial fibrillation. Circulation.

[xi] Gardarsdottir, M., Sigurdsson, S., Aspelund, T. et al. (2018). Atrial fibrillation is associated with decreased total cerebral blood flow and brain perfusion. EP Europace.

[xii] Gaita, F., Corsinovi, L., Anselmino, M., et al. (2013). Prevalence of silent cerebral ischemia in paroxysmal and persistent atrial fibrillation and correlation with cognitive function. Journal of the American College of Cardiology.

[xiii] Galenko, O., Jacobs, V., Knight, S., Bunch, T. et al. (2019) Circulating levels of biomarkers of cerebral injury in patients with atrial fibrillation. The American Journal of Cardiology.

[xiv] Conen, D., Rodondi, N., Müller, A., et al. (2019). Relationships of overt and silent brain lesions with cognitive function in patients with atrial fibrillation. Journal of the American College of Cardiology.

[xv] Taylor, P., Clark, A., Marsh, A., et al. (2013). A chemical genomics approach to identification of interactions between bioactive molecules and alternative reading frame proteins. Chemical Communications.

[xvi] Komatsu, T., Satou, Y., Tachibana, H., et al. (2006) Efficacy of long-term flecainide therapy in patients with paroxysmal atrial fibrillation—Analysis based on time of onset. Journal of Arrhythmia.

[xvii] Okin, P., Bang, C., Wachtell, K., et al. (2013). Relationship of sudden cardiac death to new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy. Circulation: Arrhythmia and Electrophysiology.

#306 The Top 10 Atrial Fibrillation Triggers

January 31st, 2021 by

The Top 10 Atrial Fibrillation Triggers

A few years back, my good friend, Mellanie True Hills, the founder of the StopAF.org website, teamed up with researchers from the University of California at San Francisco in an effort to better understand atrial fibrillation triggers. What they found in their investigation was that people who are healthier usually have definitive triggers, while people who are less healthy might not even require a trigger to push their heart out of rhythm. They also found that while just about everyone has different triggers, some triggers are far more common than others.

There’s an important distinction to make here between causes and triggers. It’s important to understand both, but the long-term factors that put people at greater risk of AFib, also known as substrate causes (like bad genetics, being overweight, high blood pressure, etc.), aren’t always the same things that prompt a specific incident of AFib. Here, a wildfire analogy might be helpful: Any spark can trigger a single blaze, but the chances of having lots of fires in a season are greatly increased by conditions that accumulate over time, including drought, insect infestation and the growth of underbrush.

1. Alcohol

The top three atrial fibrillation triggers according to Mellanie True Hills study? Alcohol, caffeine and exercise—in that order. While all of these factors may be part of the combination of causes that pushes people toward AFib, it would be very rare for any of these factors alone to be the sole cause. But once someone is at that precipice, alcohol, caffeine and exercise can be powerful inciting events that can send their heart into chaos.And that shouldn’t come as a big surprise, particularly when it comes to that first trigger; any emergency room doctor can share many stories of high school or college students who have presented with AFib after binge drinking.

Alcohol use doesn’t just increase the risk of AFib. It also increases the risk of countless other diseases, including cancer. And while there are some studies that have demonstrated that a small amount of alcohol can offer some health benefits, when it comes to all-cause mortality those benefits are outweighed by the increased risk of other health-related harms, according to a 2018 study in the prestigious British medical journal The Lancet, that pulled no punches. “The conclusions of the study are clear and unambiguous: alcohol is a colossal global health issue,” the authors wrote, adding that there was strong support for a guideline published by the chief medical officer of the United Kingdom, who found there is “no safe level of alcohol consumption.

2. Caffeine

Caffeine is a powerful stimulant that can have a significant impact on our hearts. Fortunately, for most people with AFib, caffeine isn’t a problem. Indeed, studies have shown that the caffeine that comes from chocolate, coffee, and tea don’t trigger AFib for most people. However, for some people, like the 28% of the 1,298 people participating in Mellanie True Hills’ study, caffeine is indeed an important trigger for Afib attacks.

3. Exercise

Exercise is the most natural way in the world to shift our hearts into a higher gear, so it’s no shock that, if your heart is already prone to beating erratically, a quick burst of exercise could push it over the edge. In general though, it is extreme levels of exercise, exercising at levels beyond where you have trained, or exercising in a dehydrated or electrolyte depleted state in someone that is already prone to AFib attacks that trigger AFib episodes.

Most of my patients are shocked when they learn that people who run marathons, competitively cycle, or do Ironman triathlons are five times more likely to develop atrial fibrillation. What is particularly perplexing, however, is that studies have not tended to show higher rates of arrhythmias in athletes who participate in other strenuous forms of exercise, such as boxing, wrestling and weight-lifting. There is something particular about endurance sports that increases the risk of AFib. (One exception to this may be football. Among former NFL athletes, the risk of AFib is six times higher, although this may be due to the use of performance-enhancing substances or the weight these athletes put on to compete at a professional level.)

Also, it bears noting that while aggressively competing in endurance sports might put you at a greater risk of AFib, participation in these activities certainly does not guarantee you’ll get AFib. It is reassuring to note that recreational participation in endurance sports, even if it is a marathon or triathlon, doesn’t seem to put you at risk of AFib.

4. Sleep

After alcohol, caffeine, and exercise, the second tier of AFib triggers include lack of sleep, dehydration, large meals, and stress and anxiety.  The impact of poor sleep on AFib has been well documented. Even small interruptions of sleep quality and duration can increase the risk of atrial fibrillation by 18 percent, and people who experience insomnia are 30 to 40 percent more likely to develop atrial fibrillation. People who do not reach deep levels of sleep—the sort of sleep that is key to recovery—have an 18 percent increased risk of atrial fibrillation, and it worsens each time they wake up at night. It’s even worse for people with sleep disorders such as sleep apnea; they have a 200 to 400 percent increased risk of AFib over individuals without a sleep breathing disorder. And the problem is compounded once AFib actually develops; the presence of an abnormal rhythm can increase the risk of poor sleep quality, or short sleep, by three to four times. It’s a vicious cycle.

5. Dehydration/Electrolyte Imbalance

Even simple incidences of dehydration can tip the balance of the electrically charged ions potassium, sodium, calcium and magnesium, which play critical roles in ensuring your body holds onto enough water to function and help direct the electrical impulses that keep your heart beating. That, of course, makes levels of electrolytes that are too high or too low a potential danger—especially to people who might already be prone to atrial fibrillation for other reasons. One study from researchers in The Netherlands showed that low levels of potassium could quadruple the chances of AFib in some individuals. Those experiencing magnesium deficiency are also at considerable risk.

6. Large Meals/Specific Food Triggers

Why would food a large meal or a specific food be a trigger of an AFib attack? Perhaps because gastrointestinal problems, including stretching your stomach from a large meal, are known to stimulate the vagus nerve, which connects your gut, brain and heart. We don’t understand this connection in depth, but our research has shown that gastrointestinal distress, like from a large meal, are associated with atrial fibrillation. Also, when those gastrointestinal issues have resolved, the AFib usually settles down as well.

