Dr. John Day, Cardiologist

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Is Weekend Catch Up Sleep Healthy?

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

The Longevity Plan

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

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

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

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

Modern Life = Lack of Sleep?

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

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

Weekend Catch Up Sleep Study

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

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

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

The Dangers of Acute Sleep Deprivation

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

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

The Snooze Button

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

My Sleep Challenges

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

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

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

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

Is Weekend Catch Up Sleep Legit?

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

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

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

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

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

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

Weekend Catch Up Sleep May Fight Weight Gain

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

Make the Best of An Imperfect World

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

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

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

9 Things I Would Do To Prevent Atrial Fibrillation Strokes

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

Start Here

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

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

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

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

A CHADS-VASc Primer

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

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

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

9 Things I Would Do To Prevent Atrial Fibrillation Strokes

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

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

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

1.  Reverse Atrial Fibrillation

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

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

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

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

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

Is Nattokinase the Safest Blood Thinner?

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

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

3. Hack My CHADS-VASc Score

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

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

4. Hack Virchow’s Triad

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

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

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

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

5. Track My Rhythm with a Smartphone EKG App

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

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

6. Keep Any Atrial Fibrillation Episodes Under 24 Hours

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

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

7. Pill-in-the-Pocket Blood Thinner

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

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

8. Have it Ablated

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

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

9. Consider Left Atrial Appendage Occlusion

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

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

The Big Picture

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

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

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

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

Disclaimer

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

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

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

My Views of the CHADS-VASc Scoring System

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

Brenda’s Experience

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

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

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

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

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

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

Below is how you calculate your CHADS-VASc score:

C: Congestive heart failure (1 point)

H: Hypertension (1 point)

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

D: Diabetes (1 point)

S: Stroke/TIA history (2 points)

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

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

S: Sex (female gender gets you 1 point)

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

CHADS-VASc 0:  0%

CHADS-VASc 1:  1.3%

CHADS-VASc 2:  2.2%

CHADS-VASc 3:  3.2%

CHADS-VASc 4:  4.0%

CHADS-VASc 5:  6.7%

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

The Critical CHADS-VASc Score is 2

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

How to Lower Your CHADS-VASc Score by 4 Points

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

1. Reverse Heart Failure (minus 1 point)

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

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

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

2. Reverse Hypertension (minus 1 point)

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

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

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

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

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

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

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

3. Reverse Diabetes (minus 1 point)

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

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

4. Reverse Vascular Disease (minus 1 point)

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

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

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

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

Brenda’s Story Revisited

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

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

An Ablation Won’t Get You Off Blood Thinners

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

The Big Picture

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

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

5 Best Ways to Fix Atrial Fibrillation Water Retention

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

Sarah’s Story

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

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

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

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

What Causes Leg Swelling?

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

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

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

Does Atrial Fibrillation Cause Leg Swelling?

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

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

5 Best Ways to Fix Atrial Fibrillation Water Retention

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

1.  Eat High Fiber

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

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

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

2. Eliminate Sugar and Flour

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

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

3. Eliminate Processed Foods

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

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

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

4. Break a Sweat Every Day

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

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

5. Keep Your BMI Below 25

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

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

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

Sarah’s Story Revisited

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

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

Practical Tips

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

Disclaimer

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

How Do You Diagnose Atrial Fibrillation?

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

Melanie’s Experience

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

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

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

Can an EKG Diagnose Atrial Fibrillation that Comes and Goes?

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

What is an Event Monitor?

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

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

Event Monitor vs. Holter Monitor: Which is Best?

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

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

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

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

What if the Event Monitor Doesn’t Show Anything?

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

What is an Implantable Loop Recorder?

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

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

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

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

What is a Smartphone ECG app?

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

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

Practical Tips

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

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

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

How Do You Know If You Are in Atrial Fibrillation?

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

Kim’s Experience

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

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

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

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

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

“Check your pulse,” I said.

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

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

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

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

How Do You Check Your Pulse?

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

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

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

What Should Your Heart Rate Be?

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

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

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

What Should Your Resting Heart Rate Be?

How Often Should You Check Your Pulse

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

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

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

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

1.  Have Your Spouse Put Their Ear to Your Chest

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

2. Buy a Stethoscope

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

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

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

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

4. Buy a Pulse Oximeter

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

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

5. Turn Your Smartphone into an EKG Machine

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

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

Practical Tips

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

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

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

What Does it Take to Get to Age 90?

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

The Latest Longevity Study

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

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

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

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

5 Life-Extending Hacks

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

1.  Breathe Clean Air

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

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

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

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

2. Keep Your BMI Between 19 and 25

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

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

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

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

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

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

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

3. At Least 30 Minutes of Exercise Every Day

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

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

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

4. Keep Alcohol Intake in Check

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

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

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

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

5. Eat a Healthy Diet

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

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

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

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

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

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

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

The Big Picture

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

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

6 Reasons Why There is an Atrial Fibrillation Dementia Link

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

Does Atrial Fibrillation Affect Brain Function?

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

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

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

We First Showed the Atrial Fibrillation Alzheimer’s Link

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

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

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

6 Possible Links Between Atrial Fibrillation and Dementia

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

1.  Macro and Micro Thromboembolism (Blood Clots)

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

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

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

2. Macro and Micro Brain Bleeds

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

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

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

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

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

3. Cerebral Blood Flow

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

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

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

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

4. Systemic Inflammation

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

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

5. Other Medical Problems

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

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

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

6. Genetic Factors

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

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

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

Atrial Fibrillation and Dementia in China’s Longevity Village

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

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

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

How Do You Protect the Brain from Atrial Fibrillation?

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

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

Practical Tips

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

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Flax vs. Chia: Which Seed Should You Eat?

Can Atrial Fibrillation Cause a Heart Attack?

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

Mark’s Experience

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

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

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

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

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

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

Heart Attack Risk from Atrial Fibrillation

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

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

What is the Best Stress Test for Atrial Fibrillation?

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

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

The Very Best Way to Prevent a Heart Attack

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

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

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

Practical Tips

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

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The Top 3 Dark Chocolate Health Benefits

9 Key Findings of the CABANA Study

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

Why the CABANA Study Needed to Be Done

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

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

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

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

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

It Was Hard to Enroll CABANA Study Patients

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

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

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

Cabana Study Results: Intention to Treat

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

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

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

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

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

Per Protocol Analysis: The CABANA Study

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

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

9 Key Findings of the CABANA Study

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

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

1. Ablation Patients Are More Likely to Stay in Rhythm

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

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

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

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

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

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

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

4. Ablations Kept Patients from Getting Hospitalized for Atrial Fibrillation

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

5. Ablation Patients Had a Better Quality of Life

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

6. Heart Failure Patients Really Benefited from Ablation

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

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

7. Ablation Procedures Are Safe

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

8. Younger People Did Exceptionally Well with Ablation

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

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

9. Minorities Fared Better with Ablation

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

Who Shouldn’t Have an Ablation?

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

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

How Can You Further Optimize Ablation Results?

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

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

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

The Big Picture

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

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

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Is Organic Food Really Better for You?

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Almonds vs Walnuts: Which Nut Should You Eat?

Can You Live a Normal Life with Atrial Fibrillation?

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

Maria’s Experience

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

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

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

What holds people back with atrial fibrillation?

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

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

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

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

Is sex OK with atrial fibrillation?

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

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

Can you drive your car in atrial fibrillation?

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

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

Can you be active with atrial fibrillation?

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

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

Can you travel with atrial fibrillation?

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

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

One other consideration for traveling is that you don’t want to wind up in the emergency room of some third world country. Once again, close partnership with your cardiologist should allow you a backup plan should an atrial fibrillation problem arise.

Can you ride a rollercoaster with atrial fibrillation?

The thrill of rollercoasters causes a massive adrenalin release. This adrenalin release then causes your blood pressure and heart rate to shoot up.

If your heart is already beating too fast with atrial fibrillation, then this adrenalin rush only makes matters worse. If, however, your atrial fibrillation is adequately treated then you should still be able to enjoy your favorite rollercoaster.

Can atrial fibrillation patients get in a hot tub?

Hot water causes your blood vessels to dilate. As your blood vessels dilate, your blood pressure may drop.

As this is often a dose-related effect, the longer you are in the hot tub, the lower your blood pressure may go. In fact, your blood pressure may go so low that you pass out either in the hot tub or while you are trying to get out of the hot tub.

For people not on medications, this usually isn’t a problem as the body generally compensates. However, if your doctor has you on atrial fibrillation medications that lower your blood pressure, like beta-blockers, diltiazem, or an antiarrhythmic, this could be a problem.

Another theoretical concern is for the person on a blood thinner. If you were to cut yourself somehow getting into the hot tub, the hot water could result in more bleeding.

The bottom line is that if you are on any prescription medications; please speak with your doctor before getting into a hot tub. It is possible that with the right precautions like hydrating first or limiting your time in the hot tub, you may still be able to enjoy this activity.

Can you skydive or scuba dive with atrial fibrillation?

When it comes to skydiving, I put the cardiovascular risk on par with riding a roller coaster. While both activities are not that physically demanding in most cases, the adrenalin release may be massive.

Thus, this adrenalin release could trigger an atrial fibrillation episode. If, however, your heart is already out of rhythm, then the adrenalin spike may cause your heart to beat extremely fast. As with all of the other activities discussed, if your atrial fibrillation is under good control, then skydiving should pose little risk.

Scuba diving, in contrast, may seem like it would be much more gentle on the heart. Indeed, you probably won’t get that same adrenalin rush unless you had a shark coming at you.

However, because of unexpected currents, wind, and water temperature, this sport could quickly tax your cardiovascular system. It is for this reason that I make my atrial fibrillation patients pass a full-exertion stress test before embarking on their scuba diving trip.

Practical Tips

The key to living a normal life with atrial fibrillation is to find an open-minded cardiologist who listens to your needs and can work with you to regain your normal life. For some people, medications allow them to resume full activities. For others, it may require a drug-free solution, like losing weight or a catheter ablation procedure, to get back to their previous life. As everyone’s condition, needs, and desires are different; this will require a tailored approach between you and your cardiologist.

Of course, nothing in this article should be taken as medical advice.  Make sure you are in close communication with your physician when it comes to engaging in any physical activity with atrial fibrillation.  Poorly controlled atrial fibrillation is a high risk situation that requires prompt treatment.

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Mindfulness vs. Tracking: Can you ever stop tracking?

We all know what to do.  The problem is doing it.  When it comes to losing weight and exercising daily, can you ever stop tracking?  In this article, I share the reasons behind my recent 10 pound weight gain and discuss mindfulness vs. tracking when it comes to maintaining healthy behaviors.

Why I Started Tracking

As those of you who have read our bestselling book, The Longevity Plan, know, that when I hit my health crisis a number of years ago I had to drop 30 pounds.  Fortunately, the weight loss happened effortlessly.

I didn’t even have to track.  I could be mindful.

The reason why weight loss was effortless and I didn’t have to track was because there were no temptations.  But upon returning to the US, tracking was the only thing that helped me to maintain the health I found in the Longevity Village.

Thus, to maintain my health and weight loss, I became a tracker.  I tracked everything. However, a few months ago, something changed…

My 10 Pound Weight Gain This Winter

I grew tired of tracking every piece of food I ate.  Getting on a scale everyday also wasn’t any fun.  No longer did I want to count my daily steps or record every workout.

After more than four years of tracking everything, I needed a break.  Given the healthy routines I had built over the years, as well as the lessons I learned in China’s Longevity Village, I was sure that I could make the right intentional decisions and practice mindfulness when it came to diet and exercise.

Instead of tracking every morsel of food, I let mindfulness guide my food intake.  I tried to listen to my internal food cues to know when I was hungry.  Every bite was chewed thoroughly to extract each flavor.  I ate slowly.  And I was grateful for the food I had.  With this mindfulness approach, I reasoned that moderation in all things is good and a little bit can’t hurt…

By the time spring arrived, I got out the scale.  I had expected to see the same weight I have maintained for more than four years.  To my horror, the scale read 10 pounds heavier!  I was sure the scale was wrong.  Sadly, other scales confirmed the 10 pound winter weight gain was indeed real…

During my 4+ years of tracking everything, my weight never varied by more than two to three pounds.  Now, after just taking a month or two off from tracking, my weight shot up 10 pounds!  How can this be?

