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Undoctored Protocols: Atrial Fibrillation






afib Can you stop or prevent atrial fibrillation (AF)? There are a number of important steps you can take to 1) prevent the development of the very common disorder of heart rhythm, atrial fibrillation, and 2) make it less likely to recur once you’ve experienced an episode.

One thing we CANNOT do is to use our strategies to stop an episode once it occurs; this situation needs to be addressed by your doctor. As in many areas of health, prevention is powerful but requires extended periods of time to work, not fast enough to address the dangers of an acute situation. Nonetheless, by applying some basic Undoctored principles of health, you can have substantial impact on your heart’s potential for this abnormal heart rhythm.


Overview

As with every other Undoctored protocol, we start by applying all the strategies of the Undoctored Wild, Naked, Unwashed program—the longer you apply them, the more effective they become. The elimination of grains and sugars is especially powerful, but  omega-3 fatty acid supplementation, iodine/thyroid normalization, magnesium supplementation, and restoration of vitamin D each play an important role, as well, and must be addressed before proceeding to any of the additional components of this protocol. Unfortunately, suppression of recurrent bouts of A Fib can be difficult for some, even with this all-out Undoctored effort. The key is to therefore institute these strategies as soon as possible before the rhythm becomes irreversibly established.

For additional background discussion on atrial fibrillation, see the discussion following the protocol.


Magnesium

Magnesium restoration needs to be assured, so we resort to the best absorbed form, magnesium bicarbonate, that results by using our recipe for magnesium water (below). Use magnesium water in place of other magnesium supplements. Magnesium water is the quickest, most effective, best absorbed form of magnesium available, helping suppress A. fib the most. Each 4 ounce (1/2 cup) serving provides 90 mg of elemental magnesium. Start by drinking 4 ounces of magnesium water three times per day, increase to 6 ounces three times per day if you tolerate the increase without loose stools, which provides 405 mg per day of elemental magnesium.

Monitoring magnesium levels can also be helpful by identifying low levels. Avoid the common serum magnesium level which underestimates deficiency and obtain the red blood cell (RBC) magnesium level, a more assured reflection of magnesium tissue levels. Aim to attain the high end of the reference range or just above. For instance, if the reference range for RBC magnesium for your laboratory is 4.2 to 6.2 mg/dl, aim for 6.0 to around 6.4 mg/dl. Note that this requires months to years to accomplish with full-dose, consistent magnesium supplementation.

Magnesium Water
Yield: 2 liters   2-liter bottle of seltzer (not tonic water or other sugar-containing carbonated water) 3 tablespoons unflavored milk of magnesia Naturally flavored extracts and/or sweetener (e.g., flavored liquid stevias).

Uncap the seltzer and pour off a few tablespoons. Shake the (unflavored only) milk of magnesia, and pour out 3 tablespoons. (Most brands come with a handy measuring cup that works perfectly.) Pour the milk of magnesia into the seltzer slowly, followed by the extract and sweetener.   Cap the bottle securely, and shake until all the sediment has dissolved. Let the mixture sit for 15 minutes and allow to clarify. If any sediment remains, shake again. Optionally, add a few drops of naturally flavored stevia to taste. Drink as instructed above.


Manage Sleep

Sleep deprivation, even a single night, has the potential to trigger an episode of A Fib, or to make it more readily provoked by other triggers. It is therefore important, as often as possible, to obtain adequate sleep.

Consider one of the many sleep monitoring devices or apps that provide feedback on hours slept, phases of sleep such as deep sleep and REM, etc., as such feedback can uncover patterns of sleep that can be improved, thereby yielding improved sleep quality.


Efforts to Minimize Visceral Fat

Because loss of visceral fat is accompanied by reduction of pericardial fat that drives A Fib to a substantial degree (discussed below), reduction in such inflammatory fat can be expected to reduce the potential for recurrent A Fib.   Obesity increases risk for A Fib by 50%. Risk for A Fib increases linearly with a BMI of 27 and higher in females, 28 and higher in males. Tracking waist size (measured at the level of the navel) is an easy and reliable indirect index of total and visceral abdominal fat. Risk for A Fib increases linearly with waist circumferences, such that waist measurements of ≥94 cm (42.7 inches) in Caucasian men and ≥80 cm (36.4 inches) in Caucasian women; ≥85 cm (38.6 inches) in Asian men and ≥80 cm (36.4 inches) in Asian women are associated with marked increase in risk, increasing linearly above these values. Note that individual susceptibility to visceral fat effects can vary and some people will need to achieve waist size and BMI closer to ideal.

