#347 Is Fiber the Secret to Avoiding Heart Disease and Living to 100?

September 4th, 2023 by

Is Fiber the Secret to Avoiding Heart Disease and Living to 100?

Are you looking for a simple yet highly effective way to enhance your cardiovascular health and boost your chances of living a long, vibrant life? Look no further than your daily diet. Increasing your fiber intake might be the key to achieving these goals, according to a recent study. In this blog, we’ll break down the findings of this study and provide practical tips on how to integrate fiber into your daily routine to reduce your risk of cardiovascular disease and promote healthy aging.

The Study: Unlocking the Fiber Secret

A comprehensive analysis of nearly 250 studies has unveiled the remarkable protective effects of dietary fiber. Researchers found that individuals who consumed ample fiber from vegetables, legumes, fruits, nuts, seeds, and whole grains slashed their risk of dying from heart disease, stroke, type 2 diabetes, and colon cancer by up to 30% compared to those with lower fiber intake.

How Could Boosting Fiber Prevent Heart Disease?

Fiber is a dietary powerhouse that plays a significant role in preventing cardiovascular disease. This indigestible plant material, found in foods like fruits, vegetables, whole grains, legumes, and nuts, offers a multitude of heart-healthy benefits. Indeed, high fiber diets have been shown to lower cholesterol, blood pressure, blood sugar levels, body weight, and inflammation levels.

First, one of fiber’s primary functions is to help lower levels of LDL cholesterol, often referred to as “bad” cholesterol, in the bloodstream. Soluble fiber, in particular, acts like a sponge, binding to cholesterol particles and escorting them out of the body, reducing the risk of cholesterol buildup in the arteries.

Second, fiber promotes healthy blood pressure by supporting optimal blood vessel function and reducing inflammation.

Third, fiber helps regulate blood sugar levels, which is crucial for preventing diabetes—a major risk factor for heart disease.

Fourth, Inclusion of fiber-rich foods in your diet not only promotes a feeling of fullness and aids in weight management but also contributes to overall cardiovascular wellness, making it a simple yet effective addition to your heart-healthy lifestyle.

Fifth, high fiber diets have been shown to decrease inflammation levels, as measured by CRP (C-reactive protein) which is associated with a lower risk of heart disease.

Fiber Intake in China’s Longevity Village

In our extensive five-year study of the most densely populated centenarian region in China, which was featured in our Amazon best-selling book The Longevity Plan, a striking discovery emerged. We identified a pivotal factor contributing to the remarkable longevity of these individuals, who lived beyond the age of 100 without experiencing heart disease, dementia, or mobility challenges – their remarkably high-fiber diet. Our observations revealed that their daily fiber intake consistently ranged from 60 to 90 grams, which is two to three times the recommended daily allowance of fiber in the United States.

How to Boost the Fiber in Your Breakfast: The Green Smoothie

1. Start with a base of leafy greens like spinach or kale for your green smoothie. Add a tablespoon of chia seeds for fiber, and a cup of unsweetened almond milk or unsweetened yogurt for creaminess.

2. To increase fiber content, consider adding a tablespoon of ground flaxseed or psyllium husk. These are excellent sources of soluble fiber that can help regulate cholesterol levels and promote bowel regularity.

3. Sweeten your smoothie with fiber-rich fruits like berries (blueberries, strawberries, or raspberries) for an extra dose of antioxidants and fiber.

How to Boost the Fiber in Your Lunch: Chickpea Salad

Create a delicious chickpea salad with canned chickpeas, diced cucumbers, tomatoes, red onions, broccoli, kale, and fresh parsley. Dress it with olive oil, lemon juice, and your favorite herbs and spices. Chickpeas, broccoli, and kale are all fantastic sources of fiber and are all plant-based proteins. And if you want to add some chicken or fish to your salad that is perfectly acceptable. Likewise, if you want to substitute edamame or black beans instead of chickpeas that works as well.

How to Boost the Fiber in Your Dinner: Quinoa and Roasted Vegetables

Prepare a quinoa and roasted vegetable bowl. Roast a mix of fiber-rich veggies like broccoli, bell peppers, carrots, onions, and zucchini with olive oil and seasonings. Serve them over cooked quinoa. Quinoa is a whole grain that’s higher in fiber compared to many other grains. You can also add some black beans or lentils to your quinoa for an extra fiber and protein boost. And if you want to add a little chicken or fish to your roasted vegetables that is certainly an option.

3 Tips When Increasing Fiber

1. Gradual Transition: Introduce fiber into your diet gradually to allow your digestive system time to adapt. This helps minimize any potential discomfort.

2. Stay Hydrated: Increasing your fiber intake necessitates higher water consumption to maintain digestive health. Be sure to drink plenty of fluids throughout the day.

3. Consult a Physician: If you have any existing digestive issues, especially constipation, consult your healthcare provider before making significant changes to your fiber consumption.


Incorporating more fiber into your daily diet isn’t just a health-conscious decision—it’s a recipe for a longer, heart-healthy life. The evidence is clear: fiber is your ally in the fight against cardiovascular disease and a key player in promoting healthy longevity. So, start today by embracing fiber-rich foods and making them a delightful part of your daily menu. Your heart and your future self will thank you for it.


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

About the Photo

This photo was taken on my mountain bike ride through Park City, Utah, over the weekend. It is a picture of the McPolin Barn, an iconic landmark in this picturesque mountain town.

#346 Pulsed Field Ablation for Atrial Fibrillation: A Game-Changer in AFib Treatment

September 2nd, 2023 by

Pulsed Field Ablation for Atrial Fibrillation: A Game-Changer in AFib Treatment

Atrial Fibrillation (AF) is a common cardiac arrhythmia that affects millions of people worldwide. For years, radiofrequency and cryoballoon ablation have been the standard treatments for AF, but a new player has emerged on the scene – Pulsed Field Ablation (PFA). In this article, we’ll explore the mechanisms, pros, and cons of PFA in comparison to the traditional methods, and dive into the recent ADVENT Study, shedding light on its implications for the future of AF ablation.

Comparing Radiofrequency, Cryoballoon, and PFA Ablations

Radiofrequency ablation employs heat energy to create scars in the heart tissue that disrupt AF triggers. Cryoballoon ablation, on the other hand, uses freezing temperatures to achieve the same goal. PFA, however, takes a different approach. It uses precisely controlled electrical fields to ablate heart tissue, making it a non-thermal option. Pros of PFA include shorter procedure times, faster recovery, and reduced risks of complications like esophageal injury, phrenic nerve injury, and pulmonary vein stenosis. However, PFA is still relatively new, and long-term data is limited. Radiofrequency and cryoballoon have a longer track record, and some operators may prefer these methods due to their experience.

The ADVENT Study: PFA vs Radiofrequency or the Cryoballoon

The groundbreaking ADVENT Study randomized patients with paroxysmal AF to receive either PFA or thermal ablation (using radiofrequency or cryoballoon). Paroxysmal Afib is when Afib begins and ends spontaneously. It’s typically an earlier, more manageable stage of Afib. On the other hand, persistent Afib is when Afib doesn’t stop on its own, indicating a more advanced and challenging form of Afib to treat.

The ADVENT Study involved some 65 of the most skilled operators in the U.S. from 30 centers, who were mostly unfamiliar with PFA. The primary endpoint was 1-year freedom from AF without antiarrhythmic drugs and only one ablation procedure. The PFA device used was a first-generation technology. In comparison, radiofrequency and cryoballoon technologies belong to the second, third, or even fourth generation of devices.

I had the privilege of serving on the Data Safety Monitoring Committee for the ADVENT Study, essentially acting as its overseer. This role granted me the opportunity to assess all the data in real-time throughout the study, giving me an early glimpse into the findings well before they were made accessible to the public. To provide full transparency, it’s important to note that I received compensation in the form of an hourly wage for my dedicated hours spent working on the ADVENT Study. This compensation may potentially influence my evaluation of this emerging technology.

Safety: PFA vs  Radiofrequency or Cryoballoon

From a safety perspective, there was no statistical difference in the primary endpoint in the ADVENT Study. This is quite remarkable considering PFA was a brand new device and cardiac EP’s usually need hundreds of cases before their skills are honed with a new technology. And as might be expected, there were some early “learning curve” complications with PFA (cardiac tamponade) that should go away with time and experience. However, the secondary safety endpoint, which was freedom from pulmonary vein stenosis, clearly favored PFA in this study.

Efficacy: PFA vs Radiofrequency or Cryoballoon

Efficacy-wise, both PFA and thermal ablation showed similar results, but PFA procedures were notably quicker. The single procedure success rate was 73% for PFA and 71% in the thermal ablation group (radiofrequency or cryoballoon). There was no statistical difference in these success rates. It’s important to mention that this impressive outcome refers to the percentage of patients who remained free from Afib for one year after a single treatment, and they didn’t require any additional heart rhythm medications.

Durability: PFA vs Radiofrequency or Cryoballoon

When considering long-term effectiveness, it’s crucial to opt for an ablation method that maintains its efficacy. In the ADVENT Study, the rate of needing a repeat Afib ablation within one year was 4.6% in the PFA group, whereas in the thermal group (radiofrequency or cryoballoon), it was 6.6%. Clearly, from a patient standpoint, you want the risk of having to have a repeat ablation as low as possible.

Recovery: PFA vs Radiofrequency or Cryoballoon

One remarkable difference between PFA and thermal ablation (radiofrequency or cryoballoon) was that the procedure times with PFA were much shorter. And in my experience, shorter procedure times often result in faster recoveries.

The Future of AF Ablation with PFA

1. Improved Success Rates: As operators gain experience with PFA and as the technology evolves (the ADVENT Study used a first-generation device), success rates for paroxysmal Afib are expected to increase. For persistent Afib, PFA may offer an advantage in treating the posterior wall of the left atrium, which is often a contributor to ongoing Afib. Thus, I expect success rates for both paroxysmal and persistent Afib to increase over the next 5 years as cardiac EPs gain experience and the technology improves.

2. Safer Procedures: PFA’s shorter procedure times and avoidance of the certain dreaded complications of Afib ablation, like esophageal injury, phrenic nerve injury, and pulmonary vein stenosis, definitely make it a much safer option in my opinion. Also, in addition to much shorter anesthesia times, PFA ablation should help to decrease the risk of post-procedure chest discomfort and fluid overload. This safety profile could encourage more complex Afib cases to be treated with ablation instead of antiarrhythmic drugs.

Should You Wait for PFA?

Not all PFA technologies are equal, and every device company in the Afib space is developing their own PFA device. The PFA device used in the ADVENT Study, from Boston Scientific, is expected to be commercially available in the U.S. by the summer of 2024. Of note, this PFA technology is currently available in Europe.

However, if you need an ablation now, radiofrequency or cryoballoon are well-established and safe options. Waiting for PFA may be an option if your AF is under control and your cardiac EP physician agrees it’s safe to wait.

In Summary

PFA is a promising addition to the arsenal of Afib treatment options. While it currently offers similar success rates for paroxysmal Afib as radiofrequency and cryoballoon, its advantages in safety and procedural efficiency make it a compelling choice. As cardiac EPs gain more experience and technology advances, success rates for Afib ablation should steadily improve. Thus, PFA’s role in treating Afib is expected to grow rapidly, potentially totally reshaping the landscape of Afib ablation in the coming years.


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

About the Blog Image

The accompanying blog image for this article is a captivating representation of a catheter ablation procedure for atrial fibrillation, created using AI technology known as DALL-E. This AI-generated image offers an artistic interpretation of what the procedure might entail, adding a unique visual dimension to the discussion.


#345 How to Double the Longevity Benefit of Exercise

July 29th, 2023 by

How to Double the Longevity Benefit of Exercise

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

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

The Study

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

Recommended Exercise Guidelines

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

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

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

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

The Impact of Meeting the Minimum Guidelines

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

Exceeding the Recommendations

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

The Importance of Finding the Right Exercise Balance

Although the study’s results are promising for those who prefer a more active lifestyle, it is essential to approach intense exercise with caution. It’s crucial to strike a balance between challenging ourselves physically and avoiding overexertion, which could lead to injuries or burnout. Consulting with a healthcare professional or fitness expert before adopting a more intense exercise regimen is advisable, especially for individuals with pre-existing health conditions or who have been relatively sedentary in the past.

My Daily Exercise

As one who is guilty of exercising about 800 minutes a week (approximately 114 minutes daily), I have to cross-train to avoid repetitive stress injuries. During the summer I rotate through mountain biking, hiking, running, wake surfing, and using an indoor elliptical machine. And during the winter months I switch it up by rotating through downhill skiing, cross-country skiing, running on snow-packed trails, and use an indoor elliptical exercise machine. If I’m traveling I just use the hotel’s elliptical machine.

How Does Exercise Lengthen Your Lifespan?

While the study establishes a link between higher levels of physical activity and increased life expectancy, the exact mechanisms behind these benefits remain a subject of ongoing research. One possible explanation is that more intense exercise contributes to improved cardiovascular health, stronger immune function, and enhanced metabolic efficiency. Additionally, regular exercise has been shown to combat stress, anxiety, and depression, all of which can impact overall health and longevity.


In conclusion, the groundbreaking study conducted by Harvard’s School of Public Health sheds new light on the relationship between physical activity and life expectancy. While meeting the federally recommended guidelines already confers significant benefits, those who choose to challenge themselves further and engage in more intense exercise may enjoy more than double the longevity benefit of exercise. Nevertheless, finding the right balance and listening to our bodies remain crucial in ensuring that exercise remains a sustainable and enjoyable part of our lives.

As further research continues to unlock the mysteries of human physiology, it is clear that regular physical activity will remain a cornerstone of a healthy and fulfilling life. So, let’s lace up our running shoes, hit the gym, or take that dance class we’ve been considering—all in the pursuit of a longer, happier, and healthier life.

About the Photo

The blog article’s featured photo captures a heartwarming moment of pure joy and togetherness. The image showcases my two youngest children engaged in the exhilarating activity of wake surfing on the breathtaking waters of Lake Powell in southern Utah.

Surrounded by stunning natural beauty, the family enjoys one of their favorite summer pastimes—surfing behind a boat on this picturesque lake. As the kids share laughter and excitement, the photo beautifully encapsulates the essence of family bonding and the love for an active lifestyle.

Combining exercise with cherished family time not only promotes physical health but also enriches our emotional well-being. It is a testament to the idea that the benefits of exercise can be amplified manifold when experienced with loved ones. This delightful snapshot serves as a reminder of the power of shared experiences, making lasting memories, and the joy that comes from living life to the fullest.


The information presented in this blog article is for general informational purposes only. Readers are advised to consult with qualified healthcare professionals or fitness experts before making any significant changes to their exercise routines or lifestyles. Each individual’s health and fitness needs are unique, and what works for one person may not be suitable for another.

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

July 29th, 2023 by

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

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

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

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

Why is AFib so Dangerous?

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

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

Breaking the Chain: Interventions that Make a Difference

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

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

What is a Catheter Ablation?

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

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

The Power of Timely Treatment: Results of a New Study

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

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

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

Beyond the Study: Insights from Our Experience:

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

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

The Blog Photo

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


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

If you are a resident of Utah, Wyoming, or Idaho (these are the states that I have a medical license in), I would be happy to see you either in-person or by a telemedicine visit by calling my office at 801-266-3418.

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

July 4th, 2023 by

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

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

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

1. Be Careful with Grains

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

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

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

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

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

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

2. Nuts and Seeds Daily in Moderation

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

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

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

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

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

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

3. Fruits and Vegetables: 9 Servings Daily

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

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

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

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

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

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

4. Legumes Daily

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

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

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

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

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

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

5. Dairy is a Personal Choice

When it comes to dairy, it’s important to recognize that its consumption is a personal choice. While dairy products can be a source of various nutrients, such as calcium, protein, and vitamin D, it’s worth reviewing the scientific data to make an informed decision.

Contrary to common belief, consuming three servings of dairy daily is not a necessity for maintaining healthy bones. Interestingly, cultures with the highest consumption of dairy don’t have lower rates of osteoporosis or bone fractures. This suggests that other dietary and lifestyle factors play significant roles in bone health.

While some studies have suggested a potential link between dairy consumption and certain health benefits, including improved bone density and reduced risk of colorectal cancer, the overall scientific evidence is mixed. Moreover, dairy products can be problematic for individuals with lactose intolerance or milk allergies.

If you choose to include dairy in your diet, opting for unsweetened fermented options may be a better choice. Fermented dairy products, such as plain yogurt, kefir, and certain types of cheese, undergo a fermentation process that can enhance digestibility and increase the availability of certain nutrients. Additionally, fermented dairy products may contain beneficial probiotics that support gut health.

