Note: This post is a paper I wrote for school. While it will probably be of interest mostly to other students of Chinese medicine and nutrition, I’ve decided to post it for the benefit of fellow suffers of atrial fibrillation. If you find it intriguing, I would strongly recommend that you seek an acupuncturist who also practices Chinese dietary therapy and herbology. I have found this combination tremendously beneficial in the management of my own atrial fibrillation.

Our food should be our medicine and our medicine should be our food.¹

Atrial Fibrillation

Atrial fibrillation is an arrhythmia that occurs when erratic electrical signals in the heart cause the atria to contract rapidly and irregularly. This prevents the smooth flow of blood into the ventricles, which can cause blood to pool in the atria, increasing the risk of a blood clot and stroke.²

Atrial fibrillation is the most common heart arrhythmia, affecting more than 5 million Americans.³ It may be paroxysmal (occurring suddenly and lasting anywhere from a few seconds to several days before abruptly returning to normal), persistent (continuing until converted by treatment to normal sinus rhythm), or permanent. Atrial fibrillation may also be categorized as primary or “lone” (of unknown cause), or chronic (associated with an existing heart problem).⁴ Some doctors also distinguish between adrenergic and vagal types.⁵ The adrenergic type is the result of an overactive sympathetic nervous system and usually occurs during the daytime. The vagal type is the result of an overactive parasympathetic nervous system and typically occurs at night. Some patients experience both types.

An atrial fibrillation episode can be precipitated by any of numerous triggers.⁶ Age increases risk⁷, as does prior stroke, coronary artery disease, hypertension, diabetes, dehydration, excessive consumption of alcohol, substance abuse, caffeine or other stimulants, obesity, stress, anxiety (an episode is often mistaken for an anxiety attack), food additives, electrolyte imbalances, and so on. There may be a genetic predisposition to the disease. Perhaps most frustrating, an episode can be set off by something as simple as turning over in bed, sleeping on the left side, bending over too fast, or exercising too hard.⁸ During an episode, a sufferer may experience palpitations, lightheadedness, dizziness, weakness, or shortness of breath.

From the Western point of view, atrial fibrillation is primarily an electrical problem. The ultimate solution is a catheter ablation procedure, which alters the pathway of the electrical signals. Less severe cases are managed with an array of medications designed to attenuate the tachycardia or to maintain a normal rhythm, along with blood thinners to prevent stroke. Western medicine does recognize lifestyle and dietary factors, but these considerations usually take a back seat to more aggressive approaches.⁹

There is no single TCM diagnosis that encompasses the Western understanding of atrial fibrillation. The Treatment of Cardiovascular Diseases with Chinese Medicine lists no less than a dozen patterns related to palpitations, from “Heart qi vacuity pattern” to “Heart blood stasis and obstruction pattern”.¹⁰ Palpitations may be the result of malnourishment of the Heart (yin, yang, qi, or blood deficiency), of heat ascending to harass the Heart, or of some obstruction of the free flow of Heart qi due to blood stasis or phlegm.¹¹

Western Dietary Therapy

There is no “atrial fibrillation diet” and the nutritional information that is available regarding atrial fibrillation is often conflicting. For example, there is some research which suggests the Mediterranean diet may reduce the risk for atrial fibrillation.¹² The Mediterranean diet is high in whole grains, olive oil, fruits and vegetables, with little diary or red meat. Consistent with this finding, a survey by The Afib Report¹³ found that eliminating dairy was one of the most helpful dietary changes sufferers could make. But the same survey reported that a switch to the Paleo diet, which is relatively high in meat consumption, was also beneficial.¹⁴

While it is unlikely that there is any one diet¹⁵ that would work for all sufferers of atrial fibrillation, and many recommendations are subject to conflicting research,¹⁶ there are several guidelines which are likely to be of benefit to the vast majority of patients:

Avoid known triggers. Aside from the obvious lifestyle changes, such as quitting smoking and getting moderate exercise,¹⁷ a Western approach to managing atrial fibrillation might begin with reducing or eliminating known triggers such as caffeine (coffee, tea, chocolate), alcohol,¹⁸ wheat and other gluten-containing grains, tyramine-containing foods (such as aged cheeses), and additives like aspartame and MSG.¹⁹

Balance electrolytes. Perhaps the most important dietary consideration, and the most difficult to manage, is the proper balance of the electrolytes sodium (Na+), potassium (K+), calcium (Ca2), and magnesium (Mg2).
Sodium depletes potassium, essential for a regular heartbeat,²⁰ but maintaining the proper balance is particularly challenging since almost all packaged foods contain added sodium. Sodium intake should be less than 2400 mg per day.²¹ To offset the almost ubiquitous presence of sodium, most patients will need to increase potassium intake. While potassium supplements and medications are available, it’s best to get as much potassium as possible from foods: bananas, prunes, oranges, tomatoes, raisins, apricots, etc. Two of the best sources are blackstrap molasses and coconut water.²²

Calcium is required for muscle contractions.²³ Calcium is found in abundance in the Standard American Diet, especially in dairy. Unfortunately, magnesium, which is required for muscle relaxation, is not so abundant in the average diet.²⁴ Magnesium is necessary for a normal heart rhythm, but deficiency may be common. Food sources include dark green, leafy vegetables and nuts, whole grains, and fruits, but most patients would benefit from supplementation. Magnesium is a laxative and can cause diarrhea. It is advisable to take supplements in divided doses and to titrate the dose until symptoms improve or the stool becomes loose. Magnesium is also relaxing and, if taken at night, may be of particular benefit to sufferers of the vagal type of atrial fibrillation.

