Atrial Fibrillation:  The Nutrition and Lifestyle Connection

Normally your heart contracts and relaxes to a regular beat. Your heart has a natural pacemaker, called the “sinus node,” that makes electrical signals. These signals cause the heart to contract and pump blood. These electrical signals show up on an electrocardiogram (ECG) recording. 

Atrial fibrillation (AF) is a type of abnormal heart rhythm (arrhythmia). 

Your heart has four chambers that beat in a rhythm; two atria and two ventricles. The atria are the upper chambers. In atrial fibrillation, the heart’s two small upper chambers (atria) don’t beat the way they should. Instead of beating in a normal pattern the atria beat irregularly and too fast. They “quiver” instead of pumping properly.  Atrial fibrillation’s irregular, fast heart beat leads to ineffective pumping of the blood which if not controlled, may weaken the heart. 

AF is the most common arrhythmia worldwide.  In fact, some reports say you have a 25% risk of getting it in your lifetime.  The number of people with AF is increasing and is expected to increase further as the population ages.

Symptoms of AF include fatigue, dizziness, shortness of breath, chest pain, and reduced ability to exercise.  However, sometimes you may not experience any symptoms.

Why should we be concerned with AF?  People with AF have a steep increase in risk of blood clots, heart disease, heart failure, stroke, and death.  These are because the blood is not being pumped around the body properly.

Having AF also triples the risk for dementia.

AF is a serious condition that requires medical help.  Treatment involves medications; but can also involve electrical cardioversion, catheter ablation, surgical maze procedure and atrioventricular (AV) node ablation.

How do you get AF? 

There are many risk factors for AF.  Some of them you can control, and others you cannot.  For example, you can’t control your age, or if it runs in your family. 

However, there are a lot of things you can control.  They’re known as “modifiable risk factors.”  They include how well you manage certain conditions like type 2 diabetes, blood lipids, high blood pressure, sleep apnea, hyperthyroidism, and obesity.  Managing these conditions is important for AF. There are also several diet and lifestyle factors you can improve.  These include quitting smoking, managing alcohol and caffeine intake, omega-3, vitamin D status, and exercise.

We’ll talk about these in more detail in this article, especially the healthy lifestyle habits to adopt if you’re concerned about AF.

Managing Conditions

There are several medical, diet, and lifestyle approaches to managing AF and other health conditions.

NOTE: None of these are a substitute for professional medical advice.  If you have any of these conditions, make sure you’re being monitored regularly.

Manage Blood Sugar and Type 2 Diabetes

Type 2 diabetes often exists with AF.  Type 2 diabetes is a risk factor for heart disease, high blood pressure, cancer, Alzheimer’s, and death.  Studies show that people with type 2 diabetes can have 26-34% increased risk of AF, especially women.

There are two factors of type 2 diabetes that even further increase risk of AF:

  • The longer someone has had type 2 diabetes ; and,
  • When blood sugar levels are less controlled (based on HbA1c levels).

NOTE: HbA1c levels are blood tests that your doctor can do to estimate how well your blood sugar has been controlled over the past few months.

One study showed that the combination of type 2 diabetes and AF increases risk of heart disease, stroke, heart failure, and death by 61%.

Managing your blood sugar levels is very important for type 2 diabetes and AF.

Manage Blood Lipids

The science isn’t settled yet on how blood lipid levels affect the risk of AF.  Low HDL-cholesterol (good cholesterol) increases risk of heart disease and heart failure.  Both heart disease and heart failure are risk factors for AF.

When it comes to total cholesterol and triglyceride levels, the science is less clear.

It’s thought HDL-cholesterol reduces risk of heart issues because of its ability to reduce inflammation and oxidative stress.

Interestingly, while high doses of niacin (vitamin B3) can increase your HDL-cholesterol (which sounds good), too much niacin can increase your risk of AF. 

You can help increase your HDL-cholesterol levels naturally with a heart-healthy diet, increased omega-3 fat intake, and exercise.

Manage High Blood Pressure

High blood pressure (hypertension) is very common.  It’s also a modifiable risk factor for developing AF.  In fact, the higher your blood pressure (above 120 mmHg), the higher your risk of AF. 

Managing high blood pressure is important for managing AF.

