Preventing AFIB

There’s a common type of heart condition that causes irregular heartbeats. It’s called atrial fibrillation – or Afib for short – and more and more people every year are diagnosed with it. Today, we start with the best foods to eat and avoid to decrease our risk of Afib.

Atrial fibrillation, or Afib, is the most common clinical arrhythmia––meaning abnormal heart rhythm––affecting millions of Americans, recognized as a global public health problem due to its significant burden of death and disease resulting from stroke, heart attacks, and heart failure. Is there any particular diet that may help prevent or treat it?

Well, recently we learned what not to eat. Low-carb diets are associated with increased risk of developing atrial fibrillation, for a variety of reasons. First of all, people on low-carb diets may be eating fewer anti-inflammatory foods like vegetables, fruits, and whole grains. Reducing intake of these anti-inflammatory foods may be one of the important mechanisms for the risk of getting Afib. Secondly, a low-carbohydrate diet means increased protein and fat consumption, which may stimulate oxidative stress––the formation of free radicals, which was also demonstrated to be associated with Afib. Finally, the effect could result from the increased risk of other cardiovascular disease, which can set you up for Afib. And indeed, low-carb diets are associated with an increased risk of overall mortality, dying from any cause, as well as specifically dying from cardiovascular disease and dying from cancer.

Dietary recommendations for patients with heart rhythm disorders is essentially the opposite of a low-carb diet, centered on a day-to-day basis around fruits, vegetables, grains, beans, and nuts, with seafood at most a few days a week; eggs, dairy, and chicken on more like a once-a-week basis; and other meat on more of a once-a-month basis, in part because we’re trying to cut down on saturated and trans fats.

Whole food, plant-based diets emphasizing whole grains, legumes (beans, split peas, chickpeas, and lentils), vegetables, fruits, and nuts, and excluding most (or all) animal products may play a special role, as they not only maximize protective foods, but also exclude potentially harmful animal foods. For example, there is persuasive evidence that avoidance of certain foods may beneficially affect atrial fibrillation––such as the avoidance of dark fish and alcohol.

The dark fish thing comes from the Framingham Heart Study. By dark fish, they mean salmon, swordfish, bluefish, mackerel, and sardines. And they found in an exploratory analysis that those participants who consumed more than four servings of dark fish, like salmon or sardines, a week were at a whopping six-fold higher risk of developing Afib––though the intake of fish in general didn’t seem to have any effect.

We’re not exactly sure why alcohol is so bad when it comes to arrhythmias, but we might have as much as an 8 percent increase in the relative risk of Afib associated with each drink one might have per day––though drinking coffee, or caffeine in general, does not seem to be related to arrhythmia risk.

Where plant-based diets really shine, though, is in Afib risk factor management. Plant-based diets may reduce the likelihood of many traditional risk factors that are associated with Afib, including hypertension, hyperthyroidism, obesity, and diabetes.

High blood pressure is one of the major risk factors, accounting for about one-fifth of all new cases of Afib, which is where plant-based diets can come in: improving vasodilation, the ability for your arteries to expand naturally, in addition to the anti-inflammatory and antioxidant effects, and increased potassium intake, and decreased blood viscosity or sludginess.

In terms of hyperthyroidism, excluding all animal foods from one’s diet is associated with half the prevalence of hyperthyroidism compared with those who eat meat, with vegetarians and fish-only diets associated with intermediate protection.

Having excess body fat may be responsible for about another fifth of all Afib cases, but the good news is significant weight loss is associated with a six-fold greater freedom from atrial fibrillation. You can see that those with Afib who started out overweight, but lost 10 percent or more of their body weight, five years later, only 10 percent ended up with Afib, whereas those who lost less than 3 percent or gained weight, 60 percent ended up with Afib––six times more.

Here are all the atrial fibrillation risk factors that can be prevented, arrested, or even reversed with a healthy enough plant-based diet. High blood pressure, type 2 diabetes, obesity, systemic inflammation, and heart disease. In light of these findings, dietary modifications are of paramount importance. But you don’t know if it could actually cure atrial fibrillation, until you put it to the test.