What Went Wrong?

Like most Americans, I had lost my internal cues of feeling full. I needed environmental cues.

By tracking, my iPhone app told me when I was supposed to feel full.  And with this environmental cue removed, I ate more than my body needed.  I also cheated a little bit in what I ate…

Of course, it didn’t help that I have two copies of the “Fat Gene” (FTO variant gene).  The vast majority of people in the US with just one copy of the “Fat Gene” are doomed to a life of being overweight.  For those of us with two copies, our obesity fate is almost sealed…

I should have know better.  Study after study has shown that if you don’t track your food it is next to impossible to maintain your weight loss.  I wanted to believe that being intentional and mindful would work for me in the US.  But it didn’t…

I clearly knew my purpose for maintaining my weight loss.  I wanted maximal energy.  I didn’t want to take medications again.  And I wanted to silence my Alzheimer’s gene (ApoE4).  So how did this 10 pound weight gain happen so fast?

The Problem Was that Tracking Was No Longer Fun

After analyzing my failure, the problem came from changing the tracking app I use on my iPhone.  For more than four years I have used the “Lose It” app.

My favorite part of the Lose It app are the lifetime statistics.  For example, I love to see how many calories I have burned over the years skiing, mountain biking, or running.  It is like a contest to see which sport will win.

The reason why I switched is that Lose It doesn’t track the micronutrients of foods.  I wanted to make sure that I was getting enough calcium, zinc, potassium and other essential micronutrients from my plant-based diet.  Because Lose It can’t tell me about the micronutrients of the foods I eat, I switched to the Cronometer app.

Cronometer gives you far more nutritional information than Lose It.  Because it is so good, I even opted for the paid version.

While Cronometer is a much better food and nutrition tracking app, it lacks the lifetime calorie burn from different workouts.  And because this one little component was missing, tracking was no longer fun.  When tracking was no longer fun, I thought I could rely on mindfulness…

Keystone Habits

In one of my favorite books, The Power of Habit, Charles Duhigg writes about keystone habits.  Leveraging your keystone habit is what makes behavior change possible.  The keystone habit is your key domino.  If you can do this one thing right, everything else will fall into place.

For me, my keystone habit is exercise.  Fortunately, I became addicted to exercise at age 22.

Exercising outside is my daily antidepressant. Indeed, studies show that about 15 minutes of daily exercise has the same beneficial effect on depression as taking an antidepressant.  If I even go a day without exercising outside I become very depressed.  No one wants to be around me if I miss a day of exercising outside.

The reason why I gained 10 pounds this winter is that I failed to leverage my keystone habit.  I love the sense of accomplishment of seeing my lifetime exercise statistics.

The reason why the Lose It tracking app worked for me is because I could see my lifetime workout statistics.  This reward helped me to also record my daily food intake.  When the reward was gone, it was too much of a burden to track my food.  So I stopped tracking.

I Gained Weight Even Though I Was Exercising

Whenever I talk with patients about losing weight, nine times out of ten they tell me why they can’t exercise.  For some strange reason, most people think that exercise is the key to weight loss.

Surprisingly, the medical literature doesn’t support this at all.  Indeed, study after study has confirmed that exercise alone doesn’t cause weight loss.  Weight loss is primarily determined by food choices.  What we eat, when we eat, and how much we eat.

During my mindfulness experiment in the US, I was actually exercising more.  I know it seems counterintuitive but even though I was exercising more my weight went up!

My favorite time of the year to exercise is winter.  So every day this past winter I either cross country skied or climbed snow covered mountains to ski.  Both of these activities have incredible calorie burns.  But despite these massive calorie burns, I still gained weight…

My Steps Dropped Off

When I stopped tracking my food I also stopped tracking my daily step count.  Even though I thought I was no longer tracking my steps, my Apple Watch was still tracking them in the background.

Because taking steps isn’t fun for me, my daily step count did drop when I stopped tracking.  However, in doing the math, this slight drop in steps could only explain perhaps a pound or two at most of my 10 pound weight gain.

This observation brings up another interesting point of why people don’t lose weight with exercise.  Humans, like every other animal, conserve energy.  In fact, studies show that we are hard wired to be as lazy as possible.

Indeed, countless studies show that when people or animals are exercised, they subconsciously become less active throughout the rest of the day to conserve energy.  This happened to me as well with my mindfulness experiment in the US.

When I stopped tracking my steps, I didn’t take any more steps than I needed to.  As sitting is now the “new smoking” when it comes to cancer, heart disease, and premature death risk we all need every possible advantage to avoid our prewired nature to sit.  It is for this reason that I recommend not only 30 minutes of daily exercise for my patients but also at least 10,000 steps as well.

We have to move throughout the day.  A single killer workout simply isn’t enough.

The 3 Easy Steps to Behavior Change

Behavior change is never easy.  Based on reviewing every study I could find, and from working with thousands of patients, here are the three things you need to do for successful behavior change.

1.  Have a Purpose

You need a strong purpose.  If your reason for behavior change is to fit into your bathing suit again this summer your purpose probably isn’t strong enough.  Choosing health is not easy in a life full of temptations.

Studies show that a medical crisis, like a cancer or heart disease diagnosis, can be powerful motivators.  For me it really comes down to feeling young, avoiding medications, and silencing my Alzheimer’s gene.

2. Create the Right Environment

Creating the right environment was the secret to the people living in China’s Longevity Village.  In fact, this was all they had when it came to behavior change.  And if done right, this may be the strongest of the three steps.

Historically, there were no temptations in the Longevity Village.  If you never saw sugar, processed carbohydrates, or fast food then you would never be tempted.  And if you were never tempted, then you would never miss these foods or feel deprived.

Likewise, if people ate vegetables as part of their breakfast, lunch, and dinner then you would have no choice but to learn to like vegetables.  Also, if everyone did hand farming all day, everyday, then you would never be tempted to sit.

Indeed, I found that when I lived in China’s Longevity Village I could stop tracking.  Because there were no temptations, I could be mindful.  And every time I returned from the Longevity Village, I found that I had effortlessly lost weight.

When it comes to creating the right environment you need to eliminate every temptation that you can.  For the temptations you can’t eliminate, you need to make it very difficult to get to those temptations.

For example, if you never bring junk food into your home then you will never be tempted to eat junk at home.  If, however, you have a spouse or child that insists on eating junk food then you can ask them to keep their junk food hidden from you.  This way, unless you spend hours searching your home, you will never find the junk food.

3. Accountability

For behavior change to stick you have to be accountable to someone or something.  For me, it was being accountable to an app on my iPhone.

As long as I was “having fun” tracking, I stuck with it.  However, when I changed apps and it was no longer “fun” to track, I stopped tracking.

Many of my patients have also found success being accountable to another person.  For example, having a trainer at their gym holding them accountable has been the secret to their success.

At the end of the day it really doesn’t matter if you track with an app, or a trainer holds you accountable. Accountability is key to preventing self sabotage.  For me, this accountability piece also has to be fun.

Is there a role for mindfulness?

I hope I haven’t discouraged you from practicing mindfulness with this article.  While mindfulness hasn’t been able to replace tracking for me in the US, that doesn’t mean it can’t work for you.  In fact, the real goal is that mindfulness can someday replace tracking for me.

I still remember fondly my time in China’s Longevity Village when I didn’t have to track.  Because there were no temptations, mindfulness worked for me.

However, life in the US is different.  It is hard to find great tasting vegetables when you are hungry.  There are just too many great tasting foods all around me.

For my wife, even in the US mindfulness works.  I also have many patients that can rely on mindfulness to help them eat right, keep their weight in check, and stay physically active.  However, for every one patient I have that can successfully be mindful, I have 99 who, like me, can’t.

Thus, if you are part of that 1% who can stay healthy from being mindful, keep going.  You have developed a gift.  I strive to someday reach your ranks.  However, for the 99% of us who must track, the key lesson I learned is that tracking must be fun.

Make Tracking Fun

Because I will probably never be able to stop tracking if I want to eat right, maintain my weight loss, and not sit too much, I have to make it fun.  For me, I like seeing my lifetime achievement awards on Lose It.

Sadly, the Lose It app only displays 10 years of data.  In a little more than five more years I will no longer be able to see my lifetime achievements.  Thus, I will need to come up with a new way to “gamify” tracking.

For me, the virtual medals that these apps give out don’t motivate me.  Comparing my results to others also isn’t motivating.  For me, I like to see which exercise “wins” when it comes to my lifetime exercise stats.  And by leveraging this “reward,” I can tack on other healthy behaviors like food tracking.

In case you wanted to see my results for the last 4+ years, here you go..

I know this seems stupid, but this one feature of Lose It is what keeps me tracking everyday.  My goal is to have my lifetime calories burned from skiing beat out the calories I get from walking everyday.  As snow skiing is a seasonal sport, my off-season goal is to have my total calories burned from mountain biking also beat out walking.

The key to tracking is to make it fun.  If you can make it like a video game where you achieve new levels then it can help to make the healthy behavior change stick.  The reason why I stopped tracking with Cronometer, even though it gives you so much more information than Lose It, is because it wasn’t fun for me.

Practical Tips

While mindfulness is the ultimate goal, if you are like me you may never reach this level of enlightenment.  Thus, short of permanently moving to China’s Longevity Village, I need to track.

Through my recent 10 pound weight gain I have learned that I probably can never stop tracking as long as I am living in the US.  And the way to make tracking a habit is to make it fun.

Since switching back to Lose It a week ago, I have now lost two pounds.  I have eight more pounds to lose before summer in order to get back to my ideal healthy weight…

What has helped you maintain healthy habits?  Please leave your experiences below.  The comment section will be open for the next 30 days.

If you enjoyed this article, please be sure to sign up for our free weekly newsletter, subscribe to my podcast, or read our bestselling book, The Longevity Plan.

Will Atrial Fibrillation Kill You?

Heart problems are scary, and everyone sooner or later asks will atrial fibrillation kill you?  In this article, I’ll teach you what you need to do to add extra years to your life even if you have atrial fibrillation.

Jeff’s Story

“Will atrial fibrillation kill you?” Jeff asked me on the day we met. The interesting thing is that he was only 65 and had just finished a half marathon. Somehow he figured that if something was wrong with your heart, then death was imminent.

Other than his atrial fibrillation, Jeff was a picture of health. He ate right and took nature walks daily  to keep stress levels in check.  He was asleep every night by 10 pm and got at least seven hours of good sleep.

Jeff filled his days with a part-time consulting business and running. He and his wife Margie would travel the world looking for the next race to run. It was their way of exploring each new city.

Given how well he felt, he was in a state of shock when atrial fibrillation seemed to strike out of nowhere.  He loved his family, and he loved living.  He came to see me because he didn’t want atrial fibrillation to shorten his life.

Does atrial fibrillation shorten your life?

Based on our research, people with atrial fibrillation don’t live as long as those without atrial fibrillation. What we don’t know is whether this shorter life expectancy is from atrial fibrillation or the many other medical issues that often accompany atrial fibrillation.

For example, it is rare for me to see a patient, like Jeff, whose only medical issue is atrial fibrillation. In general, most of the people I see every day with atrial fibrillation have not optimized their lifestyle.  Most are overweight, aren’t exercising every day, and they eat the Standard American Diet (SAD).  In addition to a suboptimal lifestyle, they often have high blood pressure, sleep apnea, or other lifestyle-related conditions.

What we really don’t know is will atrial fibrillation still shorten your life even if you have optimized your lifestyle?  My personal opinion is that the longevity risks of atrial fibrillation are minimal provided you are doing everything else right.

Will keeping your heart in rhythm extend your life?

The simple answer to this question is it depends. For example, if keeping your heart in rhythm means a cardioversion and antiarrhythmic medications, then the answer is no.

Indeed, many studies comparing living out of rhythm versus taking an antiarrhythmic and having your heart shocked have shown no difference in survival. The reason for this is likely due to whatever survival benefit you may get from a normal heart rhythm is completely offset by the toxicities of the drugs used to get you there.

In contrast, our studies involving close to 40,000 patients have shown that a catheter ablation procedure to treat atrial fibrillation may extend your life. Once again, while normal rhythm likely gives you a longevity boost, the life extension benefit probably seen in our studies is also due to living a healthier lifestyle. Indeed, it is pretty difficult to get out of our clinic without also being encouraged to make healthier lifestyle choices.