Sleep Apnea

There is a definite link between obstructive sleep apnea (OSA) and risk of AF.  About half of people with AF also have OSA. 

The usual treatment for OSA is a continuous positive airway pressure (CPAP).  In fact, people with OSA who use the CPAP machines have rates of AF similar to people without OSA.  This means that using the machine (if prescribed) can almost eliminate any increased risk of AF due to OSA.

If you need a CPAP machine, you should use it.

Manage Hyperthyroidism

Hyperthyroidism (overactive thyroid gland, and too much thyroid hormone) can affect the heart.  In fact, the most common heart issue of hyperthyroidism is AF.  People with hyperthyroidism have 3 to 5 times higher risk of developing AF.

Hyperthyroidism can have negative effects on heart rate and the heart’s atria.

Reduce Obesity

Studies show that obese people have a 35-49% higher risk of developing AF than non-obese people. In fact, each 1 unit BMI increase above normal increases your risk of AF by 4-5%.  And large body size in youth, or weight gain from age 20 to midlife are associated with developing AF.

Even if you don’t have high blood pressure, being overweight still puts you at increased risk of AF.  It’s considered an “independent” risk factor.  Obesity also increases your risk of progressing from a short-term “on and off” AF (called “paroxysmal AF”), to constant and permanent AF.

If you’re obese, losing 10% or more of your body weight gives you a 6x better chance for living arrhythmia-free.  This is compared with people who lose 3-9% of their body weight.  So, aim to lose a bit more weight if you need to.

Obesity’s link to AF is because of its links with heart problems, like increased size of the heart’s atria.

Diet and Lifestyle

There are several diet, and lifestyle approaches to managing health conditions. 

NOTE: Speak with your doctor before making any drastic changes to your diet or lifestyle.

Stop smoking

Tobacco is bad for your heart. Smoking increases your risk of AF by 40% or more.

This is because nicotine increases your heart rate and blood pressure. Nicotine can also cause arrhythmias. Smoking is a risk factor for heart attacks, heart failure, and lung diseases.

Reduce Alcohol 

Have you heard of “holiday heart syndrome?”  It occurs when healthy people drink too much on a holiday or weekend, and end up with AF.  Holiday heart syndrome is an alcohol-induced arrhythmia; and for many healthy people, it self-corrects within a day or two.

The problem comes when AF doesn’t self-correct.  In fact, the more alcohol that is consumed, the higher the risk; but, even moderate alcohol consumption is a risk factor.  For both men and women, your second drink of the day and every one after that increases your risk of AF higher and higher.

There are a few reasons alcohol can cause AF.  First, alcohol is a “cardiotoxin” which means it has toxic effects on the heart.  Second, alcohol can cause arrhythmias.  Third, excessive drinking increases risk of high blood pressure, which is a risk factor for AF.

To reduce your risk, limit alcohol to no more than 1-2 drinks/day.

Reduce Stress

The exact link between stress and AF is yet to be determined.  Some people with AF believe that stress is a common trigger for episodes of AF.  A recent study found that being stressed in the workplace increases your risk of AF by 48%.  Being aware of ‘unhelpful’ stressors and taking steps to address these can be beneficial in managing AF.

Reduce Anxiety

Anxiety can worsen symptoms of AF.  The experience of a fast heart rate during an episode of AF can trigger a cycle of anxiety, increased adrenaline, a further raised heartbeat, and more anxiety. Finding ways of managing anxiety is helpful in AF management and could benefit general health and wellbeing.

Monitor Your Caffeine Intake

Contrary to popular belief, low-to-moderate amounts of caffeine reduces risk of AF.  Excessive amounts, on the other hand increase the risk.

Many people have reported that excess coffee consumption seemed to cause an AF episode.

This also goes for caffeine-containing energy drinks.  Several cases of AF have been reported in young people after high intake of energy drinks.  This was especially true when the energy drinks were combined with alcohol.

One to two cups of coffee per day is fine, but excessive amounts can increase the risk of AF.

Eat Fish

More research is needed when it comes to fish intake or omega-3 supplementation and AF.  

In general, fish and omega-3 fats are considered “heart-healthy.”  However the studies done on AF have mixed results. Some show they reduce risk of AF, others show no difference, or even an increased risk.

