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.
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
For additional background discussion on atrial fibrillation, see the discussion following the protocol.
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
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
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.
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.
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.
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
The hypothalamic hormone oxytocin that we boost with our Lactobacillus reuteri yogurt
provides heart rhythm-stabilizing effects in addition to all its other age-reversing benefits such as smoother skin, accelerated healing, and restoration of youthful strength and muscle.
Normal Heart Rhythm
Your heart 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
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
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:
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.
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:
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
- 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
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
Risk factors for A Fib
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
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
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.
to Forum discussion.
This is the Undoctored protocol for atrial fibrillation. I have to tell you, atrial fibrillation's tricky,
so this approach is much more effective in preventing ever having atrial fibrillation, or in preventing
recurrences, or diminishing their frequency, if you have only occasional bouts of atrial fibrillation.
It's much more difficult to have any success if you're having prolonged (many hours or days of
atrial fibrillation) or frequent (every day or every 2 days) recurrences. It's much more
difficult to “re-train” the heart to not have atrial fibrillation, so the key here is: do this as
soon as possible.
As with all Undoctored protocols, we start with the very same Undoctored Wild-Naked-Unwashed
program. Each and every component of that program plays a role here as well, in suppressing
atrial fibrillation — especially wheat and grain elimination — an
occasional person has an extravagant response just to that alone. So be aware that everybody starts
with the very same six components of the Wild-Naked-Unwashed program. Now, some additional
strategies to consider.
Magnesium is in that basic list of strategies, but I want to encourage you to use the Magnesium water
source of magnesium. That's because it's the fastest, best absorbed, most assured way of getting
your tissue, your body's, magnesium levels up. I've reproduced that recipe below [the video on the
Protocol page]. It's also in the Undoctored book; very easy to make.
4 ounces = 90 mg Mg
We start with a 4 ounce serving (a half cup), 3 times
a day. Recall that each half cup or 4 ounces provides 90 milligrams of
elemental magnesium. A half cup 3 times a day yields 270 milligrams.
We're aiming for at least 400 to 500 milligrams per day. If you build up to 6 ounces,
3 times per day, that provides 405 milligrams per day. Now we're kind of
getting in that range.
You can try to push it a little bit higher than that, but now
you really start to run into loose stools. So you may have to build up over time to a
higher dose, from 4 to 6, say, or a little bit higher. Don't go crazy with the dose.
You can get overloaded with magnesium as well. You have to really work at that —
to get too overloaded. Using magnesium water as your source of magnesium is the
best we have.
RBC magnesium level
Consider an occasional (every 6 months, every year) red blood cell (or RBC) magnesium,
that's the test we rely on to tell us whether you're replete with magnesium.
It takes, generally, a couple of years to get your RBC magnesium levels up, so you
don't have to do it right off.
We aim for a value toward the upper end of the
Reference Range. So if the Reference Range quoted by your laboratory is 4.2 to
6.2 milligrams per deciliter, I would aim for 6.0 to 6.4 or 6.5 — at the upper
end, or a little beyond (which is not harmful), to assure that you have tissue
restoration of magnesium. That can help.
Avoid sleep deprivation
It's important to not be sleep-deprived. Avoid sleep deprivation whenever possible.
Sleep deprivation, seriously, is a very potent trigger for atrial fibrillation
recurrences. Do your best to track your sleep. Even consider use of some of the
wearable devices that track your sleep now, and give you some feedback on the
quality, duration and the stages of your sleep. Sometimes you can uncover some
peculiar issues in your sleep, that need to be addressed.
Minimize visceral fat
It's really worth minimizing visceral fat. The reason for that; so, visceral fat, recall,
is typically on the tummy; you can see it on the surface, reflected as
“love handles” — though it's really a fat encircling organ
deep inside. That fat is very inflammatory.
But it's also accompanied by what's called pericardial fat. That's fat surrounding
the heart. There's a fibrous covering around the heart, and it contains fat also,
in some people. It's highly inflammatory to the heart, including releasing
inflammatory factors that encourage atrial fibrillation. Getting rid of visceral fat
is very important. At the very least, you don't want to have a
BMI or waist size that's too high.
You'll see the cut-offs below [the video on the protocol page], in the discussion
below. Ideally, you want to have a BMI of 25.0 or less. Waist size will vary
depending on age, sex, nationality/race, and some other factors. That's a little
bit of a difficult thing to pin down. You can just look, and see if you have
visceral fat on the surface, like love handles, and you want to try to minimize that,
because then you can presume you've minimized your pericardial fat, also.
Heart Rate Variability (HRV)
You want to consider measuring and tracking your heart rate variability. Now that's
a concept and undertaking all of its own. That will be discussed separately, in
another discussion, another video. Suffice for it to say that what that means,
is you want to bring the beat-to-beat variation in your heart beat into
synchrony with breathing, with the respiratory cycle.
If you learn how to do that,
you work at it over weeks or months, you develop powerful control over the
parasympathetic nervous system. There's a sympathetic (excitable) part of your
nervous system, and a quiet (automatic) parasympathetic nervous system.
If you have better control over the parasympathetic nervous system, it acts as
kind of a brake, like the brake in your car, on the heart's rhythm. You can
slow it down. You can even brake atrial fibrillation. It takes practice.
It takes some feedback tools. I'll discuss that separately; some of the new
smartphone apps, and other ways to watch, manage and improve your
heart rate variability.
So those are the basic methods that can augment your efforts to suppress
or discourage recurrences of atrial fibrillation.