#313 Get Out of AFib as soon as Possible

September 21st, 2021 by

Get Out of AFib as soon as Possible

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

EAST-AF Study

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

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

“Get Out of AFib” also Benefits Heart Failure Patients

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

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

How Long Do You Have to Get Out of AFib?

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

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

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

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

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

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

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

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

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

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

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

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

If you want to learn more and about the importance of getting your AFib treated as soon as possible, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3184 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

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

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

September 10th, 2021 by

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

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

The Vital Trial

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

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

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

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

Vital Trial and Atrial Fibrillation Risk

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

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

Our 2011 Vitamin D Atrial Fibrillation Study

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

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

Dr. Day’s 7 Thoughts on Vitamin D

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

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

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

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

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

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

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

Is Natural Vitamin D Best?

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

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

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

If you want to learn more and about vitamin D and your risk of atrial fibrillation, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists in our practice, please call my team at 801-266-3184 (sorry telemedicine visits outside of the state of Utah are no longer possible due to government regulations).

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

Is Vitamin D Good for the Heart?

#311 Ablation or Drugs First for Atrial Fibrillation?

September 10th, 2021 by

Ablation or Drugs First for Atrial Fibrillation?

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

Background Information

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

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

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

1. JAMA Cardiology: Ablation or Drugs First

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

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

1. Ablation is better at maintaining normal sinus rhythm.

2. Ablation results in less hospitalizations.

3. Ablation is every bit as safe as medications.

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

2. British Medical Journal Heart: Ablation or Drugs First

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

3. Circulation Arrhythmia and Electrophysiology: Ablation or Drugs First

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

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

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

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

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

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

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

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

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

Ablation or drugs first for atrial fibrillation?

If you want to learn more, be sure to check out our best selling book, The AFib Cure. Or if you would like to meet with me, and you can make it to our clinic in Salt Lake City, Utah, to discuss ablation or drugs first for atrial fibrillation, please call my team at 801-266-3184 (sorry tele-med visits outside of the state of Utah are no longer possible due to government regulations).

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

#310 10 Tools To Combat Sugar Cravings

April 10th, 2021 by

10 Tools To Combat Sugar Cravings

By Kate Clemens

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

1. Hydrate

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

 2. Eat Naturally Sweet Foods

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

3. Sleep

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

4. Kick the caffeine to the curb

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

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

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

6. Move Daily

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

7. Forget about Fat-Free

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

8. Get Enough Protein

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

9. Add Some Spice to Your Life

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

10. Make Life Sweeter

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

Kate Clemens Bio

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

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

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

katemayclem@gmail.com

(415) 676 0353

www.getfitwithkate.com

#309 10 Bad Conditions Linked to Low Magnesium

April 10th, 2021 by

10 Bad Conditions Linked to Low Magnesium

By Kate Clemens

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

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

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

Magnesium: What is it?

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

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

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

15 Mighty Magnesium Rich Foods

 

FOOD    SERVING SIZE   MAGNESIUM CONTENT
SPINACH (BOILED)   1C   157 mg 
SWISS CHARD (BOILED)   1C   150 mg
DARK CHOCOLATE

(75-80% CACAO)

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

A Mighty Magnesium Breakfast

Ingredients: 

1 Ezekiel Sprouted Grain Tortilla  (48 mg Mg)

1 medium banana (32 mg Mg)

2 TBs almond butter (89.3 mg Mg)

1 TB Flaxseed (40.4 mg Mg)

½ c strawberries (9 mg Mg)

½ blueberries (5 mg Mg)

Cinnamon (to stabilize blood sugar!!)

Directions:

1.  Warm up your tortilla in the toaster

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

3. Lay your banana on top of the almond butter

4. Sprinkle on your flaxseed seed and cinnamon

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

Bon Appetit!

Should You Supplement?

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

1. What is my intake? 

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

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

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

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

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

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

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

Which Magnesium Supplement is Best?

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

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

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

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

Do Magnesium Supplements Cause Diarrhea?

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

Low Magnesium: A Very Preventable Condition

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

Kate Clemens Bio

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

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

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

katemayclem@gmail.com

(415) 676 0353

www.getfitwithkate.com

#308 9 Signs You Aren’t Getting Enough Potassium

April 10th, 2021 by

9 Signs You Aren’t Getting Enough Potassium

By Kate Clemens

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

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

Potassium: What is it?

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

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

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

The 9 Signs You Aren’t Getting Enough Potassium

1. Heart palpitations

2. Atrial fibrillation

3. High blood pressure

4. Muscle cramps and spasms

5. Weakness and fatigue

6. Tingling and numbness

7. Breathing difficulties

8. Mood changes

9. Digestive problems

What Causes Low Potassium?

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

What Causes High Potassium?

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

Where Should Your Potassium Levels Be?

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

How Much Potassium Should You Eat Each Day?

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

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

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

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

13 Potassium Packed Foods

 

                FOOD    SERVING SIZE     Potassium CONTENT
SPINACH (BOILED)   1C   839 mg 
SWISS CHARD (BOILED)   1C   96 1mg
SWEET POTATO   1 large   855 mg
BEET GREENS (BOILED)   1C   1309 mg
WILD CAUGHT SALMON   4OZ   712 mg
DRIED APRICOTS   1/2C   755 mg
COCONUT WATER   1C   600 mg
ACORN SQUASH   1C   896 mg
PINTO BEANS (BOILED)   1C   746 mg
TOMATO JUICE (CANNED)   1C   527 mg
AVOCADO    50G (⅓ of whole)   357 mg
LIMA BEANS (COOKED)   1C   955 mg
BANANAS (RAW)   1 large   487 mg

Should You Supplement? 

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

Sources: 

https://pubmed.ncbi.nlm.nih.gov/11866648/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357351

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648706/

https://www.ncbi.nlm.nih.gov/books/NBK539791/

Kate Clemens Bio

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

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

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

katemayclem@gmail.com

(415) 676 0353

www.getfitwithkate.com

 

#307 The Promise of The Atrial Fibrillation Cure

February 16th, 2021 by

The Promise of The Atrial Fibrillation Cure

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

___________________________________________________________

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

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

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

One hundred and forty beats a minute.

Then one hundred and sixty.

Then one hundred and eighty.

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

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

What is going on?

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

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

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

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

Finally, the call connects.

“911, what’s your emergency?”

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

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

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

“Will I ever see them again?”

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

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

“How is that even possible!?”

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

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

Who Gets AFib?

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

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

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

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

AFib Now Strikes the Young

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

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

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

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

Gavrilo’s Journey

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

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

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

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

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

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

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

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

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

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

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

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

But it’s time for a change in perspective.

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

No, really.

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

And so…

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

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

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

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

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

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

… then this book is for you.

Feeling a bit skeptical?

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

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

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

Do I have to quit my doctor?

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

Do I have to be a risk taker? 

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

Is this something only for young people?

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

Do I have to be into technology?

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

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

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

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

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

The traditional treatment regimen is good for people who:

1.  Accept atrial fibrillation as a lifelong medical problem.

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

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

The AFib Cure requires people who are:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That’s the bad news.

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

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

Indeed, they’ve cured their AFib.

___________________________________________________________

References

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#306 The Top 10 Atrial Fibrillation Triggers

January 31st, 2021 by

The Top 10 Atrial Fibrillation Triggers

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

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

1. Alcohol

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

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

2. Caffeine

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

3. Exercise

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

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

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

4. Sleep

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

5. Dehydration/Electrolyte Imbalance

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

6. Large Meals/Specific Food Triggers

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

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

7. Stress/Anxiety

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

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

8. Laying on Your Left Side

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

9. Cold Beverages and Foods

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

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

10. Not Exercising

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

Next Steps if You Have AFib Triggers

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

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

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

About the Photo

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

#305 The 9 Secrets of The Longevity Plan Diet

January 30th, 2021 by

The Longevity Plan Diet

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

Can it really be considered a “diet?”

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

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

Our Trip’s to China’s Longevity Village

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

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

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

My First Meal in China’s Longevity Village

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

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

1. Rice (and other unrefined grains)

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

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

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

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

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

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

2. Nuts and Seeds

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

3. Sweet Potatoes

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

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

4. Vegetables and Fruits

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

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

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

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

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

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

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

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

5. Legumes

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

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

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

6. Dairy

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

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

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

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

7. Oils

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

8. Fish

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

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

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

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

9. Other Meat

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

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

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

What diet is best for you?

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

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

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

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

Food Shouldn’t Isolate Us

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

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

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

January 2nd, 2021 by

3 Ways to Strengthen Your Willpower to Eat Better in 2021

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

1. Find Your “WHY”

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

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

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

Finding Your WHY Can Be Difficult

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

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

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

Eating Right Isn’t About Willpower

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

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

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

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

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

2. Temptation Elimination

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

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

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

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

Other Ways to Make It Without Willpower

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

Sometimes the Medications You’re On Make it Impossible

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

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

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

3. The Right Support

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

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

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

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

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

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

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

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

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

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

How to Make it When Your Family Isn’t Supportive

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

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

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

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

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

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

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

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

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

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

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

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

Sometimes Support Can Be an App

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

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

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

Bringing It All Home

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

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

#303 4 Reasons Why Sinus Rhythm Beats Atrial Fibrillation

January 2nd, 2021 by

4 Reasons Why Normal Sinus Rhythm Beats Atrial Fibrillation

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

The EAST-AF Study

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

Which Atrial Fibrillation Patients Were Included in this Study?

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

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

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

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

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

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

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

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

What Was Aggressive Atrial Fibrillation Care in this Study?

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

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

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

3. Catheter ablation.

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

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

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

4 Reasons Why Sinus Rhythm Beats Atrial Fibrillation

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

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

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

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

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

My Take on This Study

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

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

https://www.healio.com/news/cardiology/20200829/eastafnet-4-early-rhythm-control-for-af-reduces-risk-for-poor-cv-outcomes

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

#302 4 Scary Heart Problems Magnesium May Prevent

November 28th, 2020 by

5 Scary Heart Problems Magnesium May Prevent

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

The Million Person Magnesium Study

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

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

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

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

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

The 5th Scary Disease Associated with Low Magnesium Intake

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

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

You Probably Aren’t Getting Enough Magnesium from Your Diet

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

How to Boost Magnesium Levels Naturally

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

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

Should You Take a Magnesium Supplement?

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

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

The Key Take Away Message

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

Want to Learn More About Magnesium Deficiency?

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

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

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

#301 How Successful are Atrial Fibrillation Ablations?

November 26th, 2020 by

How Successful are Atrial Fibrillation Ablations?

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

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

What is Atrial Fibrillation?

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

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

New HD Arrhythmia Mapping Technology

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

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

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

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

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

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

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

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

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

Key Takeaway of this Study

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

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

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

When should I consider an atrial fibrillation ablation?

10 Ways to Cure Atrial Fibrillation without Drugs or Procedures

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

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

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

May 27th, 2019 by

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

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

1.  Bad Genes (Familial A-Fib)

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

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

How do bad genes cause A-Fib?