Unfortunately, all we have are case reports, but this one is quite compelling. An 82-year-old man presents with polypharmacy, meaning on a bunch of different medications, due to coronary artery disease, a heart attack history, ischemic cardiomyopathy, high cholesterol, high blood pressure, and persistent atrial fibrillation, who presented with memory loss, cognitive impairment, fatigue, and weakness. Now, if you’re not going to change the diet and lifestyle that led to all the problems in the first place, then drugs can certainly be better than nothing. Yet, commonly used blood pressure and cholesterol-lowering medications provide actually little absolute risk reduction and pose significant risk of adverse effects, as I’ve explored before. So, this guy decided to start treating the underlying cause. So, he started a whole food, plant-based diet with moderate physical activity, resulting in a rapid reduction of high cholesterol and high blood pressure, and the discontinuation of statin, antihypertensive, and beta blocker drug therapy. The patient also reported reversal of impaired cognition and symptoms associated with atrial fibrillation and ischemic cardiomyopathy, including light-headedness, fatigue, and weakness.

Check out these numbers. Started out on all his medications. Started eating healthier in February, and his LDL bad cholesterol dropped 37 percent down to 72. And you say yeah, but he’s still on cholesterol-lowering statin drugs. But even after his doctor discontinued it and his blood pressure meds, his cholesterol stayed down, and his blood pressure completely normalized. Okay, but what happened to his atrial fibrillation? Completely resolved.

Here’s how the patient described it. “In December 2017, I suffered a near-fatal heart attack and was rushed to the hospital. I immediately had a stent put in. The following day, I was prescribed a number of drugs to manage my condition. My brain fog got worse, and I felt tired all the time. I decided enough was enough. I had already lost four years of my life to medication-induced brain fog. I wasn’t going to sacrifice more. I had been eating a wholesome Mediterranean diet, but I was then educated on the benefits of cutting out all the crap. And now? I have the strength to lift weights and walk and run on the treadmill an hour every day. I feel more alive than I have for years. I wake up each morning with a clear head and happy heart, grateful to not have to take a handful of drugs. Even though I’m not perfect with my diet, I’ve seen huge benefits from eating this way. My blood tests have shown remarkable improvement, which keeps me motivated to stay on track. Because of my improvement, my cardiologist suggested I could let go of his last remaining drug. Eating this food gave me an opportunity to reclaim my health.”

In our next story, we look at how fish and fish oil consumption do not appear to protect against heart disease, arrhythmias, or sudden death. What about cancer?

2013 was a bad year for fish oil. Claims were crushed that the long chain omega-3s in fish oil, EPA, and DHA would stop the progression of heart disease. And then, DHA was associated with increased risk of prostate cancer and monumentally failed to treat macular degeneration. This over-the-top rhetoric sounded a little suspicious, and indeed, the paper was retracted, because the author sells some rival supplement that he failed to disclose. But, he does have a point.

I covered the fish oil failure for heart disease. What about the increased cancer risk? Men with the highest circulating levels in their blood of the long-chain omega-3 fat DHA were found to be at higher risk for prostate cancer, though, a subsequent compilation of all such studies suggested EPA, the other major long-chain omega-3 in fish and fish oil, may be more closely associated with increased cancer risk. Either way, these long chain omega-3s have been promoted for prevention of heart disease and cancer.

But now, we know that not only does there appear to be no benefit for death, heart attack, or stroke, but there may be an elevation in cancer risk. The general recommendations to increase the intake of these fats should consider its potential risks.

How could eating more fish or fish oil increase cancer risk? Well, there are some industrial pollutants, like PCBs, linked to increased prostate cancer risk, and the primary source of exposure in the general population is believed to be through diet: from fish, meat, and dairy products. If you do a supermarket survey, the PCBs] are highest in freshwater fish, and lowest in vegans—cannibals take note! No, that’s just how they label the market basket of plant foods, though vegans have been tested, and were found to be significantly less polluted, including the PCB linked to prostate cancer.

And so, maybe the confounding factor was meat consumption in general, not just fish. And, lower meat consumption may be a reason for the lower rates of prostate cancer in the lower DHA group, as the consumption of well-done meat is associated with an increased risk of prostate cancer, and intake should be restricted.

We also used to think omega-3s could protect us from arrhythmias (abnormal heart rhythms), like atrial fibrillation. Millions suffer from the condition, which causes an irregular heartbeat and a higher risk of stroke and death, but fish and fish oil consumption does not appear effective for preventing it or treating it.