We have also had many patients report to us over the years that sugar, fast foods, foods with caffeine, processed foods, fried foods, or really spicy foods have also been atrial fibrillation triggers—not just contributors to the rising risk of getting AFib in the first place. Once again, all of these triggers probably had something to do with vagus nerve stimulation or glucose fluctuations. Surprisingly, in 30 years of seeing AFib patients, I have yet to hear a patient report to me that broccoli or kale triggered an AFib attack.

7. Stress/Anxiety

What kinds of challenges can create stress that triggers AFib? A research group in Denmark concluded that the severely stressful experience of losing a partner increased the risk of atrial fibrillation for an entire year. Another international group of researchers found that divorced men had a higher incidence of death associated with atrial fibrillation. And a group from Sweden revealed a potential dose-response relationship between work-related stress, like getting fired from a job, and atrial fibrillation. In fact, the Swedish researchers found, just the experience of having a job with high psychological demands and with little control over your work situation could increase your AFib risk by 50 percent.

When Yale University researcher and electrophysiologist Dr. Rachel Lampert correlated the way her patients were feeling emotionally to see if she could predict whether or not they would go into AFib that day, the results were absolutely startling. In a study published in the Journal of the American College of Cardiology in 2014, she noted that feelings of sadness, anger, stress, impatience, and anxiety increase the risk of an AFib attack up to 500 percent in the same day. Happiness, meanwhile, appears to be protective. If you are feeling happy you are 85 percent less likely to have your heart go out of rhythm today, according to Lampert’s research.

8. Laying on Your Left Side

I must admit that I was a bit surprised to see that sleeping on your left side was an atrial fibrillation trigger for so many people. As you may or may not know, lying on the left side of the body is a position which pulls your heart against your chest wall due to gravity. And while this gravitational pull to your chest wall certainly makes palpitations more noticeable, perhaps in some people it is also an atrial fibrillation trigger. If you want to read more about laying on your left side and arrhythmia, here is a great article I wrote a few years ago on the subject.

9. Cold Beverages and Foods

Another culprit that might be a potent trigger: very cold foods. That’s what a research team from California learned when they reviewed the case of a young adult man who drank one of those sugary “slushed ice” drinks, the type of which you commonly find at gas station convenience stores. Just about everyone who has tried one of these drinks knows the sensation of “brain freeze,” an intense, rapid-onset headache also known as sphenopalatine ganglioneuralgia, that is caused by sudden temperature changes to the carotid artery and anterior cerebral artery, which are located near the back of the throat, and which feed blood to the brain. The man immediately began to suffer from both atrial fibrillation and brain freeze at the same time.

Researchers have theorized that the vagus nerve may be similarly stimulated. This doesn’t mean we need to avoid cold foods; we just need to be mindful of how we consume them. When it comes to smoothies, slow and steady wins the race.

10. Not Exercising

Regular daily exercise in general isn’t risky at all—in fact, it’s exceptionally protective against AFib and just about every other chronic medical problem. To put things into perspective, for every thousand patients we see with atrial fibrillation, perhaps one may be at risk for atrial fibrillation due to overexercising. The biggest problem, by far, is that most patients aren’t exercising enough. There is far greater risk to not exercising enough than to exercising too much. People who live sedentary lifestyles are at significant risk of AFib, not to mention all of the other health consequences of not getting enough exercise.

Next Steps if You Have AFib Triggers

If you have clear and identifiable triggers, and can easily avoid them, then that is your best option to prevent AFib attacks. But please remember that triggers alone probably won’t incite an AFib event unless you are already prone to AFib attacks from things like bad genetics, carrying too much weight, high blood pressure, etc. And your best best to beat AFib is to not only avoid the triggers but to also address the underlying causes which put your at risk for AFib in the first place.

If you suffer from AFib you need to see a cardiac electrophysiologist or “EP.” An EP physician is a board certified cardiologist who has done an extra two years of a training arrhythmia management. If you live in the US and don’t have an EP, please feel free to call my office at 801-266- 3418 to set up an in-person or video visit.

As you probably liked this article to get this far, please be sure to sign up for my monthly AFib newsletter and pick up a copy of the best selling book on the topic, The Atrial Fibrillation Cure. The Atrial Fibrillation Cure represents everything we have learned about atrial fibrillation over the last 30 years.

About the Photo

This is a picture of the beautiful Desolation Lake in the Wasatch Mountains at approximately 9,000 feet above sea level near my home. At least a couple times a week in the summer and fall, I’ll hike up to the lake. In the winter and spring, I’ll backcountry ski in this area.

#305 The 9 Secrets of The Longevity Plan Diet

January 30th, 2021 by

The Longevity Plan Diet

The centenarians of China’s Longevity Village, home to the highest percentage of centenarians in the world as described in our book The Longevity Plan, eat as they have always have–A bit of animal meat, but not much. Nothing processed. No added sugars. And, owing to the fact that most Chinese are lactose intolerant, no dairy products. Lots of roots and tubers. Lots of wild fruits, garden vegetables, nuts, seeds, and legumes. Whole grains, never refined, and not too much. In good times and bad, these foods have comprised the vast majority of their diets. A diet that contributed to remarkable health and almost complete absence of cardiovascular disease, cancer, or dementia.

Can it really be considered a “diet?”

In the Western world, the word diet tends to evoke a lot of confusion, consternation, and even emotional turmoil. It has all sorts of negative connotations. It tends to be thought of as a set of rules. But in China’s Longevity Village there were no rules. No one was “on a diet.” No one was counting calories or carbs. And with limited exceptions throughout history, they’ve always had enough.

Poor as they were, and still largely are, it was very rare for anyone to go hungry. In fact, as Boxin told me (pictured on the right), the only male centenarian in the village during the years 2012 through 2017 when the research was done for The Longevity Plan book, and as he demonstrated every time we shared a meal, the people of China’s Longevity Village ate as much as they wanted, although absolutely no one was obese.

Our Trip’s to China’s Longevity Village

Feng Chun (pictured on the far right), who cooks and serves most of our meals when we are in China’s Longevity Village, is a notorious food-pusher, and not just with the guests that stay in her family’s modest inn. I love watching her with her own family at mealtime. “Eat more! Eat More!”

The villagers of Bapan don’t have thou-shalt and thou-shalt-not lists of foods that align with the rules and regulations of the latest fad diet. They don’t have smartphone apps measuring “points.” They don’t have recommended daily allowance labels on the sides of food packaging. But what they do have, and what they have had for centuries, is geography. Much of their health miracle occurred because they were physically cut off from the rest of the world for millennia.

Even today, getting to the village isn’t easy. Chinese health-seekers, who make pilgrimages here from other parts of China, usually have to fly into Nanning, a large regional capital known as the Green City because of the lush surrounding forests. From there,
if the weather is good, it can take about four hours to make it to Bama County, and another hour to reach China’s Longevity Village. There’s only one road to the village, and summer monsoons can fell trees, create massive red mudslides, and turn the highway into a virtual river. When this happens, China’s Longevity Village can be cut off from the rest of the world for days at a time.

My First Meal in China’s Longevity Village

By the time I sat down for my first meal in the village, my expectations were quite high. And never in my life have such lofty expectations been completely obliterated by something even better. The short, round table was nearly covered with plates and bowls, each of them heaping with food. Of course there was a big steam pot of rice—a simple, unpolished varietal that, fully cooked, remained stiff but not crisp.