Achieving BMI and waist size below these cutoff values is therefore desirable, as this is associated with reductions in visceral and pericardial fat. In addition to the efforts of the Undoctored Wild, Naked, Unwashed program that reduces visceral fat, intermittent fasting and/or ketosis can be helpful to accelerate the process. See the Undoctored Inner Circle videos and discussions about these strategies.


Heart Rate Variability Monitoring

This form of feedback achieves something called “coherence”: bringing the variation in beat-to-beat heartbeat in synchrony with the respiratory cycle (breathing). The key is to apply one of the many heart rate monitoring devices (discussed separately in the Undoctored Inner Circle) to achieve coherence. Practiced over time, the response can be activated at will and used to reduce potential for A Fib recurrence or to break a recurrence, as achieving coherence involves accentuation of the parasympathetic nervous system response that discourages perpetuation of the rhythm and can, in some people, be used to “break the rhythm.


Additional Discussion on Atrial Fibrillation

Normal Heart Rhythm
Yourheart beats 60 or so times per minute, reliably, every day. For some, the rate is slower, for others faster. But you count on this wonderful mechanism every day without consciously directing its activity.

This consistent beat-after-beat rhythm originates with the primary rhythm-generating center in the heart, the sinoatrial, or SA, node, located in the right upper chamber of the heart, the right atrium. This electrical impulse then disseminates throughout the rest of the heart muscle - the left atrium, and the major blood pumping chambers, the right and left ventricle. This ordered sequence ensures that blood courses through the heart in an orderly fashion to supply oxygen to the brain and body.

The electrical system of the heart, however, is susceptible to many influences that distort, or even destroy, its ability to properly originate and conduct the electrical impulses of heart rhythm. Thankfully, the heart is wonderfully well equipped to withstand destructive forces that might impair its electrical activity. If the conduction system at some point fails, such as the SA node, secondary “backup” rhythm centers emerge, providing a source for effective heart beats. However, the protective “fail safe” mechanisms of the heart are not foolproof.

What is Atrial Fibrillation?
Atrial fibrillation is one common example of a disturbed heart rhythm. While debate has raged for years over just where in the atria this rhythm originates and why it develops, the latest thinking is that it originates in the region where the pulmonary veins (returning blood from the lungs to the heart after being exposed to oxygen) meet the left atrial tissue. The origin of 90% of atrial fibrillation has been mapped to this area. For unclear reasons, chaotic and rapid electrical signals are emitted from this area, transmitted down into the ventricles and causing the irregular and rapid heartbeat characteristic of atrial fibrillation. Because the impulses transmitted down from the source to the ventricles generally occur at rate of 150 to 300 beats per minute, the heart rate or pulse you sense is much faster than normal. For this reason, most people experience breathlessness, lightheadedness, or fatigue if the rapid rhythm is sustained. In addition to rapid heart rate, the useless fibrillatory action (i.e., not orderly contraction) of the atria fail to make the usual 20% contribution to the heart’s overall blood volume output, contributing further to the sensation of limited exercise capacity and breathlessness.

The longer the electrical chaos of atrial fibrillation persists, the more likely a peculiar thing happens: “electrical remodeling” occurs, i.e., changes in the electrical energy-generating capacity of atrial muscle cells develop that make fibrillation more likely to persist, thus the common observation that, the longer atrial fibrillation persists, the more difficult it is to regain normal heart rhythm. Electrical remodeling can then be followed by structural remodeling, in which increasing quantities of electrically-inert fibrous tissue are deposited, further inhibiting the prospects of resuming normal conduction and normal heart rhythm. Such changes generally require atrial fibrillation to persist for several months continuously.

