Atrial fibrillation - Afib

(Central Florida Bob ) #1

One of my favorite sayings (after 35 years do engineering R&D) is "the most important words in science aren’t ‘Eureka! I’ve found it!’. The most important words are ‘that’s funny…’ ". Well known National Semiconductor scientist Bob Pease told the engineers and technicians working on new prototypes, that when something acted “funny”, they should “record the amount of funny”.

With that in mind, over the last few years my wife and I said “that’s funny”, that we seem to know a lot of people being diagnosed with Atrial Fibrillation and treated in all sorts of ways. It could be that it correlates with age, and obviously we’re all getting older, but we hear a lot more talk about it in general. There are commercials for Afib drugs on TV. Then Afib hit me.

When I turned 60 (coming up on four years ago), I had been living on Zone level carbs - or less (less than 40% in 40-30-30; but not keto levels), but, hey, it was my birthday and I had a chunk of “healthy” carrot cake. The next day, while in the bathroom at work, I had a “cardiac event”; a horrible sensation, like being punched hard in the chest. I took my pulse and it was 38 - ordinarily it’s in the low 60s. Then it went away. And came back. And went away.

Long story shortened, a week or so later, I wore a Holter monitor overnight and they said I had all sorts of irregularities. Afib, PVCs, PACs. That lasted a couple of weeks, and in the time since then, I’ve never had a repeat of that. I went keto within a year after that. Only once or twice in the four years since then have I had anything I thought was Afib. I’ve had several echocardiograms, and a couple of “nuclear stress tests” and my heart has been completely normal for every test.

Since it was so close to my chunk of birthday cake and one day of eating “normal” foods, I started wondering if Afib really is getting more common and is related to the obesity and type 2 diabetes “epidemics”.

I can’t say for sure, obviously, but WebMD and other sources list diabetes as a risk factor for Afib, and at least one study I found (abstract) says Afib is increasing and is expected to continue increasing. They don’t make the link to diet, but imply the reason is just because the population is aging. By simple time sequence, it has to correlate with the lowfat diet shift, but we all know correlation doesn’t mean causation.

So it’s probably early to think this, but I’m thinking that if anyone investigates it, they’re going to find that the increase in Afib is caused by the shifts in diet from the lowfat fad diet. There probably was some level of Afib at all time, just like there always was some amount of type 2 diabetes, but it’s getting more common and that increase is diet related. Just like Alzheimer’s is getting referred to as “type 3”, I think Afib is going is to be added to the list.

Offered just to get it off my chest and to see what you folks think.

Bob

(VLC.MD) #2

I think it is quite plausible there is a relationship to long term exposure to high glucose levels and afib. … A model for testing would be do diabetics get more afib than non-diabetics ?. Of course, there would be many many confounders.

Just like keto is good for seizure disorders, it has nerve stabilization properties. Obviously afib represents abnormal heart electrical conductivity.

afib is a bit weird in general in that entirely healthy people get it for no apparent reason.

Another study could be … for people just starting with afib … comes and goes afib … if they go keto … do they spend less time in afib ? Might be hard to get pharma funding for preventing the use of drugs mind you.

And I doubt the NIH is keen on keto research.

(Central Florida Bob ) #3

Since diabetes is listed as a risk factor for afib, I’d have to guess they do get it more than non-diabetics. As you say, there must be confounders.

Of the few people I can think of right now that have afib, one is a diabetic, and the other isn’t (AFAIK) but is a high carb/low fat diet follower and a runner. He can’t accept that it’s possible to run without carb loading, regardless of what studies I point him to. The other is kind of an outlier: he isn’t a runner, eats as he pleases and isn’t diabetic, but I don’t know him well enough to know if he has other health issues that might point to metabolic syndrome and TOFI.

Just an interesting thing to keep an eye on.

A couple of times, and it was two years ago, I woke up in the middle of the night with something that may have been an afib incident. The strange thing was also having to urinate every hour. The second time, I thought this must be some sort of electrolyte balance thing and took a half teaspoon of salt in water. The cycle broke and the “afib incident” stopped. Was it the salt? Or just coincidence?

Try proving that.

(VLC.MD) #4

most afib is fairly silent.
and for people who even notice it wont be short “events” it will be sustained palpitations.
We need more people wearing heart monitors (FitBit) and tracking their symptoms :slight_smile:

R U on meds ?