There was another pot of corn porridge. There was boiled pumpkin.There was a simple dish of finely shredded potatoes and carrots that had been tossed with a small bit of rice wine vinegar. There was a dish of lightly cooked onions and peppers. There were two different cooked greens, none of which I recognized at first but which I was later told were beet greens and pumpkin leaves and stalks; both had been stir-fried with garlic. There was also a rather bleak-looking gray soup with some green vegetables in it. In that and every other meal we ate in the village, I took note of what was on the table and tried to connect it to what I knew about the nutritional benefits of certain food types. The more I studied the The Longevity Plan village diet, the more I realized that there wasn’t anything particularly magical about the food in this place; they simply ate good food, and plenty of it.

1. Rice (and other unrefined grains)

It’s probably no surprise that the villagers eat a lot of rice. It’s offered with every meal, without any pomp or circumstance. While more Asians are eating white rice, these days, historically it was not this way in Longevity Village. Brown rice (that’s whole rice, including the bran and germ), is very filling while being relatively low in calories, and is a superb source of manganese, an antioxidant, which helps activate the metabolism of carbohydrates, amino acids, and cholesterol. Brown rice is also a great source of Vitamin B6, which helps our bodies make serotonin and norepinephrine, both of which are chemicals that help our brains communicate effectively and efficiently.

While rice is the most prevalent grain in Bapan, it’s not the only choice. Corn shows up in various meals in Longevity Village, but its central place in households is as part of a simple porridge, just mashed corn and water, many villagers have for breakfast each morning.

Corn is sometimes derided in the Western world, these days, largely because it’s the base ingredient in high fructose corn syrup, which now accounts for up to a fifth of the calories consumed in the United States. That, of course, is absolutely unhealthy. In its natural form, though, corn is an antioxidant and a great source of fiber. That’s good for gut health and helps make us feel full. In corn, as in all grains, though, the more processed it is, the worse off you are. In Bapan it’s always served on the cob or freshly cut from the cob.

The other grain that often shows up on Longevity Village plates is millet, an ancient grain that might actually have a longer history in China than rice, and which is a good source of complex carbohydrates, protein, and healthy fats. Even though it is generally available in the United States and quite delicious, millet doesn’t factor into a lot of common dishes in the Western world. That’s a shame. I’ve found it’s wonderful with onions, tomatoes, and spices in stuffed peppers. Those were the main grains in the Longevity Plan diet, but that’s absolutely not the same thing as saying other grains are bad.

There’s an important distinction, though, between whole or intact grains and processed grains. While there has been a recent flurry of books and websites demonizing grains in every form, the scientific literature does not support this belief. Processed grains, on the other hand, are little more than sugar, and it’s clear that these products are responsible for much of the obesity crisis, as well as the epidemic of atrial fibrillation, heart failure, and diabetes that I see in my cardiology practice every day.

For those seeking to lose weight, even the healthiest of whole grains should be eaten in moderation if at all. What most people don’t realize is that flour from grains is really nothing more than instant sugar for your body. Is it any wonder that even whole wheat bread is converted to sugar by the body faster than a Snickers bar? For me, once I was able to free myself of the addictive qualities of traditional flour-based whole wheat breads, I actually came to prefer the flourless varieties because they are more satisfying and don’t leave me craving more.

2. Nuts and Seeds

The Longevity Plan diet includes lots of different nuts and seeds, at least a serving or two every day. In China’s Longevity Village they especially like lots of peanuts and pumpkin seeds. Yes, I realize the lowly peanut is not technically a nut, but rather a legume. Nutritionally, though, it acts like a nut, and performs like one when it comes to maintaining a healthy weight, preventing cardiovascular disease and fighting back premature death. Pumpkin seeds are a superfood. They are an amazing source of biotin, a B vitamin that helps regulate DNA formation and helps protect against ischemic heart disease. They’re packed with protein, healthy fat, fiber, and magnesium, which has been connected to a significantly reduced risk of sudden cardiac death. As I teach my patients, when you follow the seven lessons in this book it’s quite unlikely that you will get hungry between meals. But if you do feel you need to snack, nuts, and seeds are a great nutrient-packed choice.

3. Sweet Potatoes

Sweet potatoes are served in Bapan for breakfast, lunch, and dinner, usually chopped and boiled to softness but not mushiness. They’re relatively cheap, easy to grow, and easy to store, and are one of the best sources in the world for beta-carotene, an antioxidant, which is converted in our bodies into vitamin A and helps maintain healthy skin.

Most of the villagers eat sweet potatoes several times a week. While I’m not a fan of the taste of a straight sweet potato, I don’t mind them as part of a stir-fry dish. Some people love them mashed. However you enjoy eating them is fine, provided you don’t undo the health benefits by what you put on them or how you cook it them. (Beware, for instance, of sweet potato fries, which are often fried in unhealthy oils and covered in sugar and salt.)

4. Vegetables and Fruits

Just a few steps outside of the village are lush hillsides rich with native fruits, berries, and, if you know what you’re looking for, sumptuous root vegetables. Like bass fishing pros racing their sport boats out to their favorite spots before anyone else can get three, it’s common to see villagers in this region out at first light double-timing to their secret foraging locations with an empty basket or sack dangling from their arms. Indeed, when you ask around these parts for the key to longevity, many people will tell you that, if there is such a thing, it simply must be the wild veggies and fruits.

“In the toughest times,” Boxin told me, “that was all we ate. But even in the best of times we never stopped foraging for this kind of food. It is the best food because it is the most natural food.”

Every meal in Longevity Village, including breakfast, is served with leafy green vegetables, a tremendously good source of vitamin K, which is vital to blood coagulation and helpful for strengthening bones. Despite the fact that it’s really easy to get your daily
dose of K ( just one serving of kale or spinach will do it for you) most Americans fall short. Other common village veggies include various varieties of bok choy (a great source of vitamins A and C), snake beans (basically a very long string bean, another good source of vitamin C and folate), and carrots (a mega-dose of beta-carotene).

As for fruits, the village bounty is a virtual Carmen Miranda hat’s worth of apples (which are well-known to ward off stroke and prevent dementia), mangoes (lots of antioxidants and a good way to protect against many cancers), figs (even more antioxidants, along with vitamins A, E, and K), papayas (high in folate and fiber and vitamin C), bananas (packed with B6 and manganese), melons (some types of which have been found to improve eye health and lower the risk of metabolic syndrome), and lychees (rich in vitamins C, manganese, and magnesium, they’ve long been used in Chinese medicine, in addition to being served on Chinese plates).

And then there are the peppers. While food in this region of China is bland by comparison to other parts of a country where cooks tend to push their creations toward the hotter side of the Scoville scale, just about every meal in Bapan was also served with some form of pepper. Researchers have shown that capsaicin, the active component of chile peppers that produces a burning sensation when it comes into contact with living tissue, can help increase metabolism and decrease appetite. And while hot peppers have the most capsaicin, even sweet peppers have some.

The villagers don’t have a magic number for how many vegetables and fruits they eat, but having “kept score” over the course of hundreds of meals with dozens of village families, I’ve noticed that most meals include three or four fruits and veggies, with the latter being favored by a 3:1 ratio. I advise my patients to eat at least two vegetables and one fruit at every meal. That’s nine servings of fruits and vegetables a day. And, as it happens, this is right in line with the American Heart Association’s current recommendation. That might feel to some people like an impossible target to hit. That’s because they don’t start at breakfast.