One study showed that eating broiled or baked fish 3-4 times per week reduces your risk of AF.  In fact, having it 5 or more times per week may reduce your risk even further.  However, eating deep fried fish increases the risk of AF.

An interesting study showed that eating fatty fish (e.g. herring, mackerel, salmon, etc.) had no effect on risk of AF.  However, eating lean fish (e.g. cod, halibut etc.) three or more times per week lowered risk of AF.

It’s thought at least some of fish’s heart healthy effects are due to the long-chain omega-3 fats found in fish.  Some studies show that the more omega-3 fats in the blood, the lower the risk of AF.

We know that supplementing with fish oil has many heart-healthy effects, like reducing blood pressure, triglycerides, inflammation, and arrhythmias. Fish oil supplements are NOT recommended for anyone taking blood-thinning medications. 

More research is needed to sort out the actual effect of fish and omega-3 fat consumption on AF. Right now, eating fish seems to be good, however not everyone should be supplementing with fish oil. 

Coenzyme Q10 

Coenzyme Q10 is a powerful antioxidant involved in energy production in the mitochondria of cells. CoQ10 is critically important for vascular health, as it is directly involved in the production of ATP, the “energy currency” of the human body. Because the heart is a muscle that never rests, it needs a substantial amount of CoQ10. Although CoQ10 is found in food (red meat, plants, and fish), dietary amounts are insufficient to significantly increase low levels in people with heart problems. 

The idea is that supplementing with CoQ10 will improve energy production in the cell. Since impaired heart muscle function contributes to many cases of heart problems, increasing CoQ10 may improve overall heart function. Unlike other heart medicines, which block normal cellular process, CoQ10 actually enhances normal processes. Preliminary studies have shown promising results. Some studies have shown that supplementing with CoQ10 is associated with a reduction in occurrence of arrhythmias.  

Vitamin D

Vitamin D deficiency is linked with many risks of AF including high blood pressure, stroke, heart attack, type 2 diabetes, and mental stress. 

Vitamin D is a fat soluble vitamin and unlike water soluble vitamins like vitamin C, it can build up in the body over time.  One study showed that very high blood levels of vitamin D (>100 ng/mL) increased risk of AF.  A safe daily dose of Vitamin D3 is 2,000 IU/day.

Niacin (Vitamin B3)

As mentioned in the section on blood lipids, niacin can be effective at increasing your good HDL-cholesterol. While this sounds like it would reduce risk of AF, too much niacin can increase your risk of AF.  A safe upper limit of Niacin supplementation is 1,000 mg/day.  Most B-complex supplements provide around 150-350 mg of Niacin/day.

Get Enough Moderate Exercise

Exercise is great for your heart, right? 

Moderate intensity exercise reduces risk of AF.  Moderate intensity exercise would be something like walking or bicycling at a moderate pace for 40+ minutes per day.

Long-term high intensity or endurance exercise (like running/cycling) may slightly increase risk of AF.  Check with your doctor before starting a training program for a marathon or triathlon.

Don’t let this prevent you from getting exercise (with your doctor’s approval). Exercise can help to lower the risk of relapse of AF.  It also increases the quality of life. 

In fact, one small study showed that people with AF who started doing yoga had significant improvements in resting heart rate, blood pressure, quality of life, mental health and stress levels.

Consider Acupuncture

While there are only a few small studies, there seems to be evidence that acupuncture can help with AF.

Two small studies showed that stimulation of the Nei Guan spot (located three finger breadths below the wrist on the inner forearm) can reduce the arrhythmia in people with AF.  It was almost as effective as an AF medication.

More research is needed here, but acupuncture may help some people with AF.

Conclusion

Atrial fibrillation (AF) is a serious condition where your heart doesn’t beat properly (arrhythmia). It increases your risk of many other conditions such as heart attack, stroke, and death.

Risk of AF increases with many conditions including type 2 diabetes, blood lipids, high blood pressure, sleep apnea, hyperthyroidism, and obesity. Managing these conditions is important for AF. 

There are also several diet and lifestyle factors you can improve. These include quitting smoking, reducing alcohol intake, not overdoing the caffeine, getting enough coenzyme Q10, vitamin D, niacin (vitamin B3) and regular exercise, and eating fish.

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