Do your genes determine how long you live?

Most people assume that your genes determine how long you live.  While genes do play a role, it is much less than what people think.

For example, even with identical twins who share the same DNA, studies show that genes only account for 25% of how long they will live.  Thus, 75% of their life expectancy is determined by their daily lifestyle choices.

What do atrial fibrillation patients die from?

So what happens in the end?  How do people with atrial fibrillation die?

To answer this question, French researchers looked at the cause of death of every atrial fibrillation patient in a 2012 study. And what they found will likely surprise you.

Death from anything heart related ultimately claimed the lives of only a third of all French people with atrial fibrillation. However, fully two-thirds of the deaths occurred from other medical conditions.

The findings of this study come as a complete surprise to most physicians taking care of people with atrial fibrillation as well. Indeed, the real risk isn’t the atrial fibrillation but rather all of the other medical conditions that go along with atrial fibrillation.

The Top 5 Things That Shorten Your Life

Instead of thinking, “will atrial fibrillation kill you” the real focus should be on reversing lifestyle-related medical conditions.  These lifestyle-related medical conditions will rob you of far more years than atrial fibrillation.

For example, studies show that smoking, weighing more than you should, not exercising, stress, and diabetes all take approximately ten years off your life. Even if you live the rest of your life in atrial fibrillation, reversing just one of these five conditions will give you back far more years than atrial fibrillation might take. Indeed, when put in proper perspective, the risk of atrial fibrillation can’t even begin to compare to the premature death risk of smoking, weighing more than you should, not exercising, stress, or diabetes.

Jeff’s Story Revisited

Because Jeff had already optimized his health, there wasn’t anything we could do to reverse his atrial fibrillation naturally.  Interestingly, his 23andMe home genetic test showed that the cause of his atrial fibrillation was probably genetic.

As the atrial fibrillation drugs slowed his running times, Jeff was looking for a permanent solution to his atrial fibrillation that didn’t involve taking medications.  He was ready for an ablation.

While it ultimately took two ablation procedures, his atrial fibrillation is totally gone now.  And to ensure he never goes out of rhythm again, he tracks his heart rate and EKG with the new Apple Watch Kardiaband.

Practical Tips

If your goal is a long and healthy life, focus on optimizing your overall health rather than worrying about atrial fibrillation. In the big picture, atrial fibrillation can’t even come close to affecting your lifespan the way healthy living can.  And if you can optimize your overall health, then there is a good chance your atrial fibrillation may go away on its own without drugs or procedures.

The 5 Best Ways to Diagnose Atrial Fibrillation

Isn’t it frustrating when doctors can’t seem to figure out what is going wrong?  It can be that way with atrial fibrillation that comes and goes.  Atrial fibrillation never seems to happen in the doctor’s office.  In this article, I’ll teach you the five very best ways to diagnose atrial fibrillation.

Mary’s Experience

Mary’s heart never did its thing in the doctor’s office.  For years, she had palpitations and a rapid heart beat.  But it always behaved in the doctor’s office.

During the many years she suffered from palpitations and a rapid heartbeat, her doctors had ordered many tests.  These tests included electrocardiograms (EKGs) and even a 48-hour heart monitor.  And everything always came back normal.

Because her doctors could never find anything wrong with her heart, they diagnosed her with panic attacks. Under this assumption, her doctors then prescribed anxiety medications.  Despite this, she knew something was wrong with her heart even though her doctors didn’t believe her.

Does Atrial Fibrillation Come and Go?

The problem was that Mary had the kind of atrial fibrillation that comes and goes.  The medical term for this kind of atrial fibrillation is paroxysmal atrial fibrillation.

With paroxysmal atrial fibrillation, the heart periodically goes out of rhythm and then will self-correct.  For some strange reason, people suffering from paroxysmal atrial fibrillation always seem to be in normal rhythm when they are at the doctor’s office.

Finally, after years of suffering, the diagnosis was made.  Sadly, it took a stroke that left her unable to speak before the EKG finally showed atrial fibrillation.  Fortunately for Mary, she got to the emergency room in time so that they could quickly dissolve the atrial fibrillation blood clot and allow her to speak again.  While it can be hard to diagnose atrial fibrillation, it doesn’t have to be this way.

How do you know if you are having atrial fibrillation?

Mary knew she was experiencing some form of an arrhythmia.  Her heart would suddenly take off racing.  Then, it would abruptly stop.

Probably the main reason why it took so long to diagnose atrial fibrillation is that she never learned to check her pulse.  If she could have communicated to her doctors that her pulse was periodically fast and irregular, the diagnosis could have been made years earlier.

And that is how you know you are in atrial fibrillation.  Your pulse is fast and irregular.  While this method isn’t 100% accurate, in my practice it works 99% of the time.

The 5 Best Ways to Diagnose Atrial Fibrillation

To cut the possible diagnosis time of atrial fibrillation from years to days, here are my five best ways to diagnose atrial fibrillation.

1.  A Fast and Irregular Pulse

As mentioned above, all atrial fibrillation patients need to learn to track their pulse.  The easiest way is to just feel your pulse.

Your pulse should be regular.  Occasionally you might “skip” a beat, this is normal.  If every beat is irregular then it is probably atrial fibrillation.

Next, count the number of beats you have in 15 seconds and multiple by four.  This is your pulse.  Unless you are on medications to slow your heart down, most cases of atrial fibrillation have a heart rate faster than 100 beats per minute.

What should you do if you can’t feel your pulse?  If you can’t feel your pulse you could listen to your heart beats to see if it is fast and irregular with a five dollar stethoscope you can buy on Amazon.

If your hearing isn’t any good either, then you can buy a twenty dollar pulse oximeter on Amazon.  With a pulse oximeter you look at the blinking light to see if it is fast and irregular.

2. Do an EKG While Your Heart is Fibrillating

While detecting a fast and irregular pulse will get you 99% of the way to the diagnosis, to confirm things you will need an EKG.  The easiest way to do this is to get an EKG done while your heart is in atrial fibrillation.

To expedite this process, I often write a prescription for an EKG and give it to my patients.   This way, whenever the atrial fibrillation attacks, they can quickly run to the hospital, bypassing the emergency room, and getting an EKG done.

If your doctor hasn’t yet written you a prescription for an EKG, you could run to the nearest urgent care clinic or the emergency room.  If you tell them your pulse is fast and irregular they will quickly do an EKG for you.

3. Have Your Doctor Order an Event Monitor

For those people who have atrial fibrillation attacks that don’t occur frequently, and don’t last very long, an event monitor is a great way to go.  An event monitor is a heart monitor that you use at home.  Most models have several electrodes that you stick to your skin.

In my practice, I typically prescribe an event monitor for one month.  Also, the event monitor is continuously transmitting, like a cell phone, as people experience atrial fibrillation.  Thus, it may not take long to nail down the diagnosis.

4. Turn Your Smartphone into an EKG Machine

For those who don’t get atrial fibrillation attacks every month, turning your iPhone or Android phone into an EKG machine may be the way to go.  For this approach, you pay a one time $99 fee on the Alivecor website to buy some electrodes that bluetooth in to your phone.

With the KardiaMobile system, you can now email or text the EKGs from your phone.  These EKGs are no different from what you might get at the hospital so the diagnosis is usually pretty straightforward.

Unfortunately, the free “EKG apps” available for smartphone users are usually worthless when it comes to making the diagnosis.  These apps rely on the flash component of your phone to try and diagnose atrial fibrillation.  If you want to use your phone, then pay the $99 and get a high quality system.

5. Turn Your Apple Watch into an EKG Machine

If money is not an issue, and you want the coolest way to diagnose and track your atrial fibrillation, then go with the KardiaBand.  For $199, on top of the cost of buying the latest Apple Watch, as well as ten dollars a month in recurring expenses you can turn your Apple Watch into an EKG machine.  As with the smartphone version described above, you get a high quality EKG for your doctor.

Practical Tips

No one should have to wait years before atrial fibrillation is finally diagnosed.  Because atrial fibrillation can cause strokes, you don’t want any delay in making the correct diagnosis.

Of all the ways to diagnose atrial fibrillation, taking you pulse has to be the easiest.  If your pulse is fast (usually above 100 beats per minute if you aren’t on any heart medications) and irregular then you probably have atrial fibrillation.

To confirm the diagnosis, you will need an EKG.  Whether that EKG comes from the doctor’s office, an event monitor, your smart phone, or even your Apple Watch it really doesn’t matter.

What Are the Atrial Fibrillation Symptoms?

Many people wonder if they might have atrial fibrillation.  Short of doing an EKG, recognizing the symptoms can help you to determine if it is atrial fibrillation or not.  In this article, I’ll cover the key atrial fibrillation symptoms to look out for.

Bob’s Story

At 56, Bob thought he was getting old. While he never was the “exercising type,” he always prided himself on being able to do a hard day of work. Bob was a carpenter. He liked his work so much that he often joked that he wanted to keep hammering nails right up until one was nailed in his own coffin.

“Doc, I just don’t know what’s wrong with me. I can’t even make it through a day of work anymore. I’m just so tired and short of breath if I try to do anything. Is this old age?” He asked.

“You are too young to be tired and short of breath. I think it’s the atrial fibrillation,” I said.

“What can we do about it?” Bob asked.

“Let’s get your heart back in rhythm and see if you feel better,” I said.

With that, I had my nurse schedule him for an electrical cardioversion to shock his heart back into rhythm later that day. When he came back a month later, he looked a lot younger than his previous self.

“Doc, I feel young again,” he said.

“That’s sinus rhythm,” I said.

The Top 9 Atrial Fibrillation Symptoms

Having seen tens of thousands of patients with atrial fibrillation over my career, I think I have heard about every possible symptom there is.  Based on this experience, below are the top nine atrial fibrillation symptoms I hear from patients, in order.

1. No symptoms

Yes, you read this correctly.  No symptoms.

Indeed, if you ask an older or an inactive person with atrial fibrillation to describe their atrial fibrillation symptoms, they will probably tell you, “I don’t feel a thing.”

The reason for this is that if you aren’t regularly using your heart, then you probably won’t notice if your heart goes out of rhythm.  Even in people who swear they can tell the second they go out of rhythm, if you monitor them long enough you will discover they often have short atrial fibrillation attacks that they can’t feel.

Basically, the more you use your heart, the more likely you will be to notice that something isn’t right if your heart goes out of rhythm.

2. Fatigue

Of all the atrial fibrillation symptoms I hear, the most common is fatigue. Like Bob, many people don’t feel the palpitations or the rapid heartbeat.  Rather, they just are tired.  Many, like Bob, think that this fatigue is just a sign that they are getting old.

Remarkably, most patients feel much younger once we get their hearts back into normal rhythm. It’s almost like a switched was flipped.

There are so many reasons why atrial fibrillation patients feel tired.  To understand the five main reasons why people with atrial fibrillation feel so tired, here is a link to an article I wrote on this topic.

3. Shortness of Breath

After fatigue, the next most common atrial fibrillation symptom is shortness of breath.  The shortness of breath that comes from atrial fibrillation isn’t usually noticeable at rest.  Instead, it is a shortness of breath that comes from exertion.

For example, Bob’s breathing was fine when he was with me in the clinic.  However, as soon as he tried to do any physical work he felt breathless.

4. Palpitations

When most of my patients think about atrial fibrillation symptoms, palpitations immediately comes to mind.  But this isn’t the case.  In fact, many of my patients are amazed that they don’t feel anything in their chest when their heart is out of rhythm.  In Bob’s situation, because he never felt the palpitations, he didn’t think it could be his heart.

For those who can feel their atrial fibrillation symptoms, palpitations are the sensation that their heart is flopping around like a fish inside their chest. Sometimes, people may even describe “hard” or “pounding” beats with atrial fibrillation.

5. Chest Pain

Chest pain is an especially troublesome symptom to diagnose. With chest discomfort, it can be hard to tell if it is from atrial fibrillation or a heart attack.  Heck, it could even be one of a hundred other different causes.

One way that can help to determine if the cause is from atrial fibrillation has to do with the timing of the symptoms.  If you only have chest pain when your heart is in atrial fibrillation, then it is probably from the atrial fibrillation.  Indeed, if your chest pain instantaneously goes away the exact second your heart goes back to a normal rhythm then this is usually the case.