Reduce sugar intake. Diabetes is a risk factor for atrial fibrillation and even elevated blood sugar can predispose someone to an episode. Like sodium, sugar (usually high-fructose corn syrup) is almost ubiquitous in packaged food making it difficult for the average person to avoid. Worse, artificial sweeteners like aspartame may trigger episodes in some patients.

Stay hydrated. Dehydration can contribute to atrial fibrillation. But what to drink? Most soft-drinks are too high in sweeteners or contain chemicals (such as food colorings) that may be problematic for some patients. Juices are high in sugar. Many teas are high in caffeine. Water would be a good choice, but fluoride may be a problem.²⁵ The ideal beverage may be coconut water, which is high in potassium and magnesium, and low in sodium and carbohydrates.

Chinese Dietary Therapy

From the Chinese perspective, dietary therapy must take into account pattern discrimination, as well as the patient’s unique presentation, their constitution, the season, and any concurrent treatment with Chinese herbs or Western drugs.

In a sense, then, it’s impossible to say anything meaningful about Chinese dietary therapy without applying it to a particular patient at a particular time. But generally speaking, it would have to involve one or more of the following: tonifying (yin, yang, qi, or blood), clearing heat, or removing stasis (blood stasis or phlegm). The thermal nature of foods and the five flavors must also be taken into account. For example, while atrial fibrillation may be caused by yang deficiency, qi, yin, and blood deficiency are probably more common.²⁶ For those patients displaying heat symptoms, it is important to avoid yang foods (especially at night, since they can disturb sleep), as well as yang cooking methods such as grilling or frying. Bitter-cool foods supplement Heart yin and calm the mind.

To get a better understanding of how the Chinese approach differs from the Western, let’s take one of the twelve patterns outlined in The Treatment of Cardiovascular Diseases with Chinese Medicine and explore how nutritional therapy might support treatment with acupuncture and Chinese herbs.²⁷ Keeping in mind that there is no one Chinese pattern that matches a Western diagnosis for atrial fibrillation, Heart Yin Vacuity is fairly descriptive of what many patients experience.²⁸

Symptoms. Palpitations, agitation, insomnia, memory problems, malar flush, dry mouth, profuse dreaming, low-grade fever, night sweats, and dry stools. The tongue will be red, with scanty coat or no coat. The pulse will be fine and rapid.

Treatment principle. Nourish the yin and clear heat, nourish the Heart and quiet the spirit.

Nourish the yin and clear heat. Yin is cooling and helps to protect the heart from inflammation. Hot foods damage the yin and should be avoided. Paul Pitchford recommends fresh wheat germ and wheat berries, as well as mung beans, to nourish Heart yin.²⁹ Other yin tonics include duck, rabbit, and pork; clam, sardine, and scallop; egg; black bean and kidney bean; honey; asparagus, spinach, tomato, and pea; and apple, lemon, mango, and pear. Black sesame seed (Hei Zhi Ma) is also very yin tonifying and can help with dry stools due to yin deficiency. Coconut milk is neutral, tonifies yin, and enters the heart.

Obviously, the diet should consist predominantly of neutral or cooling foods, but slightly warming foods may also be helpful to invigorate the blood. Cooling foods which help clear heat include apple, banana, pear, persimmon, cantaloupe, watermelon and all citrus fruits; lettuce, cucumbers, celery, asparagus, Swiss chard, spinach, cabbage, bok choy, broccoli, and cauliflower; soy (milk, sprouts, tofu, tempeh); mung beans and sprouts and alfalfa sprouts; millet, barley, wheat and amaranth; kelp, seaweeds, and spirulina; crab and clam; and yogurt.³⁰

Nourish the Heart and quiet the spirit. The Shen resides in the Heart, so whatever benefits the Heart also benefits the spirit and vice versa. We should note that the Heart cannot be nourished in isolation. As Pitchford points out, “the qi, yang, blood, and fluid deficiencies of the heart are cured when the kidneys, spleen-pancreas, lungs and/or liver are restored to balance.”³¹ It is critical to maintain balance. For example, while cooling foods clear heat and moistening foods benefit the yin, too many cold foods, or too many moistening foods, can damage the Spleen or lead to damp.³²

According to Pitchford,³³ grains like whole wheat, brown rice, and oats have a gentle, calming effect, as do mushrooms, silicon-containing foods (like cucumbers, celery, and lettuce), and fruits (like mulberries, lemons, and Shisandra berries). Jujube seeds and Chia seeds calm the spirit. Cooking with calming spices like dill and basil can also be helpful.

Most foods which calm the spirit also nourish yin. Dairy products are calming and also yin tonifying.

Eating habits. In addition to food choices, eating habits play a role. Meals should be relatively simple and eating rich foods, or eating late at night, should be avoided. This aids digestion and is less stimulating.

East Meets West

Integrating Western and Chinese nutritional approaches can be challenging. There’s some overlap, but trying to reconcile the two may lead to more confusion that clarity.

Consider magnesium and potassium, for example. According to The Tao of Healthy Eating, magnesium “Astringes yin and suppresses yang, quiets the spirit, absorbs acid, and stops pain.”³⁴ Potassium “Fortifies the spleen and seeps dampness, clears heat and expels pus, dispels wind dampness, clears and eliminates damp heat.”³⁵ A Western doctor wouldn’t describe them this way, but the effects are consistent—magnesium has a calming effect on the heart (“quiets the spirit”) and potassium lowers blood pressure (“clears heat”).

On the other hand, milk is considered tonifying for blood, yin, and qi, and sounds like the perfect food for an atrial fibrillation sufferer. But dairy is contraindicated in the Paleo diet and eschewed by readers of The Afib Report.³⁶

Approaching a patient’s nutritional needs from two perspectives gives us a more dimensional view. Neither perspective is right or wrong, or more or less accurate. Instead, these two approaches are a reminder that, ultimately, the treatment lies in the bio-individuality³⁷ of a particular patient.