Occasionally, someone will either knowingly or unknowingly remain in atrial fibrillation with a rapid heart rate but take no corrective action. After several weeks, serious complications develop, including a marked reduction in left ventricular output and ejection fraction (i.e., the main blood pumping chamber is weakened), along with water retention and congestive heart failure. While dangerous, once managed appropriately, these changes are reversible.

The new consumer devices to monitor heart rhythm, such as the AliveCor Kardia device (www.alivecor.com), can be used to identify A Fib. A normal heart rhythm is comprised of several parts: a P-wave representing atrial electrical activity, a QRS-wave that represents ventricular electrical activity, and a T-wave that represents repolarization or recovery electrical activity:

alivecor
From Yanowitz FG, University of Utah


In normal (SA-node driven or “sinus”) heart rhythm, the PR interval, i.e, the time interval between the onset of the P-wave and the onset of the QRS-wave, should be no more than 0.2 seconds (5 small boxes of 0.04 seconds each). Any PR interval longer than 0.2 seconds suggests abnormal atrial anatomy, e.g., enlargement from high blood pressure or factors that have damaged the atrial conduction system, such as longstanding high blood sugars.

A Fib can be recognized by an abence of P-waves with QRS waves that are described as “irregularly irregular,” i.e., irregular QRS waves occurring in no predictable pattern:

pqrst wave
From Lau J, Circulation 2012


Note that the ventricular rate, i.e., the rapidity of QRS waves, can vary widely. Should A Fib be identified, this is a matter best addressed as soon as possible by a healthcare provider.

Atrial Fibrillation: Not Yet an Epidemic, But Close
Atrial fibrillation is the most common abnormal heart rhythm that carries implications for health, responsible for approximately 5% of hospital admissions. It remains largely, though not exclusively, a condition that affects people in their sixth decade and onward. Overall, approximately 1 in 15 people can expect to experience atrial fibrillation at least once in their lives, if not repeatedly or chronically. While it can affect people even in their 20s and 30s, it is uncommon in these age groups except in situations of excessive alcohol use, congenital heart conditions or other substantial structural abnormality.

The very concerning and broad deterioration of American health, thanks to such factors as the decrease of physically active occupations and increase in sedentary activities, not to mention the perverse and destructive “official” dietary advice, such as that of the Dietary Guidelines for Americans and the USDA My Plate and My Pyramid to cut our fat intake and consume more “healthy whole grains,” we can confidently expect that atrial fibrillation will, over the years demonstrate a substantial increase in incidence in the population. In the Undoctored approach, of course, we take a smarter approach and do not follow such absurd advice.

Weeds in the Garden

Let’s say you have a vegetable garden. The soil is rich, there are normal insects, bacteria, protozoa, molds, fungi, and earthworms in the soil, and your green peppers and tomatoes grow vigorously and are nutritious and delicious when ripe. But what if your soil is dry, lacks proper nutrients, and you previously used synthetic herbicides that disturbed normal soil organisms? That’s the situation in which weeds can gain control of the soil, outmuscling your fragile peppers and tomatoes.

A similar situation applies to atrial fibrillation. Think of normal heart rhythm as the healthy green peppers and tomatoes; think of atrial fibrillation as the weeds in your garden: This “weed” tends to grow and take over the garden if the soil is unhealthy.

So what makes the “soil” of your heart unhealthy and thereby more prone to allow atrial fibrillation to take over? Among the factors identified:

  • Hypertension—that exerts pressure effects on heart muscle structure
  • Diabetes—likely via the process of endogenous glycation and oxidation
  • Overweight and obesity
  • Smoking
  • Congestive heart failure and other forms of structural heart disease, such as cardiomyopathies
  • Valvular heart disease—mitral valve disease, aortic valve disease
  • Hypertensive heart disease (left ventricular hypertrophy, or abnormally thickened heart muscle due to hypertension)
  • Sleep apnea
  • Thyroid disease—both hyperthyroidism (acutely) and hypothyroidism (chronically>
  • Excess pericardial fat

The last item, excess pericardial fat, fat that surrounds the heart contained within the fibrous sac that encloses the heart, the pericardium, has recently been strongly associated with atrial fibrillation. Compared to Body Mass Index (BMI), for instance, volume of pericardial fat was several-fold more powerful a predictor of developing the rhythm. The quantity of pericardial fat correlates closely with the quantity of visceral fat in other areas (e..g, around the pancreas and liver), as well as waist circumference.

