Atrial Fibrillation - The Nutrition and Lifestyle Connection
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. AF happens when the atria beat too fast and irregularly. They “quiver” instead of pumping properly.
AF is the most common arrhythmia worldwide. In fact, in the US, 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. Sometimes you may not experience any symptoms.
Who is most likely to get AF? About 70% of people with AF are between 65-85 years old. AF is more common in men than women.
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 advice. Treatment involves medications; but, can also involve pacemakers or implantable defibrillators.
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, whether you’re a man, or if it runs in your family. These increase your risk of AF.
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.
1 - Managing Conditions
There are several medical, diet, and lifestyle approaches to managing medical 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.
1a - Manage blood sugar and type 2 diabetes
Type 2 diabetes mellitus often exists with AF. T2DM is a risk factor for heart disease, high blood pressure, cancer, Alzheimer’s, and death. Studies show that people with T2DM can have 26-34% increased risk of AF. Especially women.
There are two factors of T2DM that even further increase risk of AF:
- The longer someone has had T2DM; 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 T2DM and AF increases risk of heart disease, stroke, heart failure, and death by 61%.
Managing your blood sugar levels is very important for T2DM and AF.
1b - Manage blood lipids
The science isn’t settled yet on how blood lipid levels affect the risk of AF. Low HDL-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.
1c - 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.
1d - 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.
1e - 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.
It’s thought this is because hyperthyroidism has negative effects on heart rate and the heart’s atria.
1f - Reduce obesity
I get that obesity is a complex issue and is extremely difficult to manage. I really do! So, take this information as an educational understanding of how obesity links with AF, and then move on to the diet and lifestyle factors to reduce risk of AF.
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.
2 - Diet and Lifestyle
There are several diet, and lifestyle approaches to managing medical conditions.
NOTE: Speak with your doctor before making any drastic changes to your diet or lifestyle.
2a - 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. Not to mention it’s a risk factor for heart attacks, heart failure, and lung diseases.
If you smoke, stopping is difficult, but a great step forward to your heart health.
2b - Reduce alcohol
Have you heard of “holiday heart syndrome?” It’s 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.
2c - Caffeine - Some is good, too much is not
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 spell.
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.
Small amounts of caffeine seem to be fine, but don’t overdo it.
2d - Eat fish, but don’t supplement fish oil
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 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, 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 unnecessary if you eat enough fatty fish. They’re also not recommended for everyone, particularly people taking blood-thinning medications, so check with your doctor or pharmacist before starting them.
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 there is limited evidence for taking fish oil supplements for AF.
2e - Vitamin D: Don’t overdo it
Vitamin D deficiency is linked with many risks of AF. Including high blood pressure, stroke, heart attack, T2DM, and mental stress.
It’s not a good idea to overdo it because at least one study showed that very high blood levels of vitamin D (>100 ng/mL) increased risk of AF.
2f - Niacin (vitamin B3): Don’t overdo it
As mentioned in the section on blood lipids, niacin can be effective at increasing your HDL-cholesterol. While this sounds like it would reduce risk of AF, too much niacin can increase your risk of AF.
2g - Get enough moderate exercise
Exercise is great for your heart, right?
Moderate intensity exercise reduces risk of AF. This looks like walking or bicycling at a moderate pace for 40+ minutes per day, for example.
Long-term high intensity or endurance exercise (like jogging) may slightly increase risk of AF. So, check with your doctor before starting training for a marathon or triathlon.
Don’t let this prevent you from getting exercise (with your doctor’s approval). Exercise can improve the control and 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, and mental health/stress.
2h - 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 Neiguan spot 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.
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, vitamin D, niacin (vitamin B3) or vigorous exercise, and eating fish.
Censi, F., Cianfrocca, C. & Purificato, I. (2013). Atrial fibrillation and the 4P medicine. Ann Ist Super Sanità, 49(3), 247-248. DOI 10.4415/ANN_13_03_02
Czick, M.E., Shapter, C.L., & Silverman, D. I. (2016). Atrial Fibrillation: The Science behind Its Defiance. Aging and Disease, 7(5), 635–656. http://doi.org/10.14336/AD.2016.0211
Du, X., Dong, J. & Ma, C. (2017). Is Atrial Fibrillation a Preventable Disease? J Am Coll Cardiol, 69(15), 1968-1982. doi: 10.1016/j.jacc.2017.02.020.