It’s worth noting that there are plenty of non-dairy sources of calcium and other essential nutrients. Foods like leafy green vegetables, fortified plant-based milks, tofu, almonds, and sesame seeds can provide adequate calcium intake. Furthermore, maintaining a balanced diet rich in a variety of plant-based foods can contribute to overall bone health.

Ultimately, the decision to consume dairy or not is a personal one. It’s important to consider your individual health needs, preferences, and any dietary restrictions or intolerances you may have. Listening to your body and choosing the best options that work for you is key to maintaining a well-rounded and nutritious diet.

6. The Right Meats in Moderation

When considering meat consumption, it’s valuable to examine the dietary practices of the healthiest and longest-lived cultures worldwide. These cultures typically consume meat sparingly as part of a balanced diet. Here are some key points to consider when making informed choices about meat:

Choose Wild and Organic Meats: Opting for wild or organic meats whenever possible can be a healthier choice. Wild game meats like venison or elk are leaner and offer a distinct nutrient profile compared to conventionally raised meats. Organic meats are produced without antibiotics or hormones, providing an option for those seeking to minimize their exposure to these substances.

Prioritize Fish over Red Meat: Wild fish, especially fatty fish like salmon, mackerel, and sardines, are preferable to red meat. They are rich in beneficial omega-3 fatty acids, essential for heart and brain health. Additionally, fish offer protein, vitamins, and minerals that contribute to a well-rounded diet.

Chicken as an Alternative: If poultry is your preference, chicken is generally considered a leaner option compared to red meat. It can be a good source of protein, vitamins, and minerals. Choosing organic or pasture-raised chicken may provide additional benefits related to animal welfare and potential differences in nutrient composition.

Moderation is Key: Regardless of the meat you choose, moderation is crucial. Incorporating a variety of protein sources into your diet, such as legumes, nuts, seeds, and plant-based alternatives like tofu or tempeh, is essential. Balancing your protein intake with a diverse range of plant foods ensures a wide array of nutrients and supports overall health. Ultimately, the decision about meat consumption is personal.

Some individuals opt to reduce or eliminate meat from their diets due to ethical, environmental, or health concerns. Others may include small amounts of meat as part of a balanced approach. The key is to prioritize high-quality sources, consume meat in moderation, and maintain a diverse and nutrient-rich overall diet.

By making conscious choices about meat and considering other protein alternatives, you can craft a diet that aligns with your values and supports your well-being. Remember, a balanced approach and individual preference play significant roles in creating a sustainable and nourishing dietary pattern.

7. Eggs are a Personal Choice

Eggs have been a subject of debate in the scientific literature, and the conclusions can be mixed. While eggs are a source of high-quality protein and contain essential nutrients, such as vitamins, minerals, and antioxidants, their impact on health can vary among individuals.

For those without high cholesterol or heart disease, eggs can be a reasonable option to include in a balanced diet. However, it’s important to consider your individual health needs and consult with a healthcare professional if you have specific concerns.

Some studies have suggested that the dietary cholesterol in eggs may not have as significant an impact on blood cholesterol levels as previously thought. Nonetheless, moderation is key, and it’s advisable to monitor your overall cholesterol intake from various dietary sources. Additionally, the way eggs are prepared can also affect their healthiness. For example, opting for boiled or poached eggs over fried eggs cooked in unhealthy oils can make a difference.

As with any food, it’s important to listen to your body and make choices that work best for your individual health and preferences.

8. Foods to Minimize or Avoid

When it comes to optimizing your diet, there are certain foods that are best minimized or avoided altogether due to their limited nutritional benefits and potential negative impact on health. Here are some examples:

Sugar: Sugar provides empty calories and lacks significant nutritional value. Consuming excessive amounts of sugar has been linked to various health issues, including obesity, diabetes, and heart disease. Minimizing or avoiding added sugars, such as those found in sugary beverages, desserts, and processed snacks, can be beneficial for overall health.

Fast Foods and Fried Foods: Fast foods and fried foods are often high in unhealthy fats, sodium, and calories, while lacking essential nutrients. Regular consumption of these foods has been associated with an increased risk of obesity, cardiovascular disease, and other health problems. Minimizing or avoiding these foods can support a healthier lifestyle.

Processed Foods: Processed foods, such as packaged snacks, sugary cereals, and pre-packaged meals, are often loaded with additives, preservatives, and unhealthy fats. They tend to be low in fiber and essential nutrients. Reducing reliance on processed foods and opting for whole, unprocessed alternatives can contribute to a more nutritious diet.

By minimizing or avoiding foods high in added sugars, fast foods, fried foods, and processed snacks, and instead opting for healthier alternatives like dark chocolate, you can make positive choices for your overall well-being.

9. Make Dark Chocolate (in moderation) Your Desert Choice

When it comes to desserts, it’s possible to satisfy your sweet tooth in a healthier way. One recommended option is dark chocolate.

The higher the cocoa content, the better, as it tends to have a lower sugar content. Dark chocolate is rich in antioxidants, specifically flavonoids, which have been associated with various health benefits. These antioxidants can help reduce inflammation, improve heart health by supporting healthy blood pressure and cholesterol levels, and potentially enhance cognitive function.

However, it’s important to enjoy dark chocolate in moderation, as it still contains calories. Aim for a small portion, and choose varieties with minimal or no added sugars.

10. Make Water Your Drink of Choice

When it comes to choosing beverages, opting for the right options can significantly contribute to a healthy lifestyle. Here are some recommendations for what to drink:

Water: Water should be your go-to beverage choice. It is essential for hydration and has zero calories. By drinking water, you can quench your thirst without adding unnecessary calories to your diet. If plain water seems boring to you, try infusing it with slices of lemon, cucumber, or adding fresh fruits like strawberries to enhance the flavor naturally.

Minimize or Avoid Caloric Drinks: It’s advisable to minimize or avoid caloric beverages such as sugary sodas, fruit juices, energy drinks, and sweetened teas. These drinks can be high in added sugars, providing empty calories without providing a sense of fullness or satisfying hunger. Opting for healthier, low-calorie alternatives can make a significant difference in your overall calorie intake.

Artificial Sweeteners: While artificial sweeteners may seem like a low-calorie alternative, it’s best to minimize or avoid them as well. Some research suggests that frequent consumption of artificial sweeteners may have adverse effects on metabolic health and contribute to cravings for sweet foods. Instead, opt for natural alternatives or moderate your intake of sweeteners.

Smoothies: Smoothies can be a nutritious option, especially when made with the right ingredients. Incorporate plenty of greens, such as spinach or kale, into your smoothies for a boost of vitamins, minerals, and fiber. Adding berries not only adds natural sweetness but also provides antioxidants and fiber. To enhance the nutritional value, include nuts and seeds for healthy fats and added protein.

Avoid adding excessive amounts of sweeteners, and let the natural sweetness of the fruits shine through. By prioritizing water as your main beverage, avoiding caloric drinks, minimizing artificial sweeteners, and incorporating nutrient-dense ingredients into your smoothies, you can make healthier choices for your overall hydration and well-being. Remember, staying well-hydrated is crucial, and water remains the best choice to satisfy your body’s needs.

The Photo for this Article

The accompanying photo captures a memorable moment from a recent adventure—a long mountain bike ride in Park City, Utah. This weekend excursion took us along the scenic Wasatch Crest trail, where my son and I immersed ourselves in the breathtaking beauty of the surroundings. The photo showcases Desolation Lake, a serene body of water nestled amidst the picturesque landscape. It serves as a reminder of the joys of outdoor exploration and the importance of incorporating physical activity into a balanced and healthy lifestyle.


The information provided in this blog article is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your diet or any medical condition. The author and publisher of this article are not responsible for any adverse effects or consequences resulting from the use or application of the information presented here.

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

May 29th, 2023 by

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

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

By dedicating at least two minutes each day to physical activity, and never missing twice, you can decreases your chances of atrial fibrillation (AFib) and extend your healthy lifespan. This article delves into the data supporting the benefits of exercise, tells inspiring stories of individuals who have embraced the two-minute workout, and offers practical tips on overcoming challenges and developing lasting habits.

The Power of Exercise in Preventing AFib and Extending Lifespan

Studies have consistently shown that regular exercise significantly reduces the risk of developing AFib, a condition characterized by irregular heartbeat and associated with numerous health complications. Not only does exercise prevent AFib, but it also extends our overall healthy lifespan. Engaging in physical activity enhances cardiovascular health, strengthens muscles, improves mental well-being, and reduces the risk of chronic diseases such as diabetes and obesity. The evidence is clear: exercise is a powerful tool for promoting longevity and vitality.

The Two-Minute Workout

The beauty of the two-minute workout lies in its simplicity. Regardless of physical ability or busy schedules, everyone can commit to at least 2 minutes of exercise each day. Of course, the real goal is to exercise much longer than 2 minutes each day but the commitment here is that you will exercise for at least 2 minutes daily. In other words, do something physical for 2 minutes each day and you can feel good about checking off the exercise box for the day.

One of my all-time favorite authors, James Clear, the author of “Atomic Habits,” wisely reminds us, “You just have to be consistent.” The most important thing is to create the daily exercise habit. Missing one day of exercise is human but you never want to miss twice. Missing twice is the start of a new bad habit.

Commit now to 2 minutes of exercise every day. Everyone has 2 minutes in their day that they can carve out to do something physical. Embracing this mindset allows you to prioritize consistency over perfection, fostering a sustainable exercise habit that can transform your health and well-being.

Even individuals confined to a wheelchair can participate in this routine. The key is to choose any form of exercise that suits your preferences and capabilities. Whether it’s stretching, walking, dancing, or using resistance bands, two minutes of intentional movement is all it takes to kick-start your journey towards a healthier lifestyle.

Never Miss Twice

Clear’s insights echo the importance of never missing a workout. He emphasizes that progress stems from showing up consistently, even when motivation wanes or life gets hectic. As he states, “Missing once is an accident. Missing twice is the start of a new (bad) habit.” By committing to the 2-Minute Workout and never allowing a missed workout to become a habit, you build resilience, discipline, and ultimately, a stronger foundation for your overall fitness journey.

When James Clear advises to “never miss twice” when trying to develop a new habit, he emphasizes the crucial importance of consistency and resilience. Missing a single day may be seen as an isolated incident, a temporary stumble on the path to change. However, if that missed day turns into a pattern, it becomes a new habit altogether—one that contradicts the desired behavior.

The principle of “never miss twice” is rooted in the understanding that setbacks are inevitable, but it’s how we respond to them that determines our success. By promptly getting back on track after a missed day, we prevent the missed action from becoming the norm, safeguarding the progress we have made so far.

When we miss a day, it is essential to view it as an exception rather than an excuse to abandon our efforts. The power lies in our ability to recover swiftly, to acknowledge the slip-up, learn from it, and resume the desired behavior immediately. By doing so, we demonstrate our commitment to change and protect ourselves from falling into the trap of developing a new, counterproductive habit.

James Clear’s advice encourages us to approach missed days with a growth mindset. Instead of dwelling on guilt or disappointment, we can reframe our perspective and view setbacks as learning opportunities. Each missed day presents an opportunity to reflect on the obstacles that caused the deviation and proactively seek strategies to overcome them in the future.

By adhering to the principle of “never miss twice,” we cultivate resilience, discipline, and perseverance. We recognize that progress is not linear but consists of ups and downs. By refusing to let a missed day define our journey, we maintain our focus on the long-term goal and reinforce our commitment to the desired habit.

Ultimately, embracing the idea of “never miss twice” empowers us to navigate the inevitable challenges and setbacks that arise during habit formation. It reminds us that consistency is key and that true success lies in our ability to bounce back and remain steadfast in our pursuit of positive change.

Why Just 2 Minutes?

The philosophy of never missing a workout aligns with the principle of the 2-Minute Rule. While two minutes may seem insignificant, it is the act of honoring your commitment every single day that sets the stage for transformative change. Each time you complete those two minutes, you reinforce the belief that you are capable of sticking to your goals and nurturing a healthy relationship with exercise.

Remember, the power of the 2-Minute Workout lies in the consistency and dedication to never miss a session. Even on days when time is tight or energy is low, those two minutes become your anchor, reminding you of your commitment to self-care and personal growth. As James Clear eloquently puts it, “Every action you take is a vote for the type of person you wish to become.” With each workout, no matter how short, you are casting your vote for a healthier, more vibrant version of yourself.

So, embrace the simplicity of the 2-Minute Workout and let it be a guiding principle in your fitness journey. Take inspiration from James Clear’s wisdom and let the words of motivation resonate within you: “Make it so easy you can’t say no. Focus on effort, not results. Stay focused on the practice, not the performance.” By never missing a workout, you unlock the potential to create lasting change and pave the way for a healthier, more fulfilling life.

The Power of the 2-Minute Rule

The 2-Minute Rule is a catalyst for change, empowering you to overcome resistance and embrace a consistent exercise habit. By starting with a mere two minutes, you lay the foundation for lasting transformation. Tony Robbins once said, “It’s not what we do once in a while that shapes our lives, but what we do consistently.” Let this principle fuel your motivation as you embark on your own fitness journey.

The beauty of the 2-Minute Rule, as advocated by James Clear, lies in its simplicity. It asserts that everyone has two minutes to spare, regardless of how busy or overwhelmed they may feel. This notion challenges the common excuse of lacking time for exercise or any other habit we want to cultivate. By breaking down our desired behavior into a two-minute action, we remove the barriers of complexity and time commitment that often hinder progress.

Psychologically, the 2-Minute Rule brings about significant behavior change by leveraging the power of momentum and overcoming the inertia of starting. The rule capitalizes on the psychological principle that initiating an action is often the most challenging part, while once started, it becomes easier to continue.

When we commit to just two minutes of exercise, we lower the activation energy required to begin. We eliminate the mental resistance and friction associated with starting a workout. This small and manageable commitment helps to alleviate feelings of overwhelm or intimidation that often accompany longer exercise sessions. It shifts our focus from the magnitude of the task at hand to the simplicity of getting started.

Moreover, the 2-Minute Rule taps into the concept of habit stacking, where we associate the new behavior with an existing habit. By connecting our two-minute exercise routine with an established activity, such as waking up in the morning or brewing a cup of coffee, we capitalize on the existing neural pathways and make the habit easier to implement. This approach leverages the power of triggers and cues to prompt us to take action.

The psychological impact of the 2-Minute Rule extends beyond just the immediate two minutes of exercise. It creates a positive feedback loop. Completing the two minutes reinforces our sense of accomplishment, satisfaction, and self-efficacy. These feelings of success and progress fuel our motivation to continue and gradually increase the duration or intensity of our workouts.

The 2-Minute Rule challenges the common perception that significant behavior change requires a significant time commitment. By demonstrating that even the smallest actions can have a profound impact, it reshapes our mindset and helps us adopt a more optimistic and growth-oriented approach. It encourages us to focus on consistent progress, reinforcing the belief that small, consistent steps can lead to significant and lasting transformation.

In essence, the power of the 2-Minute Rule lies in its ability to bypass the psychological barriers that impede behavior change. It empowers us to overcome inertia, build positive momentum, and create lasting habits that can transform our lives. By embracing the philosophy of “just two minutes,” we unlock our potential for consistent action and open the door to meaningful and sustainable change.

Story 1: John – The Young Executive Balancing Work and Family

Meet John, a young executive with a heart problem and three lively kids and a demanding job. Juggling the responsibilities of work and family, John realized the importance of taking care of his health. Inspired by the concept of the 2-Minute Workout, he committed to never missing a day of exercise, no matter how busy life became.

Every morning, before the chaos of the day ensued, John woke up a few minutes earlier and found a quiet space in his home. With his children still fast asleep, he engaged in a two-minute bodyweight workout routine. Push-ups, squats, and jumping jacks became his morning companions, energizing him for the day ahead.

On weekends, John seized the opportunity for longer workouts. He and his wife coordinated their schedules, arranging for a babysitter to watch the kids while they prioritized their physical well-being. They would go for a jog together, take a bike ride, or explore new hiking trails. These weekend sessions allowed them to bond as a couple while nurturing their fitness habits.

To track his exercise progress, John utilized a simple habit-tracking app on his phone. Each day, he logged his 2-Minute Workout, noting the date and duration. The visual representation of his efforts motivated him to stay on track and visually reinforced his commitment to consistency.

Admittedly, there were days when the demands of work and family threatened to derail John’s commitment. However, he remained steadfast in his resolve. On particularly hectic days, he would break his workouts into smaller chunks throughout the day—two minutes here and two minutes there. The cumulative effect of these mini-workouts reinforced his dedication to never miss a day, regardless of the circumstances.