Notes

1The quote is from Hippocrates, but I can attest to it from personal experience. My doctors wanted me to take drugs (which I reluctantly tried) or consider surgery for my atrial fibrillation. But it wasn’t until I discovered some of the dietary guidelines and supplements I write about in this paper that I experienced any real improvement.

2 See the National Heart Lung and Blood Institute web site, http://www.nhlbi.nih.gov/health/dci/Diseases/af/af_what.html.

3 See “Mayo Clinic Studies Declare Atrial Fibrillation Epidemic, Find Genetic Cause” (http://seniorjournal.com/NEWS/Health/6-07-20-MayoClinicStudies.htm).

4 See “Types of Atrial Fibrillation” (http://heart.emedtv.com/atrial-fibrillation/types-of-atrial-fibrillation.html). For another good overview, see the eMedicine article on atrial fibrillation (http://emedicine.medscape.com/article/151066-overview).

5 See the “Paroxysmal (Lone) Atrial Fibrillation – FAQS” (http://www.afibbers.org/faq.htm#vagal). I asked my cardiologist about this and he was dismissive. Instead, he offered as an explanation of why my episodes almost always happened at the same time (about 1:30 AM), that the body produces more adrenaline at night.

6 A survey of atrial fibrillation sufferers conducted by The Afib Report (see http://www.afibbers.org/faq.htm) noted the following: “The overwhelming favourite for the title of most important trigger is emotional or work-related stress. A full 50% of all respondents listed stress as a trigger. Physical overexertion was next at 24% closely followed by alcohol (including wine) and rest at 22% each. The digestive period following a heavy meal was a trigger for 18%, caffeine was mentioned by 16%, and an ice-cold drink by 12%. Ten per cent reported that MSG (monosodium glutamate) was a trigger for them and 6% said that lying on the left side would set off an episode. Aspartame (NutraSweet) was mentioned as a trigger by two respondents (4%) as was chocolate, coughing and burping, and flying (at high altitudes). Three men over 30 years of age (6%) felt that their episodes were cyclical in nature and not related to any specific trigger. Other triggers mentioned were aged cheese, sugar, food additives, acid indigestion, a hot bath, NyQuil (a cold remedy), electromagnetic radiation, toxic chemicals, hypoglycemia, high blood pressure, and changes in weather patterns.”

7 My electrophysiologist told me that the risk increases about 1% per year after age fifty.

8 I can attest to this from personal experience. Most of my own episodes occur at night after rolling over in bed, waking up after sleeping for some time on my left side, or on returning to bed after getting up to urinate.

9 In my own experience, I received no lifestyle or nutritional advice from my physician, my cardiologist, or my electrophysiologist, all of whom offered thorough explanations of the intricacies of atrial fibrillation, the various medications available, and the catheter ablation procedure. They were either dismissive or disinterested when I raised lifestyle or nutrition questions. The best I could get from any of them was, “There’s no evidence for that, but if you think it helps, it’s okay.” I learned about what worked for me from trial and error, listening to my own body. For more lessons learned, see my blog, “Lessons Learned from Dealing With Atrial Fibrillation” (http://www.livingwithatrialfibrillation.com/lessons-learned-from-dealing-with-atrial-fibrillation).

10 See The Treatment of Cardiovascular Diseases with Chinese Medicine, by Simon Becker, Bob Flaws, Robert Casañas (Blue Poppy, 2005), 72-87. The twelve patterns are: Heart Qi Vacuity, Heart Yang Vacuity, Heart Yin Vacuity, Heart Blood Vacuity, Qi and Yin Dual Vacuity, Noninteraction Between the Heart and Kidney, Heart-Gallbladder Qi Timidity, Water Qi Intimidating the Heart, Water Rheum Intimidating the Heart, Phlegm Fire Harassing the Heart, Damp Heat Toxins Assailing and Smoldering in the Heart, and Heart Blood Stasis and Obstruction.

11 Ibid., 71.

12 See “Caffeine Without Healthy Diet Linked to Heart Risk” (http://www.womenshealth.gov/News/english/630597.htm).

13 See http://www.afibbers.org/faq.htm.

14 For information on the Paleo diet, see The Paleo Diet, by Loren Cordain, Ph.D. (John Wiley & Sons, 2002).

15 Well, there might be one: the alternate day calorie restriction diet. In one study, alternately consuming 20-50% of the normal daily caloric requirement followed by a day of ad lib eating produced a host of health benefits, including improvement of atrial fibrillation, in as little as two weeks. See “The effect on health of alternate day calorie restriction: eating less and more than needed on alternate days prolongs life.” (http://www.ncbi.nlm.nih.gov/pubmed/16529878?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=19). This study is intriguing, but I couldn’t find much in the way of corroborating research.

16 For example, I’ve read in various sources that omega 3 fish oil is beneficial for atrial fibrillation, but one study found no benefit for women (see http://www.hrsonline.org/News/Media/press-releases/omega3.cfm) and another found no benefit for men under age 65 (see http://seniorjournal.com/NEWS/Nutrition-Vitamins/6-05-18-SeniorsProtected.htm).

17 Walking as little as 5 to 10 blocks per week can lower the risk of atrial fibrillation. See “Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study” (http://www.circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.108.785626v1).

18 In one study, consumption of two or more alcoholic drinks per day was associated with an increased risk of atrial fibrillation in women. See “Alcohol Consumption and Risk of Incident Atrial Fibrillation in Women” (http://jama.ama-assn.org/cgi/content/full/300/21/2489). Atrial fibrillation is sometimes referred to as “holiday heart” because episodes are common during the holidays when people are inclined to over imbibe.