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

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

Familial A-Fib Prognosis

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

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

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

2. An Out of Balance Autonomic Nervous System

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

Sympathetic versus Parasympathetic Nervous System

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

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

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

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

Sympathetic A-Fib

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

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

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

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

Parasympathetic A-Fib: The Athletic Heart

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

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

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

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

Parasympathetic A-Fib: Gastrointestinal and Nocturnal A-Fib

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

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

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

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

3. Age and Lifestyle-Related Fibrosis of the Heart

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

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

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

What Causes Fibrosis?

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

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

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

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

How Can You Measure Fibrosis?

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

A Window of Time to Stop the Fibrosis

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

Conclusion

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

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

March 31st, 2019 by

The 10 Most Important Atrial Fibrillation Lab Tests

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

1.  C-Reactive Protein (CRP)

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

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

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

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

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

2. Hemoglobin A1C

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

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

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

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

3. Thyroid Panel

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

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

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

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

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

4. Comprehensive Metabolic Panel (CMP)

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

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

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

5. Lipid Panel

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

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

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

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

6. Vitamin D

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

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

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

7. Anemia

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

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

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

8. Homocysteine

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

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

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

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

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

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

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

10. High Sensitivity Troponin (hs-Tn)

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

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

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

More Advanced Testing

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

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

Disclaimer

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

 

 

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

December 12th, 2018 by

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

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

7 Ways What You Eat May Cause Atrial Fibrillation

1. Excessive Pericardial Fat

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

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

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

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

2. Insufficient Antioxidants

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

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

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

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

3. Unnecessary Inflammation

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

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

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

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

4. Micronutrient Deficiency

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

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

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

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

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

5. High Blood Glucose

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

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

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

6. Unhealthy Gut Microbiome/Excessive TMAO

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

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

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

7. Unnecessary Enlargement of Your Heart

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

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

4 Ways How You Eat May Cause Atrial Fibrillation

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

1.  Big Meals May Trigger Atrial Fibrillation

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

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

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

2. Eating Fast May Worsen Atrial Fibrillation

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

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

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

3. Cold Foods May Trigger an Atrial Fibrillation Attack

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

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

4. Intermittent Fasting May Prevent Atrial Fibrillation

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

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

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

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

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

1.  Lean Body Weight

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

2. Tripple Your Veggies

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

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

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

3. Eat More Plant-Based Fats

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

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

4. Tripple Your Fiber (think vegetables not supplements)

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

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

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

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

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

5. Eat Fish

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

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

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

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

6. Avoid Processed and Fast Foods

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

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

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

7. Eat Less Animal Meat and Dairy

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

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

What is an Example of the Atrial Fibrillation Diet?

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

Breakfast

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

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

Lunch

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

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

Dinner

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

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

The Top 4 Atrial Fibrillation Diet Guidelines

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

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

1.  Triple Your Vegetable Intake

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

2. Avoid Sugar

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

3. Avoid Flour

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

4. Don’t Eat After 7 PM

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

Is the Ketogenic Diet Safe with Atrial Fibrillation?

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

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

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

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

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

Final Thoughts

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

#297 Can You Exercise Too Much?

November 19th, 2018 by

Can You Exercise Too Much?

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

Does Exercise Increase Longevity?

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

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

Is There an Upper Limit to Exercise and Longevity?

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

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

What’s Worse, Smoking or Not Exercising?

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

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

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

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

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

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

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

What is the Best Exercise for Longevity?

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

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

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

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

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

Can Exercise Prevent Dementia?

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

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

Can Too Much Exercise Cause Arrhythmias?

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

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

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

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

How Do You Make Exercise a Habit?

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

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

1. Purpose.

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

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

2. Environment.

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

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

3. Accountability.

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

How do You Prevent Exercise Injuries?

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

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

The Story Behind the Photo for this Article

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

Disclaimer

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

 

 

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

October 28th, 2018 by

17 Ways to Increase Your Heart Rate Variability and Life Expectancy

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

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

How to Determine Your HRV in 5 Minutes

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

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

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

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

The Best Way to Track Your HRV

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

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

Can you use your smartwatch to measure HRV?

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

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

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

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

What is your HRV goal number?

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

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

How do heart medications affect HRV?

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

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

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

Does HRV decrease with age?

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

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

What is the relationship between HRV and arrhythmias?

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

17 Ways to Increase Your Heart Rate Variability and Life Expectancy

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

1.  Bump up Your Exercise Time

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

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

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

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

2. Yoga

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

3. Intermittent Fasting

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

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

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

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

4. Eat More Green Leafy Vegetables

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

5. Optimize Your Sleep

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

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

6. Daily Meditation

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

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

7. Slow Deep Breathing

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

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

8. Decrease Commuting Time

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

9. Eat More Omega 3 Foods

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

10. Practice Forgiveness

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

11. Listen to Calming Music

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

12. Healthy Work Environment

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

13. Minimize any Overtime at Work

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

14. Avoid Shift Work

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

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

15. Tai Chi

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

16. Spend More Time in Nature

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

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

17. Prayer

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

 

 

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

October 8th, 2018 by

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

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

What is Heart Rate Variability?

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

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

Why is There Heart Rate Variability?

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

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

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

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

How Do You Measure Heart Rate Variability?

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

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

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

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

What Does a Low HRV Tell You?

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

What is Your Goal HRV Number?

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

How do arrhythmias affect HRV?

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

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

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

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

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

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

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

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

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

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

4. A Low HRV Increases Your Risk of Cancer Death

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

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

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

The Big Picture

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

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

 

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

August 28th, 2018 by

9 Ways to Lower Your TMAO Afib and Heart Disease Risk

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

What is TMAO?

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

What’s the Proof of a TMAO Cardiovascular Risk?

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

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

How may TMAO cause atrial fibrillation?

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

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

Is there a blood test for TMAO?

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

9 Ways to Lower Your TMAO Afib and Heart Disease Risk

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

1. Eat a Mostly Plant-Based Diet

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

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

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

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

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

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

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

3. Optimize Sleep

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

4. Eat More Fiber

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

5. Probiotics

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

6. Keep Your Fat Calories Below 55%

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

7. Optimize B and D Vitamins

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

8. Eat Resveratrol Rich Foods

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

9. Get More DMB from Balsamic Vinegar and Olive Oil

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

The Big Picture

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

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

August 19th, 2018 by

Is there a Low Carb Diet Mortality Risk?

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

The Dietary Carbohydrate Intake and Mortality Study

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

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

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

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

How do you explain these results?

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

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

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

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

How do you find out your carb percentage?

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

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

How to Eat Low Carb and Live a Long Life

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

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

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

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

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

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

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

August 18th, 2018 by

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

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

The FDA Approved New Blood Thinners

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

– Eliquis (apixaban)

– Pradaxa (dabigatran)

– Savaysa (edoxaban)

– Xarelto (rivaroxaban)

1.  Safer

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

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

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

2. Lower Stroke Risk

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

3. Lower Dementia Risk

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

4. You May Live Longer

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

5. More Time and Less Hassle

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

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

6. You Can Eat All the Vegetables You Want

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

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

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

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

7. Possibly Less Coronary Artery Calcification and Osteoporosis

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

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

8. There Are Now Antidotes

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

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

5 Reasons to Stay on Warfarin

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

1.  Finances are Tight

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

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

2. You Have a Mechanical Heart Valve or Mitral Stenosis

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

3. Your INRs Have Been Perfect

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

4. You Believe the Lawyer Advertisements

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

5. You Worry About a Reversal Agent

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

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

#291 Dr. Day’s Riced Cauliflower Fast Food

July 24th, 2018 by

Dr. Day’s Riced Cauliflower Fast Food

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

My “No Cooking Skills” Disclaimer

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

4 Ingredients from Trader Joe’s

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

1. Frozen Organic Riced Cauliflower

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

2. Frozen Melodious Blend

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

3. Can of Organic Diced Tomatoes

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

4. Salt or Garlic Salt to Taste

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

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

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

Combining the 4 Ingredients

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

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

The Nutrition Stats

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

Calories

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

Fiber

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

Protein

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

Calcium

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

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

Vitamin C

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

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

Potassium

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

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

Bad Ingredients

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

My Kids Love It…Give it a Try

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

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

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

#290 4 Reasons Why Vacations Make You Live Longer

July 17th, 2018 by

4 Reasons Why Vacations Make You Live Longer

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

Vacation Longevity Study

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

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

4 Reasons Why Vacations Make You Live Longer

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

1. Vacations Allow You to De-Stress

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

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

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

2. Vacations Increase Time with Family and Friends

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

3. Vacations Increase Physical Activity

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

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

4. You’re Working Fewer Hours

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

How to Vacation Regularly on a Budget

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

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

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

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

What if You Can’t Vacation Regularly?

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

The Big Picture

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

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

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

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

 

 

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

July 4th, 2018 by

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

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

What is CHADS-VASc?

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

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

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

How CHADS-VASc Has Changed my Practice

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

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

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

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

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

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

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

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

3. No Credit is Given for an Ablation

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

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

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

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

5. No Credit is Given for the Motivated Patient

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

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

6. It Ignores Reversible Causes of Atrial Fibrillation

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

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

Sadly, CHADS-VASc gives no credit to people with reversible causes of atrial fibrillation.  Even though studies show that blood thinners don’t work very well for reversible causes of atrial fibrillation, once again CHADS-VASc doesn’t consider this.

7. It Overlooks the Brain Microbleed Dementia Risk

I suspect that most cardiologists are unaware of brain microbleeds.  While most brain microbleeds don’t cause any symptoms, the more of them you get, the worse your brain functions.  Indeed, studies show that people on blood thinners may get more of these brain microbleeds than people not taking blood thinners.  And the more brain microbleeds you get, the higher your dementia risk.

8. It Assumes People Aren’t Taking Warfarin Anymore

One of the primary arguments of why everyone should take blood thinners for life with CHADS-VASc is that the new blood thinners are so much safer.  While the new blood thinners are much safer than warfarin, the problem is that warfarin use isn’t declining.

When the new blood thinners were released, we were sure that all of the Coumadin (warfarin) Clinics would go away.  In contrast, the number of patients on warfarin has only increased.

At least 99% of my patients on warfarin would love to take one of the new blood thinners. The only problem is that they can’t afford them. For people on a fixed income, there is no way they can afford the annual $5,000 price tag to take one of these drugs.   And if you can’t afford one of the new blood thinners, then the aggressive blood thinner use called for by the CHADS-VASc scoring system may not make sense.

9. Recommending Blood Thinners for a Score of 1 or Higher is Misguided

According to the CHADS-VASc scoring system, a score of one or higher is an indication for life-long blood thinners.  While some studies may suggest a benefit for the low score of one, others don’t.

For example, one study reports that blood thinners for a CHADS-VASc score of one is misguided.  Another highly credible study argues that the cut off for blood thinners should be at least a score of three.  The bottom line is that we really don’t know what the cut off for lifelong blood thinners should be.  In my mind, a cut off of “two” was an arbitrary decision.

