Atrial fibrillation (AFib) 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. AFib happens when the atria beat too fast and irregularly. They “quiver” instead of pumping properly. This disrupts blood flow to the ventricles (lower chambers) and therefore blood flow to the rest of the body is impacted.
AFib is the most common arrhythmia worldwide. In the US, there’s a 25% risk of getting it in one’s lifetime. Between 2.7 and 6.1 million Americans have AFib and that number is increasing and is expected to increase further as the population ages.
Who’s most likely to get AFib? Older adults. About 70% of those with AFib are between 65-85 years of age. It’s more common in men than women and it may be temporary, may come and go, or it may be permanent.
Why should we be concerned with AFib? People with AFib have a steep increased risk of blood clots, heart disease, heart failure, stroke, and death. This is because the blood is not being pumped around the body properly. Having AFib also triples the risk for dementia.
AFib is a serious condition that requires medical advice.
Atrial fibrillation symptoms
Sometimes you may not experience any symptoms. Those who do, experience symptoms such as:
- fatigue
- dizziness & lightheaded
- shortness of breath
- chest pain
- reduced ability to exercise
- confusion
- chest pain
- heart palpitations
Common atrial fibrillation causes
The cause of AFib isn’t always knowable. There are several different conditions that can cause damage to the heart and lead to AFib:
- heart valve disease
- high blood pressure
- coronary heart disease
- thyroid disease & overactive thyroid gland
- binge drinking
- heart surgery
- hypertrophic cardiomyopathy (thickened heart muscle)
- congenital heart defects
- pericarditis (inflammation of the outer membrane that covers your heart)
- medications
An overall healthy lifestyle may decrease your risk of AFib. But not all causes are preventable.
Atrial fibrillation risk factors
There are many risk factors for AFib. Some of them you can control (modifiable), and others you can’t. The following risk factors are worth noting and if possible, address those that you can:
- being male
- being white
- increased age (risk increases with age)
- family history
- structural heart defects
- history of heart attacks
- metabolic syndrome
- lung disease
- sleep apnea
- high-dose steroid therapy
- obesity
- binge drinking
Some of these can be prevented or modified, others can’t be or are genetic.
How is atrial fibrillation diagnosed?
There are several different tests that can be done to get a better idea of what’s going on with your heart function.
Doctors may use one or more of the following tests to diagnose AFib:
- a physical exam to check your pulse, blood pressure, and lungs
- electrocardiogram (EKG) which, records the electrical impulses of your heart for a few seconds
If atrial fibrillation doesn’t occur during the EKG, your doctor may have you wear a portable EKG monitor or try another type of test such as a Holter monitor, echocardiogram (ultra sound to produce an image of your heart). Others may include chest x-ray, stress test or blood work.
Atrial fibrillation treatment
Treatment involves medications; but, can also involve pacemakers or implantable defibrillators. Medications typically used include:
- beta-blockers to decrease heart rate
- blood thinners to prevent blood clots
- digitalis to strengthen your heart beat (strength of contractions)
- sodium or potassium channel blockers to control your heart rhythm
- calcium channel blockers to relax the heart muscles
All with the ultimate goal of helping your heart function more normally; stronger and more rhythmic
Reducing your risk for AFib
As mentioned, 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 AFib. There are also several diet and lifestyle factors you can improve. These include quitting smoking, managing alcohol and caffeine intake, omega-3, vitamin D and magnesium status, and exercise.
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.
Manage blood sugar and type 2 diabetes
Type 2 diabetes mellitus (T2DM) often exists with AFib. 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 AFib. Especially women.
There are two factors of T2DM that increases the risk of AFib even further:
- The longer someone has had T2DM
- Poorly controlled blood sugar (based on hemoglobin A1c levels – hint, A1c should be < 7% ).
NOTE: A1c levels are blood tests that your doctor can do to estimate how well your blood sugar has been controlled over the previous 3 months.
One study showed that the combination of T2DM and AFib increases risk of heart disease, stroke, heart failure, and death by 61%. Managing blood sugar levels is very important for T2DM and AFib risk. Getting help to keep blood sugar within a target range is one of the single best thing you can do.
Manage blood lipids
The science isn’t settled yet on how blood lipid levels affect the risk of AFib. Low HDL-cholesterol increases risk of heart disease and heart failure. Both heart disease and heart failure are risk factors for AFib. Whether HDL levels therefore predict AFib risk isn’t clear, but HDL is still seen favourably.
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. One reason is because HDL carries antioxidants to the boy like vitamin E, beta carotene, lycopene and more.
Interestingly, while high doses of niacin (vitamin B3) can increase your HDL-cholesterol (which sounds good), too much niacin can increase your risk of AFib. Taking high dose vitamin B3 isn’t the best strategy to raise HDL. It fell out of favour a while ago.
You can help increase your HDL-cholesterol levels by including nutritious foods that naturally have fat. If you reduce dietary fat too much, your HDL will drop.
The best fat-rich healthy foods for HDL optimization include fatty fish, nuts, seeds, avocado, eggs, olive & avocado oil, dairy fat (yogurt, cheese and milk, so don’t go ultra low fat dairy! No skim milk products!). The fats in foods like beef, lamb, and pork, small amounts of butter and coconut beautifully maintain HDL within a healthy range too. Ditch the fat phobia.
Despite what guidelines state, exercise has a minimal impact on HDL levels BUT exercise is hugely beneficial for your cardiovascular system. Exercise is a must.
Manage high blood pressure
High blood pressure (hypertension) is very common. It’s also a modifiable risk factor for developing AFib. In fact, the higher your blood pressure (above 120 mmHg), the higher your risk. Managing high blood pressure is important for managing AFib if you have it.
