This was originally written by Robert Ellis, the former owner of this site.
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 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.
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” (https://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.