If, however, the chest pain doesn’t 100% correlate to your atrial fibrillation then it is likely a different cause.  Regardless of the cause, chest pain can be a life-threatening symptom so call for help immediately.

6. Dizziness or Lightheadedness

With the rapid heartbeat that accompanies most cases of atrial fibrillation, many people feel dizzy or lightheaded.  Dizziness and lightheadedness can also come from atrial fibrillation dropping your blood pressure.

As with chest pain, there are a million different causes of dizziness and lightheadedness.  Thus, to correctly determine if dizziness and lightheadedness come from your atrial fibrillation then these symptoms should 100% correlate to your pulse.

7. Leg Swelling

In older or heavier people, leg swelling can be a symptom of atrial fibrillation. As people get older, particularly if they have been overweight or have had high blood pressure, the heart can get very stiff. Just like when you are trying to blow up a balloon at a birthday party, a stiff heart is hard to fill with blood.

When the heart doesn’t fill properly, fluid backs up and swelling occurs. This situation is worse when the heart goes out of rhythm. Thus, many of my older, overweight, or hypertensive patients know they are out of rhythm based on how much swelling they are getting in their legs.

8. Fainting

In rare cases, atrial fibrillation can cause fainting in older people.  This happens either from the heart going so fast that the blood pressure drops or from the heart briefly flat-lining when the atrial fibrillation stops and sinus rhythm returns.

9. Other Seemingly Unrelated Symptoms

With atrial fibrillation, just about any symptom is possible. For example, some of my patients report excessive urination when they are out of rhythm. Others describe digestive issues or abdominal discomfort when their hearts are out of rhythm.  The bottom line is that atrial fibrillation can cause many other seemingly unrelated symptoms.

Practical Tips

Regardless of your symptoms, make sure your cardiologist is aware of your symptoms. Whether or not you and your cardiologist decide to treat atrial fibrillation aggressively largely comes down to your symptoms.

Also, don’t rely on symptoms to tell you that you are in atrial fibrillation.  I have seen far too many patients in my career suffer strokes because they relied on their atrial fibrillation symptoms to tell them if they were in rhythm or not. Symptoms are never 100% reliable.

Learn to check your pulse every day.  If your pulse is fast or irregular, then you just might be in atrial fibrillation.

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5 Ways to Lose Weight with Pasta

Everyone knows pasta causes weight gain.  Would you be surprised to learn that scientific studies show the opposite?  In this article, I cover the latest pasta study and share five ways to lose weight with pasta.

The Latest Pasta Study

In a study published this week in the prestigious British Medical Journal, researchers from Canada pooled together the results of 32 studies looking at 2,448 people.  And what they found goes against what you read in all of the popular health books…

When carefully analyzing the results of 32 different studies of 2,448 pasta eating people, these researchers found that eating pasta, as part of an otherwise healthy diet, doesn’t cause weight gain.  In fact, those eating pasta every day actually lost about one pound provided pasta was part of a healthy diet.

How Can this Study Be True?

This study must be wrong.  Everyone knows pasta makes you gain weight.  Let me give you four reasons why this study may be right.

1.  Pasta is relatively low on the glycemic index.

The glycemic index measures how fast food is converted to sugar in the body.  Foods high on the list, like bread, are instantly converted to sugar.

White bread has a glycemic index in the high 70s.  Even “healthy” whole wheat bread also has a glycemic index score in the high 70s.  These high glycemic scores tell us that the standard store-bought bread is little more than just sugar.

At the opposite end of the spectrum, you have foods like nuts which have almost no sugar response in the body.  With nuts, the glycemic index will typically be under 20.

Pasta, surprisingly, has a relatively low glycemic index score in the 40s.  Thus, it is somewhere between bread and nuts when it comes to how fast it is converted to sugar in the body.  Foods with a low glycemic index are generally healthier and promote weight loss as they are much more filling and don’t throw off your metabolism.

2. Pasta Portion Sizes were Controlled.

While the portion sizes of pasta varied in these 32 studies, in general, a reasonable portion size is about the size of your fist.  These studies didn’t include the massive pasta bowls that you might see in a typical U.S. restaurant.

3. What You Put on the Pasta Matters

It should come as no surprise that a lot of the 32 studies came from Italy and other Mediterranean countries.  Thus, pasta sauce using tomatoes, vegetables, and olive oil were common.  It wasn’t a big bowl of cheesy pasta like you might see at the Olive Garden restaurant.

4. It Matters What the Rest of Your Diet Looks Like

As mentioned, only those who ate an otherwise healthy diet didn’t gain weight with pasta.  If the rest of your diet is healthy, pasta won’t cause weight gain.

5 Ways to Lose Weight with Pasta

Depending on where your current diet is at, let me suggest five ways to lose weight with pasta.  I have listed these in order of their nutritional value and the likelihood that you will lose weight with pasta.

1.  Use Vegetable Noodles

Using fresh vegetables as your noodles is clearly the healthiest option.  Zucchini, carrots, squash, cucumbers, or sweet potatoes can easily be cut into spirals with a machine to create incredibly healthy pasta.

While vegetable noodles are off the charts nutritionally, there are a few downsides.  First, you need a vegetable noodle maker.  For about $15 you can get one of these at Walmart or on Amazon.  For those of you who don’t want to use a machine to cut up your veggies into noodle strips, Whole Foods always has fresh vegetable noodles available, but you will definitely pay for this convenience.

Second, vegetable pasta doesn’t taste like regular pasta.  It is for this reason that I struggle with vegetable noodles.

Don’t be fooled by a little spinach in your typical pasta.  That little bit of spinach doesn’t do anything to the nutritional aspect of your pasta.  If you want the best pasta when it comes to nutrition, it has to be all vegetables.

2. Bean Pasta

The second healthiest way to eat pasta is to use a bean pasta.  Fortunately, bean pasta comes much closer to the taste and texture of traditional pasta.

Almost any bean can be made into pasta.  With bean pasta, you are going to get an even lower glycemic index number.  Also, with a bean pasta, you will get a ton of protein and fiber as well to fill you up.

If you want to give bean pasta a try, Amazon has many choices.  Also, health food stores, like Whole Foods, has many bean pasta options.

3. Quinoa Pasta

Down one level from bean pasta is quinoa pasta.  While you won’t get as much protein and fiber as with a bean pasta, it is still probably better for you than wheat pasta.  Also, for those wishing to avoid gluten, this is another option.

4. Turn Regular Pasta into a Resistant Starch

Number four on the list is to take your regular pasta and turn it into a resistant starch.  While this doesn’t boost the nutritional content, it does put the pasta even lower on the glycemic index.

With a resistant starch, you are making the pasta even harder for your body to convert to sugar.  This slow-burning carb helps to keep you full and won’t lead to a sugar/insulin crash.

To convert your pasta to a resistant starch, simply put your cooked pasta in the fridge overnight.  The process of cooking, cooling, and then cooking again converts it to a resistant starch.

5. Replace Bread with Pasta

Last on the list if you want to lose weight with pasta is to simply replace bread with regular pasta.  Nutritionally they are about the same.  However, because even regular pasta is so much lower from a glycemic standpoint than bread, you are much less likely to mess up your metabolism.

The Big Picture

Pasta can be incredibly healthy if eaten right.  Even the standard pasta is probably “less bad” for you than eating bread.  Of course this also depends on what you put on your pasta…a big portion size or that cheesy sauce could completely undo any possible benefit.

When it comes to optimizing your metabolism, you want all of your foods to be at least less than 50 on the glycemic index.  To learn where your favorite foods fall on the glycemic index, here is a great chart from Harvard University.

Do you have any “pasta hacks” to make pasta healthy?  Please leave your tips below.

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How to Bulletproof Your Brain

I want to share a message of hope for those of you with a family history of dementia.  According to a new study, one simple habit can cut your risk of dementia by 90%!  In this article, I will teach you how to bulletproof your brain.

The Swedish Dementia Study

Researchers from Sweden just published a study that rocked the neurology/dementia world.  After following the people in this study for 44 years, researchers found that for those who are in the top 5% of their age group for physical fitness, then the risk of dementia dropped by 90%! And in those incredibly rare cases where a very physically fit person did develop dementia, it didn’t happen until after age 90.

No other intervention has ever been shown to have such a profound effect on protecting the brain. Of course, to make it to the top 5% for physical fitness in your age group will also require that you are eating right, optimizing sleep, etc.

How does exercise bulletproof your brain?

Studies show that exercise helps clear the dementia debris that piles up in the brain as we age. Also, physical activity is the most potent stimulator of brain-derived neurotrophic factor (BDNF), which causes the growth and development of brain cells.

Other studies have shown that people cut back on physical activity about ten years before developing dementia. Thus, if you have had no drop off in your daily exercise, then these studies suggest your brain will stay sharp for at least ten more years.

As dementia scares me to death, since reading this study I have significantly bumped up my daily exercise regimen.  I’m banking on the fact that because my physical fitness continues to improve that I can bulletproof my brain.

Key Takeaway

The message here is clear. If you want to bulletproof your brain it is going to require a very high level of physical fitness.  Walking around the block just isn’t going to cut it according to this study.

In addition to a high level of physical fitness, you also need to cut out the sugar and dramatically boost the veggies.  At least seven hours of sleep, embracing stress, and learning new things daily will also help to bulletproof your brain.

Of course, If you haven’t done much more than walking, now is the time to work with your physician on finding the right way to increase your stamina.  Don’t boost your daily exercise without speaking to your physician first.

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Low Carb or Low Fat: Which is Best?

Should you go low carb or low fat for weight loss? I’m guessing you would pick low carbs. However, if I had asked you this same question 20 years ago, the answer would likely have been different.  Would you believe me if I told you that it probably doesn’t matter based on a big new study from Stanford University?

The Best Low Carb vs. Low Fat Study

In this new study, Stanford researchers recruited 609 adults who were willing to eat either low carb or or low fat for a year based on the “flip of a coin.” A year later, the low-fat group lost about 13 pounds and the low-carb group also lost about 13 pounds.

When they looked at glucose and insulin metabolism, they also saw no meaningful difference. Where things really got interesting was when they looked at the genes of everyone in this study. Even if your genes predicted you would do better eating low fat or low carb, the study results showed that it just didn’t matter.

The 3 Success Factors to Losing Weight

Interestingly, when these Stanford researchers analyzed those who lost the most weight in the study, they found three factors.

1. Those losing the most weight avoided sugar.

2. Those losing the most weight avoided flour.

3. Those losing the most weigh ate a lot of vegetables.

Number one on this list, avoiding sugar, should come as a surprise to no one.  Almost everyone loses weight if they can give up the sugar addiction.

Likewise, number three, eating a lot of vegetables, is another no brainer.  If you fill up on vegetables you’ll lose weight and feel so much healthier.

Number two, avoiding flour, however may come as a surprise to many. The reason for this is that when a grain is pulverized to a dust-like form, the body absorbs it so fast that it raises blood glucose almost as much as eating straight sugar. Thus, to keep your metabolism in check, if you choose to eat grains only eat intact grains.

What does this study tell us?

Even though it may seem counter intuitive, this study fits nicely with what we know about diets and nutrition. The bottom line is that low carb or low fat can be healthy provided you avoid sugar, including flour, processed foods, and eat a ton of vegetables. Basically, you need to find what works for you and then stick with it.

Does atrial fibrillation make you tired?

No one wants to feel tired all the time.  Yet, that is what most people suffering from atrial fibrillation endure every day.  While the answer to the question, does atrial fibrillation make you tired is obviously yes, in this article I’ll explain why it makes you fatigued and how you can fix this problem.

Why does atrial fibrillation cause fatigue?

Having spent the last 30 years of my career caring for people with atrial fibrillation, the number one symptom I hear is fatigue.  Indeed, studies have confirmed that feeling tired is a hallmark symptom of atrial fibrillation.

As most of my patients with atrial fibrillation struggle with fatigue, here the top 5 reasons I have found as to why atrial fibrillation makes you so tired.

1. Losing 20-30% of Your Heart Function Can Make You Tired

When your heart is out of rhythm, the upper chambers of the heart are no longer pumping. Thus, you lose 20-30% of your overall cardiac function as the bottom two chambers are doing all of the work. And this 20 to 30% loss of cardiac performance is more than enough reason to make anyone feel tired.