19 See The Afib Report’s “12 Step Plan for Eliminating Afib,” (http://www.afibbers.org/12stepplan.pdf). For a list of tyramine-containing foods, see http://en.wikipedia.org/wiki/Foods_containing_tyramine.

20 For information on potassium, see http://lpi.oregonstate.edu/infocenter/minerals/potassium/index.html.

21 A frozen pizza contains more than 4,000 milligrams of sodium. See http://www.nutritiondata.com/facts/fast-foods-generic/8041/2.

22 Wholesome Sweeteners Organic Molasses contains 730 mg. of potassium per tablespoon. O.N.E. 100% Coconut Water contains 670 mg. per 11.2 ounce serving. It also contains 25 mg. of magnesium, and only 60 mg. of sodium and only 15 grams of carbohydrates.

23 For information on calcium, see http://lpi.oregonstate.edu/infocenter/minerals/calcium/index.html.

24 For information on magnesium, see http://lpi.oregonstate.edu/infocenter/minerals/magnesium/index.html.

25 I can’t find any research connecting fluoride and atrial fibrillation, but I have had a couple of personal experiences which make me suspect a connection. On two separate occasions, shortly after I was first diagnosed with atrial fibrillation, I suffered mini-episodes of tachycardia and dizziness after drinking fluoridated tap water when away from home, once in San Francisco and once in Larkspur. When I checked the water quality reports for San Francisco and Larkspur, I noted that both communities fluoridate their water. But I drink tap water all the time at home (filtered, but most water filters do not filter fluoride) and have no problems. Checking the water quality report for Petaluma, I noticed that Petaluma does not fluoridate their water. Even if there isn’t a connection, there may be other reasons to avoid fluoridated water. See The Fluoride Deception, http://www.fluoridealert.org/fluoride-deception.htm.

26 There is an interesting case study of an 84 year-old female with atrial fibrillation whose Chinese pattern was “cold congelation and phlegm turbidity, with stasis obstructing the heart vessels.” Treatment included herbs to warm the yang. All of her symptoms were reported eliminated after two courses of six days each. See The Treatment of Cardiovascular Diseases with Chinese Medicine, 189-190.

27 Much of what follows is taken from Healing with Whole Foods, by Paul Pitchford (North Atlantic Books, 2002), Chinese Nutrition Therapy, by Joerg Kastner, M.D., L.Ac. (Thieme, 2004), and the poster, A Guide to The Energetics of Food, by Daverick Leggett (Redwing Books, 2005). The Treatment of Cardiovascular Diseases with Chinese Medicine itself offers very little in the way of nutritional advice.28 I’ve chosen this pattern because the symptoms are typical of atrial fibrillation, even if not comprehensive, and a good match for my own experience. The symptoms and treatment principle are from The Treatment of Cardiovascular Diseases with Chinese Medicine, 76.

29 Healing with Whole Foods, 334. Note that wheat is often reported as a potential trigger by atrial fibrillation sufferers.

30 Ibid., 62.

31 Ibid., 336.

32 See The Tao of Healthy Eating, by Bob Flaws (Blue Poppy, 1998), 49. His second principle of remedial dietary therapy is, “No matter what, protect and promote the spleen and stomach”. 

33 Healing with Whole Foods, 337-338.

34 See The Tao of Healthy Eating, 135.

35 Ibid., 136.

36 I’m referring to cow milk here. Goat milk, for example, has slightly different characteristics according to Chinese medicine. Also, most people drink pasteurized, homogenized cow milk, which is very different from raw milk. It’s possible that raw milk may not have any deleterious effects for atrial fibrillation suffers.

37 It’s likely that each person has unique nutritional requirements. See Integrative Nutrition, by Joshua Rosenthal (Integrative Nutrition Publishing, 2007), 36-39.


I’ve been under an incredible amount of stress lately, finishing up my fourth trimester of acupuncture college and facing the last couple of weeks of final exams. I had three tests yesterday, including a final exam in the afternoon. I wasn’t feeling particularly stressed out when I went out to lunch, but when I returned to school I felt a wave of anxiety and my heart started pounding. By the time I reached the classroom and sat down for my final exam, I could feel that I was in afib. My heart was leaping and flopping in my chest and my pulse had the characteristic irregular beat.

There was nothing for me to do but take my exam, but when it was over, my friend Nathan put a few needles in me. I have found acupuncture and Chinese herbs to be tremendously beneficial, but they haven’t been able to convert me to normal sinus rhythm when I’ve been having an episode. The needles did calm me down considerably and after a while I was able to drive home.

At home, I took some Suan Zao Ren, an herb that nourishes the heart and calms the spirit. It knocked me out and I was able to sleep, but when I woke up, my heart was still doing flips. This is very unusual for me. I don’t think I’ve ever had an episode that began in the afternoon. They almost always begin in the evening or in the middle of the night and resolve within six to eight hours. I suspected that this episode was triggered by stress—test anxiety—and that it would resolve when I had a chance to fully relax and calm down.

I got out of bed and took some magnesium. After some time, I broke down and took a diltiazem. I only realized later when it didn’t work that I had taken the time-release pill instead of the one I’m supposed to take in an emergency. At about two this morning, I woke up feeling desperate. I found one of my other diltiazem pills and took it and went back to bed. At about 4:30, I woke up again. The diltiazem should have converted me within an hour. I could take another pill, but I my heart rate already felt slow, if irregular, and I was afraid to take another one while I was sleeping in case my heart rate became dangerously slow.