10. It Disregards the Left Atrial Appendage

As 90% of atrial fibrillation strokes arise from the left atrial appendage, why does CHADS-VASc ignore this important structure in your heart?  For example, studies from our hospital show that the bigger your left atrial appendage, the higher your risk of stroke.

Also, the shape of your left atrial appendage matters when it comes to your risk of stroke.  In particular, the chicken wing pattern carries a very low stroke risk.  To find out the size or shape of your left atrial appendage, your cardiologist can quickly order a CT scan of your heart.

Lastly, the better your left atrial appendage contracts, the lower your stroke risk.  How well your left atrial appendage contracts is something that is best determined by a transesophageal echo (TEE).

11. It Dismisses the Type of Atrial Fibrillation You Have

Whether or not your atrial fibrillation is paroxysmal (starts and stops on its own) or persistent (doesn’t terminate on its own), determines your stroke risk.  For example, studies show that persistent atrial fibrillation has about twice the stroke risk of paroxysmal atrial fibrillation.  Sadly, CHADS-VASc completely dismisses this.  Regardless of your atrial fibrillation type, CHADS-VASc doesn’t care.

12. It Assumes Your Atrial Fibrillation Burden Doesn’t Matter

Common sense would tell you that when it comes to your atrial fibrillation stroke risk, being out of rhythm all the time is probably much riskier than only being out of rhythm less than 1% of the time.  And, as you might suspect, studies back this up.  CHADS-VASc, however, doesn’t care.  To the CHADS-VASc score, one brief minute of atrial fibrillation carries the same risk as one year of continuous atrial fibrillation.

13. It Rejects the Health of Your Left Atrium

When it comes to your atrial fibrillation stroke risk, the health of your left atrium also matters.  For example, the more dilated your left atrium, the higher your stroke risk.  Also, the more scar tissue you have in your left atrium also predicts your stroke risk. Once again, CHADS-VASc doesn’t care.  A perfectly healthy left atrium is treated the same way as a massively dilated and scarred up left atrium.

Are there Any Better Scoring Systems?

Given the limitations of the CHADS-VASc scoring system, is there anything else out there?  Yes, other scoring systems have been proposed.  For example, there is the ABC-Stroke system which uses blood tests to help determine your stroke risk.  Other scoring systems include GARFIELD-AF, ATRIA, and the Intermountain (my hospital) scoring system.  None of these alternative scoring systems are perfect either.  If nothing is perfect, what should you do?

The answer is to discuss this with your cardiologist.  Only you and your physician can determine if blood thinners are right for you or not.  And to make this decision, you have to take everything into consideration.

Avoid a Stroke…Read this Disclaimer

If you are on a blood thinner, don’t stop this drug based on anything you have read in this article.  Also, don’t let anything I discussed in this article influence your decision.  Strokes can happen and they usually happen in atrial fibrillation patients who are not taking blood thinners.

I have faith that you and your cardiologist can make the right decision for you.  Because taking a blood thinner is a big decision, look at stroke risk factors beyond those of “CHADS-VASc.”  And if you and your cardiologist do decide to hold off on blood thinners, then I would at least carefully check my pulse twice daily to make sure my heart was still in rhythm.  If my heart ever did go out of rhythm, I would immediately get on a blood thinner.

 

 

#288 4 Reasons Why Eating Nuts Prevent Atrial Fibrillation

July 1st, 2018 by

4 Reasons Why Eating Nuts Prevent Atrial Fibrillation

Wouldn’t it be great if a handful of nuts could prevent atrial fibrillation?  In this article, I’ll review the atrial fibrillation nut studies and share what I have learned from treating tens of thousands of atrial fibrillation patients over the last 23 years.

The Swedish Atrial Fibrillation Nut Study

If you are a nut lover, like me, then you’ll love this most recent study. In this Swedish atrial fibrillation nut study, researchers followed 61,364 people for 17 years.  After reviewing all of the data, they concluded that eating nuts decrease the risk of atrial fibrillation by 18%.

In order to get this 18% reduction in atrial fibrillation, the Swedes in this study had to eat nuts at least three times weekly for 17 years.  Sadly, they didn’t ask what kind of nuts they ate.  Thus, we have no idea if one nut is better than another for treating atrial fibrillation.

The most interesting part of this study was that the more nuts people ate, the less atrial fibrillation they had.  Unfortunately, the researchers only analyzed the data out to eating nuts three times weekly.  Based on the direction the graph was going, I suspect that daily nut eaters probably enjoyed even more atrial fibrillation protection.

While researchers did their best to make sense of the data, we can’t know for sure whether it was the nuts or the healthy habits of nut eaters that provided this protection.  To better understand whether nuts prevent atrial fibrillation, we need to look to other studies.

Two Other Atrial Fibrillation Nut Studies

In addition to the Swedish atrial fibrillation nut study, there have been two other significant studies looking at nut eaters and atrial fibrillation.  One of these studies showed that in male U.S. physicians, nuts offered no protection against atrial fibrillation.  The other study showed that while nuts, as part of an ancestral Mediterranean diet were helpful, they didn’t specifically prevent atrial fibrillation when compared to olive oil.

4 Reasons Why Nuts Could Prevent Atrial Fibrillation

I want to believe the Swedish atrial fibrillation nut study.  It only makes sense that nuts prevent atrial fibrillation.  Below are four reasons why it is possible that nuts prevent atrial fibrillation.

1. Nuts Are High in Magnesium and Potassium

Having optimal magnesium and potassium levels may be protective against atrial fibrillation.  As nuts are high in electrolytes, they could offer some protection.  Also, all of the other vitamins and micronutrients of nuts make a compelling argument as to why they might help.

2. Nuts Help You to Lose Weight

Despite all of the fat in nuts, studies show that these healthy fats help you to lose weight.  And as weight is so tightly linked to the risk of atrial fibrillation, it only makes sense that anything you can do to keep your weight in check would also help keep atrial fibrillation away.

3. Nuts Are Anti-Inflammatory

Our studies, as well as those from many other people, have shown that the higher your levels of inflammation, the greater your risk of atrial fibrillation.  As nuts help to reduce inflammation, you would expect that this would help your heart to stay in rhythm.

4. Nuts May Prevent Almost All Forms of Heart Disease

Depending on which study you look at, nuts have been shown to be protective against almost every form of cardiovascular disease.  Thus, given the incredible track record of nuts, you would expect that the same would be true for atrial fibrillation.

Nuts in My Atrial Fibrillation Practice

I wish I could tell you that all I have to do is prescribe a handful of almonds and atrial fibrillation goes away.  If the most potent antiarrhythmic drugs only have a fifty-fifty chance of keeping people in rhythm for even just a year, we can’t have too high of an expectation for any nut.

What I can tell you is that I have seen hundreds and hundreds of patients put their atrial fibrillation into remission with healthy living and weight loss.  And as part of this healthy living and weight loss, the vast majority of these patients ate nuts every day.  Nuts fill you up and help with insulin sensitivity.  While most liked almonds, peanuts, walnuts, and other nuts were also popular.

When it comes to using food as medicine, it is hard to isolate the beneficial effects of any one given food. Instead, it is the cumulative effect of nuts, seeds, vegetables, berries, etc.

Nuts Have Been Good to Me

Before my health turn around six years ago, I almost never ate nuts.  Since that time, I eat nuts every day.  It is part of my daily breakfast.

In addition to vegetables and berries, I eat various nut butters on Ezekiel (a flourless bread).  Instead of jam, I sprinkle lots of chia seeds and flax seeds on top of the nut butters for a crunchy texture.

As with my atrial fibrillation patients, I can’t say that nuts put my autoimmune disease, eosinophilic esophagitis, high blood pressure, or high cholesterol into remission without medications but it definitely played a role. I love the taste of nut butters, and I never let a day go by without partaking.

The Big Picture

While the experts may debate whether nuts prevent atrial fibrillation, in my mind, I see no significant downside for most people (unless you have a nut allergy).  Even if nuts don’t help your atrial fibrillation, your body will still thank you for eating this superfood.

Has optimizing your diet helped with atrial fibrillation?  Please leave your thoughts and questions below.  For questions, please be patient as it may take me a few weeks to get to all the questions.

Do you want to read more about the heart and longevity benefits of nuts?  Please be sure to check out my articles below:

Almonds vs. Walnuts: Which Nut Should You Eat?

Almonds vs. Peanuts: Which Should You Eat?

#287 Is Left or Right Side Sleeping Best for Your Heart?

June 30th, 2018 by

Is Left or Right Side Sleeping Best for Your Heart?

Most of my cardiac patients sleep better on their right side.  Is right side sleeping best for your heart?  In this article, I discuss the science of behind right versus left side sleeping.

Gravity and Left vs. Right Side Sleeping?

Gravity plays a role in where the heart goes during sleep.  For example, if you sleep on your left side, then gravity will pull your heart toward your chest wall.  In contrast, gravity pulls the heart toward the center of the chest with right side sleepers. This subtle change in where gravity pulls your heart may affect symptoms, cardiac output, or even your heart rate.

Why Back Sleeping is Probably Bad for the Heart

If you are carrying any extra weight, back sleeping is definitely bad for your heart.  This is because when you sleep on your back, the extra weight collapses your airway (sleep apnea).  And studies show that sleep apnea dramatically increases your risk of heart failure and atrial fibrillation.

Stomach sleeping is another possibility.  However, as I have learned personally, stomach sleeping is a perfect recipe for neck and back issues.

4 Reasons to Sleep on Your Right Side

If you suffer from heart issues, talk with your doctor about whether you should sleep on your right or left side.  Based on the science, here are four reasons why you may want to consider sleeping on the right.

1.  Less Shortness of Breath

As far back as 1937 doctors have noted that heart patients breath better sleeping on their right side.  Indeed, the worse the cardiac function, the more likely people are to sleep right side down.  While the reason for this isn’t entirely clear, it may have to do with a better venous return and lower pressures within the heart and lungs.

2. Better Cardiac Output

For the same reasons as number one above, cardiac output may be better with right side sleeping.  Once again, gravity pulling the heart toward the center of the chest may optimize cardiac performance.

3. Fewer Palpitations

No one likes the sensation that their heart isn’t beating correctly.  As the heart is in the center of your chest with right-sided sleeping, studies show that palpitations become much less noticeable.  In contrast, when you are on your left side, the heart is pulled to the chest wall, and you may feel every irregular beat of your heart.

While many atrial fibrillation patients have noted that they have fewer arrhythmias when sleeping on the right side, I could find no studies supporting this finding.  Thus, when it comes to sleeping and arrhythmias, I suggest sleeping in whatever position that seems to help.

4. Lower Heart Rate and Less Sympathetic Nervous Activity

The sympathetic nervous system is the fight or flight response.  This fight or flight response makes the heart rate and blood pressure go up.

For most of my patients, sympathetic nervous system stimulation makes their heart failure, chest pain, or arrhythmias worse.  And when it comes to sleeping and sympathetic stimulation, studies show that right-sided sleeping may be better.