The standard American diet, after all, only sometimes includes fruit and rarely includes vegetables in the morning. Most of the time, it just includes foods that are either already made of sugar or are quickly processed by our bodies into sugar. That’s incredibly sad. If breakfast is the most important meal of the day, after all, then why not serve it with the most important foods? Veggies and fruits, in addition to being loaded with nutrients, are also excellent sources of dietary fiber. When we start the morning with a lot of them, we end up feeling satiated throughout the day.

One great way to get an early jump on your target of daily helpings is by turning two or three servings of vegetables and fruits into a smoothie. As an added bonus, throw in some seeds or nuts for protein and healthy fat. Healthy fat, protein, and fiber is the key to making it to lunch without hunger pains. Don’t dump in sugar or fruit juice; you don’t need it. If you must sweeten it a bit, try a little raw honey or a natural form of stevia. Just use some fruit, vegetables, nuts or seeds, and milk. And when it comes to milk, don’t limit yourself to just cow milk. Personally, I really prefer the myriad of alternatives, including unsweetened almond, hemp, soy, and coconut. Nobody in the village actually counts their veggies and fruits, though, and you probably shouldn’t either. Instead, an easy way to make sure you’re hitting the mark is to simply make sure most of your plate is covered with vegetables and some fruit at each meal.

5. Legumes

Legumes are another daily staple in China’s Longevity Village. As in most places in the Far East, edamame is eaten daily. Indeed, many people have credited the much lower rates of cardiovascular disease, cancer, and longevity in Japan to eating edamame.

But edamame is just the start. In Bapan, villagers eat many different beans, including mung beans, peas, and lentils of various shapes, sizes, and colors. That gives them a daily dose of a food that is high in protein, minerals, and fiber.

It’s not uncommon, though, for my patients to push back at my suggestion that they add more beans to their meals. Sometimes, they just don’t like the taste of beans all that much. In these cases I suggest trying them in homemade Indian food, chili, soup, or a dip like hummus. Dry roasted beans also make a great substitute for potato chips, and whole bean pasta is a lovely alternative to the processed grain variety.

6. Dairy

There’s no dairy in the traditional Longevity Plan diet. Like most folks across China, the people of Bama County are largely lactose intolerant. That might not be the case for you, and if you like and can tolerate dairy, a small amount of real cheese (not processed American cheese), especially made from the milk of a grass-fed cow, which has not been pumped up on antibiotics or hormones, probably isn’t going to hurt. Unfortunately, most Americans’ idea of a small amount of cheese is what we put on an average slice of pizza. That might be a small amount compared to what most people in the United States eat (23 pounds of cheese each year, about the same weight in cheese as an average one-year-old child!) but it’s really too much.

There do appear to be some health benefits to eating a little bit of cheese, particularly when it comes to creating a healthy gut flora, but whatever good it’s doing for us is almost completely obliterated by how much bad it does to us in the quantities and types of cheeses we typically consume. I’ve found that pizza is one of the toughest things for my patients (and me, too) to limit. If you love pizza, make a healthier version at home. We often add almond and coconut flour to our dough with fresh organic tomatoes, garlic, and olive oil for the sauce, sprinkled with a little organic cheese on top.

What about calcium? You don’t need cheese or even cow milk for that. And despite what the U.S. dairy industry would have you believe, you definitely don’t need three servings of dairy each day for healthy bones. As it turns out, in fact, some countries with the highest intake of dairy also have the highest rates of osteoporosis.

Yes, our bodies need calcium, but the idea that the best sources of it are products made of cow’s milk really needs to be squashed. Calcium is also readily found in green leafy vegetables, almonds, oranges, broccoli, fish, beans, seaweed, and many other foods.
If you do drink milk, does it matter if you go full fat, low fat, or non-fat? It is not clear at this time whether fat content is important at all. If you enjoy dairy, try unsweetened yogurt or kefir with live bacterial cultures, which have additional health benefits.

7. Oils

The first time Boxin saw cooking oil in a large plastic container, he was confused. He couldn’t understand how anyone would ever need that much oil for anything. “Maybe,” he remembered thinking, “it was for the entire village to use for the whole year.”
Until quite recently, there were absolutely no processed cooking oils in the village. What they used either came from the fish they cooked or from pressing hemp seeds, which is quite difficult to do using simple hand tools so they didn’t get much.

8. Fish

Longevity Villagers do eat a fair share of fish from the river. They call these you yu, which in Chinese simply means “oily fish,” and they have long been cherished as part of the village diet. In the morning, if the river (pictured on the right) is not too high, local fishermen will walk along the muddy banks, dragging a net along behind them for ten or twenty paces. When they lift the nets from the water, the little fish, no bigger than your pinky finger, glint like diamonds in the morning sunlight. They’re usually in a wok within the hour and on someone’s plate just minutes later. Served whole and eaten like French fries, they taste a little like sardines, though less pungent.

The prevalence of these fish in the village diet was quite interesting to me in light of research that was being conducted by Dariush Mozaffarian. He was finding that people who had higher levels of fish oil in their diets lived longer and had a much lower risk of dying from heart disease or stroke. Again and again I was finding that emerging Western medical research was quite well aligned with traditional village practices, most of which had little to do with conscientious healthfulness. The you yu were simply what happened to be swimming in the Panyang River.

The easiest counterparts to you yu in most American markets are sardines, anchovies, and herring. If you live close to the coast, you might also be able to get your hands on somesmelt from your local fishmonger. As in all other sorts of foods, wild and fresh is best, but fish that have been flash frozen aren’t a bad alternative. Anything that has been canned and packed in added oils should be avoided except as a delicacy—remember it’s the natural oils in these fish that help make them healthy for us. Water-packed fish can be a healthy alternative, too, but many are packed with a lot of salt, so be careful to watch the labels. The great thing about many of these choices, especially the smaller ones, is that they can be eaten whole or nearly whole, with skin and very small bones included, but the fins and skulls left behind. That sort of nose-to-tail eating, with an extra dose of calcium, closely resembles the way the villagers of Bapan eat.

There are plenty of other oily fish that are not quite so closely related in flavor or appearance to you yu, but can be a good substitute, too. To that end, I recommend the fish that are on the Super Green List of the Monterey Bay Aquarium’s Seafood Watch. The fish that make this list are lowest in mercury, highest in the healthy omega-3 fats, and are sustainably caught. The list includes Atlantic mackerel, freshwater Coho salmon, Pacific sardines, and, my favorite, wild Alaskan salmon.

9. Other Meat

Although I saw chickens running about and a few pigs being roasted, I didn’t see much meat on the tables of the village elders. Did they shun it? Were they against eating it on moral or religious grounds? Did they abstain for health reasons? “Oh no,” Boxin told me. “We like meat just fine, but many of us are just not used to having very much of it.”

Throughout his life, Boxin said, he has eaten no more than two small portions of meat of any kind each week, and there was no animal that he considered off-limits to ending up in his bowl. The reason that people throughout Bama County have not historically eaten a lot of meat is simple and logical, Boxin said. Keeping animals was a surefire way to draw the attention of marauding armies. Given the region’s turbulent history, any animals that were kept were quickly confiscated, if not by warlords and hungry soldiers then by government officials.