Instead, I reached into my nightstand drawer and took out my stethoscope. I listened to my heart bouncing around in my chest like some crazed Beat poet tapping on some bongos. My wife was already awake and asked if there was anything she could do, so I asked her if I could listen to her heartbeat. It wasn’t easy finding the right position, but we finally curled up on our right sides and I reached around and cupped the stethoscope over her chest. I heard her slow, steady heartbeat loud and reassuring in my ears, even as I felt my own heart stumble and hesitate. We fell asleep like that.

When I woke up again, it was almost 6:00. I’d pulled the stethoscope off in my sleep. I felt my pulse at my carotid artery. It was normal. My heart ached, like any muscle that had been overworked, but it was beating normally. I counted to thirty just to make sure. It didn’t miss a beat.

I can’t express how relieved I am to be in normal sinus rhythm, but if you’re reading this, you probably already know that feeling. It may have been the diltiazem, it may have been just the passage of time. I can’t be sure that listening to my wife’s heartbeat was the reason I converted, but it seems very plausible to me that my heart became entrained to my wife’s normal heartbeat.

Entrainment is a process by which two different rhythms become synchronized. Christian Huygens, the physicist who coined the term in 1666, noticed that two pendulum clocks began swinging in the same rhythm. I see no reason why this same phenomenon wouldn’t apply to heartbeats.

I’m very keen to test this theory, but if I don’t have the opportunity to test it personally it will be just fine with me. I’d be happy not to suffer another episode. But I hope you’ll try it and report your experiences in the comments.

Here are some things to know:

You’ll need a stethoscope. No need to buy an expensive one. I bought one from Amazon for $10.95 that works just fine.

You’ll need a partner. It may seem odd to ask someone if you can curl up with them and listen to their heart for an hour or more, but it might just bring you closer together. Listening to a recording may also work. I’m exploring what it will take to record my wife’s heartbeat and I’ll make the recording available for download if I do.

You’ll need to find a good position. Sleeping on your right side is ideal. This relieves the pressure on your heart and makes your partner’s heart closer so you can easily reach around to hold the stethoscope to their chest.

You’ll need to find their heartbeat. This isn’t as easy as it sounds. You’ll hear different sounds at different areas, but it doesn’t really matter. You’re only concerned with the rhythm. The best place is probably just off-center, behind the breastbone and slightly to the left.

If you have the opportunity, please try this and let me know if it works for you. I’ll be buried in school books for the next couple of weeks, so I may be slow to respond, but I’m eager to hear if anyone can duplicate my experience.

Be well.

Don’t ignore your symptoms

When my symptoms began, I dismissed them. Stress, I thought. Something I ate. Even when my episodes became more frequent, I was cavalier about seeing my doctor. I could almost certainly have avoided my trips to the emergency room if I had paid attention to my symptoms and taken action sooner. If you have symptoms, don’t wait. See your doctor as soon as possible and get a diagnosis. Not only can the symptoms of atrial fibrillation be associated with more serious health issues, but leaving your atrial fibrillation untreated can make you more susceptible to future episodes.

If you don’t know what’s going on in your body, it’s better to be safe than sorry. See your doctor.

Doctors are not the final answer

While I have the utmost respect for my doctors, I quickly came to the conclusion that they couldn’t be the last word on my condition. Doctors have a natural bias toward pharmaceutical and surgical interventions and little knowledge or enthusiasm for alternatives. Listen to your physician, but don’t let them prevent you from exploring other options.

Take responsibility for your own health

This follows from the last point. Your doctor knows a lot, but it’s your life. Ultimately, you will have the make the decisions about your treatment and live with the consequences of your choices. There are many options that are worth exploring that your doctor won’t tell you about. I quickly learned that if I didn’t want to take drugs or entertain the possibility of an ablation (a medical procedure that destroys areas of the heart responsible for causing abnormal heartbeats), I would be on my own. I pursued other methods for managing my atrial fibrillation and that’s how I found the most relief.

Avoid drugs whenever possible

I’m not advocating that you ignore your doctor’s advice, but always ask if there are other options. Almost all (if not all) drugs have potential side effects (many vitamins, herbs, and supplements can have side effects, too). Many of these effects are not fully understood when drugs are prescribed (consider the case of Fosamax, an osteoporosis drug now linked to atrial fibrillation). Once you begin taking medications, you’re on a slippery slope. Many people take medications to manage the effects of other medications they’re taking.

As soon as I began taking Diltiazem, I began the search in earnest for alternative treatments; I didn’t like the way the drug made me feel. If you haven’t started taking drugs yet, and your doctor says it’s okay to wait, explore your alternatives first. If you’re already taking medication, ask your doctor if the alternatives you’re considering are safe. If they are, try them. If they help, ask your doctor about reducing or eliminating your medications.

Absence of evidence is not evidence of absence

One reason your doctor is unlikely to be supportive if you want to try alternatives to conventional treatment is that most vitamins, herbs, and other supplements have not been extensively researched. Most physicians practice evidence-based medicine; they’re reluctant to prescribe something that doesn’t have validation from controlled studies. Ignoring the fact that much of this research is itself questionable, and that the main reason there is a dearth of research on non-pharmaceutical alternatives is because they can’t be patented, keep in mind that the absence of evidence is not evidence of absence, i.e., just because something isn’t proven to work doesn’t mean that it doesn’t work.

If you ask your doctor about a supplement, they’re likely to respond with, “There’s no evidence for that, but if you think it helps, it’s okay.” I’ve had three doctors tell me this almost word-for-word. If they don’t tell you outright that something you want to try is harmful, or interacts with medication you’re already taking, don’t be afraid to experiment. No one knows everything.