John’s unwavering commitment paid off. Not only did he experience physical benefits like increased strength and stamina, but he also noticed a positive shift in his physical and mental well-being. He became more focused, productive, and better equipped to handle the challenges of his busy life. And his heart symptoms gradually all went away. By putting in his reps each day, John solidified a daily exercise habit that became an integral part of his lifestyle.

Story 2: Lisa – The Middle-Age Working Mom Mastering Consistency

Enter Lisa, a middle-aged working mom juggling a demanding career and the responsibilities of her family. Determined to prioritize her health despite her busy schedule, she embraced the 2-Minute Workout as a catalyst for transformation.

Every morning, as the house bustled with activity, Lisa carved out two minutes for herself. In the midst of getting her children ready for school, she squeezed in a quick burst of exercise. Whether it was a brisk walk around the block or a short yoga routine, those two minutes became her daily anchor—a symbol of self-care amidst the chaos.

One day, life threw Lisa a curveball, and she missed her workout. Recognizing the potential danger of developing a new habit, as highlighted by James Clear, she quickly rebounded. She refused to let one setback define her journey. Lisa used that slip as a reminder of the importance of consistency and the potential consequences of veering off track.

With renewed determination, Lisa refocused her efforts and committed to never missing a workout again. On days when her work hours stretched late into the evening or family commitments monopolized her time, she adapted. She would wake up a few minutes earlier or seize pockets of time during lunch breaks to squeeze in her two minutes of exercise. By adapting to her circumstances and making her reps a non-negotiable part of her routine, Lisa solidified her daily exercise habit.

Over time, Lisa began to witness the incredible benefits of her commitment. Not only did she feel stronger and more energized, but her ability to manage stress improved significantly. She became an inspiration to her family, showing her children the importance of prioritizing self-care and cultivating healthy habits even in the face of a hectic schedule. And, like John, heart heart symptoms also gradually resolved.

Both John and Lisa recognized the importance of having triggers and tracking mechanisms to support their daily exercise habits. By implementing these strategies, they not only established a routine but also held themselves accountable for their commitment to consistent exercise. These triggers and tracking methods provided a sense of structure and served as reminders of their dedication, helping them overcome obstacles and stay on course.

Whether it was the sound of an alarm or the aroma of coffee, these triggers seamlessly integrated their 2-Minute Workout into their daily lives. Additionally, the act of tracking their progress visually reinforced their efforts, celebrating their consistency and motivating them to keep pushing forward.

Everyone Can Do The 2-Minute Workout

Every day as I step into the clinic, I am driven by a deep desire to inspire my patients to embrace the transformative power of daily exercise. It is disheartening to witness the array of excuses that are often presented, as many individuals vehemently argue for their limitations. I understand that health conditions, such as arthritis or knee issues, can pose challenges and create hurdles on the path to physical activity. However, I want to emphasize that regardless of these limitations, everyone has the potential to do something, no matter how small, physically for at least two minutes a day.

Compassion and understanding are at the core of my approach. I recognize the frustration and pain that my patients may experience, but I also firmly believe that dwelling solely on limitations perpetuates a cycle of inactivity. By arguing for these limitations, they inadvertently choose to keep them. Instead, I encourage my patients to shift their mindset, to envision what they can do rather than focus on what they cannot.

It is within these limitations that the true spirit of the 2-Minute Workout shines. Even those with physical constraints can engage in gentle movements, stretches, or seated exercises that are within their capabilities. Two minutes of intentional physical activity, when consistently practiced, can pave the way for progress and foster a sense of empowerment. It is through these small but meaningful actions that they can gradually expand their capabilities, improve their overall health, and reclaim control over their bodies and lives.

I urge my patients to look beyond their limitations and embrace the possibilities. Together, we explore tailored modifications, adaptive strategies, and exercises that align with their abilities. By focusing on what they can do, even in the face of adversity, they create a pathway towards a healthier and more fulfilling life. My role as their healthcare provider is to support, guide, and inspire them, providing a compassionate space where they can conquer their doubts and embark on a journey of self-discovery and growth.

So, to all those who argue for their limitations, I implore you to reconsider. Open your hearts and minds to the possibility of change, no matter how small it may seem. Embrace the two minutes a day, as it has the potential to unlock a world of transformation. Together, let us rise above the excuses and embark on a journey of self-empowerment, reclaiming our health, vitality, and the joy that comes from living an active and purposeful life.

4 Steps for Success

1. Set a 2-Minute Workout Goal: Choose a simple and achievable exercise activity, such as jogging in place. Commit to doing it for just two minutes each day. Focus on the immediate benefits of increased blood flow and a boost in energy.

2. Trigger Your Workout: Associate your 2-Minute Workout with a specific trigger, such as waking up in the morning. As soon as your alarm goes off, begin your two-minute jog in place before proceeding with your morning routine.

3. Commit to Consistency: Make a steadfast commitment to perform your 2-Minute Workout every day. Set a reminder on your phone or use a habit-tracking app to hold yourself accountable. Remember, it’s just two minutes, and consistency is key to long-term success.

4. Track Your Progress: Keep a visual record of your daily workouts to monitor your progress. Create a calendar where you mark each day you complete your 2-Minute Workout. Witnessing the accumulation of successful exercise sessions will motivate you to keep going and build upon your achievement.By implementing these practical examples alongside the four steps, you can effectively incorporate the 2-Minute Rule into your daily routine, prevent Afib, and extend your lifespan. Remember, even the smallest actions, when done consistently, can lead to significant and lasting results.


By embracing the 2-Minute Workout and its potential to prevent Afib and extend your lifespan, you take a crucial step towards a healthier, more vibrant future. As Tony Robbins reminds us, “It’s in your moments of decision that your destiny is shaped.” The 2-Minute Rule empowers you to make that decision, commit to it consistently, and transform your life. Harness the inspiration of individual stories, like those of Sarah and John, as you embark on your own journey. Begin with just a 2-minute commitment and then, with consistency, watch it develop over time.


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

About the Photo

The accompanying photo captures a breathtaking moment from the top of the tram at Snowbird ski resort, taken this past Memorial Day weekend. In this picturesque setting, my daughter and I embarked on a memorable skiing adventure that went well beyond the 2-minute workout described in this article.

The slopes of Snowbird this Memorial Day weekend provided us with a thrilling and invigorating experience, as we embraced the beauty of nature while engaging in a physical activity that brought us joy and vitality. This image serves as a reminder that daily exercise can take various forms and be adapted to individual preferences and circumstances. Whether it’s skiing down snowy slopes, exploring hiking trails, or participating in any activity that gets us moving, the key is to find what brings us fulfillment and contributes to our overall well-being.

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

May 29th, 2023 by

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

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

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

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

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

Unlock Effortless Weight Loss: Choose Your Winning Strategy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So, dive into the world of veggies, explore their incredible variety, and revel in the abundance they offer. Fill your plate with their vibrant colors, and watch as your body transforms, your energy soars, and your well-being flourishes. With each meal, you are nourishing not only your body but also your aspirations and dreams for a healthier, more fulfilling life.


The information provided in this article is for educational and informational purposes only. It is not intended as medical advice or a substitute for professional medical guidance, diagnosis, or treatment. Always consult with your healthcare provider before starting any weight loss program or making significant changes to your diet or exercise routine.

Every individual is unique, and what works for one person may not work for another. Your healthcare provider is the best resource to evaluate your specific health conditions, assess any potential risks, and provide personalized recommendations tailored to your needs. They can consider factors such as your medical history, current medications, and individual circumstances to guide you on a weight loss approach that is safe and suitable for you.

The Blog Photo

In closing, I would like to invite you to reflect on the captivating photo attached to this article. Taken by my wife during our recent visit to the French Quarters in New Orleans, it captures the beauty and serenity of the basilica of Saint Louis King of France. As we embarked on evening walks amidst the scientific sessions of the Heart Rhythm Society, this photo serves as a reminder of the importance of balance and harmony in our lives. Just as the basilica stands tall and majestic, so too can we find strength and resilience within ourselves as we embark on our weight loss journey. Let it inspire you to embrace the effortless strategies shared in this article and unlock a world of transformation and well-being. May you find the inner peace and radiance that accompany a healthy body, mind, and spirit as you pursue your path to a vibrant and fulfilling life.


#340 What’s Worse for Living a Long Life—Loneliness or Eating a Bad Diet?

September 3rd, 2022 by

What’s Worse for Living a Long Life—Loneliness or Eating a Bad Diet?

If you want to live a longer, healthier, and happier life, it’s every bit as important to be socially connected as it is to what you eat. In fact, it now seems clear from the research that being socially connected is an even more important factor in our current and long-term health than what we eat.

Being socially connected can be with your family. It can be your friends. It can be your neighbors. It can be people with similar interests with whom you maintain a connection. And, especially in the digital age, it doesn’t necessarily have to be geographically located; it can be people you feel connected to, via social media, even if you have never met each other in person.

However, you chose to define it, though, one thing is clear: When we strengthen our social connections, we strengthen ourselves.

Should You Give Your Parents a Coffin at Age 60?

There is a tradition in the Longevity Village, the mountainous area of Southwest China that has the highest percentage of centenarians in the world, that we studied in our bestselling book, The Longevity Plan, in which children build a coffin for their parents when they reach the age of sixty. That might seem morbid, but I’ve come to learn that it is not in any way because the children believe their parents are close to death. Much to the contrary, the practice is intended to let aging parents know that everything has been taken care of, and they do not have to worry that their deaths might be a burden upon their kin.

As Masongmou, age 107 at the time, shared with me, “My son has already prepared three coffins for me,” she said. “The first two became old, molded, and fell apart.”

That, I learned, was quite common. The wooden coffins tended to last ten or twenty years before they began to rot and fall apart.

Masongmou wasn’t eager to die, but when the time came, she said, she would be ready and content. And the way she saw it, death would give her a special opportunity to give back to her community.

Does Worshiping Your Ancestors Promote Longevity?

As is the case throughout most of China, each home in the village has a shrine. Ancestor worship—jìzǔ, in Mandarin—is deeply ingrained in Chinese culture and rooted in Confucian philosophy. Many Chinese believe the deceased have a special ability to do favors for the living, and can even shower their living descendants with blessings and fortune. That’s one of the reasons they make offerings to their ancestors, even burning paper money to make sure departed loved ones have plenty of cash to spend in the spirit world.

There’s a powerful social effect to this belief system. For in addition to whatever heartfelt familial obligations children feel they have to their elders, the constant presence of an ancestral shrine in people’s homes is a persistent reminder that the way parents are treated in this life won’t be forgotten when they pass on. This certainly isn’t to say that the Chinese wouldn’t be devoted to their parents anyway; the Chinese take elder care quite seriously.

Indeed, China is the only nation in the world I know of where children can be prosecuted for not visiting their parents often enough. But the spiritual coupling of familial responsibility and self-interest turns out to be a powerful motivator that helps keep the elderly engaged in the lives of their families in ways we sometimes fail at here in the United States.

What results from this belief is an understanding of mutual need that lasts until a person’s very last breath. Nearly every home in Longevity Village is inhabited by three or more generations from the same family. Each generation relies on the others for emotional, educational, social, and economic support. Children are expected to give grandparents and great grandparents love and companionship. Elders, in turn, are expected to help children learn to be good scholars and good people, and to help out with cooking and cleaning as much as they are able. Everyone is important in a meaningful way. That’s what social connection is all about.

How Dangerous is Loneliness?

It would be very hard to overstate the health benefits of feeling capable and connected to others in this way. Regardless of age, people who feel as though their communities don’t need them are at increased risk of depression and high blood pressure, and have been shown to be more susceptible to all sorts of other ailments. Disconnection is the beginning of loneliness, and that is even worse for our long-term health: Research suggests people who feel lonely are more than twice as likely to suffer from Alzheimer’s disease.

The indelible feeling of capability and connection I saw in the people of Longevity Village isn’t always present in the lives of my patients. And that’s a real problem, because loneliness and social isolation can actually be more dangerous to your health than smoking or even being an alcoholic, and perhaps twice as dangerous as being obese.

Yet even as our nation spends hundreds of millions of dollars on antismoking campaigns, billions treating alcoholism, and hundreds of billions battling the health consequences of obesity, we haven’t treated social connectedness as the public health priority it should be.

Does Modern Life Make Us Lonely?

Perhaps it’s no wonder that between 1985 and 2004—years that saw an explosion of cable television channels, a proliferation of angry talk radio shows and, of course, the emersion of the Internet from relative academic obscurity to the predominant media force of our time—the number of Americans who don’t have a single person with which to discuss matters that are important in their lives nearly tripled.

The trappings of our modern society can leave us helpless, frustrated, isolated, and sick. But these parts of our lives can also be tools we use to strengthen our connections with friends and families, and build our communities in ways that will help us feel stronger, more important and healthier than we’ve ever been.

Masongmou is the perfect example of this. When I next returned to the village, her wheelchair was nowhere to be seen. “My family and friends told me that I’d been in it long enough,” she explained. “They said, ‘you need to start walking again’ and so I did.”

Rosemary’s Loneliness

Recently, while seeing a patient who was suffering from a heart arrhythmia, I inquired about who she considered to be part of her support network.

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

“Is that your daughter?” I asked.

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

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

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

“And the weekdays?”

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

I assured her that it was perfectly reasonable to feel lonely after four or five days spent with her cat as her only companion. We discussed the health implications of loneliness, and some strategies for addressing it.

Is Social Isolation More Dangerous than Smoking, Alcoholism, or Obesity?

In one of the biggest studies ever done to explore the role of friends and family on longevity, Dr. Julianne Holt-Lunstad from Brigham Young University (BYU), published a study of 308,849 people.  In this study she found that of all the common longevity factors, such as exercise, maintaining a healthy weight, or not smoking, that being socially connected was the most important.  Indeed, her study showed that people who were socially connected lived 50% longer!

With regards to mortality, here are the 3 key findings of this study:

          1. Social isolation is more dangerous than smoking 15 cigarettes a day

          2. Social isolation is more dangerous than becoming an alcoholic

          3. Social isolation is twice as dangerous as obesity

Do People Hide Their Loneliness?

I’ve definitely noticed in my patients a tendency to downplay or deny feelings of loneliness. The deeper we get in conversation, though, the more it’s clear that this is a problem that impacts a lot of their lives, sometimes without them ever realizing it. And that’s increasingly problematic in a world in which isolation is increasingly the status quo.

Elders are far from the only people who get lonely. Loneliness is actually one of the most common emotions among Americans of every age, so much so that many people don’t even realize that they are, in fact, chronically lonely. That feeling isn’t something to be ashamed of; it’s simply our body’s way of telling us that we need to work a bit harder toward the goal of connecting with our community.

How do we do that? I often tell my patients that the best way to cure their loneliness is to cure someone else’s. After all, when two isolated people are together, they’re no longer isolated.

On occasion I’ve asked patients who appear to suffer from loneliness to do a bit of “homework,” using the Internet to research recreational sports teams, interest groups, political organizations, book clubs, volunteer organizations, and lifelong learning classes that they might be interested in joining. All of these avenues are great ways to meet new people, and the mere act of looking into these opportunities is often enough to get people to try them out.

#339 14 Reasons Why You Got AFib

August 27th, 2022 by

14 Reasons Why You Got AFib

So, why did you get atrial fibrillation? There are a lot of possible substrate causes—some of which you can control and some of which you cannot. Below is a list of the 14 most common reasons why our patients have developed AFib.

1. You Inherited the Wrong Gene

Some people inherit a genetic predisposition that makes AFib more likely. Up to a third of all people who have atrial fibrillation without another identified cause have a familial history of the condition.

At least fifteen different “potassium channel” mutations have been linked to AFib and at least seven “sodium channel” mutations are associated with AFib. Potassium and sodium ions are atoms that carry electric charges and thus are essential to the signaling system that tells parts of the heart to contract in rhythm. But a lot of non–ion-channel mutations have been linked to AFib, too. These include mutations in a protein-coding gene called NUP155; a gene linked to many heart disorders known as LMNA; a gene called NPPA that encodes a vital hormone created in the heart; and a set of genes known as GATA4, GATA5, and GATA6 that are key to the development of new heart tissue.

Those aren’t the only genes that have been linked to AFib, though—there are actually more than one hundred. Even if we were to create an exhaustive list, it would soon be outdated. Emerging research is revealing other “candidate genes” that may have links to AFib. For now, however, there isn’t a test that can scan all of the known and potential “AFib genes.”