Examine.com, Fish Oil Supplement. Accessed 2017 Aug 14.
Harvard Medical School, Harvard Health Publications. (2012). Atrial Fibrillation: What Is It? Accessed 2017 Aug 14.
Kokubo, Y. & Matsumoto, C. (2016). Traditional Cardiovascular Risk Factors for Incident Atrial Fibrillation. Circulation Journal, 80(12), 2415-2422. http://doi.org/10.1253/circj.CJ-16-0919
Lakkireddy, D., Atkins, D., Pillarisetti, J., Ryschon, K., Bommana, S., Drisko, J., Vanga, S. & Dawn, B. (2013). Effect of yoga on arrhythmia burden, anxiety, depression, and quality of life in paroxysmal atrial fibrillation: the YOGA My Heart Study. J Am Coll Cardiol, 61(11), 1177-82. doi: 10.1016/j.jacc.2012.11.060. Epub 2013 Jan 30.
Larsson, S.C. & Wolk, A. (2017). Fish, long-chain omega-3 polyunsaturated fatty acid intake and incidence of atrial fibrillation: A pooled analysis of two prospective studies. Clinical Nutrition, 36(2): 537-541.
Lombardi, F., Belletti, S., Battezzati, P.M., & Lomuscio, A. (2012). Acupuncture for paroxysmal and persistent atrial fibrillation: An effective non-pharmacological tool? World Journal of Cardiology, 4(3), 60–65. http://doi.org/10.4330/wjc.v4.i3.60
Lomuscio, A., Belletti, S., Battezzati, P.M. & Lombardi, F. (2011). Efficacy of acupuncture in preventing atrial fibrillation recurrences after electrical cardioversion. J Cardiovasc Electrophysiol, 22(3), 241-7. doi: 10.1111/j.1540-8167.2010.01878.x.
Mattioli, A.V., Pennella, S., Farinetti, A. & Manenti, A. (2017). Energy Drinks and atrial fibrillation in young adults. Clin Nutr, pii: S0261-5614(17):30162-0. doi: 10.1016/j.clnu.2017.05.002.
Matusik, P., Lelakowski, J., Malecka, B., Bednarek, J., & Noworolski, R. (2016). Management of Patients with Atrial Fibrillation: Focus on Treatment Options. Journal of Atrial Fibrillation, 9(3), 1450. http://doi.org/10.4022/jafib.1450
Menezes, A.R. et al. (2015). Lifestyle Modification in the Prevention and Treatment of Atrial Fibrillation. Progress in Cardiovascular Diseases, 58(2), 117-125.
Menezes, A.R., Lavie, C.J., DiNicolantonio, J.J., O'Keefe, J., Morin, D.P., Khatib, S. & Milani, R.V. (2013). Atrial fibrillation in the 21st century: a current understanding of risk factors and primary prevention strategies. Mayo Clin Proc, 88(4), 394-409. doi: 10.1016/j.mayocp.2013.01.022.
Morillo, C.A., Banerjee, A., Perel, P., Wood, D., & Jouven, X. (2017). Atrial fibrillation: the current epidemic. Journal of Geriatric Cardiology : JGC, 14(3), 195–203. http://doi.org/10.11909/j.issn.1671-5411.2017.03.011
Mozaffarian, D., Psaty, B.M., Rimm, E.B., Lemaitre, R.N., Burke, G.L., Lyles, M.F., et al. (2004). Fish intake and risk of incident atrial fibrillation. Circulation, 110, 368–373.
Siscovick, D.S., Barringer, T.A., Fretts, A.M., Wu, J.H.Y., Lichtenstein, A.H., Costello, R.B., Kris-Etherton, P.M., Jacobson, T.A., Engler, M.B., Alger, H.M., Appel, L.J. & Mozaffarian, D. (2017). Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association, Circulation, 135, e867-e884. https://doi.org/10.1161/CIR.0000000000000482
Skielboe, A.K., Bandholm, T.Q., Hakmann, S., Mourier, M., Kallemose, T., & Dixen, U. (2017). Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation - A randomized controlled trial. PLoS ONE, 12(2), e0170060. http://doi.org/10.1371/journal.pone.0170060