In addition to the steps required to manage atrial fibrillation once it develops, addressing the varied aspects of all the above conditions can also be important as they may have initiated or encouraged the development of the abnormal rhythm, i.e., they may have disturbed the health of the “soil.”

Among the most feared of complications of atrial fibrillation is stroke. Because the impaired contractile activity of the left atrium allows blood to immobilize, blood clotting can occur within the left atrium. Recent evidence suggests that the process of endothelial dysfunction and inflammation also contribute to promoting blood clot formation. This is why blood thinning drugs, such as warfarin and the new clotting factor Xa and thrombin inhibitors (Pradaxa, Xarelto) are commonly prescribed.

The unhealthier the “garden” of factors present that permit the appearance of atrial fibrillation in the first place, the more likely the rhythm will persist or resist efforts to restore orderly normal heart rhythm. The process may start as paroxysmal or intermittent atrial fibrillation, occurring as episodes lasting minutes to hours or days, with spontaneous return to normal rhythm. Typically, episodes become more frequent and/or longer lasting over time, eventually leading to a persistent, around-the-clock condition in many people.

Rhythm medications are typically prescribed to “break” the rhythm and suppress its recurrence. However, rhythm medications, such as sotalol, disopyramide, propafenone, and amiodarone, have been plagued by imperfect effectiveness and potential for severe side-effects. While sotalol is among the more benign but less effective agents to suppress atrial fibrillation, amiodarone, the most effective of all, is also the most toxic. Cardioversion, the application of an electrical current to the chest and back to “break” atrial fibrillation, is commonly performed to restore normal rhythm. There are also a number of procedures, such as “ablation” of atrial fibrillation, in which the source of the rhythm (usually in the left atrium, as above) is mapped then electrically isolated using, for instance, radiofrequency impulses; and various surgical procedures (usually requiring surgically opening the chest and heart) such as the Maze procedure in which the source of the rhythm is surgically severed.

While many people face the decision to take one or more of these agents chronically to suppress this rhythm with its characteristic tendency to recur , or even submit to these imperfect procedures to stop or isolate atrial fibrillation, ideally we follow a health plan that avoids being put in this situation in the first place.

Selected References:

Risk factors for A Fib
Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009 Oct 20;120(16):1640-5.

Effect of waist size, BMI, and physical fitness on A Fib
Huxley RR, Misialek JR, Agarwal SK et al. Physical activity, obesity, weight change, and risk of atrial fibrillation: the Atherosclerosis Risk in Communities study. Circ Arrhythm Electrophysiol 2014 Aug;7(4):620-5.

Heart rate variability as a predictor of A Fib
Kinoshita T, Asai T, Ishigaki T et al. Preoperative heart rate variability predicts atrial fibrillation after coronary bypass grafting. Ann Thorac Surg 2011 Apr;91(4):1176-81. Postolache G, Oliveira M, Rocha I et al. New insight into arrhythmia onset using HRV and BPV analysis. Conf Proc IEEE Eng Med Biol Soc 2011;2011:2691-4.   Van den Berg MP, Hassink RJ, Tuinenburg AE et al. Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 2001 Feb;22(3):247-53.

Visceral and pericardial fat as contributors to A Fib

Lee JJ, Yin X, Hoffmann U et al. Relation of pericardial fat, intrathoracic fat, and abdominal visceral fat with incident atrial fibrillation (from the Framingham Heart Study). Am J Cardiol 2016 Nov 15;118(10):1486-92. Smith U. Abdominal obesity: a marker of ectopic fat accumulation. Clin Invest 2015 May 1; 125(5): 1790–92.

Rarity of A Fib in free-living primitive populations

Koopman JJ, van Bodegom D, Westendorp RG, Jukema JW. Scarcity of atrial fibrillation in a traditional African population: a community-based study. BMC Cardiovasc Disord 2014 Jul 18;14:87. doi: 10.1186/1471-2261-14-87.

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