While over-the-counter commercial DNA tests can scan for some, you’re really just scratching the surface with these products. What’s important to note is that while it can be very helpful to know whether you’ve inherited a genetic predisposition to AFib, there’s nothing we can do about the genes we were dealt.

However, it is equally important to understand that research conducted over the past few decades in the field of epigenetics has conclusively demonstrated that we do have the power to influence which genes are “expressed” and which genes are “silenced” based on the hundreds of little health decisions we make every day. Indeed, health outcomes among the individuals who have inherited any of these genes vary greatly based on factors that extend far beyond that inheritance.

2. You Have Another Heart Problem

If you were to round up all of the people with AFib in the world, you would find that somewhere close to half of them have also been diagnosed with another cardiovascular condition. Of these, the three most common culprits are heart failure, cardiac valve problems, and coronary artery disease.

3. You’ve Got a Few Years Under Your Belt

Margaret had been a picture of health for most of her life. She had followed a mostly plant-based diet free of fried, processed, and fast foods. She didn’t eat sugar. She’d never been overweight. She did aerobics every day at the gym and attended a yoga class three times a week. She practiced deep-breathing exercises whenever stress levels were getting too high. She slept well at night. She even volunteered as a crosswalk guard at the elementary school across the street from her house. And since no one in her family had ever been diagnosed with AFib, she was more than a little irritated when her doctor told her she had that arrhythmia.

But here’s the thing: Margaret was ninety-four years old. And the truth is that even if your genes are perfect and you do just about everything right, you can still get AFib as a result of age. Just as your skin will wrinkle over the years, the simple act of living life will put some wear and tear on your heart cells over time.

But there’s a big difference between being ninety-four and fifty-four—between AFib that results from natural aging and AFib that comes about due to premature aging. Most of the AFib cases we see are due to the latter kind of aging. And while there is nothing we can do to stop how many candles are on our birthday cakes—that’s chronological age—there is plenty we can do to slow the process of biological aging.

4. Your Blood Pressure Is Too High

Hypertension occurs when the force of a person’s blood against the walls of their arteries is high enough that it puts a person at risk of health problems. Within the heart, this means that, with every heartbeat, the organ is working harder to pump blood through more restrictive arteries. And all of this strain on the heart can cause its muscle to thicken and enlarge, disrupting electrical pathways and causing AFib. Indeed, of all of the factors that have been associated with atrial fibrillation, none may be stronger than hypertension. High blood pressure is the most commonly encountered condition in AFib patients, and research has shown that it nearly doubles the risk of developing atrial fibrillation.

Studies show that 90 percent of Americans are hypertensive by age fifty-five, so it’s little wonder why AFib is so common. It doesn’t have to be this way. Only 4 percent of the centenarians living in southern China’s famed “Longevity Village” of Bapan, the people we studied in our best-selling book The Longevity Plan, had high blood pressure. That finding is similar to studies of hunter-gatherers living in the Amazon rainforest or elsewhere in the world consistently showing a natural blood pressure of about 110/70 that doesn’t increase much, if any, with age.

Indeed, it appears from many studies that our genes are designed to keep our blood pressure naturally in this 110/70 range without medication as long as we don’t mess things up with our modern lifestyle. Low body weight, a mostly plant-based diet devoid of sugar and processed foods, daily physical exercise, rejuvenating sleep, and low perceived stress levels protected these people from the scourge of hypertension. It might seem like it’s impossible in a modern context to live as these people do, and that’s true. But the lessons we can draw from these elders are virtually endless, and your ability to apply these lessons to your own life are limited only by your imagination.

5. It’s One of these 11 Medications You Are On

Here is a link to an article I wrote: The 11 Worst Medications For Causing Atrial Fibrillation

6. Too Much Exercise

Over the years, we explained, we have noticed a particularly increased risk of atrial fibrillation in patients who regularly compete in ultra-endurance events, including running, biking, and cross-country skiing. Most of our patients are shocked when they learn that people who run marathons, competitively cycle, or do Ironman Triathlons are five times more likely to develop atrial fibrillation.

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

7. You’re Not Getting Enough Exercise

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

8. You’re Overweight

Nearly three-quarters of American men and nearly two-thirds of American women are overweight, if not obese. Today more than two billion people worldwide are overweight or obese In fact, the scientific data connecting weight and AFib are so compelling that many electrophysiologists (EPs) specializing in heart rhythm disorders feel that carrying extra weight is a primary cause of AFib.

Our research has shown that even a few extra pounds can make a big difference in a person’s AFib risk and how they respond to treatments. Other studies have shown that carrying too much weight is the main cause of an enlarged left atrium and premature heart aging—two critical components in the development of AFib.

Even if it’s only by a few extra pounds, being overweight can significantly raise your risk of AFib as we showed in one of our studies. And maybe it’s not just a few pounds. Perhaps you are obese. That word has a lot of negative baggage attached to it, which may be one of the reasons why people are reluctant to even step on the scale. Consciously or subconsciously, they simply don’t want to know. But when people do check, many are surprised to learn that they might indeed be obese, which substantially increases the risk of atrial fibrillation.

9. You Have Diabetes or Pre-Diabetes

Just about everyone knows that obesity puts people at risk of lots of other health challenges, especially diabetes. And it stands to reason that diabetes and obesity have been shown to be associated with an elevated risk of AFib, too.

Not only is your risk of AFib substantially increased with diabetes or pre-diabetes but your experience with that disease is likely to be a lot worse, as people with diabetes have worse AFib symptoms, report a lower quality of life, are more likely to spend time in a hospital, and experience higher mortality rates. There is good news in this regard, though: type 2 diabetes (also known as adult-onset diabetes, although children are increasingly affected) is usually reversible through weight control and processed carbohydrate reduction/elimination. That makes it manageable.

Manageable doesn’t mean “easy.” We live in a world that is constantly conspiring against us when it comes to the food choices that drive so many of our metabolic challenges. It’s also a world in which we’re constantly being told there are shortcuts to just about everything. But we’ll go to battle against those forces very soon. And we’ll do it together. It is something that even we, as cardiologists, have to battle every day. But, again, the important thing, at this moment, is to understand if this is one of the challenges you are facing. If so, the first step is to acknowledge that challenge, and accept its connection to AFib.

10. You’re Not Eating the Right Foods

Food is good medicine. A diet that respects what our bodies need to thrive might be the best way to prevent atrial fibrillation, or to beat it back once it starts.

A bad diet does the exact opposite. In fact, there isn’t much that is worse for you, when it comes to AFib, than eating foods loaded with sugar and other simple/processed carbohydrates. The Standard American Diet (the acronym “SAD” is tragically telling) has way more sugar than anyone needs, and it’s a veritable mass-delivery system for other simple carbs, which your body breaks down to create fast energy.

Most people know that if they’re trying to eat healthy, they should avoid sugar-filled foods like pastries, confections, and candies, along with sugary sodas. What many people fail to recognize is that many of the foods we often think of as “healthy” are also packed with sugar. Even “healthy natural sugars,” like honey, still cause our bodies to respond in roughly the same way: a sudden shockwave of sugar courses through our blood, and these bloodsugar fluctuations may cause cardiac scarring, which, over time, can cause atrial fibrillation.

Another bulk supplier of simple carbs in many people’s diets are refined grains like white flour and white rice, which have been stripped of most of their natural nutrients and fibers. The more processed a grain is, the faster it will be digested to sugar. That has the added consequence of making these foods less filling, so when you eat a white rice dish or a piece of white toast, you’re bound to be hungry again very soon. Sadly, even whole wheat bread isn’t much better. A single slice can spike your blood glucose higher than a Snickers bar.

That doesn’t mean you should avoid carbs altogether. Not at all. In fact, some researchers believe that while working to limit carbs in general might be a good idea, exceptionally low-carb diets may actually lead to a greater risk of AFib.

The key is making sure that, to the greatest extent possible, the carbohydrates you’re getting are complex carbs, including fruits and especially vegetables. For now, though, it’s important to do a realistic assessment of your habits related to sugars and processed carbs. Anyone who isn’t actively avoiding foods with any and all types of added sugar, and limiting their processed or simple carbohydrate intake to those foods that are packed with complex carbohydrates (think vegetables and fruit), may be at an increased risk of AFib.

11. Your Thyroid Hormone Levels Are Off

Thyroxine is the main hormone created by the thyroid gland, and people suffering from hyperthyroidism have bodies that make way too much of it. That’s a big problem because thyroxine is a potent cardiac stimulant. In a way, having hyperthyroidism is like having a little energy-drink factory in your neck. So, you can see why people who have hyperthyroidism might experience increased heart rates, palpitations, and arrhythmias such as atrial fibrillation.

The scary thing is it doesn’t take full-blown hyperthyroidism to increase the risk of AFib. For example, our research showed that when people had thyroid hormone levels in the higher end of normal, they were 40 percent more likely to develop AFib.

12. Your Sleep is Off 

13. You’re Too Stressed

Psychological stress has long been thought to be a possible trigger of atrial fibrillation, and the association appears to be strong among women. But men aren’t immune. Neither are cardiologists. Indeed, we have treated countless doctors over the years with AFib as well as innumerable CEOs, lawyers, accountants, politicians, athletes, celebrities, and others who have come to see us for treatment largely because of the enormous stresses they are under.

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 that 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 surveyed 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 2014 study published in the Journal of the American College of Cardiology, 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 that day, according to Lampert’s research.

Thus, it is no surprise that those who deal with deep and abiding feelings of sadness and disengagement might be even more at risk. Depression is simply not good for the heart, especially when it comes to AFib. One study showed that depression increases the risk of AFib by up to 700 percent. Fortunately, this same study showed that getting your depression treated dramatically reduces your risk. But with more than 16 million Americans, and hundreds of millions of others around the world, dealing with depression, there are a lot of people who have a significant risk factor for AFib and don’t even know it.

But emotional and mental stress aren’t the only things that can send your body into a state of chaos. Researchers have connected AFib episodes to physical stressors caused by events like surgery, bad infections, and car crashes.54 In the case of irregular, singular events like those, there is a chance that after the stressor has passed, the AFib will go away. More likely, though, this is a harbinger of things to come. Our hearts are remarkably resilient, but if an incident of great stress pushed you into AFib, something else has likely been pushing you toward that precipice a long time before that incident occurred.

14. You’re a Smoker or Live in a Polluted City

If you haven’t been to Salt Lake City, it’s worth a trip. Nestled into the foothills of the splendid Wasatch Mountains, there are few cities in the world that boast such immediate access to the outdoors. In the summer, it’s a paradise for hikers and mountain bikers. For skiers and snowboarders, the winters are simply legendary.

Sounds nice, right? Well, before calling the moving company, there’s another thing you should know about Utah’s capital city. Because it rests in a valley, nearly surrounded by mountains, it suffers from lengthy inversions: weather events in which cold, polluted air gets trapped under a blanket of warmer air. During these periods, studies show, the air can get more harmful with each passing hour and can even increase the incidence of deadly diseases.

Among these diseases is atrial fibrillation; researchers have demonstrated a significant association between the development of AFib and the gaseous pollutants most often found in toxic air. Can bad air trigger individual AFib events? That question was at the heart of one of our early studies to assess the risks of short-term elevations in exposure to fine-particulate air pollution. Fortunately, our study failed to identify any measurable risk, so an occasional trip to a place where the air is bad isn’t likely to trigger an AFib episode, particularly if it’s brief.

In the long term, however, bad air can be a very bad thing. While not everyone has a choice about where they live, everyone can choose what they voluntarily put in their bodies. Yet across the globe, more than one billion people smoke or vape tobacco products, according to the World Health Organization. You won’t be surprised to learn that people who smoke have a substantially increased risk of developing atrial fibrillation,  not to mention all of the other health problems smoking causes, from cancer to emphysema. Even living or being around a smoker can increase your AFib risk. Every pack of cigarettes an adult smokes on an average day increases their children’s risk of getting AFib by 18 percent. That’s a legacy no parent wants to leave. Regardless of how toxic air gets into your lungs, if it’s there, there’s a good chance it has increased your risk of AFib.

Are you motivated to beat your AFib? If so, give my office in Salt Lake City, Utah a call to set up a consultation. Sorry, initial consultations all have to be in-person.

If you liked the photo with this article it was a picture I took this past week mountain biking with my teenage son overlooking Jupiter Bowl at the Park City Mountain Resort.


#338 Will Smiling Help You to Live to 100?

July 30th, 2022 by

Will Smiling Help You to Live to 100?

Smiles. That is what I came to expect more than anything else when I would visit Mawen in her home in Bapan as we described in our best-selling book, The Longevity Plan. At 107 years old when I first met, she was feisty, funny, and ferociously dedicated to helping others understand that life, while not always easy or fair, is too wonderful a thing to waste with sorrow.

I cannot recall a single moment in our time together that Mawen was not smiling (just like her 2013 photo attached to this article). When our families would sit together for a meal, her laughter carried over the muddled drone of our multilingual dinner conversations. Whenever I would pass her home, she would always wave to me, point to her mouth, and smile.

Will smiling help you to live to 100? Read on to learn more from our 5-year research project in China’s longevity belt that culminated in our best-selling book, The Longevity Plan

The Longevity Benefits of Smiling

No one lives to be so old without experiencing some tragedy, and given the ups and downs of all of our lives, it’s common for centenarians to have experienced devastating periods of misfortune. Yet researchers studying the personality characteristics of people whose lives reach one hundred years and beyond have found these individuals are almost always happy, optimistic, and resilient.

I’ve become convinced the mere act of smiling might help us live longer. One clever study showed that baseball players who smiled on their playing card photographs lived seven years longer, on average, than those who looked stern. Happiness has also been shown to be a key factor in martial stability, which in turn has been shown to be a key factor in long-term health, and another study demonstrated that a person’s propensity to smile in childhood and yearbook photographs seemed to correlate with their likelihood of staying married.


I knew Mawen wouldn’t have any photos of herself from when she was a teenager, but after hearing about the connection between getting “caught smiling” and long-term health, I was eager to ask her about that period in her life. Did she remember it as a happy time?

It was still quite early in the morning when I arrived for that visit. Mawen was already up, eating soup at her family’s low-slung dining table in a crisp blue shirt and sparkling rhinestone headband. As usual, she was smiling ear-to-ear.

“Doctor!” she exclaimed as I walked into the room, and before I could offer so much as a greeting, she began to list the various ways in which she was, as she put it, “in perfect health.” “I wake up every morning with energy,” she beamed. “I am completely pain-free. My toes and fingers all work as they should! I can’t walk as far as I once did, because I do get tired, but I can still get around.”

“And you’re still smiling!” I observed.

“Always,” she said.

“Even when you were very young?”

“Always!” she repeated.

“Even when things were very hard?”

“Always,” she said once more. “And those are the times in which smiling is most important, don’t you agree?

I very much agree. The conscientious decision to flex the muscles of your face into a smile releases neuropeptides (which work to fight off stress) along with dopamine, endorphins, and serotonin (“feel good” transmitters which are also released when we eat tasty food or engage in sex). Just seeing Mawen smile always made me smile, no matter how I might have been feeling at that moment. We have that effect on one another. Smiling is contagious, after all.

We can even have that effect on ourselves. One of the foremost advocates for mindfulness in the modern world, the poet and peace activist Thich Nhat Hanh, has spoken extensively about the power of a smile. “Sometimes your joy is the source of your smile,” he has observed, “but sometimes your smile can be the source of your joy.”

Smile as Part of Your Morning Routine

Almost everyone I know has some sort of morning routine. And almost everyone’s routine includes standing in front of a mirror for at least a few moments to brush their teeth, comb their hair, or look over their outfit. Next time you’re standing in front of a mirror, smile at yourself. Make it as sincere a smile as you can muster. Then make that a habit.

That’s how habits start: one simple action. When we feel success, we’re far more likely to repeat the action leading to that success, and we’re also more likely to try to take another small action that might, eventually, lead to another healthy habit. If you make a habit of starting each day with a smile for yourself, I can assure you, the difference you will feel will be incredible.

Let it go…

There is an old parable, variously attributed to several Asian cultures, about two monks, a master and his apprentice, who come upon a river. When they arrive, they find a rich woman who demands they carry her across the water. The older monk takes the woman on his back and, even as she moans and complains, he ensures not a single drop of water touches her. For miles thereafter on their journey, the younger monk stews and sighs. Finally he cannot take it any longer. “Master,” he asks, “how could you let that woman treat you in that way?” The older monk replies: “Why should I care now? I stopped carrying her miles ago. Why are you still carrying her?”