“The only food that could not be easily taken,” he said, “is what came from the ground or the river.”

What diet is best for you?

Cheese or no cheese? Meat or no meat? Kosher or Halal? Paleo, vegetarian, keto, or Atkins? What should you do? Well, you should trust yourself. Your genes are different than anyone else’s. Your diet probably should be, too.

The truth is that across time and around the world people have thrived on many different diets. Just about the only diet that doesn’t seem to work for anyone is the Standard American Diet—the acronym for which, SAD, is as appropriate as they come.
If you’re working hard to minimize or even avoid sugar, eat lots of vegetables, and get rid of processed foods, then you’re probably doing a good job for your health and the health of your family, regardless of your other eating habits. And if you’re struggling with that, as just about all of us have at times, then you’re not alone.

The important thing to know is that there is no quick fix. I had to learn that lesson, too.

When I first came to Longevity Village, I believed that I would be able to hone in on a dietary secret that would lead to a longer, healthier, happier life. And it’s true that I learned a lot about food and our relationship with food during that first trip. But during that stay, and in all my time in Bapan since then, I’ve learned so much more. And perhaps the most important thing I’ve learned is that the best thing we can do for our health is to make sure that eating isn’t a vice, but rather a virtue.

Food Shouldn’t Isolate Us

Confucius once said, we should “not, even for the space of a single meal, act contrary to virtue.” When I learned this I was devastated. I figured it was impossible. I might eat lots of veggies, fruits, and legumes. But what if my family or friends were to invite me out to pizza? What if I wanted to share an ice cream sundae with my daughter? Would that be acting contrary to virtue?

When I asked Boxin what he thought of Confucius’ instructions, he gazed out of his open parlor and paused contemplatively for several seconds. “Virtue isn’t just one thing we do,” he said. “It’s everything we do.” Virtue, I’ve since come to believe, isn’t just what we eat. It’s how we eat. It’s who we eat it with. It’s our relationship with where our food comes from. It’s the decisions we make about how to prepare it. It’s our determination to honor the energy it gives us in positive ways.

#304 3 Ways to Strengthen Your Willpower to Eat Better in 2021

January 2nd, 2021 by

3 Ways to Strengthen Your Willpower to Eat Better in 2021

In this article, I’ll share 3 ways that have worked for thousands of my patients to strengthen your willpower to eat right.  While we all want to eat right but it always seems like life somehow gets in the way and derails our willpower.  But if your “WHY” is strong, temptations can be eliminated, and your support is strong enough then willpower is no longer needed.

1. Find Your “WHY”

Everyone has a WHY or a purpose for what they do.  And having a WHY or purpose in life is what makes us more goal-oriented and resilient to the struggles we face. Having a clearly defined purpose can give us willpower we never thought was inside of us. It can bring a level of happiness we have never experienced before. It can relieve the stress that has been crushing us for years. Those are psychological effects that have real physiological impact on the rest of our bodies.

Purpose is powerful. That’s why the most important thing that happens inside someone when they decide it’s time to fight back against medical conditions whether they be diabetes, high blood pressure, obesity or atrial fibrillation has nothing to do with their blood flow, the electrical signals moving through their bodies, or the biochemicals that are supposed to help keep all of these things in balance. Rather, it has everything to do with what they think about their lives.

So let’s do some thinking: What is your life’s purpose? What does the fulfillment of that purpose look like in your mind’s eye? Could more healthy years of life help you fulfill that purpose even more? Could a life without medications give you more energy and vitality to achieve your life’s goals? Or perhaps a life where you are healthy enough to play with your children or your grandchildren?

Finding Your WHY Can Be Difficult

Are you struggling with this? That’s OK. A lot of people do—especially those who have been beaten down by the wily foe of medical conditions like diabetes, high blood pressure, obesity, or atrial fibrillation. If that’s the case for you, a series of conversations with your family members, close friends, coworkers, a faith leader, or a therapist can help you either bring your life’s purpose back into clarity or to develop a new purpose for the years ahead.

A patient of mine named Kyle recently told me that he’d always questioned whether he had simply been born without willpower, and felt ashamed that he couldn’t seem control his impulse to swing into the nearest drive-thru whenever he was on the road. When he stuck a sticker on his dashboard reminding himself of the first purpose of food, though, everything seemed to change. “All those years, every time I’d get an urge for fast food, I’d told myself ‘but this isn’t good for me,’ ” he said. “Somehow that wasn’t enough. But everything changed when I switched to thinking about food in a different way, not as something I can’t have because it’s bad for me but as something I should have because it’s good for me.”

The effect Kyle saw in his life has been well documented by Western researchers. When Cornell University’s Food and Brand Lab looked at dozens of studies examining messages about nutrition, they found positive messages about what food can do for us are more motivating than negative messages about what food might do to us. Of course, we can’t make something like a double-bacon-cheeseburger good for us just by thinking it is. We still have to surround ourselves with the kind of food that is actually healthy for us.

Eating Right Isn’t About Willpower

Most of my patients believe eating right is all about willpower. And that’s one of the key reasons why so many diets fail. For example, almost all people who begin eating a vegan or vegetarian diet, for instance, eventually opt to consume at least some meat. And the same holds true for all the other diets like like keto, paleo, Mediterranean, or even Weight Watchers.

A lot of people point to grim statistics like these to suggest that perhaps we’re not meant to eat that way. On the other hand, there are millions of people who do eat this way, very successfully and very happily.

Once, after giving a lecture at a Mayo Clinic cardiac conference, a well-respected fellow cardiologist approached me as I was gathering my computer and notes. “I’m afraid I just don’t have the willpower that they have in the centenarians you studied in your book, “The Longevity Plan,” he said.

“Willpower?” I asked. “What makes you think they have any more willpower than you? For a very long time, the centenarians in this village didn’t need willpower to resist the temptations that destroy our health. They simply lived in an environment that was 100 percent conducive to health and longevity.”

There were no temptations and the village provided all the support they needed.  Willpower wasn’t even needed. There were no decisions to make, I told him. There was no internal struggle. There were no “shoulds” or “should nots.” Their entire environment was conducive to healthy, happy living.

2. Temptation Elimination

For my patients who no longer want to be weighed down by chronic medical conditions, the first thing I counsel them to do is to go home and throw away all the junk food.  Yes, trash anything with added sugar and get rid of all the processed and prepared foods.

With a house free of junk food, binge eating the foods that cause disease is a lot harder. In a moment of weakness, as always happens, you’d have to leave your home in search of junk food to satisfy the cravings—giving you precious time to let cooler heads prevail.

Second, now that your kitchen is stocked with healthy foods, it’s time to eat. You can eat as many non-starchy vegetables as you want, as much as you possibly can. It’s almost impossible to eat too many vegetables. Whenever a vegetable runs out, replace it as soon as you can; in your home, eating something healthy should always be easier than eating something unhealthy.

If the only choices are healthy ones then willpower is no longer needed.  Soon you’ll be able to effortlessly eat like the centenarians we described in our book, The Longevity Plan, who all made it to 100 plus without the need for medications.