Today’s BP monitors also detect afib (irregular heart beat detection).

You can also assess afib via feeling your pulse.

(Central Florida Bob ) #5

A beta blocker (Metoprolol) and a baby aspirin a day. No diabetes meds, I never advanced past pre-diabetes.

(Liz ) #6

This is really interesting, thanks for describing your experience. My mom experienced Afib a few years ago & not since. She is trying to eat more LCHF & this idea might encourage her further. At the time we thought the Afib might be related to her Lyme disease.

(Bacon is a many-splendoured thing) #7

My mother had atrial fibrillation for the last decade or so of her life. She was on metoprolol and I believe some other drug, plus a diuretic whenever it seemed her congestive heart failure was getting too much. She was not a diabetic, but her surviving sister is, and so was Grandma. She had had a cardiac arrhythmia problem in the middle of her life, but it eventually went away after years of digoxin and stress management. She also developed dementia, whether from her circulatory problems or from metabolic derangement was never clear. I’d love to know how she would have responded to a well-formulated ketogenic diet.

(mike) #8

I just read “Atrial fibrillation Remineralizing your Heart” by Dr Carolyn Dean. She also wrote The Magnesium Miracle. Magnesium seems to be at the"heart" of the afib issue.

Very quick reads. She is selling supplements but you don’t have to buy here’s.

As someone who has afib it makes sense.

(Retta Stephenson) #9

Can download a free copy here: https://drcarolyndeanlive.com/2016/07/03/atrial-fibrillation-magnesium-miracle/

#10

Hi Bob

i started a ketogenic lifestyle in December 2014. My aim was to avert type 2 diabetes, which is prevalent in my family. It is working well with the side effects of weight loss, mental clarity, and more energy. I’m in my early 50s.

For the subsequent years I’ve monitored blood glucose and blood ketones daily, and have had only a few days without blood ketones.

in October 2017 i ended up in hospital with atrial fibrillation (AF). I had a fast heart rate of over 140bpm for about 12 hours. Then my heart rate corrected with medication through an IV drip. In November 2017 I had that horrible feeling episode you describe, of a normal heart rate of about 60bpm but premature heart contractions. in that episode I was treated with oral magnesium aspartate, which settled down the hypersensitivity of the sinoatrial node and local left atrial muscle cells. On New Years Day 2018, I was back in the emergency room hooked up to a 12 lead ECG with AF. This time the medical treatment slowed my heart rate but didn’t get it under 120. So I had a short anaesthetic (propafol), which was very nice, and the doctors did a cardioversion, reset my heart rate, with a defibrillator electrical shock.

The key relevant point is that I was already eating low carbohydrate healthy fats (LCHF), and after the first episode I tightened up the control of my eating focussing on ketogenisis. The AF occurred while I was LCHF and further episodes while I was in nutritional ketosis.

#11

“This book is not intended to be used and should not be used, to diagnose or treat any medical condition.”

#12

Hi Mike. I found taking magnesium supplementation helped control precursor episodes (palpitations and premature heart contractions) to atrial fibrillation in my case. initially I took magnesium aspartate, as that was the treatement in the hospital emergency room, along with intravenous magnesium sulphate. But with a bit more research and the help of a functional health practitioner, I now supplement with magnesium citrate. Citrate, orotate and aspartate are all high bioavailable magnesium salts (1), magnesium orotate has some science, as an oral supplement behind it, with an interesting paper on PubMed (2015, Kisters et al), but that related more to congestive heart failure and hypertension than atrial fibrillation. The aspartate salt could be related to being a brain excitogen (no reference, heard it on a podcast), so may not be best for longer term supplementation.

i have seen Dr. Carolyn Dean’s name come up in searches. It will be interesting to read what she wrote. I wonder what magnesium salt(s) her product is based on?

  1. Gröber U, Schmidt J, Kisters K. Magnesium in Prevention and Therapy. Nutrients. 2015;7(9):8199-8226. doi:10.3390/nu7095388.
(Central Florida Bob ) #13

Thanks for that info. I didn’t mention it, but I went keto for the same reason you did: my mom and my brother both have type 2 and my fasting blood sugar was always on the high side, so I went keto to try to avert the diabetes.