Other arrhythmias can be life-threatening and cause sudden death. Despite initial encouraging results, in more recent studies, fish and fish oil consumption have not only failed to reduce sudden cardiac death with omega-3s, but actually increased mortality in cardiac patients. For example, men with heart disease, advised to eat more oily fish, or supplied with fish oil capsules, were found to have a higher risk of cardiac death—maybe because of the contaminants in fish, such as mercury?

In either case, given the inconsistent benefits and the potential adverse effects, omega-3s must be prescribed with caution, and generalized recommendations to increase fish intake or to take fish oil capsules need to be reconsidered.

Finally today, did you know that a cup a day of beans, chickpeas, or lentils for three months may slow resting heart rate as much as exercising for 50 hours on a treadmill?

The accumulated weight of evidence linking elevated resting heart rate to a shortened lifespan—even in apparently healthy individuals—makes a strong case for it to be considered in the assessment of risk. It’s got strong advantages. Taking one’s pulse is cheap, takes little time, it’s understandable to people, and it’s something everyone can do, at home, to measure their progress to become an active participant in their own health management.

Every ten beats per minute increase is associated with a 10 to 20 percent increase in the risk of premature death. There seems to be a continuous increase in risk with increasing heart rate, at least for values above a beat a second. So, we can just look at our watch, and if our heart is beating faster than the seconds go by—even when we’re sitting quietly, then we have to do something about it, especially when we start getting up to 80 or 90. Men with no apparent evidence of heart disease with a pulse of 90 may have five times higher risk of sudden cardiac death—meaning their first symptom is their last—compared to those down in the safety zone. Living up around 90 increases heart disease risk at a level similar to smoking.

If you ask most doctors, though, 90 is considered normal. The accepted limits of heart rate have long been set at 60 to 100 beats per minute. How did they come up with that? It was adopted as a matter of convenience, just based on the scale of the squares on EKG paper. A historical accident, like the QWERTY keyboard, that just became the norm.

Sixty to 100 doesn’t even represent the bell curve. These cardiologists measured the heart rate of 500 people, and concluded that 45 to 95 was a better definition of normal, rounding to 50 to 90, which a survey of leading cardiologists concurred with. Now, we know that normal doesn’t necessarily mean optimal, but doctors shouldn’t tell people with heart rates in the 50s that their heart rate is too low. In fact, these people may be right where they should be.

Certainly, a heart rate higher than 80 should ring an alarm bell, but what can we do about it? Exercise is one obvious possibility. Ironically, you make the heart go faster so that the rest of the time your heart beats slower.

The public health benefits of physical exercise, especially for heart protection, are widely accepted, and among the many biological mechanisms proposed to account for this risk-reducing effect is autonomic nervous system regulation of the heart. That’s your brain’s ability to slow down the resting beat of your heart.

If you put people through a 12-week aerobic conditioning program of cycling, StairMaster, and running on a treadmill, you can drop their resting heart rate down from around 69 to about 66; so, a three beat per minute drop. And, of course, you have to keep it up; stop exercising, and your resting heart rate goes right back up.

Exercise is just one way to drop our heart rate, though. The way to our heart may also be through our stomach. What if, instead of three months of exercise, you did three months of beans? A cup a day of beans, chickpeas, or lentils. The first randomized controlled trial of beans for the treatment of diabetes. And indeed, successfully improved their blood sugar control, dropping their average A1C level from 7.4 to 6.9, but this was also the first study to ever assess the effect of bean consumption on heart rate, and, indeed, one of the few to determine the effect of heart rate of any dietary intervention. This is particularly important in diabetics, since having a higher resting heart rate not only increases their risk of death just like everybody else, but also appears to predict greater risk of diabetic complications, such as damage to the nerves and eyes.

So, how did beans do? A 3.4 beat drop in heart rate—just as much as the 50 hours on a treadmill. We’re not sure why beans are as powerful as exercise in bringing down one’s resting heart rate. In addition to the potential direct beneficial effects of all the good stuff in legumes, there is also the potential displacement value of reducing some of the animal protein foods by eating so many beans instead. Regardless, we should consider eating pulses for our pulse.