Other Ways to Make It Without Willpower

There’s no reason for self-flagellation, but putting something on the line can work miracles without willpower. For example, an atrial fibrillation patient named Heather, for instance, gave her trainer a crisp $100 Benjamin Franklin and instructions to donate it to the election campaign of a politician she abhorred if she failed to make her goals twice in a row. One year down the road, the trainer put the $100 in a card and told Heather to buy herself something nice.

Sometimes the Medications You’re On Make it Impossible

Paulina was an atrial fibrillation patient of mine.  She had done a commendable job prioritizing her sleep, and was reliably getting seven or more hours of sleep every night in regularly scheduled intervals. She was stressing less. She had done everything she could, short of moving to another city, to surround herself with a clean environment.

“Even still, when I was trying to address those last few steps, and particularly when it came to what I was eating, I just felt so powerless and self-defeating,” she said. “I knew how I was supposed to eat and exercise, but I was still feeling quite tired, I think as a result of the medications I was on, and it felt like the more tired I got, the less willpower I had to get outside for a jog and to address my mostly good—but sometimes really bad—eating decisions. However, even when I was eating clean, my weight still wouldn’t go down which I think was due to the AFib medications I was on.”

After her ablation ablation procedure to rid her of atrial fibrillation and the need for medications, something clicked. “For the first few days I was tired and hurting. For a few weeks, it felt like, although I wasn’t having any more AFib episodes, my energy hadn’t come back to even the level it was before the ablation. But then it happened.” A surge of energy. An easier time walking, and even running, from here to there. Deeper breaths, which filled her lungs with air and filled her heart with confidence. And, with all of that, a renewed sense that she could truly win her lifelong fight with obesity.

3. The Right Support

What’s the difference between those who succeed and those who don’t? In large measure, it is support. One of the key findings of a study of 11,000 Americans’ eating habits was that those who switch to vegetarianism or veganism need support to avoid feeling as though they are “standing out from the crowd.”

Changing lifelong eating habits takes a level of willpower and determination on par with what is expended by people training for marathons and triathlons, or who engage in ultra-athletic training such as CrossFit. Going it alone is almost impossible. If we’re going to be different, as it turns out, we really need people to be different with.

In the case of Paulina, my atrial fibrillation patient from the prior section who couldn’t exercise and eat right until she was able to get off her medications experienced what I like to call the “Big Reset” after a life-changing ablation procedure.  After Paulina got home from the hospital she gathered her family and asked for their help in doing something profound.

Together, she asked, could  they commit to a 95-percent unprocessed plant-based diet with no added sugars—the only exception would be Sunday dinner when they would have meat and a desert, each week? Together, she pleaded, could they decide on an exercise regimen, like a commitment to the gym and a brisk walk or bike ride after dinner each evening, that they could do together, as a family?

She looked at her teen-aged children and her husband. “I was crying a little,” she recalled, “and I said, ‘please, if we can, I think my life depends on this.’ I love my family, but I would have never had the resolve to be that vulnerable with them. But there I was.”

Her youngest daughter, 8, was the first to respond. “Mommy,” she said. “Of course.”

Her middle son, 13, was next. “You know, I didn’t really like junk food anyway,” he lied.

Her oldest daughter, 16, didn’t hesitate. “Anything,” she said.

And her husband, married to her for 18 years and in love with her since the day they met in high school, made it unanimous. “What will we do first? Go on a walk or head to the market?”

There might not be anything particularly magical about walking, cycling, or going to the gym with your family or committing to a mostly plant-based diet free of added sugars and processed foods.  But doing it together made this new healthy lifestyle stick.  And fortunately, since adopting this healthy lifestyle her atrial fibrillation hasn’t come back, her weight is way down, and she remains medication free.

How to Make it When Your Family Isn’t Supportive

If you have a spouse or partner who is willing to support you on your commitment to eating right, consider yourself lucky.  For a large percentage of my patients they simply don’t have that support at home. Does that mean all is lost?

A patient of mine named Louise learned this the hard way. In her late forties, Louise noticed that she was starting to develop chest pains, and that she would sometimes get winded just walking from her downtown parking lot to her office a few blocks away. That led to a cardiac workup which ultimately resulted in several heart stents to open up blocked arteries.

It was the proverbial wake-up call. Louise’s son was just about to graduate from elementary school. The idea of not being there for his high school graduation was too much to bear. In my mind, that was a very good thing: Louise had something to live for and look forward to that was still quite far down the road.

“The odds of seeing that dream become a reality are going to be a lot better if you change how you eat,” I told her after her workup, which included a review of her diet.

“Your life literally depends on your daily food choices.” Louise was convinced. And she began in the most logical place: the grocery store.

When Louise would go shopping for herself and her family, she would work hard to make conscientious choices about what she was putting in her cart. Soon, though, her husband, Gary, started to notice that a lot of the things that had been staples in their cupboards, like Oreo cookies and Little Debbie snack cakes, were disappearing.

When Gary confronted her about this, she told him that she had decided they were going to eat healthier. His response was to get in the car and drive directly to the store, where he loaded up a hand basket with all the things Louise hadn’t purchased. “If you’re going to eat healthier,” he told her that evening, “I’m very happy to support you, but these foods make me happy and I’m going to keep eating them.”

What Gary didn’t understand was that in bringing those foods into their home, he wasn’t supporting his wife at all. Rather, he was significantly increasing her risk of another stent, heart attack, or even a young death. Without a home free of junk food, her chances of eating healthy were really low, just like how having easily available liquor in the home of an alcoholic would drastically reduce that person’s chances of staying sober.

What Louise didn’t realize, on the other hand, is how much she had hurt her own chances of success because she didn’t invite the most important person in her community to become involved in her effort to get healthy; she’d simply made a decision for both of them.

They remained angry at one another for weeks, and Louise found it hard during this period to focus on making healthy choices. She found herself sneaking cookies, and when Gary noticed she was doing this, he used it as an opportunity to score points in their ongoing argument. That just made Louise angrier, which in turn made it even harder for her to focus on eating healthy.

“I know it seems incredibly dysfunctional,” Louise told me. “And the thing is that was such a strange place for us to be. Over twenty years of marriage we’d always been so compatible. Up to that point, I don’t think we’d ever had an argument that lasted a whole day, let alone several weeks. It was awful.”

I’m happy to report that Louise and Gary have worked out an arrangement that is helping them both work toward a common goal.When Gary is out of cookies and cakes, he has agreed to go to the store to get them for himself, and this actually has reduced his consumption of junk food, since it takes extra effort on his part to get it. He has also agreed to keep these sorts of food in his basement office, where Louise is unlikely to just happen upon it when looking for healthier foods.

Sometimes Support Can Be an App

Not everyone can reach a working agreement like Louise and Gary.  And for those with teenagers it can even be harder to keep junk food out of sight. In these cases, having a trainer you report to at the gym or even a smartphone app can make the difference between success and failure.

I have a sweet tooth.  Even though I’ve eliminated more than 99% of added sugars in my diet for the last 10 years, junk food cravings have never left me. As I can never fully escape the presence of junk food, for me the simple habit of recording every bite of food I’ve taken for the last 10 years on my iPhone app has given me all the willpower I need to eat right.