Treat the whole body, not the parts

Doctors like to break the body down into its constituent parts. If you talk to a cardiologist, he’s narrowly focused on the heart. Specialization is great—I don’t want my family doctor doing open heart surgery—but it also has it’s limits. Your cardiologist may not know anything about nutrition, for example. If you have other symptoms, he may not know if—or how—they relate to your atrial fibrillation. There’s no question in my mind that improving your health generally will improve your atrial fibrillation. Don’t be narrowly focused on treating your symptoms; take the initiative to do everything you can to become more healthy.

Start with your diet

The first thing I learned when I saw the cardiologist in the hospital was that my diet was a likely culprit in my atrial fibrillation attacks. I was dehydrated, had low potassium, and high blood sugar. When I got home, I read the packages of my recent diet of frozen pizzas, chips and salsa, cereals and ice cream. All of these processed foods were extremely high in sodium (which depletes potassium, necessary for healthy heart function), high in simple carbohydrates (which raises blood sugar, a risk factor for atrial fibrillation), and inflammatory (which may have contributed to my pericarditis, which exacerbated my atrial fibrillation).

One of the healthiest things you can do is eat a healthier diet. Change your diet, change your life.

Everyone is different

A medication, vitamin, or herb that works for someone else may or may not work for you. The same is true for other alternative treatments. I have a brother who can interrupt his episodes by bending over and bearing down as if he’s going to the bathroom. I’ve tried it; it didn’t work for me.

This principle applies to diet and nutrition, too. While there are general guidelines for healthy eating that apply to almost everyone (eat less, eat more fruits and vegetables), your constitution and current state of health requires a diet tailored to you. The principle is called bio-individuality. You’re unique.

How do you know, then, what’s right for you?

Learn to really listen to your body

Pay attention to your body. You don’t have to become a hypochondriac, just become intimately familiar with how your body feels and what makes you feel better or worse.

For example, I noticed that I felt worse at night if I slept on my left side. I later read that this is a common experience for people with atrial fibrillation. So I tried sleeping on my right side. Sure enough, that felt better. I also noticed that I felt worse if I stuffed myself at dinner, especially if I ate later in the evening. Again, I’ve since read that this is also a fairly common experience. I now try to eat dinner around 6:00 PM and to stop when I’m comfortably full.

I took this a step further and bought a stethoscope and began listening to my heart when I was relaxed and in normal sinus rhythm. Later, when I was having symptoms, I would sometimes listen to my heart with the stethoscope and remember what my heart sounded like when things were normal. I found it surprisingly comforting.

Go slowly and keep things simple

Try everything, but do one thing at a time and pay careful attention to your body. Your body is your lab. Experiment and notice what works or doesn’t work. It’s a good idea to take notes. Track how you’re feeling, what you’re doing when you experience symptoms, what you’ve been eating and what supplements you’ve been taking.

If you try supplements, try one new supplement at a time, take a small dose and slowly increase it to the recommended dose. If you’re desperate for help, then try several things and, if you begin feeling better, cut back on them one by one. Notice the effect on your body.

I’m a big believer in taking vitamins, herbs, and other supplements, but I’m not big on taking more than necessary. These substances can also have side effects or deleterious effects that are not well known. Some of them may be useless and a waste of money.

Don’t be afraid to try different options. Keep learning.

Status: Draft. Last edit: 05.27.08

First, note these warning signs of heart attack:

1. Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
2. Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
3. Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
4. Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

—From the National Heart Lung and Blood Institute’s site, Act In Time to Heart Attack Signs

If you have these symptoms, be safe, not sorry. Call 911.

If you feel comfortable enough not to call 911, here are some alternative steps you can take that may help you convert to a normal sinus rhythm (normal heartbeat):

Drink a glass of water. Palpitations are sometimes caused by dehydration. Don’t drink any alcohol, coffee, tea, or soft drinks. Alcohol and caffeine can trigger atrial fibrillation, and the phosphorus in soft drinks can deplete magnesium (see below).

Eat a banana. Atrial fibrillation can be caused by a lack of potassium, usually because of too much salt in the diet. Bananas are high in potassium, as are tomato, prune, and orange juices. But read the labels; some juices have high amounts of salt. Stay away from salt! See this list of high potassium foods. Note: Most vitamin supplements that have potassium also include large amounts of calcium. I don’t recommend taking extra calcium if you have atrial fibrillation; calcium is excitatory to the heart.

Eat some pumpkin seeds. Magnesium is essential for a normal heartbeat. Try eating some pumpkin seeds, which are high in magnesium. If you don’t have any pumpkin seeds, try brazil nuts, almonds, cashews, pine nuts, or any of the foods on this list (scroll down to Appendix B-7). If you have a magnesium supplement, you can take that, but only if it doesn’t include calcium. If you have some epsom salt, you can take an epsom salt bath. Epsom salt is magnesium sulfate; you’ll absorb it through the skin. If you can’t take a bath, try adding water to the epsom salt to make a poultice and apply it to your wrists.

Dunk your head in cold water. Fill a sink with cold water and plunge your face in it. Sometimes this little jolt can help.

Lie down. Or, do some exercise. Some people find that symptoms improve if they lie down and try to relax. Others find that doing a little exercise, which makes the heart beat faster and then slow down, helps even more. You’ll just have to experiment to find out if either of these suggestions work for you.

Try some belly breathing. Lie down or sit comfortably, and relax. Breath through your nose to a count of four, slowly filling your belly. Exhale through the nose or mouth for the same four count. Breathe deep into your belly, not your chest. Make the inhalations as long as the exhalations and breathe in a circle, i.e., don’t hold your breath on the inhale or exhale. You can also try breathing into the belly and holding the breath for a count of ten (stopping if you feel uncomfortable), then resume breathing rhythmically to a count of four.