3 Reasons to Sleep on Your Left Side

Not everyone does best with right side sleeping.  In fact, there are three distinct groups of people that may do worse.

1. Acid Reflux Sufferers

People suffering from acid reflux may sleep better on their left side.  This is because studies show that acid reflux may be worse with right side sleeping.  Thus, if your acid reflux is causing you more symptoms than your heart, you may want to consider sleeping on your left side.

2. Vagus Nerve Arrhythmias

The vagus nerve connects the heart, brain, and gut.  Because of this connection, vagus nerve activation may be an important cause of arrhythmias.

With vagus nerve stimulation, you get increased parasympathetic activity which is the exact opposite of the fight or flight response with sympathetic stimulation.  Thus, to quiet your vagus nerve at night, studies suggest that you may want to try sleeping on your left side.

3. Too Slow of a Heart Rate at Night (Bradycardia)

If you have ever worn a heart monitor, your doctor may have told you that your heart beats too slow at night.  If this is the case, sleeping on your left side could stimulate a sympathetic response and increase your heart rate.

Does it Really Matter Which Side You Sleep On?

For those of you who suffer from sleep issues, you may be asking does it matter which side is down?  I know for myself that I feel incredibly grateful for a great night of sleep regardless of which side is down.  Indeed, trying to force sleep on my right or left side would only intensify my insomnia.

Thus, I can’t definitively answer the question, is left or right side sleeping best for your heart.  The answer is a personal choice based on your specific situation and what feels best for you.

Do you prefer sleeping on the right or left side?  Please leave your thoughts and questions below.  For questions, please be patient as it may take me a few weeks to post a response.

Want to read more about sleep optimization?  Please check out this article I wrote called 10 Ways to Cure Insomnia without Medications.

#286 Is Weekend Catch Up Sleep Healthy?

June 5th, 2018 by

Is Weekend Catch Up Sleep Healthy?

Getting enough sleep during the workweek is hard.  Wouldn’t it be great if weekend catch up sleep could undo any damage from sleep deprivation?  In this study, I review a new study that goes against decades of sleep research.

The Longevity Plan

Ma Xue, one of the centenarians we came to love and know during our time in China’s Longevity Village, taught a timeless principle.

“My life is simple. Because of this, it is easy to know when something is out of balance.”

Sadly, our modern lives are usually a rhythmic mess. Indeed, when I see new patients whose hearts are out of rhythm, it is usually because their lives are also out of rhythm.  We’re generally not just out of rhythm in one way, but rather in multiple ways. And while we might be able to withstand a bit of disequilibrium in one part of our life, it’s hard to keep our balance when so many parts of our lives are so out of sync.

But starting quite simply, we can rebuild this balance piece by piece. And perhaps the best place is where almost all of us start each day, and where we end up each night.

Modern Life = Lack of Sleep?

Most of us wake up based on when we need to be somewhere, and from day to day that often changes. An early morning meeting can prompt a wake-up that is an hour or two earlier than usual. A late plane flight out of town can mean an extra few hours of slumber in the morning. And even if we keep a typical 9:00-to-5:00 workday, our five-days-on-two-days-off schedules promote sleeping timetables that are anything but routine.

Of course, very few of us are in a position to perfectly align our schedules to a sunrise-to-sunset existence. There are, however, things that almost all of us can do to bring a more consistent rhythm to our lives.  And while we work to bring our lives and our sleep into balance, fortunately, a new study just came out that offers hope.

Weekend Catch Up Sleep Study

I was amazed to read about a recent study looking at sleep duration and longevity.  After sifting through 13 years of records on 43,880 Swedes, they stumbled upon something that was rather interesting.

It should come as no surprise that these researchers found that those sleeping five or fewer hours each night increased their chances of dying early by 65%.  However, if these same sleep-deprived people could catch up by sleeping longer on the weekend, then their survival was as if they slept seven hours each night.  If this is true, it tells us that even if you have an incredibly demanding job, there is no longevity hit provided you can get some weekend catch up sleep.

I can’t even begin to tell you how this study contradicts decades of previous research.  And, quite frankly, I need to see some additional research to convince me that these findings are actually correct.

The Dangers of Acute Sleep Deprivation

To understand how bad sleep deprivation is for us, we have merely to look at the time of the year in which almost everyone is simultaneously thrown off kilter: when most folks across the United States “spring forward” an hour to accommodate for daylight saving time, effectively losing an hour of sleep. On the Monday following the spring daylight saving change, the incidence of heart attacks rises 24 percent, and the impact continues on Tuesday, when rates drop only slightly to 21 percent above the usual rate.

A lack of sleep impacts us right down to the genetic level, affecting the expression of more than 700 genes, which in turn dictate everything from our rates of metabolism, to the way our bodies deal with inflammation, to the antibodies created inside our cells to deal with infections or toxins. Pulling just one late-night work session or just staying up to watch a single TV show leads to the release of some of the same biomarkers that are increased with a concussion.

The Snooze Button

And we’re doing this damage en masse! Up to 70 million of us struggle with sleep according to the federal Centers for Disease Control and Prevention. If you regularly smack the snooze button in the morning, then chances are that you are part of this group. (And any rest you get after hitting the snooze doesn’t really even count; the sleep is so fragmented it doesn’t do anything for your body.)

My Sleep Challenges

Doctors belong to a culture that has long revered the idea of the sleepless physician selflessly putting patients’ needs above his or her own. And sure, the idea of a doctor turning in at 10:00 p.m. each night for a good night’s sleep might not be as dramatically alluring as that of a doctor who is staying up late reading through patient records in a heroic quest to save the day.

I firmly believe, though, that my commitment to a consistent bedtime when I am home has made me a better doctor for my patients. Indeed, a lack of sleep is the most significant predictor of clinical burnout, a combination of exhaustion and lack of interest in work that looks a lot like depression. You can’t help anyone when you’re burnt out.

Weekend Catch Up Sleep Didn’t Exist in The Longevity Village

For most of the past century in China’s Longevity Village, it has been a relatively simple task to be in sync with the sun, because electricity didn’t come to the village until just a few decades ago and, even once it did, there weren’t many televisions or computers until quite recently. After a long day of soaking up the sun while working in the fields and knowing that there was always another day just like it ahead, villagers had little reason to avoid getting the sleep their bodies need.

Is Weekend Catch Up Sleep Legit?

This study definitely offers hope for those who have demanding workday schedules.  Perhaps weekend catch up sleep may be a longevity hack for people with busy jobs.

Unfortunately, this is a possible longevity hack that doesn’t work for me.  The challenge I have is that I am no longer able to sleep later on weekends.  For me, my body always wakes up at the same time regardless of the day.

Regardless, I have a few concerns with weeekend catch up sleep…

1. We really don’t understand the potential risks of “yo-yo sleeping” over time.

2. Even though weekend catch up sleep may erase the longevity hit from acute sleep deprivation, what about your cognitive, behavioral, and metabolic health?

3. Are there irreparable biologic changes to your body even though you get weekend catch up sleep?

Weekend Catch Up Sleep May Fight Weight Gain

In defense of weekend catch up sleep, I did come across another interesting study.  As you know, sleep deprivation revs up your hunger hormones.  Indeed, it is well known that people who don’t sleep tend to gain weight.  However, this weight gain from sleep deprivation can be neutralized by weekend catch up sleep.

Make the Best of An Imperfect World

Not everyone can simply align their lives with the rotation of the globe. Shift workers. Traveling salespeople. Emergency workers. Graveyard convenience store clerks. Hospital staff members. As a cardiologist who is often called upon to care for patients with middle-of-the-night emergencies, this is a fact of life for me, too.

While weekend catch up sleep is certainly not ideal, it is probably less bad for you than sleep deprivation.  I just wish I could sleep in on the weekends…

Does weekend catch up sleep work for you?  Please leave your comments below.

#285 9 Things I Would Do To Prevent Atrial Fibrillation Strokes

June 4th, 2018 by

9 Things I Would Do To Prevent Atrial Fibrillation Strokes

Everyone fears an atrial fibrillation stroke.  Fortunately, most of these strokes are preventable.  As blood thinners are a scary prospect, patients always ask me what I would do.  In this article, I share the nine things I personally would do to prevent atrial fibrillation strokes.

Start Here

Before we jump in with the nine things I would do to prevent atrial fibrillation strokes, I need to confess that I don’t have atrial fibrillation.  While my grandmother had it, so far I have escaped it.

However, every week someone asks, would you take a blood thinner?  Based on a career of helping tens of thousands of patients prevent atrial fibrillation strokes, here is what I would do.

Please be warned, every case of atrial fibrillation is different.  What I would personally do may be completely different than what your doctor recommends (please listen to your doctor first).  My passion for extreme skiing and mountain biking doesn’t fit well with prescription blood thinners.  Thus, these are the nine things I would do to minimize my stroke risk and the need for daily pharmaceutical blood thinners.

This article is not medical advice.  I am not giving any recommendations.  As atrial fibrillation strokes can be catastrophic, please follow your doctor’s advice when it comes to atrial fibrillation stroke prevention.

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.

#284 4 Best Ways to Lower Your CHADS-VASc Score (How to Safely Get Off Afib Blood Thinners)

June 2nd, 2018 by

4 Best Ways to Lower Your CHADS-VASc Score (How to Safely Get Off Afib Blood Thinners)

No one wants to be on a blood thinner.  By optimizing your lifestyle, it is possible to get off your atrial fibrillation blood thinner.  In this article, I’ll share the four best ways to lower your CHADS-VASc score.

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.

#283 5 Best Ways to Fix Atrial Fibrillation Water Retention

May 29th, 2018 by

5 Best Ways to Fix Atrial Fibrillation Water Retention

No one wants swollen legs.  Besides the unsightly appearance, it often hurts.  With a few simple tweaks, fluid retention can be eliminated for most people.  In this article, I’ll share the five best ways to fix atrial fibrillation water retention.

Sarah’s Story

Sarah was 52 years old.  All her life her weight was a little higher than it should have been.  In addition to carrying the extra weight, she was also recently diagnosed with pre-diabetes and high blood pressure.  All told, she was on six prescription medications for her atrial fibrillation, hypertension, and pre-diabetes.

At the end of each day, her legs would swell up.  The swelling was terrible on the days she ate out or was on her feet a lot. However, nothing could compare to the days when her heart went out of rhythm.  On those days, the atrial fibrillation water retention was especially bad.

Her primary care physician wanted to put her on diuretics.  But given her family history of kidney problems, she didn’t want to take any medications that might harm the kidneys.  She came to see me for a second opinion.

Fortunately, we were able to quickly rule out heart failure, kidney failure, and liver failure as the cause of her fluid retention.  In her case, we had to optimize her lifestyle and keep her in sinus rhythm.

What Causes Leg Swelling?

While everyone immediately worries about the heart when the legs swell, fortunately, the heart is usually not the cause of the problem.  The primary cause of leg swelling is chronic venous insufficiency.  What this means is that the valves in the veins of the legs are not functioning properly.