2. A Rapidly Beating Heart Causes Fatigue

When most people go out of rhythm, their heart rate suddenly jumps up. Indeed, many people have a resting pulse of 100 beats per minute or faster when they are out of rhythm. With this fast of a heart rate, it is almost as if they are always running on a treadmill and their heart never gets a chance to rest.

3. An Irregular Pulse Makes You Tired

Another possibility is that the irregularity of your pulse with atrial fibrillation makes you tired. While there isn’t a lot of research in this area, we do know that there are many nerve endings in your heart tissue. It is possible that activation of the vagus nerve, which connects your heart and brain, causes you to feel tired when your heart is out of rhythm.

4. Atrial Fibrillation Medications Cause Fatigue

Most atrial fibrillation patients are on a lot of medications.  Putting all of these chemicals into your body can have side effects.  And if you don’t know what these side effects are then my guess is that you just haven’t discovered it yet.

To help illustrate this point, let me challenge you to read the package insert of any atrial fibrillation drug you have been prescribed.  I’ll bet that fatigue is somewhere on the list of possible side effects.

Why are atrial fibrillation drugs notorious for causing fatigue?  This is because these medicines often slow the heart and drop the blood pressure. Too slow of a heart rate or too low of a blood pressure can definitely cause fatigue.

If you can pin your fatigue down to one medication, then work with your doctor to see if this medication can be eliminated or changed.  However, if all of the atrial fibrillation drugs make you tired, then you will likely be looking at a catheter ablation procedure unless you can put your atrial fibrillation into remission with a 100% commitment to healthy living for the rest of your life.

5. Underlying Problems Are Making You Tired

Most cases of atrial fibrillation didn’t happen by chance.  There is usually an underlying problem that contributed to the wear and tear on the heart that ultimately caused the atrial fibrillation.

In my practice, at least 80% of atrial fibrillation cases can be at least partially traced back to being overweight, too much sugar or processed carbohydrates, not enough vegetables, a lack of physical activity, excessive stress, or sleep deprivation. Sadly, not only can these conditions cause atrial fibrillation but they can also make you very tired as well. Fortunately, correcting these underlying causes of atrial fibrillation may not only help you to reverse this condition but also energize you in the process.

Practical Tips

Atrial fibrillation causes most of my patients to feel tired.  Unless you can live with this atrial fibrillation fatigue for the rest of your life, then you need to proactively work with your cardiologist/electrophysiologist to make sure your heart never goes out of rhythm again.

The bottom line is that atrial fibrillation can make you very fatigued. While getting your heart back in rhythm helps tremendously with fatigue, to experience the full energy your body was designed to have will likely require you to treat the underlying causes of your atrial fibrillation. Besides a normal heart rhythm, nothing will cure your fatigue faster than getting back to a healthy weight, eating real foods, making physical activity a part of every day, embracing stress, and optimizing your sleep.

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Is Nattokinase the Safest Blood Thinner?

Most of my heart patients are scared to death of blood thinners.  No one wants a blood clot, but yet no one wants to bleed to death either. Nattokinase may just be the safest blood thinner you have never heard of.  In this article, I’ll teach you everything you need to know about this natural blood thinner.

Why I Eat Natto for Breakfast

Since my health turn around nearly seven years ago, natto has been a part of my daily breakfast.  This is a practice I described in our best selling book, The Longevity Plan.  And if you haven’t read it yet, pick up your copy now to find out why this best selling book has consistently maintained a 4.9-star rating on Amazon!

When I first tried natto, I’ll admit I was grossed out.  Even though it smells like a dead rat what bothers me the most is how slimy and sticky it is.

The reason why it is sticky and slimy is that it is a probiotic.  In other words, the helpful bacteria from this probiotic make it slimy and sticky.

While the Japanese eat it every morning over rice with mustard, soy sauce, or other flavorings, I just eat it plain. I scoop up a big tablespoon of the stuff and quickly swallow it down.

It doesn’t taste good but knowing how good it is for me makes it tolerable.  Of note, my wife and two-year-old son also eat natto with me.  My older three children won’t go near the stuff.

One Reason Why the Japanese Rarely Get Heart Disease

For decades researchers have tried to figure out why the Japanese rarely get heart disease and why they live so long.  Despite high rates of smoking among men, the Japanese are somehow still protected.

One possible explanation may be natto.  Natto, or fermented soybeans, is their equivalent for cereal in the morning.  Natto contains nattokinase, a natural blood thinner, and is also off the charts in vitamin K2. For those not familiar with vitamin K2, vitamin K2 helps to keep calcium out of your arteries and into your bones where it belongs.

Indeed, studies show that Japanese eating the most natto have the lowest rates of heart disease and strokes.  They also live the longest.  Interestingly, some studies show that it is only fermented soy that offers any of these benefits.

What is nattokinase?

Nattokinase is a food enzyme found in natto.  Natto,  in turn, is made from fermenting soybeans with the helpful bacteria called Bacillus natto.  Thus, to get nattokinase, you can either get it naturally from eating natto or in a supplement extract form called nattokinase.

Natto vs. Nattokinase: Which is Best?

In choosing between eating natto or taking a nattokinase supplement, I have always gone with natto.  The reason for this is really quite simple.  Natto is so much better for you than taking a nattokinase supplement.  To visualize what natto is doing for you just think of natto as nattokinase plus vitamin K2 in a probiotic form.

When you take a nattokinase supplement, you don’t get the probiotics and you don’t get vitamin K2 either.  And when it comes to vitamin K2, no other food on this planet comes anywhere close to natto.  As I described in a previous article, vitamin K2 may be one of the best ways to protect your heart and bones from the aging process.

I also worry about the purity of any supplement.  With supplements, you really never know what you are getting.  As supplements are totally unregulated, the blood thinning effects you get from bottle to bottle may not be the same.

My philosophy on supplements is that a supplement should be a supplement.  In other words, you should only consider a supplement when you can’t get it naturally from food.  Given that natto can be easily purchased at your local Asian grocery store, or shipped over ice from an online source, most people should have no problem obtaining natto.

How does nattokinase thin the blood?

Whether you get nattokinase from eating natto or from taking a supplement, nattokinase thins your blood many different ways.  For example, one study showed that nattokinase decreases plasma levels of fibrinogen, factor VII, and factor VIII.  For those of you not familiar with fibrinogen, factor VII, or factor VIII, let me explain.

Fibrinogen is a protein that causes blood to clot.  Naturally, if you decrease fibrinogen levels, your blood will be much less likely to clot.

Factors VII and VIII are also blood clotting proteins.  Once again, if plasma levels of factors VII and VIII are reduced, clotting is less likely to occur.

In addition to fibrinogen and factors VII and VIII, another study showed that nattokinase also works on platelets.  Platelets can clump together in your blood which can be the start of a blood clot.  Two common anti-platelet drugs are aspirin and Plavix (clopidogrel).

Will nattokinase make you live longer?

As the Japanese are the longest-lived people on this planet, could it be the natto?  To find out, researchers gave nattokinase to worms in a study.   If you are a worm, nattokinase will help you live an extra six days.  This extra six days translates into a 16% longer life expectancy.

For humans, we really don’t know if nattokinase increases longevity or not.  Until a nattokinase longevity study is done, the best data we have are from the natto eating Japanese population.

Does nattokinase cause bleeding?

Fortunately, studies show that when it comes to bleeding, natto and nattokinase are very safe.  Indeed, of the studies I reviewed in writing this article, I could find no significant bleeding risk from natto or nattokinase.

I should point out that theoretically nattokinase probably has a higher bleeding risk than natto.  This is because natto contains both nattokinase and vitamin K2.  Vitamin K2 has an anti-bleeding effect.

Thus, the vitamin K2 and nattokinase in natto likely cancel each other out when it comes to the risk of bleeding.  Because I want to keep my body in a state of “natural balance,” this is another reason why I prefer natto over the nattokinase supplement.

However, for those of you already on a blood thinner, nattokinase could increase your bleeding risk.  Thus, if you have had a problem with bleeding in the past, or are currently taking a blood thinner, do not eat natto or take a nattokinase supplement without talking to your doctor first.

Does nattokinase help with inflammation?

When it comes to staying young and healthy, you want to keep inflammation levels as low as possible. One additional way to do this may be with nattokinase. While there aren’t a lot of studies on nattokinase and inflammation levels, of the studies that do exist nattokinase may function as a natural anti-inflammatory agent.

Nattokinase Prevents Blood Clots When Flying

I’m guessing that you have probably heard that sitting too long in the car, or on an airplane, may cause blood clots.  And it is for this reason that most doctors recommend that you frequently get up and walk around when traveling.

As long airplane flights are known to cause blood clots, scientists wanted to see if nattokinase could prevent clots from forming in a study of 300 people scheduled for a long flight.  Based on ultrasound imaging after their long airplane flight, none of the people taking nattokinase suffered a blood clot.  In contrast, five people not taking nattokinase developed a blood clot.

Nattokinase vs. Aspirin: Which is Best?

As we have covered in this article, nattokinase and aspirin both help to prevent platelets from clumping together.  In fact, it is platelets clumping together that causes many heart attacks and blood clots.

In one study, researchers wanted to find out how nattokinase and aspirin compared.  To sort this out, they gave various doses and measured the effect in rabbits.

What they found is that it took mega doses of nattokinase (500 mg of nattokinase for every kilogram of body weight) to have the same effect as 30 mg of aspirin.  For reference, a “baby aspirin” has just 81 mg of aspirin.

Thus, if it takes megadoses of nattokinase to have the same blood thinning effect as less than a half of a baby aspirin, this probably explains why I couldn’t find any significant reports from nattokinase in the studies I reviewed.

Does nattokinase work for atrial fibrillation?

Atrial fibrillation is the most common heart rhythm abnormality.  Indeed, one in four adults will experience atrial fibrillation at some point during their lives.

Of all the bad things that atrial fibrillation can cause, strokes have to be at the top of the list.  It is for this reason that most people with atrial fibrillation take a blood thinner.

The problem with atrial fibrillation strokes is that it takes a powerful blood thinner to prevent them.  This is why aspirin is largely ineffective against atrial fibrillation strokes.  And, as we have discussed, it takes a megadose of nattokinase even to be comparable to less than half of a baby aspirin.

While most of my atrial fibrillation patients would love to take nattokinase rather than their blood thinner, there are no studies showing that nattokinase works for atrial fibrillation.  Anecdotally, I have seen a stroke in one of my atrial fibrillation patients who faithfully took her nattokinase.  Even though I recommended a stronger prescription blood thinner in this patient, she was confident that nattokinase would protect her. Since her stroke, she now reluctantly takes a proven atrial fibrillation blood thinner.

Does nattokinase prevent heart attacks?

As heart disease remains the number one killer in the Western world, anything that could decrease this risk would be highly welcomed.  While nattokinase will never prevent every case of heart disease, some interesting research in rabbits shows that nattokinase can help to repair damaged arteries.  As with all of the other animal studies I have covered in this article, it is never clear whether the findings in animals will eventually translate to humans.

Does nattokinase treat high blood pressure?

If you live in America, studies show that you have a 90% chance of getting high blood pressure by age 55.  High blood pressure is a major medical problem as it leads to heart attacks, strokes, kidney failure, blindness, and dementia.

In a study of 79 North Americans, half were given a placebo and the other half 100 mg of nattokinase daily for eight weeks.  By the end of the eight weeks, nattokinase lowered the systolic blood pressure by four points and the diastolic blood pressure by three points.  Surprisingly, this blood pressure reduction from nattokinase seemed to be better for men.

While a four-point reduction in the systolic blood pressure and a three-point lowering of the diastolic blood pressure may not seem like much, this is the equivalence of about a half dose of your typical blood pressure medication.

Does nattokinase treat high cholesterol?

As with high blood pressure, most Americans also have high cholesterol.  One study from China found that nattokinase seemed to work just as well as a statin for cholesterol lowering.

However, before you throw out your statin drug for nattokinase, please note that there were only 82 people in this study.  Also, I could only find one study specifically looking at the effects of nattokinase on cholesterol.  Thus, we really don’t have adequate proof yet that nattokinase lowers cholesterol.