Listen to a normal heart. If you’re not alone, ask someone if you can listen to their heart. I know this sounds strange—and you’ll want to be selective about who you ask—but I have found it surprisingly helpful. The phenomenon is known as entrainment. Your heart will tend to slow down to match the slower, normal heartbeat. Try it.

If your symptoms continue or worsen, go back to the top of this post. It may be time to call 911.

When you’re feeling better, come back and read my other recommendations for managing atrial fibrillation.

Status: Draft. Last edit: 05.26.08

Though all of these recommendations should be helpful—and safe—for almost everyone, be sure to consult with your physician before trying them. If you have not already seen a physician, don’t wait; these symptoms may be indications of more serious conditions.

Recommendations

First, eliminate potential triggers: alcohol, caffeine (coffee, tea, chocolate), and any stimulating herbs (ephedra, ginko biloba, ginseng, guarana, horny goat weed, etc.).

Check for side effects of any prescription medications you’re taking. Also, check for stimulants in any over-the-counter drugs you’re taking (e.g., pseudoephedrine).

Reduce sodium. This is difficult since almost all packaged foods contain added sodium. Read the labels. Intake should be less than 2400 mg per day. Stop using table salt. Sodium depletes potassium, essential for the heart.

Increase intake of potassium. You can take supplements (try Source Naturals Potassium Amino Acid Chelated 99 MG – 100 Tablets), but it’s best to get as much potassium as you can from food: bananas, prunes, oranges, tomatoes, raisins, etc. Two of the best sources are blackstrap molasses and coconut water.

Increase intake of magnesium (this is the single most helpful thing I have found). Deficiency is common and magnesium is necessary for a normal heart rhythm. Food sources include dark green, leafy vegetables and nuts, whole grains, and fruits. But if you’re having symptoms, you’re most likely deficient and would benefit from supplementation. I use magnesium citrate (Natural Vitality Natural Calm OZ – 16 Powder), an inexpensive and easily assimilated form, and experienced improvement almost instantly. Start with a spoonful mixed with hot water and work up to as much as 1200 mg. per day (stop if you get diarrhea; magnesium is a laxative). It’s best to divide the dosage into two or three drinks per day. If you take it an hour or so before bedtime, it will help you to relax and you’ll be less likely to experience a racing heart or anxiety in the middle of the night.

Take a good, low-dose multi-vitamin (more is not always better), such as Nature’s Plus Source Of Life Multi-Vitamin W/Whole Food – 90 Tablets.

Experiment with other helpful supplements. We’re all different; what works for me may not work for you. I also take taurine (try

Jarrow Formulas Taurine 1000 MG – 100 Capsules) and CoQ-10 (try

Nature’s Life Coq 10 30 MG – 60 Softgels). These are both helpful for the heart.

Eat a heart healthy diet. Simply put—eat more fruits and vegetables. I consider these three books essential reading: Eat to Live and Eat for Health, by Joel Fuhrman, M.D., and Prevent and Reverse Heart Disease, by Caldwell B. Esselstyn, Jr., M.D.

Get some exercise. Walking even 15 or 20 minutes every day will help.

Drink ample fluids. Dehydration can contribute to atrial fibrillation.

Status: Draft. Last edit: 05.23.08

Causes of Atrial Fibrillation

1. Aging
2. Alcohol
3. Caffeine
4. Cardiomyopathy
5. Coronary Heart Disease
6. Dehydration
7. Heart Valve disease
8. High Blood Pressure
9. Hyperthyroidism
10. Illicit Drugs
11. Mitral Valve Prolapse
12. Pericarditis
13. Pneumonia
14. Prescription Drugs
15. Sick Sinus Syndrome
16. Stimulants

Status: Draft. Last edit 05.20.08

A Little History

I went to the emergency room with atrial fibrillation on February 15, 2008. I’d had a few mild episodes of rapid, erratic heartbeat several years before, sometime in 2002. I would feel my heart begin to race, feel anxious and weak, and have to lie down. Within an hour or so, I usually felt a bit better and went about my business. I did ask my doctor about it and he hooked me up to an ECG (electrocardiograph) machine, pored over the paper as the graphs sputtered out, and said everything looked normal. Probably stress, he said. If it really bothered me I could go to the emergency room when it was happening and they should be able to tell me more. I had a few more mild episodes after I saw him, but nothing that would make me want to go to the emergency room, and sometime later, without my really doing anything, the episodes went away.

Last fall, the episodes began again. They always started at night, either sometime before I went to bed (usually around 10:00 or 10:30 PM) or in the middle of the night. My heart would start to race, I would feel anxious and weak, maybe a little lightheaded. I would lie down and feel a bit better after a while, but I would toss and turn all night or be aware, even in my dreams, that my heart was leaping. Usually, after I got up in the morning, sometimes after breakfast, I would begin to feel normal again and wonder, What the heck was that all about?

I also noticed around that time that I had a chronic pain in my chest, a kind of dull ache. I had taken up archery in the fall and thought I must have pulled a muscle or strained something. It never seemed very serious—some days I would barely notice it—so I didn’t pay much attention to it.

The episodes began to come every month or so, then every few weeks. I wondered if it was something I’d eaten. I thought I was a pretty healthy eater—no sodas, no candy (well, a little chocolate and some Chunky Monkey ice cream), limited red meat—and I took a handful of miscellaneous supplements (whatever was touted in the latest Men’s Health magazine). But I began to wonder if I was low in calcium, or wasn’t eating enough salt, or maybe I was allergic to something? In other words, I didn’t have a clue. But I recognized, after the episodes continued to become more disconcerting, that I needed to see a doctor, something I am always reluctant to do.