If you think about it, these valves in the veins of the leg are asked to perform a difficult task.  They have to fight gravity in returning the blood from your big toe all the way back to your heart.  How they do this is that they have to open and close every time you move the muscles in your leg.

Conditions like obesity, physical inactivity, poor diet, history of blood clots, etc. can all cause chronic venous insufficiency.  While chronic venous insufficiency is the leading cause of leg swelling, sometimes leg swelling can be due to the heart.

Does Atrial Fibrillation Cause Leg Swelling?

When the heart goes into atrial fibrillation, the upper chambers of the heart stop pumping.  With the loss of the atrial contribution, you lose at least 20% of your cardiac performance.

If you are already prone to leg swelling from being overweight, eating a poor diet, or not exercising much, then atrial fibrillation could definitely make things worse.  Indeed, the older you get, the more likely atrial fibrillation water retention will be an issue for you.

5 Best Ways to Fix Atrial Fibrillation Water Retention

Besides keeping the heart in sinus rhythm, there are many things you can do to avoid leg swelling. Below are the five best ways to fix atrial fibrillation water retention.

1.  Eat High Fiber

Fiber helps to suck any extra water out of your body.  Fiber isn’t digested, and it pulls large amounts of water with it as it travels through your gut.

While our government recommends somewhere around 30 grams of fiber each day, this number can’t even begin to compare to what our ancestors used to eat.  Indeed, many experts peg hunter-gatherer diets close to 150 grams of fiber daily.

While 150 grams of fiber is out of reach for most modern people, my goal is to get 100 grams daily.  When it comes to fiber, health, and longevity the more, you get the better off you will be.  To read more about fiber, here is an excellent article I wrote.

2. Eliminate Sugar and Flour

Not only will sugar and flour mess up your metabolism and cause intense weight gain, but they also act as a magnet to water.  Indeed, it is for this reason that people drop water weight fast when they go on a low carb diet.

If you are like me and you can’t give up your sweet tooth, there are other options.  For example, I satisfy my sweet tooth with stevia-sweetened dark chocolate.  This delicious treat is very low carb and very heart healthy.  Instead of eating the traditional whole wheat bread, I like the Ezekiel flourless bread.  Because there is no flour, you don’t get the sugar spike.

3. Eliminate Processed Foods

Every doctor will tell you to limit the salt if you are retaining water.  And there is a good reason for this advice.  As with sugar and flour, sodium acts as a magnet for water.

When it comes to sodium, the problem isn’t the salt shaker. Instead, the problem is with processed foods, fast foods, and restaurant foods.  Processed foods, fast foods, and restaurant foods easily account for 80% of the sodium in the diet.

As strange as it may seem, I actually don’t mind my patients using the salt shaker provided they are not going crazy with the salt. The reason for this is because if they are using the salt shaker, then they are probably preparing their own foods at home.

4. Break a Sweat Every Day

When it comes to atrial fibrillation water retention, exercise is a must.  Vigorous physical activity causes you to lose both the excessive sodium and water in your body.  In addition to the salt and water loss, exercise also helps the valves in your veins get the fluid back to the heart where it can be put to good use.

How you exercise is really up to you.  The important thing is that you never let a day go by without breaking a sweat doing some form of physical activity.

5. Keep Your BMI Below 25

Even if you are eating right and exercising daily, studies show that if your body mass index (BMI) is over 25 you are prone to water retention.  The exception to this observation is the person who lifts for muscle bulk.  Indeed, in powerlifters, the BMI calculations may be completely inaccurate.

To find out your BMI, please click this link.  If your BMI is over 25, it can be easily corrected.  By simply following every item on this list, your BMI will be below 25 in no time at all.

Better yet, if you are physically fit with a BMI below 25, then you have an excellent chance of driving your atrial fibrillation into remission without drugs or procedures.  Nothing would fix atrial fibrillation water retention faster than putting your arrhythmia into remission!

Sarah’s Story Revisited

Fortunately for Sarah, she eagerly accepted the challenge of fixing the atrial fibrillation water retention problem naturally.  Within just six months of eating high fiber, eliminating sugar, flour, and processed foods, as well as exercising every day, she quickly dropped 50 pounds.

This 50-pound weight loss gave her a BMI of 23.8.  It also drove her fluid retention challenges, atrial fibrillation, high blood pressure, and pre-diabetes into remission.  No longer did she need the six prescription medications she was previously taking.

Practical Tips

You don’t need to suffer from atrial fibrillation water retention.  And you also probably don’t need to take diuretics to get the water off.  Unless fluid retention resulted from end-stage heart failure, kidney failure, or liver failure, in the 23 years since I graduated from medical school, I can’t think of a patient who required diuretics who faithfully followed all five things discussed in this article.

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.

#282 How Do You Diagnose Atrial Fibrillation?

May 29th, 2018 by

How Do You Diagnose Atrial Fibrillation?

If your heart isn’t beating right, you want it diagnosed quickly.  Sometimes it can take years before your doctor can make the correct diagnosis.  If you suspect that you might have atrial fibrillation, this article is for you.  In this article, I will teach you how to diagnose atrial fibrillation.

Melanie’s Experience

Every time Melanie’s heart raced uncontrollably, she rushed to the hospital.  She knew that if she could get to the hospital in time, her doctors could finally make the diagnosis. But they never could.

Instead, they merely diagnosed her with panic attacks.  Despite being labeled with panic attacks, Melanie still knew there had to be something wrong with her heart—something that her doctors couldn’t find.

Melanie isn’t alone.  Many people suffer from atrial fibrillation for years because it never seems to show up on an EKG.

Can an EKG Diagnose Atrial Fibrillation that Comes and Goes?

The problem with the standard EKG is that it is only about a 10-second snapshot of what your heart is doing.  If atrial fibrillation happens to be occurring during those exact 10 seconds, then the diagnosis is easy to make.  However, if you are like most of my patients, atrial fibrillation never seems to happen when the doctor’s EKG machine is running.

What is an Event Monitor?

The key to finally making Melanie’s diagnosis was a much longer EKG—an EKG that continued for an entire month.  This one month long EKG is also known as an event monitor.

An event monitor is a small electronic device that monitors your EKG for prolonged periods of time.  You wear it under your clothes.  You even wear it while you are sleeping.  The only time you take it off is when you shower or go swimming.

Event Monitor vs. Holter Monitor: Which is Best?

Perhaps you have heard of a Holter monitor.  The Holter monitor is usually much larger than an event monitor.  Also, the Holter monitor is taped to your chest for 24 to 48 hours.  During this period, you can’t even shower.

The benefit of a Holter monitor is that it is only 24 to 48 hours.  If your atrial fibrillation happens during this short period, then you are golden.  If, however, nothing happens then it was a waste of time and money.  This is why I generally prefer the event monitor over the Holter monitor.

Besides being stuck with the monitor for a month, the only other drawback of the event monitor is the cost.  Event monitors generally cost much more than a Holter monitor.

If cost is an issue, talk with your doctor about using the Alivecor system described below.  While the Alivecor system probably isn’t covered by your insurance, the $99 you’ll pay is likely much less than the co-pay on an event monitor.

What if the Event Monitor Doesn’t Show Anything?

For some of my patients, a month-long EKG may still not be a long enough period to detect atrial fibrillation.  For these people, more advanced technologies are needed.  Two such possibilities include an implantable loop recorder or a smartphone EKG app.

What is an Implantable Loop Recorder?

An implantable loop recorder is a small chip that cardiologists inject under the skin on your chest.  This chip continuously monitors your EKG for the life of its battery which is generally about three years.

This technology is especially helpful in that any episodes of atrial fibrillation you may be having, even if you are asleep, are automatically recorded and sent to your physician.  All of this happens without you having to do a thing.

The implantable loop recorder automatically communicates with your transmitter at home once a day.  If you are having symptoms, you can do a manual transmission of your EKG to your doctor’s office.

One thing to remember is that while the implantable loop recorder goes in quickly, there is usually a bigger scar getting it out three years later.  Thus, if you don’t want a half inch scar on your chest, then this technology is not for you.

What is a Smartphone ECG app?

The second approach to prolonged EKG monitoring is to turn your smartphone into an EKG machine. This is done through Bluetooth enabled electrodes and a smartphone app.  The best-studied device is the FDA-approved Alivecor system.

If you really want to go high tech on this, you can get it on your Apple Watch.  Hundreds of my patients have used this system with excellent results.  Indeed, studies show that the Alivecor system is one of the best ways to diagnose atrial fibrillation.

Practical Tips

If you think you may be suffering from atrial fibrillation, you need to get it diagnosed.  And you need an EKG to diagnose atrial fibrillation.  Only then can you be appropriately treated.  Knowledge is power, and you have to capture your symptoms on an EKG.

How you do the EKG doesn’t matter.  The key is to document the rhythm.

Of course, don’t try to diagnose atrial fibrillation without the help of your doctor.  Unless you are an EKG master, there will be mistakes. As the stakes are high with heart issues, work with your doctor to correctly diagnose atrial fibrillation.

#281 How Do You Know If You Are in Atrial Fibrillation?

May 29th, 2018 by

How Do You Know If You Are in Atrial Fibrillation?

Sometimes it is hard to know what your heart is doing.  Fortunately, with a few simple tricks, you can tell with 99% accuracy if your heart is out of rhythm.  In this article, I’ll teach you how to know if you are in atrial fibrillation.

Kim’s Experience

Kim was never quite sure when she was in atrial fibrillation.  She didn’t get the palpitations that her sister and neighbor got when they had an atrial fibrillation attack.

All she knew was that sometimes she just felt tired.  That was it.  No palpitations, no shortness of breath, no chest pain, and no dizziness.  Just fatigue.

“How come I can’t feel my atrial fibrillation,” Kim asked.

“Many people can’t feel their hearts beating irregularly,” I said.

“Then how do you know if you are in atrial fibrillation?” she asked.

“Check your pulse,” I said.

“I think I can feel my pulse,” she said.

“Good.  If your pulse is regular and is beating about once a second, then you are likely in sinus rhythm.  If the pulse is irregular and fast then you are probably in atrial fibrillation,” I said.

How do you know if it is atrial fibrillation or just your heart skipping beats? She asked.

“If it is an occasional missed beat, and all the other beats are perfectly timed, then it is probably just a premature beat,” I said.

How Do You Check Your Pulse?

Checking your pulse to see if you are in atrial fibrillation is simple.  Indeed, most of my patients can learn to tell within 10 seconds.  All you have to do is find your pulse.

How you check your pulse doesn’t matter.  It can be on your wrist, neck, the temple of your head, or just about anywhere else you can feel your pulse.

If you feel your pulse about once per second, and it is regular, then you are probably in sinus rhythm. Atrial fibrillation typically has a fast and chaotic pulse.  The heart rate is often faster than 100 beats per minute at rest, and every heartbeat is irregular.

What Should Your Heart Rate Be?

Most people have a resting heart rate of 50 to 90 beats per minute.  If your heart goes into atrial fibrillation, it will likely be at least 10 to 20 beats per minute faster.