Where do you buy natto?

Every time I mention natto in a blog article or on my podcast, I get a flood of emails asking me where I buy natto.  Thus, to stop my email inbox from filling up, I thought I would answer the question here.

I now buy my natto from a local Asian grocery store.  Most Asian grocery stores carry fresh natto.  If not, they can order some for you.

In the past, I purchased natto online from a company out of California.  This online natto was shipped over ice.  The reason why I now buy it from a local Asian grocery store is that by the time online natto arrived at my house the ice was always melted and they charge more than my local Asian grocery store.

If there are no Asian grocery stores near your home, here is the link if you want to try this company.  Please note that I have no relationship whatsoever with this company.

Final Points

Based on the research available, nattokinase probably is the safest blood thinner.  Side effects seem to be minimal and the wide range of positive effects most impressive.

However, nattokinase is a relatively weak blood thinner.  Thus, nattokinase isn’t strong enough for atrial fibrillation stroke prevention.

In choosing how to obtain nattokinase, my preference is to get it naturally from food (natto) rather than from a pill.  Letting food be your medicine always seems to work better than tablets or capsules.  It is for this reason that I will continue to gulp down a heaping spoonful of natto for breakfast.

It goes without mention that you shouldn’t stop your current blood thinner based on what you have read in this article.  Also, if you have a history of bleeding, or currently take a blood thinner, don’t even think about taking nattokinase from any source without speaking to your doctor first.  Blood clots and bleeding may cause serious disability or even death.  Always speak with your doctor first before ever considering a natural blood thinner.

Does Atrial Fibrillation Get Worse Over Time?

With the diagnosis of atrial fibrillation, most people want to know does atrial fibrillation get worse over time? While atrial fibrillation is a progressive condition in most people, it doesn’t have to be this way.  In this article, I’ll teach you what you need to do to stop the disease progression and hopefully make your atrial fibrillation go away.

Carrie’s Atrial Fibrillation

Like 99% of my patients, Carrie wanted to know, does atrial fibrillation get worse over time?

“That depends,” I said.

“Depends on what?” Carrie asked.

“It depends on whether you can stop the heart from scarring further or not. If you can stop the scarring, then you can prevent atrial fibrillation from getting worse. The key is to identify what caused your heart to scar up and disrupt electrical pathways in the first place. If you can identify the cause and correct it, then your heart will have a chance to heal. Otherwise, atrial fibrillation gets worse over time,” I said.

I then went on to share with Carrie what I am going to share with you now…

Premature Heart Aging, Heart Scarring, and Atrial Fibrillation

For most people, atrial fibrillation represents premature aging of your heart. The thousands of little health decisions you make every day determine whether your heart ages fast or slow.

With each episode of atrial fibrillation, more scarring is possibly happening to your heart. This is because heart scarring, or fibrosis, can occur with each atrial fibrillation attack.

Also, other medical conditions such as high blood pressure, sleep apnea, obesity, diabetes, anxiety, etc. may also cause heart scarring.  The key is to stop the scarring if you don’t want atrial fibrillation to get worse over time.

In my experience, if patients can lose the necessary weight to get back to a normal weight, keep their blood pressure in the normal range, eat right, exercise daily, optimize sleep and stress levels then not only does atrial fibrillation not progress but it also may go away on its own

Is there an atrial fibrillation tipping point?

As more heart scarring occurs, you will likely have more frequent and more prolonged episodes of atrial fibrillation. Eventually, the heart may be out of rhythm all of the time.

This phenomenon is what my colleague, Dr. Jared Bunch, and I described as the “Atrial Fibrillation Tipping Point” in an article we recently published in a prominent heart rhythm medical journal. Basically, this AFib tipping point means that once enough scar tissue is laid down within the heart, the heart will no longer hold rhythm on its own.

Can You Reverse Atrial Fibrillation?

Yes, you can absolutely reverse atrial fibrillation!  I have seen this countless times in my cardiology practice.

The key is to stop the progressive scarring through healthy living and then reduce the strain on the heart so that future episodes don’t occur.  For a primer on how to do this, please read this article I wrote called, How to Get Rid of Atrial Fibrillation Once and For All.

Carrie’s Outcome

Carrie was motivated.  Her diagnosis of atrial fibrillation was a wake-up call.

She always knew she needed to get rid of the sugar and processed foods.  She also knew that she needed to exercise every day, get more sleep at night, and stress less.  However, with the stress of a full-time job and teenage kids at home, there never seemed to be enough time for self-care.

Atrial fibrillation was a game changer.  It forced her to confront her own mortality.  She had to be there for her kids.  It was her body’s way of telling her that she was aging way too fast.

With the fear of another atrial fibrillation attack, Carrie never missed a day.  Eating real food, daily exercise, and optimizing sleep and stress levels was a top priority for her.

She also lost weight, a lot of weight, without even dieting.  A year later her weight was down 40 pounds and the atrial fibrillation gone.  After several years without an attack, I have now moved her visits to the atrial fibrillation clinic to an “as needed” basis.

To ensure that her bad habits never come back, Carrie keeps her emergency room EKG of her heart in atrial fibrillation taped to her refrigerator.  This daily reminder is all she needs to stay strong.

Carrie is living proof that atrial fibrillation doesn’t have to be a progressive condition.  Despite what your doctor may tell you, atrial fibrillation doesn’t have to get worse over time.  Her experience also highlights that if your incentive for behavior change is strong enough, then anything is possible.

Practical Tips

To prevent the atrial fibrillation tipping point from happening, the most important thing you can do is to live the healthiest life possible. You have to stop the scarring today if you want to stop or even reverse the progression of atrial fibrillation going forward. Resolve today to slow the aging process of your heart.

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The 9 Best Ways Saunas Help Your Heart

Nobody wants a heart problem.  Fortunately, most heart conditions are very fixable.  In this article, I will answer what is atrial fibrillation and point you on the way to fixing this problem.

What is Atrial Fibrillation?

Atrial fibrillation is the most common heart rhythm condition.  When your heart is in atrial fibrillation the upper chambers of the heart are no longer beating and your pulse is usually rapid and irregular.  As a result, you will probably experience symptoms of fatigue, shortness of breath with exertion, or palpitations.

Mary’s Experience

Mary knew something was wrong.  Initially, she thought she just had a cold.  But when her cough never went away despite the antibiotics her doctor had prescribed, Mary knew something was wrong.  However, what ultimately brought her to the emergency room was when she was no longer able to walk up stairs without becoming short of breath.

With one EKG in the emergency room, the diagnosis was obvious.  Mary’s heart was in atrial fibrillation.  Not only that but it was also beating faster than 150 beats per minute at rest. With this diagnosis, it was just a few minutes before I was called to the emergency room to help out.

“What is atrial fibrillation?” Mary asked when I saw her for the first time in the emergency room. As atrial fibrillation is a tough name for people to remember, let alone pronounce, most people just call it “AFib” or “AF.”

“Atrial fibrillation, or AFib, is the most common reason why hearts go out of rhythm,” I said.

“Why haven’t I heard of it before,” she asked.

“I bet you already know many people with this condition. Just ask around,” I said.  I then went on to answer her questions below.  To find out what happened to Mary, continue reading until the end of the article.

What causes atrial fibrillation?

For the vast majority of the atrial fibrillation cases I see every day, atrial fibrillation comes from the gradual wear and tear on the heart over time.  This wear and tear then result in little patches of scarring (fibrosis) throughout the heart.  And the more scarring (fibrosis) that occurs, the more difficult it is to maintain a normal rhythm.

When it comes to the causes of scarring in the upper chambers of the heart (atrial fibrosis), the three leading causes that I see are age, obesity, and high blood pressure.  While there isn’t anything we can do about the age listed on our driver’s license, we can maintain a healthy weight and keep our blood pressure in check thereby slowing the rate at which our hearts age.

How many people are affected by atrial fibrillation?

If you ask around, you will be surprised to learn how many people in your life have atrial fibrillation.  In fact, studies show that one in four U. S. adults will have their hearts go out of rhythm with atrial fibrillation at least one time in their life.

What does atrial fibrillation look like?

Atrial fibrillation represents the complete electrical chaos of the upper chambers of the heart.  In other words, there is no organized rhythm and consequently, the upper chambers of the heart aren’t beating at all.

If you were to three-dimensionally map the electrical signals of atrial fibrillation in the heart, like I do every day when performing catheter ablation procedures, you would see chaotic electrical signals going in every direction. Upon closer inspection, you would notice that these signals often are the most intense and chaotic around patches of scar tissue in the upper chambers of the heart.

What does atrial fibrillation feel like?

While some people report feeling like a fish is flopping around in their chest, many people do not have any sensation at all.  The two main symptoms I see in my patients are fatigue and breathlessness with exertion.

Strangely, many people don’t have any symptoms at all with their atrial fibrillation.  In my experience, those people without symptoms tend to be older or more sedentary.  Indeed, if you are pushing your heart hard every day while exercising, then you will quickly notice the 20% drop off in the cardiac performance that happens when the heart is in atrial fibrillation.

Are the upper chambers of the heart beating with atrial fibrillation?

These chaotic electrical signals then cause the upper chambers of the heart to beat so fast that they just appear just to be quivering. With the two atria of the heart quivering, they are no longer pumping any blood. Thus, people in AFib are living entirely off the two lower two chambers of the heart.  Hence, this is why cardiac output drops by 20% with atrial fibrillation.

Is a heart murmur the same as atrial fibrillation?

All a heart murmur means is that someone heard blood moving through the heart with a stethoscope.  In contrast, atrial fibrillation represents the complete electrical failure of the upper chambers of the heart.

Some murmurs are benign whereas others can represent life-threatening heart valve problems.  The only definitive way to find out if you should worry about a murmur or not is to do an echocardiogram or ultrasound of the heart.

Perhaps the reason why some people think that a heart murmur is the same thing as atrial fibrillation is that an abnormally functioning valve in the heart can both make the sound of a murmur and cause atrial fibrillation.  The reason for this is that blood makes a lot of noise going through a tight or leaky heart valve.  Likewise, a tight or leaky heart valve puts a lot of stress on the heart which may disrupt electrical pathways and cause atrial fibrillation.

What happens if you have atrial fibrillation?

For some of my patients, they know the exact minute, down to the second, that they went out of rhythm.  This is because these people can instantly feel when their hearts stop beating normally.  In other words, they feel the irregularity of their heart, as well as the faster heart rate, that often accompanies atrial fibrillation.

However, it isn’t this way for everyone.  For many of my patients, they don’t know precisely when their heart went out of rhythm.  What they do know is that they just feel tired and their exercise stamina has dropped off.   While symptoms are important with atrial fibrillation, the real goal is to prevent the dangerous things that can happen when your heart is out of rhythm.

What are the dangers of atrial fibrillation?

With the upper heart chambers not pumping at all, blood clots can form from this stagnant blood flow. This blood pooling then increases your stroke risk five-fold.

Not only are you at high risk of a stroke, but you also lose 20% of your overall heart function when you are out of rhythm. This loss of heart function also puts you at risk for heart failure, kidney failure, or even dementia.

How is atrial fibrillation diagnosed?

To diagnose atrial fibrillation, you need to capture it on an EKG.  As with taking your car to a mechanic, atrial fibrillation never seems to happen in the doctor’s office.  It is for this reason that your doctor may prescribe a heart monitor that you wear at home for up to a month to make the diagnosis.

How is atrial fibrillation treated?

The most important thing in treating atrial fibrillation is to prevent a stroke.  Because atrial fibrillation patients have a five-fold increased risk of stroke, blood thinners are necessary when the risk of a stroke outweighs the risk of bleeding.

In addition to preventing strokes, medications may be used to slow the heart or to keep it in rhythm.  The two most common heart slowing drugs are diltiazem (Cardizem or Cartia) and metoprolol (Toprol).  Medications to hold the heart in rhythm are called antiarrhythmics.  When medications alone don’t work, your doctor may recommend a cardioversion.

What is a cardioversion?

If atrial fibrillation is causing symptoms, your doctor will probably recommend a cardioversion.  A cardioversion is a simple outpatient procedure to shock the heart back into normal rhythm.  However, it is critical to know that a cardioversion doesn’t correct the underlying electrical problem in your heart.

A cardioversion is just a temporary fix.  It is like rebooting your computer.