Dietary strategies to maintain a healthy blood pressure include:
- getting more potassium & magnesium
- exercise
- reducing excessive sodium intake
- getting more omega 3 fats
- maintaining therapeutic levels of vitamin D (> 100 nmol)
- getting more dietary nitrates
- celery, spinach, beet root, beet juice, radish, lettuces, leafy vegetables
Sleep apnea
There is a definite link between obstructive sleep apnea (OSA) and risk of AFib. About half of people with AFib 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 AFib similar to people without OSA. This means that using the machine (if prescribed) can almost eliminate any increased risk of AFib 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 AFib.
People with hyperthyroidism have 3 to 5 times higher risk of developing AFib. It’s thought this is because hyperthyroidism has negative effects on heart rate and the heart’s atria; specifically causing palpitations, rapid heart rate (tachycardia), and arrhythmia (irregular heartbeat).
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 AFib, and then move on to the diet and lifestyle factors to reduce risk of AFib.
Studies show that obese people have a 35-49% higher risk of developing AFib than non-obese people. In fact, each 1 unit BMI increase above normal increases your risk of AFib by 4-5%. And large body size in youth, or weight gain from age 20 to midlife are associated with developing AFib.
Even if you don’t have high blood pressure, being overweight still puts you at increased risk of AFib. It’s considered an “independent” risk factor. Obesity also increases your risk of progressing from a short-term “on and off” AFib (called “paroxysmal AFib”), to constant and permanent AFib.
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 AFib 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 medical conditions.
NOTE: Speak with your doctor before making any drastic changes to your diet or lifestyle.
Stop smoking
Tobacco is bad for your heart. This isn’t news but it might be new information to learn that smoking can affect your health because its role in AFib.
Smoking increases your risk by 40% or more.
This is because nicotine is a potent stimulant and 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.
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 AFib. 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 AFib 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 AFib higher and higher.
Am I being a kill-joy? Don’t know, don’t care. I’m just giving the facts folks.
There are a few reasons alcohol can cause AFib. First, alcohol is a “cardiotoxin” which means it has toxic effects on the heart (muscle). Second, alcohol can cause arrhythmias. Third, excessive drinking increases risk of high blood pressure, which is a risk factor for AFib. Fourth, alcohol has a lot of calories and is a contributing factor to weight gain which, is a risk factor for AFib.
To reduce your risk, limit alcohol to no more than 1-2 drinks/day. A standard drink is 1 bottle of beer, 1-1/2 ounces of spirits or 5 oz of wine.
Caffeine. Some is good, too much is not
Contrary to popular belief, low-to-moderate amounts of caffeine reduces risk of AFib. Excessive amounts, on the other hand increase the risk.
Many people have reported that excess coffee consumption seemed to cause an AFib spell.
This also goes for caffeine-containing energy beverages. Several cases of AFib have been reported in younger people after consuming several energy drinks. This was especially true when those drinks were combined with alcohol.
Small amounts of caffeine seem to be fine, but don’t overdo it. What does that mean? Keep it between 200-400 mg per day or about four, 6oz cups of coffee, or five to six, 6oz of a typical brewed black tea.
Eat fish. Consider omega-3 supplements
More research is needed when it comes to fish intake or omega-3 supplementation and AFib but it is promising.
In general, fish and omega-3 fats are considered “heart-healthy.” However the studies done on AFib have mixed results. Some show they reduce risk of AFib, others show no difference, or even an increased risk.
Part of the problem is that studies didn’t have a predetermined intake of the 3 main types of omega 3s EPA, DPA and DHA to assess. Not surprisingly, all the different studies had subjects consuming different amounts of omega-3 fats making comparisons nearly impossible. It would have been different if they looked at the subjects’ omega 3 index. This is annoying because the omega 3 index was validated as a validated biomarker in the mid 2000s.
One study showed that eating broiled or baked fish 3-4 times per week reduces your risk of AFib. In fact, having it 5 or more times per week may reduce your risk even further. However, eating fried fish increases the risk of AFib.
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 AFib.
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 AFib. Right now, eating fish seems to be good, however there is limited evidence for taking fish oil supplements for AFib. This is because dosages used were inconsistent and they didn’t differentiate how EPA and DHA might work differently.
Studies that have found benefit with AFib focused on getting enough omega 3 DHA, about 1 g per day. Most supplements have far less DHA than they do EPA. DHA is better at increasing the omega 3 index as well. If you want to take a supplement, get one that supplies a decent amount of DHA.
Vitamin D: Don’t overdo it
Vitamin D deficiency is linked with many risks of AFib. 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 > 250 nmol (>100 ng/mL) increased risk of AFib.
But don’t worry, you’d have to take a ton of supplemental vitamin D to get to that level, like > 15,000 IU per day for a few months. The sweet spot can be found by taking 2000-4000 IU per day.
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 AFib.
Get enough moderate exercise
Exercise is great for your heart, right?
Moderate intensity exercise reduces risk of AFib. 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 AFib. 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 AFib. It also increases the quality of life.
In fact, one small study showed that people with AFib who started doing yoga had significant improvements in resting heart rate, blood pressure, quality of life, and mental health/stress.
Bottom line
Atrial fibrillation (AFib) 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 AFib increases with many conditions including type 2 diabetes, blood lipids, high blood pressure, sleep apnea, hyperthyroidism, and obesity. Managing these conditions is important for AFib.
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.
Doug Cook RDN is a Toronto based integrative and functional nutritionist and dietitian with a focus on digestive, gut, and mental health. Follow me on Facebook, Instagram and Twitter.
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