Of course, there are no hard and fast rules.  Sometimes the heart rate slows with atrial fibrillation.  It is for this reason that you can’t rely on the heart rate alone to tell if you are in atrial fibrillation.  You also have to check your pulse to know if the heartbeat is regular or not.

If you want to learn more about what your heart rate should be, here is an excellent article I have written on this topic:

What Should Your Resting Heart Rate Be?

How Often Should You Check Your Pulse

For my patients with atrial fibrillation, I recommend that they check their pulse twice daily.  The reason for a twice daily check is to minimize their risk of stroke.  Knowing your rhythm is especially important for those people not taking a blood thinner.

The reason for the twice-daily check is because studies show that the risk of a stroke starts going up somewhere around 24 hours of uninterrupted atrial fibrillation.  If you are checking your pulse twice daily, then you will be able to detect atrial fibrillation before this 24 hour time point.

What Should You Do if You Can’t Feel Your Pulse?

As many of my older patients struggle to feel their pulse, there are other ways to tell if you are in atrial fibrillation.  Here are some different ways to check your pulse if you can’t feel it on your wrist or neck.

1.  Have Your Spouse Put Their Ear to Your Chest

If your spouse puts their ear on your chest, it is almost like using a stethoscope.  When your heart is in rhythm, they should hear a regular heartbeat at about once per second.  If, however, you are in atrial fibrillation then they should hear faster and irregular heartbeats.

2. Buy a Stethoscope

Stethoscopes are cheap.  For example, Amazon’s choice for stethoscopes will only set you back $25.48 at the time of this writing.  As with #1 above, if you are in atrial fibrillation the “lub dubs” should be fast and irregular.

3. Buy a Blood Pressure Monitor that Detects an Irregular Pulse

Every home needs a blood pressure monitor.  As high blood pressure is one of the leading causes of heart disease, knowing your numbers could save your life.

When shopping for a blood pressure monitor, look for one that will also detect an irregular pulse.  Usually, these monitors will have a heart icon on the screen.  Whether or not the heart icon is lit up or not will tell you if your pulse is regular or irregular.  The only challenge with these devices is that the blood pressure machine can’t know the difference between atrial fibrillation and skipped heartbeats.

4. Buy a Pulse Oximeter

Pulse oximeters are also cheap.  The best selling model on Amazon was only $18.95 on my last check.  While most people buy a pulse oximeter to see what their oxygen saturation is, it can also be used to monitor for atrial fibrillation.

As with a blood pressure machine, you can’t just focus in on the actual pulse number.  You need to carefully look at the flashing or blinking lights on the pulse oximeter.  Every time the pulse oximeter detects a heartbeat, it will flash or blink.  If you are in atrial fibrillation, the flashing or blinking will be fast and irregular.

5. Turn Your Smartphone into an EKG Machine

For $99 you can turn your smartphone into an EKG machine with the Alivecor system.  Hundreds of my patients have used this device with excellent results.

With the Alivecor system, you put your thumbs on the small Bluetooth electrodes.  The electrodes then transmit the data to your phone.  With the app, you can see your actual EKG.  While the app can give you a reasonably accurate EKG interpretation, you’ll want to show it to your doctor for confirmation.

Practical Tips

It really doesn’t matter how you check your pulse.  The key is to be consistent.  With a little training, most of my patients can tell if they are in atrial fibrillation with 99% accuracy.

#280 Harvard Scientists Reveal 5 Life Extending Hacks: Your Best Lifestyle for Longevity

May 28th, 2018 by

Harvard Scientists Reveal 5 Life Extending Hacks: Your Best Lifestyle for Longevity

Wouldn’t you like to know the real secret to a long and healthy life?  Based on the latest longevity study, Harvard researchers found five easy life-extending hacks that could get you to age 93.  In this article, I’ll share the very best lifestyle for longevity.

What Does it Take to Get to Age 90?

The human body is genetically programmed to make it to 90.  As long as we don’t screw it up, 90 is within reach for most people.  If you can get a few simple, healthy lifestyle habits down, then the odds are that you will thwart a fatal cancer or heart condition.  Indeed, if you can stave off heart disease and cancer then cruising past 90 should be a breeze.

The Latest Longevity Study

In search of life’s Holy Grail, Harvard researchers recently revealed five simple life-extending health hacks. These five hacks are all you need to know to find your best lifestyle for longevity.

As part of this new study, Harvard researchers painstakingly dissected the medical records of 123,219 people. With an average of 34 years of medical records at their disposal, they were able to deconstruct the five secrets to a life free of heart problems, cancer, or a premature death.

When it comes to beating heart disease, these five health hacks will slash your heart disease risk by 72%!  If a 72% reduction of death from heart disease isn’t compelling enough, these five hacks will also drop your cancer risk by 52%!

As you will likely be free of heart disease and cancer, this study shows that for women you will get 14 bonus years of life allowing you to reach 93.  For men, these same five health hacks predict 12 bonus years of life achieving an age of 88.

5 Life-Extending Hacks

Without keeping you in suspense any longer, here are the five longevity hacks to find your best lifestyle for longevity.

1.  Breathe Clean Air

Okay, nothing new here. While this study specifically looked at smoking, countless other studies have linked any form of air pollution to heart disease, cancer, and a shortened life.  The message is simple.  Make clean breathing a must.

In addition to not smoking, you also don’t allow anyone to smoke around you.  The same goes for electronic cigarettes.

Besides smoking, air pollution can be a huge problem.  Indeed, studies show that air pollution may rob you of up to 5.5 years of life!  And when it comes to air pollution, indoor air quality is generally much worse than anything you may encounter outside of your home.   For indoor air pollution, studies show that even breathing the stench of smoke on the clothes of smokers puts you at risk.

What can you do?  Besides banning cigarettes in your home, don’t go anywhere near where people are smoking.  If air pollution is bad, then don’t exercise outside.  For your home, invest in many indoor plants and be sure to also buy a HEPA filter.  These filters are cheap and can be very effective at scrubbing the indoor air of pollutants.

2. Keep Your BMI Between 19 and 25

I’m guessing that if you are like most people, this will be the most challenging longevity hack.  Food manufacturers have scientifically designed their fake foods to get you hooked, steal your money, and make you gain weight.

Not quite sure what your body mass index (BMI) is?  Here is the link to find out. If you are like most people, you are probably in shock as to how high your BMI is.  The natural inclination is to say the BMI system is wrong, bogus, or a terrible measure of health.

Yes, there are limitations.  No system is perfect.  For example, it doesn’t account for excessive muscle mass.  Thus, if you are faithfully doing hardcore strength training, your BMI measurement won’t be accurate.

Despite the limitations, BMI is a proven predictor of longevity within a population of people.  And when it comes to living a long life, studies show that the BMI sweet spot seems to be 20 to 25.

Even if you have battled weight all your life, it is easy for most people to maintain a BMI below 25. In fact, after working with thousands of patients, you only need to remember three things when it comes to optimizing your weight – No sugar, no flour, and nothing after 7 PM.

No sugar and no flour are really just the same things.  Flour, whether it comes from wheat, rice, corn, etc. turns instantly to sugar minutes after swallowing it down.  Sugar and flour will throw off your metabolism, mess up your insulin sensitivity, and keep you hungry all day long.  Unless you are exercising for hours and hours every day, you can’t eat this stuff long-term and expect to stay lean.

Likewise, late night eating is another sure fire way to thwart your body’s natural metabolism.  To optimize metabolism and insulin sensitivity, you need a period of time without food.  And the easiest way to accomplish this goal is to stop eating by 7 PM assuming that you don’t work nights.

3. At Least 30 Minutes of Exercise Every Day

With regards to this Harvard study, they don’t give you any days off. You have to be active every day. No excuses.

What you do for exercise doesn’t matter. My only rule is that you enjoy doing it because if you don’t, it will never stick. That daily dose of physical activity can be anything provided you break a sweat and get your heart rate up.

A quick disclaimer…if you haven’t been exercising regularly, please speak with your physician first before adopting this longevity hack or, for that matter, any other hack mentioned in this article.

4. Keep Alcohol Intake in Check

In this study, Harvard researchers only looked at those with moderate levels of alcohol intake.  Interestingly, those who drank the least seemed to live the longest.

Alcohol and longevity is a difficult question to answer.  On one hand, you have some studies that claim moderate alcohol consumption has life-extending properties.  However, other studies claim this research is bogus because they didn’t account for the abstainer bias.

And then you have the American Institute for cancer research which claims that there is no safe level of alcohol that can be consumed.  Even for the heart condition, atrial fibrillation, studies also show that there is no safe level of alcohol.

If you chose to drink, my advice would be to look for the minimally effective dose that you need.  If your BMI runs high, minimizing alcohol intake will help you to optimize your weight as alcohol packs a big sugar punch.

5. Eat a Healthy Diet

Despite evidence to the contrary, 75% of Americans think they are eating a healthy diet.  Just so there is no confusion, eating a healthy diet is really quite simple.  Eat real food.

If there is an ingredient list, it probably isn’t real food.  Likewise, if it comes in a box, can, or jar it also probably isn’t real food.  Real food looks like something you would grow in your garden or bring back from a hunt.

If you can just do these three things, then you are 90% of the way to a healthy diet.

1.  Don’t eat sugar. (This includes fruit juice, honey, maple syrup, etc.)

2. Don’t eat flour.  (Flour, whether it be from wheat, rice, corn, or potatoes, is still just sugar)

3. Eat vegetables with every meal. (And by every meal I also mean breakfast!)

Of course, I am not saying that vegetables should be the only thing in your diet.  Far from it.  It is just that people struggle with vegetables.  If you can get the vegetable thing right then the rest of the diet usually falls in line.

The Big Picture

If you want a life free of heart disease, cancer, and an early death it comes down to five simple health hacks.  Breathe the clean air, keep your BMI between 19 and 25, exercise daily, minimize alcohol, and eat real food.  Simply put, this is the best lifestyle for longevity!

What are your tips and tricks for optimizing these five health hacks? Please leave your thoughts and questions below. This comment section will be open for 30 days during which time I will respond to every question posted.

#279 6 Reasons Why There is an Atrial Fibrillation Dementia Link

May 28th, 2018 by

6 Reasons Why There is an Atrial Fibrillation Dementia Link

Besides not feeling well, maintaining brain function is one of the main concerns of people suffering from atrial fibrillation.  Fortunately, studies show that driving atrial fibrillation into remission and optimizing your daily health decisions may preserve long-term cognitive performance.  In this article, I share six reasons why there is an atrial fibrillation dementia link. And I’ll also teach you what you can do to optimize brain function even if you have atrial fibrillation.

Does Atrial Fibrillation Affect Brain Function?

Things Exercise Does To Your Brain

Before we ever get to the atrial fibrillation dementia link, the first question is does atrial fibrillation affect brain function? In a worrisome study, researchers from Italy showed that when the heart is out of rhythm, blood flow to the brain is compromised and cognitive function drops.

Sadly, all aspects of brain functions suffered in atrial fibrillation.  And, as atrial fibrillation progresses from paroxysmal to persistent, brain function gets even worse.