With your new atrial fibrillation diagnosis, your doctor will probably start you on a handful of medications.  Don’t get depressed!  With some simple lifestyle changes, there is a good chance you can get off of these medications.

How do you treat atrial fibrillation naturally?

Studies show that with simple healthy lifestyle changes, including weight loss, you have a 50% chance of making your atrial fibrillation go away without any drugs or procedures.  Indeed, I have seen countless patients over the years successfully reverse their atrial fibrillation with healthy living and you can too!

When medications and healthy lifestyle changes fail to control atrial fibrillation symptoms, the next step is usually a catheter ablation.  With a catheter ablation, your cardiologist/electrophysiologist goes into the heart with a catheter to map out those areas that are electrically misfiring.  Once the rogue sites are mapped, your doctor will then burn or freeze those areas so that the heart beats normally again.

Can a person live with atrial fibrillation?

Absolutely.  In fact, our former president, Herbert Walker Bush, has lived with atrial fibrillation for more than 25 years.  While most people with atrial fibrillation experience at least some degree of fatigue, some people are totally unaware that their heart is out of rhythm.

For those older people who truly cannot feel their atrial fibrillation, you don’t need aggressive treatment.  The focus of your therapy really should be to prevent strokes and ensure your heart doesn’t beat too fast.

For stroke prevention, blood thinners are usually prescribed.  The decision as to whether or not you should take a blood thinner comes down to how many risk factors you have for a stroke. The bottom line is that if the risk of stroke outweighs the risk of bleeding, then you probably need a blood thinner.

The reason why we don’t want the heart to beat too fast with atrial fibrillation is that we don’t want the heart to wear out.  In general, as long as you are feeling okay and your echocardiogram looks good, we try to keep your resting atrial fibrillation heart rate below 110 beats per minute.

What can trigger atrial fibrillation?

While there can be many triggers for atrial fibrillation, like alcohol, surgery, an illness, stress, or sleep deprivation, this usually doesn’t happen in completely normal hearts.  If you were to do a cardiac MRI of anyone with atrial fibrillation, you would probably find some degree of scar tissue in the upper chambers.

This scar tissue, or fibrosis, can gradually build up over a lifetime.  The top three causes of atrial fibrosis that I see every day come from the aging process, being overweight, or having high blood pressure.

One of the key strategies for treating atrial fibrillation is to avoid your triggers.  If you can learn which situations, food, etc. trigger an atrial fibrillation attack, you can be better prepared to prevent it in the first place.

What doctors treat atrial fibrillation?

As with any medical condition, you want to make sure you go to the right doctor. As you probably wouldn’t want a general handyman to do the complicated electrical work in your house, the same logic holds true with atrial fibrillation.

When it comes to atrial fibrillation, you want the best doctor with the most experience in treating this condition. Thus, my recommendation would be to schedule an appointment with a cardiologist who specializes in arrhythmias as soon as possible.

Cardiologists who specialize in arrhythmia treatment are called electrophysiologists or “EP’s” for short. To find an electrophysiologist near you, please click on this link:

http://www.hrsonline.org/Find-a-Specialist

Mary’s Transesophageal Echocardiogram and Cardioversion

As we had no way of knowing how long Mary had been in atrial fibrillation, we transferred her to our cardioversion unit.  First, we put her to sleep and performed a transesophageal echocardiogram to make sure there were no blood clots in her heart from the atrial fibrillation.

A transesophageal echocardiogram, or TEE, is an ultrasound probe that you swallow.  It is like a big piece of spaghetti.  With the TEE probe in the esophagus, your cardiologist gets a front row seat to see what is happening in the heart.

Fortunately, Mary didn’t develop a blood clot from her atrial fibrillation.  Knowing that there were no atrial fibrillation clots, we then shocked her heart back into rhythm and put her on a blood thinner for a month.

Mary was lucky.  Not only did she not develop an atrial fibrillation blood clot, but her heart looked strong.  All too often when people come into the emergency room with a rapid heart rate from atrial fibrillation we see some degree of heart failure.  The reason for the heart failure is that if the heart beats too fast for too long, it can start to wear out.

Mary’s Atrial Fibrillation Outcome

After further investigation, I suspect that Mary did indeed initially develop bronchitis.  A bronchitis diagnosis would then explain why her doctor prescribed antibiotics without any further examination.  As what often happens from respiratory illnesses, this respiratory illness then triggered an atrial fibrillation attack.

After following her in my clinic for more than five years, she has had no further episodes of atrial fibrillation.  She also hasn’t had any more respiratory illnesses.  I suspect that the reason why she has been so healthy for the last five years is that her “heart scare,” gave her the strength to quit sugar, all types of flour, and processed foods.

Besides feeling ten years younger without the sugar, flour, or processed foods, her weight naturally dropped 40 pounds without even dieting.  Never before in her life had she been able to eat as much as she wanted and still lose weight.  Simply put, Mary was able to put her heart, and her metabolism, back into rhythm.

Practical Tips

Atrial fibrillation is definitely something that no one wants. The key is to get treated immediately before something terrible happens.

For most people, there is a short window of time where healthy lifestyle changes, and possibly even a procedure, may cure you of this condition. Make sure a cardiologist, who specializes in arrhythmias, sees you as quickly as possible.

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The 6 Best Ways to Reverse Your Biological Age

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How Much Calcium Do You Really Need? You May Be Surprised…

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3 Easy Ways You Can Optimize Dietary Iron and Cardiac Blood Flow

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10 Ways to Boost Brain Function with BDNF

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9 Signs You May Have Vitamin K2 Deficiency

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How to Make Your Heart 30 Years Younger: Lessons from the Tsimane

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What Should Your Resting Heart Rate Be?

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How to Bulletproof Your Heart: The Roseto Effect

Drugs versus Diet for High Blood Pressure: Which is Best?

No one wants to take drugs for high blood pressure.  A new study shows that one specific diet may lower blood pressure more than drugs.  In this article, I’m going to deconstruct this new diet for high blood pressure and teach you what you need to do to lower your blood pressure naturally.

My Blood Pressure Struggles

I know what it is like to have high blood pressure.  At one time, my blood pressure used to run 150/90.  As readers know, a blood pressure of 150/90 is far higher than the new blood pressure guidelines which recommend treating blood pressures higher than 130/80.

Like most other doctors, I turned to a pill.  Except, rather than have my doctor prescribe a pill, I did it myself.

At first, I tried a beta-blocker.  However, beta-blockers made me tired.

Then I tried lisinopril.  But lisinopril gave me a cough.

Finally, I ended up on losartan.  Losartan kept my numbers down until I found a natural solution.

Today, my blood pressure runs 110/70 without medications.  I now know that drugs are not the answer for most people with high blood pressure.

If you can treat high blood pressure quickly enough with lifestyle changes, then you can avoid a lifetime of medications.  The key is to act fast before your heart and arteries are permanently damaged, and high blood pressure becomes unavoidable.

The Drugs versus Diet for High Blood Pressure Study

While this wasn’t specifically a drug versus diet study design, this study showed that a new diet can completely blow away any drug for high blood pressure.  Personally, I will refer to this diet as the DASH Plus Diet.  I have added the “plus,” because this new diet has tweaked the well-established DASH Diet in a way that even the researchers of this study didn’t understand.

In this study, researchers from Harvard and Johns Hopkins University recruited 412 people suffering from high blood pressure.  The average age was just 48 which highlights the fact that high blood pressure is so common even in young people today.

These 40-year-olds were then randomized to the Standard American Diet (SAD), DASH Diet, or the DASH Plus Diet.  For the Standard American Diet (SAD) people, these folks were instructed to eat like the typical Americans.  In other words, have all the sugar, processed foods, and fast foods you want to eat.

For the DASH Diet people, they were instructed to limit their grains to intact grains and eat large amounts of fruit, vegetables, and legumes.  Any meat consumed in this group had to be lean chicken or fish.

The DASH Plus people followed the DASH Diet approach and dialed their sodium way back.  As readers well know, the only way to eat an ultra low salt diet is to be incredibly strict about eliminating any foods that come in a bag, can, or box.  Basically, 100% of all processed foods have to be removed to eat ultra low sodium.

What Did The Drugs versus Diet for High Blood Pressure Study Show?

The results of this drugs versus diet for high blood pressure study completely blew away any preconceived notion of what the right diet can do.  The dramatic results of this study likely explain why this study was published in the most prestigious cardiology medical journal on this planet.

Would you believe me if I told you that the DASH Plus Diet reduced blood pressure by 21 points when compared to the Standard American Diet (SAD) in those people who started out with a systolic blood pressure of more than 150?

Considering that the average blood pressure drug only drops blood pressure by 8 points, these results are anything but spectacular.  The right diet is the equivalent of almost three high blood pressure drugs!

For those readers with a blood pressure not quite as high as 150, don’t worry that this type of diet will lower your blood pressure too much.  Not one of the 412 people in this study got in trouble from too low of a blood pressure.

One key point to remember in this study was that the average age was 48.  The people in this study were young enough that dietary changes alone could be curative.

The only way to avoid a lifetime of high blood pressure pills is to start eating healthy before permanent damage occurs.  Once the arteries become hardened with plaque build up, it is hard for diet alone to fix the problem.

However, even if you are in your 60s, 70s, or 80s, eating right may be the difference between taking one versus three or four high blood pressure drugs.  Thus, everyone, regardless of your age, is much better off eating real foods!

What These Harvard and Hopkins Researchers Missed

Like 99% of other physicians, these Harvard and Johns Hopkins researchers were too focussed on reducing sodium.  They attributed all of the benefits to lowering salt intake.

While salt may contribute to high blood pressure in some people, this isn’t a universal truth.  In fact, for people who sweat a lot from high endurance exercise (think marathon runners or triathletes), an ultra low salt diet might be dangerous.

Of course, I would never advocate for industrially processed foods to boost salt intake.  Instead, for my ultra endurance athlete readers, I would suggest salting the real food you prepare at home if your doctor is in agreement.

When it comes to industrially processed foods, these Harvard and Hopkins researchers failed to account for the fact that eliminating processed foods also eliminates most sugars and unhealthy oils from your diet.  Indeed, studies show that reducing sugar may lower blood pressure far more than salt could ever dream of.  Perhaps it is time for the medical community to accept that sugar may be far more dangerous to cardiovascular health than salt.

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5 Life Secrets That Centenarians Know

Do you want to know the secret of a long and happy life?  Ask someone who has lived the longest.  Indeed, centenarians can teach us the five simple life secrets.

My 100th Birthday Plans

No one in my family has ever made it to 100.  I suspect this is because of the genes that run in our family.  Despite not winning the genetic lottery in life, I am determined to ski on my 100th birthday.

Even though I don’t have the longevity genes, I know that I can reprogram the genes that I do have to optimize my health in a way to still ski the moguls at age 100.  Indeed, studies show that fully 75% of our health and longevity comes from our daily health choices, not our genes!

My Centenarian Patients

Since graduating from Johns Hopkins Medical School in 1995, I have kept close records of the centenarians in my cardiology practice.  Interestingly, all seven of these centenarians required a pacemaker.

Even at 100 plus, each of these patients effortlessly breezed through their pacemaker surgeries.  Indeed, none of them required any narcotics for pain relief.  Each was stoic, and each went home from the hospital in under 24 hours.  When compared to pacemaker patients half their age, these centenarians put them to shame.

One of these centenarians, Mike age 102, was very frustrated with me when I told him that he couldn’t ride his bicycle for three weeks after his pacemaker surgery.  It wasn’t that I was trying to be mean I just didn’t want him to fall and potentially pull a pacemaker wire out of his heart.

In the end, Mike could only go ten days without riding his bike before he was back at it.  Fortunately, he didn’t crash, and his pacemaker wires stayed in place.

Each of these seven centenarians is a hero to me.  They, along with the centenarians in our book, The Longevity Plan, have taught me that you can still be active and enjoy every day at 100 and beyond if you just take care of your body today.  And to help you care for your body today so that you can still hike, bike, or ski at 100, let me share with you the five secrets of life from 100 centenarians.

The Annual US Centenarian Study

Each year United Healthcare randomly surveys 100 US centenarians and asks them a series of questions to better understand the secret of life.  As one who wants to learn from those who have lived the longest, I have studied each of these surveys for the last ten years.  Below are the top five themes that came up every year from these centenarians.