In the intervening few months, I had another one of those episodes where I was awakened in the middle of the night having an unpleasant feelings of a really odd pulse rate, coupled with unusual number of trips to the bathroom. to dump water. As in the previous time, I took 1/4 teaspoon of salt in water and the problem went away, although it took something like an hour.

I’ve found I have to concentrate on keeping my salt up because I don’t particularly like the taste of it, and I won’t add it to my food unless I make an effort to. Dr. Phinney says people won’t get enough if you “salt to taste” and recommends bouillon. I don’t see why I shouldn’t just put some in a capsule and take it. Like people do with liver.

I always take 500mg of magnesium as MgO, every day just after dinner. The oddity of that day was that I had taken more Vitamin D3 than I usually do. Sure enough, I’ve found excessive levels of D3 have been correlated to Afib. (Just one result from a quick search).

I have no particular reason to think my D is low, but my wife takes them, they’re handy and I sometimes grab one. That particular day, I accidentally got two out of the bottle, and since my hand was damp I didn’t want to put it back in the bottle.

As always, was the D3 the cause, or just something I noticed? Did the saltwater stop it, or did it stop on it’s own? I have no answers to either and no way to do a controlled test.

(Brian) #14

This is an interesting thread. And yes, I’ve seen quite a lot of people around me with Afib. I’ve even had some palpitations myself though nothing severe. (I started getting them before I went keto and a bit after I started, I think mostly when trying to get my electrolytes balanced out. Really no issues at this point.) I am pretty sure I was insulin resistant before the keto and probably headed towards T2D, just did something about it before a diagnosis.

My mom had Afib, quite severely, before she died. And my dad, who we always thought was the picture of health, got diagnosed with it at age 94. Hmmm. (He got the flu very badly and ended up in the hospital, that’s when they found it. Not sure if it was just flu related or whether it had been going on long before.) But no one else in the family has been keto. Others in the family have had some health issues, though, and T2D was not unheard of in members of the family who didn’t look after themselves. I have wondered whether insulin resistance might not have been a creeping problem even for those, like my mom & dad, that did try to look after themselves.

#15

Bob, I hope you don’t mind if our discussion takes me off down some scientific worm holes to explore? It’s great to have an inspirational chat that leads toward knowledge building. So, if it’s OK, I’m going to use our discussion to develop some notes to help my own thinking on this topic close to my heart.

There is the notion that the general western diet eating populace may be deficient in nutrients, including micronutrients such as vitamins and minerals. Our current interest is the element magnesium. But as you note in terms of taking ‘salt’ and also Vitamin D, which is important in calcium metabolism, and calcium can compete cells with magnesium, the whole thing is more complex than just the magnesium. it’s a wonderful fishing line tangle when we are fishing for answers.

I’m particularly interested in magnesium + atrial fibrillation in the context of the electrolyte effects of the ketogenic diet. That interest stemming from individual observations (n=1) that taking a magnesium supplement, while in cycling in and out of ketosis, reduces the progression of heart beat irregularities (palpitations, premature beats) into atrial fibrillation that requires a trip to the emergency room in hospital.

I wonder, Does following the ketogenic diet require an adjusted LONG TERM approach to body electrolyte balance?

https://www.ketogenicforums.com/t/atrial-fibrillation-magnesium-ketogenic-eating/36218?u=frankobear

(Central Florida Bob ) #16

By all means, I’m interested in this topic, too.

“Conventional wisdom” in our community (if you’ll pardon me thinking I know what that wisdom is) is that we get all the nutrients we need from whole foods. Magnesium is in chlorophyll, the magnesium analog of iron in hemoglobin, so they say we get all we need if we eat enough greens. The thing is that we all seem to vary in our absorption of those minerals. I think some people will benefit from the right supplementation. Maybe not all people, but if you’re the one that needs the supplements, how do you know?

Like you say, this is very complicated; lots of moving parts. Maybe we need some trace minerals as catalysts along the way. Again, everything is supposed to be fine if we eat “whole foods, grass-fed, pastured” and so on. If the soil the plant was grown in was low in those minerals, the plant will be low in them, and any animal that ate that grass will be low in those minerals.

Those are just a couple of considerations. I’ll go over to your thread.

This thread really was just me saying, “hey, that’s funny” that so many people seem to have afib these days. The medical world has known about afib since the EKG was invented. Since it seems to be going up at the same time diabetes is going up, I wonder if they’re not related. Maybe not caused, but the same causes trigger both.