Mawen’s Hardships

Mawen had always adhered to the philosophy espoused in this story. She was certainly not free of the sorts of pain, suffering, trials, and tribulations that mark so many of our lives. But when it came time to deal with these misfortunes, she let go of her previous hardships and was more able to deal with whatever came her way.

I wondered for a long time how that could be. After all, when Mawen lost her family, she literally had nothing at all. She returned to Bapan in her mid-seventies without a single Chinese yuan and had to begin rebuilding her life from the ground up. In those days there was nothing like social security in China. The economy was in shambles.

But Mawen told me she simply had a choice to make, and it was a simple one: Survive or perish. And when you consider that our evolutionary compulsion is to survive, it makes it simpler still. The way Mawen saw it, her needs came down to the basics: food and water, shelter and security, love and belonging. Once she’d returned to the village and taken up residence with another child, she had everything she needed. Content in that way, she was able to go on.

None of this should imply that Mawen wasn’t interested in striving for more, or that we shouldn’t do the same. Mawen most certainly did continue to work to better her family’s fortunes. In those years, she accomplished a great deal, but she didn’t need to do that in order to put a smile on her face. It was already there. That’s why today, when she speaks of her husband, her son and even the daughter-in-law who ultimately cast her out of her home,

Mawen likes to focus on the times in which her life experiences exceeded her expectations. And because her expectations were always quite simple, it’s not very hard for her to embrace those memories. When we strip away the inessential elements of our lives and focus on what really matters most, it’s a lot easier to feel content. And while it’s certainly not easy to switch our perspective from “I want more” to “I have what I need,” it can have a drastic impact on our health.

Sadly, Mawen passed away shortly after The Longevity Plan was published. However, her smiles will be something I forever carry with me. No matter how difficult life can be, a simple smile can make things a little better…

#337 Should You Weigh Yourself Daily to Beat AFib?

July 17th, 2022 by

Should You Weigh Yourself Daily?

Should you weigh yourself daily? The simple answer is it depends on what you are optimizing for. If your goal is normal sinus rhythm and longevity then for most of my patients the answer is a resounding “yes.”

However, for my rare patient that has achieved a very high level of mindfulness, a daily weight check could be counterproductive. So, unless you have years of optimal weight management under your belt using a mindfulness approach, you’re probably better off doing the same thing I do every morning which is checking the scale.

Why should you weigh yourself daily?

Although the benefits of daily weight monitoring are backed by research, it doesn’t take a scientific study to understand why this habit tends to work. People who weigh themselves on a daily basis are getting a steady stream of data—and a reminder to take manageable corrective action when the numbers aren’t moving in the right direction. Indeed, I’ve rarely seen an AFib patient in my 30-year career who hasn’t successfully lost or maintained their weight loss by simply weighing themselves regularly.

Why do daily weight checks work?

Why does this work so well? After seeing a bit of weight gain, “maybe they exercise a little bit more the next day, or they watch what they are eating more carefully,” explained University of Georgia exercise and nutrition researcher Jamie Cooper, who led a study showing that people who weigh themselves every day during the holidays either maintain or drop weight during a time that most people pack on a few extra pounds. “The subjects self-select how they are going to modify their behavior, which can be effective because we know that  interventions are not one-size-fits-all.” Just the simple act of weighing yourself daily almost subconsciously sets off a chain reaction of behaviors that makes maintaining a healthy weight a lot easier.

What should you do if you hate the scale?

For some, the thought of stepping on the scale each day is nauseating. There are other options. For example, we have many AFib patients who have successfully maintained their weight loss through the use of a food journal, often in the form of a notebook or an app on their smartphone. Still others have achieved desired results from commercial weight loss programs or fitness coaches. Whatever you do, the key is daily accountability—a regular time in which you must reckon with the choices you’ve made and those you intend to make moving forward. For most, stepping on a scale is the easiest way to do that.

How much do you need to lose for normal sinus rhythm?

So, how much do you need to lose? Well, everyone’s healthy body weight is different. But let’s not sugarcoat this: the vast majority of people we see with atrial fibrillation are significantly above the recommended body mass index. And while BMI isn’t a perfect indicator of what a healthy body weight looks like for everyone, it’s generally a good target. What’s more, most of these individuals have been overweight for many years, and quite often many decades. As such, the amount of weight most people need to lose is usually quite a bit more than most people think they can lose.

Can even a 5-pound weight loss help AFib?

Rather than be discouraged about how much you need to lose, know this: anything helps. For example, in one study we showed that even patients who lose just 3 percent of their body weight, which could be as little as five pounds, increased their long-term chances of putting AFib into remission. If you are going to take the necessary steps to get your weight in check, however, you have to be 100 percent committed. “Yo-yo dieting,” in which your weight constantly goes up and down, is really bad for AFib, with our research and that of other physicians showing that back-and-forth weight changes could be an additional AFib risk factor. You cannot let that keep you from trying, though, because the data is very clear on this point: if you want to end your affair with AFib, losing weight isn’t optional.

Eileen’s Experience

Knowing that even a few pounds could help improve her life, when Eileen was diagnosed with AFib, she set a goal of losing one pound every month. That’s a very conservative and reasonable goal, and one that we suggest for many of our AFib patients. Even that, however, can be hard, especially since weight gain is a side effect of some medications and because AFib can make it hard to exercise, which is why it is okay to celebrate an initial month in which you simply don’t gain any weight.

If your scale currently tells you that you are 220 pounds, for instance, then that is the number you need to maintain for this month. Do everything possible to keep things from tipping over that point. Next month your goal is 219. After that, it’s 218. Is that slow? Sure it is. Will some people need to lose more, and more quickly? Absolutely. But slow and constant progress in one direction is far preferable to erratic shifts this way and that. Moving in the right direction is key to a life without AFib.

Eileen didn’t meet her one-pound-less-per-month goal within the time frame she was planning, but her weight loss was nonetheless commendable. On average, she shed a little more than half a pound each month. And while a half a pound might not seem like a lot, over time it adds up. In the first three and a half years after she began her journey toward putting AFib into remission, she dropped twenty-four pounds—mostly by making the sorts of day-to-day adjustments that come with increased daily awareness of “the biggest biomarker of them all.” That resulted in some very big improvements to her condition, “but I didn’t want to settle for ‘less bad,’” she said.

Take-Home Message

Optimizing your body weight may be the key to optimizing for normal sinus rhythm. And to achieve this goal, daily weight checks can be very beneficial. If your goal is to beat AFib and you would like to meet with me, or one of my colleagues, in Salt Lake City please call my team at 801-266-3418 to set up an in-person appointment (sorry, telemedicine visits are not available for initial consultations).

Did you like the photo attached to this article? It is a photo of my favorite place in the world to run, Desolation Lake. Desolation Lake can be reached from trails originating in Park City, Millcreek Canyon, or Big Cottonwood Canyon in Utah.

#336 5 Scientifically Proven Reasons Why AFib Ablations Are Better than Drugs

June 11th, 2022 by

5 Scientifically Proven Reasons Why AFib Ablations Are Better than Drugs

The primary goal of anyone who has just experienced their first atrial fibrillation attack is to do everything possible to reverse this condition so that you don’t ever get another attack. Ideally, you can make the key lifestyle changes after the first AFib event to maximize the chances of this approach being successful. And of all the healthy lifestyle changes you could make, the most effective is to get down to a healthy weight.

How much weight do you have to lose? A good rule of thumb is to get your BMI (body mass index) below 25. If you’re not sure if your weight is in the healthy zone, follow this link to a BMI calculator.

I’ve also seen patients put their AFib into remission by other means such as getting out of a toxic job, getting their sleep apnea treated, or avoiding AFib triggers like alcohol. But if lifestyle therapy isn’t enough for your AFib should you opt for drugs or an ablation?

When is it time for an ablation?

Accepting ablation is not accepting that you weren’t “good enough” to cure your AFib in other ways. After all, many of our patients are endurance athletes, often in their thirties or forties, who are a picture of health. As most of these athletes can’t compete on medications, and have already optimized many aspects of their lives, many end up getting their AFib ablated. And, with that, because so many aspects of their health have already been optimized, almost all are able to return to full physical activity, including competitions, without any medications and without any further AFib episodes.

I cannot emphasize this enough: Ablation isn’t what you do when all other options fail, anymore than a cast is something you put on a broken arm when all other options fail. Ablation is a procedure that can in some cases be avoided—and it’s nothing to rush into lightly—but for many people, it’s an absolutely necessary treatment that should be discussed with an expert EP (a cardiologist specializing in AFib) sooner than later.

What is an ablation?

In a catheter ablation, an electrophysiologist controls the movement of several catheters—specialized tools designed to work in the heart which are gently inserted into a patient’s body through a large inner thigh vein. A lot of people are surprised to learn that doctors can reach the heart in this way, but cardiac catheterization is nearly a century old, having been first completed by the German physician Werner Forssmann, who slid a 24-inch catheter from his own arm to his right ventricular cavity in 1929.

In the decades that have passed, doctors have learned to guide catheters toward malfunctioning heart cells in the atria. And those malfunctioning cells are destroyed with either radiofrequency or cryo energy creating a barrier of scar tissue to prevent abnormal electrical signals from triggering AFib (like with electrically isolating heart tissue near the pulmonary veins) or directly eliminating misfiring cells in the heart. Either way, the end goal it to stop AFib from happening again. As no cutting or stitches are needed, 99% of my patients are able to go home the same day after a few hours of monitoring.

How does an ablation get rid of AFib?

Now, it might seem counterintuitive that purposefully creating more scar tissue in an ablation procedure is one of the ways to fight a condition that is usually caused in part by scar tissue that has built up in your heart over the decade. But when you consider what the newly scarred tissue does—or rather, what it doesn’t do—it makes a lot of sense.

The process creates an electrical bypass, of sorts, that takes malfunctioning heart cells out of the equation. Once that happens the electrical currents that run through a patient’s body, controlling the action of their heart, have no choice but to move through the remaining healthy tissue. Or, in another way of thinking, the currents can no longer get “lost” in a jumbled maze of bad cells. What’s more, studies show that when these “bad cells” are eliminated, it can strengthen the rest of the heart so much that both the atria and ventricles are stronger after the procedure, since they are now working in harmony with one another.

What happens after an AFib ablation?

The result can seem miraculous. Patients who felt doomed to a life of atrial fibrillation with all of the accompanying medications, cardioversions, and hospitalizations are suddenly free from this affliction. As you know, AFib begets AFib. This condition tends to get worse with time. And for this reason, our research shows that the earlier we can treat your AFib the more likely we’ll be able to put it into remission.

But something remarkable happens when the heart can maintain normal sinus rhythm for prolonged periods of time. Rhythm begets rhythm. The heart can heal itself! In a fascinating study, Australian researchers using MRI and high-tech 3D mapping technologies of the heart were able to show that by eliminating AFib with an ablation, non-ablated diseased areas of the heart were able to heal themselves over the following two years. Remarkably, inflamed and fibrotic areas of both the atria and the ventricles resolved. It was as if the heart repaired what could be repaired and replaced that which needed to go—structurally the cells were healthy again and electrically most of the “electrical shorts” went away.

What do AFib ablation studies tell us?

A lot of other problems can be reduced by ablation. In our study of nearly 38,000 patients, for instance, we showed that ablation didn’t just reduce AFib, but also reduced the risk of premature death, stroke, and dementia. Further research has demonstrated that patients getting an ablation also enjoy much better kidney function which makes sense because AFib may compromise blood flow to vital organs. Perhaps the greatest benefits seem to come for the sickest patients—those who are fighting both AFib and heart failure. After ablation, research shows, their risk of death, stroke, bleeding, or cardiac arrest plummeted by half.

The CABANA AFib Ablation Study Results

Of course, results like the ones we just covered in the paragraph above are always met with skepticism. And they should be. That’s why dozens of researchers from around the world aided in the nearly decade-long Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation trial, also known as the CABANA study, the biggest ablation study ever done, which enrolled more than 2,200 mostly older AFib patients from around the world and randomized them to either medications or an ablation. These patients were then followed for about four years to see what happened next.

The only problem to this simple study design is that more than a quarter of patients assigned to drugs required an ablation before the four years were up, while 9 percent of the patients randomized to an ablation decided not to have the procedure done. This muddied the statistical waters, because some statisticians will argue that the “pure” way to conduct a study is to count the results based on how patients were assigned rather than what therapy they ultimately received.

Under this way of analyzing the data, patients who were assigned to medications, but who really had an ablation, would be counted as “medication patients.” Likewise, those patients assigned to ablation, but who never had the procedure, would be counted as if they really did have a procedure. It should come as no surprise that if you analyze the results based on how patients were assigned, rather than the therapy they actually received, that the primary end points of the study—strokes, bleeding, cardiac arrest or death—were similar between the groups.

5 Scientifically Proven Reasons Why AFib Ablations Are Better than Drugs

And yet, even when looked at in this way, the advantages of an ablation are clear, with the CABANA study showing that:

1. If your goal is normal sinus rhythm, then ablation is significantly better than drugs at keeping your heart in rhythm.

2. If your goal is a better quality of life, then ablation is also your answer.

3. If your goal is to stay out of the hospital, then once again ablation is your best bet.

4. If you have heart failure, ablation is also much better, a finding that has been backed by other trials.

5. While the complication risks of an ablation or drugs were different, overall the risks were no higher with ablation when done at the experienced hospitals participating in this study.

Take-Home Message

For those suffering from atrial fibrillation that doesn’t quickly go away with weight loss and other lifestyle changes, it is time to see a cardiac electrophysiologist (cardiologist specializing in AFib) to discuss the role of medications or catheter ablation. If you would like to meet with me, or one of my colleagues, in Salt Lake City please call my team at 801-266-3418 to set up an in-person appointment (sorry, telemedicine visits are not available for initial consultations).

Did you like the photo attached to this article? I took it yesterday on my run over a mountain range to Desolation Lake which is located between Salt Lake City and Park City, Utah.

#335 The Top 3 Drugs Your Cardiologist Wants to Put You on to Slow Your Heart Rate

May 21st, 2022 by

The Top 3 Drugs Your Cardiologist Wants to Put You on to Slow Your AFib Heart Rate

Of all the drugs that doctors prescribe for AFib, rate controllers are probably the most popular. And yet, in most of the cases we see, these drugs usually don’t reduce AFib attacks and seldom do they prevent them all together. They also don’t always prevent heart failure—because, when it comes to heart failure, rate control alone may not be enough. Many doctors don’t even know this yet, but research suggests that just the irregularity alone from AFib is enough to put some hearts into heart failure.

What do rate controllers do, then? They slow your heart down. And for this reason alone, the rate controlling drugs are frequently prescribed to AFib patients. In this article, we’ll discuss the top 3 drugs your cardiologist will probably want to use to slow your AFib heart rate.

Why do you need to slow the AFib heart rate?

When your heart is beating away at 150 beats per minute, slowing things down is a good thing. But rate controllers slow your heart no matter if its in an active state of AFib or not. And that can result in bradycardia, a condition in which the heart is beating too slow and thus the heart isn’t pumping enough oxygen-rich blood to the rest of the body.

Can these AFib rate controlling drugs slow your heart too much?

We’ve seen countless patients—usually older ones—admitted to the emergency rooms of the hospitals where we work with heart rates of under 45 beats per minute and are either fainting or coming close to fainting from such a slow heart rate. That’s why, if you are on a rate controller, it’s vital to invest in a smartwatch or other device with which you can monitor your heart rate.

What is the purpose of these AFib heart rate slowing drugs?

The rate controlling drugs do serve a purpose. In addition to making AFib feel “less bad,” they also help to prevent your heart from beating so fast with AFib that it could put you into heart failure. Our hearts simply cannot keep racing 24 hours a day, seven days a week, and keep functioning properly.

How much AFib rate controlling do you need?

As long as you aren’t having any symptoms, studies suggest an AFib resting heart rate below 110 beats per minute is best.129 Under the right conditions, rate controllers can help with that and, fortunately, these drugs tend to be available as generics, and are quite inexpensive. But they’re not all the same, so let’s look at the top 3 drugs your cardiologist will probably want to use to slow your AFib heart rate.

#1 Most Popular AFib Rate Controller: Beta-blockers (especially metoprolol)

Beta Blockers are the most commonly prescribed rate controllers. They are also the only rate controllers that might actually help to prevent AFib episodes, particularly in situations in which your body releases a lot of adrenalin, such as when you are stressed out, exercising or angry. That’s because these drugs—which include metoprolol, carvedilol, atenolol, and basically any medication whose generic name ends in “olol”— shield the heart from adrenalin.