1. Stay Positive

A Yale University study showed that those who were the most positive about their lives and the aging process lived 7.5 years longer.  Indeed, when it comes to staying positive, most centenarians reported that laughing and having a sense of humor was critical.

These centenarians were ahead of their time.  Even before apps like Head Space took over, these centenarians had already learned to meditate.  Now we know, based on the work of Nobel Prize-winning Dr. Elizabeth Blackburn, that meditation may slow cellular aging by 30%!

Contrary to popular belief, most people get happier as they get older.  Indeed, a study of 340,847 Americans confirmed that the older you get, the happier you are.

Interestingly, the age at which people start getting happier seems to be about age 50. Perhaps the reason why age increases happiness is that we stop worrying about what might happen and start living.

2. Keep Close to Family and Friends

The centenarians in this study stayed very close to their family and their friends.  Indeed, 89% of the centenarians reported that visiting family and friends was the number one thing they enjoyed doing.

Thus, it should come as no surprise that centenarians reported that their best memories came from the time they spent with friends and family, especially family vacations.  All centenarians intuitively know that you need social support to thrive.

Recently, while seeing a patient who was suffering from a heart arrhythmia, I inquired about who she considered being her social support.

“Oh, Rosemary,” she said with a sly smile.

“Is that your daughter?” I asked.

“No, my cat,” she laughed. “The best friend a woman could have!”

We both got a good chuckle out of this, but I did want to know that she also had some human support. Did she have regular visitors? Did she ever feel lonely?

“How could I feel lonely?” she asked. “I have three wonderful kids and seven beautiful grandchildren. Someone is over at my place almost every weekend.”

“And the weekdays?”

“Oh, well,” she said. “Those days can get pretty lonely. But I wouldn’t want to complain.”

As it turns out, a lot of people think that there’s a difference between being lonely and being isolated. But at least regarding health impacts, that’s not the case. That was a key finding of a 2010 study of social relationships and mortality by Brigham Young University’s Julianne Holt-Lunstad.  What Holt-Lunstad has found is that when it comes to your risk of premature death, loneliness is far more critical than your smoking status, what you eat, or if you are even overweight.

I’ve definitely noticed in my patients a tendency to downplay or deny feelings of loneliness. And that’s increasingly problematic in a world in which isolation is increasingly the status quo.

The centenarians in China’s Longevity Village, my cardiology practice, and in this United Healthcare Study have all learned how to keep daily intimate contact with family and friends.  How do we do that? I often tell my patients that the best way is to cure their loneliness is to heal someone else’s. After all, when two isolated people are together, they’re no longer isolated.

3. Eat Healthy

If you study the diets of centenarians around the world, you will find that it is very consistent.  They aren’t following the latest fad diets on the Internet or in “health books.”

As described in The Blue Zones and The Longevity Plan, and backed by many scientific studies, centenarians tend to eat primarily a plant-based diet.  They load up on the vegetables, legumes, and fruit with every meal.

Sugar and processed foods are mostly absent from centenarian diets.  The grains they do eat are primarily intact grains rather than the processed and refined flour-based grains we eat in the U.S.

Meat, except for fish, is eaten sparingly.  Centenarians also tend to eat lighter meals and stay away from fried and oil-heavy foods.

4. Never Sit

These centenarians in this United Healthcare Centenarian Study were no slouches.  And they certainly weren’t sitting around in a wheelchair waiting to die.

Instead, the centenarians in this study loved to hike, lift weights, or do cardio exercises outside.  They defied the stereotype that most people have about centenarians.

Those who couldn’t do these activities walked regularly.  The centenarians in this study have learned by experience that the adage, “use it or lose it” is entirely correct.

Centenarians almost intuitively knew that sitting was the new smoking.  Their bodies were always moving.

5. Think Yourself Young

On average, the centenarians in this study felt and acted 21 years younger than they actually were.  Indeed fully 60% of the centenarians didn’t even “feel old!”

There is a lot of truth to thinking yourself young.  In the book, Counterclockwise by Harvard psychologist Ellen J. Langer, she recounts a scientific study she did in the 1980s.

On the day of this study in 1981, eight arthritic and debilitated men in their 70s entered into the time warp study that Dr. Langer had created.  Everything in this converted monastery was 1959.  From the books to the radio, and even to the TV, everything was 1959 rather than the 1981 world in which they were living.

For the five days of this experiment, these eight old men lived as if they were 22 years younger.  They did the activities that younger people did.  Everything they discussed had to be from the 1950s.  No mirrors, modern-day clothing, or any technologies created after 1959 were allowed into the monastery.

At the end of their five-day stay, the previously old and frail men were tested again.  Interestingly, after pretending to be 22 years younger, all study participants started becoming 22 years younger.  When tested they showed better physical strength, dexterity, posture, memory, cognition, hearing, and vision.

Even the way they walked changed.  No longer were they hunched over and shuffling.  They walked as younger people walked.  Almost unbelievably, on the last day of the study, these previously old and frail men had even spontaneously organized a game of touch football on the lawn.

Could Aging Be a Nocebo Effect?

Everyone has heard of the placebo effect where you think something will help you and it actually does.  The nocebo effect is the opposite of the placebo effect.

In fact, I’m convinced that at least in the US, most people’s view of aging is a nocebo effect.  We think we will lose our health as we age and it then becomes a self-fulfilling prophecy.  Dr. Langer’s work confirms that much of aging is really just a mindset.

At least 99% of my patients never want to live to 100.  They are sure that one hundred-year-olds must be miserable.

Based on my studies and interactions with centenarians, this is anything but true.  Almost without exception, centenarians are some of the happiest people you will ever meet.  Also, many centenarians are physically much more active than people half their age.

Practical Tips

Every year you will add one more year to your age.  You can either choose to act, feel, and be one year older or one year younger.  The choice is up to you.

Famous author Jim Rohn used to say, “You are the average of the five people you spend the most time with.”  If you hang around people who complain about getting old and health problems, then this is what you will become.

In contrast, if you surround yourself with people who think, feel, and act young then this will naturally rub off on you.  Aging is mostly a mindset.  To live to 100 is a beautiful thing as studies show that to make it to 100 you had to have had fantastic health in your 90s.

The five secrets that the 100 centenarians in the United Healthcare Annual Centenarian Study have taught us are simple things that everyone can do.  Studies show that our bodies are genetically hard-wired to help us live to age 90 in good health.

To unlock the 90 good years of health we are genetically programmed to get, you need to make the right daily health decisions now and embrace a youthful mindset.  To get the last ten years and make it to 100 will require a meticulous following of the five life secrets that centenarians know.

What are you going to do on your 100th birthday?  Please leave your thoughts and questions below.  The comment period will be open for 30 days.  I promise to answer every question posted.

If you liked this article, please be sure to sign up for our free weekly newsletter, podcast, or pick up a copy of our new book, The Longevity Plan.

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How to Optimize Your Sodium to Potassium Ratio for Longevity

Could the secret to health and longevity come down to the ratio of how much sodium to potassium you eat each day?  In this article, I will teach you how to optimize your sodium to potassium ratio for health and longevity.

David’s Experience

David recently came to see me as a new patient for atrial fibrillation.  Like most patients, he wanted to know how he developed this condition.

As we discussed his diet, it was quickly apparent what the problem was.  David was living on the Standard American Diet.

For breakfast, it was typically cereal or bacon and eggs.  Lunch was a slice of pizza or a deli sandwich, a bag of chips, and a diet Coke.  For dinner, it was ribs, pasta, or a cheeseburger.  Of course, lunch and dinner were always topped off with a cookie or some other treat.

If he was honest, on a good day he was lucky to eat one or two servings of a vegetable and fruit.  For readers of this blog, a diet like this seems almost unbelievable.  However, this is what most Americans eat each day.

Quickly pulling out my calculator, I estimated that his sodium to potassium ratio was at least 2 to 1.  In other words, he ate two milligrams of sodium for every one milligram of potassium.  If he wanted any chance of naturally treating his atrial fibrillation, he would need to completely reverse this ratio to 1 mg of sodium for every 2 mg of potassium in his diet.

3 Bad Things that Happen from a High Sodium to Potassium Ratio

If your dietary sodium to potassium ratio is high, then you are putting yourself at high risk for a stroke, heart disease, or hypertension.  Indeed, one large study from Japan showed that a high sodium to potassium ratio resulted in up to a 57% increased risk of stroke, 39% more heart disease, and at least twice the risk for high blood pressure.

The Sodium to Potassium Ratio Trumps Sodium or Potassium Intake Alone

The push by the American Heart Association to get Americans to eat less salt may be misplaced.  Indeed, based on a study of 2,974 Americans, the sodium to potassium ratio may better predict your risk of a stroke, heart disease, or hypertension than the actual number of milligrams of sodium or potassium alone that you eat.  Thus, rather than restricting salt, we should instead focus on eating more potassium-rich foods.

Good News for Salt Lovers

As long as you are getting your salt from the salt shaker, rather than processed, prepared, or fast foods, then studies show that you can eat crazy amounts of salt and not put yourself at risk provided the milligrams of potassium you consume is higher than the milligrams of sodium you eat.

What is the Optimal Sodium to Potassium Ratio?

In a perfect world, people would get at least 1 mg of sodium for every 2 mg of potassium they eat.  By eating this way, their sodium to potassium ratio would be 1 to 2.  Considering that the average American consumes 3,300 mg of sodium and 2,600 mg of potassium daily, this ratio of 1 to 0.7 is far below minimally acceptable levels.

Interestingly, studies of our paleolithic ancestors have shown that their sodium to potassium ratio was somewhere in the range of 1 to 16.  One study even showed that among the primitive Yanomamo Indians in South America, who do not eat salt but do eat large amounts of bananas, the sodium to potassium ratio was in the range of 1 to 100.

Best 3 Ways to Lower Your Sodium Intake

Contrary to popular belief, you don’t have to get rid of your salt shaker to reduce your sodium intake.  In fact, I wish that blog readers would use their salt shakers more as that would indicate that they are probably eating more home-cooked meals.

The real enemy when it comes to sodium intake is processed, prepared, or fast foods.  Based on my calculations, at least 80% of sodium comes from these three sources.  Thus, to reduce your sodium, you need to eat more real food at home and less fake foods on the run.

Top 3 Ways to Boost Your Potassium Intake

When it comes to boosting your potassium intake, just remember three foods–Fruits, vegetables, and legumes.  If you can fill your plate with mostly fruits, vegetables, and legumes, then you should have no problem in optimizing your sodium to potassium ratio.

Who is at Risk from Too Much Potassium?

If you have kidney failure, then boosting your potassium intake is the wrong thing to do.  The reason for this is that your kidneys are responsible for optimizing potassium blood levels.  If the kidneys can’t do their job, then you could be at risk.

Likewise, many people with heart failure or high blood pressure may be taking medications that increase potassium levels or potassium supplements.  If you are on any prescription medications, or have any chronic medical conditions, please speak with your doctor first before increasing the potassium-rich foods in your diet.

David’s Experience Revisited

Once David gave up 99% of the processed, prepared, and fast foods he was eating, and started eating real food at home, his body transformed immediately.  Within just three months his weight dropped 30 pounds, his systolic blood pressure came down by 15 points, and his heart palpitations went away.  While eating a real food diet took more preparation and thought on his part, his increased energy levels more than compensated for the additional preparation time.

Practical Tips

As I have repeatedly shared on this blog, you are only as old as your arteries.  If you can keep your arteries, and your heart young, then you will likely live a long life free of medications and other chronic medical problems.

And when it comes to keeping your arteries young, the sodium to potassium ratio is critical.  While you could undoubtedly track every milligram of sodium and potassium you eat, there is a much simpler method.

Namely, eliminate 99% of processed, prepared, and fast foods and instead replace them with fruits, vegetables, and legumes.  This change alone should put your sodium to potassium ratio at the goal target of at least 1 to 2.

What is your sodium to potassium ratio?  I would love to hear from you.  Please leave your thoughts, comments, and questions below.

The comment period will be open for 30 days.  During this period of time, I will answer every question posted.

If you enjoyed this article, please be sure to subscribe to my free weekly newsletter, podcast, or pick up a copy of our recent book, The Longevity Plan.