It took me a long time to see a doctor. My old doctor had switched to a concierge plan, limiting his practice to those patients who would pay a yearly fee to be under his care, with an emphasis on prevention. A good idea, but I always thought of myself as too young (51) and too healthy. I had to do an intake interview with the nurse practitioner to be a new patient with my new doctor and because of various scheduling issues it took me a couple of months to get in. I finally saw the nurse and told him about my symptoms. He took copious notes and said he’d fix me up with a treadmill test, whatever that was, to rule out cardiovascular disease. I had little idea what he was talking about, but at least I was finally taking some steps to solve the mystery.

Emergency

I never made it to the treadmill test. At least, not to the test the nurse practitioner scheduled for me.

The evening after my appointment, I begin feeling anxious. My heart starts racing and I feel weak. It’s almost bedtime, so I think I’ll just go to bed and sleep it off as I have so many times in the past. But this night is different. I feel slightly better for a few minutes—and then it gets worse again.

My wife, Meg, hovers over me, checking in. Should she take me to the hospital? No, let’s wait a few minutes. I already have an appointment to have things checked out. It’s always passed before.

But it continues to get worse. Finally, I relent. We get dressed and get in the car. The hospital is only about five minutes away; no need for an ambulance. I’m ushered into the emergency room immediately. They hook me up to the ECG. They take a chest x-ray. They take a blood sample.

My heart rate is about 190. The doctor comes around—a slender, gentle woman with a soothing voice—and explains patiently (no pun intended) that I have atrial fibrillation. She gives me a simple explanation, very similar to the description on my Discharge Instructions:

“Atrial Fibrillation” is a condition where the heart beats in an irregular pattern. It is due to a disturbance in the electrical pathways of the heart. It is a sign of heart disease or other health problem affecting the heart.

The most common symptom is “palpitations”. This is the feeling that your heart is fluttering or beating fast or hard or irregular. When the heart beats too fast it does not pump blood very well. This can cause other symptoms such as anxiety, fatigue, shortness of breath, chest pain, dizziness or fainting.

Atrial Fibrillation may come and go, lasting from a few hours to a couple of days. Or, it may become chronic, lasting for months at a time or longer.

I’m given a drip of Cardizem and “convert” (my heart returns to normal) a short time after. They keep me awhile to make sure I’m okay, then send me home with a prescription for Diltiazem (Cardizem) and the number of a cardiologist. I’m scolded for having Meg drive me to the hospital. I’m instructed to take one 120 mg tablet “if rapid palpitations recur”, wait and hour, then take another one. “IF LIGHTHEADEDNESS, SHORTNESS OF BREATH, CHEST PAIN, NAUSEA, SWEATINESS, THEN CALL 911 IMMEDIATELY.”

But I think I’ll be good for another month. A few weeks, at least.

911

The next night, I wake up in the middle of the night to pee. When I crawl back into bed again, the race horse breaks out of the stable. I give Meg a little nudge and tell her my heart is at it again. Should we call 911? No, I’ll just pop one of these tablets.

A few minutes later, my heart is still galloping and I begin shivering. Should we call 911? No, let’s give it a few minutes to work.

Minutes later, I’m shaking. I can’t lie still. I feel nauseous and lightheaded. My chest hurts. What did they tell me in the hospital? “IF LIGHTHEADEDNESS, SHORTNESS OF BREATH, CHEST PAIN, NAUSEA, SWEATINESS, THEN CALL 911 IMMEDIATELY.”

Meg calls 911. Within a few minutes, the doorbell rings and five athletic guys walk in with a stretcher. I’m not sure why it takes five guys, but they’re young and buff and Meg isn’t complaining, and they hook me up the ECG and begin quizzing me about my symptoms. I don’t feel any worse, but I can’t stop shivering. I’m rattling the bed. They can’t get a read because the electric blanket is on, but they give me some nitro and cart me out to the ambulance. I half expect the neighbors to be out, standing on their lawns in their pajamas and bathrobes, but it’s probably about two in the morning and the cul de sac is quiet. In the ambulance, they give me some more nitro for the chest pain. I’m still shaking, they don’t know why, but I’m beginning to relax.

At the hospital, my heart rate is only around 120. Why was I lightheaded and nauseous? Oh, that’s probably just a side effect of the medication. But since I’ve had episodes two nights in a row they decide to keep me for the day and overnight the next night. They have to move me from the emergency room, though, and most of the hospital is booked. I get an upgrade to a private room in Intensive Care. I think I may have the IC Unit to myself. They hook me up to the ECG and the blood pressure cuff and tuck me in.

Do I Hear an Echocardiogram?

It’s now Sunday afternoon. As I’m undergoing an echocardiogram, the cardiologist arrives. They have trouble getting a clear picture of my heart from every angle—something about my rib cage getting in the way—but one thing is clear: I have pericarditis, inflammation of the pericardium, the thin membrane that surrounds the heart. Oh, and pericardial effusion, fluid in the pericardium. This in itself, I discover later, can cause arrhythmias, including atrial fibrillation.

On Monday morning, the cardiologist stops by again. He wants me to wear a Holter monitor, a device about the size of a beeper that records the heart’s rhythms, for 30 days. In the meantime, I should also have a treadmill test. When that’s out of the way, I should see him in his office for a follow up appointment.

He prescribes Cardizem CD 180 mg once a day, plus an aspirin (81 mg once a day). I’m given my discharge papers.

DISCHARGE DIAGNOSES:

1. Atrial fibrillation in sinus rhythm.
2. Hypokalemia [low blood potassium], resolved.
3. Normal lipid status, except low HDL.
4. Borderline elevated blood sugar of 109.
5. Mitral valve prolapse [a heart valve defect], anterior mitral leaflet mild.
6. Small pericardiac effusion, probably due to pericarditis.

This post will be updated. There’s more to the story.