Indeed, my lawyer, physician, and CEO patients tell me their thinking isn’t sharp when their heart is out of rhythm.  This “brain fog” then affects them negatively in the courtroom, boardroom, or operating room.

We First Showed the Atrial Fibrillation Alzheimer’s Link

In the early part of my career, I saw many atrial fibrillation patients develop Alzheimer’s disease.  Based on these observations, Dr. Jared Bunch and I decided to see if an atrial fibrillation dementia association existed.

To better understand if an atrial fibrillation dementia link existed, we looked at nearly 40,000 patients.  To be sure that it was Alzheimer’s disease, we required both a brain MRI and neurologist evaluation confirming this diagnosis. We then went back through their medical history to see what role atrial fibrillation played.

In the final analysis, our study showed that atrial fibrillation roughly doubles the risk of Alzheimer’s as well as all other forms of dementia.  Probably the scariest finding was that this dementia risk was highest in our younger patients with atrial fibrillation.

6 Possible Links Between Atrial Fibrillation and Dementia

So what is the mechanism to the atrial fibrillation dementia link?  While we don’t have all the answers yet, there are some clues.  Below are my six best explanations of how atrial fibrillation may cause dementia.

1.  Macro and Micro Thromboembolism (Blood Clots)

While most doctors and patients worry about the big clots, the little ones are all of concern.  Indeed, with a transesophageal echocardiogram (TEE), you can see these micro-clots when the heart is out of rhythm.

These micro-clots, also known as spontaneous echo contrast, occur when blood isn’t moving.  As the upper chambers of the heart aren’t beating with atrial fibrillation, clots may quickly form.

Preventing strokes is critical to eliminating the atrial fibrillation dementia link. And If you want to treat the underlying cause of atrial fibrillation strokes, you have to keep the heart in rhythm and eliminate every atrial fibrillation stroke risk factor possible.   Because, as you will see below, blood thinners are not a risk-free option.

2. Macro and Micro Brain Bleeds

The top concern of every atrial fibrillation patient taking a blood thinner is bleeding.  This concern is top of mind in the U.S. where lawyers encourage anyone who has ever been on a blood thinner to sue drug maker.

No doubt about it, blood thinners are especially effective at preventing atrial fibrillation clots.  The only problem is that they also significantly increase the bleeding risk.  By bleeding risk, I’m not just talking about bleeding if you get hurt.  I’m talking about spontaneous internal bleeding.

Spontaneously internal bleeding could take the form of gastrointestinal bleeding or even a brain bleed.  And the brain bleeds can be the big ones that everyone fears or the microbleeds that develop over time.

Microbleeds don’t cause any immediate symptoms.  However, studies show that these microbleeds may lead to progressive brain injury and dementia.  Sadly, blood thinners, especially warfarin/Coumadin, may increase this risk.

If you have to be on a blood thinner, then the best option would be a “NOAC.”  The “NOAC” blood thinners are Pradaxa, Xarelto, Eliquis, or Savaysa.  When compared to warfarin/Coumadin, our studies show that these blood thinners have a much lower risk of brain bleeding and dementia.

3. Cerebral Blood Flow

The key to optimizing brain performance is to maximize blood flow.  Unfortunately, atrial fibrillation decreases blood flow to the brain. How this occurs isn’t entirely clear, but three obvious reasons arise.

First, with atrial fibrillation, you lose the pumping ability of the right and left atria.  This loss of “atrial kick” decreases cardiac performance by about 20%.  Any loss of cardiac performance is linked to dereduced blood flow to the brain.

The second possible explanation is the irregularity of the pulse with atrial fibrillation.  Indeed, studies show that even if the heart is in atrial fibrillation, if you can normalize the pulse with a pacemaker then you can also normalize blood flow to the brain.  This study argues that it is the irregularity, not the loss of atrial function, that decreases blood flow to the brain.

Lastly, either too slow or too fast of a heart rate with atrial fibrillation could impact cerebral blood flow.  In another study (see abstract PO06-103) from our hospital, we have observed that the optimal atrial fibrillation heart rate to preserve brain blood flow is probably somewhere around 100 beats per minute.  Of course, sinus rhythm would be preferable but if you have to be in atrial fibrillation, then a higher heart rate may be necessary to preserve blood flow to the brain.

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4. Systemic Inflammation

Keeping inflammation as low as possible may be the secret to living to 1oo and beyond without any significant medical problems.  Indeed, studies of semi-supercentenarians, or those older than 105, have shown that the secret to their health is keeping inflammation barely detectable.

Years ago we published a study showing that inflammation levels, as measured by C-reactive protein, are much higher in people with atrial fibrillation.  Likewise, elevated inflammation levels have also been seen with dementia.  Thus, it is quite possible that the same inflammatory factors causing atrial fibrillation are also causing dementia.

5. Other Medical Problems

Atrial fibrillation doesn’t usually occur in isolation.  Generally, the same people with atrial fibrillation are also the same people suffering from obesity, high blood pressure, diabetes, sleep apnea, etc.  As all of these conditions also increase the risk of dementia, it is hard to know the exact atrial fibrillation dementia link.

The bottom line is that if you want to minimize your risk of atrial fibrillation, you can’t ignore your other medical challenges.  In other words, you can’t just focus on maintaining sinus rhythm while not also addressing the obesity, high blood pressure, diabetes, sleep apnea, etc.

This is where lifestyle optimization becomes so important.  Fortunately, most of these conditions can all be reversed by eating real food, keeping your body mass index below 25, exercising daily, and optimizing your sleep and stress levels.

6. Genetic Factors

reverse aging

Despite every effort at optimizing your lifestyle, genetics always play a role.  Fortunately, studies show that only about 25% of your health and longevity is determined by your genes.  The good news here is that the other 75% is completely up to you.

Interestingly, the Nigerians have the highest rates of the the Alzheimer’s gene.  Despite having the worst genes in the world, the Nigerians living in Nigeria rarely get dementia.  However, if they give up their healthy ancestral ways and migrate to the US then they lose these protective effects.

If you want to know whether your genes code for atrial fibrillation or dementia, there is a simple test you can do to find out. 23andMe offers a simple genetic analysis with a saliva sample at a cost of $199 USD.  While the FDA limits what 23andMe can share with you, by allowing Promethease access to your 23andMe raw data, you can unlock everything that is currently known about your genes for an additional $10 USD.

Atrial Fibrillation and Dementia in China’s Longevity Village

The Longevity Plan

In our book, The Longevity Plan, we deconstructed the secrets of China’s Longevity Village.  In this village, which has the highest percentage of centenarians in the world, atrial fibrillation and dementia are almost non-existent.  Indeed, during our five years of research, we couldn’t find any cases of atrial fibrillation or dementia.

Initially, my assumption was that the only way these people could live to 100 and beyond without atrial fibrillation or dementia had to be due to their genes.  However, when we analyzed the genes of these centenarians, we found nothing special.  As with us, they also had genes that predicted heart disease and dementia.  Clearly, it was something else that protected them.

After five years of research, the protective factor was that they had unknowingly optimized all aspects of the their daily health decisions.  Indeed, this book showed just what kind of heath and longevity is possible if you can optimize all of your health decisions.

How Do You Protect the Brain from Atrial Fibrillation?

Foods That Reverse Brain Aging

For those who are unable to reverse their atrial fibrillation with lifestyle changes, in 2011 we published a follow-up study  of 37,908 people showing that if you could eliminate atrial fibrillation with an ablation, then the increased dementia risk was completely gone.  Indeed, we have learned that the two key factors to preventing dementia are to maintain sinus rhythm and optimize your lifestyle.

For those in whom sinus rhythm is no longer possible, all is not lost.  When it comes to maintaining long-term brain function, the most important thing is to optimize your daily health decisions. Study after study has confirmed that healthy lifestyles trump genes and just about everything else.

Practical Tips

The key message is that despite the atrial fibrillation dementia risk, you can preserve long-term brain function by maintaining sinus rhythm and optimizing your health.  Do everything possible to keep your heart in rhythm.  Keep your weight in check.  Include vegetables with every meal and stay as far away from sugar, flour, and processed foods.  Never miss your daily workout and always look for ways to optimize your sleep and stress levels.

#277 Can Atrial Fibrillation Cause a Heart Attack?

May 20th, 2018 by

Can Atrial Fibrillation Cause a Heart Attack?

One of the biggest concerns people have during an arrhythmia is can atrial fibrillation cause a heart attack?  Fortunately, with the right lifestyle and proper treatment, the answer is usually no.  In this article, I’ll discuss how you can minimize the risk of a heart attack with atrial fibrillation.

Mark’s Experience

Mark was afraid to exercise. He was sure he was going to have a heart attack if he did anything that was physically active. The biggest thing on Mark’s mind was, can atrial fibrillation cause a heart attack?

Mark worried that when his heart rate hit 160 beats per minute in atrial fibrillation that he must be doing damage to his heart.  He kind of felt like he was “redlining” his heart much the same way you might “redline” your car from running the engine faster than it was designed to go.

Since his diagnosis of atrial fibrillation a month previously, Mark had stopped exercising. He had even stopped playing with his kids outside. He mostly just sat in a chair for fear that any activity might trigger atrial fibrillation or a heart attack.

With our initial visit I scheduled him for a stress echocardiogram and lab work to make sure that with the exception of his atrial fibrillation, the rest of his heart was healthy. Fortunately, his stress echocardiogram and lab work didn’t indicate any problems.

With a normal stress echocardiogram, I then got Mark on the lifestyle I described in our best selling book, The Longevity Plan. By optimizing his lifestyle in every way, and by providing him with some flecainide and metoprolol to be used only in the possibility of another atrial fibrillation attack, we had effectively dropped his heart attack risk as close to zero as possible.

Fortunately for Mark, optimizing his lifestyle was all that was needed to get his atrial fibrillation under control.  While he has kept a dose of flecainide and metoprolol in his wallet at all times for an emergency, he has not had to take either of these medications yet…

Heart Attack Risk from Atrial Fibrillation

It is easy to see why many people confuse heart attack symptoms with atrial fibrillation symptoms.  For example, both atrial fibrillation and a heart attack can cause shortness of breath and chest discomfort.

 

Based on a study we published many years ago, atrial fibrillation does indeed increase your risk of a heart attack. The good news though is that our studies also show that once the atrial fibrillation is properly treated, this increased risk goes away.

What is the Best Stress Test for Atrial Fibrillation?

When it comes to stress testing, my favorite is the stress echocardiogram. I like this test because it involves no radiation, no IV, and it provides the most information about the heart in a simple and cost-effective test.

For those patients who are unable to walk on a treadmill, I usually stress their hearts with a medication. The main downside is that these “chemical stress tests” generally involve radiation.  In addition, the information you get from a chemical stress test is rather limited.  Thus, I usually combine a chemical stress test with a resting echocardiogram.  This way I can make the valves and other aspects of the heart are also functioning properly.

The Very Best Way to Prevent a Heart Attack

Heart attacks are largely a phenomenon of living a modern lifestyle.  Indeed, heart attacks are very rare in cultures that have maintained their ancestral ways.