And when you look at all the drugs in the beta-blocker family, the very most popular beta-blocker in the US is metoprolol (also known as Toprol or Lopressor). In fact, none of the other beta-blockers even comes close to metoprolol…

When are adrenalin blocking effects of beta-blockers a good thing?

An adrenalin blocking medication is good when your heart is in AFib and beating at 150 beats per minute, but, if you are in normal rhythm, the adrenalin-shielding property of these drugs can literally put you to sleep. That’s why fatigue is one of the top complaints among users of these drugs. In women beta blockers are often additionally associated with weight gain. In men, one of the big problems is erectile dysfunction.

One of the most beneficial effects of beta blockers is that they often have a calming effect on users, which is good for people with AFib that is triggered by stress or anxiety. These drugs also tend to lower blood pressure, and since most people with AFib have high blood pressure that’s a good thing, too. Beta-blockers also often improve sleep, and since a lack of sleep can be a trigger for AFib, that’s also a significant benefit.

Which AFib patients should use beta-blockers?

The main group of patients who can most benefit are those whose AFib is induced by exercise, anger, stress, or heart failure. On the other hand, taking beta blockers for exercise-induced AFib can also be counterproductive since they can make it hard to get your heart rate up sufficiently to engage in vigorous exercise a vital component of the interventions nearly everyone needs if they want to put their AFib into remission.

Are beta-blockers safe to take for AFib?

Unlike antiarrhythmics, beta blockers are quite safe to take for almost everyone. Indeed, our sickest cardiac patients, those with a history of a major heart attack or heart failure from a low ejection fraction, generally live longer on beta blockers. If there’s a single type of drug that has the highest ratio of benefits-to-drawbacks, it’s beta blockers. But, of course, that doesn’t make these drugs right for everyone. That’s why there are two other classes of rate controllers.

#2 Most Popular AFib Rate Controller: Calcium Channel Blockers (especially diltiazem)

Calcium channel blockers that are used for rate control work by blocking calcium electrical connections between heart cells. Some patients get nervous when they first learn about these drugs. Calcium is vital, after all, for strong bones, among other important functions. But these drugs don’t significantly block calcium absorption in your gut, calcium metabolism in general, or your overall bone health.

While calcium channel blockers aren’t used as frequently as beta blockers, they can be a good second-line rate controlling strategy in the event there are intolerable side effects with beta blockers. Yet these drugs, often known by generic names including diltiazem and verapamil, can have many of the same effects on the body as beta blockers. Calcium channel blockers may also cause swelling of the legs, and you should be sure to tell your doctor if you notice your legs getting a little “puffy” with diltiazem or verapamil. Additionally, calcium channel blockers aren’t safe for people with heart failure from a low ejection fraction.

#3 Most Popular AFib Rate Controller: Digoxin (rarely used now days)

Digoxin, often known by the brand name Lanoxin, is the least prescribed rate controller. This is the drug that was derived from the foxglove plant and, as the very first AFib medication, doctors have been using it to treat arrhythmias for a very long time. However, digoxin, is rapidly falling out of favor among doctors.

That’s because research has indicated that it might increase users’ risk of premature death. Even before this startling concern was revealed, however, this nearly century-old medication was losing market share due to its myriad negative side effects, including loss of appetite, vision problems, fatigue, and confusion. It also has a very narrow margin between a dose that is strong enough to be effective and a dose that is strong enough to be toxic, making precise dosing a precarious endeavor.

And, compared to other rate controllers, it is relatively weak in its rate-slowing effects. Despite all of this, however, digoxin is quite inexpensive and can be helpful in a small subset of patients. One possible advantage of this drug, which comes from a class of heart-slowing medications known as cardiac glycosides, is that it doesn’t lower blood pressure like beta blockers or calcium channel blockers. That can be good for people who struggle with low blood pressure. Beta Blockers, calcium channel blockers, and digoxin all have an appropriate place in the pharmaceutical quiver that doctors use to treat their patients.

Do you also need an AFib rate controller if you are also on an antiarrhythmic?

Given the side effects and other concerns of the AFib rate controlling drugs, people often wonder if they really need these drugs, especially if they are also on an antiarrhythmic. If the antiarrhythmic your doctor has prescribed is flecainide or propafenone, the answer is “yes.” This is because the atrial flutter proarrhythmic effects of flecainide and propafenone are serious enough that you need a rate controller around to make sure the heart never beats too fast.

However, some antiarrhythmics do have some rate controlling effects. This is especially the case with amiodarone, sotalol, and Multaq (dronedarone). As a result, if you are combining antiarrhythmics with rate controlling medications—and especially if your are elderly—you will need to monitor your heart rate very closely, lest you find yourself with a heart rate that is so low that you pass out from lack of oxygen to your brain or or develop severe low blood pressure.

What should you do if you don’t want to take any of these drugs?

Most of our patients, especially the younger and more active AFib patients, don’t want to take any medications. Is there a way to get off the rate controlling and antiarrhythmic drugs?
Fortunately, catheter ablation of atrial fibrillation just keeps getting better and better. Ablations are a relatively simple 2-hour procedure now and our patients can go home 2-3 hours after their procedure with just a bandaid.
There is no cutting and no stitches with these procedures. Everything is done through a special IV in the leg. Patients are fully asleep and don’t feel a thing during the procedure. Recovery is quick and our patients are back to the gym exercising within 5 days. Ablations are also covered by Medicare as well as all insurance plans in the US.
Of course, not everyone can be helped with a catheter ablation but for our younger and healthier patients with paroxysmal atrial fibrillation it is very rare that we can’t put their AFib into remission with this procedure. Sometimes a touch up ablation is needed for complete resolution of the AFib.
If you live in Utah, or are willing to travel to Utah for care, feel free to call my team at 801-266-3418 to schedule an AFib consultation with me or one of my colleagues.
Also, if you liked the photo with this article, I took it yesterday while hiking with my wife and daughter. It is a majestic view from the Grandeur Peak Trail overlooking Salt Lake City, Utah.

#334 Could the News and Social Media be Causing Your Heart Problem?

April 9th, 2022 by

Could the News and Social Media be Causing Your Heart Problem?

Good, bad, or otherwise, the news used to come to us in far more manageable doses—a bit in the morning when the newspaper hit the doorstep and a bit in the evening when Walter Cronkite, or another seemingly trustworthy person, sat behind the desk of the evening news. Nowadays, news is a 24-hour affair. And what often passes for news—angry people screaming over one another, blowhard commentators spewing politically predictable talking points, and celebrity news aimed at exposing the embarrassing secrets of the not-so-rich and only-so-famous—is so ubiquitous via the internet and social media that it can take a pretty heroic effort to stay informed (as all citizens of a democracy should be) without going mad. But could this non-stop news and social media be the cause of your heart problem?

Negative News and Heart Problems

We’ve known for decades that a constant flow of negative news can cause people to feel sadness and anxiety, exasperating worries that news consumers already have about their own lives. Research is now showing that unremitting psychosocial stressors can have physiological repercussions, too, with copious studies showing a link between stress and heart problems, and “profound effects on the cardiac rhythm.”

What’s the most common emotion you associate with consuming news content? If you said “anger,” you should know that researchers have found that the likelihood of an atrial fibrillation episode goes up nearly six times following an experience with anger. By contrast, according to the same study, atrial fibrillation episodes are decreased 85 percent when you are feeling “happy.”
It’s not just “hard news” that can start a chemical chain reaction that can push our hearts out of rhythm. We’ve grown increasingly tribal when it comes to our sports allegiances, too. (If you’ve ever yelled at a referee through your television, this applies to you.)
And while social media can be a way to spread all kinds of emotions—from joy and humor to sadness and empathy—nothing goes viral like anger. “Anger is a high-arousal emotion, which drives people to take action,” Jonah Berger, a professor of marketing at the Wharton School at the University of Pennsylvania, told Smithsonian Magazine in 2014. “It makes you feel fired up, which makes you more likely to pass things on.” In a world in which clicks equal cash for savvy social media marketers, what emotion do you think is most likely to be pushed in your direction when you open that app?

How to Fix Heart Problems from Negative News

What should you do if your media habits are adding stress to your life? Well, you don’t need to completely tune out, although that might not be a bad idea for a while. There isn’t a lot of hard research, yet, on what is often called “social media fasting,” but it’s not hard to find plenty of personal anecdotes about how it made people feel more productive, more clear-headed, and less stressed. I know this is what I have had to do from time to time when negative news gets me all fired up.
By contrast, it’s not nearly so easy to find people who took a break from social media and didn’t feel like it was a worthwhile break, even if they ultimately returned to their old ways. While you’re considering a social media fast, you might as well consider a more general media fast as well.
Indeed, I’ve seen many people decrease their atrial fibrillation or chest pain episodes just by getting rid of social media and the news. Or you might simply consider consuming your media the way people did a few decades ago. That doesn’t necessarily mean subscribing to a morning newspaper and only watching one network news show, but spending a little time each morning and evening checking the latest state of the world, sports updates, and celebrity gossip—and keeping away from that content throughout the rest of the day—can do wonders for your psychological and physical health.

#333 Can High Blood Pressure Cause Atrial Fibrillation?

March 26th, 2022 by

Can High Blood Pressure Cause Atrial Fibrillation?

Whenever I meet with newly diagnosed atrial fibrillation patients they always want to know why they got Afib. Sadly, one of reasons is usually something they haven’t given much thought to…their high blood pressure. Indeed, high blood pressure or hypertension is one of the main causes of atrial fibrillation.

How Does High Blood Pressure Cause Atrial Fibrillation?

Hypertension occurs when the force of a person’s blood against the walls of their arteries is high enough that it puts a person at risk of health problems. Within the heart, this means that, with every heartbeat, the heart is working harder to pump blood against a more forceful wall. And all of this strain on the heart can cause the heart muscle to thicken and enlarge, disrupting electrical pathways and causing AFib.

Indeed, of all of the factors that have been associated with atrial fibrillation, there may be none that is stronger than hypertension. High blood pressure is the most commonly encountered condition in AFib patients, and research has shown that it nearly doubles the risk of developing atrial fibrillation. Studies show that 90 percent of Americans are hypertensive by age 50 so it is little wonder why AFib is so common.

Does High Blood Pressure Have to be Part of the Aging Process?

Everyone goes on high blood pressure medications as they get older, right? It really doesn’t have to be this way. There is no rule that your blood pressure has to go up as you get older. In fact, among the those groups of people in the world still living an ancestral lifestyle, hypertension is very uncommon.

For example, among the centenarians living in southern China’s famed “Longevity Village,” that we described in our best-selling book The Longevity Plan, only 4% had high blood pressure. That’s a finding that is similar to studies of hunter-gatherers living in the Amazon rainforest or elsewhere in the world consistently show a natural blood pressure of about 110/70 that doesn’t increase much, if any, from age. Indeed, it appears from many studies that our genes are designed to keep our blood pressure naturally without the need for medication, in this 110/70 range as long as we don’t mess things up with our modern lifestyle.

A lean body weight, a mostly plant-based diet devoid of sugar and processed foods, daily physical exercise, rejuvenating sleep, and low perceived stress levels protected these people from the scourge of hypertension. It might seem like it’s impossible in a modern context to live as these people do, and that’s true, but the lessons that can be drawn from these elders are virtually endless, and your ability to apply these lessons to your own life are limited only by your imagination.

How Do You Keep Your Blood Pressure in the Normal Range without Medications?

If your goal is to keep your blood pressure as close to 110/70 without medications then it is very possible provided lifestyle changes are made before your blood pressure stays permanently high. In this article below, I describe 8 scientifically proven ways to lower your blood pressure naturally. Of course, never stop your blood pressure lowering medications without first speaking with your healthcare provider.

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

If you would like to see me or one of the other cardiologists in my practice in Salt Lake City, Utah specializing in AFib, please give my team a call at 801-266-3418.

Did you like the photo attached to this article? It was taken while running along the Jordan River in Salt Lake City, Utah in early March.

#332 Can You Only Take AFib Blood Thinners When Needed?

March 19th, 2022 by

Can You Only Take AFib Blood Thinners When Needed?

The vast majority of my AFib patients hate their blood thinners. In fact, most would be willing to do just about anything to get off them. While the official AFib treatment guidelines don’t yet recognize only taking AFib blood thinners when needed, for some patients this can be a reasonable approach to balancing the risk of stroke versus life-threatening bleeding from blood thinners. Is there a way to only take blood thinners when you have an AFib attack? Read on to learn more…

Pill-in-the-Pocket Approach to AFib Blood Thinners

A pill-the-pocket approach is similar to what some patients use with antiarrhythmics like flecainide. Just like they only take flecainide to stop that rarely occurring AFib attack, they take an AFib blood thinner the same way. While they stop their flecainide once the heart is back in normal sinus rhythm they still continue their AFib blood thinner for a month after the AFib episode ended.

This “on-demand” approach to blood thinners is truly only for highly motivated AFib patients who are at low to intermediate risk of stroke, and even then, your doctor may not approve, because it is not part of the official guidelines for treating AFib. But in the era of AFib detecting smartwatches, lifestyle and biomarker optimization, newer blood thinners, and ablations, I believe there is a role for the pill-in-the-pocket approach to protect patients from a “once in a blue moon” AFib attack.

Most AFib Patients Quit Their Blood Thinners

Just like pill-in-the-pocket antiarrhythmics, this “on-demand” approach means you would only take a blood thinner when you need it—like when you’re having an AFib attack—and not when your heart is in a perfectly normal rhythm. Dr. Rod Passman, a cardiologist from Northwestern University in Chicago, has been a champion of this approach, and he hasn’t been shy about sharing his opinion on its merits, going so far as to say the way we typically administer blood thinners “is stupid.”

“We know that only about half the patients who should be receiving an anticoagulant are actually prescribed one and when we do prescribe it, probably only half are still taking it after a year or two,” he told TCTMD, a comprehensive online resource focused on interventional cardiology. “People simply do not want to be on these drugs long-term and if they can minimize their exposure to it without compromising stroke risk, well that’s a win-win.” (article here)

Passman not only has a good point, he might in fact have understated patient detest for these drugs. Studies show that as many as two in three patients have quit the drug on their own within a year. But, unfortunately, the vast majority of these patients are stopping their blood thinners the wrong way—going against the wishes of their doctors, instead of working with those doctors to come to consensus about what is prudent.

Do Studies Support the Use of On-Demand Blood Thinners for AFib?

As of the writing of this article, there have been four major studies published on pill-in-the-pocket blood thinners in patients with lower CHADS-VASc scores, (here, here, here, and here) and the results were very promising. All of these studies showed that it may be a reasonable alternative to the daily blood thinner, protecting patients from side effects and saving them money without increasing risk.

But, to put things into perspective, altogether these four studies involved fewer than 3,000 patients. By way of contrast, the study that resulted in FDA approval for Eliquis included more than 18,000 patients. A lot is at risk here—especially considering that an AFib stroke could put you in a nursing home for the rest of your life.

3 Key Points About Only Taking AFib Blood Thinners When Needed

There are a few other things that need to be said about this approach:

First, all of the studies that have been completed so far have used one of the newer blood thinners. Warfarin cannot be used “on-demand,” as it takes a few days before it has an effect; by then a stroke could have already happened.

Second, there is no consensus how long an AFib episode should be before it triggers the use of a pill, or how long you should continue taking the pill after the episode ends. Intuitively though, most EPs who are open to this pill-in-the-pocket approach would probably recommend a month of blood thinners after an AFib attack

Third, studies show that there is no direct temporal relationship between when the AFib attack starts and when the AFib stroke occurs. Strokes don’t always happen around the time of an AFib attack. This is because, as you know, AFib sufferers are almost always dealing with other medical conditions, including diabetes, hypertension, heart failure and coronary artery disease, that also raise the risk of stroke. It would be delusional to think that a blood thinner, taken only in the aftermath of an AFib episode, could work for anyone except those people who are completely healthy other than their AFib.

Is Only Taking AFib Blood Thinners When Needed Right for You?

As only taking AFib blood thinners when needed is not part of the official AFib treatment guidelines it can’t be recommended. Also, it goes without saying, that you should never stop your AFib blood thinner without first discussing it with your healthcare provider.

Don’t be discouraged. This approach might not be right for you just yet, but there are studies ongoing that are evaluating whether implanted or wearable heart monitors can make the pill-in-the-pocket blood thinner approach work even better for even more people. For those who are highly motivated, though, it can be a viable option right now, provided a patient has had their AFib eliminated with an ablation, they are 100% committed to optimizing their lifestyle to make sure the AFib doesn’t come back, and they have totally mastered the use of the latest AFib monitoring technology to guide their use of blood thinners.