(Madge Boldt) #17

This topic is near and dear to my heart :wink:

7 years ago I had surgery to correct AFIB. Long story there, but the surgery worked. Until last week. I donated blood on Wed. On Thursday morning my heart was doing flip flops and I had an exhausted feeling. Uh oh, thought I. Felt my pulse and was dismayed to realized it was not steady.

Yadda yadda yadda… EKG on Friday showed AF. Since then, my rate has been steady, but I’m going back on Monday and we’ll see if it is NSR or just a steady version of AF.

My doc, who is a PCP and not a cardiologist, said that the blood donation (blood volume change) in addition to caffeine, ketones, lack of sleep and stress are all things that can exacerbate AF. I was surprised about the ketones. She said it is similar to caffeine in that it excites the heart a bit. I guess that makes sense… we do feel focused and energetic, right? However, I can find no supporting research to back that up. It is just anecdotal,

In the end, I had surgery 7 years ago to correct AF and was told to go live like I never had it. And that is what I did. It was a lovely 7 years! (I do supplement with Mg and have been for over 8 years)

Swirling in my head now are thoughts about ketones and their future affect on my now less steady heart rhythm. I do believe that the keto benefits outweigh the possible unproven effects on heart rhythm.

What do you other folks with AF think? In this thread, some of you also seem to be wondering about this. Is your AF correlated with this diet, or is it just a coincidence?

(Central Florida Bob ) #18

FWIW, my initial problem with AFIB was before I went Keto. I was still on a relatively low carb diet - Zone levels, not the SAD - but not Keto until later. The first, pre-keto arrhythmia episode lasted a long time. It was at least two weeks from the time I had my first episode before I got the Holter monitor, and it eased up for another week or so. The Holter test said I had afib, PACs and PVCs.

If I’ve had it since that initial problem (back in '14) it has been a few times in the early morning, waking me up from a sound sleep, and that stuff I described way up in this thread. If I’m remembering everything properly, I went fully keto around March of '15 and have been trying to tweak and improve since then.

#19

I don’t think that the atrial fibrillation is directly related to serum ketones(1). That is a personal opinion. But it may be related in part, or secondarily, or in some way to a problem, or problems, already existing that are exacerbated by some of the effects of a ketogenic diet. An existing problem, for example, may be anelectrolyte imbalance.

As Bob has pointed out, there is an observed increase in atrial fibrillation diagnoses over time. And that increase could me more closely correlated to a myriad of other factors affecting public health.

We do know that following a poorly formulated ketogenic diet that does not include adequate salt (minerals) can lead to muscle cramps. Mineral elements dissolved in solution are electrolytes. if we lack electrolytes, we get muscle cramps from an electrolyte imbalance. The ketogenic diet can induce increased urine production, and when we pee a lot, loss of some electrolytes from the body resulting in the electrolyte imbalance.

Add to that heart beat problems like irregular heart beats and changes in rhythm (e.g. too fast, or too slow, or chaotic) can, as a common diagnosis, be due to electrolyte imbalances. So there may be an observable association, a correlation there, between ketogenic eating witha poorly formulated diet and heart problems. But not a direct cause and effect of blood ketones on heart muscle.

#20
  1. this 2013 paper by Cotter et al gets a lot of citations. It’s dense in physiology and cites a lot of rat studies. on page 23 there is a reference to a finding that human Afib hearts atrial biopsies were found to have an increased amount of a type of betahydroxybutyrate (bhb), but it wasn’t the same type of bhb as found in blood serum circulation. The heart under stress or in failure will use ketones as a preferred fuel over the more usual primary fuel of fatty acids. But that does not mean ketones cause heart failure. it seems to mean the opposite, that the heart uses ketones to avoid heart failure. The other bit of interesting information was that was that ketones prolong the time between heart beat electrical complexes. in a roundabout way this could lead to premature contractions occuring in the longer spaces, which could flip the heart into AF. But the initial evidence is that ketones slow the heart rate and increase heart muscle efficiency. it is really delicious reading.

Cotter DG, Schugar RC, Crawford PA. Ketone body metabolism and cardiovascular disease. American Journal of Physiology - Heart and Circulatory Physiology. 2013;304(8):H1060-H1076. doi:10.1152/ajpheart.00646.2012.