For example, in our book, The Longevity Plan, people living in and or around China’s Longevity Village didn’t get heart disease.  Even among the centenarians, only 4% had heart disease.  Atrial fibrillation was likewise rare in this group of people.

How these people were effectively able to avoid all of the medical conditions that afflicted those of us living in the modern world were spelled out in this book.  The bottom line is that only eating real food (no sugar or processed carbs/foods, etc.), maintaining a lean weight, exercising every day, connecting with friends and family on a daily basis and optimizing sleep and stress levels can prevent at least 90% of all heart conditions.

Practical Tips

The take-home message is that with a healthy lifestyle, like the one we described in our book The Longevity Plan, a normal stress echocardiogram, and being under the care of a cardiologist specializing in arrhythmias (electrophysiologist), the chances of atrial fibrillation triggering a heart attack are incredibly low.  Of course, if you are experiencing chest discomfort, or any other symptom possibly related to your heart, please let your doctor know immediately.

#275 9 Key Findings of the CABANA Study

May 12th, 2018 by

9 Key Findings of the CABANA Study

No one wants to be on drugs for the rest of their life to treat a heart arrhythmia called atrial fibrillation (Afib).  In a perfect world, you would have a safe and simple procedure that would make it all go away.  In this article, I’m going to share the results of the most important study that has ever been done for atrial fibrillation, the CABANA Study.

Why the CABANA Study Needed to Be Done

Gently placing a small catheter into the heart to treat the areas that are misfiring is a procedure that cardiologists have done regularly for nearly 20 years.  Those of us who have taken care of patients with atrial fibrillation have all seen miracle results.  Patients doomed to a life of atrial fibrillation are suddenly free from this affliction.

In fact, the results have been so striking that we even published our results of 37,908 patients in a 2011 study.  In this study, we showed that the procedure was safe and that it could significantly reduce the risk of premature death, stroke, and dementia from atrial fibrillation.  The only problem was that this study was never randomized.  And because it was never randomized it can’t be considered as “proof” that patients live longer and healthier lives with ablation.

In other words, were these findings in our study because catheter ablation works or did healthier patients somehow opt for ablation more than drugs?  No matter how we looked at the data, the only difference we could find in the ablation patients was that people with atrial fibrillation symptoms were more likely to get an ablation.  Which raises an interesting question…are atrial fibrillation patients with symptoms somehow “healthier” than atrial fibrillation patients without symptoms?

We needed proof from other hospitals that catheter ablation works.  Which is the precise reason why the CABANA Study is so important.  And while we thought we were going to get that proof, instead we just got more questions and more controversy.

Perhaps things will be a bit clearer when the study is finally published.  All we know so far is what was shared from a 15 minute presentation at a recent medical conference…

It Was Hard to Enroll CABANA Study Patients

Before we get to the actual results, the CABANA Study was a hard study to do.  As it is well known from many prior studies that ablation is better at keeping people in rhythm and reducing symptoms, it was hard enroll patients to participate in this study.  I personally met with hundreds and hundreds of atrial fibrillation patients who were not interested in participating in this study because they didn’t want to take drugs.

Thus, enrollment in the CABANA Study was slow and it took much longer to complete that what was previously anticipated.  For anyone who has done clinical research, motivated patients always have the best outcomes.

Right from the start, motivated patients generally were not included in this study.  Or at least that was the case from our hospital which was the number one enrolling hospital in this study.  Pretty much the only people we could enroll were those rare patients who had either never heard about ablation before or were ambivalent about how they wanted to treat their atrial fibrillation.

Cabana Study Results: Intention to Treat

To the scientific purists, you can only analyze a study based on the intent to treat.  For 99% of the studies out there, this approach works.

However, the CABANA Study was different than most other studies.  Hence, the controversy.

Nine percent of the people assigned to an ablation never actually had the procedure.  Nine percent is a big number.  That means more than 100 patients in this study of 2,204 people never got the therapy they were supposed to get.  So, if you are interpreting the results, how do you account for the 9% who were assigned to ablation but didn’t get an ablation?

But that was just the tip of the iceberg.  Of those assigned to take drugs, 28% couldn’t do it.  The CABANA Study required these patients to stick with drugs for five years.

If so many patients didn’t get the treatment they were supposed to get, it makes interpreting the study really difficult.  If you use the “intention to treat” method then you have to ignore the fact that too many patients in the CABANA Study never received the therapy they were supposed to receive.

Per Protocol Analysis: The CABANA Study

Just like you probably wouldn’t give your kids credit for doing the dishes unless they actually do the dishes, do you analyze the results of the CABANA Study in a way where you give credit for a treatment they never received?  If you only believe in giving credit where credit is due, then you probably want to interpret this study based on a per-protocol analysis.

According to the per protocol analysis, you simply see what happened to the people who actually completed the protocol.  In other words, if you had an ablation then it was counted as an ablation.  Likewise, if you took drugs it was counted as taking drugs.

9 Key Findings of the CABANA Study

As I have thought more about how the CABANA Study, I have decided to take myself out of the intention to treat versus per-protocol analysis debate.  Rather, I will show you the results both ways and then let you decide whether you subscribe to the intention to treat or the per-protocol way of interpreting the study.

If you are an intention to treat person, then I’ll give you the results based on how the patients were randomized and we’ll ignore what therapy they actually received.  An if you are a per-protocol person, then I’ll share with you what happened to the 1,307 patients who had an ablation compared to the 897 who were able to stick with the drugs.

1. Ablation Patients Are More Likely to Stay in Rhythm

If your goal is to eliminate atrial fibrillation, then ablation was the clear winner.  Regardless of how you analyze the CABANA Study, there is no controversy when it comes to maintaining rhythm.  Even by handicapping drugs and using an intention to treat analysis, your chances of remaining in normal or sinus rhythm is increased by 47% with an ablation (HR 0.53, CI 0.46-0.61, p<0.0001).

2. The Mortality Benefit Depends on How You Analyze the Data

If you choose the intention to treat methodology, then there was no difference in survival between drugs and ablation.  However, if you choose the per-protocol methodology then the numbers are radically different.

Of those who actually received an ablation, their risk of dying during the study was 40% lower (4.4% vs 7.5%, HR 0.60, P=0.005).  This is a huge mortality reduction and it is right in line with our 2011 study showing the exact same thing.  But then again it begs the question I raised earlier in this article, are atrial fibrillation patients with symptoms somehow healthier than those without symptoms?  Unfortunately, this is a question that has yet to be answered.

3. The Composite End point of Death, Strokes, Bleeding, and Cardiac Arrests Also Depends on How You Analyze the Data

As with the mortality question above, the combined end point of death, strokes, bleeding, and cardiac arrests in the CABANA Study also depends on how you interpret the results.  If you choose intention to treat then there was no meaningful difference.

On the other hand, the primary end point of death, strokes, bleeding, and cardiac arrests of this study was dramatically lowered with ablation.  In fact, those patients who actually got an ablation in this study experienced a 33% lower risk of death, strokes, bleeding, or cardiac arrest (HR 0.67, CI 0.50-0.89, p=0.006).   Once again, these finings are right in line with our 37,000 patient study.

4. Ablations Kept Patients from Getting Hospitalized for Atrial Fibrillation

Regardless of how you interpret the results, the finding was the same.  Ablation did a much better job at keeping atrial fibrillation patients from winding up in the hospital.  And even if you use the intention to treat analysis thereby handicapping ablation, drug patients were 17% more likely to end up in the hospital (HR 0.83, P=0.002).

5. Ablation Patients Had a Better Quality of Life

Although the numbers haven’t been presented yet, the lead investigator of this study, Dr. Doug Packer, shared that ablation patients enjoyed a better quality of life.  This finding came as no surprise and is right in line with just about every other study that has been done.

6. Heart Failure Patients Really Benefited from Ablation

For the sickest patients in this study, those with not only atrial fibrillation but who also had heart failure, did exceptionally well with ablation.  In fact, their risk of death, stroke, bleeding, or cardiac arrest plummeted by 49%!

Of course, to those who follow the latest atrial fibrillation research, this came as no surprise.  A recent study in the prestigious New England Journal of Medicine by Dr. Nassir Marrouche came to the same exact conclusion.

7. Ablation Procedures Are Safe

For me, probably the biggest surprise was how safe ablations have now become.  It should be noted that the CABANA Study was only done in the most experienced centers in the world.  Thus, these results are not applicable to every hospital in the world performing catheter ablation procedures.  However, in the most experienced hands, there were only three strokes, eight tamponades, a couple of vascular events, and no atrial esophageal fistulas in the ablation patients.  As our hospital was the top enrolling site in the US, I can tell you that I personally saw more drug complications than ablation complications in this study.

8. Younger People Did Exceptionally Well with Ablation

As I have said many times on this blog, young and active people like sinus rhythm.  They like using all four chambers of their heart.  Young and active people don’t like the way they feel when their hearts are out of rhythm.

Thus, it should come as no surprise that people under age 65 were much less likely to suffer from death, strokes, bleeding, or cardiac arrests with ablation.  And, based on the results of the CABANA Study, you could make an argument that younger patients should now be offered an ablation as first line treatment for their atrial fibrillation.

9. Minorities Fared Better with Ablation

This is a finding from the CABANA Study that I’m not sure what it means.  For some reason, minority groups fared better with ablation.  Perhaps future studies will shed light on this finding.

Who Shouldn’t Have an Ablation?

Despite the positive findings of ablation in the CABANA Study, there was one group that didn’t do so well with ablation.  For those age 75 and older, medications seem to be the best option (HR 1.54).

Perhaps this group, on average, wasn’t so active.  Thus, sinus rhythm may not have had that much of a benefit.  I suspect that if the CABANA Study could have separated out the active versus sedentary people, they may have found a different result.

How Can You Further Optimize Ablation Results?

For those who want even better ablation results than those reported in the CABANA Study, lifestyle optimization is the answer.  Even though this study didn’t look at lifestyle optimization, countless studies by Dr. Prash Sanders, as well as our own studies, have shown that you can at least double the positive effect of ablation with lifestyle optimization.

By lifestyle optimization, I’m talking about losing any extra weight, exercising daily, optimizing your nutrition, optimizing sleep, optimizing stress levels, etc. Indeed, when it comes to long-term freedom from atrial fibrillation, nothing works better than lifestyle optimization.

In fact, studies show that you can eliminate drugs or procedures in about half of everyone diagnosed with atrial fibrillation just by optimizing your lifestyle.  Thus, before you even consider drugs or procedures, the most critical question to ask is can I reverse this condition naturally?

The Big Picture

In my opinion, the big take away from the CABANA Study is that ablation performed remarkably well.  It is especially an attractive option for the patient with atrial fibrillation symptoms that don’t respond to medications.

Should everyone get an ablation?  Of course not.  If you can’t reverse atrial fibrillation with an optimized lifestyle then it may be a reasonable option.  For those in whom drugs don’t work or cause side effects, then ablation is definitely a logical choice.