If you would like to see me or one of the other cardiologists in my practice in Salt Lake City, Utah specializing in AFib, please give my team a call at 801-266-3418. Also, if you like the photo attached to this article it was recently taken on a run while on the Pipeline Trail in Millcreek Canyon (Salt Lake City, Utah area).

#331 How to Reprogram Your Genes to Live to 100

March 11th, 2022 by

How to Reprogram Your Genes to Live to 100

Just prior to giving the keynote lecture at a large medical conference organized by Northwestern University in Chicago on the subject of “How to Thrive to 100,” a surprising number of conference attendees I met said something to the effect of, “who in their right mind would want to live to be 100?” That sort of response completely ignores the fact that a person who arrives at 100 still skiing and in good health most likely also enjoyed great health when they were sixty, seventy, eighty, and ninety, too. And these were other doctors!

If you are the type that still wants to be skiing, running, or cycling at age 100 then this article is for you. But to achieve this goal will require you to reprogram your genes to still be thriving at 100. Read on to learn more…

Do Your Genes Determine your Lifespan?

Are some of us genetically destined to live long lives and others not? Not at all. Today we’re learning the impact we can have on our genes is profound. Rather than being stuck with what we’ve inherited from past generations, our research that we shared in our best-selling book, The Longevity Plan, shows the expression of our genes can change significantly, and positively, as a result of the decisions we make every day.

Indeed, the genetic work done by my team with the centenarians living in China’s centenarian belt in the Bama County of the Guangxi Province has shown that the majority have genes that should predispose them to hypertension, atrial fibrillation, myocardial infarction, hypertriglyceridemia, and hypercholesterolemia. In fact, one of the centenarians we studied had gene markers for an increased risk of all five of these conditions!

Our findings are not the exception. Other studies of people in Bama County have revealed genes that, based on everything we know about genetics, should actually predispose these folks to heart disease, Alzheimer’s disease, high cholesterol, and diabetes. In one study, researchers found that 516 people from Bama County, all over the age of 90, carried a gene that often results in elevated homocysteine and cholesterol levels leading to heart attacks and dementia.

Despite being genetically “programmed” for early heart disease and memory impairment, though, these people showed almost no signs of these diseases. In fact, studies of Bama centenarians have shown that even in those over the age of 100, heart disease is only seen in 4 percent. Another study looking at 267 long-lived Bama residents at an average age of 88 could only find one case of dementia. To put these numbers in context, about 85 percent of people over the age of 85 in the U.S. have already developed heart disease, and roughly half of all people in the U.S. age 85 or older have developed dementia.

Your Lifestyle is Far More Important than Your Genes

As it turns out, the only measurable genetic difference between the people in this region who live a long time and those who don’t is something called methylation, a mechanism our cells use to change the way our genes are expressed in response to how we live. And we know from studies of people from gene pools all across the world that everyone has the ability to positively impact their genomic expression, for good and for ill.

We’ve all known someone, for example, who was gifted in some way but didn’t work to hone that gift, with rather predictable consequences. We’ve also all heard the inspiring stories of people who are naturally disadvantaged in some way, but are able to overcome that disadvantage through hard work and dedication.

Approximately 80% of Your Lifespan is Determined by Lifestyle Choices

In a ground-breaking study, a group of researchers considered the genetic and environmental factors impacting the lives of nearly 3,000 identical and fraternal twins from Denmark, they concluded that “longevity seems to be only moderately heritable.”

For women, the researchers concluded, only about 26 percent of longevity was the result of heredity. For men it was about 23 percent. The rest, the scientists concluded, is up to us. When I came to recognize this, it was exceptionally freeing. For years I’d blamed my health problems on a rather poor draw in the genetic lottery, and in some ways it was true. When I had my DNA analyzed, the lab report was downright depressing. I carry variations of genes associated with obesity, diabetes, Alzheimer’s disease, and inflammatory arthritis. But what the people of Longevity Village have taught me is that our genes aren’t a prison sentence.

Rather than being genetically destined to live long and healthy lives, it’s quite clear that the people of Bapan have benefitted from lifestyle choices and attitudes that have actuated their genes in ways that have allowed them to thrive to one hundred years of age and longer without medications, surgeries, or doctor visits. We know this, too, from looking at what happens when people leave the village and significantly alter their lifestyle. When one young man I met left the village to seek work in the city of Guangzhou,
for instance, his job in a factory sweatshop and changes in eating habits took an almost immediate toll on his health. After suffering from the effects of stress, a lack of healthful physical activity, a poor diet, air pollution, and weight gain, he decided to return to the village and re-integrate, best he could, with the traditions of his ancestors. His health was remarkably restored within months of his return.

How to Reprogram Your Genes

While you are “stuck” with the genes you were born with, you can determine which genes get turned on and which genes get turned off. And, as it turns out, we’ve got a lot of control over our genetic destiny. And the really simple formula to reprogram your genes for health and longevity is as follows:

1. Optimize nutritional intake while maintaining a healthy body weight.

Only eat real foods. Avoid anything processed or prepared whenever possible. Stay away from added sugars and grain flours as much as possible. Consider supplements to correct nutritional deficiencies. Stay lean.

2. Physical activity every day.

Ideally, you are getting at least 30 minutes of moderate-intensity exercise and recording at least 10,000 steps daily. Shorter periods of daily exercise are also good if you are doing high-intensity work-outs. Strength training is also important to optimize for longevity.

3. Prioritize sleep.

Restorative sleep is priceless. Whether you think you need it or not, target for at least 7 hours of sleep each night. Going to bed and waking at the same time every day is also associated with better health and longevity.

4. Minimize your stress response.

There will always be stress in your life. The key is to proactively do something every day to allow you to process the stress. For me, nothing puts stress in its place like a daily epic workout in the mountains.

5. Nurture relationships.

At the end of the day, it’s our relationships that count the most in this life. And studies show that relationships may better predict health and longevity than smoking or obesity. Prioritize time each day with the most important people in your family.
Did you like the photo attached to this article? It is our front walkway light after an unexpected big snowstorm this past week.

#330 The 12 Most Common Atrial Fibrillation Symptoms

February 12th, 2022 by

The 12 Most Common Atrial Fibrillation Symptoms

Most of our patients mistakenly believe they don’t have any AFib symptoms because they can’t feel the palpitations that are commonly associated with this arrhythmia. While many patients do indeed experience palpitations, in my experience most do not. In this article we’ll cover the 12 most common AFib symptoms and how to get rid of them once and for all. Read on to learn more…

The Top 3 AFib Symptoms

Sadly, most AFib patients don’t experience palpitations. If you’re not sure what “palpitations” are, many of my patients describe it as if there is a fish flopping around in their heart.

In fact, I put palpitations as the third most common symptom associated with AFib. If everyone felt palpitations with AFib, patients would be alerted to the second AFib started which would lead to a much earlier diagnosis, quicker treatment, and a much better chance of avoiding the long-term complications from AFib.

With palpitations solidly in the number 3 position, the very most common AFib symptom I see is fatigue followed by shortness of breath or getting winded easily with exertion.

It can, of course, be hard to pin feelings of being fatigued and breathless to one specific problem. Fatigue and shortness of breath can be side-effects of many medications. They can also result from not exercising regularly, being overweight or not sleeping well.

But if you’re feeling tired and breathless, and you can’t figure out why, you need to find out why. Lara, one of my patients we discussed in our best-selling book, The AFib Cure, didn’t do that, at first. “I’ve skied my whole life,” she recalled. “Suddenly I couldn’t anymore. I was always so tired—the way I used to feel after a race, except I wasn’t racing.”

That is likely because Lara’s heart was beating much faster than normal and her body was struggling to keep up. It takes a lot of energy to keep a heart on overdrive, the same sort of energy it takes to engage in a heavy workout. But, like many people, Lara at first chalked up these symptoms as the consequences of “getting too old.” (Which is why, when we help our patients get their hearts back into normal rhythm again, they often remark how much younger they feel.)

The 4th, 5th, and 6th Most Common AFib Symptoms

Lightheadedness, dizziness and confusion are also very common symptoms of atrial fibrillation. “Brain fog,” the feeling of not being able to think clearly, is another common symptom. And, again, once you understand what AFib does inside the body, these symptoms make perfect sense. Our brains are ravenous for oxygen, after all, and oxygen moves through our bodies via our circulatory system. In a healthy human body, this system is perfectly designed to deliver oxygen exactly where it is needed, when it is needed. But when the organ at the center of this closed system is malfunctioning, the entire system begins to falter. The oxygen molecules being transported by hemoglobin, a protein carried throughout our bodies by our red blood cells, may still arrive, but not at the same, steady rate our brains are used to.

All of this helps explain why we, as well as other researchers, are coming to discover a long-term consequence of atrial fibrillation that is terrifying to a lot of people: brain damage. Our research team has discovered that many of the chemical signs of brain injury that are elevated after a concussion—like glial fibrillary acidic protein, stress response marker growth/differentiation factor 15, and tau protein—are chronically high in atrial fibrillation patients. These proteins, which typically are elevated in response to an injury to the brain and its barrier from the rest of the body, are released very early in people who have atrial fibrillation, a reflection of the chronic insult of the abnormal heart rhythm on the brain.

It’s not just molecules swimming around in our body that testify to the damage being done to our brains. When you use an MRI to look at the brains of people with AFib, nearly half have visible signs of brain damage in the form of brain lesions, even if they’ve never suffered from a stroke. Those who do not have brain lesions consistent with stroke often have volume loss, also known as “brain shrinkage,” and small patterns of brain injury called “white matter disease.” These changes reflect damage done to the brain both from atrial fibrillation and other medical problems, like hypertension and diabetes, that may have caused the AFib.

This might help explain why the rate of dementia is so much higher among people with atrial fibrillation. We’ve known for nearly half a century that lesions are more common in the autopsied brains of people who suffered from dementia at the end of their lives, but it hasn’t always been clear where these lesions came from. More recently, our research has shown that atrial fibrillation is independently associated with all forms of dementia, including Alzheimer’s disease. Not surprisingly, our ground-breaking research showed that the presence of AFib was a strong predictor of which dementia patients are at highest risk of death. Also, and quite disconcertingly, these findings suggested that the risk of Alzheimer’s, in particular, was increased even among younger AFib patients.

Other AFib Symptoms (Top AFib Symptoms 7-12)

7. Chest pain

Chest discomfort is always a scary symptom for AFib patients. How do you know if it is a life-threatening heart attack or just your AFib acting up again? While this may require a trip or two to the emergency room and a few visits with your cardiac electrophysiologist to figure out, in general, if the chest discomfort starts the exact second you go into AFib and then stops the very same second your AFib stops then there is a pretty good chance it is just the AFib.

8. Fainting

Fainting from AFib happens from a lack of blood flow to the brain. This can be from either the heart beating so fast in AFib or from the heart stopping for a few seconds when the AFib stops.

9. Anxiety

There is something very unsettling about AFib. And even for patients who don’t feel palpitations, there is a sense of generalized anxiety that happens when their hearts are out of rhythm and then goes away when normal sinus rhythm returns.

10. Sweaty

Over the years many of my patients have reported feeling sweaty, excessive sweating, or feeling “clammy” when their heart is doing its AFib thing.

11. Weakness

For many of my older patients, the only AFib symptom they experience is just generalized weakness while they are in AFib. Some older patients even report they have trouble getting out of bed or out of a chair when they are in AFib.

12. Urination

Surprisingly, many of my patients know they are in AFib because in the early stages of an AFib attack they have to keep running to the bathroom to urinate. What causes frequent urination in the early part of an AFib attack? A fibrillating atrium releases the hormone atrial natriuretic peptide (ANP) which causes the kidneys to quickly dump urine.

How to Make AFIb Symptoms Go Away

Based on my experience of having treated tens of thousands of AFib patients over the last 30+ years, most of my patients are suffering from at least one of the 12 symptoms covered in this article. And if you are like most of my patients, you probably want to get rid of these symptoms. The key to beating AFib, as we described in our book The AFib Cure, is as follows:

1. Get your AFib diagnosed and treated as fast as possible.

2. If you have AFib triggers, such as alcohol, stress, sleep deprivation, etc. avoid these triggers.

3. Live as healthy as you possibly can by optimizing your nutrition to maintain a healthy body weight, exercise every day, get enough rejuvenating sleep every night, and keep stress levels down.

4. If avoiding triggers and living as healthy as you possibly can doesn’t put your AFib into remission, consider an ablation.

5. Always track your health and maintain a lifelong commitment to healthy living.

If you would like to see me or one of the other cardiologists in my practice in Salt Lake City, Utah, please give my team a call at 801-266-3418. Also, if you like the photo attached to this article it was taken from my favorite chairlift, the 9990 chairlift at Park City Mountain Resort.


#329 Are Grains Bad for Your Heart?

January 30th, 2022 by

Are Grains Bad for Your Heart?

While there has been a recent flurry of books and websites demonizing grains in every form, the scientific literature does not support this belief. Indeed, in major study after study, real whole or intact grains have consistently been associated with decreased cardiovascular mortality, cancer and premature death.

Processed grains, on the other hand, behave just like sugar in the body. 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.

The key then is determining whether or not grains are bad for your heart lies in the distinction between whole or intact grains and processed grains. And an intact grain is one that hasn’t been turned into flour. For example, Quinoa and brown rice are intact grains unless they are pulverized into flour.

Can you eat grains if you’re trying to lose weight?

For those seeking to lose weight, even the healthiest of whole or intact grains should be eaten in moderation. In China’s Longevity Village that we described in our best-selling book The Longevity Plan, villagers ate 3 or 4 servings of grain per day at most, far less than what the typical American eats in a day, let alone the 11 daily servings that the U.S. government once recommended in its food pyramid. 

If bread is your thing, then ideally look for one of the flourless forms with no added sugar, industrial oils, or other preservatives; these often come frozen at health food stores. Sprouted multigrain and legume-based bread, often sold as Ezekiel bread, is a good choice for people who are not gluten sensitive.

Paleo bread is an option for people wishing to enjoy bread without the grains or gluten. Alternatively, you can make your own healthy bread with almond flour which doesn’t have the same gluceric effects as grains or by grinding your grain with the coarsest setting rather than pulverizing it into flour.

Why is grain flour such a problem for the heart?

What most people don’t realize is that finely ground 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? Thus, is it any surprise obesity and diabetes rates are reaching epidemic proportions. Sugar is a powerfully addictive drug whether it comes in the form of a Snicker’s bar or wheat flour.

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.

Like bread, pasta is another grain-based product that a lot of people can’t resist. It’s also typically made of heavily processed wheat. For people who enjoy spaghetti, lasagna, or baked ziti, I recommend substituting in spaghetti squash or quinoa. You can even find great tasting pastas made from mung beans, black beans, or edamame these days. Our current favorite is edamame spaghetti.

The bottom line on grains is pretty simple: Seek to eat grains in moderation and as close to their natural state as possible which means intact grains that haven’t been pulverized into flour.

Should heart patients avoid carbs?

That doesn’t mean you should avoid carbs altogether. Not at all. In fact, some researchers believe that while working to limit carbs in general might be a good idea, exceptionally low-carb diets may actually lead to a greater risk of AFib.

The key is making sure that, to the greatest extent possible, the carbohydrates you’re getting are complex carbs, including fruits and especially vegetables. 

For now, though, it’s important to do a realistic assessment of your habits related to sugars and processed carbs. Anyone who isn’t actively avoiding foods with any and all types of added sugar, and limiting their carbohydrate intake to those foods that are packed with complex carbohydrates, think vegetables and fruit, may be at an increased risk of AFib.

Grains are problematic for most of our heart patients because of the strong role that refined grains plays in diabetes and weight gain, but this doesn’t mean you need to avoid grains. If you do choose to eat grains, stick with intact grains whenever possible—foods like quinoa and brown rice, which haven’t been pulverized into flour as anything that has flour or added sugar—are a sure-fire way to send your blood sugar through the roof.

Many people believe that whole wheat or gluten-free flour are healthy, but these flours can also spike your blood glucose very quickly. If you can’t live without bread, keep an eye open for flourless breads, which have long been available at health food stores and are increasingly stocked at mainstream supermarkets.

4 Things to Consider If You Choose to Eat Grains

Dr. Dariush Mozaffarian, my friend and former classmate at Stanford University, is one of the world’s leading cardiologists in nutrition. When it comes to grains, he says, there are four things to consider:

1. The fiber content of grains (more is better)

2. The impact on blood sugar (the lower the better)

3. The whole-grain content (the more whole or intact the better)

4. The structure of grains (the less pulverized into fine flour or liquefied the better). 

I’ve found, though, that there’s a simple way to summarize all of these factors: As much as possible, the grains we eat should look pretty much the way they do when they come off the plant. 