Like any video gamer, I always want the highest score possible.  To me it is a game. I want all my food numbers, as close to perfect as possible.  The graphs and charts on the app all have to look good. And knowing that a careless bite of junk food could ruin my score or mess up the chart on my app, I don’t do it.

Bringing It All Home

If you’re relying on willpower to eat right for 2021 you’re in for a huge disappointment.  No matter how strong your willpower is it will eventually fail you.  The key is to create the right environment where willpower is no longer needed.  By having an unshakable WHY, eliminating temptations before you’re ever tempted, and having the right support system eating right can be the only option available for you in 2021.  This was the secret to the centenarians in our book, The Longevity Plan, and can be the secret as well to your new life without chronic medical conditions.

Did you like the artwork associated with this article? It was my wife’s painting of our old Park City, Utah farmhouse where we used to live from the mountain trails above (you’ll have to really magnify the painting to see the small red farmhouse).

#303 4 Reasons Why Sinus Rhythm Beats Atrial Fibrillation

January 2nd, 2021 by

4 Reasons Why Normal Sinus Rhythm Beats Atrial Fibrillation

The long awaited EAST-AF Study was finally published and the results were compelling–normal sinus rhythm beats atrial fibrillation. If you or a loved one is battling atrial fibrillation the results of this study could completely change the way you and your cardiologist treats atrial fibrillation. No longer should atrial fibrillation be ignored–as long as it can be caught early hitting it hard is your best chance at maintaining normal sinus rhythm and avoiding long-term complications from atrial fibrillation.

The EAST-AF Study

The EAST-AF Study was an international study of 2,789 patients from 135 hospitals in 11 different countries. And after an average follow up of 5.1 years per patient, the study was stopped early because the early results clearly showed that normal sinus rhythm beats atrial fibrillation.

Which Atrial Fibrillation Patients Were Included in this Study?

Understanding which patients were studied in EAST-AF is critical to applying it to your own situation. To even be considered for this study you had to have newly diagnosed atrial fibrillation.  This is an important feature as the longer you are out of rhythm the harder it is to ever get your heart back in normal sinus rhythm.  In fact, the median number of days from atrial fibrillation diagnosis to enrollment in this study was just 36 days.

Once you met the criteria of new onset atrial fibrillation, there were three different ways you could get into this study.  The first way was to have atrial fibrillation and be 75 years old.

The second way to get into this study was to have newly diagnosed atrial fibrillation with a history of a stroke or TIA (“mini-stroke”).

The third way to get into this study was to have new onset atrial fibrillation and be 65 years old with any two of the following risk factors: female sex, high blood pressure, diabetes, severe coronary artery disease (prior heart attack, heart stent, or heart bypass surgery), heart failure, a thickened heart, chronic kidney disease, or peripheral vascular disease.

The bottom line is that the atrial fibrillation patients evaluated in this study all had newly diagnosed atrial fibrillation and were either older or suffered from other medical conditions. And after being eligible for the study you were then randomized to “usual” atrial fibrillation care or aggressive atrial fibrillation care.

What Was “Usual” Atrial Fibrillation Care in this Study?

The usual care for atrial fibrillation was that you were prescribed a blood thinner and a second medicine to slow your heart down.  And as long as your symptoms weren’t too bothersome, they just let your heart stay in atrial fibrillation.

To many readers this might sound rather barbaric.  Just take drugs and don’t worry if your heart out of rhythm.  However, based on flawed studies from 20 years ago, most physicians still today make no effort to keep your heart in rhythm unless you report horrible symptoms from atrial fibrillation.  It still amazes me that poorly designed studies from 20 years ago doomed an entire generation of atrial fibrillation patients to a life without normal sinus rhythm.

What Was Aggressive Atrial Fibrillation Care in this Study?

In order to keep the people in normal sinus rhythm in the EAST-AF Study, aggressive treatment meant that physicians could try any combination of the following three options:

1. An anti-arrhythmic medication like Dronedarone, Amiodarone, Flecainide, or Propafenone.

2. Cardioversion where the heart is shocked back into normal sinus rhythm.

3. Catheter ablation.

How Did They Determine Whether or Not Normal Sinus Rhythm Beats Atrial Fibrillation?

Before the EAST-AF Study ever enrolled their first patient, it was decided ahead of time that the winner of this study would be the group of patients who had the fewest number of patients experiencing the combined end-point of cardiovascular death, stroke, TIA (mini-stroke), or hospitalization for worsening heart failure or coronary artery disease.

In all fairness, aggressively pursuing normal sinus rhythm wasn’t without complications.  As most patients took an anti-arrhythmic to maintain normal sinus rhythm there were a number of complications from these medications.  While only 20% of the aggressive treatment group underwent a catheter ablation procedure, the results were so good from this small group of ablation patients that the authors of the study felt that this is what tipped the balance of the study to show sinus rhythm beats atrial fibrillation.

4 Reasons Why Sinus Rhythm Beats Atrial Fibrillation

Now that we’ve covered the basics of the study, let’s get to what it showed.  And below are the 4 reasons why normal sinus rhythm beats atrial fibrillation according to the EAST-AF Study.

1. Doing whatever it takes to keep your heart in normal sinus rhythm decreased your combined risk of something really bad happening by 21%.  And really bad in this study was defined as a cardiac death, stroke/mini-stroke, or getting hospitalized for worsening heart failure or coronary artery disease.

2. Aggressive atrial fibrillation treatment resulted in many more hearts maintaining normal sinus rhythm.  In fact, 85% of patients with aggressive treatment were in normal sinus rhythm a year later with only a slight decrease over time.

3. Having a goal of maintaining normal sinus rhythm decreased the risk of stroke by 35%.

4. Keeping your heart in rhythm was associated with a 28% less risk of a cardiac death.

My Take on This Study

This study fits nicely with our experience in taking care of tens of thousands of patients with atrial fibrillation over the last 30 years. It also validates our previous studies showing that you have to hit atrial fibrillation early and hard if you want to maintain normal sinus rhythm long-term. Also, our research has shown that maintaining normal sinus rhythm may prevent an early death, strokes, and dementia which is right in line with the EAST-AF Study.

If you want to see my additional comments, I was interviewed in this news report on the EAST-AF Study:


Did you like the photograph with this article? It shows my daughter perfectly in rhythm doing a handstand on the beach with two of my sons watching her from the water.

#302 4 Scary Heart Problems Magnesium May Prevent

November 28th, 2020 by

5 Scary Heart Problems Magnesium May Prevent

No one wants unnecessary heart problems, especially scary heart problems magnesium may have prevented. In this article, I share the findings of a study of over 1 million people showing just how effective magnesium is at preventing the worst heart problems.

The Million Person Magnesium Study

To obtain the data of more than a million people, the researchers of this study had to pull the raw data from 40 individual studies. And when they looked at those consuming the highest amount of magnesium, here is what they found:

1.  High magnesium intake was associated with a 22% decreased risk of heart failure.

2. High magnesium intake was linked to 7% lower stroke risk.

3. High magnesium intake was associated with a 19% lower diabetes risk.

4. High magnesium intake was linked to a 10% lower risk of premature death.

The 5th Scary Disease Associated with Low Magnesium Intake

For those of you who read the title of this blog post and then counted up the 4 scary diseases mentioned in the previous paragraph, you may have noticed that one was missing. Sadly, the researchers publishing this million person magnesium study never looked at the association between low magnesium intake and atrial fibrillation. Indeed, studies show that magnesium deficiency can increase your risk of atrial fibrillation by 50%!