Did you like the photo with this article? It was taken on a backcountry ski adventure with my young son.

#328 Is AFib Caused by Premature Aging? 6 Ways to Reverse Aging

January 30th, 2022 by

Does Atrial Fibrillation Have to Get Worse with Age?

AFib is a heart condition that, for many people, is little more than another inevitable consequence of aging, many doctors still tell their patients that there is nothing they could have done about it—and that there’s not much they can do now but make it “less bad.” They prescribe some drugs, or order up a procedure, and that is that. While AFib may be a warning sign that you are aging too fast, does atrial fibrillation have to get worse with age? And, is it possible to reverse aging to stop AFib?

Mary’s Experience with AFib

Mary had been a picture of health for most of her life. She had followed a mostly plant-based diet free of fried, processed, and fast foods. She didn’t eat sugar. She’d never been overweight. She did aerobics every day at the gym and attended a yoga class three times a week. She practiced deep-breathing exercises whenever stress levels were getting too high. She slept well at night. She even volunteered as a crosswalk guard at the elementary school across the street from her house.

And since no one in her family had ever been diagnosed with AFib, she was more than a little irritated when her doctor told her she had that arrhythmia. But here’s the thing: Mary was 94 years old. And the truth is that even if your genes are perfect and you do just about everything right, you can still get AFib as a result of age. Because just as your skin will wrinkle over the years, the simple act of living life will put some wear and tear on your heart cells over time.

But there’s a big difference between being 94 and 54—between AFib that results from natural aging and AFib that comes about due to premature aging. Most of the AFib cases we see are due to the latter kind of aging. And while there is nothing we can do to stop how many candles are on our birthday cakes—that’s chronological age—there is plenty we can do to slow the process of biological aging.

Stop Age Related Fibrosis of Your Heart

Fibrosis is a fancy term for scar tissue, which is made up of dead heart cells. If there is no fibrosis in your atria then a premature atrial contraction (PAC) spark from the pulmonary veins probably won’t trigger an AFib episode.

However, the more fibrosis you develop, the more likely it is that one randomly occurring premature beat from the pulmonary veins, or elsewhere in the atria, is all that is needed for a full-blown AFib attack, and a resulting visit to the emergency room. That’s why, if your goal is to stop AFib from getting worse, you absolutely have to stop the ongoing process of age related scarring or fibrosis. And if your goal is to make things better, you have to stop age related fibrosis of your heart.

What causes heart scarring (fibrosis)?

Before you can fight fibrosis, though, you’ve got to understand what it is. Fibrosis occurs naturally with aging—particularly after the age of 60. But natural scarring usually isn’t enough to sustain an AFib episode from a pulmonary vein- initiated premature contraction.

Excessive fibrosis, on the other hand, may disrupt how normal heart cells, called cardiomyocytes, look and move, just like how the kind of scarring we’re most familiar with—called dermal fibrosis—can make our scarred skin look and move differently than the rest of our skin. When we remember that every part of our heart is in constant movement, and all of those parts have been designed to work in harmony with the others, it becomes clear how this can become problematic.

Imagine, for instance, what would happen if you were to replace a valve in your home plumbing with one that was ever-so-slightly different in shape, or which moved a little differently than the valve that came before. Everything downstream of that valve would be impacted, right? The same thing is happening in the hearts of people with atrial fibrillation when cardiomyocytes are transformed from their ever-supple natural state to the tough and inflexible nature of scar tissue. Because in heart tissue, fibrosis causes another problem; it changes the ways in which electrical impulses move through our hearts.

Is AFib caused by premature aging?

The risk of AFib increases with age or premature aging, as we showed in our telomere study of AFib patients from my former hospital. But there’s an important difference between age and aging; the first term can be marked in months and years while the second term can only be seen in our biology. 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. 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.

6 Scientifically Proven Ways to Reverse Aging

As the work from my former hospital clearly showed that aging and premature aging may be a significant cause of AFib, can this aging process be stopped? While we’ll never be able to completely stop the aging process, we can slow aging to a crawl so that the AFib can be stopped. Below are the 6 best scientifically proven ways to “reverse” aging (click on each to see the study).

1. Optimize Stress Levels to Become 10 Years Younger
2. Faithfully Exercise To Take 10 Years of Your Telomeres
3. Optimize Your Diet to Reverse Telomere Aging By 5 Years
4. Maintain an Ideal Weight To Lengthen Telomeres By 9 Years
5. Sleep At Least 7 Hours To Reverse Telomere Old Age
6. Avoid Loneliness for Optimal Telomere Health

Did you like the photo attached to this article? I took this picture on a recent run with my teenage daughter. It was taken with an iPhone using the night photo feature on a full moon as we were running on a ski trail in Park City, Utah. You can see the lights of Park City below.

If you are looking for drug-free options to treat atrial fibrillation and would like to be treated in our AFib Clinic, please give my team a call at 801-266-3418 for an in-person consultation (sorry–telemedicine visits outside of Utah are not possible).

#327 Does Stress Cause Atrial Fibrillation?

January 8th, 2022 by

Does Stress Cause Atrial Fibrillation?

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

Evangelina’s Experience with Stress and AFib

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

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

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

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

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

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

Dr. Legallois’ Experience with Stress and AFib

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

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

What do studies say about stress and AFib?

What kinds of challenges can create stress that triggers AFib?

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

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

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

Physical Stress also Triggers AFib

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

How I Manage Wintertime Stress

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

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

#326 How To Lose 100 Pounds

January 1st, 2022 by

How to lose 100 pounds

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

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

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

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

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

1. Eliminate All Temptations

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

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

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

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

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

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

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

3. Track Your Food and Weight Daily

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

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

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

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

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

4. Exercise 1 Hour Every Day

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

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

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

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

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

December 27th, 2021 by

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

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

What Causes Atrial Fibrillation Strokes?

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

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

What Happens During a Stroke?

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

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

Why Are Blood Thinners Used for Atrial Fibrillation?

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

Left Atrial Appendage Closure (Watchman or Amulet devices)

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

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

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

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

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

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

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

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

3. Left atrial appendage closure does nothing for AFib

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

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

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

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

Despite the Risks Patients Love the Watchman Procedure

Despite the 4 significant challenges with left atrial appendage closure with either the Watchman or Amulet devices, patients still love this procedure. Blood thinners frighten patients and many of my patients will do anything to get off these medications. And because left atrial appendage closure can be thought of as a blood thinner alternative, patients love them.

If you want to learn more about atrial fibrillation, be sure to check out our best-selling book, The AFib Cure. To see one of the cardiologists or EP’s in our practice, please call my team at 801-266-3418. Sorry, telemedicine visits outside of the state of Utah are not possible.

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

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

December 26th, 2021 by

Dear readers,

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

Thanks for listening!


Wise Athletes Podcast episode website

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

December 11th, 2021 by

The 12 Best Ways to Fix Atrial Fibrillation with Sleep

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

Most of Us Are Really Bad at Sleep

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

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

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

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

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

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

Why is Sleep so Critical for Atrial Fibrillation?

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

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

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

The 12 Best Ways to Fix Atrial Fibrillation with Sleep

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

1. Go to Bed at the Same Time Every Night

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

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

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

2. Wake Up at the Same Time Every Morning

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

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

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

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

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

3. Create the Perfect Sleeping Room

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

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

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

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

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

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

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

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

5. Have a Caffeine Curfew

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

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

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

6. Avoid the Booze

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

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

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

7. Time Your Workouts (Outdoors is best)

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

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

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

8. Take a Warm Bath or Shower

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

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

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

9. Read Something Relaxing

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

10. Treat Your Sleep Apnea

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

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

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

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

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

11. Time Your Fluids

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

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

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

12. Consider a Natural Sleep Aid

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

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

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

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

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

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

#322 The 11 Worst Medications For Causing Atrial Fibrillation

November 28th, 2021 by

The 11 Worst Medications Causing Atrial Fibrillation

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

1. Diuretics

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


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

3. Proton Pump Inhibitors

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

4. Steroids

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

5. Any Stimulant

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

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

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

7. Fish Oil

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

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

8. Antiarrhythmics like Amiodarone, Flecainide, and Propafenone

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

9. Antidepressants

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

10. Opiates

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

11. Too Much Vitamin D

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

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

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

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

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

Consider an Ablation

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

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

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

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

#321 The 7 Most Important AFib Triggers to Avoid

November 20th, 2021 by

The 7 Most Important AFib Triggers to Avoid

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

What are your AFib triggers?

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

1. Alcohol

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

2. Exercise

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

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

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

3. Dehydration/Electrolyte Depletion

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

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

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

4. Poor Sleep

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

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

5. Stress/Anxiety

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

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

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

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

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

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

 7. Energy Drinks

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

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


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

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

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

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

November 14th, 2021 by

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

By Kate Clemens with John Day

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

Dr. Day’s Experience with Low Caloric Density Eating

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

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

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

Caloric Density Works

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

5 Key Findings from Weight Loss and Caloric Density Research

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

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

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

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

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

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

Never Diet Again by Following the Caloric Density Eating Approach

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

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

Kate’s 6 Tips to Healthy Eating

1. Get in tune with hunger and satiety:

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

2. Order matters:

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

3. Form matters:

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

4. Dilution Solution:

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

5. Facts on Fats:

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

6. Less High Dense:

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

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

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

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

November 6th, 2021 by

8 Scientifically Proven Ways to Lower Your Blood Pressure Naturally

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

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

My Struggle with High Blood Pressure

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

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

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

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

1. Cut the Sodium

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

2. Eliminate any Added Sugars

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

3. Commit to a Daily Workout

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

4. Drop Some Weight

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

5. Embrace a High Fiber Diet

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

6. Learn to Eat Plant-Based

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

7. Get More Nitric Oxide from Greens and Root Vegetables

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

8. Lower the Stress Levels

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

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

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

November 2nd, 2021 by

13 Simple Weight Loss Tips That Actually Work

Authored by Kate Clemens with Dr. John Day

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

1. Diets Don’t Work, Lifestyles Do

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

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

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

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

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

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

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

3. Find What Works for You

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

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

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

4. Crash Diets Crash Your Metabolism

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

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

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

5. Have a Daily Plan

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

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

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

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

6. Schedule at least a 12-Hour Daily Fast

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

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

7. Dairy is Personal Decision

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

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

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

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

8. Keep Your Meat Wild

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

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

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

9. The More Fiber the Better

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

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

10. Be Accountable for Your Food Choices

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

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

11. Eat the Right Carbs

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

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

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

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

12. Use Breathing Techniques to Help with Stress Eating

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

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

13. Relationships May Be More Important than Food Choices

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

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

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


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

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

#317 Can You Exercise with AFib?

October 16th, 2021 by

Can You Exercise with AFib?

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

Can Exercise Cause AFib?

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

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

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

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

Can Not Exercising Cause AFib?

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

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

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

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

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

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

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

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

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

Dr. Day’s 3 Thoughts on Exercise and AFib

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

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

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

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

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

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

October 9th, 2021 by

The 4 Best Reasons Why Intermittent Fasting May Prevent AFib

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

Why Did I Write this Article?

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

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

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

1. Fasting May Slow Aging

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

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

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

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

2. Fasting May Lower Blood Pressure 10 mmHg

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

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

3. Fasting is Good for a 9 Pound Weight Loss

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

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

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

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

 4. Fasting May Fix Diabetes

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

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

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

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

How to Fast?

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

Will Fasting Cure AFib?

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

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

#315 The 7 Best Ways to Stop an AFib Attack

September 25th, 2021 by

The 7 Best Ways to Stop an AFib Attack

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

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

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

1. “Pill-in-the-Pocket”

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

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

2. Rehydrate

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

3. Optimize Your Electrolytes

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

4. Exercise Away Your AFib Attack

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

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

5. Lie Down

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

6. Stimulate Your Vagus Nerve

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

7. Get a Quick Cardioversion

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

Concluding Thoughts

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

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

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

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

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

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

September 24th, 2021 by

Is Fish Oil Still Good for the Heart and Longevity?

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

Six Reasons Why I’ve Taken Fish Oil

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

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

2. Fish Oil Lowers Triglycerides

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

3. Fish Oil May Keep Inflammation Levels Lower

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

4. Fish Oil May Promote Longevity

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

5. Fish Oil May Help with Weight Loss

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

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

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

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

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

Fish Oil May Increase Your Risk of Atrial Fibrillation

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

Does Fish Oil Increase Your Bleeding Risk?

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

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

Fish Oil in China’s Longevity Village

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

Is Dr. Day Still Taking Fish Oil?

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

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

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

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

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

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

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

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

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

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

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

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

#313 Get Out of AFib as soon as Possible

September 21st, 2021 by

Get Out of AFib as soon as Possible

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


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

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

“Get Out of AFib” also Benefits Heart Failure Patients

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

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

How Long Do You Have to Get Out of AFib?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

September 10th, 2021 by

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

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

The Vital Trial

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

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

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

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

Vital Trial and Atrial Fibrillation Risk

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

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

Our 2011 Vitamin D Atrial Fibrillation Study

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

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

Dr. Day’s 7 Thoughts on Vitamin D

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

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

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

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

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

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

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

Is Natural Vitamin D Best?

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

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

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

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

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

Is Vitamin D Good for the Heart?

#311 Ablation or Drugs First for Atrial Fibrillation?

September 10th, 2021 by

Ablation or Drugs First for Atrial Fibrillation?

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

Background Information

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

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

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

1. JAMA Cardiology: Ablation or Drugs First

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

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

1. Ablation is better at maintaining normal sinus rhythm.

2. Ablation results in less hospitalizations.

3. Ablation is every bit as safe as medications.

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

2. British Medical Journal Heart: Ablation or Drugs First

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

3. Circulation Arrhythmia and Electrophysiology: Ablation or Drugs First

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

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

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

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

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

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

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

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

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

Ablation or drugs first for atrial fibrillation?

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

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

#310 10 Tools To Combat Sugar Cravings

April 10th, 2021 by

10 Tools To Combat Sugar Cravings

By Kate Clemens

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

1. Hydrate

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

 2. Eat Naturally Sweet Foods

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

3. Sleep

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

4. Kick the caffeine to the curb

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

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

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

6. Move Daily

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

7. Forget about Fat-Free

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

8. Get Enough Protein

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

9. Add Some Spice to Your Life

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

10. Make Life Sweeter

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

Kate Clemens Bio

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

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

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


(415) 676 0353


#309 10 Bad Conditions Linked to Low Magnesium

April 10th, 2021 by

10 Bad Conditions Linked to Low Magnesium

By Kate Clemens

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

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

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

Magnesium: What is it?

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

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

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

15 Mighty Magnesium Rich Foods


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

(75-80% CACAO)

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

A Mighty Magnesium Breakfast


1 Ezekiel Sprouted Grain Tortilla  (48 mg Mg)

1 medium banana (32 mg Mg)

2 TBs almond butter (89.3 mg Mg)

1 TB Flaxseed (40.4 mg Mg)

½ c strawberries (9 mg Mg)

½ blueberries (5 mg Mg)

Cinnamon (to stabilize blood sugar!!)


1.  Warm up your tortilla in the toaster

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

3. Lay your banana on top of the almond butter

4. Sprinkle on your flaxseed seed and cinnamon

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

Bon Appetit!

Should You Supplement?

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

1. What is my intake? 

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

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

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

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

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

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

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

Which Magnesium Supplement is Best?

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

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

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

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

Do Magnesium Supplements Cause Diarrhea?

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

Low Magnesium: A Very Preventable Condition

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

Kate Clemens Bio

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

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

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


(415) 676 0353


#308 9 Signs You Aren’t Getting Enough Potassium

April 10th, 2021 by

9 Signs You Aren’t Getting Enough Potassium

By Kate Clemens

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

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

Potassium: What is it?

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

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

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

The 9 Signs You Aren’t Getting Enough Potassium

1. Heart palpitations

2. Atrial fibrillation

3. High blood pressure

4. Muscle cramps and spasms

5. Weakness and fatigue

6. Tingling and numbness

7. Breathing difficulties

8. Mood changes

9. Digestive problems

What Causes Low Potassium?

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

What Causes High Potassium?

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

Where Should Your Potassium Levels Be?

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

How Much Potassium Should You Eat Each Day?

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

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

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

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

13 Potassium Packed Foods


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

Should You Supplement? 

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






Kate Clemens Bio

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

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

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


(415) 676 0353