Low magnesium levels have long been observed in AFib patients. Magnesium works its magic by calming the cell-to-cell electrical channels in the heart.  It has even been shown to help treat AFib in many studies, and it can make some antiarrhythmics like sotalol or dofetilide much safer. Magnesium can also calm palpitations from premature atrial or ventricular contractions, known as PACs and PVCs.

You Probably Aren’t Getting Enough Magnesium from Your Diet

Studies show that at least half of Americans don’t get enough magnesium from their diet. Basically, the plant-light diet of most Americans means millions upon millions of people are magnesium deficient. Prominent cardiologists have even called magnesium deficiency a principal driver of cardiovascular disease and a public health crisis.

How to Boost Magnesium Levels Naturally

Want to boost your magnesium levels? Probably the most important thing to do would be to triple your vegetable intake (especially triple the “greens” in your diet).  And right behind tripling your greens would be to eat at least one serving of nuts and seeds each day.

Perhaps the best news when it comes to magnesium is that most people don’t need to supplement for it. Unless you are taking a stomach-acid-blocking medicine, or have other gut absorption issues, you can pack your diet full of magnesium just by eating nuts, seeds, and greens—the more greens the better, in fact.

Should You Take a Magnesium Supplement?

If ever there was a supplement that even the most traditional of all traditional doctors could accept, it would have to be magnesium. And magnesium is that essential mineral which is responsible for hundreds of biochemical reactions in the human body.

We have some patients who swear magnesium is the secret to treating their AFib. If that’s true—and some research suggests it may indeed be—it might partly be because it is quite effective at also helping people sleep—and deep, restful, restorative sleep is absolutely vital for anyone who wants to put their AFib into remission.
While I don’t suffer from atrial fibrillation or magnesium deficiency, I still take a magnesium supplement each night.  My personal experience has been similar to that of published medical studies—magnesium simply helps me sleep. It also prevents those annoying middle-of-the-night leg cramps that I often get after a long mountain bike ride.
So long as your kidneys are healthy and you don’t take more than the recommended dosage, magnesium is remarkably safe. The most common side effect is loose stools, which can usually be resolved by simply taking a lower dose or switching to a different form of magnesium. If you do need extra supplementation, and you are concerned about the purity of supplements, your doctor can prescribe a prescription version of magnesium.

The Key Take Away Message

No one wants heart problems—especially the scary heart problems magnesium just might have prevented.  Given the asymmetric risk reward benefit of magnesium, who wouldn’t want to at least give it a try? In the 26 years since I graduated from medical school, I have yet to meet a patient that suffered a side effect from eating too many magnesium rich foods like nuts, seeds, and especially greens. But over that same 26 year period of time, I’m sure my patients have prevented thousands of unnecessary emergency room visits by simply eating more of these foods.

Want to Learn More About Magnesium Deficiency?

Want to learn more about how magnesium can both protect your heart and help with other medical conditions?  Below is a link to a great article I wrote a few years ago on the subject:
In this article I discuss the symptoms associated with magnesium deficiency, how to test for magnesium deficiency, and what medical problems you may be able to avoid by getting enough magnesium in your diet.

As you already know, this article is for general information only and does not provide any medical advice.  If you need medical advice please speak with your physician.

If you have atrial fibrillation and would like to see me as a patient, please call my office at 801-266-3418 to set up an in-person or virtual consultation. Most U.S. insurance plans are accepted. Sorry, international patients aren’t being accepted at this time.

#301 How Successful are Atrial Fibrillation Ablations?

November 26th, 2020 by

How Successful are Atrial Fibrillation Ablations?

Atrial fibrillation ablations may be the answer to when your heart is pounding away uncontrollably at 130, 140, or faster than 150 beats per minute and medications are no longer working. And while ablation procedures have had a bad rap for lots of redo procedures in the past, fortunately with the latest HD mapping technology all of that is rapidly changing.

Our hospital has been at the forefront of making these procedures much safer, quicker, and more effective.  Indeed, based on our most recent study, which I will share with you in this article, procedural success rates are now extremely high and it is unlikely that you will need a second ablation.

What is Atrial Fibrillation?

Before I share our latest study showing how effective atrial fibrillation ablations have become in getting rid of atrial fibrillation and cardiac medications, let me explain what atrial fibrillation is. Atrial fibrillation is a condition where the upper chambers of the heart are in complete electrical chaos thereby causing the heart to beat fast and irregular.

The fast and irregular heart rate of atrial fibrillation causes palpitations, shortness of breath, chest pain, fatigue, and other symptoms. Sadly, atrial fibrillation leads to strokes, heart failure, dementia, and other medical problems.  Clearly, this is a medical problem that you want to quickly get rid of if possible.

New HD Arrhythmia Mapping Technology

Do you remember when HD TV arrived in 1998? I certainly do.  Suddenly, we were able to see things we had never seen before. Watching a football or basketball game was a whole new experience.

Well, HD mapping of arrhythmias has finally arrived.  And with the new HD mapping catheters and HD mapping systems, we can now see atrial fibrillation electrical signals that we never could before.  Ablations are now much more successful and the chances that you might need a second ablation procedure have gone way down.

5 Key Findings from Our Latest Study on HD Mapping in Atrial Fibrillation Ablations

In our latest study, we compared state of the art HD mapping technology versus the old arrhythmia mapping technology.  In this study, we had a total of 472 patients who had all undergone an atrial fibrillation ablation procedure at our hospital.  And here are the 5 key findings of our study:

1. The 1-year success rate increased from 75% to 87% with HD mapping technology (Ablation success in this study was defined as no need for anti-arrhythmic medications and no recurrence of atrial fibrillation).

2. The 1-year need for a second atrial fibrillation ablation procedure decreased from 20% to 6% with HD mapping technology.

3. The need for fluoroscopy (real-time X-ray imaging of the heart) decreased by 72%.

4. Procedures were 32 minutes faster with the new HD mapping technology.

5. No long-term complications were seen in any of these 472 atrial fibrillation ablation patients.

Key Takeaway of this Study

The key takeaway of this study is that as technology has improved so too have atrial fibrillation ablations. The procedures have become much safer, quicker, and more effective.  No longer are multiple ablations needed in most cases to control atrial fibrillation and to get off anti-arrhythmic medications.

If you would like to see my presentation of our atrial fibrillation approach as well as a more detailed explanation of how we use this new HD mapping technology in these ablation procedures, let me recommend this presentation.  This was the presentation I gave at this year’s Asian Pacific Heart Rhythm Society meetings.

For additional reading, let me suggest two of my previous blog posts:

When should I consider an atrial fibrillation ablation?

10 Ways to Cure Atrial Fibrillation without Drugs or Procedures

As you already know, this article is for general information only and does not provide any medical advice.  If you need medical advice please speak with your physician.

If you have atrial fibrillation and would like to see me as a patient, please call my office at 801-266-3418 to set up an in-person or virtual consultation. Most U.S. insurance plans are accepted. Sorry, international patients aren’t being accepted at this time.

#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?